Elevating the Post-Acute and
Long Term Care Profession

May 26, 2021

Home Care Providers Begin to Receive Appendix K Payments. OHCA members have begun to report receiving payments from the state's Appendix K COVID-19 Relief program. The Department of Medicaid (ODM) is making these one-time payments to eligible Ohio Home Care, PASSPORT, and MyCare Ohio Waiver home care providers. Payments reportedly were issued via check. The amounts should equal 16% of the total paid claims for waiver nursing, personal care, and home care attendant services for dates of service from August 1-October 31, 2020. According to ODM, all payments are to be released by the end of May 2021. Medicaid state plan home health and private duty nursing services are not included in this payment distribution. Please send questions to medicaid@medicaid.ohio.gov.

SNFs/NFs: Reduce the Risk of CMPs and Citation by Reporting Vaccination and Therapeutics Data to NHSN Before June 13 (from AHCA/NCAL). Earlier this month,?the Centers for Medicare & Medicaid Services (CMS) published an?Interim Final Rule?and a?QSO memo that requires nursing homes to submit COVID-19 vaccination rates and treatments given to residents.  

The rule [went] into effect on May 21, 2021.?However, CMS will start to enforce compliance and issuing Civil Money Penalties (CMPs) for facilities that do not report data to NHSN by midnight on June 13.  

To reduce the risk of CMPs, AHCA/NCAL recommends that facilities report data to the NHSN COVID-19 Vaccination and Therapeutics modules immediately.  

Tips on Submitting:
  • Facilities should start submitting data immediately to the two modules (COVID-19 Vaccination and Therapeutics) to make sure they learn how to do it correctly. Submitting vaccination data at the last minute potentially will not allow enough time to resolve any challenges with the submission process before the deadline.  
  • Review the instructions and training provided by the CDC before submitting data. (See below.) 
  • Providers do NOT need to upgrade to SAMS Level-3 access to submit vaccination data.  
  • Providers should have at least two people trained with a process in place to prevent gaps in reporting (i.e., vacations, illness, resignation/termination) and to maintain compliance with reporting requirements. 
NHSN COVID-19 Training and Instructions for Completion 
For more information, providers are encouraged to view the?webinar?recorded on this new rule or contact COVID-19@ahca.org ?for more information. [As part of AHCA/NCAL's webinar, they provided tools for SNFs to use to comply with the new rule's requirements. These materials include a vaccine policy (Word download), a sample vaccine declination form (Word download), and a staff vaccination log (Excel download).]

DODD COVID-19-Related Guidance. Last evening, Department of Developmental Disabilities (DODD) personnel met with stakeholders to discuss COVID-19-related precautions that still should be used after the Department of Health (ODH) orders are rescinded, which Governor Mike DeWine announced will occur next Wednesday, June 2. DODD’s Kim Hauck shared a draft guidance document and answered questions about it. While the guidance still needs to receive final approval from the Governor’s Office and ODH, here is a preview of what we anticipate it will include:

  • ICFs: DODD points ICFs to the Centers for Disease Control and Prevention's (CDC's) "Infection Prevention and Control Guidance for Healthcare Professionals" and reminds that congregate health care settings are excluded from the May 13, 2021, CDC guidance, "Interim Public Health Recommendations for Fully Vaccinated People," which allows fully vaccinated people to stop wearing masks. DODD also noted that CMS QSO-21-14-ICF/IID from February is still in effect and states that visitors to ICFs should wear masks. When residents and staff leave the ICF, DODD feels there is flexibility on whether or not to wear masks and suggests each provider develop a policy on when to require masks in community settings. Of course, certain community settings likely will have their own policies.
  • Other Residential Settings: DODD recommends that each person and their team discuss the risks and benefits of masks and vaccinations. Ms. Hauck said people receiving services can ask staff to wear masks and to be vaccinated, but providers may decline, and the person may need to find another provider if their current staff are unwilling to comply with their request. Provider agencies can create their own policies on when staff must wear masks.
  • Transportation: DODD encourages transportation providers to follow the CDC guidance on rideshares and carpooling. It’s important to note, however, that most of this guidance is for people utilizing public transportation. CDC also has an order and corresponding guidance for public transportation that requires masking but has disability exemptions. 
  • Adult Day Services/Vocational Habilitation: When the ODH order for these settings expires on June 2, 2021, masking no longer will be required, but DODD encourages staff and people receiving services to continue wearing masks while in an enclosed space for an extended time. DODD and the state are not mandating masks, but providers can choose to create their own mask policy that may consider, among other things, vaccination status. DODD's provider assurance process also will go away on June 2 and with it, all of the requirements such as cohorting, group size, and social distancing. DODD intends to update their website to remove many of these requirements, but will leave the risk/benefit tool on the site. Providers are not required to use the risk/benefit tool, but some may find it helpful as people contemplate returning to day services. The adult day flexibilities in the Appendix K also will remain until DODD determines otherwise.

