11/30/2020

Today's COVID-19 Report: Wednesday, December 2, 2020

Wednesday, December 2, 2020

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

In Today's Report

• LeadingAge Ohio All-Member Q & A: TODAY at 3:00PM
• ODH Call Covers Crisis PPE, Ventilation Grants, Vaccination
• COVID and the Holidays: Join Bereavement Professionals Forum next week
• CMS releases the annual Physician Fee Schedule rule and additional updates
• NF Providers Association Monthly Meeting - new MEPL 150B with new case processing guidance
• December 11 deadline for HUD COVID-19 payment applications and call with HUD on December 7
• LeadingAge Need to Know

LeadingAge Ohio All-Member Q & A: TODAY at 3:00PM

LeadingAge Ohio will host its bi-monthly all-member webinar focused entirely on member questions and answers, today at 3:00PM. Tune in today to learn what we know -- and don’t yet know -- about how Ohio will use its initial round of vaccinations, estimated to arrive in mid-December.

During the unscripted, 30-minute webinar, LeadingAge Ohio policy and regulatory experts Stephanie DeWees, Anne Shelley, Kathryn Brod and Susan Wallace will field YOUR questions related to all things compliance, including infection control, testing, surveys, reporting requirements, and other fast-moving topics.

Members still have time to send questions in advance to the COVID-19 mailbox. Alternately, members will be able to chat in questions during the webinar.  Registration is required, but there is no fee to participate.

ODH Call Covers Crisis PPE, Ventilation Grants, Vaccination

On its monthly call with representatives of the Ohio Department of Health (ODH), LeadingAge Ohio received updates and clarification on a number of items, including:

• Use of N-95s in crisis capacity. Staff of the ODH Bureau of Infectious Disease (BID) recommends wearing a procedure mask over an N95 or a face shield that covers the N95 to protect the N95 and maintain compliance with the maximum limit of five (5) donnings/doffings. In these situations, the procedure mask would be removed between caring for a quarantined resident and the N95 would remain on.

If a face shield is used, then it should be cleaned between each resident care episode for those quarantined residents.

Staff are still able to wear an N95 for all residents on a COVID+ unit without having to remove it between care as long as a resident is not in additional precautions for a different disease, such as C-Diff.

These recommended practices only apply if a facility is having to use conservation strategies for the N95 masks. If a full supply of N95s is available and conventional strategies could be implemented, then the recommendation would be to not wear a procedure mask over an N95.

ODH recognized that most providers are not able to implement conventional strategies for N95s at this time due to a high burn rate resulting from positive cases in the facility. As part of a facilities respiratory protection program, the facility and their designated team should evaluate this process and any process that would need to be implemented outside of a conventional strategy.

• Quarantine guidance. ODH is aware CDC plans to change guidance related to the current 14-day quarantine recommendations. ODH has not received this guidance yet but will disseminate that as soon as they receive it.

• Health Care Isolation Centers (HCIC). In the past month, ODH has received dozens of applications for facilities to be designated as HCICs. To date, only six of them have completed their applications --- three in zone 1, two in zone 2 and one in zone three.

• Annual and focused infection control (FIC) surveys. ODH has not received further guidance from CMS on conducting annual surveys in a modified way like the Focused Infection Control (FIC) surveys. They continue to follow the QSO-20-30 memo which provides guidance to states on conducting annual surveys if the state is in phase 3 as outlined in the memo. ODH noted that it is struggling to complete the volume of complaint and FIC surveys, given the rise in outbreaks. ODH is aware that CMS is considering a different method for FIC surveys, given the increasing frequency and duplication of surveys, but CMS has yet to release any information regarding their future direction.

Some states have cited facilities for not having consistent staff in COVID unit. CMS has communicated to state agencies that not having consistent assignment of staff in a COVID+ unit is not a citation in and of itself. ODH has seen citations around staffing and COVID units when there is another a breach in infection control practices.

• Air Quality Assistance Program: As previously reported in the COVID-19 report, the Administration will be making grants of up to $15,000 for nursing homes, assisted living or adult day providers to use to evaluate their HVAC systems and make some changes. Of the $30 million approved by the Controlling Board, $28 million will go to providers, and $2 million will go to older adults in homes. At this time, the Ohio Department of Aging believes the grants will be able to be used to cover the costs of investments already made by Ohio providers. 

