Governor moves to re-open child care centers and more. During today’s press conference, Governor Mike DeWine announced plans to re-open child care centers and day camps effective May 31, 2020. The state will utilize $60 million dollars of Coronavirus Aid, Relief, and Economic Security Act funding to help child care providers with the costs of required safety measures and decreased class sizes.

Several other openings were announced today:

• Bureau of Motor Vehicles services, May 26, 2020. 
• Campgrounds, May 21, 2020. 
• Gyms and fitness centers, as well as non-contact sports leagues, May 26, 2020.
• Pools, not including water parks and amusement parks, May 26, 2020.
• Horse racing May 22, 2020, with no spectators.

DODD day service guidance changes: The Department of Developmental Disabilities (DODD) stakeholder group on day services under the current Department of Health (ODH) order met today. The group discussed recently issued DODD guidance documents on adult day, vocational habilitation, and non-medical transportation. Per the group's input, DODD will update the monitoring log to make it clearer for direct support professionals (DSPs) to use. The department also will revise the provider assurance form to include a virtual tour and to allow DSPs to use face coverings and gloves instead of full personal protective equipment (PPE) during personal care and feeding. We anticipate the updated documents will be available early next week, but DODD approved sharing the PPE requirement change now. The stakeholder group also provided feedback on transportation and visitation that DODD will use to create additional guidance documents. OHCA will keep members apprised of progress in these areas.

Requesting temporary NHSN enrollment numbers. The National Healthcare Safety Network (NHSN) will offer a Zoom webinar tomorrow from 1:00-2:00 p.m. for facilities that still need temporary enrollment numbers to complete enrollment. These webinars will allow attendees to submit requests and immediately to receive temporary NHSN ID numbers. Before receiving the number, you will need to enter the following:

• Facility type(s).
• Number of enrollment numbers needed.
• Have you submitted a request to nhsn@cdc.gov for a temporary enrollment number for this facility (yes or no)?
• First and last name of person who submitted the NHSN help desk ticket.
• Email address used to submit the NHSN help desk ticket.

Please use this link to register. Space is limited.

EVOLVE offers complimentary reporting policy. Rolf Goffman Martin Lang, OHCA’s legal counsel, formed a legal services company called Evolve Legal Solutions to provide SNFs with self-service information, guidance, and materials on legal issues. They currently are providing resources related to COVID-19 free of charge. EVOLVE prepared a sample policy on COVID Resident & Staff Reporting Requirements and sample notices to help SNFs comply with ODH and Centers for Medicare and Medicaid Services (CMS) requirements. Additional information on required reporting as well as other helpful compliance resources can be found at the EVOLVE website.

Hospitals that refuse to test. If you encounter a hospital that refuses to test (at least once) patients being discharged to post-acute care, please let OHCA know. Dr. Mary Applegate, the Department of Medicaid medical director, said in a Zoom meeting this morning that hospitals should not test elective surgery patients, who are tier three, ahead of congregate care patients, who are tier two.

CMS clarifies therapy assessments for HHAs. Late last week, CMS issued a clarification of the previously issued blanket waiver for home health agencies that allows occupational therapists to conduct initial and comprehensive assessments during the public health emergency, whether or not occupational therapy is the service that establishes home care eligibility. The new clarification expands this flexibility to include physical therapists and speech-language pathologists. 

Communal dining. CMS's prohibition of communal dining continues to spark member questions. CMS explained the prohibition in Quality, Safety, and Oversight letter 20-28-NH, writing:

Residents are not forced to eat in their rooms. Residents may still eat in dining rooms, however, nursing homes should adhere to social distancing, such as being seated at separate tables at least six feet apart. We note that social distancing should be practiced at all times (not just while dining). We further note that eating in dining areas with appropriate social distancing only applies to residents without signs or symptoms of a respiratory infection, and without a confirmed diagnosis of COVID-19. Facilities should refer to [Centers for Disease Control and Prevention (CDC)] guidelines for managing residents with signs or symptoms of a respiratory illness.

This guidance applies specifically to SNFs, but CDC provided similar direction in their guidelines for assisted living: "[i]nstead of communal dining, consider delivering meals to rooms, creating a 'grab n’ go' option for residents, or staggering meal times to accommodate social distancing while dining (e.g., a single person per table)."

More on beauticians. In the May 8 COVID-19 Update, we discussed the interaction of re-opening beauty salons and the ODH order limiting entry to SNFs, assisted living communities, and ICFs/IID to essential personnel. Today, James Hodge of ODH offered additional clarification:

OHCA provided a specific scenario concerning training beauticians in essential functions at a NH or RCF in order to allow them access to the building. It was the assumption that they would perform those duties in addition to their normal beautician functions.

Answer: The reasoning for the order barring non-essential individuals into the facilities was that this vulnerable population should only have interactions that were essential for their care. Regardless of training beauticians in other functions, the question alludes to the individual performing non-essential functions within the facility, thus defeating the purpose of the exclusion. If a facility makes the determination to train a beautician or any other individual to provide care in the facility, it is the expectation that the duties that individual performs are essential functions.