March 22, 2020

Director of Health issues "stay at home" order. The last shoe in the series of state orders relating to COVID-19 may have dropped today, as Director of Health Dr. Amy Acton issued what Ohio is calling a stay at home order (elsewhere referred to as shelter in place). The order mandates that people stay at home, but has numerous exceptions for permissible reasons to venture forth, such as working in all types of health care, including in-home care and services for people with intellectual and developmental disabilities. We urge you to read the order carefully to understand its provisions and to follow it scrupulously. Health also published a frequently-asked questions document on the order.

As a reminder, yesterday we posted on our COVID-19 web page a template letter designating a person as an essential worker that you may download and customize for your employees' needs. The Director's order does not require people traveling to work in essential jobs to carry such documentation, but it may give them a greater feeling of comfort in their commute.

Inasmuch as they are integral components of the delivery of health care/human services, we believe the order clearly allows corporate offices to remain open to the extent that the functions performed in the corporate office cannot be done from employees' homes.

DODD on stay at home order. The Department of Developmental Disabilities posted a notice highlighting the provisions of the order that apply to ID/DD service providers and workers.

Nursing reciprocity. The Board of Nursing (OBN) issued a statement explaining that in an emergency like the one that exists now relative to COVID-19, nurses licensed in other states may work in Ohio under a temporary permit from the board. OBN affirmed that they will process requests for temporary permits within 3 days of receipt. The OBN statement also notes that nurse aide trainees can perform functions of state-tested nurse aides for four months before completing the required training and testing, but to deliver a service, the person must be enrolled in a training program and must be checked off on the applicable skill.

Relief on QRP reporting deadlines. Today, the Centers for Medicare and Medicaid Services (CMS) announced extensions of and exceptions to the Quality Reporting Program (QRP) data submission deadlines for post-acute care providers.

For the Skilled Nursing Facility, Home Health, and Hospice QRPs, CMS delcared that the data submission requirements for the fourth quarter of 2019 are optional. If you submit (or already submitted) data anyway, it will be used to calculate the 2019 performance and payment. Additionally, providers are not required to submit data to CMS for the first two quarters of 2020 (January 1-June 30, 2020) to comply with QRP requirements. Please note, however, that other programs such as reimbursement may require submitting the data.

Home health and hospice providers do not need to submit the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data for the first three quarters of 2020 (January 1, 2020- September 30, 2020).

Also, for the SNF Value-Based Purchasing (VBP) program, claims from the first two quarters of 2020 will be excluded from the claims-based, 30-day, all-cause readmission measure calculations.

Utilizing non-direct care staff to support needs (from AHCA). COVID-19 has interrupted usual daily operations in all long term care facilities. This means some direct or non-direct care staff usual duties are on hold or not urgent during this pandemic. Thus, there is opportunity to engage those staff in supporting activities that must continue despite the pandemic disruptions. Below are some ideas to consider.

Typical Nurse Aide Duties to be Stopped and Shifted to Other Non-Direct Care Staff: 

• Deliver water and snacks 
• Deliver linen and supplies 
• Restocking supplies 
• Assisting residents in wheelchairs to/from events (bathing, etc.) 
• Take menu/orders from residents 
• 1-on-1 with resident who have behavioral challenges or need socialization 
• Deliver meals to residents during mealtime 
• Applying/removing glasses and hearing aids to residents 
• Bed making 
• Responding to call lights 
• Assisting with feeding non-choking or non-aspiration risk residents 
• Doing errands for the resident 
• Doing personal care such as combing hair or washing faces/hands 
• Stay with resident while in the bathroom to free up NA to do other tasks while waiting to transfer 

Nurse and Nurse Aide duties that could be supported by physical and occupational therapy and speech-language pathology staff: 

• Restorative and functional ADL and mobility maintenance services 
• Perform and document routine vital signs, orthostatic BPs, etc. 
• Assisting to feed moderate risk residents (history of some choking issues)  
• Any other basic support duties that could also be performed by non-direct-care staff 

Typical Nurse (or some medication aide) duties to be shifted, stopped, or requests to reduce/discontinue: 

• Request discontinue of non-critical medications (e.g. vitamins, calcium) 
• Request discontinue or reduced blood sugar checks (e.g. decrease to daily or weekly) 
• Request discharge of sliding scale insulin and standard/set amount of long-acting insulin administered every day 
• Request to reduce dressing changes to daily or biweekly (as appropriate) 
• Routine vital signs decrease to weekly or monthly (as appropriate) 
• Orthostatic B/Ps - reduce to one time daily or weekly (as appropriate) 
• Stop routine monthly vital signs