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09/16/2020

Today's COVID-19 Report: Wednesday, September 16, 2020

Wednesday, September 16, 2020

Here are the latest need-to-know updates for Wednesday, September 16, 2020 regarding the COVID-19 pandemic.

DeWine Administration shares plans for nursing home testing

In a meeting with officials from the DeWine Administration yesterday, LeadingAge Ohio learned their plans for reconciling the discrepancies between Ohio’s Director’s Order governing nursing home testing, and CMS’s interim rule on nursing home testing. Administration officials affirmed their desire to help Ohio nursing homes meet the increased requirement for testing while also preserving testing capacity and supplies for antigen testing. They recognize that with federal requirements now in place, Ohio’s nursing home testing program adds burden, and their strategy will seek to minimize duplication and also support nursing homes’ efforts to achieve the cadence outlined in QSO-20-38-NH.

They shared that the updates will be outlined in an updated Director’s Order in the coming days, but also provided information on both what Ohio’s requirements will be, as well as what support Ohio nursing homes can expect.

Regarding Ohio requirements:  

  • Ohio will relax its twice-a-month testing for nursing homes, instead adopting CMS’s three-tiered approach.
  • For testing frequency, Ohio will follow CMS’s county ranking for green (monthly), yellow (weekly) and red (2x weekly) counties. Additional information is anticipated for counties on Ohio’s Public Health Advisory System map, which are ranked at a higher prevalence than CMS data.
  • Ohio will follow CMS’s schedule for updating data, on the first and third Monday of each month. This means that even if a county becomes “red” on Ohio’s Public Health Advisory System, it will not be required to increase the frequency of testing until the following Monday.

Regarding support Ohio nursing homes can expect to receive from the state:

  • Nursing homes in low-prevalence counties (monthly) will no longer receive support from Ohio’s nursing home testing program. They will be required to contract for their own testing to meet the once-monthly testing requirements.
  • Nursing homes in medium-prevalence counties (weekly) will receive testing support from the state twice monthly. This means that they will receive support from the state for roughly half of their testing, and will need to arrange for the remainder of testing directly with labs.
  • Nursing homes in the high-prevalence counties (2x/week) will receive testing support from the state on a weekly basis. However, they will need to provide at least for the first round of testing, as the state will require at least a week to get them on the schedule and arrange logistics.
  • For outbreaks, facilities would be elevated to the “yellow” level, with the state offering testing once every two weeks.
  • As before, providers will be permitted to opt-out of state support for testing, but if they choose to opt back in, they should expect to not be on the schedule for at least 1-2 weeks, so should not rely on state support for emergent testing needs.

These guidelines were determined after assessing the Ohio’s experience with the current nursing home testing program and lab capacity. They hope that the lab capacity freed up by not offering support to low-level counties can be redirected to support testing in high-prevalence counties. Ohio has planned to develop written materials and offer a webinar to nursing homes to prepare providers on the anticipated changes.

The Administration acknowledged that this plan is complex, and it will take time and patience to implement. Additionally, they acknowledged that it may only be a temporary solution, while other testing mechanisms, like the Abbott cards, are deployed.

Related to reporting requirements, Department of Health officials reminded providers that a positive antigen result does not necessarily mean a positive case, but rather, that providers should notify their local health department so that they may trigger a case review to look at other factors (symptoms, etc.) to identify whether it is a true positive.

LeadingAge Ohio will continue to advocate on behalf of its members for more clarity on testing requirements, to ensure a program that poses minimal burden to providers. Testing questions can be sent to COVID19@leadingageohio.org.

Governor’s press conference focuses on nursing home testing

In the Governor’s semi-weekly press conference, Director Ursel McElroy provided an overview of Ohio’s testing program for nursing homes and assisted living. She offered Ohioans an overview of Ohio’s testing initiatives in congregate settings, notably the 160,000 residents and staff in Ohio’s nursing homes, and 80,000 residents and staff in Ohio assisted living. 

She noted that in nursing homes, Ohio has supported facilities by acquiring and delivering kits, as well as picking up test specimens and transporting them to Ohio labs, facilitated by the Ohio National Guard. In assisted living, the current protocol is tested every other week, but in late August, the state was notified of inconsistencies in testing results. The program was paused, the inconsistencies were investigated and they’ve identified the source of inconsistencies and will be resuming.

