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Today's COVID-19 Report: Thursday, April 22

Thursday, April 22, 2021

Here are the latest need-to-know updates for Thursday, April 22 regarding the COVID-19 pandemic and other topics of importance.


LeadingAge Ohio releases weekly Affordable Housing newsletters on Mondays and Home Health and Hospice newsletters on Tuesdays. Please email to receive either/both publications.

In Today's Report

  • Omnibus amendment makes no changes to House budget sub bill
  • Regional Rapid Response Assistance Program offering assistance 7:00AM to 7:00PM
  • Survey Tip of the Week: Falls with major injury
  • All providers invited into AHRQ's Project ECHO
  • Careers in Aging Week continues until April 24 – show off your aging services pride!
  • You asked... We answered regarding discarding N95's after multiple uses.
  • LeadingAge Need to Know

Omnibus amendment makes no changes to House budget sub bill

On Tuesday afternoon, the Ohio House Finance Committee released its omnibus amendment and passed House Sub Bill 110, the operating budget for SFY2022-23, out of committee. On Wednesday, the House passed the bill 70-27, moving the bill over to the Senate for consideration.

The omnibus amendment made no changes to LeadingAge Ohio’s key priorities related to nursing homes, adult day services and home- and community-based services. As it currently stands, the budget bill does the following:

Nursing Homes

  • Restoration of the rebasing process in the Ohio Revised Code, with language specifying that it would take place no later than June 30, 2022, and be based on CY2019 data. The bill partially funds rebasing at $100 million ($50 million per year) across the biennium—short of the projected $360-460 million that would be required to bring nursing home reimbursement in line with costs for the entire biennium

  • Restoration of language implementing the quality incentive payment (QIP) in Ohio Revised Code, with certain modifications, including:
    • Replacing the occupancy-based exclusion from the QIP. Providers will now be excluded from receiving the QIP if their total points falls into the bottom 33% of providers statewide
    • Continuing the methodology used for SFY 2022 through SFY 2023
    • Increases the funding for the QIP by $108.5 million for each year of the biennium (up from $50 million in the Executive Budget)

  • Creation of a Quality Incentive Payment Commission to quality incentive payment metrics, nursing facility base rates, and cost centers with a report due to the General Assembly no later than August 31, 2022.

  • Significant modification to the Executive Budget’s proposal to expand the authority of the Director of Health. Modifications include:
    • Requiring the Director to provide 24 hours advance notice prior to entering a facility
    • Allowing nursing home to request a hearing regarding the action
    • Lowering the maximum fine to $100,000 per incident (rather than $250,000 per instance of noncompliance, as indicated in the Executive Budget)

  • Elimination of the bed buyback program and lump-sum capacity payments described in the Executive Budget.

Home Health & HCBS

  • Preservation of the 4% increase across a wide variety of home- and community-based services, including PASSPORT nursing & aide services, Ohio Home Care Waiver nursing & aide services, MyCare Ohio waiver, assisted living waiver and state plan nursing and aide services.

  • Preservation of the Executive Budget’s increase to home-delivered meals.

  • Inclusion of language from HB179 which would require licensure for medical and non-medical home care providers.

Adult Day

  • Inclusion of amendment boosting funding for PASSPORT adult day services & transportation by $10 million over the biennium.

Assisted Living

  • Preservation of a 4% reimbursement increase for Ohio’s assisted living waiver, originally proposed under the Executive Budget.

  • Inclusion of language from HB179 which would allow providers to pay for expedited review of any changes to the residential care facility license, including increasing the number of beds.

  • Preservation of language which would allow the Department of Health to increase the time between regular surveys by as much as 30 months, under certain circumstances.

In the Senate, LeadingAge Ohio will be working to protect the adult day language and boost funding for rebasing considerably. Other work will include:

  • Advocating for the removal of the language expanding ODH authority.

  • Making various modifications to the home health licensure language for clarity and to prevent licensure requirements from becoming a significant barrier to workforce.

  • Raising the CON review threshold from $2 million to $6 million, to account for the rising construction costs since the threshold was implemented in the 1990s.

  • Moving the rebasing deadline up to the beginning of the biennium.

  • Clarifying language related to critical access payments for nursing homes.

To learn more about the state budget and LeadingAge Ohio’s advocacy work, join the next all-member call on Tuesday, April 27 at 11:30AM. There is no fee to participate, but registration is required and can be done by clicking here. A slide deck from the all-member call (where the House sub bill was reviewed) is available on the LeadingAge Ohio website.  

Any other budget questions may be directed to Susan Wallace, Chief Policy Officer, at

Regional Rapid Response Assistance Program offering assistance 7:00AM to 7:00PM

Today, provider associations were encouraged to remind members of Ohio Department of Aging’s (ODA) Regional Rapid Response Assistance Program (R3AP, pronounced “RAP”). As reported in the April 2 COVID-19 Report, the program has been designed by ODA and the Ohio National Guard “to help Ohio congregate care centers support and protect older Ohioans through the COVID-19 pandemic and beyond.”

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.

Interested locations should contact the R3AP team between 7:00AM and 7:00PM by calling 1-855-R3AP-ODA (1-855-732-7632).

Survey Tip of the Week: Falls with major injury

Accidents and hazards, F-tag 689, was the second highest immediate jeopardy citation in Ohio in 2020. It was the fourth highest cited F-tag for annual surveys in Ohio in 2019. Falls with major injury is an area commonly cited in F-tag 689. Common reasons for the citations include care plan interventions not in place or not carried out at the time of the fall, such as not using a Hoyer lift or two-person transfer. The opportunity to impact this measure is to reduce the number of falls through root cause analysis. Mitigating the risk of citations for falls should include evaluating falls to determine if they were avoidable or unavoidable.

