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05/05/2021

Today's COVID-19 Report: Thursday, May 6, 2021

Thursday, May 6, 2021

Here are the latest need-to-know updates for Thursday, May 6 regarding the COVID-19 pandemic and other topics of importance.

Off the Record

“The value of the worker, I think, became abundantly clear to many -- which has been clear to us within the network for a very long time. And they kept doing it, they persevered, in spite of criticism, in spite of many changing expectations and duties they had, long hours, the impact to them, the risk. They have been champions.”

From testimony to the Ohio Senate Health Committee by Ohio Department of Aging Director Ursel McElroy, May 5. The full Senate Health Committee testimony, including LeadingAge Ohio’s, is accessible on the LeadingAge Ohio website.

In Today's Report

You asked... We answered: Masks with clear shields

You asked:

Are masks with a clear shield acceptable source control?

We answered:

Yes, the Centers for Disease Control and Prevention (CDC) provides the following recommendations:

Clear masks or cloth masks with a clear plastic panel are an alternative type of mask for people who interact with:

The Ohio Department of Health (ODH) has also provided a response to the following question: Can a facility provide clear face masks for families to use during indoor visitations? ODH responded that a clear face mask would serve as source control. However, clear face shields worn with no mask are insufficient.

LeadingAge Ohio All-member call: Tuesday, May 11 at 11:30AM on R3AP

LeadingAge Ohio will hold an all-member Q&A call next Tuesday, May 11 at 11:30AM. Members can register in advance for this webinar by clicking here. All questions for the call can be sent in advance to COVID19@leadingageohio.org. The call will also allow participants to ‘chat’ questions.

LeadingAge Ohio staff will be joined by National Church Residences’/Central Ohio Geriatrics’ Dr. John Weigand to discuss his work with the Department of Aging’s (ODA) Regional Rapid Response Assistance Program (R3AP, pronounced “RAP”). The program has been designed by ODA and the Ohio National Guard to help Ohio aging services providers support and protect older Ohioans through the COVID-19 pandemic and beyond. Dr. Weigand will discuss how members can use R3AP, particularly in light of Governor DeWine’s Monday announcement yesterday that “the Ohio Department of Aging and Ohio Department of Health have developed a homebound vaccination playbook for organizations working to ensure homebound individuals have access to the vaccine”.

Ohio plans to utilize R3AP to deliver the vaccine where it is needed, so Dr. Weigand’s presentation will provide insights into how members can engage with the program. In addition, the program provides services to Ohio’s congregate care settings, as well as senior housing, day centers, senior centers, assisted living and nursing facilities that include but are not limited to: vaccination, COVID-19 testing (and variant identification) and contact tracing, temporary staff support, PPE distribution, infection control resources, and training. The R3AP will also work with local health teams to mobilize and deploy personnel to provide key services. Partners include local health departments and local emergency management agencies. That playbook is available on the coronavirus website at coronavirus.ohio.gov. 

ODH provider call updates: Surveyor guidance; eye protection; visitation; family satisfaction survey

This week, LeadingAge Ohio staff met with staff of the Ohio Department of Health (ODH), including individuals from the Bureau of Survey and Certification and the Bureau of Infections Disease (BID). They offered the following updates and clarifications:

Surveyor guidance. Surveyors have been instructed to minimize their footprint in buildings and the Ohio Department of Health (ODH) is requesting facilities to provide remote access to the EMR during the survey which would facilitate surveyors doing items such as closed record reviews off-site and not while located at a nurse’s station. Several surveyors are still being trained. Members are encouraged to let LeadingAge Ohio know of any concerns with trainees or trainers.

Eye protection clarification. LeadingAge Ohio has asked ODH for clarification on eye protection requirements if the county has a positivity rate of greater than 5%, designated as yellow or red counties due to the variety of opinions by surveyors on this guidance. LeadingAge Ohio also provided to ODH the response the Centers for Disease Control and Prevention (CDC) gave to LeadingAge Ohio that universal eye protection, when there is moderate to sustained spread, would only need to be worn during patient encounters. This was also stated during the April 29 CDC call. ODH’s Bureau of Infectious Disease has forward the question onto CDC for clarification on how patient encounters are defined. 

