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11/02/2020

Today's COVID-19 Report: Monday, November 2, 2020

Monday, November 2, 2020

Here are the latest need-to-know updates for Monday, November 2 regarding the COVID-19 pandemic. 

In Today's Report

  • LeadingAge Ohio all-member Q&A on Thursday: Send questions early
  • COVID-19 vaccination planning; healthcare providers can enroll to become vaccine providers
  • New COVID IFR published
  • Visitation dashboard allows providers to update license number, administrator name, and more
  • CDC launches Project Frontline
  • PEPPER reminder
  • New Medicaid provider "front door" will go live in March; Applications to freeze in February
  • Home health final rule includes 2% increase
  • LeadingAge Need to Know

LeadingAge Ohio all-member Q&A on Thursday: Send questions early

COVID-19 has drastically reshaped the way our sector operates, with emergency rules and guidance often released mere days before becoming effective. Increasingly, aging service providers feel swamped in an “info-demic” and unsure if they’ve missed a critical new requirement.

This Thursday, November 5 at 9:30am, LeadingAge Ohio will host the first in a series of all-member sessions focused entirely on questions and answers. These twice-monthly Q&A webinars will be held on the first and third Thursday of the month, beginning in November.

During the unscripted, 30-minute webinar, LeadingAge Ohio policy and regulatory experts will field questions related to testing, telehealth, visitation, vaccination and other fast-moving topics. Join Kathryn Brod, Anne Shelley, Stephanie DeWees and Susan Wallace to hear Q&A on survey expectations, visitation logistics, testing processes, reporting and more.

Members are encouraged to send advance questions to the COVID-19 mailbox so research can be completed if needed. Alternately, members will be able to chat in questions during the webinar.  Registration is required, but there is no fee to participate

COVID-19 vaccination planning; healthcare providers can enroll to become vaccine providers

In anticipation of a safe and effective COVID-19 vaccine, the Governor’s Pandemic Recovery and Response Leadership Team has created a Vaccine Preparedness Office to coordinate a smooth and swift distribution and vaccination process statewide. The DeWine Administration is closely monitoring guidance from the Centers for Disease Control and Prevention (CDC), Operation Warp Speed, and the U.S. Food and Drug Administration on the status of each vaccine candidate and are hopeful that one or multiple vaccines might be authorized in the coming weeks and months.

Once a vaccine has been authorized, Ohio expects to receive shipments allocated by the federal government with guidance to first vaccinate high-risk populations including healthcare workers and older adults. In preparation for receiving a vaccine, Ohio has launched an inter-agency working team in collaboration with partners to create and execute a comprehensive vaccination program.

If you have ultra-cold storage capabilities (below -70 degrees Celsius) and are able to administer COVID-19 vaccines to 500 or more individuals, enroll no later than Friday, November 6! Please note that not every provider needs to have ultra-cold storage capabilities to be a COVID-19 vaccine provider.

A recorded webinar about the Ohio COVID-19 Vaccine Program and how you can participate is available here.

Ohio has launched a provider enrollment process with the goal of registering all interested vaccine providers in the coming weeks. A “job aide” is available explaining how to complete a Vaccination Provider Program application, as well as an enrollment checklist.

CDC also offers a FAQ about COVID-19 vaccinations.

New COVID IFR published

An Interim Final Rule with Comment Period (IFC) was issued last week by the Departments of Health and Human Services (HHS), the Department of Treasury, and the Department of Labor. The rule covers the following topics:

  • Vaccine Related Provisions: The rule implements the provisions of the CARES Act related to coverage and payment for an eventual COVID-19 vaccine. There are provisions in the rule related to Medicare, Medicaid, and private health insurance.
  • Updated policy for maintaining Medicaid enrollment during the COVID-19 PHE: The rule discusses how CMS is interpreting the provisions of the Families First Coronavirus Response Act (FFCRA) related to the increased FMAP and maintenance of Medicaid enrollment during the public health emergency (PHE).
  • Section 1332 waivers: This rule creates flexibilities in the public notice requirements and post-award public participation requirements for State Innovation Waivers (section 1332 waivers) during the PHE for COVID-19.
  • Enhanced Medicare Payments for new COVID-19 treatments: These provisions relate to how Medicare will pay inpatient and outpatient hospital settings to encourage utilization of new, approved COVID-19 treatments.
  • Price transparency for COVID-19 diagnostic tests: Implementation of a CARES Act provision around publicizing cash prices for COVID-19 diagnostic tests.
  • Extension of the Comprehensive Care for Joint Replacement model for 6 months so that the model will end on September 30, 2021.

A fact sheet on the rule can be found here and we will provide more analysis in the coming days.

Visitation dashboard allows providers to update license number, administrator name, and more

Facilities that need to make updates to information in the visitation dashboard can now do so. For example if a license number is incorrect, the administrator has changed, or the address is incorrect, providers now have the ability to make those changes. 

License number needs to be in the following format: ####N or ####R

ODM noted that the Medicaid number is requested; however, if the Medicaid license number isn’t entered, enter the Medicare number instead. 

CDC launches Project Firstline

Last week, the Centers for Disease Control and Prevention (CDC) launched Project Firstline, a comprehensive infection control program designed to help prevent the spread of infectious diseases in U.S. healthcare settings. The $180 million program features new training for staff in hospitals, outpatient clinics, dialysis centers, nursing homes, and other healthcare facilities to protect workers on the frontlines. CDC has teamed up with a coalition of more than a dozen healthcare, public health, and academic partners, as well as 64 state, territorial, and local health departments through the Epidemiology and Laboratory Capacity cooperative agreement to support development and dissemination of Project Firstline’s innovative, interactive infection control curriculum for healthcare and public health workforces across the United States.