The Centers for Medicare & Medicaid Services (CMS) defines the avoidable and unavoidable criteria in Appendix PP of the State Operations Manual:

  • “Unavoidable Accident” means that an accident occurred despite sufficient and comprehensive facility systems designed and implemented to:
    • Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and
    • Evaluate/analyze the hazards and risks and eliminate them, if possible and, if not possible, reduce them as much as possible;
    • Implement interventions, including adequate supervision, consistent with the resident’s needs, goals, care plan, and current professional standards of practice in order to eliminate or reduce the risk of an accident; and 
    • Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current professional standards of practice.

  • “Avoidable Accident” means that an accident occurred because the facility failed to:
    • Identify environmental hazards and/or assess individual resident risk of an accident, including the need for supervision and/or assistive devices; and/or 
    • Evaluate/analyze the hazards and risks and eliminate them, if possible, or, if not possible, identify and implement measures to reduce the hazards/risks as much as possible; and/or
    • Implement interventions, including adequate supervision and assistive devices, consistent with a resident’s needs, goals, care plan and current professional standards of practice in order to eliminate the risk, if possible, and, if not, reduce the risk of an accident; and/or
    • Monitor the effectiveness of the interventions and modify the care plan as necessary, in accordance with current professional standards of practice.

LeadingAge Ohio encourages providers to use the Accidents Critical Element Pathway as part of the facilitie's QAPI process. The survey pathways can be found on the CMS Nursing Home webpage, under the download section, and within the zip file called LTC Survey Pathways.

As the re-start of the annual surveys continues, LeadingAge Ohio is sharing tips each week to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at

All providers invited into AHRQ's Project ECHO

LeadingAge Ohio is excited to share that all provider types have been invited to participate in the next phase of the Agency for Healthcare Research and Quality's (AHRQ) Project ECHO COVID-19 Action Network. This federally supported initiative is a collaboration between AHRQ, Project ECHO and the Institute for Healthcare Improvement (IHI) to advance improvements in COVID-19 preparedness, safety and infection control.

LeadingAge Ohio and Island Peer Review Organization (IPRO) have partnered to be a training center for Ohio.

A significant majority in phase one have already confirmed their participation in this second phase. LeadingAge Ohio anticipates that the cohorts will fill quickly. In order to secure your spot, please complete the expression of interest contained in this link.

LeadingAge Ohio and IPRO will serve as a virtual community of practice for providers to engage with experts and their peers and share cases and challenges for real-time discussion and advice. Participating in the network provides facilities with practical information, skills and resources needed to protect residents/patients and staff from the virus. Any entity providing services to patients/residents/clients is eligible to participate at no cost. CEU credit is available through BELTSS for each session. Network sessions will begin in April and run through August.

The ECHO model is an “all teach, all learn” methodology developed around case-based learning and active engagement. ECHO’s virtual guided practice approach has gained significant traction both nationally and globally as a core learning strategy for education and training in healthcare. LeadingAge Ohio and IPRO assembled an experienced team of experts to help facilitate this community of practice and to support participating nursing homes in areas of safety and quality improvement (QI). The curriculum covers a wide scope of topics related to COVID-19 response and preparedness, as well as QI methods to support ongoing testing and learning by staff.

LeadingAge Ohio appreciates your deep commitment to protect residents, clients and staff, and we firmly believe that your participation in this initiative will support that mission-driven aim. If you have additional questions please reach out to Stephanie DeWees at

Careers in Aging Week continues until April 24 – show off your aging services pride!

LeadingAge Ohio is partnering with LeadingAge, the Gerontological Society of America, AHCA/NCAL, and Argentum on ‘Careers in Aging Week’ this week, April 18-24. Careers in Aging Week (CIAW) brings awareness to the numerous career opportunities available in long-term care and aging services, and celebrates caregivers for their heroic efforts.

According to the Governor’s Office of Workforce Transformation, Ohio’s top three jobs all serve elders within the aging services fields (Home Health Aides, Registered Nurses, and Personal and Home Care Aides). While job fairs and site visits continue to be challenging, we continue to honor the heroic individuals who work in this field. LeadingAge continues to connect individuals in Ohio to jobs assisting elders through its jobs webpage.

LeadingAge Ohio encourages all members to highlight ‘Careers in Aging Week’. Mentions by members give the aging services workforce a boost and encourage awareness of the vast career opportunities within the field, as well as highlight the hardworking aging services workforce to policymakers. Social media participation should use the hashtag #CareersInAging.

As you may have seen, LeadingAge Ohio successfully encouraged Governor DeWine, Lt. Governor Husted, and leaders in the legislature to join in and recognize #CareersinAging!

LeadingAge has provided sample social media posts, which you are welcome to use or be inspired by, as part of the LeadingAge Careers in Aging Week toolkit. LeadingAge Ohio has also produced a series of graphics available for download.

You asked... We answered regarding discarding N95's after multiple uses.

You asked:

If we are following the Centers for Disease Control and Prevention (CDC) guidance to discard N95’s after five doffings, do we record this as conventional strategies within the National Healthcare Safety Network (NHSN)? 

We answered:

No, you would record this as contingency strategy. Unless staff are discarding N95’s after ever resident encounter, then a facility would not be in conventional strategy. The CDC outlines the conventional, contingency, and crisis categories with examples on the Strategies for Optimizing the Supply of N95 Respirators webpage.

LeadingAge Need to Know

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's Need to Know featured information on the 2021 LeadingAge Annual Awards Call for Nominations and an April 29 webinar for home health and hospice members.

Check out the full report here.

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Please send all questions to 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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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.