12/29/2021

CDC updates quarantine and isolation guidance for general population, HB169 signed and more

CDC updates quarantine and isolation guidance
for general population, HB169 signed and more

This alert contains information on the following topics:

• CDC updates quarantine and isolation guidance for general population, ODH clarifies
• Governor signs HB169, provider relief incoming
• ODH offers new oral therapeutics
• LeadingAge Town Hall tomorrow (Thursday) at 11:00AM

CDC updates quarantine and isolation guidance for general population, ODH clarifies

On Monday, December 27, the Centers for Disease Control & Prevention (CDC) announced it is shortening the recommended time for isolation for the general population from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after. Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others.

Additionally, CDC is updating the recommended quarantine period for those exposed to COVID-19 in the general population. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure. For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.

The full release and guidance can be found here. 

ODH clarifies impact for Ohio providers

The Ohio Department of Health (ODH) sent an EIDC bulletin on Tuesday, December 28 advising facilities to follow current policies until they can confirm with the Centers from Medicare and Medicaid Services (CMS) that the Centers for Disease Control and Prevention (CDC) updated guidance for isolation and quarantine for the general population (updated 12/27/2021) and for healthcare personnel (updated 12/23/2021) applies to all provider types.

LeadingAge Ohio shared with ODH that the CDC Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes webpage links to the updated CDC quarantine and isolation guidance for healthcare personnel, with no guidance for residents. On this webpage under the Evaluating and Managing Personnel and Residents section, the guidance advises nursing homes to:

Refer to CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic for more information.

• HCP should not work while acutely ill, even if SARS-CoV-2 testing is negative, in order to minimize the risk of transmission of other infectious pathogens, including respiratory pathogens such as influenza.
• Implement sick leave policies that are non-punitive, flexible, and consistent with public health policies that support HCP to stay home when ill.
• Guidance on when HCP with SARS-CoV-2 infection could return to work, and on work restrictions for HCP with higher-risk exposures, is in the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2.

One area of confusion is whether the CDC general population updated guidance applies to residents living in congregate care/healthcare settings. The Discontinuation of Transmission-Based Precautions webpage has not been updated with the CDC general population isolation and quarantine guidance. Managing residents with close contacts has also not been updated with the newest guidance.

LeadingAge is working to get clarification from CMS and CDC, and LeadingAge Ohio will continue to work to get clarification from ODH and will update members accordingly.

Governor signs HB169, provider relief incoming

On Thursday, December 23, Governor Mike DeWine signed HB169, which distributes more than $4 billion for schools, child care, health care, law enforcement, employment and other areas using funding from three federal COVID relief packages. DeWine issued a line-item veto for a Senate-added a provision in the bill that would have delayed quality standards for publicly funded child care under the Step Up To Quality (SUTQ) program.

The bill includes over $1B in funding for healthcare providers, including $529 million to support home and community-based services administered by the Departments of Medicaid, Aging, Developmental Disabilities and Mental Health and Addiction Services, to be used according to Ohio’s plan approved by the Centers for Medicare and Medicaid Services (CMS). These are the federal funds made available through the American Recovery Plan (ARPA) by way of an enhanced 10% federal match for home and community-based services. The amount comes close to the proposed allocation for the first year of Ohio’s plan ($540 million), which principally funds provider relief for a wide variety of Ohio’s HCBS and waiver providers as well as some long-term workforce investments. Years two and three of the plan include system reforms like PACE expansion and adult day grants, as well as longer-term workforce investments, technology investments and other proposals. Ohio’s plan has yet to be approved by CMS.

Other appropriations contained in the bill are:

• $300 million for payments to nursing facilities
• $33 million for payments to residential care facilities
• $23 million for payments to hospices
• $42 million for payments to intermediate care facilities for individuals with  intellectual disabilities (ICF-IIDs)
• $100 million for Medicaid services via the Department of Developmental Disabilities
• $124 million for rural and critical access hospitals
• Nearly $11 million for nursing home strike teams

The payments to facility-based providers (nursing facilities, ICF-IIDs and hospitals) come with some strings attached, requiring funds to be spent exclusively on “direct care staff compensation, which may include staff retention bonus payments, overtime pay and shift differential payments, staff recruitment costs, and new hire incentive payments.” 

Last week, LeadingAge Ohio met with the Department of Medicaid to urge them to disburse the funds expeditiously as well as take a liberal interpretation of “direct care” to include housekeeping, dietary and other critical frontline staff. ODM officials shared that while most funds will be disbursed as Medicaid payments, residential care facilities will most likely expect to have to apply for the funds. Disbursing funds will require significant administrative work, including modifying Ohio’s 1135 and Appendix K waivers, and issuing a number of emergency rules. LeadingAge Ohio will report back with further clarification on how these funds will be distributed in the coming days. 

ODH offers new oral therapeutics

Two oral therapeutics, Pfizer’s Paxlovid and Merck’s molnupiravir, were recently granted emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) for the treatment of COVID-19.

An alert from the Administration indicates that a limited supply of these new oral therapeutics is being allocated to Ohio by the federal government. Due to the limited supply, the state is utilizing a selection of the existing monoclonal providers to distribute the medication on day one. As supply becomes more readily available, the state will expand to additional providers.

Members are encouraged to continue reaching out to their pharmacies for monoclonal antibody treatments as well as these new oral therapeutics. 

LeadingAge Town Hall on Thursday at 11:00AM

The Omicron variant of COVID-19 is spreading quickly. Increasing protection in the most vulnerable citizens with vaccinations and boosters is a top priority for the Department of Health and Human Services (HHS). To learn more about what providers can do to protect residents and staff, LeadingAge invites members to join HHS Secretary Xavier Becerra and other Senior COVID-19 Response Leaders for a Virtual Town Hall – co-sponsored by LeadingAge, Service Employees International Union (SEIU), the American Health Care Association and National Center for Assisted Living – to discuss the latest news on the Omicron variant of COVID-19 and the impact of boosters for residents and staff.

The Virtual Town Hall will be held on Thursday, December 30 at 11:00AM with ASL and Closed Captioning available. Please join the event at: HHS.gov/Live. 

Please note, this Town Hall will be recorded.