All individuals in Ohio must wear facial coverings in public at all times when:

• At an indoor location that is not a residence
• Outdoors, but unable to maintain six-foot social distance from people who are not household members
• Waiting for, riding, driving, or operating public transportation, such as a taxi, a car service, or a private car used for ride-sharing.

The order only requires those 10 years old or older to wear a mask. Additional exclusions include: 

• Those with a medical condition or a disability or those communicating with someone with a disability;
• Those who are actively exercising or playing sports;
• Those who are officiants at religious services;
• Those who are actively involved in public safety; or
• Those who are actively eating or drinking.

Schools should follow the guidance previously issued pertaining to masks.

Trump Administration directs $5 billion more to SNFs, other measures. In a surprise to us at OHCA, President Donald Trump announced that the Department of Health and Human Services (HHS) will award SNFs across the country another $5 billion from the Provider Relief Fund. The amount is similar to the SNF-only tranche HHS distributed earlier. The release provides no details about how and when this latest tranche will be allocated among centers, but after listing expenses for which the money could be used, it states, "[n]ursing homes must participate in the Nursing Home COVID-19 Training ... to be qualified to receive this funding." The release describes the required program as, "an online, self-paced, on-demand Nursing Home COVID-19 Training focused on infection control and best practices. The training being offered has 23 educational modules and a scenario-based learning modules that include materials on cohorting strategies and using telehealth in nursing homes to assist facilities as they continue to work to mitigate the virus spread in their facilities."

In addition, the announcement declares that the Centers for Medicare and Medicaid Services (CMS) will require all SNFs "in states with a 5% positivity rate or greater test all nursing home staff each week." According to the Johns Hopkins COVID-19 website, Ohio's current 7-day average positivity rate is 5.9%. CMS also is deploying Task Force Strike Teams "to provide onsite technical assistance and education to nursing homes experiencing outbreaks ...." We mentioned in Tuesday's COVID-19 Update that the Strike Teams were piloted in Ohio recently.

Applying for state CARES Act distributions. As reported yesterday, the Office of Budget and Management (OBM) opened a portal for eligible providers to apply for state funding under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. As members applied, these three frequently-asked questions appeared:

• What is meant by a federal award in the question about revenue coming from federal awards? Do Medicare and Medicaid payments constitute awards? No, awards refer to federally-funded grants. Payments to Medicare and Medicaid are not grants.
• Will I receive the full amount due or only half? This depends on the timing. If the second half (expected to be approved July 27) is ready to go out before the first half is paid, the two halves may be combined into a single payment.
  
• Can I apply once for all of my facilities and other provider types? No, a separate application must be filed for each provider requesting funding. For instance, a home health agency, an assisted living community, and a SNF all operated under the same tax identification number would file three separate applications, unlike in the federal Provider Relief Fund (PRF) portal. Only one application is needed for the two halves of the payments, and the SNF infection control payment does not require a separate application.

Members begin to receive MTD payments. A couple of OHCA members reported that they received payments from HHS's Medicaid Targeted Distribution (MTD) after applying via the PRF portal. As with other PRF payments, these sums appeared in the providers' bank accounts overnight, followed by an email explaining the payment later in the day.

DD waiver team process. Various stakeholders, including OHCA, collaborated to create a guidance document entitled “Trusting the Team Process” in response to many questions related to residents’ rights and the impact of the Ohio Public Health Advisory System and the related Risk Level Guidance document, which contain recommendations based on the level or color of the county in which services are being provided. While the Department of Developmental Disabilities (DODD) did not create the guidance document, a couple of DODD staff members were involved in the process to ensure the material is in line with DODD’s direction. The document, which is being shared with both providers and county boards, stresses the need for the team process to include all members of the team and for all potential legal requirements and recommendations (including the Public Health Advisory System) to be part of the team discussions. The document includes scenarios to showcase sample questions the team should ask and topics it should discuss.  

A new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim is rejected, modify your billing so the claim spans past the last day of the interrupted stay:

• Bill two months at a time, or
• Bill a month plus the days in the following month that span the interrupted stay plus 1 day

Adjusting the statement covered from and through dates to encompass the entire interrupted stay will allow your claim to process and pay correctly. Medicare Administrative Contractors will finalize any suspended claims that meet the criteria, so you can make corrections and resubmit your claim.

If we rejected an inpatient hospital claim, the hospital should ask the SNF to modify their claim. Until October 5, a SNF cannot submit an adjustment to a paid claim; they must cancel the paid claim and all subsequent claims in the same stay and resubmit them in sequential order.

CMS will correct the system in the future.