08/03/2020

Today's COVID-19 Report: Monday, August 3, 2020

Monday, August 3, 2020

Here are the latest need-to-know updates for Monday, August 3 regarding the COVID-19 pandemic.

State-supported Staff Retesting in Nursing Homes - Webinar Recap & Resources

Today, the Ohio Department of Medicaid (ODM) conducted a State-Supported Staff Retesting in Nursing Homes webinar. LeadingAge Ohio's Stephanie DeWees provided a summary of the webinar:

ODM began today’s webinar reminding facilities about the last activities being completed to wrap up the first round of testing, which just concluded. A summary of testing results of the baseline testing needed to be submitted to CCURT@odh.ohio.gov. For those that completed the testing with the state and Ohio National Guard (ONG) support, the letter noting summary results for any staff that were NOT tested on the testing date was due three weeks after the testing date. If a facility conducted testing without the state and ONG, a letter with a summary of all the results needed to be submitted by Friday, July 31. The letters should be submitted to the CCURT email. Furthermore, facilities must maintain a spreadsheet with the list of all resident and staff testing that can be immediately provided to ODH upon request

Beginning today, August 3, nursing homes are required to have staff tested every other week. Facilities that do not use state support must have the staff testing completed by August 14 and no earlier than August 1.

Facilities utilizing the state-supported testing will be required to do the testing on the date assigned by ODH, which might be later than August 14. Facilities that conduct their own testing must perform RT-PCR or Antigen testing using FDA EUA Rapid POC Devices. Instead of sending a verification letter of testing results, facilities will complete an online survey.

Lab assignment will be based on the state regions and the weekly schedule of testing sites will be publicly available. If you see something wrong, such as the number of test kits, email CCURT immediately. All test kits will be sent to the nursing home, eliminating the need for a facility to pick them up. Quest lab will send facilities their test kits every other week. All other labs will send three rounds of testing kits at a time.

Facilities are responsible to ensure staff are trained and appropriate PPE is available. ODM reminded providers to use the checklist and video sent out last week. Test kits need to be maintained according to the instructions, as some require refrigeration following specimen collection. The swab may be a nasopharyngeal swab, which can also be utilized for anterior nasal swabbing. The vials need to be maintained upright, have two forms of identifiers on them, such as name and date of birth, and must be kept in a biohazard bag. All specimens should be packaged in one large zip lock bag. The ONG will call on the day of pick up and providers will proceed with a curbside hand-off.

The lab requisition must be complete, have an appropriate ICD-10 code, and include insurance information. The state affirmed that it will be the payer of last resort after all other insurance options are exhausted. However, for incomplete forms or all forms reflecting uninsured, the state will bill the nursing home employer. The state is in the process of developing a way to financially support self-insured nursing homes, but those are not yet finalized.

PRN staff and new hires need to be tested prior to being scheduled for work. The person can work while awaiting results if they remain asymptomatic, but these individuals need to assume they may be positive and should always wear a mask, including in breakrooms. They should not eat with the other staff.

The state strongly recommends non-nursing home staff coming into the facility be tested; they can then be counted in the facilities count and be tested through the state-supported plan.

A campus with assisted living may choose to test staff with the nursing home process or assisted living process. If staff miss the testing day they should have a specimen collected before they work again. Staff that previously tested positive should not be retested for up to 12 weeks.

Resources

• State-Supported Staff Retesting in Nursing Homes webinar recording
  • Slides
• COVID-19 Testing in Ohio Nursing Facilities Congregate Care Unified Response Team FAQ
• ODH Guidelines for Testing of Nursing Home Residents and Staff

You Asked... We Answered

You Asked:  During the Ohio Department of Health (ODH) and Ohio Department of Medicaid (ODM) presentation last Tuesday, Rebecca Sandholt of ODH stated that hospice staff did not need to be tested prior to entering a nursing home for end of life/compassionate care. However, the slide that was up said that all staff had to be tested and it referenced testing of hospice staff. Would you confirm that hospice staff are not required to be tested?

We Answered:  Hospice staff are not required to be tested. LeadingAge Ohio reached out to ODH for clarification on whether hospice workers needed to be tested every two weeks, and ODH stated hospice workers do not need to be tested. ODH then referenced the Director’s Fourth Amended Order to limit access to Ohio’s Nursing Homes and Similar Facilities with Exceptions dated July 2, 2020, specifically noting: 

• Individuals participating in end-of-life situations are permitted in-person visitation and should not be required to be tested first.
• End-of-life situations are defined in the Director’s Order.

