Resident testing program. SNF providers should have seen in the Enhanced Information Dissemination and Collection (EIDC) system an announcement for tomorrow morning's state-sponsored webinar on mandatory testing for all SNF patients. In case you missed it, here is the Health Department's (ODH's) message:
On May 27, 2020, the Ohio Department of Health Director issued a Public Health Order requiring Nursing Homes to take additional action to control and prevent the spread of COVID-19 within their facility. As we near completion of baseline testing for all staff, we will begin baseline testing of all residents that reside within a Nursing Home in the State of Ohio. All Nursing Homes in the state will be invited to a webinar on Wednesday, July 15th, 2020 at 9:30am to discuss updates to resident testing plans, logistics, and partners for the pre-testing, test scheduling, and post-test support.
Please register for the webinar at the following link: https://attendee.gotowebinar.com/register/9102317314378773775
In today's meeting with ODH and the Departments of Medicaid and Aging, state personnel explained that the resident testing program will run through facilities, not the National Guard. Each SNF in the state will be assigned a testing date. Before that date, Quest Diagnostics (the single laboratory for this program) will send the center swabs. On the designated date, facility staff will swab all patients and return the swabs to Quest within 24 hours. It will be critical for them to be returned timely to use laboratory capacity efficiently. As was the case with the National Guard program for staff testing, a facility can opt out and obtain their own testing. This includes full-house testing done since approximately June 6. The state staff affirmed that patients have the right to refuse testing.
The resident program will begin next week in Zone 1, starting with centers not yet tested by the National Guard, where the residents and staff will be combined in the new process. Zones 2 and 3 are expected to follow in in 10-14 days, when the staff testing is finished. All SNFs will be asked to complete a Survey Monkey by July 20. State personnel indicated that Quest assigned Ohio SNF testing their highest priority, hopefully reducing turn-around time. The laboratory fees are to be billled to the patient's payer. The patient testing requirement, under the May 27 order, only applies to SNFs, not other facilities.
HHS promises point-of-care testing machines to SNFs. Today, the Department of Health and Human Services (HHS) announced that they intend to start distributing point-of-care testing devices to SNFs across the country. Per the news release:
Each nursing home will receive one diagnostic test instrument and associated tests. Following initial distribution, nursing homes can procure additional tests directly from the respective manufacturers. Nursing homes must have the capability to screen and test residents, and test staff on a weekly basis or according to specific guidance by the state and local health departments. This procurement will also enable testing of visitors if appropriate for that facility.
The testing equipment, made by two different manufacturers, provides rapid antigen test results using nasal swabs.
More visitation guidance; essential personnel. Director of Aging Ursel McElroy provided additional interpretations of the ODH fourth amended order on visitation. She said the order does not require beauticians to be tested before entering facilities on July 20, although she strongly recommends it because of their close contact with residents. She also said beautician entry into SNFs is not contingent on the center's compliance with the staff testing order, as visitation is. Relative to the testing requirement for visitation, Director McElroy said the SNF actually must receive the test results. She asserted that the facility should have the results to make an informed decision about whether to reinstate visitation.
Director McElroy said the state has no plans to loosen the essential personnel exception, which applies to ICFs/IID, SNFs, and assisted living communities, in light of the recent spike in cases. Beauticians were allowed because of public outcry. The Director, however, interprets essential personnel in a person-centered way - providers of services that the facility documents that an individual resident needs - not as broadly applying to everyone in a certain provider category. Needed services include "preventive services necessary for health" by preventing decline. Director McElroy said the order as written allows for those services.
Responsibility for testing payment. State Medicaid Director Maureen Corcoran said SNFs should not receive bills from labs for COVID-19 testing of staff members by the National Guard. If the facility chooses to do testing on their own, they are responsible for determining how they will handle the payment. For the testing offered through the National Guard, however, the lab first should bill the employee’s insurance. If the employee does not have insurance, the lab should work through the Health Resources and Services Administration (HRSA). HHS, through HRSA, launched a COVID-19 Uninsured Program Portal that allows health care providers who conduct COVID-19 testing or provide treatment for uninsured individuals on or after February 4, 2020, to submit claims for reimbursement. If the lab is unable to secure compensation through those means, they should bill the state. OHCA encourages providers to use this information to help educate a lab if they attempt to bill the provider. If that is not successful, please contact OHCA for assistance.
Providers, however, will receive a bill for testing residents who are in a Medicare Part A stay, as it would fall under consolidated billing.
ICF-IID call with CMS. Today, OHCA participated on a stakeholder call with both Central and Regional Office staff from the Centers for Medicare and Medicaid Services (CMS) regarding ICF-IID services. Don Howard of the CMS ICF-IID Quality, Safety, and Oversight Group led the call with support from other CMS staff. At this point, CMS does not plan to issue any additional guidance for ICFs related to testing, but stated that ICFs can review the Centers for Disease Control and Prevention guidance for healthcare organizations.
Mr. Howard again this month stated that CMS doesn’t plan to issue any more blanket waivers of ICF requirements, but will review requests submitted by organizations or individual providers. OHCA specifically asked about the 1135 waiver request we submitted in March. It was apparent CMS made some changes in processes, as well as who reviews these requests. CMS’s Linda Smith asked OHCA to resubmit the March request and assured us that she will review it and respond timely.
OHCA asked if ICFs will be required to have Focused Infection Control (FIC) surveys. CMS responded that Quality, Safety, and Oversight letter 20-31-All only requires FIC surveys for SNFs. While not required, State Survey Agencies may complete a FIC survey on an ICF if a complaint or other action warrants it. ODH confirmed this morning that they have not conducted any FIC surveys of ICFs, but have had some internal discussions about it. If you are notified by ODH that you are scheduled for a FIC survey, please email Debbie Jenkins.
Day service and transportation guidance for DD providers. Today, the Department of Developmental Disabilities released updated adult day guidance and shared transportation guidance from the Department of Transportation (DOT) (via recommendations from the Ohio Public Transit Association). The biggest change for adult day services is that providers no longer need to have separate entrances/exits and restrooms for each group of 10. The new guidance states, ”[w]hen separate entrances/exits and restrooms for each group are not possible, the provider will stagger arrival, departure, and break times for thorough sanitization of the area and minimal contact between individuals.” The DOT guidance deals with the 6 feet of distance between passengers with the following recommendation: “[e]ncourage social distancing, particularly when facial coverings are not worn, by the use of signage, decals, audio messaging, etc., to remind passengers to sit apart from others as feasible and try to minimize use of high touch areas on vehicles.”
CMS extends HCBS Settings Rule deadline. Already extended once, CMS postponed the deadline for states to comply with the Home and Community-Based Settings Rule to March 17, 2023, a one-year extension. CMS granted the posptonement because of the COVID-19 Public Health Emergency. At this juncture in Ohio, the extension primarily affects waiver-funded day services people with intellectual and developmental disabilities, as most other waiver services either are in compliance with the rule or were on a path to compliance by the previous deadline.