March 24, 2020
Thoughts on leaves of absence, end-of-life visitation, background checks. These three issues are controversial. The first two are ways that families sometimes try to get around the strict visitation bans for assisted living, SNFs, and ICFs/IID under Director of Health Dr. Amy Acton's March 13 order. Unable to visit, family members take their loved one out of the building for a sojourn and then return, under the theory that facility residents have the right to go out. Likewise, under the exception to the visitation ban for end-of-life situations, some families asserted (with support from Health Department survey officials) that any hospice patient can be considered at the end of life. While both of those situations could be argued in the abstract, protecting other facility residents from potential infection is the overriding consideration.
The leave of absence situation was addressed by Director Acton's stay-at-home order that mandates Ohioans stay in their homes (wherever they may be) except for certain exceptions that do not include surreptitious visits. We also recommend that providers interpret the end-of-life exception to apply only to true end-of-life times.
Background checks for new employees also is a thorny issue because of Ohio's fingerprint requirement and the closure of many fingerprinting sites across the state (often, sheriff's offices). We recommend providers who do not have the Webcheck technology try to find a fingerprinting site and if they cannot, document that fact. State law allows a 30-day provisional employment period while awaiting background check results, which in ordinary times requires that the applicant already submitted fingerprints. These are not ordinary times.
Infection control self-assessment. We reported yesterday that the Centers for Medicare and Medicaid Services (CMS) issued Quality, Safety, and Oversight (QSO) letter 20-20-All, which deals with a variety of survey issues, most notably the 3-week suspension of standard surveys and revisits for SNFs, ICFs/IID, home health agencies, and hospices. Today in conversation with Health Department survey managers, they pointed out another aspect of the QSO: the infection control self-assessment that the document spells out in great detail. Relative to this, CMS wrote, "[w]e expect facilities to use this new process, in conjunction with the latest guidance from [the Centers for Disease Control of Prevention], to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19." Health emphasized this expectation.
DODD release. The Department of Developmental Disabilities (DODD) issued new guidance related to major unusual incidents (MUIs) and reporting in the Incident Tracking System (ITS).
Pharmacy Board rule on malaria drugs. Responding to reports of people hoarding the anti-malarials chloroquine and hydroxychloroquine, the Board of Pharmacy (BOP) adopted an emergency rule Tuesday that limits prescriptions of the drugs. While approved for treatment of immune disorders, these medications also may be helpful in combatting COVID-19. The rule limits prescription quantities to 14 days and prohibits prescribing for COVID-19 unless the patient is confirmed positive, not presumptive or exhibiting symptoms. There is an exception to the prohibition at the discretion of the BOP Executive Director.
UHC relaxes prior authorizations. UnitedHealthcare announced that it suspended prior authorization requirements for post-acute care and for transfers to a new provider through May 31, 2020.
Lessons from the front line. India Chrisman-Williams of AdCare, which manages the first center in Ohio to have COVID-positive residents, shared key teachings from her experience that may be of value to other providers preparing for possible exposure. She recommends ensuring that you have back-up plans for all key vendors, as some may refuse to serve a center with COVID-19. Establishing a relationship in advance with the local health department and maintaining transparency and frequent communication with staff and families are critical to navigating the crisis.