Even though ODH has stated hospice staff do not need to be included in every two-week nursing facility testing, some facilities, per their organizational policy, may require hospices to test their staff. During the ODM nursing home staff test, it was again confirmed that hospice staff do not need to be tested. ODM did go on to say they recommend testing of hospice staff as a best practice and are allowing facilities to include in their numbers hospice staff in every two-week testing.

REMINDER: Assisted Living Members - Submit Data for HHS by 5:00 pm

As previously reported (Data Collection for Possible New Provider Relief Fund Distribution) and re-sent this morning, LeadingAge has teamed up with other national assisted living associations to gather data on behalf of the Department of Health and Human Services (HHS) to support its efforts to channel relief funds to the assisted living sector. Previous articles included problem hyperlinks, so members are encouraged to use the direct portal link. Data is needed by 5:00 pm today to allow for data to be validated and submitted to HHS by Wednesday, August 5.

As of 2 pm Friday, the portal had received 4715 total records and 3243 records, which is a steep increase from before but still represents only a small segment of the sector. All data submitted is matched with data provided by HHS and state governments. Those that match will go on the validated list which will be submitted to HHS. Over the weekend, the portal vendor will be providing the associations with those files that cannot be matched because of insufficient data, and LeadingAge will reach out to those members to resolve discrepancies.

Technical issues experienced with the portal:

• When using Internet Explorer, some members have been unable to enter data. Therefore, it is recommended to use Chrome, Edge or Firefox to access the portal.

• Members who opt to upload a file should not click ‘submit’--they will receive an error if they do. There is information on this now in the FAQs on the portal website.

• Some IT security systems--particularly Cisco systems--block access to the site identifying this URL as unsecure. It is not unsecure nor does it have malware. Because it is a private portal that was just created in the past few days, it is triggering the warnings. For help with this issue, reach out to the portal vendor at techsupport@infernored.comor leadingage@leadingage.org.

• Once data is submitted, providers will not receive an email confirmation.  They will see either a green banner or a pop-up confirming successful submission. If they don’t, it is likely a browser issue (see first bullet).

Members can submit questions to the leadingage@leadingage.org inbox, which will be monitored continually to ensure quick response.

Wanted: Billing & Eligibility Specialists

LeadingAge Ohio is assembling an ad hoc subcommittee of billing, eligibility and operations specialists from across the continuum, to respond to members’ most pressing challenges related to reimbursement, including emergency rule changes related to the pandemic, ongoing relations with Ohio’s managed care plans, and other challenges.

Do you know the tips and tricks for communicating managed care plans? Do you have a colleague who is a wiz walking families through the Medicaid application process? We want to hear from you! To nominate a colleague for the subcommittee, email Susan Wallace at swallace@leadingageohio.org.  

House Passes HUD FY 2021 Bill 

On Friday, July 31, the U.S. House of Representatives passed its fiscal year 2021 Housing & Urban Development (HUD) spending bill within a massive package of four FY21 spending bills. The bill includes increases for the Section 202 account, including $110M for new Section 202 homes. The Senate is not expected to take action on its FY21 HUD bill until at least September. There will most certainly be a continuing resolution to keep programs funded at FY20 levels from the start of FY21, on October 1, until after the November elections.

Also, in the package of bills was the Health & Human Services (HHS) discretionary budget, which includes a few items of interest to LeadingAge members. Included in the bill was the National Academies of Science Engineering and Medicine study updating and modernizing how to identify, measure and implement quality of care in nursing homes that LeadingAge has been recommending. Further, there is an intriguing study ordered on whether and how to create Geriatric Centers of Excellence that would address integrated and holistic supportive care. 

The report language also acknowledges the importance of the Program of All-Inclusive Care for the Elderly (PACE) program and urges CMS to move forward on PACE-specific pilots authorized by the PACE Innovation Act, to test “the innovative, comprehensive, integrated and fully risk bearing PACE model with new Medicare or Medicaid beneficiaries.” 

Finally, the proposed amount for state survey and certification activities is $10,000,000 more than the FY 2020 level, with language indicating that additional funds allocated to address COVID-specific survey activities have not yet been allocated.

Final FY 2021 Hospice Payment Rule Issued

On Friday, July 31, the Centers for Medicare & Medicaid Services (CMS) issued its final FY 2021 hospice payment rule containing updates for the applicable wage index, payment rates (with a 2.4 percentage update), and cap amount. The rule incorporates, as part of the FY 2021 wage index, recent Office of Management and Budget (OMB) statistical area delineations, with a 5 percent cap on wage index decreases for a one-year transitional period. The rule does not finalize plans to sunset the Service Intensity Add-on (SIA) budget neutrality factor.

