Vaccination Information/Resources

Communication around the vaccine with residents and staff is important.  We've compiled several resources below to help in getting the word out and building confidence around the vaccine.

LeadingAge Ohio All Member Q & A: Vaccine Participation (1/12/20)

Attendees will hear from Willow Brook Christian Communities regarding tools they used to achieve an 88% employee vaccination rate.

VIDEO: City of Columbus Dr. Roberts COVID Vaccine PSA

FAQs and Resources on COVID-19 Vaccines and Issues Surrounding Vaccinations (Updated 1/8/21) 

LeadingAge Ohio All Member Q & A: Vaccines (12/16/20)

LeadingAge Vaccine Resources

LeadingAge (National) Resources

New Insights and Tools From LeadingAge

LeadingAge staff experts are developing essential advocacy, guidance and tools, and curating the most relevant resources for aging services providers on COVID-19 and beyond. A complete timeline of insights, tools, and useful COVID-19 links is available here, so you’ll never miss an update.

• COVID-19 Information and Resources (LeadingAge)
• COVID-19 Member Community Group - A place where members can communicate with one another and share resources on COVID-19.
• LeadingAge Learning Hub- FREE Covid-19 Online Education for members

• LeadingAge Job Board. - Please post jobs of all kinds – including temporary positions and those that do not require certification 

• Coronavirus Communication and Media Tools

StoryCorps Connect

LeadingAge is excited to partner with StoryCorp on a new free digital platform developed to address the pressing need for connection during the coronavirus pandemic, to older adults, their families, and caregivers across America, with the goal of conducting and recording meaningful remote interviews between loved ones.  

StoryCorps Connect achieves 2 goals: 

1. A purpose to connect with loved ones during this challenging time of isolation.

2. A way to give back. Your interview—and story—can be archived in the Library of Congress for future generations.

StoryCorps makes the interview process easy. Use these materials to plan your interview today!

• Toolkit for Organizations Serving Older Adults
• Participant Packet for Older Adults and Families

LeadingAge Ohio understands that, throughout the pandemic, our members have had to constantly share new information and updates – with staff, with family members, and with the greater community. Members may receive a surge of media interest related to how the COVID-19 pandemic is affecting their community. We know that many of our members have already had to respond to difficult questions from the press about outbreaks and COVID-related deaths.

What happens if/when a member community discovers it has widespread COVID-positive residents and staff? What happens when a community experiences losses of residents or staff related to COVID-19?

LeadingAge Ohio wants members to be prepared and has worked with an industry leader, Cleveland-based Hennes Communications, to produce this toolkit. This toolkit provides information on establishing an action plan, describes ways LeadingAge Ohio can support members, and offers communications resources and templates.

We hope this toolkit will be helpful in preparing for crisis communications situations during the pandemic. LeadingAge Ohio will continue in its work to drive an informed coronavirus conversation around the state – highlighting the need for greater support for aging services providers, sharing member stories from the frontlines, and working with state leaders to ensure that LeadingAge Ohio members have access to critical resources.

Crisis Communications Toolkit

LeadingAge Ohio Crisis Communications Toolkit (full pdf version)

The toolkit includes the following:

• Developing an Action Plan 
• Sample Action Plan
• What can LeadingAge Ohio do?
• Communications Resources & Templates

What can LeadingAge Ohio do? 

LeadingAge Ohio is prepared to come alongside providers and assist on communications when COVID spread occurs. LeadingAge Ohio can provide messaging that can help providers tell their side of the story.

LeadingAge Ohio can:

• Assist in proofing an organization’s action plan;
• Join staff huddles assembling the organization’s action plan;
• Align the organization’s message with that of LeadingAge Ohio and other members;
• Assist in answering media requests;
• Send a press release supporting a member who has acted in good faith but still suffered a spread of cases (example in communications resources and templates);
• Connect members to crisis communications material from LeadingAge, including:
  • Communications planning,
  • Communications about positive cases, and
  • Communications about COVID losses;
• Connect members to LeadingAge Ohio staff experts, training, and resources.

We are here to stand by and support our members as they combat the spread of COVID-19.

Communication Resources & Templates

Below is a sample press release that can be sent on behalf of a member by LeadingAge Ohio:

• Sample Press Release

Templates & Resources from LeadingAge

          Communications planning:

• Planning for a COVID-19 Outbreak in Your Community: Crisis Media Plan
• Talking Points: Responding to Negative Views on Aging Services in Pandemic
• Sample Coronavirus Media Talking Points
• Crisis Communications Webinar
  
  Communication regarding testing for COVID-19:
  
  
• Press Release
• Letter to Residents and Families

          Communication of positive cases of COVID-19:

• Press Release
• Letter to Residents and Families
• Letter to Residents and Families - Positive Diagnosis in Staff
• Letter for Essential Workers

          Communication of COVID-19 -related deaths:

• Press Release
• Letter to Residents and Families

Resources & Articles from Hennes Communications

Thank you to Bruce Hennes at Hennes Communications for contributing to this toolkit and license of Crisis Management Today newsletter articles, which are available to all LeadingAge Ohio members below.

• Combating Uncertainty: How to Talk about COVID-19
• Creating a Post-Pandemic Crisis Team
• Why Hiding Or Changing Facts To Protect Against Panic Can Cause One
• Leadership in Action Dr. Amy Acton Director of Ohio's Department of Health
• Mastering the Zoom Apology
• As Coronavirus Spreads Use Smart Communications to Spread Word on Your Plans
• What Can You Do to Help Your Employees Through this Crisis
• What We've Learned So Far: Communicating About COVID-19
• Why People Feel Misinformed Confused and Terrified About the Pandemic

LeadingAge Ohio Contact

Patrick Schwartz
Director of Strategic Communications
pschwartz@leadingageohio.org
330.933.9825

Press Releases

• PRESS RELEASE: LeadingAge Ohio member joins Gov. DeWines press conference to share story 11/30/20
• PRESS RELEASE: LeadingAge Ohio issues holiday ideas for family gatherings involving older loved ones (11/19/20)
• PRESS RELEASE: Apprenticeships an opportunity to bolster hard-hit (11/10/20)
• PRESS RELEASE: LeadingAge Ohio stands by Crandall Medical Center other quality providers amid COVID-19 outbreaks (9/23/20)
• PRESS RELEASE: LeadingAge Ohio Remembers the Elders Lost to Coronavirus, Urges Greater Support (7/8/20)
• PRESS RELEASE: Service Coordinators are Unsung First Responders in Fight Against COVID-19 (6/9/20)
• PRESS RELEASE: LeadingAge Ohio Stands by Quality Providers Amid COVID-19 Outbreaks (5/13/20)
• PRESS RELEASE: Central Ohio Collaboration Introduces Rapid COVID-19 Testing Innovation (4/16/20)

Miscellaneous

• COVID-19 Grants, Loans, and Funding Opportunities for Nonprofits Quick Reference Guide (4/16/20 [Members only] 
  
  

Home Health and Hospice Newsletter

In Today's Newsletter

• All-member call: Today at 11:30AM
• You asked... We answered regarding notification of discharge
  
• LeadingAge home health and hospice recap
• Opportunities to provide feedback on hospice payment rule
• CMS increases Medicare payment for COVID-19 monoclonal antibody infusions 
• CMS encourages hospices to submit Notices of Election (NOEs) via Electronic Data Interchange (EDI)
• Ohio updates testing orders
• ODH provider call updates: Surveyor guidance; eye protection; visitation; family satisfaction survey
• LeadingAge Ohio, members testify before Ohio Senate Health
• What the Media Said 

All-member call: Today at 11:30AM

LeadingAge Ohio will hold an all-member Q&A call today 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 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. That playbook is available on the coronavirus website at coronavirus.ohio.gov. 

You asked... We answered regarding notification of discharge

You asked: 

We are seeking clarification as to whether a physician or other allowed practitioner must be notification of discharge when a home health plan of care (POC) is followed as written, goals have been met and is signed by the ordering provider? The State Operations Manual (SOM) doesn’t have any additional guidance and the Conditions of Participation (CoPs) state the physician must agree with the discharge from home health services. Does the physician signature on the POC indicate agreement?

We answered: 

LeadingAge Ohio reached out to the Ohio Department of Health (ODH) asking them what a surveyor is looking for related to involving the physician when preparing to discharge a home health patient from service who has their goals met. ODH provided the following response.

The regulation says at G458 (Rev. 182, Issued: 09-28-18, Effective: 09-28-18, Implementation: 09-28-18)

• 484.50(d)(3) The transfer or discharge is appropriate because the physician who is responsible for the home health plan of care and the HHA agree that the measurable outcomes and goals set forth in the plan of care in accordance with §484.60(a)(2)(xiv) have been achieved, and the HHA and the physician or other allowed practitioner, who is responsible for the home health plan of care, agree that the patient no longer needs the HHA’s services. 

Generally, there would be some discussion with the physician (or other practitioner) prior to discharge in addition to a physician order. The agency wouldn’t/shouldn’t make the decision to discharge the patient without input from the physician. There should be documentation in the patient’s record related to contacting the physician and their agreement with the patient’s discharge from home health services. For questions about home health discharges or services, please contact Anne Shelley at ashelley@leadingageohio.org.

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition featured information on the upcoming Hospice Quality Reporting Program Forum and a new telehealth legislation action alert.

Read the complete recap here.

Opportunities to provide feedback on hospice payment rule

LeadingAge will hold two feedback sessions to discuss the hospice payment rule. LeadingAge invites feedback, particularly regarding changes to the hospice quality reporting program and changes to the labor portion of the hospice wage index. The sessions will be on May 18 and May 20, both at 2:00PM; the rule comments are due on June 7. No registration is necessary. Please reach out to Mollie at mgurian@leadingage.org if you have questions or would like to provide feedback on the rule but are unable to attend either session.

