Tuesday, October 6, 2020

Here are the latest need-to-know updates for Tuesday, October 6 regarding the COVID-19 pandemic. 

ODH clarifies surveys, anticipates visitation guidance on weekly call

In its weekly meeting with LeadingAge Ohio, the Ohio Department of Health (ODH) offered numerous updates on visitation, survey resumption, and the family satisfaction survey. These updates are as follows:

• Visitation guidance. While the date announced for indoor visitation in long-term care facilities is fast approaching (October 12), Ohio providers are still awaiting a revised Director’s Order and other guidance from the state. ODH confirmed that the documents and guidance are developed but awaiting final approval from leadership, and should be shared publicly very soon.
  
  
• Nursing home access by contractors. Numerous providers are reporting challenges with transportation companies who refuse to provide evidence of testing for their staff who transport residents to and from medical appointments.  In accordance with the CMS Interim Final Rule CMS-3401-IFC included in QSO-20-38-NH, dated August 26, 2020, personnel who are providing non-urgent medical transportation (e.g., ambulettes, non-emergent EMS transports) are considered as providing services under arrangement.

  The memo states:

  “Facility staff” includes employees, consultants, contractors, volunteers, and caregivers who provide care and services to residents on behalf of the facility, and students in the facility’s nurse aide training programs or from affiliated academic institutions. For the purpose of testing “individuals providing services under arrangement and volunteers,” facilities should prioritize those individuals who are regularly in the facility (e.g., weekly) and have contact with residents or staff. We note that the facility may have a provision under its arrangement with a vendor or volunteer that requires them to be tested from another source (e.g., their employer or on their own). However, the facility is still required to obtain documentation that the required testing was completed during the timeframe that corresponds to the facility’s testing frequency... Regardless of the frequency of testing being performed or the facility’s COVID-19 status, the facility should continue to screen all staff (each shift), each resident (daily), and all persons entering the facility, such as vendors, volunteers, and visitors, for signs and symptoms of COVID-19. When prioritizing individuals to be tested, facilities should prioritize individuals with signs and symptoms of COVID-19 first, then perform testing triggered by an outbreak.”

  Personnel providing services under arrangement should be tested by the facility or provide documentation that required testing was completed during the timeframe that corresponds to the facility’s testing frequency.  ODH noted that it is the facility’s responsibility to offer testing and/or verify compliance with the requirement.
  
  LeadingAge Ohio encourages long-term care members to develop policies that delineate which contractors will be required to provide evidence of a negative COVID-19 test (for example, a contracted therapy service that offers frequent direct service to residents), and which ones should not (for example, those with low- or no-contact with residents, such as an electrician visiting the site). 
  
  Individuals providing emergency services, such as EMS workers or law enforcement, are not required to show proof of testing and should not be delayed in responding to emergency situations. Additional questions concerning COVID-19 testing requirements should be referred to the Ohio Department of Health.
  
  
• The Office of the State Long-term Care Ombudsman shared that it will be postponing its family satisfaction survey until the spring, recognizing that results are likely to be skewed as a result of the COVID-19 pandemic. They have alerted the Department of Medicaid, which uses this survey as one quality indicator contributing to nursing home payment rates.
  
  
• ODH confirmed that the survey monkey is not yet available for reporting testing results, nor is the survey for outbreak notification complete. In the meantime, providers seeking to notify ODH of an outbreak should email ccurt@odh.ohio.gov with the subject line “OUTBREAK TESTING REQUIRED” to alert ODH staff to the emergent need, as the CCURT inbox is often very full, causing delays in responses. In no case should individual employee or resident name be shared through the CCURT mailbox.
  
  
• ODH confirmed that for the time being, providers should continue to enter point of care (POC) testing results into the state portal daily by 11am. However, ODH will confirm whether the latest announcement that NHSN would be able to accept POC device results would allow providers to meet its CLIA reporting requirements, making the state data entry unnecessary. ODH is investigating this new change and will share its decision with LeadingAge Ohio in a future meeting.  LeadingAge Ohio has posted the ODH webinar on reporting testing results as well as the CSV File Creation Formatting Guide and sample completed CSV file.

