Self-Insured Portal Down. The Department of Aging (ODA) portal for self-insured providers to apply for reimbursement of COVID-19 staff testing costs has been down for more than a day. The legend reads that the "portal is currently unavailable for maintenance." We believe ODA is revising the portal based on feedback we and others provided. We also believe the February 1 deadline will be extended. We are seeking confirmation from the department.
Walgreens Third Clinics. On the eve of the third round of COVID-19 vaccination clinics, a number of members informed us that their Walgreens representatives refused to provide a first shot at the third clinic. This does not appear to be universal to all Walgreens locations. We recommend that if you run into this issue, push back. There is no governmental mandate or even recommendation that first shots not be given at the third clinic. It inhibits getting people vaccinated, including those who may have been hesitant previously but now are willing, which is counter-productive to the goal of putting shots in the arms of as many Ohioans as possible. There is no question that vaccine will be available in the future to give the second shot, it just won't be in the Pharmacy Partnership for Long-Term Care. In fact, some Walgreens representatives even assured members that individuals needing a second dose could get it later at a Walgreens store. We brought this issue to the state's attention and asked that they direct Walgreens to provide the first shot, but be aware that message may not have gotten through yet.
Clarification of Vaccine Outside Limit. We previously reported that changes to the primary Centers for Disease Control and Prevention (CDC) guidance on vaccination established a 6-week outside limit on the second dose. This description of the change does not tell the full story. The relevant section of the guidelines states, in full:
The second dose should be administered as close to the recommended interval as possible. However, if it is not feasible to adhere to the recommended interval, the second dose of Pfizer-BioNTech and Moderna COVID-19 vaccines may be scheduled for administration up to 6 weeks (42 days) after the first dose. There are currently limited data on efficacy of mRNA COVID-19 vaccines administered beyond this window. If the second dose is administered beyond these intervals, there is no need to restart the series.
In other words, while the six weeks is the recommended maximum interval, if the second dose cannot be administered in that time period (for instance, if the patient receives monoclonal antibody treatment), it still should be administered later rather than starting over.
Relative to the earliest date for the second dose, the guidance describes the grace period for administering earlier than the recommended time as follows:
The mRNA COVID-19 vaccine series consist of two doses administered intramuscularly:
- Pfizer-BioNTech (30 µg, 0.3 ml each): 3 weeks (21 days) apart
- Moderna (100 µg, 0.5 ml): 1 month (28 days) apart
Persons should not be scheduled to receive the second dose earlier than recommended (i.e., 3 weeks [Pfizer-BioNTech] or 1 month [Moderna]). However, second doses administered within a grace period of 4 days earlier than the recommended date for the second dose are still considered valid. Doses inadvertently administered earlier than the grace period should not be repeated.
Again, the recommended earliest date (17 or 24 days) is not hard and fast, although the word "inadvertently" suggests that one should not plan to administer the second dose earlier than the recommended interval with the grace period applied.
The Health Department also circulated guidance on second doses of vaccine that restated the CDC language above and emphasized:
When administering first-dose vaccinations, providers should not hold vaccine back for the second dose. [CDC] will allocate vaccine for series completion closer to the time that it is due to be administered.
Ohio Star Rating Data. In yesterday's COVID-19 Update, we reported on the updates the Centers for Medicare and Medicaid Services (CMS) made to the Five-Star Rating System for SNFs, as well as AHCA/NCAL's analysis of the impact of the updates nationally. Today, AHCA/NCAL provided Ohio-specific data. The analysis includes 953 SNFs. The results are shown in this table.
Change in Star Rating | Lose Star(s) | No Change In Stars | Gain Star(s) |
| | | |
Overall | 162 | 610 | 166 |
| 17% | 65% | 18% |
| | | |
Quality | 209 | 501 | 228 |
| 22% | 53% | 24% |
| | | |
Staffing | 119 | 567 | 120 |
| 15% | 70% | 15% |
| | | |
Survey | 98 | 732 | 108 |
| 10% | 78% | 12% |
Like the national numbers, the state numbers reflect the forced distribution of stars that has characterized the SNF 5-Star system from the beginning, which differs from all other CMS star rating structures. In the SNF system, no matter what the raw scores are, there must always be a set percentage of facilities in each survey star category. As a result, the only changes are the facilities that fall into each category, not the total numbers. That leads to essentially equal numbers of buildings moving up and down, while most stay the same.
Multiple Extensions to SNF PA Waivers. OHCA received several updates from managed care organizations this week regarding SNF prior authorization (PA) waivers, many of which were set to expire this Sunday, January 31, 2021. We updated our SNF Prior Authorization Waiver Grid to reflect these changes, as listed below. Please note we have not yet seen any communication from Anthem of Ohio or UnitedHealthcare, both of whose waivers also expire on January 31.
- Medical Mutual of Ohio (MMO) recently updated their COVID19 Provider FAQ to extend the SNF PA waiver through February 28, 2021. The waiver, which would have expired January 31, applies to their commercial and Medicare Advantage lines of business for contracted provider admissions. SNFs still are responsible for notifying MMO of an admission the following business day, including admitting clinical information, and all patients must meet SNF admission level of care criteria.
- Aetna Better Health of Ohio (sometimes referred to as “MyCare Aetna”) extended their SNF PA waiver, also expiring January 31, through February 28, 2021. Providers must notify Aetna of admission within 48 hours. Medical records can be sent via fax to 355-734-9393. As a reminder, Aetna Medicare and Aetna commercial products already have a PA waiver that runs through February 15, 2021.
- Humana is suspending SNF PA requirements for all Ohio Medicare Advantage and commercial members through February 28, 2021. This only applies to in-network providers. Please provide notification of admission within 24 hours.
Seeking Feedback on Staff and Resident Vaccination (from AHCA/NCAL). AHCA/NCAL launched the #GetVaccinated campaign to encourage and empower all staff members and residents to get the COVID-19 vaccine. Since vaccines were distributed to facilities across the country, many staff and residents have proudly and excitedly received it.
To ensure that as many people get vaccinated, we want to hear your stories of what’s working in your buildings. What has motivated your staff and residents to get vaccinated? Have there been any challenges? Please email storiesofcare@ahca.org with this information or if you have any questions.
It’s effective when people you know get vaccinated, as it assures others that it’s safe and will more likely motivate them to get vaccinated as well. So highlight individuals in your facility who signed up to get the vaccine. Print copies of our #GetVaccinated selfie sign, and have staff and residents write in why getting the vaccine is important to them. Then submit their selfie and their story through Share Your Story submission form. Make sure to share on your social media pages as well.