Elevating the Post-Acute and
Long Term Care Profession

March 22, 2021

Positivity Rates a Mixed Bag. This week's county-level positivity rates, as published by the Centers for Medicare and Medicaid Services (CMS), had some good news and some not so good for Ohio's SNFs. The state table can be found here. The positivity rates reflect last week's apparent plateauing of the decline in cases among Ohio's general public. While Butler County finally got out of red territory this week, Licking County is the state's first locale to go back to red. Athens, Gallia, Harrison, Hocking, Logan, and Lorain Counties went from yellow to green. On the other hand, Morrow, Richland, Shelby, Van Wert, and Wyandot Counties moved back to yellow after being green last week. The key practical differences are:

  • The Health Department (ODH) requires eye protection throughout the building in red and yellow counties, but not green counties.
  • CMS guidance requires suspending visitation for unvaccinated residents in buildings with less than 70% overall resident vaccination rates in red counties, but not in yellow or green counties.
Free BinaxNOW Cards to Continue. OHCA previously heard the Department of Health and Human Services (HHS) planned to stop distributing free BinaxNOW cards to assisted living communities and SNFs with Clinical Laboratory Improvement Amendments (CLIA) waivers in the near future. Facilities would have to purchase the cards, at a discount, from McKesson or Medline. HHS on Saturday notified providers that they are continuing the free program through early June. The notice reads as follows:

We are reaching out to you in order to provide another update on the U.S. Department of Health and Human Services (HHS) investment in the Abbott BinaxNOW™ COVID-19 Rapid Antigen Point-of-Care Tests as you have been identified as your facility’s point-of-contact.   

We are pleased to announce an extension of the HHS federal distribution of free Abbott BinaxNOW™ rapid tests anticipated to run through early-June. As was done in previous distributions, new test allocations will be based on a combination of current federal COVID-19 testing guidelines, the location of the CMS facility, and current, regional epidemiological data. 

Nursing homes and assisted living facilities that are currently receiving shipments of the Abbott BinaxNOW™ rapid tests directly from the HHS/Abbott federal distribution will continue to be sent tests if a facility continues to meet the criteria needed for distribution. 

For facilities where tests are no longer being used, you may choose to opt out of the distribution of Abbott BinaxNOW™ tests through contacting Abbott at ARDxUSGovernmentSupport@abbott.com.

We appreciate your continued commitment to ending the COVID-19 pandemic through increased testing capacity to help save lives.

We do not believe this announcement affects the state's distribution of BinaxNOW cards through the state-supported testing program, as the state buys cards from Abbott separate from the federal purchase.

AHCA/NCAL Webinar on OSHA Special Emphasis Program. We recently publicized the Occupational Safety and Health Administration's (OSHA's) new special emphasis program that applies to long-term services and supports providers, among others. AHCA/NCAL today announced a free webinar on this program featuring an attorney from Littler that will be held next Tuesday, March 30, from 12:30-1:30 p.m. You may register for the webinar here. Quoting from the session description:

On March 12, 2021, the Occupational Safety and Health Administration (OSHA) implemented a National Emphasis Program (NEP) to ensure employees in high-hazard industries are protected from contracting COVID-19. OSHA will prioritize COVID-19-related inspections involving deaths or multiple hospitalizations due to occupational exposures to COVID-19. In addition, this NEP will focus on protecting workers from retaliation. The NEP includes: Skilled Nursing Facilities, Residential Intellectual and Developmental Disability Facilities, Continuing Care Retirement Communities and Assisted Living Facilities [and home health]. This webinar will review the NEP and what it means for AHCA/NCAL members. 

COVID-19 Testing Opt-In/Opt-Out Surveys Open. While the Department of Aging (ODA) has not yet published updated testing guidelines following last week's webinars, they did reopen their opt-in/opt-out surveys for state COVID-19 testing support. The residential care facility (assisted living) survey is available here and the SNF survey here. Both surveys are open today through Sunday, March 28. While the SNF webinar is posted on the department's YouTube channel and shows the cadence of state support, the assisted living webinar is not posted. Director Ursel McElroy informed us today that the increased testing frequency for unvaccinated assisted living staff will be covered by MAKO for opt-in providers, as is the current testing.

Vaccination Updates. Last week, we wrote that the ODA vaccination web page includes a list of long-term care pharmacies that are enrolled with ODH as vaccine providers and a portal for assisted living communities and SNFs in the long-term care vaccination maintenance program to find their clinic schedules. The instructions for the portal specify that facilities are to enter their ODA-supplied usernames and passwords. We were told over the weekend that ODA sent these credentials last Friday via encrypted email to the contacts facilities designated in the state's survey. Hopefully you received and can open this email and have been able to gain access to the schedule.

Director McElroy appealed again this afternoon for providers who have not completed the survey to do so right away, even if they do not wish to take part in the maintenance program. "Just tell us," she said. The Director added that participation in the progam, or another method of continuing vaccinations, is important for future relaxation of COVID-19-related restrictions.

Updated State Visitation and Testing Requirements. Long-term care again played a part in Governor Mike DeWine's press conference today, as he discussed plans for changes to the state's visitation order and testing guidelines for SNFs and assisted living communities. ODA previously covered these topics in their webinars, but the Governor provided confirmation. As reported in the summary released after the press conference:

The Ohio Department of Health will issue an updated order related to assisted living facilities and nursing homes. The general visitation requirements will remain the same, including the requirement that visitors schedule appointments in advance, are screened at the door, and wear masks. Changes to the order include: 

  • Ohio is requiring that visitation be permitted whenever safety protocols can be met. Previously, visitation was permitted, not required;
  • Vaccinated residents may have physical touch with their visitor while wearing a mask. Previously, touch was discouraged;
  • Visits may occur in a resident’s private room, as opposed to the previous requirement of a separate visitation area;
  • 30 minutes should serve as the minimum amount of time for a visit. Previously, 30 minutes was the maximum time to visit.

The order will also expand the circumstances in which compassionate care visits should be granted.

In addition, the order will update nursing home and assisted living testing requirements to require the facilities to test vaccinated staff once per week and unvaccinated staff twice per week. The previous order made no distinction between vaccinated or unvaccinated staff.

"We must continue regularly testing for the virus," said Governor DeWine. "It’s just good science, and it will help us identify cases early and prevent the spread. Further, if COVID is controlled, that means less disruption to visitation."

Certain circumstances, such as a facility outbreak, may necessitate that visitation be restricted on a case-by-case basis. Nursing homes must also continue following federal regulations from the Centers for Medicare and Medicaid Services.