Elevating the Post-Acute and
Long Term Care Profession

March 4, 2021

COVID-19  Cases in LTC Continue to Decline; Governor Sets Bar to Remove Health Orders. This week's Department of Health long-term care dashboard again brought good news, as the number of cases continued their now two-and-a-half-month decline. This week's total was 1,253 (733 residents and 520 staff), down 132 from last week. The state's COVID-19 death data remain problematic. Director of Health Stephanie McCloud announced a change in the way deaths are recorded that will slow data reporting but hopefully will be more accurate. This is more fallout from the serious undercounting that occurred in late 2020. The change also affects the long-term care mortality figures, as the web page this week bears the following legend: "Mortality data is verified by coded death certificate information received from the National Center for Health Statistics, and can take some time to receive. Data displayed reflects March 2020 to present. Previous versions of this dashboard displayed data beginning April 15, 2020." Despite going back farther in time, this week's page shows nearly 500 fewer deaths than last week.

Governor Mike DeWine today announced a standard for determining when public health orders relating to COVID-19 will be lifted. He chose 50 cases per 100,000 population for two weeks. As of today, the figure is 179 cases per 100,000. This contrasts favorably with the rate of 731 in December, but is still well above the Governor's benchmark. Although the Governor referred to lifting "all" health orders, it is unclear whether it would include orders affecting long-term services and supports. Also to the extent the state orders mirror federal requirements, such as the visitation order, elimination of a state order would not relieve a provider subject to the federal requirements from complying with those requirements.

Key CDC Guidance Revised. Yesterday, the Centers for Disease Control and Prevention (CDC) revised their main guidance on COVID-19 vaccination, removing the term "mRNA" from the title to reflect changes to incorporate the Janssen vaccine. CDC listed the key changes as follows:

  • Clinical considerations added for use of Janssen (Johnson & Johnson) COVID-19 vaccine.
  • Updated recommendations for fully vaccinated people who subsequently develop COVID-19.
  • Updated recommendations related to COVID-19 vaccination timing for immunocompromised people.
  • Updated contraindications and precautions to mRNA COVID-19 vaccines.
  • Updated information on interpretation of SARS-CoV-2 antibody test results after vaccination.

In the section about second-dose timing for the Moderna and Pfizer vaccines, CDC removed the sentence suggesting that even if the second dose is given more than the recommended 42 days after the first, the vaccination cycle need not start over.

CDC also added a paragraph for when a fully vaccinated person tests positive for COVID-19. OHCA members have reported a number of these instances. CDC evidenced a desire to investigate these cases, writing:

If a person is fully vaccinated (i.e., =2 weeks after completion of a two-dose mRNA series or single dose of Janssen vaccine) and tests positive for SARS-CoV-2, healthcare providers and local health departments are encouraged to request the specimen be held and to report the case to their state health department. CDC will work with the state health department to collect information about the case. In addition, information about these cases should be reported to VAERS.

AHCA/NCAL Vaccine-Related Guidance. AHCA/NCAL issued two helpful new guidance pieces relating to COVID-19 vaccine.

  • Guidance on what Ohio is calling the long-term care maintenance program. This material borrows largely from CDC. Ohio's program may have some different nuances, although the state program is not yet underway and thus is not fully defined.
  • Guidance for SNFs on biling for vaccine administration under Medicare. This option may or may not be available to a center depending on how the relationship with the long-term care pharmacy is structured.  

IRS Updates Employee Retention Credit for 2020 (from AHCA/NCAL). This week, the Internal Revenue Service (IRS) issued guidance for employers claiming the employee retention credit under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), as modified by the Taxpayer Certainty and Disaster Tax Relief Act of 2020 (Relief Act), for calendar quarters in 2020. According to the IRS: 

The guidance in Notice 2021-20 is similar to the information in the employee retention credit FAQs, but includes clarifications and describes retroactive changes under the new law applicable to 2020, primarily relating to expanded eligibility for the credit.  

For 2020, the employee retention credit can be claimed by employers who paid qualified wages after March 12, 2020, and before January 1, 2021, and who experienced a full or partial suspension of their operations or a significant decline in gross receipts. The credit is equal to 50 percent of qualified wages paid, including qualified health plan expenses, for up to $10,000 per employee in 2020. The maximum credit available for each employee is $5,000 in 2020. 

A significant change for 2020 made by the Relief Act permits eligible employers that received a Paycheck Protection Program (PPP) loan to claim the employee retention credit, although the same wages cannot be counted both for seeking forgiveness of the PPP loan and calculating the employee retention credit. Notice 2021-20 explains when and how employers that received a PPP loan can claim the employee retention credit for 2020. 

Notice 2021-20 also provides answers to questions such as: who are eligible employers; what constitutes full or partial suspension of trade or business operations; what is a significant decline in gross receipts; how much is the maximum amount of an eligible employer’s employee retention credit; what are qualified wages; how does an eligible employer claim the employee retention credit; and how does an eligible employer substantiate the claim for the credit.  

While the Relief Act also extended and modified the employee retention credit for the first two calendar quarters in 2021, Notice 2021-20 addresses only the rules applicable to 2020. The IRS plans to release additional guidance soon addressing the changes for 2021.

A page on the IRS website is focused on providing information to businesses on all aspects of the CARES Act.