Zoom Link for May 18 session

Zoom Link for May 20 session

CMS increases Medicare payment for COVID-19 monoclonal antibody infusions 

As part of the ongoing response to address the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished – including in a physician’s office, healthcare facility or at home.

As of Friday May 8, the national average payment rate increased from $310 to $450 for most health care settings. In support of providers’ efforts to prevent the spread of COVID-19, CMS will also establish a higher national payment rate of $750 when monoclonal antibodies are administered in the beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging (e.g., hotel/motel, cruise ship, hostel, or homeless shelter). 

The new national payment rate for at-home administration of monoclonal antibodies accounts for increased costs associated with the one-on-one nature of this care model. These higher national average payment rates reflect additional information provided to CMS about the costs of providing these services in a safe and timely manner, such as clinical staff and personal protective equipment. This action also means Medicare payments to providers and suppliers will be more aligned to their costs to administer these products.

CMS’s goal during the COVID-19 PHE has been to ensure that the agency is supporting beneficiary access to care. This new policy is based on timely, valuable input from stakeholders including the home health and ambulatory infusion industries on the costs associated with administering monoclonal antibodies.

CMS is updating the set of toolkits for providers, states and insurers to help the health care system swiftly administer monoclonal antibody treatment with these new Medicare payment rates. 

In addition, CMS is updating coding resources for providers.

For additional information, please visit CMS news.

CMS encourages hospices to submit Notices of Election (NOEs) via Electronic Data Interchange (EDI)

Since the implementation of change request (CR) 10064 in October 1, 2018, which allowed the submission of Notices of Election (NOEs) to be accepted via Electronic Data Interchange (EDI), hospices have submitted only a small percentage of type of bill 8xA-8xE via EDI. The hospice industry requested that Medicare implement submission of NOEs via EDI to reduce administrative burden, so CMS would like to remind and encourage hospices to take advantage of this option. Filing electronically reduces, and potentially eliminates, problems with NOEs that result from keying errors during the Direct Data Entry process and helps hospices export data from their electronic medical record or other software system into the EDI format without human intervention.

Submitting NOEs via EDI could be particularly beneficial to hospices serving Medicare Advantage beneficiaries enrolled in plans participating in the Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component. For these patients, the NOE is submitted to both the Medicare Administrative Contractor (MAC) for Original Medicare and the MA plan. Submitting systematically generated NOE EDI transactions to both payers can reduce manual effort.

Hospices wishing to adopt EDI NOEs should consult the companion guide for NOE transmissions, which can be found at the Hospice Center webpage. This guide provides instructions about how to use the 837 health care claim as a NOE. Hospices should note that NOEs submitted via EDI are subject to all front-end edits and may be rejected if all required data elements are not submitted or do not meet the required elements as outlined in the companion guide.

Electronically filed NOEs will receive a 999 acknowledgment within minutes of submission if accepted. Thus, hospices should also ensure that they monitor their acceptance reports (277CA and 999) at regular intervals. In addition, hospices should be aware that the NOE is subject to the batching process. Therefore, Medicare encourages hospices to submit batch transmissions with groups of NOEs separate from batch transmissions with groups of claims. This practice may reduce the risk that translator-level rejections related to NOEs, if they occur, that could impact payments to the hospice.

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. 

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

Last 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.

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.

What the media said about end of life care this week – May 11, 2021

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Upcoming Educational Opportunities

HospiLearn Webinars for June

HospiLearn Webinars: Earn continuing education credits through online educational programs.

• June 2: Utilizing Validated Tools for Evaluating Hospice and Palliative Care Eligibility  

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding physician orders being required for change in level care
• LeadingAge home health and hospice recap
• April 29 webinar for hospice and home health members
• Medicare Part A Cost Report webinar: April 29
• EVV system training offered by ODM
• Key telehealth bill introduced in Seattle
• Palmetto GBA hospice coalition request for questions
• Omnibus amendment makes no changes to House budget sub bill
• All providers invited into AHRQ's Project ECHO
• FCC announces round 2 COVID-19 Telehealth Program application window
• What the Media Said 

You asked... We answered regarding physician orders being required for change in level care

You asked: 

For hospice, is a physician order required for a change in the level of care to General Inpatient (GIP) or Continuous Home Care (CHC)?

We answered: 

LeadingAge Ohio reached out to Palmetto GBA to ask about the need for a physician order for a hospice change in level of care.

The Palmetto representative shared the following:

Physician orders for a change in level of care to GIP or CHC are not required for a MAC/CMS. However, a physician should have some knowledge of the change, more so for GIP since the patient would be going to an inpatient unit.

LeadingAge Ohio also checked the Ohio Administrative Code, which is consistent with the federal conditions of participation in that no physician order is required for GIP or CHC in Ohio.  If you have any question regarding GIP or CHC for hospice patients, please contact Anne Shelley at ashelley@leadingageohio.org.

April 29 webinar for hospice and home health members

Mark your calendar! On April 29 at 1:00PM, LeadingAge is hosting an event for hospice and home health members to highlight opportunities and connect members who have joined through previous affiliation with VNAA. Join LeadingAge President & CEO Katie Smith Sloan, LeadingAge staff, and your colleagues for this special event. To register for this webinar, please click here.

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition information on the Home Health Emergency Access to Telehealth (HEAT) Act being reintroduced in the Senate and what is on Congress's upcoming agenda.

Read the complete recap here.

Medicare Part A Cost Report webinar: April 29

Medicare Part A providers can learn about the new user-friendly upload feature for the Medicare Cost Report e-Filing (MCReF) system during a webinar on Thursday, April 29 from 1 - 2:30PM. To register for the Medicare Learning Network webcast, please click here.

The new feature allows providers to:

• Submit documents without turning them into ZIP files
• Tag documents
• Get alerts about missing documents

Also during this webcast:

• Get an overview of the system
• Attend a Q&A session

Use MCReF to:

• Submit cost reports (individually or in bulk) for fiscal years ending on or after December 31, 2017.
• Track the status of cost reports with fiscal years ending after December 31, 2009.
• Electronically transmit through MCReF, mail, or hand deliver cost reports to a Medicare Administrative Contractor. Providers must use MCReF if choosing to submit electronically.

Questions may be sent to OFMDPAOQuestions@cms.hhs.gov with “MCReF Webcast” in the subject line. Questions will be answered during the webcast or used to develop educational materials.

EVV system training offered by ODM

The Ohio Department of Medicaid (ODM) continues to offer providers the opportunity for more personalized Electronic Visit Verification (EVV) system training and an EVV account review. This is a great opportunity for providers to work one-on-one with a Sandata EVV representative to review how to use EVV or how to improve on issues related to EVV claims matching. To participate, please visit the calendar of available dates and times to sign up. Please note that Google Chrome is the preferred browser when accessing the calendar.

If you click on the link and there are no available sessions, please check back again soon. ODM is continuously opening up more sessions. 

Key telehealth bill introduced in Seattle

A bipartisan group of U.S. Senators introduced legislation on Thursday, April 22, to provide reimbursement to providers for telehealth services in the Medicare Home Health benefit, titled S. 1309, the Home Health Emergency Access to Telehealth (HEAT) Act.

While the concept of allowance for reimbursement for telehealth services is not a new one, the prohibition has become a glaring shortcoming in the era of the coronavirus pandemic. Congress ultimately elected to provide encouragement to the Centers for Medicare and Medicaid Services (CMS) on incorporating telehealth into the home health benefit as opposed to a firm directive.

The new legislation calls for permitting CMS the authority to issue a waiver that would allow for telehealth visits to count towards in-person visits as included on the plan of care in the event of a public health emergency (PHE). During the drafting, concerns were raised of the need for patient protections to ensure for protection against fraudulent and improper behavior. To assuage these concerns, guardrails were added that would require for patient consent for telehealth services, as well as a requirement that telehealth visits can comprise of no more than half of all visits. The bill will also require a pre-existing relationship between the patient and ordering physician for the patient to be eligible to receive reimbursable telehealth services.

LeadingAge Ohio will keep members informed on updates to the status of the HEAT Act.

Palmetto GBA hospice coalition request for questions

The Hospice Coalition will be meeting virtually with Palmetto representatives in June. Please send any questions you might have for Palmetto to Jeff Lycan at Jlycan@NHCooperative.org. Please submit questions by close of business on Tuesday, May 4.

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 swallace@leadingageohio.org.

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 sdewees@leadingageohio.org.

FCC announces round 2 COVID-19 Telehealth Program application window

The Federal Communications Commission (FCC) will begin accepting applications for Round 2 of the COVID-19 Telehealth Program on Thursday, April 29 at 12:00PM through Thursday, May 6 at 12:00PM.

The program allows eligible health care providers to be reimbursed for providing telecommunications services, information services and connected devices necessary to enable telehealth during the pandemic. The Consolidated Appropriations Act of 2021, enacted in December 2020, allocated $249 million for the program on top of the initial $200 million that was established as part of the CARES Act. Eligible health care providers of the COVID-19 Telehealth Program include sites that treat patients. Eligibility is limited to select nonprofit and public eligible health care providers, which includes skilled nursing facilities.

Please click here to register for the upcoming FCC webinars, “COVID-19 Telehealth Eligibility Overview,” to be held on Monday, April 26 at 2:00PM, and Wednesday, April 28 at 1:00PM

To learn more about the FCC’s COVID-19 Telehealth Program application process, visit the FCC's website.

What the media said about end of life care this week – April 27, 2021

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Upcoming Educational Opportunities

HospiLearn Webinars for May and June

HospiLearn Webinars: Earn continuing education credits through online educational programs.

• May 5: New Medications and Implications for Hospice Care
• June 2: Utilizing Validated Tools for Evaluating Hospice and Palliative Care Eligibility  

May Education

Virtual Conference on Pain and Palliative Care
**VIRTUAL**

May 5, 2021
12:00PM-5:00PM

Description:
Nationally renowned healthcare professionals with expertise in pain and palliative care will be coming together to present in-depth sessions for SPPCP's Fourth Annual Virtual Conference.

