State getting handle on POC testing. State Medicaid Director Maureen Corcoran said this morning that Governor Mike DeWine and state officials are trying to sort out the impact of the federal government's offer of point-of-care testing devices to all SNFs in the country on Ohio's ongoing testing program. Director Corcoran expressed concern about turn-around times using the existing testing approach. She indicated the state would make more information available as they learn more about the POC program. She added that another concern is possible relaxation of appropriate behaviors by facility staff. The state is considering developing back-to-basics training. Director of Aging Ursel McElroy also discussed this new focus in a separate meeting earlier in the morning.

ODH infection control interpretations. In a meeting today with the Departments of Health (ODH) and Medicaid, ODH provided some new interpretations:

• OHCA asked if a SNF is in crisis capacity relative to a certain personal protective equipment (PPE) item, it is still required to utilize full PPE for new admissions who are in 14-day quarantine. ODH's Amanda Smith (not to be confused with OHCA's Mandy Smith) at first said the PPE requirements for quarantine apply regardless, and facilities in crisis capacity should not take admissions. Sarah Mitchell of ODH referred providers to the long-term services and supports toolkit and other resources such as the Bridge Team to assist with PPE shortages. Ms. Smith, however, agreed that providers could use approved KN95 respirators instead of approved N95s for care of quarantined patients. She said the same for gown substitutes (see Centers for Disease Control and Prevention (CDC) gown guidance) if gowns are not available.

• ODH directed local health departments to the revised CDC guidance on discontinuing transmission-based precautions for patients and staff by means of a Health Alert Network notice.

• Responding to questions OHCA received from members about communications from county elections personnel, ODH reiterated previous guidance in this area: “The Director’s Order allows government employees and their contractors to enter the building after screening. Employees of the board of election would be permitted to enter the building under the Director’s Order. The CMS guidance is less clear and some facilities are reading it very narrowly to exclude any government worker that is not a surveyor. We have tried to work with those facilities on the particular issue/inspection.  

  The Secretary of State may issue different guidance about who can assist with voting and who to deputize for this function. The Secretary of State can then direct the county boards of election to follow the guidance.”
  

• Rick Hoover of ODH said as far as they are concerned, nursing students and nurse aide trainees who are in clinical rotations can be considered essential health care personnel and allowed into SNFs.
  

We raised other questions with ODH on which we hope to get answers in the near future, including open window visits and assistance with move-in/move-out.

Updated NHSN reporting instructions. CDC issued revised instructions for providers to use in reporting data to the National Health Care Safety Network. The instructions pertain to reporting on PPE, not to reporting COVID-19 case data.

A new kind of FIC survey. ODH's Rebecca Sandholdt explained that the Centers for Medicare and Medicaid Services (CMS) requires Focused Infection Control (FIC) surveys in a new circumstance: a so-called "super hot spot" with 30 or more new COVID-19 cases in a week. CMS technical assistance personnel accompany state surveyors on the visit, which must occur within two days. Two super hot spots have been surveyed so far in Ohio.

AHCA fourth stimulus asks. As we reported yesterday, Congress returned to the business of negotiating a fourth COVID-19 stimulus package. The House of Representatives and the Senate have very different priorities, and President Donald Trump has some of his own. Yesterday we featured what was known at the time about the Senate's liability protection proposal. Today we offer AHCA/NCAL's priorities for the stimulus legisation. The items on the list are not necessarily in priority order, as the top priorities to our knowledge are immunity, replenishing the PRF, and restructuring the Medicare accelerated and advanced payment debt.

Updated HCIC list. Julie Davis of ODM supplied the following new table of approved Health Care Isolation Centers (HCICs) in Ohio and an explanation.