• Rapid Response Team model. Also approved by the Controlling Board was $7 million to support the development of a statewide program that will offer rapid response to COVID outbreaks in congregate care facilities. The program is modeled after the Post-acute Rapid Response Team (PARRT) program, but will provide more expansive,  end-to-end support of providers. LeadingAge Ohio will share more details about this model as they become available.

• Finally, Administration leadership affirmed that there is a dedicated team working on Ohio’s vaccination distribution plan, but that there is yet no information to share with long-term care providers. LeadingAge Ohio encouraged the Administration to consider sharing incremental information, such as how and when the plan will be available, so that providers may begin to prepare.

If you have a question you’d like answered by ODH or the Administration, please send it to the COVID-19 mailbox.

COVID and the Holidays: Join Bereavement Professionals Forum next week

LeadingAge Ohio invites bereavement, counseling and spiritual care staff to join its next Bereavement Professionals Forum on Tuesday, December 8 at 1:00PM. This month, we will spend time discussing how to help families, loved ones and colleagues through the holidays, with particular attention to how the COVID-19 pandemic will shape typical grief reactions around the holidays. Maren Simon, Bereavement Counselor from Hospice of Northwest Ohio, will share their approach to this unprecedented holiday season, and attendees will have the opportunity to share practices in large and small-group discussions.

Advance registration is required, but there is no fee for this member-only event.

CMS releases the annual Physician Fee Schedule rule and additional updates

The Centers for Medicare & Medicaid Services (CMS) released the annual Physician Fee Schedule (PFS) final rule, prioritizing CMS’ investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions. The rule includes the following updates:

Allows non-physician practitioners to provide the care they were trained and licensed to give, so healthcare professionals can practice at the top of their license.

• Allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services.
• Commissions a study of its telehealth flexibilities provided during the COVID-19 PHE. The study will explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity
• Increasing the value of many services that are similar to evaluation and management (E/M) office visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, and physical and occupational therapy evaluation services.
• Simplifies coding and documentation changes for Medicare billing for these E/M visits, effective beginning January 1, 2021.
• Makes permanent several workforce flexibilities provided during the COVID-19 PHE that allow non-physician practitioners to provide the care they were trained and licensed to give, without imposing additional restrictions by the Medicare program. These include: 
  • Certain non-physician practitioners such as nurse practitioners and physician assistants can supervise the performance of diagnostic tests within their scope of practice and state law, as they maintain required statutory relationships with supervising or collaborating physicians.
  • Physical and occupational therapists will be able to delegate “maintenance therapy” – the ongoing care after a therapy program is established – to a therapy assistant.
  • Physical and occupational therapists, speech-language pathologists, and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient’s medical record. As a result, practitioners have the flexibility to delegate certain types of care, reduce duplicative documentation, and supervise certain services they could not before, increasing access to care for Medicare beneficiaries.

For a fact sheet on the CY 2021 Physician Fee Schedule Final rule, please click here.

For a fact sheet and frequently asked questions on the CY 2021 Quality Payment Program final rule, please click here.

For a fact sheet Medicare Diabetes Prevention Program, please click here.

To view the CY 2021 Physician Fee Schedule and Quality Payment Program final rule, please click here.

NF providers association monthly meeting - new MEPL 150B with new case processing guidance

Discussed during a recent Nursing Facility (NF) Providers Association Meeting, a Medicaid Eligibility Procedure Letter (MEPL) has been issued to address CMS’ reinterpretation of the continuous coverage requirement. Information pertaining to MEPL 150B can be found at this link.

December 11 deadline for HUD COVID-19 payment applications and call with HUD on December 7

The Department of Housing and Urban Development (HUD) announced a second application period for COVID-19 Supplemental Payments from the CARES Act. The filing deadline for multifamily housing owners is December 11, 2020 for expenses incurred from August through November. Properties that did not receive payments for the earlier time-frame, March 27 through July 31, may resubmit for that period as well. Compared to the previous notice, HUD made changes to include clarifications on the eligibility of Rental Assistance Demonstration (RAD) Section 8 properties, eligible activities for CSP funds, and allowable signatories for the request form. More information is available here, and members can reach out to jbilowich@leadingage.org with any additional questions.

On Monday, December 7 at 12:30PM, LeadingAge will be hosting a call with HUD staff on the use of electronic signatures and the recently revised guidance surrounding them. Questions can still be submitted through the end of today and If you are interested in joining the call, please reach out to Juliana Bilowich at jbilowich@leadingage.org.

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

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured news from ACIP on the upcoming COVID-19 vaccine allocations.

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.