ODH posts order re-opening SNFs posted; hair salons allowed. This evening, the Department of Health posted a fourth amended Director's order addressing visitation in facility-based settings and related issues. The order codifies Governor Mike DeWine's Monday announcement that outdoor visitation could begin at SNFs on July 20. The order specifies that to allow visitation, "[n]ursing Homes shall be in substantial compliance with testing requirements for all staff as established by the May 27, 2020 Director's Order for the Testing of the Residents and Staff of all Nursing Homes." This means visitation cannot begin until the SNF has completed the baseline staff testing, either through the National Guard program or through alternative arrangements.

In sharing the order, Aging Director Ursel McElroy added that related guidance will follow. The order itself contains a considerable amount of guidance that applies to SNFs, assisted living communities, and ICFs/IID, including allowing all facilities to re-open hair salons on July 20 subject to guidelines generally applicable to salons. Other new provisions allow communal dining and activities, subject to social distancing, and for SNFs and assisted living, restrict the age and number of visitors and the duration of visits. These requirements do not apply to ICFs. Although the number of minimum parameters has grown, the fourth amended order retains the hallmark of offering providers flexibility to allow or not to allow visitation and to develop their own policies on the subject.

Ohio cases skyrocket; cities start to order masking. Today's count of new COVID-19 cases in Ohio jumped to 1,301. The two straight days with more than 1,000 cases marks the only time that has happened throughout the pandemic, other than when the state tested all inmates and guards at the prisons. With the mushrooming case count, city mayors (Dayton, Columbus) began to require residents of their cities to wear masks in public.

Governor announces Public Advisory Alert System, impact on visitation. During his press conference today, Governor DeWine announced that Ohio will maintain necessary baseline orders to control the spread of COVID-19 while also implementing a new alert system. The Ohio Public Health Advisory Alert System uses color coding to indicate a county’s COVID-19 flare-up severity, as determined by seven data indicators:

1. New cases per capita
2. Sustained increase in new cases
3. Proportion of cases that are not congregate cases
4. Sustained increase in emergency room visits
5. Sustained increase in outpatient visits
6. Sustained increase in new COVID-19 hospital admissions
7. Intensive care unit (ICU) bed occupancy

Counties are categorized by color for each alert level:

• Alert Level 1 (Yellow) with 0-1 data indicators demonstrates active community spread, and all current health orders should be followed. 
• Alert Level 2 (Orange) with 2-3 data indicators demonstrates increased spread. Counties should proceed with a high degree of caution in addition to following public health orders. 
• Alert Level 3 (Red) with 4-5 data indicators demonstrates very high spread and exposure. Activities should be limited as much as possible in addition to following all public health orders. 
• Alert Level 4 (Purple) with 6-7 data indicators demonstrates severe spread and exposure. Residents should only leave their homes for supplies and services.

Currently, 7 counties meet the Alert Level 3 or Red status (Butler, Cuyahoga, Franklin, Hamilton, Huron, Montgomery and Trumbull), with Franklin county having a special star to indicate it is approaching Alert Level 4. 

Most notable are the risk level guidelines, which state that at Alert Level 2 (Orange) and above, residents should “[s]eek medical care as needed, but limit or avoid unnecessary visits to hospitals, nursing homes, and residential care facilities to see others as much as possible,” and “high-risk individuals should take extra care to follow precautions.” Providers should review this document in relation to their current or developing visitation policies. To check the status of your county, please check the Public Health Advisory System website to view the color-coded map. County severity will be updated on a weekly basis.

HHS adds numerous items to PRF FAQ. The Department of Health and Human Services (HHS) placed quite a few new questions and answers into its burgeoning frequently-asked questions (FAQ) compendium. The new items bear the date June 30, 2020. Many of them deal with the Medicaid Targeted Distribution (MTD), including this one:

I am a provider that did not receive a General Distribution payment and does not meet the eligibility for the Medicaid Distribution. Will I be eligible for a Provider Relief Fund payment? (Added 6/30/2020)

HHS has not yet determined the methodology for future Provider Relief Fund distributions at this time, but will share additional information in the future. Providers should not have the expectation that they will be advantaged by applying for funds from one distribution over another. Providers should apply for a Provider Relief Fund payment in the first distribution in which they are eligible.

This is an interesting comment because we understand some assisted living providers are concerned that if they apply for the MTD, they will lose out on a higher amount in a potential future tranche for private-pay assisted living.

Final first-round FIC survey results. Focused Infection Control (FIC) surveys now have been completed for all SNFs in Ohio. According to ODH's Rebecca Sandholdt, the surveys resulted in citation of 5 Level D, 18 Level E, 17 Level F, and one Level L deficiency, although these numbers apparently do not include FIC surveys conducted by the Centers for Medicare and Medicaid Services.

Report on DSP survey. The University of Minnesota's (UM's) Institute on Community Integration and the National Alliance for Direct Support Professionals collaborated on a survey of direct support professionals (DSPs) to gather information on their experience during the COVID-19 pandemic. UM compiled the results in a report that includes data on DSP workforce pay and hours, safety measures, and effects on people with intellectual and developmental disabilities.