March 20, 2020

Today unfortunately saw the first Ohio death from COVID-19. Not related, but Governor Mike DeWine added senior centers and adult day care centers to the list of businesses he has closed. The Governor suggested that he may order a broader business closure if employers do not follow Health Department guidelines for preventing the spread of the coronavirus.

In the Governor's daily televised press conference, Health Director Dr. Amy Acton spoke emotionally about the sacrifices of long-term care workers who deliver care in the face of COVID-19. She recognized them as the heroes they truly are. You can watch a clip of Dr. Acton's remarks.

Patient movement between hospital and SNF. As COVID-19 patients become more prevalent in Ohio communities, a growing issue is when COVID-positive patients and persons under investigation in SNFs should be transferred to a hospital and when SNFs should admit these patients from hospitals. OHCA is working with hospital representatives to develop statewide guidelines for these transitions. Until they are finalized, we offer two suggstions for your consideration. One is a protocol developed by University of Cincinnati Hospital and the other is guidance from AHCA. Neither of these is approved by the Department of Health or otherwise adopted for statewide use, but you may find them helpful.

Quarantining staff exposed to a PUI. A frequent question from members is whether health care personnel who have been exposed to a person under investigation (PUI) for COVID-19 are required to be quarantined. The answer is no. The Centers for Disease Control and Prevention (CDC) guidelines are clear. Quarantine is required only for exposure to a confirmed positive COVID-19 case, and then only for workers who had prolonged, close contact with the patient. The extent that the workers and the patient used personal protective equipment also is relevant in determining whether quarantine is appropriate. The guidelines contain a table showing what should be done depending on the matrix of those factors. If your local health department attempts to quarantine workers exposed to a PUI who has not been confirmed positive, show them the table in the guidelines. If that does not work, contact OHCA, and we will ask the state Health Department to intervene.

COVID-19 summary for home health agencies and hospices. NAHC developed a COVID-19 summary containing relevant information impacting home health agencies and hospices related to the COVID-19 pandemic. The information is broken down into three categories: patients, home health and hospice staff, and regulatory and operations. NAHC intends to review the information daily and provide a revised document as information changes. The document will be housed on the NAHC coronavirus webpage at https://www.nahc.org/resources-services/coronavirus-resources/.

More DODD COVID-19 materials.

• The Department of Developmental Disabilities (DODD) issued guidance to providers struggling to find health and safety supplies, which recommends contacting the local Emergency Management Agency (EMA) and also the county board (CB).
• DODD released guidance on billing for waiver claims that still requires providers to get approval from their CB, but Payment Authorization for Waiver Services (PAWS) updates and prior authorizations are not needed. In addition, the Monthly Rate Calculator will pay for claims above the 3% threshold. OHCA recommends providers always get approval for increases in services from the CB in writing.  
• RN quality assessment reviews are postponed until after May 31, 2020.
• DODD created a screening tool that providers can use to screen staff before their shifts. While this is required for ICFs, it is also recommended for waiver providers.

Home health care for assisted and independent living residents. Residents of assisted living and independent living communities often contract for home health agencies to provide health care services to them in their apartments. These services are not prohibited by Dr. Acton's ban on visitors. Providers delivering essential health care servics are not covered by the ban. Socialization is.