07/12/2020

Today's COVID-19 Report: Monday, July 13, 2020

Monday, July 13, 2020

Here are the latest need-to-know updates for Monday, July 13 regarding the COVID-19 pandemic.

Ohio Relief Payments: $91 million for Nursing Homes, $78 million for ICFs, Waivers

Today, the DeWine Administration requested Controlling Board approval of $91 million in relief payments to be made to Ohio nursing facilities, in addition to the previously-announced $25 million in payments to nursing homes based on their performance on the focused infection control surveys. The Administration also received approval for $78 million in relief payments to intermediate care facilities for individuals with intellectual and developmental disabilities (ICFs), as well as to providers of the Ohio Assisted Living and PASSPORT waivers.

In its request, the Office of Management and Budget noted that providers have incurred significant losses, continue to incur losses, and are experiencing additional costs due to the pandemic, making these payments necessary to respond to the COVID-19 public health emergency. The Administration noted that it had surveyed nursing homes to identify staffing issues, additional costs for Personal Protective Equipment (PPE), and other cost drivers and used historical cost report information to calculate the losses. Nursing facilities also experienced significant declines in their census of private pay and Medicare-only patients.

The calculated amounts are based on estimates of the three-month impact of these losses on each respective provider group. Ohio is among the last states nationwide to signal how it will disburse CARES Act provider relief funding.  Provider relief payments will be made by the Office of Budget and Management to providers upon completion of registration and certification online through OBM’s Ohio Grants Partnership website.

Two New Resources Added to COVID Hub on Social Isolation and Outdoor Visitation Guidance

As members continue to provide high-quality care to Ohio’s vulnerable populations, LeadingAge Ohio has created two new resources on the COVID-19 Hub for members to help address concerns with social isolation and the upcoming outdoor visitation for long-term care settings. 

The new Outdoor Visitation Toolkit provides members with sample letters, templates and signage to help communicate valuable information for staff, residents and families regarding the upcoming outdoor visitation for long-term care communities effective July 20, 2020.

Working with LeadingAge Partner Link-age, the social isolation resource page provides a series of resources and opportunities to help providers tackle social isolation in their communities, offer telehealth solutions, and help older adults as they adapt to this “new normal.”

ODA Offers Face Coverings to Adult Day in Preparation for Reopening

The Ohio Department of Aging (ODA) announced they are offering cloth face coverings to both adult day facilities and senior centers across the state in preparation for reopening. ODA has asked that all adult day and senior centers compete the following shipping and center information. 

Facilities have been asked to take one survey for each location, and complete the survey multiple times, if necessary, for additional locations. Shipments will be bundled by postal address. ODA has asked that facilities complete the request no later than end of day Wednesday, July 15.

You Asked... We Answered

This week’s You Asked... We Answered question asks: “How long should a resident be quarantined following a hospital stay?”

You asked: We are running out of rooms for our hospitalized residents and would like to move them to a regular unit sooner than 14-days following a hospital stay. Do all new admissions to a nursing home require a 14-day quarantine?

We answered: Discontinuation of transmission-based precautions is based on whether COVID-19 status is known.

A resident with unknown COVID-19 status is to remain in quarantine for 14 days. The term "unknown COVID-19 status" in the context of this guidance describes anyone who has not tested positive, that includes those who have tested negative as well as those who have never been tested. ODH recommends the use of transmission-based precautions, including full PPE (with N95 respirator) during this period so that you protect your staff and other residents if one of the new admissions/readmissions turns out to be COVID positive.

For a resident who has tested positive, the CDC test-based strategy or a symptom-based strategy can be used to discontinue transmission-based precautions to determine when to move the resident to a regular unit. Symptomatic residents should remain in transmission-based precautions.

For a resident who tested positive but has not had symptoms, a time-based or test-based strategy can be used. When a COVID-19 positive hospitalized patient recovers, has had transmission-based precautions discontinued and needs to go to a nursing home, they do not require further restrictions, based upon their history of COVID-19.

2020 LeadingAge Ohio Compensation Survey Follow-up: Impact of COVID-19

This year’s LeadingAge Ohio compensation survey offered members the opportunity to receive their organization’s performance alongside the final survey results providing a customized comparison to similar organizations in the same service area.  Those organizations that participated in the survey should have already received their customized  survey results from LR Webber. Non-participating member organizations have the opportunity to purchase the overall compensation survey results for $200.  Contact Jennifer Taylor at jtaylor@leadingageohio.org to learn more.

Additionally, those member organizations that participated in this year’s survey will be contacted by LR Webber in the next week to answer several questions on the impact of COVID-19 on compensation.   

Certain CMS Activities to Resume

A new memo from the Centers for Medicare & Medicaid Services (CMS) was released called Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs). The memo outlines activities halted by CMS during the emergency that are starting back up.

