CMS guidance on re-opening SNFs. This afternoon, the Centers for Medicare and Medicaid Services issued a new Quality, Safety, and Oversight (QSO) letter, 20-30-NH, spelling out requirements for re-opening SNFs. The QSO uses the framework of the Opening Up America Again plan, dividing the guidelines into three phases. The main takeaway is that visitation restrictions remain as they are until the SNF goes 28 days without any new COVID-19 cases and a number of other criteria are met, including decining cases in the general community and weekly testing of residents and staff. CMS also released a frequently-asked questions document pertaining to QSO, which is inconsistent with the QSO itself because it does not call for weekly resident testing. As SNFs progress through the three phases, surveys also will ramp back up.

Two key points:

• CMS makes it very clear that the guidelines are only recommendations that states are not required to follow.
• The guidelines only apply to SNFs, not to assisted living communities or to ICFs/IID.

ODH again makes COVID-19 survey mandatory for 3 days. By way of a notice on the Enhanced Information Dissemination and Collection (EIDC) system, the Health Department (ODH) announced that they are making their COVID-19 online survey mandatory for tomorrow, Wednesday, and Thursday. ODH notes that there are some changes to the data collected, but does not explain what will be done another mandatory data submission when providers already have to report essentially the same information to other governmental agencies. Please see the EIDC notice for more information.

Reminder: OHCA survey on regional hospital zones. We apologize for asking you to complete another survey contemporaneously with the ODH one, but we promise ours will take much less time. We also are happy to tell you its purpose: to understand better the impact of the state's regional hospital zone plan on OHCA members. Please complete the survey by 5:00 p.m. tomorrow. Assisted living, home care, hospice, and ID/DD provider members do not need to fill it out.

DODD daily. The Department of Developmental Disabilities shared a recorded webinar related to employment services during COVID-19. DODD also released updated guidance for ICFs on bed hold prior authorizations (limiting them to 30 days for each prior authorization span) and Economic Impact Payments (EIPs or stimulus payments) (not included in patient liability calculations). Lastly, DODD’s Office of System Support and Standards (OSSAS) has suspended compliance reviews until further notice (previously suspended through May 31, 2020).

EIPs to go out to rep payees. The Social Security Administration issued a press release stating that beneficiaries who have representative payees, which includes many people in long-term services and supports, will begin receiving their EIPs in late May.

Shoe covers available. An OHCA member over-ordered slip-on booties. They have 48,000 available at $1.00 per pair. Please email Diane Dietz if you are interested.

CMS approves Ohio’s Appendix K. Late last week, CMS approved Ohio’s Appendix K requests for both Aging waivers and DD waivers. The Appendix K application asked to relax specific regulations for Ohio’s 1915(c) Home and Community-Based Services waivers. The state did not include any Medicaid reimbursement increases or other funding requests. Although Ohio submitted a combined Section 1135 waiver/State Plan Amendment/Appendix K request and CMS approved a handful of routine items, it has not yet approved a number of other waivers relating to general Medicaid program considerations, Health Care Isolation Centers, and regulatory relief for SNFs, ICFs/IID, and home health services.

Detailed list of LSC blanket waivers. We thank Kenn Daily for compiling a list of the Life Safety Code (LSC) blanket waivers CMS has issued. These waivers came out in two separate iterations, but Mr. Daily's document pulls them all together, adds the appropriate K-tags, and provides a succinct description of each. Both ODH and the AHCA LSC Committee reviewed the summary. Mr. Daily also will present a webinar entitled, "Life Safety Code: What Facilities must do during the Pandemic.” It is set for May 28, 2:00-3:30 p.m.

Updated Provider Relief Fund FAQ. The Department of Health and Human Services (HHS) updated its frequently-asked questions (FAQ) document on the Provider Relief Fund last week, adding a number of new answers and reorganizing the document. Of particular note are HHS's decision to report publicly amounts paid to providers and an item on page 7 that reverses previous language (see May 4 COVID-19 Update) suggesting providers whose payments based on 2% of 2018 net patient revenue were less than their lost revenue in March and April 2020 could receive additional money. The FAQ clarifies that:

Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you will not receive additional General Distribution payments. (Emphasis added.)  

CMS releases new MDS specifications. CMS posted on their MDS Technical Specifications web page a new MDS release. According to CMS:

These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1.  This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models.

Although the Department of Medicaid in the past has expressed interest in this type of analysis, we do not know at this time if they intend to require calculation of Patient-Driven Payment Model codes on OBRA assessments.