Governor requires face coverings. In his press conference today, Governor Mike DeWine gave greater meaning to the Ohio Public Health Advisory Alert System when he announced that people in the seven counties in Red Level 3 (Cuyahoga, Franklin, Hamilton, Huron, Trumbull, Montgomery, and Butler) will be required to wear face coverings in public starting at 6:00 p.m. tomorrow. According to the Governor's press release (the order on this topic is not yet available):
Those in counties designated as Red Alert Level 3 or Purple Alert Level 4 are required to wear a face covering:
- In any indoor location that is not a residence;
- When outdoors and unable to consistently maintain a distance of six feet or more from individuals who are not members of their household; or
- While waiting for, riding, driving, or operating public transportation, a taxi, a private car service, or a ride-sharing vehicle.
The order does not apply to children under the age of 10 or any other minor who cannot safely wear a face covering. The order also reflects the mask guidance in place for employees and businesses which does not require a person to wear a mask if their physician advises against it, if wearing a mask is prohibited by federal regulation, if communicating with the hearing impaired, when alone in an office or personal workspace, and other similar measures.
The Governor did not say anything today to clarify how the color levels affect visitation in ICFS/IID, assisted living communities, and SNFs. Do any of the levels mandatorily override the fourth amended Director of Health order on visiting, or is the alert system simply a consideration (the order lists the case status in the surrounding community as the first consideration for facility visitation policies)? Another needed clarification of the visitation order is what is considered substantial compliance with the Director's testing order to allow visits to proceed - in other words, is swabbing sufficient or does the facility have to have the results?
Focused Infection Control surveys. The Department of Health (ODH) completed the initial round of Focused Infection Control (FIC) surveys in all Ohio SNFs on June 26. This round allows a center to qualify for the infection control incentive payment when it becomes available, depending on any deficiencies cited and their correction status. Per Ms. Sandholdt, ODH is aware of 34 SNFs that had E or F-level deficiencies and 2 with immediate jeopardy deficiencies. The buildings with E and F-level cites have the opportunity to qualify for the incentive by clearing either a revisit or a desk review, as ODH determines applies in each case. Items commonly cited on FIC surveys included:
- Personal protective equipment (PPE) contamination.
- Failure to wear PPE properly.
- Not screening staff.
- Cleaning chemicals not used per manufacturer's recommendations.
- Not quarantining or isolating patients when needed or staff not following proper procedures.
- Incorrect hand hygiene.
- Improper handling of meal trays.
- Lack of social distancing while dining or smoking.
Ms. Sandholdt added that ODH completed second FIC surveys at all SNFs with previous COVID-19 outbreaks, defined per Centers for Medicare and Medicaid Services (CMS) Quality, Safety, and Oversight letter 20-31-All as cumulative confirmed cases at 10% of bed capacity or more, cumulative confirmed plus suspected cases at 20% of bed capacity or more, or ten or more deaths reported due to COVID-19. In addition, ODH is scheduled to do 27 FIC surveys within three to five days of SNFs with 3 or more new suspected/confirmed cases since their last National Healthcare Safety Network (NHSN) report or one confirmed resident case in a facility that was previously COVID-free. ODH has not yet scheduled any annual surveys. Ms. Sandholdt said ODH is working with CMS Chicago to develop protocols for safe surveying.
Testing news. Speaking about the National Guard testing program, ODH's Rebecca Sandholdt said as of yesterday, staff and residents at 367 SNFs had been tested by the Guard and another 136 centers opted out by having testing done through other arrangements. This is fewer than half of all SNFs, but Ms. Sandholdt said the state still expects to complete the baseline round by July 31, with Zones 2 and 3 finishing earlier. As for the next steps, Medicaid Director Maureen Corcoran explained that the state is considering testing at assisted living communities and other congregate settings serving seniors, especially in high-risk areas of the state. The state is also looking at more testing of SNF residents and staff, but does not have a concrete plan yet. Governor DeWine said later in the day, in response to a reporter's question, that future testing in SNFs would be coordinated by the facilities themselves.
CMS HQRP COVID-19 tip sheet. CMS released a Hospice Quality Reporting Program (HQRP) tip sheet today that provides practical guidance to address hospice quality data submissions starting on July 1, 2020, now that the temporary exemptions from the COVID-19 Public Health Emergency have ended. Hospices are expected to resume timely quality data collection and submission of CAHPS® Hospice Survey and HIS records.
