01/29/2021

Today's COVID-19 Report: Tuesday, February 2, 2021

Tuesday, February 2, 2021

Here are the latest need-to-know updates for Tuesday, February 2 regarding the COVID-19 pandemic and other topics of importance.

A REMINDER TO ALL MEMBERS

Check LeadingAge's FAQs and Resources on COVID-19 Vaccines and Issues Surrounding Vaccinations frequently. The most recent update includes Q&A on implications of mandating the vaccine for staff.

The Ohio Department of Health (ODH) has released a preliminary toolkit that has been developed with talking points, language tips, social media language, and trusted resources to help providers better communicate information regarding the COVID-19 vaccines. 

In Today's Report

• You asked... We answered regarding nursing home residents being tested in an outbreak
• DeWine previews SFY 2022-2023 budget
• First doses at third PPLTC clinics: CDC vs. Ohio
• N95 decontamination strategy limited to four times
• February 8 monoclonal antibody webcast
• LTC consumer guide and bed fee invoices due
• CareSource shares SNF billing updates
• Next all-member webinar - Tuesday, February 9 at 11:30AM

You asked...

How often do nursing home residents and staff need to be tested in an outbreak? Ohio guidance says 3 to 7 days so does that mean we only have to test weekly?

We answered...

Residents: Residents are required to be tested weekly at a minimum during outbreak testing. The Ohio Department of Aging (ODA) and the Ohio Department of Health (ODH) provided updated testing guidance on December 21 that states, “All staff and residents that tested negative should be retested every 3 - 7 days until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least 14 days since the most recent positive result.” ODH has confirmed that testing the resident weekly meets the requirement. If a nursing home chooses to test more frequent during the outbreak the recommendation is wait at least 3 days before re-testing.

Staff: Although this outbreak testing references 3 to 7 days for staff, the updated guidance now includes twice per week routine testing for all staff. This means staff would need to be tested twice a week for routine testing regardless if they are in outbreak status or not.

Please reach out to Quality and Regulatory Specialist - Long Term Care Stephanie DeWees at sdewees@leadingageohio.org with additional questions.

DeWine previews SFY 2022-2023 budget

Late day on Monday, Governor DeWine released the “blue book” and fact sheets that include details about what would be contained in the Executive Budget. The legislative language will not be released until next week at the earliest, at which point the details of the proposals will become clearer. The bill touts $1 billion in investment towards coronavirus recovery, which includes supports for local health departments and businesses impacted by the pandemic.

Included in the budget were numerous changes pertaining to nursing homes, which preserve existing funding levels and create new investments for those impacted by the pandemic and those that demonstrate quality care. Another proposal would give the Director of Health more authority to act when an individual’s health or safety is in danger due to substandard care.

LeadingAge Ohio is still learning details on budget impacts for Ohio’s home- and community-based providers, including personal care services and adult day provided under PASSPORT and assisted living provided under Ohio’s assisted living waiver.

The proposals include the following:

• Invest $50 million for a nursing home reform initiative in response to the underutilization of licensed nursing home beds in Ohio. The Department of Health, in collaboration with the Department of Aging and Medicaid, will launch a reform initiative to encourage facilities to voluntarily downsize, move to single patient rooms, and remove the costly excess unused beds from the system. The way the nursing home payment structure in Ohio was designed years ago, Medicaid is required to cover a portion of expenses for unused bed days. According to current Department of Health records, nearly 20% (approximately 11,000) of eligible nursing home beds were vacant prior to the start of the COVID-19 pandemic; occupancy has weakened significantly since its start. As Ohioans demand more community-based care options, this initiative will help rebalance the services available and improve the quality of care for all Ohioans, regardless of setting.
  
  
• Increase the authority and ability of the Department of Health to protect nursing home patients from dangerous situations. The Patient Protection proposal would give the Department of Health the authority to swiftly intervene to protect patients in nursing facilities when they determine the safety of patients is in jeopardy. If needed, the Department will have the authority to immediately remove patients and relocate them into a safe facility.
  
  
• Launch new training opportunities through the Department of Aging. The Training and Improving Ohio Nursing Facilities proposal will launch a series of new quality improvement initiatives and a technical assistance programs to improve the quality of care across the board for Ohio nursing homes. Programming will be targeted to address infection control, elder abuse, and other areas that are flagged as prominent during the Department of Health's inspection process.
  
