Elevating the Post-Acute and
Long Term Care Profession

June 1, 2020

Information on tomorrow's testing webinar. The Health Department posted on the Enhanced Information Dissemination and Collection system and emailed the associations information about registering for the state's webinar on the mandotry testing program for SNF staff. The program, which is open to all SNFs, is scheduled for 9:30 to 11:00 a.m. tomorrow. Attendees must register using this link: https://attendee.gotowebinar.com/register/5053969376051868176. Audio will be via computer speakers, not call-in.

On a related note, reports from four of the pilot facilities tested last Thursday and Friday are that only one staff member had a positive result. It is worth noting, though, that none of these buildings had COVID-19 outbreaks before the testing. The state so far has provided no further guidance about the testing program or return-to-work. An OHCA member who participated on a Zone 3 call today said after this week, the state plans to provide notice to a center a week or two before testing.

CMS ramps up surveys, enforcement. Today the Centers for Medicare and Medicaid Services (CMS) announced expanded survey and enforcement requirements against SNFs, citing the first round of data from facility reporting to the Centers for Disease Control and Prevention (CDC). CMS outlined the new mandates in Quality, Safety, and Oversight (QSO) letter 20-31-All. The QSO has three main parts. The first part imposes financial penalties on states that do not complete all of their assigned infection control surveys, rains on-site surveys down onto SNFs with COVID-19 cases, and reinstitutes normal survey activities as re-opening occurs. The second part significantly enhances penalties on SNFs that are cited for infection control deficiencies, particularly higher-level or repeated deficiencies. The third part tasks the Quality Improvement Organizations with providing technical assistance to centers, especially targeting "low-performing" SNFs and centers that have had outbreaks. 

CMS wrote in a press release announcing the QSO:

As of May 24, 2020, about 12,500 nursing homes – approximately 80 percent of the 15,400 Medicare and Medicaid nursing homes – had reported the required data to the CDC. These facilities reported over 60,000 confirmed COVID-19 cases and almost 26,000 deaths. Of the nursing homes that reported data, approximately one in four facilities had at least one COVID-19 case, and approximately one in five facilities had at least one COVID-19 related death.  Early analysis shows that facilities with a one-star quality rating were more likely to have large numbers of COVID-19 cases than facilities with a five-star quality rating. CMS will take enforcement action against the nursing homes that have not reported data into the CDC as required under CMS participation requirements.

CMS plans to post facility-specific data as reported to CDC later this week, with a link to Nursing Home Compare. In the meantime, CMS posted state-level data comparing reported COVID-19 cases and deaths and the percentage of infection control surveys completed. Ohio ranks below the national average in cases and deaths per 1,000, both for patients and staff, but also is behind the national average in survey completion.

Reminder, PHE remains in effect through July 24, 2020. OHCA has received many questions regarding the applicability of CMS waivers that are in effect during the Public Health Emergency (PHE), which first was declared on January 27, 2020. On April 21, 2020, the Department of Health and Human Services extended the PHE effective April 26, 2020, which allowed the PHE, which has a 90-day duration, to run through July 24, 2020. All applicable CMS waivers remain in place for the duration of the PHE. Please check with your contracted health plans for information on deadlines and extensions for provider service relaxations, such as for prior authorization requirements. 

Resident stimulus checks. While OHCA shared ODM’s verbal guidance relating to federal stimulus checks (Economic Impact Payments or EIPs) residents began receiving in early May, which was supported by the Congressional Research Service analysis, today we received our first written communication from ODM on this issue. ODM's Cheryl Guyman confirmed that the EIP is not counted as income, so the county does not need to re-run the post-eligibility treatment of income calculation to determine a new patient liability. The EIP also will not be considered a resource for a one-year period.

Ms. Guyman also relayed guidance on how the facility should handle the money. If a resident has a personal needs allowance (PNA) account with the facility and deposits the money into the account, the facility must track it separately to ensure it does not count against the $2,000 resource limit. Likewise, the facility would need to issue a receipt signed by the resident for any withdrawals, which is standard practice for PNA account withdrawals. Finally, Ms. Guyman wrote that a resident would have to approve applying their EIP to an outstanding balance owed to the facility. She suggested maintaining written documentation of the approval, witnessed by someone who is not an employee of the facility. The EIP differs from the PNA itself, which is designated at both the federal and state level to be used only for items the resident wishes to purchase. OHCA anticipates a Medicaid Eligibility Procedure Letter (MEPL) soon will cover these issues.

CMS clarifies when CR and DR codes are to be used. In a MLN Matters release today, CMS provided a detailed chart showing when the CR modifier and DR condition code should be used on various types of claims. These codes are necessary for providers to take advantage of the many Medicare-specific 1135 blanket waivers CMS has issued. Many of the waivers relate to hospitals, but some apply to SNFs (e.g., three-day stay) or home health and hospice (e.g., face-to-face).