Visitation for fully vaccinated individuals. Ohio Department of Health (ODH) has confirmed that, while visitation orders in Ohio remain inconsistent with CDC visitation recommendations found in the Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination webpage, Ohio did not release a new order on access in nursing homes and residential care facilities yesterday along with the updated testing orders. The seventh amended order remains in effect at this time but the order does state facilities shall adhere to all relevant Centers for Medicare & Medicaid Services (CMS) guidance for dining and communal activities. ODH Bureau of Survey and Certification stated that they survey facilities under the Centers for Medicare & Medicaid Services (CMS) guidance and CDC recommendations. LeadingAge Ohio advocated for the removal of the restrictions that were more stringent than CDC and CMS, especially the visitor escorting requirement which creates an additional staffing challenge for facilities already impacted on staffing because of the pandemic.

Family survey. The Ohio Department of Aging (ODA) is contracting with Scripps now on its biannual satisfaction survey of family members. The first communication providers will receive is anticipated in July, with the entire satisfaction survey process going through June of 2022. LeadingAge Ohio requested that communications to family members include information on the length of time it will take before survey results will be provided to the facility and posted. This year, the satisfaction survey will also include an optional eight questions specifically addressing COVID. LeadingAge Ohio also expressed concern on the results of the survey since families have been restricted from entering facilities since the beginning of the pandemic. The COVID questions will not be part of an individual facility’s results but will be looked at in their aggregate.

Ohio updates testing orders

On May 4, the adult day, nursing home and residential care testing orders were updated to allow fully vaccinated staff to be removed from the routine staffing cadence. Unvaccinated staff are required to be tested twice a week. Ohio has made the nursing homes and residential care facilities testing frequency for unvaccinated staff the same. The Ohio Order is more restrictive than the QSO-20-38-NH memo which allows a less frequent cadence for unvaccinated staff in counties with low to moderate county positivity rates. Ohio nursing homes will need to follow the more restrictive Ohio order which will require all unvaccinated staff to be tested twice a week.

Regardless of vaccination status, strategic testing of staff and participants shall continue. Strategic testing may include, but is not limited to, testing staff and residents/participants with known or suspected COVID-19 exposure; testing symptomatic staff and participants; or testing staff and participants as determined clinically necessary. Residential care facilities and adult day centers should work with their local health department to determine the strategic testing necessary when there is a new positive case. Nursing homes must conduct outbreak testing as outlined in the Ohio Order and the CMS memo which requires a nursing home, if there is a single new case of COVID-19, meeting the outbreak definition outlined in the order, then to begin outbreak testing of all staff and resident are to be tested and re-tested every three to seven days until now new cases have been identified for a period of 14 days. 

Communal activities and dining

Ohio Department of Health (ODH) has confirmed that facilities are able to move forward with implementing the Disease Control and Prevention (CDC) communal dining and activities guidance found in the Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination webpage. Ohio did not release a new order on access in nursing homes and residential care facilities yesterday along with the updated testing orders. The seventh amended order remains in effect at this time but the order does state facilities shall adhere to all relevant Centers for Medicare & Medicaid Services (CMS) guidance for dining and communal activities.

LeadingAge Ohio, members testify before Ohio Senate Health

On Wednesday, May 5, LeadingAge Ohio Chief Policy Officer Susan Wallace testified before the Senate Health, Human Services & Medicaid Committee on HB110, Ohio’s operating budget for SFY 2022-2023.  She was joined by LeadingAge Ohio members Ann Conn of the McGregor Foundation, who testified in support of expanding Ohio’s PACE program, and Tom Thompson of JRC, who testified in support of boosting adult day reimbursement, as recommended by the House. Three other members (Salli Bollin, MemoryLane Care Services; John Gazzuolo, Jennings; Eric Murray, Youngstown Jewish Federation) submitted written testimony in support of the adult day amendment that was included in the House budget.

