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Workforce regulatory relief for SNFs. Between the blanket waivers that the Centers for Medicare and Medicaid Services (CMS) granted yesterday and the General Assembly's passage of House Bill 197 last week, Ohio SNFs now are free to hire individuals such as displaced restaurant and hospitality workers to function as nursing assistants without completing the standard nurse aide training and testing. The Ohio legislation postponed ("tolled") all deadlines and time limits established by the Revised Code, which includes the 4-month time limit that a SNF can employ a nurse aide before they must complete the training and testing. The CMS waiver did the same relative to federal regulations, but CMS noted that an individual cannot serve as a nurse aide "unless that individual is competent to provide nursing and nursing related services [and is] able to demonstrate competency in skills and techniques necessary to care for residents’ needs." Today, AHCA opened an 8-hour, online temporary nurse aide course. We recommend using this free program, which is available to all providers, member and non-member, to provide baseline training for new hires who will serve as nurse aides under the temporary flexibility.
Relief on background checks. The tolling provision in HB 197 discussed in the previous article also extends the deadline for requesting a criminal background check under the Revised Code, along with the thirty-day time limit on conditionally employing someone who has not been background-checked. The requirements for other record checks, such as the Department of Health abuse registry, still apply, and we recommend using other available, online background checking sources for patient safety purposes. This flexibility applies to all workers with statutory background check requirements, such as in assisted living, ID/DD services, and home health.
DODD determines ID/DD service staff are health care providers for FFCRA purposes. In a directive published this evening, the Department of Developmental Disabilities (DODD) wrote, "[b]ased on the DOL guidance and the essential nature of services and supports to people served in the disabilities system, DODD concludes that DSPs and SSAs are health care providers and are thus exempt from the paid sick leave and expanded family and medical leave provisions of the FFCRA." This ruling answers a critical question that was of great concern to providers: would their staff be allowed to stop working and take the paid leave, leaving insufficient workforce to deliver needed services and supports. Other DODD guidance released today provides a direct support professional on-boarding checklist that highlights the temporary flexibility the department is allowing relative to regulatory requirements, an announcement of webinars tomorrow and Thursday on using telehealth for behavioral health services, and a link to the Ohio Benefits website to sign up for government assistance. DODD asks providers to complete emergency inventory. DODD asked that OHCA members and other providers fill out an inventory of their building(s), supplies, and vehicles to assist in the department's emergency planning. You may download the inventory spreadsheet and a list of provider liaisons at each county board from OHCA's website. Completed spreadsheets should be returned to DAR@DODD.ohio.gov by Monday, April 6. If you have questions about the inventory, please contact Joslyn Tijerina at Joslyn.Tijerina@dodd.ohio.gov. OHCA urges all members to cooperate with this emergency planning measure.
Summary of blanket waivers for home health and hospice.
1. A definition of the home health “homebound” requirement that means that any individual determined by their physician to be at high risk of contracting the COVID-19 virus due to a compromised health condition meets the homebound requirement because it is “medically contraindicated” to leave the home.
2. A waiver of Conditions of Participation, including the requirement for an onsite visit for home health aide supervision. Additionally, instead of in person initial patient assessments, home health agnecies (HHAs) can provide these assessments remotely or by record review. 3. The waiver allows use of telehealth if the visits are ordered as telehealth in the plan of care. In other words, a HHA cannot replace in-person ordered visits with telehealth visits. HHAs are still not considered valid providers to bill telehealth services. Therefore, all telehealth visits DO NOT COUNT towards the Low-Utilization Payment Adjustment (LUPA) threshold. Only in-person visits count towards the LUPA threshold at this time. 4. Utilizing enforcement direction to permit non-physician practitioners (nurse practitioners, physician assistants, and clinical nurse specialists) to certify eligibility for the home health benefits and to establish and manage the plan of care if it is allowed under state practice laws.
5. Extending the 5-day completion requirement for the comprehensive assessment and waiving the 30-day OASIS submission requirement. HHAs are expected to complete the comprehensive assessment within 30 days, and the OASIS is still required to be on file for final claim processing requirements.
6. Suspend the Review Choice Demonstration program for claims for services furnished on or after March 29, 2020. Palmetto GBA will continue to review all review requests already submitted, and HHAs will have the choice to continue with pre-claim review if they wish. Claims submitted for pre-claim review will continue to be excluded from future medical review. Other claims will be subject to possible post-payment review. OHCA confirmed today with Palmetto GBA that Ohio providers will STILL NEED to make their Round 2 selection, even if the demonstration is paused.
1. Allowance to use telehealth for the physician face-to-face encounter requirement.
2. Permit hospice physicians to bill telehealth services and allow routine home care through telehealth if feasible and appropriate. 3. Waive the requirement for hospices to use volunteers. 4. Waive timeframes for updating comprehensive patient assessments - extended the deadline from 15 to 21 days.
5. Waive the non-core services requirements that include physical therapy, occupational therapy, and speech-language pathology. 6. Waive the 14-day home health aide in-person supervisory requirements. 7. Suspend all medical review audits other than in cases of fraud investigation.
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