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January 7, 2021

Long-Term Care COVID-19 Numbers Continue to Drop. This week's Department of Health (ODH) data release showed new cases in Ohio long-term care facilities down for the fourth consecutive week, but at 5,176, still well above where the state was before the COVID-19 spike began in late October. Deaths also fell for the fourth week in a row, to 203. Unfortunately, however, this trend may be temporary, as cases across the state rose the last couple of days, topping 10,000 today. Hospitalizations also are up.

Humana Extends SNF Prior Authorization Waiver Through January 31. OHCA received notification that Humana waived prior authorization requirements for SNF admissions for their Medicare Advantage and commercial health plans through January 31, 2021. This suspension only applies to in-network providers. Please provide notification of admission within 24 hours. We updated our SNF Prior Authorization Waiver grid to reflect this change.

Monoclonal Antibodies Update. This morning, Tom Muldrow of ODH presented information about the state's plans for distributing monoclonal antibodies (mAbs) during a meeting of the Ohio Medical Directors Association in which OHCA participated. Mr. Muldrow explained that the department's goal is to make mAbs widely available, particularly to people in long-term care. He explained the different pathways for providers to obtain mAbs (hospitals, long-term care pharmacies, infusion companies), including pointing out a Department of Health and Human Services (HHS) website that allows users to identify which hospitals in their area received shipments of one of the two types of mAbs with Emergency Use Authorizations from the Food and Drug Administration. Please see Mr. Muldrow's presentation and notes for more information about distribution of the treatment.

Although many OHCA members have been able to gain access to mAbs in various ways, we are working to clarify and smooth the available pathways so all members can obtain this treatment for people they serve or staff members who meet the medical qualifications. In particular, we understand the main impediment to in-house mAb adminstration is availability of RN time to administer the treatment and to monitor the patient afterward for any adverse reaction. Partnering with a hospital often requires transporting patients to the hospital infusion clinic, which is not ideal. To address these issues, we are seeking to identify hospitals and home health agencies that will administer this potentially life-saving treatment on-site at long-term care facilities.

COVID-19 Vaccination Data. Members have inquired about data on vaccinations in Ohio, particularly through the Pharmacy Partnership for Long-Term Care (PPLTC). The ODH vaccination dashboard shows that 221,302 people have started the vaccination process in Ohio. The dashboard also divides the data by county and by age cohort, but it does not separate out health care workers or congregate care facility residents. The Centers for Disease Control and Prevention (CDC) has a vaccination data tracker that does break out PPLTC, but only at the national level (603,313 of the 5,919,418 people who have intiated vaccination). CDC's state-level data are limited to doses distributed and administered. Ohio has received 4,930 doses per 100,000 population and has administered 1,503 per 100,000. Both of these figures are below the national averages (7,391 and 1,927). The only source of detailed data on PPLTC is partial, as it only includes CVS. The CVS data cover 488 SNFs and 942 assisted living and other facilities. Of these, 379 SNFs and 132 other facilities have had their first doses, encompassing 32,335 doses.

Outstanding Vaccination Success! OHCA member Grafton Oaks achieved 100% vaccination compliance for both staff and residents. Lisa Hamilton, the administrator/owner, shared keys to achieving this impressive feat.