To kick-off this training collaborative, the American Medical Association hosted a webinar featuring Dr. Mike Bell to discuss important infection control questions from workers on the frontlines. Dr. Bell was also featured in AMA’s Daily COVID-19 Update on Thursday, October 29.

PEPPER reminder

LeadingAge Ohio has been asked to provide an updated one page summary of PEPPER with our membership by the RELI Group.  The RELI group, along with its partners TMF Health Quality Institute and CGS, is contracted with the Centers for Medicare & Medicaid Services (CMS) to develop, produce and disseminate PEPPER. PEPPER summarizes one provider’s Medicare claims data statistics and provides comparative data with the state, jurisdiction and nation.  Providers can review the PEPPER to evaluate their statistics and determine whether they should take any actions, such as reviewing records to ensure the care provided was necessary, and that documentation supports the diagnosis codes and services billed. Providers are urged to access PEPPER as a tool to support their auditing and monitoring efforts. 

If you have questions, visit Help Desk to request assistance with PEPPER.

New Medicaid provider "front door" will go live in March; applications to freeze in February

The Ohio Department of Medicaid (ODM) is developing a new Provider Network Module (PNM) to serve as the “front door” to Medicaid provider enrollment.  The goal of PNM is to create a single point of entry to manage the provider enrollment process in Ohio’s Medicaid program. The PNM system is expected to go-live in March 2021. To ensure the successful launch of the new system, ODM will stop accepting provider applications in MITS in February 2021. In the coming weeks, ODM will share insight into this change, provide timelines, resources, and instructions for PNM through email notifications to providers and other communication with stakeholders. 

While PNM does not change ODA’s requirement to certify waiver providers, it will impact the ODA application process as providers will now begin their application in the PNM portal instead of with ODA. The processes outlined in OAC rule 173-39-03 require all provider applicants to have an on-site pre-certification review before the certification is completed. To accommodate this process and meet the February cut-off date in MITS, ODA will set the following application deadlines to ensure sufficient time for reviews to be completed. 

PNM Implementation – Application Deadlines for ODA Provider Certification:

  • Participant Directed Applications – December 15, 2020
  • Non-Agency (Non-business entity) – December 15, 2020
  • Agency/Non-Agency (business entity) – December 1, 2020
  • Assisted Living – December 1, 2020

Prior to these dates, providers will continue to submit applications to ODA. Providers who miss these deadlines or submit an incomplete application will have to reapply in PNM after the system launches in March 2021. These deadlines also apply to changes of ownership interest or organizational structure as outlined in OAC rule 173-39-03.2.

ODA will place this information on our website. ODA is also in communication with the PASSPORT Administrative Agencies about these dates and required activities. 

Any questions may be directed to the ODA provider email address.

Home health final rule includes 2% increase

The Centers for Medicare & Medicaid Services (CMS) has released the final CY2021 Home Health Prospective Payment System Rate Update rule. The final rule:

  • Updates the payment rates for home health agencies by 2% for 2021.
    • The base 30-day payment rate is increased from $1864.03 to $1901.12 after application of wage index budget neutrality factor of 0.9999. HHAs that did not submit required quality data have that rate reduced by 2%.
    • The LUPA per visit rates are set at:
      • SN $152.63
      • PT $166.83
      • SLP $181.34
      • OT $167.98
      • MSW $244.64
      • HHA $69.11
    • LUPA rates are also reduced by 2% for those HHAs that did not submit required quality data.
    • The LUPA add-on for LUPA only patient continues. For example, for SN as the first LUPA visit the add-on results in a first visit payment of $281.62. Each discipline would get its own add-on rate.
    • The area Wage Index that applies based on the patient’s residence has changed significantly to reflect updated census information. Due to the significant change, CMS caps any reduction in the wage index at 5%. There is no cap on wage index increases.
    • The Outlier Fixed Dollar Loss ratio stays a 0.56. That would mean that no increase or decrease in the national volume of outlier episodes is expected.
    • The rural add-on phase-out continues
    • High Utilization areas---- 0% add-on
    • Low Population Density areas—2% add-on
    • All other areas-----1% add-on
    • The PDGM case mix weights and LUPA thresholds stay at the 2020 levels
    • CMS maintains its RAP and NOA policy which will include a penalty for late filing in 2021 and later years when filed after 5 days. The penalty is a payment denial for each day from the start of the episode until the date of filing.
  • Adopts the new OMB statistical area delineations while capping wage index decreases at 5% for 2021 which is consistent with CMS policy across the Medicare program. The wage index changes will have significant impact on HHAs that serve certain geographic areas. This reimbursement factor does not get the headlines, but it can be very meaningful for some providers.
  • Holds LUPA thresholds, case-mix weights, and behavior assumptions at the same levels as CY2020. CMS rejected pleas to roll back the 4.36% behavioral adjustment based on its position that it does not have the data yet to evaluate whether its budget neutrality obligation has been met in 2020.
  • Finalizes the changes to §409.43(a) as implemented in the March 2020 IFC that states that the plan of care can and must include any provision of services furnished via telecommunications systems. The rule reiterates that visits via a telecommunications system cannot substitute for a home visit ordered as part of the plan of care and cannot count as a home visit for purposes of eligibility or payment.
  • Discusses the new home infusion benefit, reporting on the Home Health Value Based Purchasing Program, and changes to the Conditions of Participation OASIS requirements.

Providers are urged to send an action alert to Capitol Hill about the HEAT Act which would allow for payment for telecommunications visits during a public health emergency.

LeadingAge Need to Know: COVID-19 – November 2, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured a request to complete a short survey gauge members’ experiences with the various government-supplied tests, as well as to understand your overall ongoing testing needs. 

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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