- The CAHPS® Hospice Survey starts July 1 with July deaths.
- HIS also starts July 1 with all new HIS admission records and any HIS discharge records that occur on or after July 1, 2020.
The calendar year 2020 data used for meeting the HQRP requirements cover July 1-December 31, 2020, because CMS exempted the first two quarters of 2020 (January 1-June 30, 2020).
ODH resumes NLTC complaint surveys. Last week, OHCA reported that ODH confirmed resumption of Accrediting Organizations survey activity in Ohio. We also learned today that ODH resumed non-long term care (NLTC) complaint survey activity, with a focus on infection control, for home health and hospice agencies. In preparation for their surveys, providers should review the CMS blanket waivers, current ODM waivers, current public health orders, CDC guidelines, and their internal infection control policies.
Quarantining new admissions. We discussed the requirement to quarantine all new SNF admissions regardless of COVID-19 testing status with ODH today. Amanda Smith of ODH said the guidance from the beginning has been to quarantine all new admissions. We explained that the recently updated CDC guidelines say new admissions whose COVID-19 status is unknown must be quarantined, but CDC does not define unknown as including patients who had one or more negative tests before admission. ODH added that definition. OHCA also asked about patients who have negative testing after admission to the SNF. Ms. Smith said ODH would seek clarification from CDC.
Resident masking requirements. In response to member questions about when facility patients and residents are required to wear face coverings, we share the following passage from Centers for Disease Control and Prevention (CDC) guidance, updated most recently June 25, which ODH enforces as regulation: Residents should wear a cloth face covering or facemask (if tolerated) whenever they leave their room, including for procedures outside the facility. Cloth face coverings should not be placed on anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. In addition to the categories described above cloth face coverings should not be placed on children under 2.
From CMS guidance, issued May 18 and also enforceable by ODH:
Restrict group activities, but some activities may be conducted (for COVID-19 negative or asymptomatic residents only) with social distancing, hand hygiene, and use of a cloth face covering or facemask.
Another Medicaid Distribution webinar. CMS released the following announcement about a fact sheet and webinar on the Medicaid Targeted Distribution (MTD) from the Provider Relief Fund:
Today, Health Resources & Services Administration (HRSA) released a new Fact Sheet for Medicaid and CHIP Providers that is now available on the Provider Relief Fund website. Please feel free to share this, as well as the Medicaid and CHIP Provider resources below, with relevant stakeholders and trade associations. Also note, HRSA is hosting a Webinar on Wednesday, July 8 from 4-5pm ET discussing the Medicaid and CHIP distribution and application. Pre-register for the webcast is encouraged.
Unfortunately, the fact sheet does not appear to offer any new information about the MTD.
ODA providing meals for older Ohioans. The Department of Aging (ODA) today announced a new partnership with local area agencies on aging and restaurants throughout the state to provide free meals to older Ohioans who are unable to prepare meals and lack meal support at home or in their communities. The department developed the Staying Healthy program with funding from the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. Local restaurants participating in the program receive reimbursement from these funds for the meals they provide to eligible participants. The short-term program is designed to serve older adults with the greatest economic and social need. It places special emphasis on low-income older adults, as well as older Ohioans living in rural areas and those with severe disabilities, limited English-speaking ability, or Alzheimer’s disease or related disorders. For more information about the Staying Healthy program or nutrition services for older adults, contact your area agency on aging. Call 1-866-243-5678 to be connected to the agency serving your community or visit www.aging.ohio.gov/findservices to look up agency contact information.
CMS webinar on managing staffing challenges in SNFs. The National Nursing Home Training Series, presented by CMS and the Quality Improvement Organization Program, will focus this week on managing staffing challenges in SNFs. The webinar will help participants understand staffing challenges that are exacerbated by COVID-19 and associated resources from federal, state, and local guidance and policies related to nursing home staffing during a public health emergency. Additionally, participants will learn effective plans to optimize staffing during a pandemic. Lastly, the training will provide best practices to promote the safety, health, and well-being of SNF staff to minimize stress and promote resiliency. The webinar is on Thursday, July 9, from 4:00-5:00 p.m. Interested providers can register here.