More counties hit red. Ohio's Public Health Advisory Alert system is updated every Thursday. Today, the number of counties at Red Level 3 hit 19, as Athens, Allen, Delaware, Licking, Lucas, Richland, Scioto, and Union Counties were upgraded from Level 2. Level 3 means mandatory mask-wearing in public. Athens County not only became red, it also received an asterisk as being on the watch list for moving to Purple Level 4. No county has yet become purple, and the counties with asterisks last week had them removed this week. Trumbull County was downgraded from red to orange. Today also continued the run of days with cases over 1,000, at 1,290. Unfortunately, the numbers for Ohio's long-term care facilities continue to reflect this trend. This week, there are 1,306 reported current cases in SNFs, assisted living communities, and ICFs/IID. This is about a 40% increase from the week ending June 24.

With COVID-19 POC units coming, does your facility have a CLIA Certificate of Waiver? With the official announcement by the Department of Health and Human Services (HHS) that all SNFs in the country will receive one of two Food and Drug Administration-authorized point of care (POC) units to run COVID-19 antigen tests, SNFs must have a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver to perform and to bill for these tests.

Fortunately, per a list the Department of Health (ODH) provided, it appears virtually all Ohio SNFs already have a Certificate of Waiver to perform a variety of CLIA-waived tests, including the forthcoming COVID-19 antigen test. If, however, your center does not have a certificate, please act now by reviewing this brochure, which explains how to complete a CLIA application. You will need to send your application directly to ODH via mail or email. To learn more about the ODH Laboratory Certification Program, please click here.  

We also noticed that the vast majority of existing Certificates of Waiver expire on August 31, 2020. Per ODH, CLIA certificates are good for two years. Approximately six months before the expiration date, ODH mails billing coupons for renewal to the facility. ODH attempts to bill a provider a total of three times. Once the fees are paid, the certificate is renewed automatically, and a new certificate is mailed approximately 2-3 weeks before the current one expires.

OHCA is also beginning to investigate the guidelines for billing COVID-19 antigen tests and will provide more information in the near future.

ODH guidance on facility-required testing of hospice staff, facility access. This week, during a call with ODH, OHCA inquired about the ODH guidance for testing SNF residents and staff, which includes this statement:

Currently, licensed and/or certified nursing homes must follow the infection control requirements set forth in regulations. These include developing a system of identifying and controlling the spread of communicable diseases among residents, employees, contract and agency staff (including hospice staff, attending physicians, etc.), volunteers, and private caregivers. As part of its infection control activities, the facility may encourage or require these types of individuals who are not employees to participate in the facility’s testing plan or obtain and verify their testing status.

OHCA expressed concern about requiring verification of testing status for hospice staff who care for patients who meet the end-of life-criteria outlined in the fourth amended Director of Health order on visitation. ODH's Rebecca Sandholdt said the state is revising the guidance and that she shares the same concerns. She added that ancillary providers, such as home health and hospice staff, should comply with facility requests for testing outside of end-of-life situations. Ancillary provider staff may participate in facility testing led by the National Guard if they are present; the employee's insurance will be billed. Staff also may use the pop-up testing sites provided by the state and may present the results as verification.

Ms. Sandholdt further stated that hospice and home health providers who are unable to access patients in congregate care settings, such as SNFs, assisted living, and ICFs, after reasonable attempts may request assistance from ODH to remedy the situation. While telehealth can assist with some patient needs, in-person visits often are required to deliver the appropriate services. According to Centers for Medicare and Medicaid Services guidance for SNFs (Quality, Safety, and Oversight letter 20-14-NH), hospice staff are considered essential health care personnel and are excluded from visitation restrictions. Facilities should follow Centers for Disease Control and Prevention guidelines for restricting access to health care workers.

Frequently-asked questions about orders and guidelines, part two. Today we continue our coverage of frequently-asked questions that we receive from members.

• Must a SNF, ICF/IID, or assisted living community provide ODH with a copy of the written communication or telephone script that it uses to notify family members every time there is a new case? Yes, according to verbal direction from ODH. The Director of Health's April 15 notification order only requires family notice for the first case, but department staff interpret a separate provision about submitting the documentation to ODH as applying to each case. We believe this interpretation is an incorrect reading of the order and intend to raise the issue again with ODH, along with the window visit question covered in yesterday's COVID-19 Update that generated considerable outcry from members questioning ODH's interpretation.
  
• If a newly admitted assisted living resident is under a 14-day quarantine period and the community allows visitation, can it allow the resident to visit outside during the 14-day quarantine, if they wear a mask while going outside? No, residents who are in isolation/quarantine should only be leaving their rooms for medically necessary reasons. This would not include outside visitation. [We just received this interpretation today. The 14-day quarantine requirement does not apply specifically to assisted living communities (or ICFs/IID), so this interpretation may be questionable for those settings.]
• Does a SNF have to receive test results for new hires before allowing them to work? No, ODH does not prohibit employees who have been tested and are awaiting results from working before the results are in. This would apply to new hires as well. ODH informally allows three weeks after starting work to have a new hire tested and to get the results back. ODH, however, does intend to update its testing guidance for the new resident testing program and to address new hires, so this answer could change.

MTD deadline clarification. As the July 20 deadline for applying for funding from the Medicaid Targeted Distribution (MTD) under the Provider Relief Fund approaches, providers may have concerns about the tax identification number (TIN) verification process. TIN verification is the initial part of applying for the MTD, and in some cases, there can be delays in verifying the TIN. Fortunately, this is not a problem, as HHS interprets the act of submitting a TIN for verification as sufficient to meet the deadline, even if verification occurs later. See the guidance on page 37 of the latest version of HHS's frequently-asked questions document.

Announcement from State Medical Board about license renewals. On March 27, 2020, House Bill 197 was signed into law by Governor DeWine. HB197 granted an extension to Medical Board licensees who have licenses that will expire during the declared COVID-19 emergency. If the emergency is not lifted by August 31, 2020, you have until December 1, 2020 to renew your license. If the emergency is lifted before August 31, we will notify you of your license expiration date (90 days after the emergency ends).

Despite the extension, many Medical Board licensees have already chosen to renew. A couple of the benefits to doing so are:
1. There is no risk of forgetting to renew which could result in an expired license and having to pay a late renewal fee.
2. Staying on the same renewal cycle timeline you are used to. Whether you renew now or at a later date your next license renewal date will not change. For example, if your license is due to expire on July 30, 2020, your next renewal date will be on July 30, 2022, regardless of when you renew during this extension period.

Please feel free to contact us at License@med.ohio.gov if you have any questions or need any assistance during the renewal process.