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News and Information exclusively for members of OHCA - please do not forward to non-members

November 6, 2020


Top Stories

OHCA HCH Hot Topics Call

Erin Begin

On Wednesday, November 11, 2020, at 1:00 p.m., OHCA will host our monthly Hot Topics call for home care and hospice members. On the call, OHCA staff members will provide updates on the most important issues of the day, such as the hospice final payment rule, provider relief fund options and review choice demonstration.  Hot Topics calls usually are held on the second Wednesday of every month and are free to OHCA members. There is no need to register, and we encourage you to have as many people listen in as you wish.  We understand and respect the value of your time, so we try to keep the calls to less than one hour.  This month, we will be discussing how the COVID-19 vaccination distribution plans, home health final payment rule, access to COVID-19 testing, updates from the quarterly ODH meeting and much more.


To join the video conference:

1. Join using Zoom Meeting link

2. OR Use your telephone to dial the conference call number: (312) 626-6799. When prompted, enter the conference code: 841 7966 9810, password 2020


POC Tests and Machines Available for Home Health and Hospice
Diane Dietz
McKesson informed OHCA that they are taking orders for BD Veritor point-of-care (POC) COVID-19 testing machines along with test kits. This opportunity may be particularly beneficial to home care and hospice providers who previously did not have access to this rapid testing technology.


Only organizations with a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver are permitted to run rapid COVID-19 diagnostic tests through a POC machine. The Department of Health’s CLIA Laboratory Certification webpage provides information on how to obtain a CLIA Certificate of Waiver. Please note that according to McKesson, BD is drop-shipping their Veritor machines directly. Once ordered through McKesson, fulfillment is running approximately 4-6 weeks, although some orders have shipped faster. To learn more, please contact Jeff Mazer at Jeff.Mazer@McKesson.com.

Reimbursement

Provider Relief Fund (PRF) Phase 3 General Distribution Application Due Tonight
Erin Begin
Before 11:59 p.m. tonight, applications for Phase 3 must be submitted to the Department of Health and Human Services (HHS). A broad range of health care providers are eligible for this phase, which is intended to fill any gaps between previous PRF distributions and lost revenue/increased cost incurred in the first two quarters of 2020. According to HHS officials on a call this afternoon, an applicant must submit their Tax Identification Number (TIN) for validation by tomorrow, and they will have until November 27 to complete the application. A provider who still has an application pending for Phase 2 may apply for revalidation of their TIN for Phase 3.


CMS Home Health and Hospice Open Door Forum Updates
Edited from NAHC Report
The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice and Durable Medical Equipment (DME) Open Door Forum (ODF) on November 4 where CMS reviewed information and resources it has recently released.  A summary relative to hospice providers is below:

  • The November 2020 Hospice Compare refresh covers Q1 2019 through Q4 2019 HIS data and Q1 2018 through Q4 2019 CAHPS Hospice Survey data.  This will be the last Compare update until 2022 due to the impact of the Public Health Emergency (PHE) exception of HQRP for the first two quarters of 2020.  .  This means there will not be any preview reports provided during 2021.
  • Early last month CMS posted the list of successful hospices for the  FY 2021HQRP.  These hospices met the CY 2019 hospice quality data reporting requirements that impact FY2021 payment.  Successful hospices receive their full annual payment update (APU).
  • Any hospice that believes it qualifies for the CAHPS Hospice Survey exemption for size for 2019 must complete and submit the Participation Exemption for Size Request by December 31, 2020.  The form can be found on the CAHPS Hospice Survey Participation Exemption for Size webpage.
  • CMS provided an update on the development of the Hospice Outcome and Patient Evaluation (HOPE) instrument, which is currently undergoing alpha testing and an analysis of the results of this phase of testing is expected in Spring 2021.

