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10/01/2020

Today's COVID-19 Report: Friday, October 2, 2020

Friday, October 2, 2020

Here are the latest need-to-know updates for Friday, October 2 regarding the COVID-19 pandemic. 

You asked… We answered

You asked: When should staff wear eye protection?

We answered: According to the Centers for Disease Control (CDC), when caring for COVID+ residents, eye protection should be worn when caring for exposed no-symptom residents depending on the prevalence of COVID-19 in the community, and for all resident care when COVID-19 is identified in the facility or there is sustained transmission in the community. The CDC recommends collaboration with the local health department so that transmission within the community is considered. The Ohio Department of Health (ODH) also recommends eye protection for exposed no-symptom residents in their Long Term Services and Support COVID Pre-Surge Planning Toolkit.

Because of the potential for asymptomatic and pre-symptomatic transmission, source control measures are recommended for everyone in a healthcare facility, even if they do not have symptoms of COVID-19.

The CDC has developed the Infection control assessment and response tool (ICAR) for nursing homes preparing for coronavirus disease 2019 (COVID-19) tool to assist nursing homes in infection control practices.

Below are CDC recommendations and considerations for when healthcare personnel should wear eye protection in the management of COVID-19:

Nursing home actions when COVID-19 is identified in the facility, or there is sustained transmission in the facility, uses all recommended PPE for the care of all residents on affected units (or facility-wide depending on the situation). Because of the higher risk of unrecognized infection among residents, universal use of all recommended PPE for the care of all residents on the affected unit (or facility-wide depending on the situation) is recommended when even a single case among residents or HCP is identified in the facility; this should also be considered when there is sustained transmission in the community. The health department can assist with decisions about testing of asymptomatic residents.

Create a Plan for Managing New Admissions and Readmissions Whose COVID-19 Status is Unknown.

  • Depending on the prevalence of COVID-19 in the community, this might include placing the resident in a single-person room or in a separate observation area so the resident can be monitored for evidence of COVID-19. HCP should wear an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (i.e., goggles or a face shield that covers the front and sides of the face), gloves, and gown when caring for these residents.
  • Because of the higher risk of unrecognized infection among residents, universal use of all recommended PPE for the care of all residents on the affected unit (or facility-wide depending on the situation) is recommended when even a single case among residents or HCP is newly identified in the facility; this could also be considered when there is sustained transmission in the community. The health department can assist with decisions about testing of asymptomatic residents.

Implement Universal Use of Personal Protective Equipment

  • HCP working in facilities located in areas with moderate to substantial community transmission are more likely to encounter asymptomatic or pre-symptomatic patients with SARS-CoV-2 infection. If SARS-CoV-2 infection is not suspected in a patient presenting for care (based on symptom and exposure history), HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis).
    They should also:
      • Wear eye protection in addition to their facemask to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters.

  • For HCP working in areas with minimal to no community transmission, HCP should continue to adhere to Standard and Transmission-Based Precautions, including use of eye protection and/or an N95 or equivalent or higher-level respirator based on anticipated exposures and suspected or confirmed diagnoses. Universal use of a facemask for source control is recommended for HCP.

Ohio Board of Pharmacy requires additional licensure

The Ohio Pharmacy Board requires a license separate from a facility's house stock license if administering vaccine from that stock to employees. The Ohio Board of Pharmacy has outlined specific requirements as it relates to the management of biologicals or vaccines administered to individuals for the purpose of preventing diseases. Examples of these products include influenza vaccine, tetanus toxoids, hepatitis B vaccines, PPD or TB tests. For a Skilled Nursing or Assisted Living Facility to procure these vaccines and biologicals for residents and staff on a bulk stock basis, there must be a TDDD (Terminal Distributor of Dangerous Drugs) license to which the prescription drug stock is transferred to.  Detailed guidance is provided in the attached.

Provider Relief Fund update and request for action if concerns regarding potential for return of PRF payments

Health and Human Services (HHS) confirmed early this week that roughly $37 billion of the $175 billion in Provider Relief Funds (PRF) appropriated remains; in addition the Trump Administration announced $20 billion in new funding “for providers on the frontlines of the coronavirus pandemic.”  Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.

For members who applied for Phase 2 General Distribution (e.g. Medicaid, CHIP, Dental, private pay AL and nursing homes and certain Medicare providers), HHS is continuing to distribute those funds on a rolling basis. We have heard from several members that they just recently received payments.  Some of our AL members who are part of larger organizations have been told that they do not qualify for funds as their organization/Tax Identification Number has already received the full 2% of net patient revenue. This is possible especially for CCRCs/LPCs who operate under one TIN that may have already shared their tax information as part of Phase 1 and therefore received a payment equal to 2% of their net patient service revenue for their nursing home as well as their AL and IL. We wanted to make you aware of this issue again in the event that you are contacted by similarly-situated members.  