Adult day will be permitted to reopen for congregate services on September 21. Adult day will require testing for all staff every two weeks once they open. If a person is symptomatic, they would be separated and sent home according to protocol. 

Director McElroy noted that in all of these settings, there are extensive requirements including screening, log books, and infection control. 

On the topic of visitation, Director McElroy noted that since July 20, nursing homes were permitted to have outdoor visitation.  They are working to bolster residents’ connections to loved ones, and will be able to announce plans for indoor visitation “very soon.” Furthermore, ODA is creating a public facing communication interface that will demonstrate what visitation is permitted in a given community. In response to questions related to why visitation isn’t always offered, Director McElroy noted that sometimes visitation is put on hold when there’s a positive case in the facility or a high level of spread in the community around the facility.

The press conference builds on information shared with LeadingAge Ohio by Administration officials, that described a new protocol for nursing home testing. (See “DeWine Administration shares plans for nursing home testing,” above.)

Testing Update: Adult Day Services and Assisted Living

The state is ‘unpausing’ testing for assisted living (AL) and providing access to testing for Adult Day Services through MAKO Medical, a North Carolina lab.  Nasal (anterior nares) swabs will be used instead of saliva and a new reporting tool will be utilized. ODA is planning a webinar on Friday for providers (one webinar for AL; one for Adult Day) to introduce MAKO and what the state believes will be a testing program with considerably more support from the lab for Ohio providers. MAKO has promised 48-hour turnaround/reporting of results from receipt of the specimens. Providers using MAKO will receive the state’s support in funding for the tests, as well.  Providers will be given the option to opt out of using MAKO to conduct testing through their own contracts.  An important change to the testing process (available through MAKO) is that training on swabbing will be provided; this training relieves the need for a nurse to collect the specimens.  A physician’s order is required for the testing; providers without a Medical Director or physician will need to reach out to the local health department for assistance in securing this order.    

Any questions related to plans for testing in assisted living and adult day may be directed to the LeadingAge Ohio COVID-19 mailbox.

ODH provides email addresses for questions

The Ohio Department of Health (ODH) has provided a more specific set of email addresses depending on the type of question providers have. 

All provider types:

Provider Relief Fund Questions: crfprovider@obm.ohio.gov 

When emailing, providers should include their Medicaid ID number in the subject field of the email, to allow for easy sorting by OBM staff. In addition, the content of the email should identify the organization’s NPI, street address, corporate street address (if part of a multi-site system), and D/B/A. 

Assisted Living testing:

Testing questions: ALCOVIDTesting@age.ohio.gov

Nursing Home testing:

OPT-IN/OPT-OUT of state testing mandate program

Testing reporting link available here

Challenges with 48 Hour turnaround time:  CCURT@odh.ohio.gov

  • Subject line: CMS 48 turn-around time

Facility 1st Case: Liccert@odh.ohio.gov or to ODH Bureau of Survey and Certification at 246 N. High St Columbus, Ohio 43215

State Supported Testing questions: CCURT@odh.ohio.gov

Nursing Home Bridge Team Support: Bridgeteam@odh.ohio.gov

Billing Questions: CCURT@odh.ohio.gov

  • Subject line:  Billing question

Notifications of positive results: Facility should report to the local health department and NHSN.

If providers are testing with the POC machine they must follow the CLIA guidance and report based upon their “laboratory” reporting requirements, which were detailed in Friday’s Daily COVID Report.

Infectious Disease related questions: LHD or orbit@odh.ohio.gov

5-Star analysis & trends analysis reports: an update

Due to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has held the quality measure (QM) ratings for 5-star constant based on data from the fourth quarter 2019. A few claims-based QMs were updated in July 2020, and health inspection data has also been held constant since March 3, 2020.

Since there would be very limited changes in the 5-star reports, LeadingAge is not preparing 5-Star Analysis Reports to members for the July 2020 data release. The latest direction from CMS indicates that the QM data will not be updated for October, and new inspection data is anticipated to begin to show up in the 5-star reports around October. LeadingAge will analyze the data released in October to determine if there is enough change to warrant the release of new 5-star reports.

ODM shares bed tax for FY2021

This week, the Ohio Department of Medicaid shared the FY2021 franchise permit fees (“bed tax”) and the rationale used for their calculation. The updated fee will be $13.34 for all licensed beds, and any certified beds in excess of 200 will receive a rate of $7.55. ODM planned to hold steady the amount collected via the bed tax, but because there was a drop in beds of roughly 900 beds statewide, the fee itself rose for providers. For providers, the fee is up from $13.16/$8.63 last year. The calculation also takes into account declining caseloads during the COVID-19 pandemic, which were estimated based on MDS data.