Finally, the rule imposes, as proposed, requirements for modifications to the hospice election statement and that hospices offer an Election Statement Addendum containing information about diagnoses, services and treatments that will not be covered by the hospice as they are deemed “unrelated” to the principal diagnosis and any related conditions (the Patient Notification of Hospice Non-Covered Items, Services, and Drugs). These changes were proposed during the FY 2020 rule cycle to become effective October 1, 2020. CMS also offers a model election statement and sample addendum for use in fulfilling the new Election Statement/Addendum responsibilities. The overall impact of the rule is an estimated $540 million in increased hospice payments.

A summary of the final rule was created by the National Association for Home Care & Hospice. If you have any questions regarding the FY2021 hospice final rule, please contact Anne Shelley at ashelley@leadingageohio.org.

NAHC Survey - Home Infusion Therapy Supplier Benefit

LeadingAge Ohio is sharing the following survey from the National Association of Home Care & Hospice (NAHC) as a reminder for providers of the change in infusion services in January 2021 and to receive feedback.

The National Association for Home Care & Hospice is interested in knowing how home health agencies (HHAs) are preparing for the new home infusion therapy supplier benefit. As you are aware, beginning  January 1, 2021, HHAs will no longer be permitted to provide the professional services with the provision of Part B infusion drugs under the home health benefit. The professional services associated with Part B infusion drugs must be provided by a Medicare home infusion therapy supplier. HHAs may enroll in Medicare as a home infusion therapy supplier or may subcontract with a home infusion therapy supplier to provide the professional services. To inform our comments to CMS on the HHPPS proposed rule for the home infusion therapy supplier benefit, we are asking for your help by completing this brief survey by August 21, 2020. 

FEMA PPE: Second Shipment Challenges & Action Steps

LeadingAge has heard concerns and problems with the second Federal Emergency Management Agency (FEMA) PPE shipment. LeadingAge met with FEMA staff to try to resolve the concerns. One week’s supply of PPE (in anywhere from one to 20 boxes) has been shipped to all Medicare/Medicaid certified nursing homes in the country, using a list provided by CMS.

Here are some helpful insights from FEMA:

• FEMA official. When it was mentioned that more than half of nursing home members who responded to a poll on a LeadingAge member call said they had not yet gotten the shipment, the FEMA official, Dave Sanford, was surprised and committed to finding a resolution.  Sanford said only about 10-12% are still in the shipping process.  If nursing homes have not received their packages from FEMA, they are invited to contact Sanford at Sanford@dla.mil. 
• Updates on contents.  The packages should include gloves, surgical masks, and gowns. Hearing criticism and dissatisfaction with the heavy blue plastic gowns, FEMA switched to disposable gowns (with hand and wrist holes already cut). If any of the items are not functional or useable, Sanford suggests first calling the 1-800 number included in the package.  It will connect to the contractor Federal Resources, who will replace the items. This applies to things like gloves that are too small, the wrong kind of gloves, masks that are defective, etc.  If organizations don’t get satisfaction from Federal Resources, feel free to email Sanford.
• Additional PPE. For additional PPE, FEMA suggests working with state authorities.  If that is impossible, Sanford suggests reaching out to him and he and his staff will work with the FEMA regional office to solve the problem.

Sanford plans to join LeadingAge's 3:30 update call on Wednesday, August 5. 

Life Plan Communities/CCRCs: NSL Wii Bowling Championships Coming Up

Residents with access to a Nintendo Wii can participate in the upcoming National Senior League (NSL) Wii Bowling Championships. NSL is committed to providing senior Wii bowlers with the opportunity to socialize with friends, Wii Bowl and have fun!  NSL understands and respects communities which remain closed or have limited activities available for residents/members.

The 2020 Wii Bowling Fall Championships begin the week of September 7.  Registration is available online at www.nslgames.com, by calling 435-714-9491, or by sending an email to Dennis Berkholtz at dennis@nslgames.com. 

Links

CMS Finalizes $750M Medicare Payment Boost for Nursing Homes in Fiscal 2021 (Skilled Nursing News)

LeadingAge Need to Know: COVID-19 – August 3, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured a reminder about the assisted living data collection portal deadline today and information on a legal-focused webinar dealing with COVID-19 and its effects on the workforce.

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.