Elevating the Post-Acute and
Long Term Care Profession

March 9, 2021

Today marks the anniversary of the first OHCA COVID-19 Update, March 9, 2020.

Federal Stimulus Legislation Nears Finish Line. After the US Senate passed the American Rescue Plan Act in an amended version Saturday, the House of Representatives is preparing to vote on the legislation again tomorrow. The plan appears to be that the House will adopt the Senate version of the bill rather than make any further changes that would delay finalization beyond the March 14 expiration of enhanced unemployment benefits. While the Senate made a number of amendments to the House-passed bill, its size and structure remains largely intact. At this time, we will highlight three items of significance among the Senate changes:

  • Increases the enhanced Federal Medical Assistance Percentage from 7.35% to 10% for home and community-based services rate increases and other expansions for one year, starting April 1, 2021. The House language gave a laundry list of permissible uses for this funding, but the Senate removed the detail and simply provided that it be expended on "one or more activities to enhance, expand, or strengthen home and community-based services under the State Medicaid program."
  • Retains the $350 billion appropriation for aid to state and local governments, but requires a governmental unit to certify to the Secretary of Health and Human Services (HHS) that each expenditure meets the requirements of the legislation. According to a spreadsheet distributed today by Senate Democrats, Ohio's share of this funding would be $5.638 billion at the state level, plus $274 million for capital projects, and the local share for Ohio would be an additional $5.325 billion.
  • Adds an $8.5 billion appropriation to the HHS Provider Relief Fund for Federal Fiscal Year 2021, targeted to Medicare and Medicaid providers located in rural areas to cover COVID-19-related expenses and lost revenues.  

CMS Real Time Webinar Canceled. In yesterday's COVID-19 Update, we alerted members to a webinar scheduled for tomorrow by Centers for Medicare and Medicaid Services (CMS) Chicago on mysterious revisions to SNF visitation requirements. Those revisions apparently will remain mysterious, as this morning CMS abruptly canceled the webinar "[d]ue to unforeseen issues ...."

New SNF and Assisted Living Testing Schedules Out. Late this afternoon, the state released its latest COVID-19 testing schedule for both SNFs and assisted living communities, which will run from March 15 to April 9, 2021. According to the state's notice, they are starting to ship supplies this week. Unfortunately, though, despite the prevalence of vaccinations and the steep decline in COVID-19 cases in long-term care, the state left the testing frequencies for both provider types the same.

CMS Clarifications for ICF Providers. Today, OHCA participated on a call with CMS to discuss ICF/IID services. During the call, OHCA asked several questions hoping to gain clarification on CMS's intent behind Quality, Safety, and Oversight (QSO) letter 21-14-ICF/IID & PRTF, which provides guidance for visitation in ICFs. OHCA asked CMS if the QSO is guidance or recommendations or if it will be enforced as regulation. CMS’s Don Howard stated, “unless the memo cites a specific regulation, it is intended to be guidance and provide recommendations.”  

In response to other questions about survey citations related to the pandemic, Mr. Howard pointed to the current regulations for ICFs on infection control, which are found at 42 CFR 483.470(l)(1) and are limited to the following four requirements:

(l) Standard: Infection control.

(1) The facility must provide a sanitary environment to avoid sources and transmission of infections. There must be an active program for the prevention, control, and investigation of infection and communicable diseases.

(2) The facility must implement successful corrective action in affected problem areas.

(3) The facility must maintain a record of incidents and corrective actions related to infections.

(4) The facility must prohibit employees with symptoms or signs of a communicable disease from direct contact with clients and their food.

Although Mr. Howard stated that surveyors cannot cite from guidance, but only against current regulations, he also mentioned that CMS is trying to learn from COVID-19 and will determine what changes to regulations may be necessary going forward.

ANCOR Offers Member Briefing for ID/DD Providers. OHCA received the following message from ANCOR:

Join experts from ANCOR's Government Relations team and our partner organizations on Thursday March 11 from 12 - 1:30 pm EST for an exclusive, members-only briefing on the $1.9 trillion American Rescue Plan that is expected to be signed into law by the end of this week. Register Now

Expanded CDC Fully Vaccinated Guidance. Yesterday, we highlighted the Centers for Disease Control and Prevention's (CDC's) new guidance, "When You've Been Fully Vaccinated." CDC also published an expanded version entitled, "Interim Public Health Recommendations for Fully Vaccinated People." While more detailed than "When You've Been," the guidelines are substantively the same. Neither document addresses congregate care settings, although there is some question where certain settings (e.g., group homes) fall.

ODH Summary of Vaccine Provider Responsibilities. The Health Department (ODH) sent a notice to enrolled vaccine providers reminding them of the state's expectations for them. The memo provides a good summary of the requirements with a number of links. In addition to such matters as timely vaccination reporting, not wasting vaccine, proper storage and handling, making sure second doses are administered, and the Vaccine Management System (VMS), ODH makes the following point that may be helpful for OHCA members such as home care, hospice, and ID/DD providers seeking vaccinations for Phase 1A personnel:

You must continue to vaccinate Phase 1B and limited Phase 1A vaccinations. Providers should continue to vaccinate those previously eligible who are still seeking the vaccine. Limited vaccinations continue for Phase 1A through local health departments, the federal long-term care pharmacy program, and hospitals. Hospitals should follow updated guidance for ongoing vaccinations for Phase 1A hospital-based healthcare workers who are in frequent or episodic contact with COVID-19 patients or those who care for immunocompromised patients. Local health departments should continue to follow guidance for vaccinating 1A populations in congregate care settings and non-hospital affiliated healthcare workers.