  
• Invest $440 million into quality outcome incentives for Medicaid nursing home services. The Quality Driven Reimbursement proposal seeks an increase of $100 million into a new payment formula that moves to reward nursing homes for providing high-quality care, based on meaningful outcome-driven industry leading metrics. The Department of Medicaid will work in collaboration with a joint committee and seek input from experts across multiple agencies, providers, and senior advocates to ensure a robust and high-quality incentive-based payment structure. Additionally, to encourage high quality oversight, recipients will be required to ensure that key nursing home staff such as an administrator, medical director, nursing director, and quality improvement director reside in and work in the state of Ohio.

The $440 million reflects both the continuation of the investment made in the quality incentive payment during SFR 2020-21 budget, as well as an additional $100 million to expand the portion of the reimbursement formula incentivizing quality care. Other changes that were not included in the budget preview, but were shared with LeadingAge Ohio by Administration leadership, include delaying rebasing and providing some regulatory relief by extending the licensure survey interval for providers with consistently high survey performance.

Other proposed changes likely to affect LeadingAge Ohio members include several managed care provisions:

• The Department will ease the claims and reimbursement timeline by implementing a fiscal intermediary to serve as the front door to submissions.
  
  
• The Department will centralize provider credentialing, eliminating redundancies embedded in the program today due to this function being managed by each of the six MCOs.
  
  
• The Department will simplify and standardize Medicaid’s preferred drug list to eliminate the need for providers to understand and comply with six individual preferred drug lists managed by MCOs.

LeadingAge Ohio urges caution, as the documents released today are only the first view of the executive budget, with very little detail provided. The full budget language is anticipated next week, at which point LeadingAge Ohio’s policy team will closely examine and communicate the details of each proposal. Furthermore, the Executive Budget is only the first step in what will be a five-month long legislative process, as the budget bill passes through the House, Senate, conference committee and ultimately, back to the Governor’s desk for signature.

Throughout the budget process, members are encouraged to dial in to the LeadingAge Ohio Advocacy in Action calls on the second and fourth Monday of the month at 10am. The calls will feature the latest from the Ohio Statehouse related to various aging services proposals.

Advocacy questions may be directed to Susan Wallace, Chief Policy Officer, at swallace@leadingageohio.org.

First doses at third PPLTC clinics: CDC vs. Ohio

On Friday evening, LeadingAge received clarification from the Centers for Disease Control and Prevention (CDC) that Walgreens and CVS “plan to vaccinate staff with first doses at third clinics. Potentially also residents in states that chose Moderna for the LTC program,” which is not a large number of states. The rationale is that staff are able to get around in the outside community to obtain a second dose of the Pfizer vaccine. However, since onsite clinics operated under the soon to be rolled out Retail Pharmacy Program will use the Moderna vaccine, after the third Pharmacy Partnership LTC (PPLTC) clinic, no additional Pfizer doses will be available in onsite clinics.

However, this information conflicts with the EIDC alert received by Ohio’s long-term care providers on January 29. The Administration is working to develop a plan for staff and residents who have now decided they’d like to receive the vaccine. Once the plan is made public, LeadingAge Ohio will provide full details to its membership.

N95 decontamination strategy limited to four times

The Ohio Department of Health (ODH) sent an EIDC bulletin on February 1 alerting providers to updated FDA guidance which limits N95 decontamination to a maximum of four times. The FDA is reissuing the Emergency Use Authorizations (EUAs) for decontamination systems that are authorized to decontaminate compatible N95 respirators for use by healthcare personnel (HCP) to prevent exposure to pathogenic biological airborne particulates when there is an insufficient supply of new respirators resulting from the COVID-19 pandemic. Among other things, the reissued EUAs for certain decontamination systems are now only authorized to decontaminate each compatible N95 respirator a maximum of four or fewer times.

Battelle, using the Battelle CCDS Critical Care Decontamination System™, has been authorized under the January 21, 2021 FDA EUA to decontaminate compatible filtering facepiece respirators (FFR).

Compatible FFR include NIOSH-approved N95 respirators found on the CDC website and non-NIOSH approved respirators listed in Exhibit 1.

FFRs that meet this policy:

• do not have exhalation valves,
• do not incorporate a duck-bill design, and
• do not contain antimicrobial/antiviral agents.

In addition, FFRs that meet this policy:

• have been authorized under the emergency use authorization (EUA) for NIOSH-approved FFRs, or
• have been authorized under the EUA for non-NIOSH-approved FFRs that are not manufactured in China, or
• are FDA-cleared as intended for use by healthcare personnel (HCP).

CDC recommends limiting the number of donnings for an N95 FFR to no more than five per device. The facilities respiratory protection program should address both decontamination strategies along with limited re-use of an N95 for no more than five donnings.

