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04/04/2020

Today's COVID-19 Report: Saturday, April 4, 2020

Saturday, April 4, 2020

Here are the latest need-to-know updates for Saturday, April 4 regarding the COVID-19 pandemic.

ODH Restricts Hospice Visitation to Imminent Death

The Ohio Department of Health (ODH) Bureau & Certification Chief, Rebecca Sandholt, sent revised guidance to Long-Term Care Facility Administrators and nursing home administrators yesterday, Friday, April 3.

The Updated COVID-19 Guidance changed hospice visitation language by deleting the following sentence: This includes any resident who is receiving hospice care, not just a resident who is facing imminent death.

The newly added sentence in the April 3 guidance is as follows: Visitation would be limited to any resident who is facing imminent death as determined by a medical professional acting within their scope of practice. 

EMA PPE Request Protocol

ODH provided instructions on requesting resources from Emergency Management Agencies (EMAs) in the COVID-19 Resource Request Guidance sent to nursing home administrators yesterday. When additional supplies are needed, ODH instructs healthcare facilities to contact their respective county EMA, who will attempt to find resources at the local or regional level.

The guidance instructs providers to be prepared with the following information:

  • Details about the incident/situation;
  • The gap between existing resources and what is needed to handle the incident/situation; and
  • Details about how you have tried to fill that gap locally (asked for volunteers; reached out to the local business community, attempted to purchase goods, etc.)

CMS Guidance to Nursing Homes Includes Masks for Residents 

Yesterday, the Centers for Medicare and Medicaid Services (CMS) also provided updated guidance on mitigating the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes.

The guidance includes five key actions:

  1. Ensure compliance with the CDC and CMS guidance on hand hygiene, infection control, CDC long-term facilities guidance and conservation of PPE.
  2. State and local health departments working with long-term care facilities on PPE needs and Medicare coverage of COVID-19 testing.
  3. Implement symptom screening and, in particular, monitor entrance and egress more tightly and screen everyone coming in for symptoms except EMS workers
  4. Ensure staff are using appropriate PPE based on availability of PPE. Note that this includes the following two additions:
    • Patients and residents who must regularly leave the facility for care (e.g., hemodialysis patients) should wear facemasks when outside of their rooms.
    • When possible, all long-term care facility residents, whether they have COVID-19 symptoms or not, should cover their noses and mouths when staff are in their room. Residents can use tissues for this. They could also use cloth, non-medical masks when those are available. Residents should not use medical facemasks unless they are COVID-19-positive or assumed to be COVID-19-positive.
  5. Designate separate staffing for COVID-19 and units or facilities to separate positive COVID-19 negative residents from COVID-19 positive residents.

For those who missed the Thursday CMS call, a summary of the Q&A is available for review.

ODM Clarifies: "Blanket Waivers Apply to Medicaid"

In an email to long-term services and supports associations yesterday, staff of the Ohio Department of Medicaid (ODM) shared that after further researching the nature of the 1135 blanket waivers granted by CMS on Monday, they believe that, unless otherwise noted, the waivers also apply to Medicaid requirements as well.

The letters stated:

“Based on internal conversations and research, the blanket waivers apply to both Medicare and Medicaid unless it specifically calls out Medicare."

For example, under the hospice-specific blanket waivers granted by CMS, it notes “Medicare telehealth” which means that those telehealth waivers apply only to Medicare. Workforce-related waivers do not specify Medicare, so are interpreted to waive the corresponding state requirements.

ODM also confirmed that it is working on its own 1135 waiver requests, which will expand on the blanket waivers provided.  

ODA Provides Updates on PASSPORT Services, Aide Training, EVV

ODA has been conducting weekly meetings with the Passport Administrative Agencies (PAAs) to provide COVID-19 information and updates. On April 3 they provided an update related to PASSPORT and Ohio Home Care Waiver and MyCare Ohio are as follows:

  • If PASSPORT and waiver individuals are willing to have services decreased, then case managers can approve their requests, but should attempt to find alternative services to meet the individual’s needs.
  • Provider’s supervisory visit(s) can be conducted telephonically if a supervisory visit is required by the waiver service.
    • The modified supervisory schedule must be documented in the individual’s service plan by the provider’s nurse supervisor.
    • The provider shall notify the case manager if they elect to perform the supervisory visit telephonically.