Each week, LeadingAge Ohio submits its long-term care members’ need-to-know questions to ODH. If you have a question you’d like addressed, email COVID19@leadingageohio.org.

CDC Update on Transmission

CDC updated guidance today on the transmission of COVID-19 to include airborne transmission. Airborne transmission means the virus can hang in the air for minutes or even hours and can infect people further than six feet away or after the infected person has left the area. Evidence indicates that when airborne transmission has occurred, it has been in enclosed spaces with inadequate ventilation. Airborne transmission is uncommon; close contact is still the most common source of spread of COVID-19. Nonetheless, this new information highlights the importance of adequate ventilation and source control (masking of nose and mouth, social distancing). Here are four things providers can do:

• Stress the importance of masks and social distancing with residents/patients, staff, and visitors.
• Talk with your building engineer about ventilation.
• Bring in fresh outdoor air as much as possible.
• Allow ample time before entering spaces for cleaning and turn-over.

Check out this CDC guide on air changes / hour for airborne contaminant removal.

More information on BinaxNOW cards and surveyor testing

In case you missed it, yesterday’s LeadingAge Coronavirus Call featured Admiral Brett Giroir, Assistant Secretary for Health and the Administration’s Coronavirus testing lead. He had some great insights for LeadingAge members and the recording of the call can be listened to here. Among other highlights, Admiral Giroir said that Binax tests are going out weekly to nursing homes and assisted living communities that have CLIA waivers and are in red (and some yellow) zones. If a provider meets those two criteria and has not received Binax test cards, they can email HHSbinax@HHS.gov. It’s likely the inbox will have/receive a lot of traffic, so delays in responses may occur.

In addition, today Abbott announced two educational webinars this week in support of their BinaxNOW COVID-19 tests. These webinars are designed to reinforce the Training Toolkit and highlight key points that should be kept in mind during BinaxNOW COVID-19 and NAVICA implementation. To register for either training, please use the links below.

• Wednesday October 7 from 4:00 EST – 5:00 EST: Registration link
• Friday October 9 from 4:00 EST – 5:00 EST: Registration link

For additional training videos and documents, please visit the BinaxNOW™ COVID-19 Ag Card and NAVICA™ App Set-Up and Training portal.

Please reach out to Stephanie DeWees at sdewees@leadingageohio.org with questions related to the Abbot BinaxNOW cards.

Home Health and Hospice distribution of Binax Cards: Survey response requested 

LeadingAge sent an email yesterday to home health and hospice members with a survey asking for information requested by HHS in order to assist with the distribution of Abbott BinaxNOW testing cards to these provider types. Please complete the survey by Friday, October 9. Completion of the survey does not guarantee that an agency will receive the Abbott BinaxNOW cards, but the more LeadingAge can help HHS gather what they need, the more likely providers will fare well. If providers did not receive the survey, please reach out to Susan Wallace at swallace@leadingageohio.org.

Provider Relief Phase 3 available to behavioral health and new providers

The U.S. Department of Health & Human Services (HHS) has announced that the application process for Phase 3 is now open and will remain open until 11:59 pm ET on November 6. Phase 3 is open to all providers who have applied before and received a full 2% General Distribution, in addition to all other previously eligible providers. There are two newly eligible groups for this application: 1) behavioral health providers including those who are exclusively private pay and/or accept commercial insurance, and 2) providers who opened/began delivering care in the first quarter of 2020. 

Providers are encouraged to apply early as the distribution process is also different this time with a two-step process. The first step will be to review applicants to ensure they receive a full 2% payment in combination with any prior general distribution payments received. After that, HHS will seek to “calculate an equitable add-on payment” for providers demonstrating a continuing need for funds. All providers seeking funds in Phase 3 must submit an application and this application will require providers to submit additional information to support their financial losses and increased expenditures due to the coronavirus. LeadingAge is still waiting for further information about HHS webinars that will provide additional instruction about the application process. This Phase 3 Primer pulls together all the new information from the HHS website regarding the Phase 3 application.