Questions related to the franchise permit fee may be directed to Susan Wallace at swallace@leadingageohio.org.

Reminder: surveyors can enter building

At its weekly meeting with the Ohio Department of Health (ODH), ODH officials shared that they’ve heard of nursing homes denying surveyors building access when they can’t prove negative COVID testing results. ODH reiterated that their staff are being managed and screened for symptoms, and they will not send individuals with symptoms or those who have a positive COVID-19 test result. LeadingAge Ohio strongly encourages members to notify their administrative and reception staff, to ensure they are aware.

Housing Happenings call explores Dementia Inclusive Communities and highlights from CDC latest guidelines

In this morning’s Housing Happenings call Episcopal Retirement Services' CEO Laura Lamb shared the importance of educating our greater communities on what it’s like living with dementia in an effort to create welcoming and safe places in cities across the country. Laura shared four principles for education and community training as the foundation for aging services providers to share what they have learned by working with those with cognitive loss.

  1. What is dementia?
  2. What communication challenges does a person with dementia face?
  3. What can we do to create a welcoming environment and have a positive interaction with a person with dementia?
  4. Real world scenarios (customize training to the audience, i.e. restaurant, libraries, churches, banks- different environments create different challenges)

Members are encouraged to reach out to Episcopal Retirement Services to learn more about how to make your cities and communities more dementia inclusive. Visit dementiainclusivecincinnati.org to learn more.  

LeadingAge’s Juliana Bilowich reviewed the recent guidelines released by the CDC regarding infection control and operation procedures for affordable senior housing providers. The recommendations, developed through input from LeadingAge, cover a wide range of scenarios focused in three key areas of healthy behavior, healthy environments and healthy operations including:

  • Unit turn-over and move-ins
  • Visitors, service providers, and prospective tenants
  • Loneliness and social isolation among older adult residents
  • Resident communication systems
  • Protections for at-risk residents and staff
  • In-unit maintenance and Inspections
  • Safe communal spaces
  • Cleaning and disinfection
  • Property signage and messaging
  • Mask policies and social distancing
  • Confirmed COVID-19 cases

Housing Happenings is a free member benefit co-hosted by LeadingAge Maryland and LeadingAge Ohio each Wednesday morning from 9-9:30am. To join next week’s call, register on the LeadingAge Ohio website.

Update from LeadingAge Ohio Partner, Benesch and their Labor & Employment Practice Group

The Department of Labor (DOL) has clarified and revised its temporary "Rule" implementing the Families First Coronavirus Response Act (FFCRA) in response to a federal court’s ruling that certain parts of the Rule were invalid. The revised Rule becomes effective on September 16, 2020.

To read the full bulletin, please click here.

Recruit the next generation now at LeadingAge’s Virtual Student CareerFair

Are you currently hiring for any entry-level positions or internships for your organization? There's no better time to find the next generation of aging services professionals than at LeadingAge's Annual Meeting Student Program. NEW for this year, the Virtual Student CareerFair will offer students the chance to meet with organizations that are hiring right now, and ask the hiring managers specific questions in their "virtual booth."  If your organization is currently hiring for any entry-level positions, you can sign up for a booth at the CareerFair! The cost of a booth is free for all LeadingAge provider members, and $500 for any LeadingAge business firm members.

Students will be able to search for jobs in the following fields:

  • Administration/management
  • Business/finance/office management
  • Culinary Environmental services/ maintenance/facilities
  • Fundraising and development
  • Human resources
  • Information technology
  • Lifestyle and enrichment
  • Marketing/communications
  • Nursing

To sign up for a virtual booth, complete the 2020 Student CareerFair Participation Application.   

For questions regarding the Student Program contact Christy Kramer, LeadingAge’s Vice President of Student Programs & Workforce Relationships, at 202-508-9446 or email ckramer@leadingage.org.

LeadingAge Need to Know: COVID-19 – September 16, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured a message from LeadingAge President and CEO Katie Smith Sloan and an update on the Families First Coronavirus Response Act.

Check out the full report here.

                Linkage                         Buerger


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. 

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Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.