For additional details and/or to register, please click here.

Home Health and Hospice Newsletter

In Today's Newsletter

• Home Health, Hospice and DME open door forum: Today at 2:00PM
• You asked... We answered regarding hospice recertification surveys
  
• LeadingAge home health and hospice weekly recap
• Proposed hospice FY 2022 Wage Index Rule released; includes a Home Health Quality Reporting Program update
• Home Health NOA Companion Guide released
• Reminder: Changes in the hospice quality reporting program webinar, April 15
• Ohio advises temporary pause for Johnson & Johnson vaccine
• Employee Retention Credit could infuse millions into aging services

LeadingAge home health and hospice weekly recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition featured the White House Budget Request, Biden nominee updates and provider relief funds update.

Read the complete recap here.

Proposed hospice FY 2022 Wage Index Rule released; includes a Home Health Quality Reporting Program update

The FY 2022 Proposed Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice and Home Health Quality Reporting Program Requirements were released on April 9. The proposed increase to the hospice payment rate is 2.3% ($530 million dollars in increased payment to hospice providers) and there are proposed changes to the hospice program that include permanency of certain 1135 waivers, changes to the proposed labor shares of the hospice payment rates, clarifications and clarifying regulation text changes related to the hospice election statement addendum, and asks for comments on hospice utilization and spending patterns.

Additionally, the rule proposes to update the Hospice Quality Reporting Program by adding the claims-based Hospice Care Index and the Hospice Visits in the Last Seven Days of Life Measure for public reporting, removal of seven HIS measures because the Centers for Medicare & Medicaid Services (CMS) sees them as duplicative of other measures being reported, and contains more information on the development of the Hospice Outcome and Patient Evaluation (HOPE) assessment instrument. The rule also has a proposal related to the home health quality reporting program so that timely comments can be received prior to implementation. The proposed rule can be found here. LeadingAge's summary of the rule can be found here.

Comments are due by June 7 and LeadingAge will organize opportunities for members to provide feedback.

Home Health NOA Companion Guide released

The home heath notice of admission (NOA) 837I Companion Guide has been posted on the home health Coding and Billing website, first link in the download section. The Centers for Medicare & Medicaid Services (CMS) is working on the Change Request and is hoping to have it released sometime next month.

Reminder: Changes in the hospice quality reporting program webinar, April 15

The Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar on Thursday, April 15 from 2:00 to 3:30PM. The purpose of this training is to provide a general overview of the changes included in the Hospice Item Set (HIS) Manual V3.00. Specific topics include:

• The Hospice Quality Reporting Program (HQRP) Requirements
• Changes in Hospice Item Set (HIS) Manual V3.00
• The data sources that will comprise the HQRP
• The new quality measure (QM) created from administrative data (Medicare claims)
• HQRP resources

Please register only if you know you will be able to attend the webinar, as space is limited. If you would like your name placed on a list to receive an email notification when the recorded version of the webinar is available, please Click here to be placed on an email notification list.

Ohio advises temporary pause for Johnson & Johnson vaccine

This morning Governor Mike DeWine, Ohio Department of Health (ODH) Director Stephanie McCloud, and ODH Chief Medical Officer Bruce Vanderhoff, M.D., are advising all Ohio vaccine providers to temporarily pause using the Johnson and Johnson (Janssen) vaccine. 

This is in response to a statement by the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) recommending a pause in the use of the Johnson and Johnson vaccine following the extremely rare blood-clotting events of six people in the U.S. after receiving the vaccine. 

Later today the FDA and the CDC will hold a media briefing. In addition, the CDC will convene a meeting of the Advisory Committee on Immunization Practices tomorrow to further review these cases.

Officials with ODH are following this situation closely.

Employee Retention Credit could infuse millions into aging services

The two latest relief bills expanded the utility of a tax credit that would reimburse businesses that retained employees through the pandemic shut down. The Employee Retention Credit (ERC) was initially included in the CARES Act, but thought to be largely off-limits to organizations who had taken Paycheck Protection Act (PPP) loans to cover wages. The ERC would provide tax credits of up to $7,000 per employee per quarter ($28,000 annually) to eligible employers through the end of 2021.

More recent guidance provides clarity on how the ERC would interact with PPP loans. LeadingAge Ohio strongly encourages members to reach out to their financial advisors to ensure they are informed of any potential benefit to the organization. LeandingAge Ohio would like to extend its thanks to Chad Kunze at CLA for elevating the issue to our attention.

Upcoming Educational Opportunities

HospiLearn Webinars for April - May

HospiLearn Webinars: Earn continuing education credits through online educational programs.

April 14: Forgiveness at the End of Life and Beyond 

May 5: New Medications and Implications for Hospice Care

Virtual Conference on Pain and Palliative Care
**VIRTUAL**

May 5, 2021
12:00PM-5:00PM

Description:
Nationally renowned healthcare professionals with expertise in pain and palliative care will be coming together to present in-depth sessions for SPPCP's Fourth Annual Virtual Conference.

For additional details and/or to register, please click here.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We Answered regarding hospice addendums
  
• LeadingAge home health and hospice weekly recap
• Ohio RCD transition
• ODH releases orders for visitation, testing
• What the media said
  

You asked... We Answered regarding hospice addendums 

You asked:

When legal representatives request the hospice addendum, they are sometimes out of town and have limited accessibility. In these cases, we send the form electronically within the mandated five days from start of care. Our challenge is getting a signed copy returned to us within the five day timeframe, if at all. What can we do to get the signed copy back?

We answered:

LeadingAge Ohio reached out to Palmetto regarding the representative’s signature on the hospice addendum and what hospices need to do to acquire the signature. The response from Palmetto was:

If the representative lives out of state the hospice can email the addendum to the representative, as long the addendum was sent within the five day timeframe and the hospice has documentation they sent it. The hospice, in this case, has met the letter of the regulation by providing the addendum to the representative within five days. If the hospice gets a signed copy back, then that is all the better, but to meet the regulation, the hospice just needs to be able to prove they sent the addendum within the five day timeframe.

LeadingAge Ohio suggests hospices retain a copy of the email that was sent to the representative with the addendum to prove when it was sent or retain a copy of the fax if the addendum was faxed to the representative. If you have any questions regarding the hospice addendum, please contact Anne Shelley at ashelley@leadingageohio.org. 

LeadingAge home health and hospice weekly recap

Each week, LeadingAge will be providing a recap regarding home health and hospice. This week's edition featured new MLN articles on home health and home infusion billing, a reminder on accelerated and advanced payments, PPS extension and more.

Read the complete recap here.

Ohio RCD transition

As the Review Choice Demonstration (RCD) for home health agencies (HHAs) in Ohio continues, the time for Cycle 3 is approaching. For those options that are evaluated every six months, the claims or Pre Claim Review (PCR) requests reviewed during the cycle will determine the provider’s results. Providers will continue in their selected option during the calculation and selection period. The affirmation/claim approval rate calculation period occurs during the month of March 2021 with results letters being sent to HHAs by the end of March 2021. The selection period for Cycle 3 will take place from April 1, 2021 through April 15, 2021. Click here to read the entire article on the Palmetto website. If you have any questions about RCD, please contact Anne Shelley at ashelley@leadingageohio.org.

ODH releases orders for visitation, testing

Last week, the Ohio Department of Health (ODH) released a set of four new orders governing visitation and testing in Ohio’s nursing homes and assisted living.

Visitation Orders

• Director’s 7th Amended Order to Permit Access to Ohio’s Nursing Homes, with Exceptions
• Director’s 7th Amended Order to Permit Access to Ohio’s Residential Care Facilities, with Exceptions

Testing Orders

• Director’s Amended Order for the Testing of the Residents and Staff of all Residential Care Facilities
• Director’s Amended Order for the Testing of the Residents and Staff of all Nursing Homes

During last week's all-member call, LeadingAge Ohio Quality and Regulatory Specialist Stephanie DeWees fielded dozens of questions on how the new orders will be implemented. Since questions exceeded the allotted hour, LeadingAge Ohio has committed to creating a special alert in which provider questions related to visitation and testing can be fielded.

LeadingAge Ohio anticipates user-friendly guidance documents to be released in the coming days for providers to share with families and the public. The anticipated revision to the Director’s Order governing Ohio’s adult day and senior centers has yet to be released, but is anticipated this week.

What the media said about end of life care this week – March 30, 2021

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Upcoming Educational Opportunities

HospiLearn Webinars for April - May

HospiLearn Webinars: Earn continuing education credits through online educational programs.

April 14: Forgiveness at the End of Life and Beyond 

May 5: New Medications and Implications for Hospice Care

Virtual Conference on Pain and Palliative Care
**VIRTUAL**

May 5, 2021
12:00PM-5:00PM

Description:
Nationally renowned healthcare professionals with expertise in pain and palliative care will be coming together to present in-depth sessions for SPPCP's Fourth Annual Virtual Conference.

For additional details and/or to register, please click here.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding state plan home health aid hours
  
• Changes made to provider reports
• Hospice TEP report on HOPE tool available
• American Rescue Plan
• BWC air quality assistance now includes hospice
• National hospice study: Providers encouraged to complete input survey
• Ohio's Strategic Action Plan on Aging provides ODA priorities
• Deadline for health professionals' temporary licenses extended
• What the Media Said
  

You asked... We answered regarding state plan home health aid hours

You asked:

If a company provides state plan home health aide hours and then another agency provides PASSPORT hours for the same consumer, does there have to be a break in services? For example, can one agency provide state plan services from 9:00-11:00AM and then another agency provide PASSPORT services from 11:01-2:00PM? 