Related to Nursing Home Infection Control Incentive Payments, HHS has indicated they are aiming to begin distributing the first $400 million in payments to qualifying nursing homes around mid-October. Still no detail on the formulas being used for those Measure calculations.  Finally, LeadingAge has raised its concerns with HHS about the new approach to eligible expenses and lost revenues as discussed in their recent reporting guidance.  LeadingAge is seeking concrete member examples of how these changes could impact members, including potentially requiring some providers to be required to return PRF payments that can’t be used because of the limits being applied to their use for lost revenues. LeadingAge Ohio members with these concerns are asked to reach out directly to Nicole Fallon at nfallon@leadingage.org with any concrete examples about how these changes may impact their ability to use the PRF dollars. 

Provider Relief Funds: Demystifying recent HHS reporting curveballs webinar

Leadingage Ohio Associate Firm CliftonLarsonAllen LLP (CLA) is hosting a webinar on October 8, from 2:00 pm - 3:00 pm, on the newly released post-payment reporting requirements. While all are welcome to participate, this webinar is designed for finance personnel of health care organizations and those involved with organizational compliance requirements. For additional information and/or to register, please click here.

Nursing Home State Supported Testing Schedule Update

The nursing home state-supported testing schedule for October 5 through October 18 can be found by clicking here.

Please carefully review the schedule for the day of the week and any possible lab changes. These changes were made to ensure state support could be available for routine and outbreak testing, as described in these webinar slides.

Additional updates will be made next week to accommodate future outbreak testing needs.

Batch upload for electronic lab portal submission now available and webinar scheduled

The Ohio Department of Health (ODH) has completed work on its electronic specimen submission portal. Thanks to Maple Knoll Communities for assisting ODH with this work! 

Providers should see a batch upload tab in the electronic lab submission portal. This function will allow providers to upload data stored in an excel sheet to generate the PDFs. This process change means that the need to capture the required data from those routinely tested just once and that a provider alters only the fields that need to be altered prior to each upload. Instructions for use of the batch upload are attached. Any file that is uploaded must match the template file and be formatted according to the instructions on the second sheet of that template document. If there are ANY issues with the upload, please reach out to odhlabportal@odh.ohio.gov for assistance.

Please register for ODH Lab Portal - New Bulk Upload Lab Requisition for Nursing Homes webinar on October 5 at 1:00 pm by clicking here. ODH will discuss the functionality in more detail.

As always, with use of the portal, ODH asks that providers please remember the following items:

  • Portal use may be timed out after 8:00 pm, while files are being transferred from the ODH system to the testing laboratories. Please refrain from using the portal between 8:00 am and 8:00 pm.

  • Any file that is generated from the portal has a unique bar code:
    • Do not cover up the barcode in any way.
    • If mistakes on the form occur, do not change on the form using a PDF editor or any other type of editing software. Please re-upload that one record and generate a new file
  • Name and date of birth information on the submission form MUST match name and date of birth information listed on the specimen collection tube.

Administration testing lead to speak on October 5 LeadingAge Coronavirus Update Call

Should we be using antigen testing for surveillance? What’s your PCR testing experience lately, looking for shorter turnaround times? How long will you have to wait for BD test kits? If you offer assisted living services and do not have a CLIA waiver, how can you get Abbot BinaxNOW tests? Will home health providers or hospice providers receive Abbott cards? Admiral Brett Giroir, MD, Assistant Secretary for Health, U.S. Department of Health and Human Services (HHS), Administration testing lead, will speak on Monday’s LeadingAge Coronavirus Update call. The call will also feature LeadingAge California President and CEO Jeannee Parker Martin, who served on the Coronavirus Commission on Safety and Quality in Nursing Homes. Hear her first hand account of serving on this commission and what key takeaways were found during the Commission’s work. Join the LeadingAge Coronavirus Update Call at 3:30 EST on Monday, October 5 to hear from these two leading experts. To register for these calls, you can register here.

Hospice QRP APU FY 2021: Successful Facilities

On Thursday, the Centers for Medicare & Medicaid Services (CMS) posted the list of successful hospices for FY 2021 Hospice QRP. These hospices met the CY 2019 hospice quality data reporting requirements that impact FY 2021 payment. Successful hospices receive their full annual payment update (APU). The list can be found under the Download box on the Hospice QRP Best Practices webpage.

Updated SNF QRP COVID-19 PR tip sheet is available

An updated version of the SNF COVID-19 PR Tip Sheet that was posted on September 8, 2020, is now available. The purpose of this Tip Sheet is to help providers understand CMS’ public reporting strategy for the PAC QRP in the midst of the COVID-19 public health emergency (PHE).  This Tip Sheet explains the CMS strategy to account for CMS quality data which were exempted from public reporting due to COVID-19, and the impact on CMS’ Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) data on the Nursing Home Compare website refreshes.  The updated Tip sheet is available under the Downloads section of the SNF Quality Reporting Training webpage.

LeadingAge Need to Know: COVID-19 – October 2, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured new additions to the LeadingAge Knowledge Center and news on the Summer Enrichment Program.

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.  

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.