ODA realizes there are challenges for providers to acquire fingerprint impressions related background checks.  The Attorney General’s office has a complete list of sites that offer fingerprint impressions, but it is suggested to call the site before making a trip as the site may be temporarily closed.

Home Health workers are considered essential workers under the CARES Act, so therefore should be allowed to travel to and from work is travel restrictions are applied in the future. The worker should carry their badge with them and provide it is stopped for any reason.

ODA has determined that remote, internet-based trainings are acceptable for training aides as long as there is an in-person demonstration/return demonstration for skills training. This will meet the requirement in the laws and rules during the COVID-19 pandemic.

There have been changes to the EVV system in provider training has been suspended at this time. Also, the voice or signature requirement has been waived and exception for billing do not need to be cleared.

From Value First - Personal Safety Mask Solution

The following was sent to LeadingAge Ohio from partner Value First to share with the all LeadingAge Ohio membership:

Value First has been researching various suppliers that can fill member needs for critical supplies such as masks, gowns, sanitizer, etc. We believe we have found a viable solution for reusable antimicrobial personal safety masks.

America Knits www.americaknits.com is a textile manufacturer based in Swainsboro, GA. The company is owned by Steven Hawkins and Dr. David Talton. Mr. Hawkins has more than 30 years of experience in the textile industry and Dr. Talton is a cardiothoracic surgeon at North Mississippi Health System; a 600-bed health system in Tupelo, Mississippi. The two are lifelong friends and launched America Knits in the fall of 2019. Mr. Hawkins manages the day to day operations while Dr. Talton is still a practicing surgeon.

America Knits is part of a consortium with Hanes to provide 5-6 million masks to FEMA per week. As part of that consortium, America Knits will be providing about 500,000 masks for FEMA per month. Their mask has several properties that make it unique: 

  • It has antimicrobial / antiviral properties impregnated into the fabric
  • The mask is reusable / washable. The antimicrobial properties are guaranteed to last 20 wash cycles. They have washed masks 50 times that still retain their anti-microbial properties
  • The entire mask is made in the US. The raw material and production are all based in the US
  • 30,000 masks have been ordered by both North Mississippi Health System and the University of Alabama Birmingham Health System
  • The mask is FDA approved and is currently being provided to FEMA
  • The cost is $2.50 per mask including shipping. They will have a capacity of 70,000 – 100,000 masks available per week starting in 2 weeks.
  • A 50% deposit is required when the order is placed, and the balance is due 15 days after delivery of the product.
  • Minimum order is 1 case, which is 500 masks
  • Please note that Value First does not have GPO agreement with this supplier; LeadingAge members are receiving the manufacturer cost with no fees being paid to Value First or any other entity outside of America Knits

It should be noted that these masks are not intended to be used when treating a resident that has a confirmed or suspected COVID-19 diagnosis. These masks are intended for general use by staff, residents and visitors that are not having direct interaction with individuals with confirmed cases of COVID-19. The masks are a great option based on the increased cost and lack of availability of disposable masks as well as the recent CMS guidance for everyone in the facility to wear a mask. https://leadingage.org/regulation/cms-issues-new-recommendations-nursing-homes-covid-19-crisis

We have had a number of members review the product, and the response has been positive. LeadingAge members have placed orders for about 80,000 masks so far. America Knits is committed to helping LeadingAge members meet their supply needs during these challenging times. If you are interested, please reach out to Denise May at dmay@valuefirstonline.com for additional information.

Ohio Statistics: 3,739 Cases, 102 Deaths

As of today, the Ohio Department of Health confirmed there were 3,739 confirmed cases, 326 ICU admissions, 1,006 hospitalizations, and 102 deaths as a result of the COVID-19 pandemic.

More data is available on the COVID-19 Dashboard.

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.

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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.