SNF Five-Star Ratings Updated. The Centers for Medicare and Medicaid Services (CMS) followed through on their announcement last month that they would update Care Compare and the SNF Five-Star Rating System today. The survey stars now include complaint investigations and Focused Infection Control surveys done in 2020, to the extent they were reported to CMS. According to the new edition of Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, the staffing and Quality Measures stars also use updated data from 2020. In the case of the Quality Measures, and of relevance for the Medicaid quality incentive payment if it is reinstated, the data currently available and used in Care Compare include only the first half of 2020. CMS did not change the cut points in the Technical Users' Guide. They still are based on data from 2017-2018.
AHCA/NCAL performed a detailed analysis of the 5-Star changes, with the results outlined in this blog post and this more extensive chartbook. The key finding, which is not surprising in light of the forced distribution nature of the SNF 5-Star system, is that, "[o]f the 15,340 nursing homes in the nation, 9,937 (65%) saw no change in their Overall rating. Meanwhile, 2,565 (17%) had a decrease of one or more stars and 2,613 (17%) saw an increase in their rating." AHCA also provided talking points about the 5-Star changes.
COVID-19 Cases in Long-Term Care. It seems odd to say that there were "only" 3,176 new cases in Ohio long-term care facilities in the past week, but this number represents a reduction of over 900 cases from last week and is the lowest total since the first week of November 2020. As usual, the COVID-19-related mortality numbers lag the case numbers, but also are declining. This week's total of 177 deaths is 38% less than the peak of 286 in the week ending December 16. Statewide, today's cases bounced up to 5,366, but this is still more than 1,000 below the three-week average.
Recent Scientific Notes. The key question in determining whether COVID-19 vaccinations will allow reduction of various restrictions in place in long-term services and supports to protect staff and people served is whether the vaccine actually prevents infection or simply prevents symptoms. If the vaccine prevents infection, it also prevents individuals who are vaccinated from being asymptomatic carriers - the reason behind not lifting certain restrictions. Buried in the journal article reporting the findings of the Moderna vaccine trial is an interesting note. In the trial, participants were tested before each shot, but unfortunately not after the second one. The testing before the second shot, though, showed that the first dose of the vaccine alone reduced the number of asymptomatic positive participants by 61.5%. While not conclusive, this finding holds promise that the second dose will protect even more against asymptomatic infection.
Could monoclonal antibodies work like a vaccine? Eli Lilly, the makers of the monoclonal antibody treatment bamlanivimab, reported that their infusion not only helps COVID-19 symptoms, but it may even prevent the disease. According to Eli Lilly:
For the pre-specified subgroup of nursing home residents, there was also a significantly lower frequency of symptomatic COVID-19 in those treated with bamlanivimab versus placebo in this important population .... These results suggest that residents randomized to bamlanivimab have up to an 80 percent lower risk of contracting COVID-19 versus residents in the same facility randomized to placebo.
While the quote refers to nursing homes, the study also included assisted living communities.
AHCA/NCAL Recorded Webinar on PRF Reporting. The Department of Health and Human Services recently announced a reporting portal for providers who received distributions from the Provider Relief Fund (PRF) along with changes to the PRF guidance. To assist with digesting the requirements and registering for the portal, AHCA/NCAL recorded a webinar that is available on demand to members. Please use this link to register and to view the webinar.
State Vaccine Announcements Relevant to LTSS. In his remarks yesterday, Governor Mike DeWine made several comments about vaccine allocations to long-term services and supports (LTSS) settings. As summarized in the press release that followed the conference:
Ohio is second in the nation for the number of people vaccinated in nursing homes, however, because not all residents and staff are choosing to receive the vaccine, Ohio will begin directing approximately 77,000 vaccines set aside to use in nursing homes to others in Phase 1A and 1B.
Ohio has put focus on vaccinating members of the public living in congregate settings because these individuals are especially vulnerable to contracting COVID-19. In Ohio's state-run developmental centers, 89 percent of residents have accepted the vaccine; 73 percent of long-term patients in state-run psychiatric hospitals have accepted the vaccine; a total of 92 percent of veterans in state-run veterans homes have accepted the vaccine. Of those with developmental disabilities not living in state-run facilities, 5,500 people have been vaccinated so far.
The statement about Ohio ranking second in the nation in vaccinating people in SNFs (actually, residents and staff in all long-term care facilities participating in the Pharmacy Partnership for Long-Term Care) is backed by the data displayed on this Centers for Disease Control and Prevention (CDC) data page. The CDC data show that Ohio has delivered second doses to 29,216 residents and staff, trailing only New York (33,788). California, Florida, and Texas also are ahead of Ohio in total doses administered. The CDC table does not depict the data on a per-capita basis.
According to the Department of Developmental Disabilities (DODD), the number of 5,500 people with intellectual and developmental disabilities vaccinated underestimates the total because it does not include ICFs/IID, along with developmental centers as stated. They feel the total is more like 8,000.
Also noted in the press release:
Governor DeWine announced today that, in pursuit of fairness and equity in the distribution of the scarce vaccines, Ohio will be delivering vaccines directly into affordable senior housing locations starting the week of February 8. These senior housing facilities are home to several thousand older Ohioans throughout the state and are often residential clusters with apartment buildings ranging in units from 30 to over 200.
The Ohio Department of Health will be working with local partners to offer assistance through onsite clinics. These clinics will help ease the burden for many seniors having trouble navigating the registration process and arranging transportation.
ICF Cost Report Deadline Extension. Following in the Department of Medicaid’s footsteps, DODD also will issue a blanket extension for the ICF/IID cost report deadline, making the due date April 30, 2021. No extensions will be granted past this date. Please note that the deadline for ICF providers to have policies in place and implemented to meet the quality indicators program has not changed from March 31, 2021.
OHCA TNA Survey Results. We thank all the OHCA members who participated in our survey on temporary nurse aides (TNAs). The data will be very helpful in our efforts to advocate for a continued employment pathway for TNAs when the COVID-19 Public Health Emergency expires. We received responses for 371 SNFs, an amazing rate. These buildings represent 39% of all centers in the state. We appreciate the 87 buildings that reported they currently do not employ any TNAs because these responses ensure the data are not skewed by including only centers with TNAs. The total number of current TNAs for the 371 respondents was 1,651, or 4.45 per facility. Extrapolating this per-facility rate over the entire 953 SNFs yields an estimated 4,241 TNAs currently employed in Ohio centers.