Governor hints at repeat SNF staff testing requirement. Although it was not part of his scripted remarks at today's press conference, Governor Mike DeWine responded to a reporter's question by saying he plans to announce next week repeat testing of SNF staff every 10 days. This was the first inkling that the Governor had decided on a frequency for repeat testing. The 10 days conflicts with the weekly staff testing requirement the Centers for Medicare and Medicaid Services announced yesterday. The Governor also suggested that his travel advisory recommending people who travel to Ohio from specified more-infected states self-quarantine came about because of an incident involving SNF employees.
Public Health Emergency extended. US Health and Human Services Secretary Alex Azar today extended the current Public Health Emergency (PHE) he originally declared on January 31 (retroactive to January 27) and previously extended on April 21. The extension will run for 90 days, staring July 25. The PHE declaration is very important because it is the foundation for numerous federal regulatory waivers that benefit long-term services and supports providers. Ohio not in first wave of POC testing machines. Last week, the Department of Health and Human Services (HHS) unveiled a point-of-care (POC) testing program that representatives said would give all SNFs in the country with active Clinical Laboratory Improvement Amendments (CLIA) waivers free POC machines. HHS said the first wave of 1,500-2,000 machines would go to centers in hot spots identified by the agency. Today, HHS released the list of centers participating in the first wave, which unfortunately does not include any Ohio buildings. Most of the hot spot locations are in Florida, Texas, Arizona, and California. Even though Ohio SNFs will not receive testing devices in the first wave, HHS released a frequently-asked questions (FAQ) document that contains the following statement: "Most shipments will occur in the first 4 weeks, although it may take up to 14 weeks for all nursing homes to receive their shipment due to supply availability." Please review the FAQ so you will be prepared when your machine arrives.
Open window visits okayed. Earlier this week, we asked the Health Department (ODH) to interpret their visitation order to allow open window visits at SNFs and assisted living communities, with the visitor outdoors and both the visitor and the resident wearing masks and maintaining social distance. We feel this approach is a good alternative to outdoor visits when it would not be advisable for a resident to go outside (e.g, because of extreme heat). Today, ODH's Rebecca Sandholdt wrote, "I have been in contact with [the Bureau of Infectious Disease (BID)] and [the Department of] Aging regarding the window visitation during hot weather, both have stated that this would be allowable. BID stated as long as they are following all appropriate infection control safety measures (appropriate PPE and social distancing)."
More frequently-asked questions about Ohio CARES Act portal. As more members apply using the state's portal for Coronavirus Aid, Relief, and Economic Security (CARES) Act funding for health care providers, more questions emerge. We answer three more below. Also please note that the portal requires the applicant to attest that, "[t]hese funds will solely be used to continue to provide services and to address costs related to business interruption and increased costs resulting from the COVID-19 health emergency."
- For SNFs, are Medicaid hospice days, Medicaid managed care days, and bed-hold days included? Medicaid days are defined the same as for cost reporting purposes. Medicaid managed care days are included. Leave days are included at 50%. Hospice days are not included because they are reported as other days.
- I completed my application on the portal. When will I receive my payment? There is no defined period of time, but the Office of Budget and Management memo on the portal ends with the following sentence: "It will take several weeks to achieve a timely turnaround, so we ask for your patience during this start up period."
- Does OHCA have the list showing how much each provider will receive? No, the Department of Medicaid has not given us these lists.
OSHA and COVID-19: reportability, inspections, and fit-testing. OHCA learned that the Occupational Safety and Health Administration (OSHA) is inspecting Ohio SNFs, stemming from hospitalizations and in some cases, fatalities among COVID-19-infected employees. OSHA Standard 1904.39 requires all employers to report inpatient hospitalizations within 24 hours and fatalities within 8 hours, if the event is work-related.
When is a COVID-related hospitalization or fatality work-related? Per OSHA Standard 1904.5, employers must consider a variety of circumstances when assessing work-relatedness. Specific to COVID-19, on May 19, 2020, OSHA released "Revised Enforcement Guidance for Recording Cases of Coronavirus Disease 2019 (COVID-19)". This guidance became effective May 26, 2020, and addresses how employers should evaluate work-relatedness of COVID-19 infections. You will note that because of the difficulty of determining COVID-19 work-relatedness, OSHA exercises enforcement discretion when assessing an employer’s efforts in making these determinations. The guidance provides a variety of considerations to evaluate and to document when evaluating work-relatedness of an employee's COVID-19 infection.
We believe recent OSHA inspections and citations of three SNFs in the Akron/Canton area were triggered by COVID-19 employee hospitalizations reported as work-related. Because of the attention on COVID-19 and proper infection control practices, we believe these inspections will continue.
Fit-testing was one of the recent citations. Per OSHA fit-testing requirements, any employee who wears an N95 respirator must be fit-tested. On April 9, 2020, OSHA issued a memo entitled "Expanding Temporary Enforcement Guidance on Respiratory Protection Fit-Testing for N95 Filtering Facepieces in All Industries During the Coronavirus Disease 2019 (COVID-19) Pandemic." This guidance allowed OSHA field offices to exercise enforcement discretion concerning the annual fit-testing requirement, as long as the employer made a good-faith effort to comply with the requirements in OSHA's March 14, 2020 memorandum. That memorandum highlights, among other things, the importance of performing initial fit tests for each employee with the same model, style, and size respirator they will wear.
Providers have many options for fit-testing. Professional fit-testing services can perform this service for a fee. Many SNFs conduct their own fit-testing because it is less costly. This approach is particularly beneficial if your center uses multiple respirator brands because employees must undergo a new fit test for each new brand of respirator. A very popular fit-testing kit is the 3M Qualitative Fit Test Apparatus, which can be used to test any type of N95 respirator. This kit is available through a variety of distributors. If you are a McKesson customer, you may order product #382499. After you obtain the kit and reusable hood, you can purchase additional testing solutions for continuous use.
We will update you on other OSHA citations related to COVID-19 as we gather more information. These citations relate to the requirements for medical evaluations to determine employees’ ability to use a respirator and for a comprehensive, written, respiratory protection program.
Two-negative standard for admission obsolete. Some SNFs still may insist on two negative COVID-19 tests before admitting a patient from a hospital. Under the current Centers for Disease Control and Prevention guidelines on quarantining admissions and release from transmission-based precautions, along with a shortage of laboratory capacity, we hear more hospitals are dropping this practice. Under the quarantine guidelines, an asymptomatic patient with two negative tests before hospital discharge still must be quarantined for 14 days at the SNF. If the patient tests positive, then they must be isolated at the SNF until they meet the criteria for discontinuing transmission-based precautions. A patient who has not been tested at all or who has one negative test must be quarantined - the same result as if they test negative twice.