We answered:

LeadingAge Ohio reached out to a representative at the Ohio Department of Medicaid (ODM) regarding the above question and the response was:

The Ohio Administrative Code 5160-12-04(B) addresses this situation and says:

When an individual is enrolled in a home and community based services (HCBS) waiver and is receiving consecutive home health or PDN services with waiver services that have the same scope of service, there must be a lapse of time of two or more hours between the services.  A “scope” of a service includes the definition of the service and the conditions that apply to its provision and the provider who renders the service(s).

In addition, please note that the provider of state plan services has a responsibility to coordinate with the care manager and ensure that the state plan services are reflected in the all services plan. 

If you have any questions regarding this information please contact Anne Shelley at ashelley@leadingageohio.org. 

Changes made to provider reports

The Centers for Medicare & Medicaid Services (CMS) made several updates to the Hospice Quality Reporting Program’s (HQRP’s) confidential reports available in CASPER. The reports undergoing updates include:

1. The QM reports, which provide hospice agencies feedback on their quality measure scores, allowing them to continuously improve the quality of care delivered; and
2. The Review and Correct reports, which provide hospice agencies an opportunity to identify any reporting errors that may affect quality measure performance.

With the new changes, the QM reports direct readers to the HQRP Public Reporting: Key Dates for Providers page to obtain more information on public reporting in light of the COVID-19 Public Health Emergency. In addition, the QM reports and the Review and Correct reports align with the Hospice Item Set (HIS) V3.00, which removes Section O from the Discharge Assessment and thus ends data collection for the Hospice Visits When Death Is Imminent (HVWDII) measure pair. The HIS Manual V3.00 received OMB approval as of February 16. Because of this change to the HIS, the QM and Review and Correct reports display HVWDII measure scores only when hospice agencies select quarters before or including Q4 2020; when hospice agencies select quarters after Q4 2020, the reports will display a dash for HVWDII.

Please find more information on the QM reports on the HQRP Requirements and Best Practices page and additional information on the HIS V3.00 on the Hospice Item Set page.

Hospice TEP report on HOPE tool available

The Centers for Medicare & Medicaid Services (CMS) has released the summary report from the Technical Expert Panel (TEP) meetings convened in 2020 by CMS’s measure development contractor, Abt Associates. The standing TEP is composed of 11 members representing a wide range of hospice stakeholders, including providers, caregivers, and quality improvement experts. The TEP’s role is to help develop and refine new hospice quality measures, focusing on measures derived from the Hospice Outcomes and Patient Evaluation (HOPE), a real-time hospice assessment instrument. The full TEP convened in March and November 2020, and a subset of TEP members convened between May and June 2020.

This report provides a summary of these activities, including background on the focus of each TEP meeting, a summary of the discussion, and key recommendations.

American Rescue Plan

The final American Rescue Plan, which will be voted on in the House on Wednesday March 10, includes language that specifically states that home health, hospice, and long-term services and supports providers that serve individuals in their homes in a rural area can qualify for provider relief funds. LeadingAge advocated for this change late last week when the rural provider relief fund language was added.

More on the bill in its entirety will be released later this week by LeadingAge.

BWC air quality assistance now includes hospice

Members should be aware of upcoming webinars focused on air quality improvements to help prevent the spread of COVID-19, including recent expansions to the Bureau of Workers’ Compensation (BWC) COVID-19 Indoor Air Quality Assistance Program. The BWC has expanded this program to also include hospice providers. This program, funded with federal CARES Act dollars, makes grants available to providers to update HVAC systems to prevent the spread of COVID-19 and other airborne viruses.

National hospice study: Providers encouraged to complete input survey

The nation’s hospice community is changing at an unprecedented rate. Last year, the sector faced its biggest challenge - COVID-19. This challenge, combined with patient access and staffing shortages, is forcing provider organizations to redefine themselves. To do this, national-level research is needed that will guide programmatic efforts and help define what it means to provide health care in the home.

For this reason, the National Hospice and Palliative Care Organization (NHPCO) is co-sponsoring a national study with LeadingAge designed to help the hospice community both manage and provide quality outcome-driven care in the new reform environment. Known as the 2021 National Healthcare at Home Best Practices and Future Insights Study, the research project will help identify best practices that agencies can implement to position themselves for future success. NHPCO and LeadingAge encourage all agencies to complete the online input survey.

Deadline to complete the input survey is Friday, March 12.

Ohio’s Strategic Action Plan on Aging provides ODA priorities

Yesterday Ursel J. McElroy, Director of the Ohio Department of Aging (ODA), presented Ohio’s Strategic Action Plan on Aging (SAPA) to a group of stakeholders, including LeadingAge Ohio. The stated goals of the SAPA are that all Ohioans live longer, healthier lives with dignity and autonomy and that disparities and inequities among older Ohioans are eliminated. The SAPA prioritizes 15 issues to improve the lives of all older Ohioans. It then provides a menu of evidence-informed strategies to be implemented at the state and local levels to improve outcomes.

The SAPA’s key issues are organized into six topic areas: community conditions, healthy living, access to care, social connectedness, population health, and preserving independence. Within each topic area, priority populations most affected by those issues are identified.

To achieve the goals of the SAPA, Director McElroy has called on state and local partners in the public and private sectors to act on the SAPA by aligning with its issues, advocating for policy change and funding, implementing one or more of the evidence-informed strategies, partnering and collaborating, and evaluating the state’s progress.

The 2020-2022 Strategic Action Plan on Aging and supporting documents are available here.

Deadline for health professionals’ temporary licenses extended

The Ohio Board of Nursing (OBN) passed along the following information regarding H.B. 6 and its passing in the House and Senate. The passing of H.B. 6 will allow a path for individuals who have not taken the National Council Licensure Examination (NCLEX) to apply for temporary licenses that would be good through July 1, 2021:

To amend Section 30 of H.B. 197 of the 133rd General Assembly to modify the laws governing certain health professionals and educator preparation programs due to COVID-19 and other circumstances...; to amend the version of section 4729.92 of the Revised Code that is scheduled to take effect on October 9, 2021, to continue the changes to that section on and after that date; and to declare an emergency.

Please ensure you have urged your nurses with temporary licenses to be ready to sit for and pass the NCLEX exam before this extension date.

What the Media Said About End of Life Care This Week – March 9, 2021

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding MA Plans participating in the hospice VBID model
  
• Hospice Self-Determined Aggregate Cap report due March 1
• CDC guidance for vaccinating homebound persons
• Home health claims processing issues
• VFW Rural Hospice grant not available in 2021
• What the Media Said:
  

You asked... We answered regarding

You asked:

Do you know how many Medicare Advantage (MA) Plans will be participating in the hospice Value-Based Insurance Design (VBID) model in Ohio and can a hospice provider still apply to be in the demo?

We answered:

LeadingAge Ohio reached out to Mollie Gurian, Director of Hospice, Palliative and Home Health Policy with LeadingAge to inquire more about the hospice VBID model and her response was as follows:

“Humana is the only participating MA plan in the hospice VBID model in Ohio today. Humana is partnering with hospice providers in a few northeast Ohio counties. Please see Humana’s hospice VBID landing page to see what counties Humana will be providing the model in 2021. Other MA Plans are in the process of considering applying for the VBID model in CY 2022 so there may be an expansion of the of the demo in Ohio next year.

There has been a lot of confusion about hospice’s “applying” to be in the VBID model. Hospices can negotiate to be in network for a plan who has applied to be in the demo, or the hospice can choose to be out of network, which, for the first two years will ensure fee for service rates for the hospice, but the out of network hospice will not be able to offer the other components of the demo such as palliative care or concurrent care for their patients.”

For more information for hospices in northeast Ohio who might want to negotiate with Humana regarding the VBID model, contact Kevin Curey at kcurey@humana.com or call 502-580-4059.  If you have any questions regarding hospice VBID, please contact Anne Shelley at ashelley@leadingageohio.org.

Hospice Self-Determined Aggregate Cap report due March 1

Hospice providers you have until March 1 to submit the Self-Determined Hospice Cap Report (SDHC) to Palmetto. Click here to access the form as well as directions for submission on the Palmetto website. 

CDC guidance for vaccinating homebound persons

The Centers for Disease Control and Prevention (CDC) has come out with new guidance for vaccinating homebound persons with COVID-19 vaccine. The guidance goes into detail about the type of individual who might be considered homebound as well as the training, pre-vaccination planning, storage and handling of the vaccine prior to administration of the vaccine. Providers who are considering administering COVID-19 vaccines to homebound individuals should read the guidance thoroughly and follow the suggestions and procedures. One item the guidance does not discuss is the acquisition of the vaccines for homebound persons. A provider should reach out to their local health department to inquire about vaccine acquisition for homebound persons.

On Wednesday's Vaccine Stakeholder call, the Ohio Department of Health (ODH) shared that the state estimates Ohio has approximately 22,000 homebound individuals. The CDC change – that a punctured vial can go from one home to another (within 6 hours), as long as cold storage requirements are maintained – should greatly enhance the ability to reach the homebound with vaccines. ODH is reviewing the CDC change and will provide guidance ASAP.

If you have any question regarding vaccinating homebound individuals, please contact Anne Shelley at ashelley@leadingageohio.org.

Home health claims processing issues

According to the National Association for Home Care & Hospice (NAHC), home health claims are not processing when the date for revenue code line 0023 on the Request for Anticipated Payment (RAP) does not match the date on line 0023 on the final claim. There are two reason codes associated with the date mismatch, reason code 38107 and U5391.  

Reason code 38107 occurs when the dates on the RAP and the final claim for line 0023 do not match. The Centers for Medicare & Medicaid Services (CMS) confirmed the instructions permit line 0023 on RAPs for subsequent periods to be the first date of the period to assure timely submission of RAPs, however, line 0023 on the claim must match that date. CMS does permit the actual first visit date to be different than line 0023 on the claim, but line 0023 on the RAP and claim must always match.  