The FDA has issued Emergency Use Authorizations (EUAs) for the emergency use of decontamination systems for use in decontaminating certain respirators used by health care personnel when there are insufficient supplies of new respirators resulting from the COVID-19 pandemic. New FDA-cleared N95 respirators or NIOSH-approved N95 respirators or other FDA authorized respirators are always the first choice before a decontaminated respirator.

February 8 monoclonal antibody webcast

The Ohio Hospital Association (OHA), in partnership with the Ohio Department of Health (ODH), is hosting a webcast on February 8 at 12:00PM to discuss the considerations for Monoclonal Antibody usage. Facilities are being asked to limit attendance to two staff per facility. To join the webinar, register at the following link.

In November, the United States Food and Drug Administration (FDA) issued an emergency use authorization for monoclonal antibodies (mAbs) therapy (specifically, bamlanivimab); it is approved for use in the treatment of mild to moderate COVID-19. This treatment was shown in clinical trials to reduce COVID-19-related hospitalization or emergency room visits in high risk patients. The state of Ohio has received an allocation of mAbs, but there is also a federal initiative to distribute this infusion method directly through home infusion in nursing home and assisted living facilities and through participating pharmacies. This federal allocation program, called the Special Projects for Equitable and Efficient Distribution (SPEED), is working to distribute mAbs to priority populations, including nursing homes and federally qualified health centers.

Again, SPEED is separate and complementary to the state-based mAbs allocation system. If your facility is interested in learning more and potentially accessing mAbs, you should reach out to your medical director and/or pharmacy. This list represents those pharmacies currently signed up to receive mAbs.

Furthermore, yet another route is available to northeast Ohio providers who think their residents may benefit for monoclonal antibody treatment. CVS subsidiary Coram has received 1,000 doses of mAbs therapy for infusion across seven (7) metro areas. One of these is the Cleveland market. Nursing homes and assisted living within 75 miles of the Coram site in Solon may request this treatment, until all doses are expended. As of this Monday, over 50 doses remained for use in the Cleveland market, with the potential for more after the initial stock is expended. One challenge to the treatment is the short window in which it can be administered. It should be delivered within the first 10 days of detection, only to those who have a confirmatory PCR test. Because of lab delays for PCR turnaround time, once the positive test result is received there may only be a few days left to deliver the treatment.

If you are a northeast Ohio provider who would like to be linked to the Coram team to learn more about this treatment, email Susan Wallace at swallace@leadingageohio.org.

As the vaccine continues its roll-out – with a number of weeks before Ohioans in congregate settings are fully vaccinated -- mAbs therapy offers potential life-saving mitigation of the COVID-19 virus. Watch for more information on this program on the Ohio Medical Directors Association website.

LTC consumer guide and bed fee invoices due

Each year, the Ohio Department of Aging (ODA) bills long-term care facilities for the Long-Term Care Consumer Guide Fee and LTC Ombudsman Bed Fee. Both payments were due November 1, 2020.

This year, first invoices for residential care facilities and nursing homes were not mailed. Click here to pay online by credit card (2.5% fee applies), electronic check (no fee), or download an invoice to pay by check.

1. Visit the payment site for ODA here, and click Find, View and Pay LTC Consumer Guide Invoices or Find, View and Pay Bed Fee Invoice to reach the Invoice Payment Portal.
   
   
2. Search the spreadsheet here for your facility's customer and invoice numbers. Note: the customer number is the same for Bed Fee and Consumer Guide; the invoice numbers are different. Bed Fee will start with 200; Consumer Guide will start with 100.
   
   
3. Payment options:
   
   - Online via electronic check (no fee) or credit card (2.5% fee applies). Add the selected invoices to your cart and proceed to the payment screen. Invoices marked PAID have already been paid.
   - Check or money order: use the link "download invoice" to print each invoice to send with payment.

Please email facilityfee@age.ohio.gov if you have any questions.

CareSource shares SNF billing updates

This week, CareSource reissued several network notifications to providers, including a SNF Tool/checklist for submitting claims, their current policy of suspending prior authorization requirements for SNF stays, and changes to the PASRR process. LeadinAge Ohio encourages members to forward these items to their billing office staff.

Next all-member webinar - Tuesday, February 9 at 11:30AM

LeadingAge Ohio will host its bi-monthly all-member webinar focused entirely on member questions and answers on Tuesday, February 9 at 11:30AM.

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 on the vaccine and all things compliance, including infection control, testing, surveys, reporting requirements, and other fast-moving topics.

Members can 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.

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.