Wallace urged the Senate to fully fund the rebasing of rates. While LeadingAge Ohio supports the quality incentive program, the low base rates in Medicaid lead to lower quality at facilities with high rates of Medicaid residents. "Rebasing is a critical way to shore up the system and ensure no provider falls below a basic level of reimbursement," she said. "It is also a predictable relief and stabilizing force in a sector that is still reeling from the past year. It also, ultimately, ensures that those Ohioans who need facility-based care have access to quality care wherever they reside."

She called the 4% increase for home and community-based services in the executive budget a "modest but needed step" and said it should be boosted to 5% each year. Also needed is a new process to review rates. "Outside of the state budget process, there is currently no stakeholder process for regular analysis of the adequacy of Medicaid reimbursement," she said. "As a result, we time and again see the erosion of the provider community and always feel that we're playing catch-up each budget, working to correct misalignment that at times dates back decades."

LeadingAge Ohio’s full testimony is available on its website.

Changes coming to COVID-19 vaccine reporting module on NHSN

The Centers for Disease Control and Prevention (CDC) shared yesterday that changes are underway to the COVID-19 vaccine reporting module on the National Healthcare Safety Network (NHSN). A few data elements are changing to streamline reporting and provide greater clarification around requested data. Recall that this reporting is currently optional; however, based on the Centers for Medicare & Medicaid Services (CMS) “strongly encouraging” reporting through this module and the recently proposed FY 2022 SNF PPS rule that includes a proposed SNF QRP measure on COVID-19 vaccination rates among staff, LeadingAge Ohio will be keeping an eye out for a switch from optional to mandatory reporting. Updated Tables of Instructions and FAQs on this reporting module will be released next week and NHSN will hold a training on Tuesday, May 11 at 3:30PM. Registration has not yet opened but will be posted here, along with the above-mentioned documents. A recording of the May 11 training will be available at the same link following the training.

Appendix K approval

The Ohio Department of Medicaid (ODM) and the Ohio Department of Aging (ODA) have received federal approval to make COVID relief payments through a Centers for Medicare & Medicaid Services (CMS) Appendix K approval to eligible Ohio Home Care, PASSPORT, and MyCare (HCBS) providers; Assisted living waiver is not included.

The amount of each eligible provider’s payment will be calculated as a percentage of the total amount of paid claims for waiver nursing, personal care, and home care attendant for dates of service from August 1, 2020 through October 31, 2020. In addition, the Ohio Department of Developmental Disabilities, under the same authority, received federal approval and has made COVID relief payments for the same dates and similar community-based services.

These are one-time payments and no other actions are required by the provider to receive payment. Furthermore, ODM confirmed for LeadingAge Ohio that no reporting would be required for these payments: they would be treated as any other Medicaid reimbursement. ODM officials indicated the rationale for payments is the ongoing workforce shortage, particularly in nursing and aide services. Eligible providers can expect payment between May 17 and the end of the month. Please send inquiries to medicaid@medicaid.ohio.gov.

Don’t throw away BinaxNOW cards with an imminent expiration date

The BinaxNOW cards sent from the Department of Health and Human Services (HHS) have an expiration date on the boxes of 6 months, so some of the tests members received in the fall may be reaching that date -- but don’t throw them out! Abbott has filed with the Food and Drug Administration (FDA) to have a longer expiration period for all lots of tests in the field. The 12-month expiration date for BinaxNOW cards is explained here.

Bills introduced on Citizenship for Essential Workers during COVID-19

The bicameral Citizenship for Essential Workers Act, which would allow undocumented persons working as essential workers during the COVID-19 pandemic to be eligible for a path to citizenship, has been introduced. The legislation (S. 747 and H.R. 1909) proposes that these workers receive permanent resident status. Individuals eligible for the adjustment of status under the legislation include those working in the nonprofit sector, or health care occupations, including home health care and residential care and home and community based services (HCBS). An article on the legislation, and other legislative proposals that address permanent path to citizenship, is available here.

LeadingAge Need to Know

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's Need to Know featured the campaign launch of Building Communities of Strength and a photo request for your community.

Check out the full report here.

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Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook gro up 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. 

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