Updated CDC guidance. The Centers for Disease Control and Prevention (CDC) updated key guidance documents on release of transmission-based precautions for COVID-19-positive patients and staff (also known as return-to-work guidance). The guidelines are not specific to any one type of provider but apply to health care generally. Both documents and the supporting research summary reflect the key changes. First, CDC no longer recommends a test-based strategy for discontinuing transmission-based precautions. Second, under the symptom-based strategy, CDC reduced the time without a fever from 72 hours to 24 hours and broadened improvement in symptoms. Together, these changes allow COVID-positive patients to emerge from isolation and COVID-positive workers to return to work sooner. We will discuss the revised guidelines with the Department of Health (ODH) tomorrow.

ODH issues SNF visitation guidelines. As SNF visitation opened today, ODH issued guidance on the fourth amended visitation order they published July 2. Given its late arrival, it is fortunate that the guidelines do not break any new ground, but basically just restate the order in a different format. You may find the guidance helpful because it is better organized than the order and groups related points together, but it does not include some of the subsequent clarifications of the order we published in previous COVID-19 Updates.

With this lifting of statewide restrictions, waiver providers (including licensed waiver facilities) can no longer implement blanket restrictions of rights for people with developmental disabilities. This includes restricting someone’s ability to have visitors inside their home; restricting someone’s ability to go into the community for activities, appointments, etc., prohibiting someone from returning to their home if they leave, and requiring someone to quarantine when they return to their home. The ODH orders restricting group sizes for Adult Day Services and Vocational Habilitation as well as visitation restrictions at ICFs remain in place. These limitations continue to not be categorized as restrictive measures.

For a waiver provider to be able to continue implementing other restrictions, the requirements for a restrictive measure outlined in OAC 5123:2-2-06 need to be met on an individual basis, including, but not limited to: meeting the risk of harm or likelihood of legal sanction requirements, having an assessment that meets the rule requirements, and approval by the HRC. Any rights restrictions that are implemented without meeting these requirements should be reported as a major unusual incident (MUI) or unusual incident (UI).

In addition to the updated rights restriction guidance, DODD also announced that the Office of System Supports and Standards (OSSAS) will resume compliance reviews August 1, 2020, and regulatory work by county boards will re-start in September.

HHS provider focus groups on Medicaid fund starting tomorrow. Ginnie Whisman of DODD shared the following announcement on the Department of Health and Human Services' (HHS's) request for focus groups:

Sincere apologies for the short notice on this, but HHS and the Health Resources and Services Administration (HRSA) are organizing two focus group sessions on the Medicaid and CHIP distribution of the Provider Relief Fund (PRF). The PRF supports American families, workers, and the heroic healthcare providers in the battle against the COVID-19 outbreak. HHS is distributing $175 billion to hospitals and healthcare providers on the front lines of the coronavirus response.

The purpose of these focus groups is to identify opportunities to increase application volumes in the current Medicaid/CHIP distribution, which is intended to support eligible providers with $15B in funding. The focus group discussion will center on three topics:

1. Awareness of the PRF program and Medicaid/CHIP distribution
2. Understanding of program components, such as eligibility
3. Technical challenges faced during the application process

These sessions will be held on Tuesday, July 21^st from 6:30 – 7:30 pm ET and Wednesday, July 22^nd from 3:00 – 4:00 pm ET. We would greatly appreciate your participation and look forward to hearing your valuable input on the experiences of providers with the Medicaid and CHIP distribution of the Provider Relief Fund. We would also welcome your support in identifying and encouraging Medicaid and CHIP providers to participate the focus groups.

To confirm your participation, please send an email to preston.white@mckinsey.com with your name, email, title, organization and state, and note which session you would like to attend.

Thank you for your collaboration to improve the PRF program and how we support providers in their coronavirus response. More information can be found on the Medicaid/CHIP distribution at the PRF website and in the Medicaid/CHIP distribution fact sheet.

Medicare cost reporting and financial updates. AHCA's Dan Ciolek pointed out two relevant items in the Centers for Medicare and Medicaid Services' (CMS's) latest revision of its frequently-asked questions document on Medicare fee-for-service billing. One item on page 113 clarifies that Medicare providers can accept governmental assistance for control of infectious disease and still bill Medicare for related services. On page 94, CMS provides a table of extended Medicare cost report due dates, accompanied by the following text: "CMS will delay the filing deadline of Fiscal Year End (FYE) 10/31/2019 and FYE 11/30/2019 cost reports until June 30, 2020. CMS will also delay the filing deadline of the FYE 12/31/2019 cost reports until August 31, 2020. For the FYE 01/31/2020 cost report, the extended due date is August 31, 2020. For the FYE 02/29/2020 cost report, the extended due date is September 30, 2020." These extensions apply to SNFs, home health agencies, and hospices, among others.

US Senate immunity concepts. Congress returned to work today, with a plan for a three-week session before summer break. The primary, and possibly only, order of business is passing a fourth stimulus bill. The two houses reportedly are far apart at the present time, but we expect they eventually will reach agreement on a bill. The top priority for Senate Majority Leader Mitch McConnell (R-Kentucky) is liability protection for reopening businesses and for health care providers. Although the actual language of the Senate proposal is not available yet, a high-level summary was released that outlines its major aspects.

Webinar on Wednesday: social isolation-caused behavioral health issues. The necessity to protect patients from exposure to COVID-19 led to unintended consequences for residents in assisted living communities and SNFs. OHCA will present a webinar on July 22 focusing on the increasing behavioral health issues caused by social isolation resulting from the COVID-19 pandemic. It is important for caregivers to be alert to isolation-induced changes in mood so they can try to alleviate distress. Members pay just $35 for this important webinar. One hour of continuing education credit is available for nursing home administrators, social workers, nurses, and Certified Executives in Assisted Living. You may register at this link.

OHCA 1135 waiver request. Friday night, CMS finally responded to the 1135 waiver application OHCA, in conjunction with LeadingAge Ohio, filed back in March. The waiver application requested specific relief for ICFs/IID, SNFs, home health agencies, and hospices. OHCA brought the languishing application to CMS's attention on a call Tuesday, and they acted on it very quickly. Unfortunately, though, it appears the only items CMS approved are also in the national blanket waivers. We are still combing through the approval letter, but it looks like that is the case.