Regulatory

Updates from ODH for Home Health and Hospice
Erin Begin
Earlier this week, OHCA participated in a non-long term care provider association meeting with the Department of Health (ODH). We sent several questions in advance to be addressed during the meeting. Please find below a summary of updates and comments:

  • Survey activity: Currently, ODH still is conducting only complaint surveys and initial certification surveys for non-long term care providers, with the exception of maternity units. ODH does not have a date when they expect regular survey activity will resume. ODH personnel did clarify that once surveys resume, ODH will prioritize providers whose dates for recertification lapsed. Providers are not subject to penalty at this time, as the state reserves the right to suspend regular survey activity during the Public Health Emergency (PHE). Additionally, ODH staff stated that there have not been any citation trends on the complaint surveys, but they issued several individual citations. ODH provided examples of screening practices for staff, lack of eye protection in COVID-19-positive patient rooms, and lack of COVID-19 policies.
  • Accrediting Organizations (AOs) and virtual surveys: In previous meetings, ODH informed OHCA that Centers for Medicare and Medicaid Services (CMS) does not accept the virtual surveys conducted by the Joint Commission. ODH subsequently reached out to CMS, who explained that they intend to release a memo to the AOs providing clarification and guidance on resumption of recertification surveys that will address this question. We will advise members once that information is available.
  • Ohio vaccination program: ODH staff were unable to provide an update on prioritization of home health and hospice workers in the Ohio Vaccination Distribution Plan at this time.
  • Line-level Clinical Laboratory Improvement Amendments (CLIA) reporting: ODH's CLIA program will conduct random inspections of providers who perform CLIA-waived tests for compliance, including line-level reporting, in the near future. ODH is not aware of any compliance issue associated with home health or hospice specifically.
  • Alternative testing options: OHCA requested an update on availability of point-of-care antigen tests for home health and hospice staff. While Abbott BinaxNOW tests are not available for purchase, ODH’s Shannon Richey said they have seen several applications come through for other approved CLIA-waived options. This would be test options in addition to the BD Veritor machine mentioned in the article above.  She agreed to share the list with us. As soon as we receive the information, we will pass that on to home health and hospice members.
  • Palliative Care Interdisciplinary Council: Because of the PHE, the council temporarily suspended its work and meetings. Bimonthly meetings are set to resume in January 2021.

FDA Issues Letter on Antigen Testing
Diane Dietz
The Food and Drug Administration (FDA) released a letter to laboratories and health care providers with interesting information about false positive results from antigen COVID-19 tests, for example point-of-care testing machines like the BD Veritor and Abbott BinaxNOW cards. The FDA explains that false positive results can arise from improper testing techniques and conditions. Any member using antigen tests should review these reasons for false positives to ensure that their testing process affords the best opportunity for accurate results. The FDA letter also explains the statistical probabilities of false positives in surveillance testing, which vary inversely with the prevalence of COVID-19 in the general population. For instance, if prevalence is low at 0.1%, 96% of positive antigen test results are likely to be false. According to the Centers for Disease Control and Prevention, positive antigen test results in a surveillance testing regimen should be confirmed with a PCR test.


Pharmacy Partnership for Long-Term Care, Application Due Tonight
Mandy Smith
The opportunity to register for COVID-19 vaccinations for facility residents, including inpatient hospices, ends at 11:59 p.m. tonight. We strongly urge facility members to sign up for this free, no-obligation program to ensure their residents are not left behind when a vaccine becomes available. Inpatient hospices should register at this link
.


Latest CMS Positivity Ratings for SNF Testing/Visitation
Pete Van Runkle
On Monday, the Centers for Medicare and Medicaid Services (CMS) released a new table of county positivity ratings used to set SNF routine staff testing frequency. Like the Ohio Public Health Advisory System (OPHAS), the CMS ratings show the impact of the surge of COVID-19 cases in Ohio. Sixteen Ohio counties are now listed as red by CMS, meaning SNFs in those counties must test staff twice a week. Most of the rest are yellow, with only 12 still green. Under Ohio's SNF testing guidelines, however, there is no distinction between yellow and green, as both must test weekly. Only the CMS red counties, not the OPHAS red counties, count for the testing requirements, and there is no mandate to test all residents in a red-county SNF unless there is an outbreak.

CMS red county status is also relevant to SNF visitation, as we reported last week that the Health Department (ODH) interprets federal guidance as prohibiting indoor visitation at SNFs in red counties (or that have an outbreak). 


