Stay-at-Home Order revised, re-named. Governor Mike DeWine announced the first steps to re-opening Ohio earlier this week. The state posted protocols for businesses that can re-open on the new Responsible Restart Ohio sub-page of their COVID-19 website. The first phase began today and involves health care. See the re-start guide for health care, which explains the changes and includes the regional hospital zone structure affecting long-term services and supports. Late last night, Health Director Dr. Amy Acton codified all of the changes in a revised version of her original stay-at-home order, now called “Stay Safe Ohio.” The new order lists the businesses permitted to re-open and the parameters around re-opening and also lists businesses and activities that still are prohibited, including gatherings. While not specifically mentioned, the new order does not change anything relating to visitation at SNFs, residential care facilities, and ICFs/IID – those restrictions remain in place. The Stay Safe Ohio order expires May 29.

More on CMS reporting regs. The new Centers for Medicare and Medicaid (CMS) rule on tranparency around COVID-19 cases is an interim final rule, which means it takes effect immediately upon publication in the Federal Register. The rule addresses two things, reporting to the Centers for Disease Control and Prevention (CDC) via the National Healthcare Safety Network and disclosure to residents and families. The rule applies only to certified SNFs. Here are some of the details, which can be found on pages 270-271 of the rule.

Reporting to CDC includes:

• Both residents and staff and both confirmed and suspected COVID-19 cases.
• Both total deaths and COVID-19 deaths among residents and staff.
• Inventories of personal protective equipment and hand hygiene supplies.
• Ventilator capacity and supplies.
• Bed capacity and census.
• Access to COVID-19 testing.
• Staffing shortages.
• Any other information specified by the Secretary of Health and Human Services.

Reporting is at least weekly or more often if specified by the Secretary. The rule also requires public disclosure of the data reported.

Notification to residents, their representatives, and families includes:

• Either a single confirmed infection of COVID-19 or three or more residents or staff with new onset of respiratory symptoms occurring within 72 hours of each other (triggering events).
• Actions taken by the facility to reduce the risk of infection.

The notification must be given by 5:00 p.m. the day after the first triggering event occurs. A cumulative notice must be given each time a subsequent triggering event occurs. The commentary to the rule allows facilities to utilize communication mechanisms other than telephone calls, such as paper notification, listservs, website postings, or recorded telephone messages.

Quest billing guidance for Lucas County COVID-19 testing. In a call with Lucas County Health Department and the Hospital Council of Northwest Ohio (HCNO), OHCA received billing guidance for the Quest Diagnostics COVID-19 test kits being utilized in Lucas County. Under the guidance, Quest will bill all appropriate payors for both resident and staff tests, but will look to the facilities to communicate pay source information. Quest will bill SNFs for Part A patients because the tests are included in consolidated billing. Members interested in obtaining these test kits are encouraged to follow the instructions provided in this letter.

OHCA strongly supports this program and urges all members to take advantage of it. We have advocated for statewide, universal testing for some time, as members throughout the state have struggled to get people tested. Universal testing of patients and staff gives you critical information needed to protect and care for your residents. Failure to do so could increase public relations and liability exposure.

HCNO set to roll out expanded testing in 18-county region. In related news, HCNO informed OHCA that they plan to begin rolling out Quest Diagnostics COVID-19 test kits to facilities across their 18-county region, which identified as Region 1 on the COVID-19 Region/Zone Map. HCNO coordinates the Northwest Ohio Healthcare Emergency Management Coalition, which oversees the planning and resources for the region’s emergency and disaster mitigation, preparedness, response, and recovery efforts. The parameters and billing for the expanded testing program will be the same as those described above for the Lucas County initiative. We encourage members throughout Region 1 to contact their local health department to obtain test kits through Quest.

ANCOR survey results. Today, ANCOR released the results of a national survey of developmental disabilities (DD) providers. The report shows the financial impact of COVID-19 on DD providers, including increased staffing costs, closed lines of service, and financial viability of organizations over time. OHCA requested from ANCOR the Ohio-specific data and will share them with members when received. 

DODD Health and Welfare Alert. The Department of Developmental Disabilities (DODD) released a new Health and Welfare Alert “Coping with COVID-19.” The alert covers a variety of topics related to COVID-19 including handwashing, personal protective equipment, supporting people through the crisis, and options for staying connected. DODD's rule 5123-17-02 requires all developmental disabilities employees to review Health and Welfare Alerts as part of their annual training. In addition, DODD Director Jeff Davis shared a video message explaining the department’s thoughts on steps that will need to be taken to increase the number of people receiving adult day services.

Notification of residents and sponsors of COVID-19 cases. The April 15 Department of Health order requires residential care facilities to notify residents, sponsors, and guardians of positive or probable COVID-19 cases within the setting. Assisted Living Waiver providers also must notify the PASSPORT Administrative Agency (PAA) and MyCare Ohio plan regardless if the individual is a waiver enrollee or utilizes a different funding source. This reporting is consistent with the requirement in OAC rule 173-39-02 (Department of Aging (ODA) conditions of participation), directing providers to notify ODA or its designee of any significant change that may affect the individual’s service needs. Notification to the PAA and MyCare plan is only required upon the first COVID-19 positive or probable case in the setting. This does not change the requirement that a waiver provider notify a waiver case manager or waiver service coordinator upon becoming aware that a waiver enrollee is COVID-19 positive or probable. Please see this letter for further information on communication flow and contact information.

Assured Partners offers senior living town hall virtual forum. On Thursday May 7, 2020, beginning at 2:00 p.m., OHCA preferred vendor Assured Partners is holding a complimentary virtual town hall forum bringing together various disciplines within the senior living sector to offer creative advice on how to prepare for the new normal. To learn more and register, please click here.