ODM to begin PDPM data collection on October 1

As previously reported in the LeadingAge Ohio Daily Report, the Ohio Department of Medicaid (ODM) will begin collection of certain MDS items to compare RUGS IV to PDPM (patient-driven payment model) as a component of the Medicaid nursing facility payment calculations. Last week, ODM released a fact sheet about the MDS items that would be collected, which include items I0020, J2100, and section GG. Providers will need to ensure that all of their MDS entries include these elements beginning on October 1, to ensure ODM has the best data to support payment modeling.

Register for BD Veritor Batch Testing Training

Please join representatives from Becton Dickinson(BD) for a second session on the point of care (POC) antigen testing machine, Veritor. The session will be held Thursday, October 8, at 3:00pm EST. Providers will learn about the Veritor device and advanced usage in batching. The labor-intensive process of point of care testing has been a chief complaint among providers, and this training will enable providers who use BD devices to process tests more rapidly. Register for the training here.

Hospice FY 2021 Medicare Rate Tool

Members now have access to LeadingAge Medicare rate tool for hospice services updated for fiscal year (FY) 2021. This incorporates the 2.4% rate update from the final rule and calculates the rates for routine home care, general inpatient care, continuous home care, and respite care by core-based statistical area (CBSA). Member login is required to access the tool.

Caresource billing change: include PDPM scores

Effective October 1, 2019 most insurance companies changed from the RUG based reimbursement to the patient-driven payment model (PDPM). Caresource was one of the few insurance plans that has not yet changed to PDPM. Recently facilities have begun seeing their claims deny from Caresource stating they now require the PDPM score on the claim (no longer accepting the RUG score). Facilities now need to use the PDPM score when billing Caresource.

LTC Consumer Guide Fee information from ODA

Each year, the Ohio Department of Aging bills long-term care facilities for the Long-Term Care Consumer Guide Fee and LTC Ombudsman Bed Fee. The online payment portal is now open for 2020 invoices. Both payments are due November 1, 2020.

ODM releases HOME choice annual report

This week, the Ohio Department of Medicaid (ODM) released its annual report on the HOME Choice program, Ohio’s iteration of the federal Money Follows the Person program which transitions individuals who could reside in community-based settings out of nursing homes with supports to ensure the transition is successful.  The HOME Choice program is now one year into its latest phase, having narrowed the services offered as well as the agencies responsible for assessment and transition coordination.

The annual report includes data on the number of transitions per quarter, populations served, and counties which have the largest numbers of transitions.

Provider Relief Funds: Demystifying recent HHS reporting curveballs webinar

Leadingage Ohio associate firm CliftonLarsonAllen LLP (CLA) is hosting a webinar on October 8, from 2:00 pm - 3:00 pm, on the newly released post-payment reporting requirements for providers receiving coronavirus relief funds. While all are welcome to participate, this webinar is designed for finance personnel of health care organizations and those involved with organizational compliance requirements. For additional information and/or to register, please click here.

Good news on Accelerated and Advance Payment Program

The continuing resolution (CR) passed last week by Congress contained updated terms for the Accelerated and Advance Payment Program. Prior to the CR’s passage, providers who received these payments would have been required to pay them off beginning 120 days after the payment was made, with interest beginning to accrue at 210 days. The new provisions delay the repayment period to a year after the initial payment, offering more time to providers who are still working in the midst of pressures created by the pandemic. This article provides detailed information on the changes made to the program in the CR.

Supporting Resident Voting

Should older adults make it a point to vote in person? Are mail ballots safe? How can provider community leaders support residents when transportation is limited during the pandemic? Wednesday’s LeadingAge Coronavirus Update call will feature Leslie Reynolds, Executive Director of the National Association of Secretaries of State to discuss voting and older adults during this pandemic. She is going to address some known issues that have been occurring in states in regards to voting and will also work to dispel some common myths and misconceptions that may be facing older adults as they plan to vote in the coming weeks. She will provide some useful resources for providers as they work with residents to ensure that they can vote safely.

LeadingAge Need to Know: COVID-19 – October 6, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured information on the LeadingAge Affordable Housing Survey and also a reminder that it is Mental Illness Awareness week!

Check out the full report here.

Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information.