March 17, 2020
Among the points mentioned in Governor Mike DeWine's press conference today were two specific ideas OHCA advanced: child care in health care centers and specific buildings to take COVID-19 patients who no longer need to be hospitalized. The child care item is closer to being ready. We will report details as we obtain them.
Surveys, exception reviews. In conversations with the Health Department (ODH), officials confirmed that they are not doing any more surveys except complaints alleging immediate jeopardy or infection control issues. The Centers for Medicare and Medicaid Services (CMS) has not issued anything in writing, so ODH also has not done so. There is a question about residential care facility annual surveys because they are governed by state law instead of federal. OHCA recommended that ODH deploy surveyors to provide technical assistance. We also learned from the Department of Medicaid that they suspended MDS exception reviews.
ODH "end of life" letter blows up. Yesterday, we reported that ODH issued a letter attempting to define every hospice patient in a facility as end of life and an exception to the no-visitation requirement. This immediately blew up, as members reported families rushing to take advantage of the loophole. Issues of numbers of visitors arose, and there even were unconfirmed reports of families attempting to elect hospice just to gain visitation rights. We raised these issues and the dangers spreading disease to Health, which is re-assessing the policy. In the meantime, we recommend applying a reasonable definition of end of life (the term used in both the Director of Health visitation order and CMS Quality, Safety, and Oversight letter 20-14-NH) and establishing reasonable limits on the number of visitors.
Leaves of absence. Another way members report families try to get around the restrictions on visitation is by taking the resident out of the facility for an outing. This obviously is a public health problem. We recommend adopting a policy of not allowing outings except for urgent medical reasons and educating families about the reasons for the policy.
OHCA all-provider audio update. You may listen to an audio recording of the latest COVID-19 news for long-term services and supports (LTSS) as of 1:00 p.m. today. This recording addresses a number of frequently asked questions about recent developments.
OHCA, LAO letter on HCBS issues. OHCA and LeadingAge Ohio collaborated on another letter asking Governor DeWine and Lieutenant Governor Jon Husted for regulatory and reimbursement flexibility to assist home health, hospice, and assisted living providers in responding to COVID-19.
ID/DD services update. All indications are that the Governor will order day programs and vocational habilitation sites to close later this week. OHCA worked with the Department of Developmental Disabilities (DODD) to minimize the impact of these closures on providers and to prevent the loss of direct support professionals from the field. The department has been very open to some of those ideas. While they may not implement all of the measures we’ve requested, we do believe there will be some exceptions to the closures and some financial assistance to providers in the short term. In addition, DODD released guidance on health and safety supplies. The department also announced that it suspended Ohio Developmental Disabilities Profile assessments and Individual Assessment Form reporting.
More closures affect LTSS. We have heard from members that closures of necessary sites because of COVID-19 are preventing employees from being fingerprinted for background checks and from testing for state-tested nurse aide and licensed practical nurse credentials. We elevated these issues to the state and requested waivers of these requirements because of unavailability.
Laid-off restaurant employees: a source of labor. OHCA contacted the Ohio Restaurant Association about informing their members that LTSS providers can employ laid-off restaurant workers in positions not requiring not requiring a state-approved credential. You may wish to contact local restaurant operators for connections to their former staff members or target those workers through advertising. OHCA also is advocating for flexibility in entry-level credential requirements (such as state-tested nurse aide) to expand the number of positions in which laid-off restaurant workers can be employed.