Much of the confusion relates to the instructions in the Medicare Claims Processing Manual, Chapter 10 section 40.2, that reads, “For subsequent episodes, the HHA reports on the 0023 revenue code the date of the first visit provided during the episode/period, regardless of whether the visit was covered or non-covered.”

Agencies will need to correct line 0023 on the claim to match the RAP in order for claims with reason codes 38107 or U5391 to process.

VFW Rural Hospice grant not available in 2021

For almost two decades, the former Midwest Care Alliance, now LeadingAge Ohio has worked with the Veterans of Foreign Wars (VFW) of Ohio, Hospice Grant Fund, supporting an opportunity for Small Hospice Providers to apply for grant funding meant to support small hospice programs that provide services to the underserved and/or rural populations. The VFW shared with LeadingAge Ohio they expended all funds last year and due to low donations, will be unable to offer the rural hospice grant program in 2021. LeadingAge Ohio hopes this program can return in 2022. Please direct any questions to Jennifer Taylor at jtaylor@leadingageohio.org.

What the Media Said About End of Life Care This Week – February 23, 2021

While 2020 may have be synonymous with COVID, compassionate care for those who have been struggling has brought hospice providers across the country an opportunity to shine light on the core of what hospice is truly about, the right care, at the right time in the right place. Throughout the pandemic hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews countless articles and media venues to share with our members the buzz in the industry.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding social work visits
  
• JM home health overview of the Request for Anticipated Payment (RAP) in 2021
• Hospice quality reporting program
• CMS answers home care question
• Survey reforms and other significant changes for hospice
• February office hours for the Value-Based Insurance Design (VBID) model
• Summary and analysis of Biden relief plan 
• What the Media Said

You asked... We answered regarding social work visits

You asked:

In speaking with social workers from other hospices, and there are differences of opinion regarding what can be counted as a social work visit under the current Hospice CMS Flexibilities. Can LeadingAge Ohio clarify whether a phone call (audio only) with a patient counts as a visit or not? I thought that if a telephone was used for a social work visit, there needed to be audio and visual with real-time with interactive capabilities.

I thought that if a telephone was used for a social work visit that there needed to be audio & visual, real-time with interactive capabilities, otherwise it would simply be a social work telephone call. I appreciate any information you are able to share.

We answered:

Social worker phone calls have been billable contacts for hospice social worker since 2010. According to the regulations in MM6440, social worker phone calls that are necessary for the palliation and management of the terminal illness and related conditions as described in the plan of care can go on the hospice claim. What is not clear is if a social worker telehealth visit, conducted by real-time audio/visual capabilities, should be considered a phone call and go on the claim, or if a social worker telehealth visit should not be documented on the claim as telehealth visit.

LeadingAge Ohio reached out to Palmetto GBA to ask if social worker telehealth visits conducted on a device with real-time audio/visual capabilities should be documented on a hospice claim as a social worker phone call or not. The Palmetto representative gave the following guidance: It is up to the hospice if they want to document real-time audio/visual social worker telehealth visits on the claim as a social worker phone call or not, but it definitely could be billed, as it uses audio communications, and the video goes above and beyond.

JM home health overview of the Request for Anticipated Payment (RAP) in 2021

Presented by Palmetto GBA, this webcast is designed to provide education and updates for the Calendar Year (CY) 2021 Home Health (HH) Request for Anticipated Payment (RAP) policies. This presentation is geared towards billing staff members. Register for this webinar by clicking here.

Hospice quality reporting program

The Centers for Medicare & Medicaid Services’ (CMS) Home Health, Hospice, and DME (Durable Medical Equipment) Open Door Forum on January 26 left some questions about the Hospice Quality Reporting Program (HQRP) unanswered. The National Association for Home Care & Hospice (NAHC).followed-up with CMS HQRP experts and received important clarifications. Full details are available to LeadingAge Ohio members here. (NAHC Report February 5)

CMS answers home care question

The Centers for Medicare & Medicaid Services (CMS) has provided the following response to an outstanding question submitted by the National Association for Home Care & Hospice (NAHC).

There is confusion based on the regulations below. Section 424.22(a)(v) (A)(2) states that a NP, PA, or a CNS may conduct the F2F encounter when collaborating with certifying physician whether in a facility or in the community. However, 424.22(a)(v) (C) (1) and (2) seem to limit who may conduct the F2F encounter when an NP, PA, or CNS is certifying beneficiaries admitted to home health from the community. Section (C) reads as though the NP, PA, or CNS may only conduct the F2F encounter if they are the certifying practitioner. These sections are conflicting and seem to prohibit NPPs who are not certifying but are working in collaboration with a certifying physician to conduct the F2F encounter for beneficiaries admitted to home health from the community.

To see the complete question and answer, please click here. (NAHC Report February 4)

Survey reforms and other significant changes for hospice

The Consolidated Appropriations Act 2021 that was passed at the end of December 2020 contains numerous provisions applicable to all provider types and some that are hospice-specific. Attached is a detailed summary of the hospice-specific provisions in date order, as appropriate, and any additional information about the provision available at this time. (NAHC Report February 2)

February office hours for the Value-Based Insurance Design (VBID) model

The Value-Based Insurance Design (VBID) Model team will host its monthly office hours to provide technical and operational support on the VBID Model, the Hospice Benefit Component and the 2022 application cycle.

During this office hour session, presenters will answer questions received in advance to the VBID Mailbox and also offer attendees an opportunity to ask additional questions.

• What: Webinar: February Office Hours for the Value-Based Insurance Design (VBID) Model
• When: Thursday, February 11, 2021 4-5 PM ET
• How to Join: Registration for the webinar is now open. Register now using the link here.
  • Event number:  177 872 0287
  • Event password:  2022RFA-feb

For more information, visit the VBID overview page or contact VBID@cms.hhs.gov.

Summary and analysis of Biden relief plan 

LeadingAge has released an article about the Biden Administration’s $1.9 billion relief plan, the National Strategy for the COVID-19 Response and Pandemic Preparedness. The article contains a nine-page summary and analysis of the seven goals within the plan, highlighting elements that particularly affect LeadingAge members. The Administration put together an outline of a legislative proposal, the American Rescue Plan, that contains some of the elements of the National Strategy. The House approved the Senate amended budget resolution, so the process is in place now to pass relief legislation using the budget reconciliation process. The content of the final bill that will move through Congress is yet to be finalized.

The budget resolution gives committees budget figures to work with, but not instructions on specific policies. Those will be determined by the House and Senate committees. It is likely that a majority of the bill will follow the Biden proposals, but Congress will be shaping the details and adding some pieces of its own over the next couple weeks. Speaker of the House, Nancy Pelosi, optimistically said she hopes the House can pass something within two weeks.

What the Media Said About End of Life Care This Week – February 8, 2021

While 2020 may have be synonymous with COVID, compassionate care for those who have been struggling has brought hospice providers across the country an opportunity to shine light on the core of what hospice is truly about, the right care, at the right time in the right place. Throughout the pandemic hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews countless articles and media venues to share with our members the buzz in the industry.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered
• CMS open door forum addresses HIT, Home Health CAHPS, and claims processing issues
• Hospice quality reporting program updates for January 2021
• Welcome VNAA and ElevatingHOME to LeadingAge
• DeWine previews SFY 2022-2023 budget
• N95 decontamination strategy limited to four times
• LeadingAge shares CDC guidance
• Next all-member webinar - Tuesday, February 9 at 11:30AM
• Lobbying expense percentage of membership dues
• What the Media Said About End of Life Care This Week

You asked:

There was an open-door forum in early January where CMS said, “If two visits occurred on the same day and there are appropriate claims submitted for the two visits in the last three days of life, it would count toward meeting this new measure.”

Is that really true? The way the measure is written, it sounds like the visits would have to be on two separate days in the last three days of life.

We answered:

Mollie Gurian, LeadingAge Director of Home Health and Hospice Policy, met with CMS regarding the measure Hospice Visits in the Last Days of Life (HVLDL), and CMS clarified that at least two visits on separate days need to be made in the last three days of life for the measure to be met.

CMS open door forum addresses HIT, Home Health CAHPS, and claims processing issues

On January 26, the Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice, and Durable Medical Equipment (DME) Open Door Forum addressing several issues of interest to home health providers. A summary of the issues pertaining to home health are below:

Home Infusion Therapy Supplier Benefit

CMS officials reminded participants that the HIT supplier benefit applies only to infusion drugs listed in the Durable Medical Equipment local coverage determination (LCD) for external infusion pumps. The list of drugs can be found in MedLearn Matters article 11880. The list will be updated as drugs are added and removed from the list. There are no antibiotics included on the list.

Claims Processing Issues

Three claims processing system errors related to the No-pay Request for Anticipated Payment (RAP) submissions have been identified.

1) RAPs are being returned to provider (RTP’d) for not having value code 61 and the core-based statistical area code even though these elements are optional on RAPs beginning January 1. The Medicare Administrative Contractors have been instructed to add value code 61 and a placeholder CBSA code 10180 to the RAP so it can continue to process. For RAPs that were RTP’d before the MACs received instructions for the workaround causing HHas to be concerned that the RAP may have been recorded as late, CMS instructs HHAs to apply for an exception to the penalty describing the system error.

2) RAPs are being RTP’d incorrectly with reason code W7216 indicating an invalid line item date with revenue code 0023 when the date falls outside of the “from” and “through” date. Until this issue is resolved the contractors will suspend the RAP in status/location S MWRAP and bypass the edit for the RAP to process. HHAs concerned that the RAP may have been recorded as a late submission before these errors were identified should apply for an exception to the penalty describing the circumstances beyond the HHA’s control.