McCloud Becomes Director of Health
Mandy Smith
At his press conference yesterday, Governor Mike DeWine announced that he appointed Stephanie McCloud, previously Administrator of the Bureau of Workers' Compensation, as Director of Health. The Governor also made other personnel moves in the department. From the official release by the Governor's Office's: 


Chief Medical Officer Dr. Bruce Vanderhoff: Dr. Vanderhoff previously served for more than a decade as a Senior Vice President and as the Chief Medical Officer at OhioHealth. He has years of experience leading large teams in successfully dealing with important healthcare issues in Ohio and prepared OhioHealth to deal with the threat of Ebola and the H1N1 flu pandemic.  


Director Stephanie McCloud: Director McCloud previously served as Governor DeWine's administrator of the Ohio Bureau of Workers' Compensation, managing an agency of 1,800 colleagues and over $28 billion in assets. She has considerable experience in the area of mental health and addiction treatment which is a priority in Ohio's health improvement plan. 


Senior Deputy Lance Himes: Himes had previously served as the interim director of ODH where he has played an integral role in running and managing many aspects of the pandemic response operation. He will lead the coordination of the state’s vaccine distribution plan and will continue to work directly with Ohio’s local health commissioners.


Chief of Staff Kathleen Madden: Madden had previously served as Assistant Director at the Ohio Office of Budget and Management and will now play a key role in keeping ODH's pandemic and non-pandemic programs and operations on track. She will work to prioritize and resolve critical issues, provide oversight and guidance to ODH staff, and ensure that ODH funds are spent responsibly and strategically.


OSHA Issues New Long-Term Care Respiratory Protection Guidance
Diane Dietz
Late last week, the Occupational Safety and Health Administration (OSHA) released a new document entitled, "Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and Other Long-Term Care Facilities During the COVID-19 Pandemic." This is of particular interest to home health and hospice workers who care for patients in these facilities.  In the guidance, OSHA provides a hierarchy of items that can be used to cover an employee's mouth and nose, starting at the bottom with cloth face coverings and moving on to facemasks. OSHA characterizes both of these as beneficial for source control, but not as personal protective equipment. Surprisingly, OSHA equates KN95s with facemasks: "An example of this type of product would be a KN95 respirator with ear loops instead of head straps and that has not undergone rigorous fit testing to demonstrate a proper fit/effective seal to the wearer’s face." Next in the hierarchy are true surgical masks, which protect against splashes and sprays but do not provide respiratory protection, and at the top, N95 or higher filtering facepiece respirators (FFRs).


After the hierarchy, OSHA discusses in some detail the required respiratory protection program. Here are a couple of noteworthy provisions:

  • "During times like the present pandemic, when there are increased demands on the supply chain for N95 FFRs, consider alternatives to N95 FFRs, including other FFRs (e.g., P100s, N99s), reusable elastomeric (rubber) respirators, and powered air purifying respirators (PAPRs)." OSHA goes on to say that while initially more expensive, the latter two types of respirators may save providers money because they are reusable.
  • "Note that while N95 FFRs are meant to be discarded after each use, CDC has developed contingency and crisis strategies, including reuse and decontamination of N95 FFRs, to help healthcare facilities conserve their supplies in the face of shortages." This section of the guidance specifically links to one of the Centers for Disease Control and Prevention (CDC) guidelines that in crisis capacity for N95s allows use of respirators "that are similar to NIOSH-approved respirators but are not NIOSH approved and are approved according to standards used in other countries. The performance of some internationally approved respirators was evaluated by NIOSH and the results can be found here." The referenced list includes a number of KN95s.

This provision, which seems to condone the practice of substituting KN95s for N95s when a facility is in crisis capacity, appears to conflict with the earlier provision equating KN95s with simple facemasks for source control only. OHCA will continue to investigate how this guidance affects the practice of wearing KN95s when N95s are not available. We will provide more information as we learn it, but want members to be aware that the new OSHA guidance is out.


CMS Resource: How to Prepare for the COVID-19 Vaccine
From Medicare Learning Network Connects
Get ready to administer the COVID-19 vaccine when it’s available. Read the enrollment section of our COVID-19 provider toolkit to see if you need to take action now:

  • Many Medicare-enrolled providers don’t have to take any action until a vaccine is available – make sure your provider-type enrollment is all set
  • Some Medicare-enrolled providers must also separately enroll as a mass immunizer to administer and bill for COVID-19 vaccines when they’re available – find out if you must also enroll as a mass immunizer
  • If you’re not a Medicare-enrolled provider, you must enroll as a mass immunizer or other Medicare provider type that can bill for administering vaccines

Enrolling over the phone a mass immunizer is easy and quick — call your MAC-specific enrollment hotline (PDF) and give your valid legal business name, national provider identifier, tax identification number, practice location, and state license, if applicable.