  • They started early, as soon as they heard CVS and Walgreens would distribute the vaccines, allowing the time needed for education.
  • Management staff discussed the importance of vaccination to achieve leadership buy-in first.
  • At the beginning, they placed a sign-up sheet in a public area, which encouraged staff to participate and also fostered peer-to peer-discussion.
  • Ms. Hamilton set up education events for staff and residents, offering them at different times to ensure they captured as many staff as possible. The facility medical director assisted with presenting frequently-asked questions and information. The medical director also was available for questions/concerns during the meetings, follow-up questions after the sessions, and one-on-one discussions. They also presented to the resident council.
  • Facility leadership implemented one-page fact sheets and incentives and was very open and transparent.
  • Ms. Hamilton and the medical director went from room to room to discuss the vaccination with residents and to answer any questions.
  • They met with employees who initially did not consent one-on-one to find out their "why" and to help work through their concerns.
  • The entire time, they often reminded staff of the facility's culture, the concern for the residents they care for, and their mission to have a safe environment: "Grafton Strong." They stressed that it is their duty to have full compliance.
  • Ms. Hamilton confirmed it was always the employees' choice. When it came down to just a few remaining staff members who were unsure, the reminder that it was their choice whether or not to take the vaccine was important. The facility did not mandate the vaccine, but did emphasize that it was an expectation. Everyone ultimately made the choice on their own.
  • Pregnant employees discussed the vaccine with their obstetricians, and all of them consented.
  • On the first clinic date, Ms. Hamilton went room-to-room and held the hand of every resident who received the vaccine and offered to do the same for all of her staff.

Grafton Oaks shows that this goal is achievable, and we applaud their dedication. Hopefully, the measures they implemented will provide some ideas that may help others gain greater vaccine compliance.

Governor Announces Beginning of Phase 1B, Amended Visitation Order. In his press conference today, Governor Mike DeWine addressed the initiation of Phase 1B of the COVID-19 vaccine distribution plan, which will apply first to individuals 80 and above who are not in congregate care settings. In addition, ODH issued a sixth amended visitation order, in which the only change appears to be removal of the prohibition on compassionate care visits in COVID-19 units. This provision conflicted with Centers for Medicare and Medicaid Services guidance. The order applies only to SNFs and assisted living communities. The Governor's Office post-conference press release summarizes the Phase 1B announcement, relative to older people and those with disabilities, as follows:

Governor DeWine announced those in Phase 1B will be able to receive vaccinations beginning on Tuesday, January 19. Those 80 years of age and older will be prioritized first in this next phase, roughly totaling 420,000 Ohioans. Ohio is expected to receive 100,000 doses during the first week of distribution to Phase 1B.

“With up to 420,000 people 80 years and above, and only 100,000 doses available the first week, it will take several weeks to vaccinate those 80 years of age and older," said Governor DeWine. "Phase 1B will take a few weeks, and a lot of coordination in distribution.”

Vaccines for Ohioans 80 years of age and older will be administered by physicians, local health departments, hospitals, federally qualified health centers, in-home health service providers, and some retail pharmacies.  As of today, the Ohio Department of Health has approximately 1,700 providers registered to distribute vaccines. 

Additionally, the Ohio Department of Health will be hosting a webinar for registered providers to discuss expectations, and instructions for distribution. Additional details will be shared with registered providers in the coming days.

Governor DeWine anticipates vaccinations will be available to Ohioans 75 years of age and older beginning Monday, January 25. The following week, vaccinations will be available to those 65 years of age and older.

“As we include other age ranges, please know that does not mean vaccinations will be complete for the previous age range,” said Governor DeWine.  

The week of January 25 will also include vaccinations for Ohioans with severe congenital, developmental, or early onset medical disorders.  Additional details about distribution for this group will be forthcoming.

Point-of-Care Test Result Reporting Option Returns. Originally, providers using point-of-care antigen COVID-19 tests had the option of reporting test results at the line level either to the state or to the National Healthcare Safety Network (NHSN). In October, HHS amended their reporting directive, which still bore the date June 4, to mandate that certified long-term care facilities report to NHSN, which requires Secure Access Management System (SAMS) Level 3 access. After providers went through months of challenges getting SAMS Level 3, HHS now flipped again, removing the mandatory paragraph from the reporting directive and amending the CDC guidance to clarify that line-level test results can be reported to either the state or NHSN. As a practical matter, HHS's reversal may have little impact, as most SNFs already are reporting to NHSN, but it does allow the option of state reporting and could be of value to members who are despairing of ever getting SAMS Level 3 access.