3) The late submission penalty is erroneously being applied to RAPs submitted earlier than 5 days of the “From” date. This error impacts RAPs for the second 30 day periods where HHAs are permitted to submit the RAPs early. A system fix will not be installed until March 1, 2021. Therefore, HHAs might want to wait to submit claims until after the fix is installed to avoid an erroneous penalty. If claims are submitted prior to the system fix, the MACs will automatically adjust the claims when a fix is installed.

Consumer Assessment of Healthcare Providers and Systems (HHCAHPS)

The agenda and slides for the self-paced 2021 introduction to the (HHCAHPS) (why is this in parenthesis?) Survey training and the HHCAHPS Survey Vendor Update training are now posted under the “Training” tab of the HCAHPS Website. CMS reminded participants that approved HHCAHPS survey vendors must attend the vendor update training session scheduled for January 29, 2021 (via the NAHC Report January 29).

Hospice quality reporting program updates for January 2021

Below are announcements, updates and plans hospices should be aware of from the Hospice Quality Reporting Program (HQRP).

Future Quality Measures

The Centers for Medicare & Medicaid Services (CMS) announced in its January 26 Home Health, Hospice, & DME Open Door Forum that it presented the newly proposed Hospice Care Index (HCI) quality measure to the National Quality Forum’s (NQF) Measures Application Partnership (MAP). The MAP has conditionally approved the measure and CMS is now working towards formal NQF endorsement. The Hospice Index (HI) measure is a claims-based composite measure composed of the following 10 indicators:

• Hospice Provided No Continuous Home Care & General Inpatient Care
• Nurse Minutes per Routine Home Care Day
• Skilled Nurse Visits on Weekends
• Live Discharges in First Seven Days of Hospice
• Live Discharges On or After the 180th Day of Hospice
• Burdensome Transitions (Type I) – live discharges from hospice followed by hospitalization followed by hospice readmission
• Burdensome Transitions (Type 2) – live discharges from hospice followed by hospitalization with the patient dying in the hospital
• Gaps in Nursing Visits
• Per Beneficiary Spending 
• Receiving Visits Near Death

In developing the HCI, CMS would establish scoring for these indicators and determine a threshold for each indicator above or below from which a hospice’s score is determined to be substandard. CMS would then add scores for the indicators together and establish a threshold for the composite value. The expectation is that only a small percentage of hospices, approximately 10-15%, would fall outside of the normal range and be considered a poor performer. The MAP conditionally approved the HCI, and CMS is working towards formal recommendation from the MAP. The MAP reviews the measure for the second time in February and a final decision will be made by the MAP at that time. It is expected that the HCI will be part of the FY2022 hospice proposed rule due out at the end of April. NAHC submitted comments to the MAP regarding the HCI. Comments coordinated by a group of national hospice organizations can be found here.

In response to questions during the ODF, CMS indicated that the HCI would replace the HIS measures in the Hospice Quality Reporting Program (HQRP). Unfortunately, the CMS staff on the ODF were not HQRP specialists and indicated they would have to consult with specialists to confirm the accuracy of this statement. Of note is the fact that CMS has planned to replace the HIS with the HOPE (Hospice Outcome & Patient Evaluation) tool. The HOPE is currently undergoing alpha testing and will need to go through beta testing and rulemaking so it is not expected to be implemented for all hospices for some time. So, if it is accurate that the HCI will replace the HIS measures, this would be expected to occur in this year’s rulemaking process and could be effective October 1, 2021. Again, it is not clear if CMS’ response during the ODF was accurate, and NAHC will provide more information when it becomes available. 

Hospice Item Set (HIS) and the Hospice Visits in Last Days of Life (HVLDL) Measure Clarification

The HIS v3.00 is still pending approval from the Office of Management & Budget (OMB). Once OMB approval is confirmed (expected spring 2021), the HIS v3.00 will be posted on the HIS webpage and the corresponding User’s Manual v4.00 will also be posted. While awaiting OMB approval, CMS moved forward with implementation of the HIS v3.00 on January 1, 2021. Both HIS v3.00 and HIS v2.00 are being accepted by the ASAP system and not resulting in fatal errors or rejected records. A hospice may choose which version it submits knowing that if using HIS v2.00, Section O of the HIS-Discharge record will not be retrieved by CMS. 

Hospices will recall that HIS v3.00 removes Section O from the HIS-Discharge record. Section O is the section where all the visit information was recorded. This information will now be obtained from claims, leaving the only information remaining from the HIS-Discharge record being the patient’s discharge date and discharge disposition. Therefore, it would be possible that CMS would no longer need hospices to submit the HIS-Discharge record.  When asked about this on the ODF, CMS indicated it has plans to no longer require the HIS-Discharge from hospices. This is being confirmed with CMS staff working on the HQRP.

CMS indicated in the latter half of 2020 that it re-specified the Hospice Visits When Death is Imminent (HVWDII) measure with the claims-based HVLDL measure calculations. The HVLDL measures the proportion of patients receiving visits from an RN or MSW in at least 2 of the last 3 days of life. CMS has received many questions about the HVLDL. During the recent ODF, CMS explained that the visits to be counted in this measure are in person visits only.  No telephone calls will be counted, just as was the case for the HVWDII measure. And, just as was the case for the HVWDII measure, the following is the calculation for the last 3 days of life:

• The day of death is the same as the date provided in A0270, Discharge Date. (or the day of death) 
  • One day prior to death is calculated as A0270 minus 1. 
  • Two days prior to death is calculated as A0270 minus 2.

Therefore, the day of death does count as one of the three days. It is expected that the HVLDL will begin being publicly reported with the spring 2022 Care Compare refresh. From previous information shared by CMS, it is believed that the HVLDL will be calculated beginning with January 2021 hospice claims; however, NAHC has reached out to CMS to confirm this.  

Another frequent question about the HVLDL is whether two visits on the same day will count as two visits, and the answer is no. The measure calculates the proportion of patients receiving a visit from an RN or MSW in at least 2 of the last 3 days of life. It is not a measure of the number of visits but, rather, the number of days that a visit by one of these disciplines was made. More information on the re-specification of the HVWDII measure with the HVLDL measure can be found in CMS’ Hospice Visits When Death is Imminent: Measure Validity Testing Summary and Re-Specifications report. 

Public Reporting of Hospice Quality Data

A new quality reporting period began on January 1, 2021 and will conclude on December 31, 2021. During this time, hospices must meet quality reporting program requirements that apply to both the HIS and the CAHPS Hospice Survey and impacts the Annual Payment Update (APU) for FY2023 (which begins with payments on October 1, 2022). During the CY2021 the CAHPS Hospice Survey will continue data collection as normal. The next data submission deadline is February 10 and covers patient deaths occurring July 2020 through September 2020.  

Due to Public Health Emergency (PHE) the publicly reported data will be held constant from the Care Compare refresh in November 2020 through November 2021. During this time no Preview Reports will be issued. Care Compare will display PUF (Public Utilization File) data from 2016-2018.  Zip codes that source from HIS records will remain constant until November 2021 at which time the zip codes used to power the PUF search functions will be updated. 

The new Participation Exemption for Size  form for the CAHPS Hospice Survey is posted on the CAHPS Hospice Survey website. Hospices that served fewer than 50 survey-eligible decedents/caregivers in CY 2020 (January 1, 2020 through December 31, 2020 [or from assignment of CCN]) can apply for an exemption from participation in the CAHPS Hospice Survey for CY 2021. The form is due no later than December 31, 2021.

Any hospices thinking of switching CAHPS vendors should not try to switch without talking with the CAHPS Hospice Survey technical team. Email at hospicecahpssurvey@HSAG.com or call1-844-472-4621. This is critical to avoiding the APU penalty.

Hospice Quality Reporting Program Resources

• HQRP webpage
• Hospice QRP Requirements and Best Practices
• Hospice QRP Training and Education Library
• HQRP Helps Desks
• Hospice Compare/Public Reporting
• HQRP Quarterly Updates for October - December 2020 (via the NAHC Report January 27)

Welcome VNAA and ElevatingHOME to LeadingAge

This week, LeadingAge officially welcomes ElevatingHOME and the Visiting Nurse Associations of America (VNAA) members. The addition makes LeadingAge membership richer than ever. Together, this union forms a community of more than 5,000 care providers that encompasses the continuum of services for people as they age, including those with disabilities. LeadingAge and VNAA are united in a collective commitment to providing quality care and service -- with innovation, integrity, and accountability to our workforce and our communities.

DeWine previews SFY 2022-2023 budget

Late day on Monday, Governor DeWine released the “blue book” and fact sheets that include some details about what would be contained in the Executive Budget. The legislative language will not be released until next week at the earliest, at which point the details of the proposals will become clearer. The bill touts $1 billion in investment towards coronavirus recovery, which includes supports for local health departments and businesses impacted by the pandemic.

Included in the budget were numerous changes pertaining to nursing homes, which preserve existing funding levels and create new investments for those impacted by the pandemic and those that demonstrate quality care. Another proposal would give the Director of Health more authority to act when an individual’s health or safety is in danger due to substandard care.

LeadingAge Ohio is still learning details on budget impacts for Ohio’s home- and community-based providers, including personal care services and adult day provided under PASSPORT and assisted living provided under Ohio’s assisted living waiver.

The proposals include the following:

• Invest $50 million for a nursing home reform initiative in response to the underutilization of licensed nursing home beds in Ohio. The Department of Health, in collaboration with the Department of Aging and Medicaid, will launch a reform initiative to encourage facilities to voluntarily downsize, move to single patient rooms, and remove the costly excess unused beds from the system. The way the nursing home payment structure in Ohio was designed years ago, Medicaid is required to cover a portion of expenses for unused bed days. According to current Department of Health records, nearly 20% (approximately 11,000) of eligible nursing home beds were vacant prior to the start of the COVID-19 pandemic; occupancy has weakened significantly since its start. As Ohioans demand more community-based care options, this initiative will help rebalance the services available and improve the quality of care for all Ohioans, regardless of setting.
  