Two important pieces that will resume are:

• Medical review for Medicare FFS restarts on August 3. CMS suspended most FFS Medicare reviews on March 30 due to the PHE (Public Health Emergency). They will be restarting on August 3 regardless of the status of the PHE (which LeadingAge expects to be extended). Pre-payment medical review conducted by the Medicare Administrative Contractors (MACs) under the Target, Probe, and Educate (TPE) program and post-payment reviews by MACs, SMRCs, and RACs will resume.  If selected for review, providers can discuss with their contractor if they have COVID-19 related hardships that could impact their audit response timeliness. The contractors will take into account waivers and flexibilities in place at the time of claim submission for any they review (for example, telehealth).
  
  
• The Home Health Review Choice Demonstration was paused on March 29 due to the pandemic and CMS will resume demonstration operations in all states on August 3. A forthcoming memo regarding resumption of the demonstration will provide additional details. CMS also said they are not planning to extend this demonstration beyond its current end date of May 31, 2024.

New Announcements from CMS: Hotspots & LTC Roundtable 

The Centers for Medicaid & Medicaid Services (CMS) recently made several important announcements.  “CMS Directs Additional Resources to Nursing Home Hotspot Areas” explains how CMS is going to deploy Quality Improvement Organizations (QIOs) to provide immediate assistance to nursing homes in hotspot areas identified by the White House Coronavirus Task Force. 

The second announcement is a press release about a virtual long-term care (LTC) roundtable convened by Seema Verma in Detroit.  The press release includes a full list of CMS public health actions to-date for nursing homes on COVID-19.

CMS Addresses Inquiries on COVID Testing for Hospice Staff Entering Long-term Care Facilities

The Centers for Medicare & Medicaid Services (CMS) answered questions recently raised regarding COVID testing for hospice staff entering long-term care (LTC) facilities to serve hospice patients. Based on the guidance published on May 18 it is expected that hospice staff should be included in the LTC testing program as stated on page 2 of the memo.

For tracking purposes, CMS encourages providers to continue to reach out to CMS regarding situations where there may be concerns or other inconsistencies impacting hospice care during the COVID-19 pandemic.  Additionally, CMS encourages providers to share inquiries with the LTC team and during the CMS “office hours” for both hospice and LTC.

CMS has provided the guidance document related to testing and links to the Hospice Resource mailbox; LTC Resource mailbox; and dates/times of the office hours for your convenience.

1. LTC Resource mailbox: DNH_TriageTeam@cms.hhs.gov 
2. Hospice Resource mailbox: QSOG_Hospice@cms.hhs.gov
3. HHS/Hospice and LTC call information in addition to other general office hour calls hospice providers may be interested in: Access this information on the CMS website.

Members are encouraged to reach out to LeadingAge Ohio's Susan Wallace swallace@leadingageohio.org or Anne Shelley ashelley@leadingageohio.org if there are issues contacting CMS. 

FDA Updates on Hand Sanitizers with Methanol

The U.S. Food and Drug Administration (FDA) is warning consumers and health care providers that the agency has seen a sharp increase in hand sanitizer products that are labeled to contain ethanol (also known as ethyl alcohol) but that have tested positive for methanol contamination.  Methanol, or wood alcohol, is a substance that can be toxic when absorbed through the skin or ingested and can be life-threatening when ingested.  Read the FDA warning to learn how you can identify contaminated products and keep your staff safe.   

HUD Releases “Light Touch” MOR Memo

The U.S. Department of Housing and Urban Development (HUD) has now publicly shared an internal memo from June 23 to restart Management and Occupancy Reviews (MORs) at HUD-assisted properties. Effective May 22, HUD lifted the suspension on MORs in locations where there are no health restrictions by state or local law. The memo included guidance for an alternative approach for MORs, or “light touch” reviews. Among other flexibilities, the alternative guidance temporarily allows PBCAs to conduct on-site MORs without entering resident units and will allow the file review to be completed without contact with management staff. LeadingAge has pushed back on the restarting of MORs, regardless of an area’s “reopening” status, because of the ongoing health risk at older adult communities. 

HUD Announces Service Coordinator CARE Act Allocation

The U.S. Department of Housing and Urban Development (HUD) released a memo outlining plans to allocate the $10 million in Service Coordinator funding approved by the CARES Act at the end of March. The funds will support approximately 1,600 properties with grant-funded Service Coordinator programs.

Grantees with an approved 2020 Service Coordinator grant extension will receive a one-time grant supplement; the amount will be directly proportionate to each grantee’s approved 2020 budget, resulting in an estimated 9% of each program operating budget. The agency said they plan to issue guidance for budget-funded Service Coordination and other COVID-related expenses soon. The LeadingAge summary is available at this link.

LeadingAge Need to Know: COVID-19 – July 13, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured highlights of LeadingAge's continued advocacy and media efforts, registration information for the upcoming August 6 webinar on "Re-opening the Workplace" and the 2020 Collaborative Health IT Summit.

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.