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07/20/2020

Today's COVID-19 Report: Monday, July 20, 2020

Monday, July 20, 2020

Here are the latest need-to-know updates for Monday, July 20 regarding the COVID-19 pandemic.

CDC Alerts on Implications of Viral Shedding, Encourages Symptom-based Strategies 

This weekend, the Centers for Disease Control and Prevention (CDC) shared some breaking information. The CDC indicated that many people have prolonged viral shedding, and thus will test positive for COVID-19 long after they are no longer contagious. Potentially, this means that a testing-based strategy is of limited utility for deciding when people can return to work and for deciding when to discontinue transmission-based precautions for new and existing residents.

CDC asserts in this guidance that the recommendations are based on evolving research. CDC has shared several links that explain this guidance further. 

  • (Decision memo) Duration of Isolation and Precautions for Adults with COVID-19 
    • Individuals may require retesting if they develop new symptoms.
    • For most people with COVID, isolation and precautions can be discontinued 10 days after symptom onset with symptom improvement and resolution of fever.
    • For most people, a test-based strategy to determine when to stop using isolation and precautions is no longer recommended; for those who are immunocompromised, a test based strategy could be considered in consultation with infectious disease experts.
    • For people who had symptomatic COVID and remain asymptomatic, retesting is not recommended within 3 months. Quarantine for these people is not recommended if they come in contact with someone who has COVID.
  • (Interim Guidance) Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings
    • 10 days after symptoms first appeared for those with mild to moderate illness who are not immunocompromised;
    • 20 days since symptoms first appeared for those with severe to critical illness; and
    • 20 days after the first positive viral test for severely immunocompromised patients who were asymptomatic.
    • If transmission based precautions are still required, the patient should go to a facility that can care for COVID patients or designated for them.
    • If transmission based precautions are not required, the patient does not require further restrictions.
    • Except for rare situations, a test based strategy is no longer recommended to determine when to continue transmission based precautions.
    • Transmission based precautions can be discontinued if the person has no fever for 24 hours and an improvement in symptoms after:
    • Specifically related to discharge of patients TO a nursing home or other LTC facility (e.g., assisted living), patients can be discharged:
  • (Interim Guidance) Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection 
    • A test based strategy is no longer recommended to determine when to allow health care personnel with COVID to return to work.
    • Health care personnel with severe to critical illness or who are severely immunocompromised can return to work 20 days after their positive test.
    • Health care personnel with mild to moderate illness can return to work 10 days after symptoms first appeared and at least 24 hours since their last fever.

This guidance potentially allows staff to come back to work if they are no longer symptomatic; testing is not recommended. CDC is recommending that nursing homes not use a test-based strategy in determining whether to admit individuals from the hospital. It is important to note that this is CDC guidance and recommendations, and the Ohio Department of Health (ODH) will need to adapt these recommendations for Ohio.

LeadingAge has promised a more detailed analysis in the near future. Meanwhile, LeadingAge Ohio has elevated numerous questions to ODH, asking how this guidance will be integrated into its current recommendations and expectations of Ohio providers.

Visitation Begins: Tell Us How It Went

Today, outdoor visitation resumed at nursing homes across the state of Ohio. In addition to guidelines that were listed in the Director’s Order, the Ohio Department of Health released guidance and best practices for facilities, families, friends, and other visitors.

The visitation opens at a time when over 60 percent of Ohio’s population resides in a county at “Level 3” or red level of risk, indicating high levels of coronavirus transmission in the community. While the state did not prohibit nursing homes in level 3 counties from opening visitation, it did note that prevalence of COVID-19 in the local community should be one factor that nursing facilities consider when developing their visitation policies and protocols.

LeadingAge Ohio asks members to take a moment to email the COVID-19 mailbox to let us know 1. If your nursing facility opened visitation today and if so, 2. How it went and any unanticipated challenges you encountered.

You Asked...We Answered

You Asked: Since CMS has provided a blanket waiver for fire drills and permits hospice inpatient units to document an orientation training program related to their current fire plan instead of conducting actual quarterly fire drills, is the Ohio Department of Health (ODH) honoring this same blanket flexibility?

We answered: LeadingAge Ohio reached out to an ODH representative to ensure they were honoring the CMS blanket waiver (bottom of page 3) for the Ohio licensure rules. ODH responded, if there is a blanket waiver for a federal requirement and there happens to be a cross over licensure rule requirement, then we would not cite that requirement for licensure.

2020 LeadingAge Ohio Compensation Survey Addendum: Impact of COVID-19

LeadingAge Ohio member organizations that participated in the 2020 compensation survey should have already received their customized survey results from LR Webber. As a reminder, non-participating member organizations have the opportunity to purchase the overall compensation survey results for $200.  

LR Webber will be contacting those member organizations that participated in this year’s survey to answer questions on the impact of COVID-19 on compensation.  The survey addendum will be sent out in the next few days and deadline to respond to the survey will be Friday, July 31.  Contact Jennifer Taylor at jtaylor@leadingageohio.org to learn more.


Date for Medicaid Providers to Apply for PRF Funds Extended to August 3

The U.S. Department of Health & Human Services (HHS) released another $10 billion to hospitals in hotspots. In that announcement, HHS also extended the Medicaid application for Provider Relief Funds (PRF) deadline to August 3 and provided a fact sheet to help applicants through the process.

Medicaid providers have until August 3 to apply for funds from the approximately $15 billion Medicaid Distribution of the PRF. Eligible providers include but are not limited to: assisted living, Medicaid-only nursing facilities, home and community-based services, and adult day centers, as long as they or their parent organization under the same Tax Identification Number(TIN) did not receive a General Distribution from the Provider Relief Fund.  

Providers paid by Medicaid managed care and/or under Medicaid waivers are also eligible to apply for this distribution. For more information on applying, providers can check out the LeadingAge Provider Relief Fund Explainer and HHS resources on CARES Act Provider Relief Fund websiteincluding their FAQs, which have two sections on the Medicaid Distribution and the corresponding Enhanced Provider Relief Fund Payment Portal, through which providers will apply.  

LeadingAge Need to Know: COVID-19 – July 20, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured a three minute member survey to help LeadingAge assure the reality on the ground is reflected in the media and new insights and tools. 

Check out the full report here. 

                Linkage                         Buerger


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.  

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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.