  
• Increase the authority and ability of the Department of Health to protect nursing home patients from dangerous situations. The Patient Protection proposal would give the Department of Health the authority to swiftly intervene to protect patients in nursing facilities when they determine the safety of patients is in jeopardy. If needed, the Department will have the authority to immediately remove patients and relocate them into a safe facility.
  
  
• Launch new training opportunities through the Department of Aging. The Training and Improving Ohio Nursing Facilities proposal will launch a series of new quality improvement initiatives and a technical assistance programs to improve the quality of care across the board for Ohio nursing homes. Programming will be targeted to address infection control, elder abuse, and other areas that are flagged as prominent during the Department of Health's inspection process.
  
  
• Invest $440 million into quality outcome incentives for Medicaid nursing home services. The Quality Driven Reimbursement proposal seeks an increase of $100 million into a new payment formula that moves to reward nursing homes for providing high-quality care, based on meaningful outcome-driven industry leading metrics. The Department of Medicaid will work in collaboration with a joint committee and seek input from experts across multiple agencies, providers, and senior advocates to ensure a robust and high-quality incentive-based payment structure. Additionally, to encourage high quality oversight, recipients will be required to ensure that key nursing home staff such as an administrator, medical director, nursing director, and quality improvement director reside in and work in the state of Ohio.

The $440 million reflects both the continuation of the investment made in the quality incentive payment during SFR 2020-21 budget, as well as an additional $100 million to expand the portion of the reimbursement formula incentivizing quality care. Other changes that were not included in the budget preview, but were shared with LeadingAge Ohio by Administration leadership, include delaying rebasing and providing some regulatory relief by extending the licensure survey interval for providers with consistently high survey performance.

Other proposed changes likely to affect LeadingAge Ohio members include several managed care provisions:

• The Department will ease the claims and reimbursement timeline by implementing a fiscal intermediary to serve as the front door to submissions.
  
  
• The Department will centralize provider credentialing, eliminating redundancies embedded in the program today due to this function being managed by each of the six MCOs.
  
  
• The Department will simplify and standardize Medicaid’s preferred drug list to eliminate the need for providers to understand and comply with six individual preferred drug lists managed by MCOs.

LeadingAge Ohio urges caution, as the documents released today are only the first view of the executive budget, with very little detail provided. The full budget language is anticipated next week, at which point LeadingAge Ohio’s policy team will closely examine and communicate the details of each proposal. Furthermore, the Executive Budget is only the first step in what will be a five-month long legislative process, as the budget bill passes through the House, Senate, conference committee and ultimately, back to the Governor’s desk for signature.

Throughout the budget process, members are encouraged to dial in to the LeadingAge Ohio Advocacy in Action calls on the second and fourth Monday of the month at 10am. The calls will feature the latest from the Ohio Statehouse related to various aging services proposals.

Advocacy questions may be directed to Susan Wallace, Chief Policy Officer, at swallace@leadingageohio.org.

N95 decontamination strategy limited to four times

The Ohio Department of Health (ODH) sent an EIDC bulletin on February 1 alerting providers to updated FDA guidance which limits N95 decontamination to a maximum of four times. The FDA is reissuing the Emergency Use Authorizations (EUAs) for decontamination systems that are authorized to decontaminate compatible N95 respirators for use by healthcare personnel (HCP) to prevent exposure to pathogenic biological airborne particulates when there is an insufficient supply of new respirators resulting from the COVID-19 pandemic. Among other things, the reissued EUAs for certain decontamination systems are now only authorized to decontaminate each compatible N95 respirator a maximum of four or fewer times.

Battelle, using the Battelle CCDS Critical Care Decontamination System™, has been authorized under the January 21, 2021 FDA EUA to decontaminate compatible filtering facepiece respirators (FFR).

Compatible FFR include NIOSH-approved N95 respirators found on the CDC website and non-NIOSH approved respirators listed in Exhibit 1.

FFRs that meet this policy:

• do not have exhalation valves,
• do not incorporate a duck-bill design, and
• do not contain antimicrobial/antiviral agents.

In addition, FFRs that meet this policy:

• have been authorized under the emergency use authorization (EUA) for NIOSH-approved FFRs, or
• have been authorized under the EUA for non-NIOSH-approved FFRs that are not manufactured in China, or
• are FDA-cleared as intended for use by healthcare personnel (HCP).

CDC recommends limiting the number of donnings for an N95 FFR to no more than five per device. The facilities respiratory protection program should address both decontamination strategies along with limited re-use of an N95 for no more than five donnings.

The FDA has issued Emergency Use Authorizations (EUAs) for the emergency use of decontamination systems for use in decontaminating certain respirators used by health care personnel when there are insufficient supplies of new respirators resulting from the COVID-19 pandemic. New FDA-cleared N95 respirators or NIOSH-approved N95 respirators or other FDA authorized respirators are always the first choice before a decontaminated respirator. 

LeadingAge shares CDC guidance

Each week, members of LeadingAge’s team in DC meet with the Centers for Disease Control & Prevention (CDC) to address a host of questions LeadingAge receives from LeadingAge Ohio and other state associations. LeadingAge Ohio received these three updates from LeadingAge’s CDC meeting yesterday:

• There won’t be any changes to the advice on masks – that is, double masking is being reported in the media, but there will be no change in CDC guidance.

• CDC is anticipating putting out guidance at some point on boosters and Pharmacy Partnership LTC clinics, should additional boosters be needed to address new strains.

• The announcement of a Retail Pharmacy Program is expected very soon (days? weeks? – not clear yet, but CDC notes “soon”). Once this is up and running, anyone will be able to go into the CDC website, find a pharmacy (including as many as 40,000 pharmacies nationwide; and LTC pharmacies) and arrange an onsite clinic.

Next all-member webinar - Tuesday, February 9 at 11:30AM

LeadingAge Ohio will host its bi-monthly all-member webinar focused entirely on member questions and answers on Tuesday, February 9 at 11:30AM.

During the unscripted, 30-minute webinar, LeadingAge Ohio policy and regulatory experts Stephanie DeWees, Anne Shelley, Kathryn Brod and Susan Wallace will field your questions on the vaccine and all things compliance, including infection control, testing, surveys, reporting requirements, and other fast-moving topics.

Members can send questions in advance to the COVID-19 mailbox. Alternately, members will be able to chat in questions during the webinar.

Registration is required, but there is no fee to participate. 

Lobbying expense percentage of membership dues

As providers begin to gather information for annual cost reports, knowing the percentage of lobbying expenses for annual dues is necessary information to have. LeadingAge Ohio includes this information for our members on dues invoices each year. Payments of dues or other contributions to LeadingAge Ohio are not tax deductible as a charitable contribution. For 2020, LeadingAge Ohio reports 8.3% and LeadingAge reports 2.8% of dues reflect lobbying activities. 

What the Media Said About End of Life Care This Week – February 1, 2021

While 2020 may have be synonymous with COVID, compassionate care for those who have been struggling has brought hospice providers across the country an opportunity to shine light on the core of what hospice is truly about, the right care, at the right time in the right place. Throughout the pandemic hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews countless articles and media venues to share with our members the buzz in the industry.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding Low Resource Utilization Residents in nursing facilities
  
• Home Health Value-Based Purchasing (HHVBP) model expansion
• ODM and Sandata hosting 3 EVV webinars
• NHC releases white paper on approaching loss with patients, families, communities and staff
• ODH to providers: “Create a backup plan so no vaccines are wasted”
• ODH shares vaccine progress: 51% complete in nursing homes
• Timing of TB Testing following COVID vaccines
• ODH modifies visitation guidance
• What the Media Said About End of Life Care This Week

You asked:

I am wondering if LeadingAge Ohio has any knowledge about Low Resource Utilization Residents (PA1 and PA2) in nursing facilities.  I was informed by a nursing facility that the payment should be $115.00 for a resident who is considered a PA1. However, if the nursing facility reimbursement is $115.00 per day, do you know how much the hospice should bill the payer?  Would a hospice bill at 95% of the daily per diem like we do other Medicaid recipients? 

We answered:

Low Resource Utilization Residents are those who have low utilization needs and their facility payment is based on a flat rate instead of the facility-specific total per diem rate. Low resource utilization residents are those residents who are assigned to the PA1 and PA2 resource utilization groups, which are assigned to two lowest relative resource weights possible: 1.0000 and 1.1111. Beginning in Oct 2019, payment for low resource utilization residents shall be a flat rate of $115.00 per Medicaid day, as set by the Ohio General Assembly.

LeadingAge Ohio also asked a representative at the Ohio Department of Medicaid (ODM) the amount a hospice should bill for a PA1 or PA2 resident, and their reply is as follows:

For individuals identified as PA1/PA2, ODM pays the nursing facility the flat fee of $115/day in place of their usual per diem rate. If the nursing facility communicates to the hospice provider that the individual is PA1/PA2, it would be appropriate to pay 95% of the $115 daily rate in place of the facility’s per diem rate. Hospice providers should follow the same process that is used for ventilator dependent/weaning individuals. Below are the step-by-step instructions that are followed for vent dependent/weaning claims. However, instead of mentioning that this is a vent management claim, the provider will specify in the email (sent to MCDHospice@medicaid.ohio.gov) that this is a PA1/PA2 claim and include which dates of service these apply to and be sure to include the ICN

Home Health Value-Based Purchasing (HHVBP) model expansion

The U.S. Department of Health and Human Services (HHS) Secretary, Alex M. Azar, II, has approved the expansion of the Home Health Value-Based Purchasing (HHVBP) Model. The HHVBP expansion would be implemented through rulemaking no earlier than January 1, 2022.

Tested by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, the HHVBP Model began its first performance year in 2016. The CMS Office of the Actuary has certified, based on its independent assessment of the model’s performance over the first three years of the Model, that an expansion would reduce, or not result in any increase in, net Medicare spending.