Again, this guidance is a draft only and not final. OHCA will share the official guidance once DODD gets approval to publish it.

During the question-and-answer period, OHCA asked what DODD’s Office of System Supports and Standards (OSSAS) will expect related to these precautions during compliance reviews. Both DODD’s Lindsay Nash and Director Jeff Davis said OSSAS will not cite for not utilizing masks or any other COVID-19 precautions. This flexibility most likely will not apply to ICF providers, as they have stricter regulatory standards for infection control and prevention. OHCA plans to ask CMS to clarify a couple items for ICFs, including whether surveyors will require masks or other precautions when ICF residents are off the grounds of the ICF, such as in a day program or in the community. 

There also was a question regarding continuing the Acuity B rate for day services once the order is rescinded. Both Ms. Hauck and the Ohio Association of County Boards' (OACB’s) Lori Stanfa repeated that OACB suggested during last week’s ADS Core stakeholder group that the Acuity B rate continue until September 1, 2021. Please be aware OACB cautioned that they need to get approval from their members, so this suggestion is not final yet. OHCA informed the group that some members had concerns about the Acuity B rate ending September 1, given that the $300 federal unemployment payment will not go away until late June and the struggles with staffing. OHCA specifically asked OACB to consider funding the Acuity B rate longer, at a minimum through October 1, 2021. Unfortunately, OACB felt they may be challenged to get all their members on board with the September 1 date and didn’t think they would be able to ask for any additional time. They understood the staffing issues, and there was some minor discussion about using funding from the 10% Federal Medical Assistance Percentage (FMAP) increaseto extend the Acuity B rate. In reality, though, it is unlikely the Acuity B rate will last beyond the end of August, and even that is not locked in yet. 

BWC Update - COVID-19 Claims (from Sedgwick). The Ohio Bureau of Workers’ Compensation (BWC) is proposing a change to the Ohio Administrative Code to exclude COVID-19 claims from an employer’s workers’ compensation experience/rates for those employers that pay premiums to BWC. 

Currently, BWC may cover a COVID-19 claim if certain criteria are met including contracting COVID-19 during the employee’s course of employment.  If approved, all claim costs associated with allowed COVID-19 workers’ compensation claims will be excluded from your experience and will not impact your premiums.  This change will also include costs being excluded from both individual and group retrospective rating programs.

The BWC Actuarial Committee discussed the rule change during their May 26, 2021 meeting however it is NOT FINAL at this stage.  The proposed rule will be formally heard in June during the Committee and Board meetings where it is expected to be approved.

We at Sedgwick will continue to keep you informed about this important change.

OIG Weighs in on COVID-19 Vaccination Incentives. In an update to their COVID-19 frequently-asked questions (FAQ) yesterday, the Office of Inspector General (OIG) posted an answer to the question: "Would the offer or provision of cash, cash-equivalent, or in-kind incentives or rewards to Federal health care program beneficiaries who receive COVID-19 vaccinations during the public health emergency violate OIG's administrative enforcement authorities?" In summary, OIG states that providers offering incentives or rewards for vaccination would be at sufficiently low risk of violating the federal anti-kickback statutes or the beneficiary inducement civil money penalty provision if they have the following safeguards in place:

  1. The incentive or reward is furnished in connection with receiving a required dose of a COVID-19 vaccine (which could include either one or two doses, depending on vaccine type);
  2. The vaccine is authorized or approved by the Food and Drug Administration as a COVID-19 vaccine and is administered in accordance with all other applicable Federal and State rules and regulations and the conditions for the provider or supplier receiving vaccine supply from the Federal government;
  3. The incentive or reward is not tied to or contingent upon any other arrangement or agreement between the entity offering the incentive or reward and the Federal health care program beneficiary;
  4. The incentive or reward is not conditioned on the recipient's past or anticipated future use of other items or services that are reimbursable, in whole or in part, by Federal health care programs;
  5. The incentive or reward is offered without taking into account the insurance coverage of the patient (or lack of insurance coverage) unless the incentive or reward is being offered by a managed care organization and eligibility is limited to its enrollees; and
  6. The incentive or reward is provided during the COVID-19 public health emergency.

The last condition is of particular note for employers who may be considering ongoing incentives past the Public Health Emergency for employee vaccinations.

HHS Replenishes HRSA Uninsured Fund. Yesterday, the Department of Health and Human Services (HHS) announced that it allocated an additional $4.8 billion from the American Rescue Plan Act (ARPA) to the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program. This funding will allow the program to continue reimbursing health care providers for testing uninsured individuals for COVID-19. As of May 19, 2021, the program has issued nearly $4 billion in testing reimbursement to providers. For more information on the HRSA COVID-19 Uninsured Program, please click here.