Other News

Ohio Daily Case Count Nearly 5,000, LTC Cases Skyrocket

Mandy Smith

The number of positive COVID-19 test results ballooned to 4,961 yesterday, 732 (17%) more than the previous daily record. A record number of 2,075 people are currently hospitalized with the disease, with 541 in intensive care, also an all-time high. We are beginning to hear of hospitals reaching capacity. On the newly-released Ohio Public Health Advisory System map, 56 counties are at the red level, 13 more than last week. Most of the counties remaining orange and yellow are sparsely-populated rural counties.

 

Previously, on Wednesday, the state dashboard showed 1,788 new resident cases in SNFs, assisted living communities, and ICFs/IID and 1,228 cases among staff. The total of more than 3,000 long-term care cases in one week easily surpasses previous levels. The explosion of weekly cases in long-term care from 1,097 as recently as September 30 to 3,016 this week thankfully has not been accompanied by an increase in COVID-19-related deaths.

 

ACHC Offers Distinction in Telehealth Accreditation

Erin Begin
Accreditation Commission for Health Care (ACHC) announced this week the launch of its Distinction in Telehealth accreditation program.  The ACHC
Distinction in Telehealth recognizes the value telehealth offers to improving patient care delivery, reducing hospital readmissions, and lowering costs for providers and patients.  It is available for organizations offering services in home health, hospice and private duty. To earn a Distinction in Telehealth, a provider must be accredited by ACHC.

 

Ohio Elections: GOP Strengthens Hold on General Assembly
Pete Van Runkle

While the national election results remain in doubt, Ohio's legislative races are final, save one Senate seat. Reflecting President Donald Trump's relatively easy, 8-point win here, Republicans consolidated their already-massive majorities in the Senate and House of Representatives. As was the case with the Presidential and Ohio Congressional races, the legislative results confounded the predictions, which had Republicans losing seats in both the House and Senate.


Senate Republicans either gained one seat or maintained their 24-9 advantage, depending on a recount in the 16th District, where incumbent Republican Stephanie Kunze finished 41 votes ahead of her challenger, Crystal Lett. The Republican pickup was in the 32nd District, where Sandra O'Brien ousted the incumbent Democrat, Sean O'Brien.


In the House, Republicans achieved a net gain of 3 seats, running their majority to 64-35. While incumbent Republican Dave Greenspan lost to Monique Smith in the 16th District, Mike Loychik (63rd District) and Gail Paviglia (75th District) defeated incumbent Democrats Gil Blair and Randi Clites, while Republicans Ron Ferguson and Sarah Fowler picked up the vacant 96th and 99th Districts, both formerly in Democratic hands.


The Supreme Court races, featuring two Republican justices running for re-election, split. Democrat Jennifer Brunner defeated incumbent Judi French, while the other incumbent Republican, Sharon Kennedy, dispatched challenger John O'Donnell.

Association News & Services 

Free Recruiting Website
As part of a national platform, OHCA developed Ohio Care For The Aging as an informational resource that offers education on a wide range of career opportunities available in the long-term services and supports profession. The site will inspire those who are looking for a new career opportunity to become part of this rapidly growing and gratifying field. As a complimentary member benefit, OHCA members who set up accounts and post their employment opportunities will have job seekers directed to them. Ohio Care for the Aging is an OHCA initiative to provide career information and workforce development and to recruit compassionate and dedicated people to the mission of serving the elderly and disabled in long-term and post-acute care professions in Ohio. The national website carefortheaging.org directs job seekers to the Ohio portal.

Free Job Posting Available to Members
Members may post openings in the Job Opportunities section of the OHCA website for 30 days at no cost. To post an opening, go to the Long Term Care Careers page at www.ohca.org, log in, and post the job through your account. You will need to be logged into the site with your user name and password before you attempt to post a position.


Hospice News Bites
OHCA's Hospice News Bites is distributed electronically each week to OHCA hospice members. To be added to or deleted from the distribution list, please email
Debbie Jamieson.