Ohio sets COVID-19 record. The state recorded 1,679 cases today, 154 more than the previous high last Friday. Today was the 9th straight day with more than 1,000 new cases. There were 121 hospitalizations, 9 deaths, and 25 intensive care unit admissions.

State COVID-19 funding. This afternoon, the Department of Medicaid (ODM) provided more detail on the payments approved by the Controlling Board on Monday from Coronavirus Aid, Relief, and Economic Security (CARES) Act funds.

• SNFs: approximately 21.1% of each facility's June 30 per diem times 1.5 months of Medicaid days from 2019, including managed care days.
• SNF infection control: $17.27 per day for April Medicaid days.
• ICFs/IID: 11.46% of June 30 per diem times 3 months of Medicaid days from 2019.
  
• Ohio Home Care Waiver: approximately 6.36% of 2019 fee-for-service payments.
• PASSPORT: not yet determined - could be around 5.5% of 2019 fee-for-service payments.
• Home health and private duty nursing: approximately 3% of 2019 Medicaid fee-for-service and managed care payments.
• Assisted living (all licensed residential care facilities): about $250 per licensed bed.
• MyCare Ohio Waiver: not yet determined (appropriation $18.4 million).

Deadline to apply for Medicaid Targeted Distribution extended to August 3. With little fanfare, the Department of Human Services (HHS) extended the deadline for Medicaid-only providers to apply for the Medicaid Targeted Distribution of the Provider Relief Fund (PRF) from July 20 to August 3. The new date appears both on the PRF web page and in HHS's frequently-asked questions document, although it is not highlighted in either place. Apparently very few Medicaid providers have applied for the funding, prompting the extension. We also are unaware of any members who have received payments from the Medicaid distribution, even though HHS said they would be issued on a rolling basis.

ODM managed care policy changes for home health authorizations. Today, on a call with the ODM Managed Care Policy group, we learned that the managed care plan provider agreement, effective July 1, 2020, includes a revision requested by OHCA at previous meetings relative to the timeframe for plans to approve prior authorizations. The provider agreement states, on page 60, that if the plan requires authorization for home health assessments, it must complete the prior authorization review within 48 hours of the request.

Previously, managed care plans that considered home health assessments “non-urgent” had up to 10 days to approve the authorization. OHCA explained that, per the home health Conditions of Participation (42 CFR 484.55), the initial assessment visit must occur within 48 hours of referral or ordered start of care. 

The provider agreement change applies only to managed Medicaid and MyCare Ohio plans when Medicaid is the primary payor and does not affect prior authorization timeframes for MyCare Ohio Medicare services.

We encourage members who experience authorization delays greater than 48 hours for Medicaid home health assessments to submit a complaint to the ODM Provider Complaint Portal.

Emergency telehealth rules extended. Yesterday, Governor Mike DeWine issued an executive order to extend emergency rules that provide additional flexibilities for health care professionals to deliver services via telehealth. The rules otherwise would have expired in several days. Through the emergency rule (5160-1-18), the executive order permits audio, video, and even text messaging to allow people to access critical health care services while remaining socially distant and safe. The emergency rule added therapists and hospice and home health agencies as eligible rendering and billing providers. It also updated the list of eligible procedure codes to include those added after the initial emergency rule was issued in March, including codes for home health and hospice. For more information, please see the fact sheet ODM issued today.

Updated Medicare testing coverage, spell of illness billing instructions for SNFs. Today, the Centers for Medicare and Medicaid Services (CMS) released an update to their Medicare Learning Network article (SE20011) addressing Medicare coverage of COVID-19 testing for SNF patients. In response to the July 2 Centers for Disease Control and Prevention SNF testing guidelines, the article states that Original Medicare and Medicare Advantage plans will cover diagnostic COVID-19 testing. Diagnostic testing includes testing residents with signs or symptoms of COVID-19, testing asymptomatic residents with known or suspected exposure, initial testing of asymptomatic residents without known or suspected exposure as a part of the recommended reopening process, and testing to determine resolution of infection.

CMS also updated the recently issued SNF billing protocols for the spell of illness waiver. The new guidance strengthens CMS's position on use of the waiver, stating that, “[t]o qualify for the benefit period waiver, a beneficiary’s continued receipt of skilled care in the SNF must in some way be related to the PHE.” In addition, CMS revised the billing instructions. Instead of submitting the final discharge claim on the last covered day, the instructions now read: “Submit a final discharge claim on day 101, with patient status code 01. Readmit the beneficiary to start the benefit period waiver.” This would prevent non-payment for day 100 as a non-covered date of discharge. Providers are still required to use the condition code DR and 57, as well as remark code “COVID100,” for the claim to process.

Update on notifying ODH of new COVID-19 cases. As suggested in our previous COVID-19 Update article on the topic, we revisited whether the Director of Health's notification order requires facilities to send the Health Department (ODH) copies of their written notice or telephone script for families for every new case. We are happy to report that ODH does not require this, as the department's Rebecca Sandholdt responded, "that is not the intent of the order to send in every time they have a positive."