The Secretary has also determined that an expansion of the HHVBP Model would likely improve quality of care for Medicare beneficiaries, without denying or limiting coverage or provision of benefits to Medicare beneficiaries. These combined determinations, coupled with the actuarial certification, meet the criteria set by Section 1115A(c) of the Affordable Care Act to allow the Secretary to expand the model through rulemaking.

For more information, please click here. For questions, please call the helpdesk at (844) 280-5628 or email HHVBPquestions@cms.hhs.gov.

ODM and Sandata hosting 3 EVV webinars

The Ohio Department of Medicaid (ODM) and Sandata are hosting 3 Electronic Visit Verification (EVV) webinars in January 2021. The webinars will focus on best practices related to EVV maintenance and ensuring visits are accurately captured to support claims. Please use the webinar links in the attached to register. After registering, you will receive a confirmation email containing information on joining the webinars.

NHC releases white paper on approaching loss with patients, families, communities and staff

With the new year in full swing, hopefully it signifies closeness to the ability to gain control over the coronavirus and begin to reign in its destructive consequences. Grief and loss in the last year have affected all to some degree. Weekly news and articles speak of the coronavirus spread and the disruption it causes to everyday routines. National Hospice Cooperative (NHC) has released the following white paper discussing how some have approached loss with our patients, families, communities, and staff.

Special thanks to Patti Anewalt, Director of Pathways Center for Grief & Loss in Mount Joy, PA., Diane Synder Cowan, Director of grief services at Hospice of the Western Reserve in Cleveland, OH., and Lisa Balster, Director of patient & family support services at Ohio’s Hospice of Dayton for their contributions and sharing of experience.

ODH to providers: “Create a backup plan so no vaccines are wasted”

Over the past few days, the DeWine Administration has become increasingly concerned about wasted vaccine doses when providers overestimate the number of individuals who will receive the vaccine. While nursing homes and assisted living work closely with their Pharmacy Partners to get an accurate estimate in the days leading up to their clinic, they have issued special guidance to other providers, advising them to create a backup list of other individuals who may receive the vaccine, should there be extra/unused doses on the day of vaccination.

LeadingAge Ohio encourages all members to have a list of individuals who may be able to respond quickly in the event of an overage of doses. Individuals who may be considered are those that would fall into the 1B category noted below. Particularly, family caregivers may be willing and eager to receive vaccine doses.

Below is the full notice issued by the Ohio Department of Health (ODH):

ODH offers the following additional guidance for ensuring COVID-19 vaccine is not wasted. In order to mitigate the risk of wasting COVID-19 vaccine, providers should attempt to verify the number of vaccine recipients immediately prior to each scheduled clinic.

To prevent vaccine wastage in the event that you have excess vaccines upon completion of a vaccination clinic and those vaccines are set to expire, it is critically important that providers have a plan in place to immediately identify and administer vaccine to backup recipients. Many providers have implemented waiting lists of eligible individuals for such circumstances. 

To the extent possible, ODH advises that providers administer excess vaccines in the following priority order:

1. Identify Phase 1A eligible individuals to administer the vaccine to (healthcare providers, EMS personnel, or congregate care residents/staff).

1. Identify Phase 1B eligible individuals to administer the vaccine to (individuals age 65+, people with severe congenital, developmental, or early onset medical disorders that make them particularly vulnerable, and teachers/staff in K–12 schools that plan to return to in-person classes in March).

1. Identify otherwise eligible adults not included in Phases 1A or 1B to administer the vaccine to (e.g., priority to adults with underlying medical conditions before adults with no underlying medical conditions).

1. If more than 20 doses are at risk of wastage, please call the ODH Provider Call Center at the number below to discuss options including, but not limited to, transfer of vaccine to other enrolled providers.

IMPORTANT:  To prevent wastage of COVID-19 vaccine, providers should have a backup recipient plan in place. Where possible, follow the priority guidance outlined above. When not possible due to time constraints or lack of availability of priority individuals, please administer vaccine to any individuals eligible under the appropriate FDA Emergency Use Authorization (EUA).

As noted in previous guidance on this issue, if you administer vaccinations under the circumstances outlined above:

• The vaccine administration must be reported in ImpactSIIS, including race and ethnicity data, within 24 hours.
• Target population/occupation data does not need to be reported for vaccinated individuals not in Phase 1A.
• Be sure to include these vaccinated individuals in your follow-up plans for administering second doses.

If you have any questions or issues, please call the ODH Provider Call Center between 8:00 a.m. – 7:00 p.m. Monday through Friday, and 8:00 a.m. – 5:00 p.m. Saturday and Sunday, at 1-844-9ODHVAX (1-844-963-4829) or email COVIDVACCINE@odh.ohio.gov. You also may visit the ODH COVID-19 Vaccine Provider Information Training page for additional information and resources 

ODH shares vaccine progress: 51% complete in nursing homes

On its monthly call with stakeholders yesterday, Ohio Department of Health (ODH) leadership shared that the first round of vaccinations in nursing homes was 51 percent complete, and anticipates finishing nursing homes in the next week to ten days. For a small number of facilities that had significant absences or outbreaks, the pharmacy partners will return for an additional vaccination clinic, but they are working to stay as close to the three-week window between doses as possible.

Administration leadership noted that 70-90 percent of residents are accepting the vaccine, while only 30-40 percent of staff received vaccines in the initial round. The Administration is holding roundtable discussions this week in hopes that staff who are on the fence about the vaccine will be able to have their vaccine-related questions answered by Ohio’s leading clinical experts.

The Administration is actively discussing what types of incentives it may offer to providers who achieve a high vaccination rate. A clinical advisory group is considering steps like reducing testing frequency for individuals who have received the vaccine. Other conversations related to the wind-down of COVID restrictions, including how visitation and access will be reopened as vaccine rates continue to increase in facilities and the community at large.  

While assisted living is slated for the next phase of vaccines, many assisted living facilities already have their first clinic dates.

Timing of TB Testing following COVID vaccines

The Centers for Disease Control and Prevention (CDC) has updated Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States. This guidance addresses a number of the frequently asked questions, such as dose intervals, mixing of COVID vaccines, mixing of COVID vaccines with other vaccines, allergic reactions and anaphylaxis, etc. LeadingAge, thanks to the experience of a member, would like to draw attention to a piece about vaccines and TB testing, tucked neatly into the last section of the document title “Laboratory Testing.”

In that section, the CDC recommends that individuals who have received a COVID-19 vaccine should delay TB testing (tuberculin skin test or interferon gamma release assay) until four weeks after receiving the second dose of COVID-19 vaccination. Understanding that this may cause an issue with new hires and annual employee health certifications, LeadingAge reached out to the Centers for Medicare & Medicaid Services (CMS) for further guidance and will share with members once it is received.

ODH modifies visitation guidance

This week, the Ohio Department of Health (ODH) released a sixth amended Director’s Order on visitation in nursing homes and similar facilities. The change to the order can be found under section 8. B. iii. b. 2. which now reads: “Residents who are on transmission-based COVID-19 restrictions may receive in-person compassionate care visits with adherence to transmission based precautions.” Previously, the order stated, “Compassionate care visits shall only be conducted in COVID-free areas of the homes.”

All other sections of the Order remain unchanged.

What the Media Said About End of Life Care This Week – January 11, 2021

While 2020 may have be synonymous with COVID, compassionate care for those who have been struggling has brought hospice providers across the country an opportunity to shine light on the core of what hospice is truly about, the right care, at the right time in the right place. Throughout the pandemic hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews countless articles and media venues to share with our members the buzz in the industry.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding home care workers being in the first tranche of vaccines
• You asked... We answered regarding billing for services
• Hospice changes in year-end package
• Overview of year-end congressional package
• COVID-19 vaccine billing update
• Upcoming Medicaid changes (MITS)
• Vaccination roll-out challenges emerge
• Vaccine process challenges communicated to state
• State-mandated testing frequency increasing for all Assisted Living, for some Nursing Facilities              

You asked:

Will home care workers (home health and hospice employees) be in the first tranche of vaccines (1A), with those they serve will be a later tranche? If so, will these agencies be given the vaccines by their local health department (LHD)?

We answered:

LeadingAge Ohio reached out to the governor’s office to ask about home health and hospice employees receiving COVID-19 vaccines and received the following reply. Yes, these healthcare workers are in phase 1A and those they serve will be in a later phase (yet to be determined). For home care and hospice agencies who did not enroll in the federal pharmacy partnership program, their LHD will coordinate vaccines once they become available.

It is recommend that home care and hospice agencies who did not enroll in the federal partnership program and who are not owned/operated by a hospital, go ahead and reach out to their LHD now. As far as when the vaccines will be given, the appointment process, and insurance billing, the LHD will coordinate the vaccination process.

You asked:

We have a couple initial certifications of terminal illness (CTI’s) that have not been signed by the attending physician. The attending physicians for these patients are community physicians. We have faxed the CTI’s, mailed the CTI’s, and talked to the physicians’ offices but the physicians still have not signed the CTI’s. Is there anything that we can do to bill for services if our hospice physician signed the CTI’s but the attending physician did not sign them? In both cases, the patient has since died.

We answered:

LeadingAge Ohio reached out to Palmetto GBA to see if there is anything the hospice could do if the certification of terminal illness was not signed by the attending physician but was signed by the hospice physician. 

The Palmetto representative said: “If the hospice maintains the documentation that they attempted to contact the physician, without response, then they can bill for their services rendered. The important thing is for the hospice to have documentation that proves their attempt to get the CTI signed by the attending physician.”

Hospice changes in year-end package

The HOSPICE Act passed out of the House on December 8, 2020. LeadingAge and VNAA, along with other stakeholders, advocated for changes to the survey frequency provision of the HOSPICE Act and were successful. In the version of the bill that will pass as part of the Consolidated Appropriations Act, 2021, routine hospice survey frequency will remain permanently at 36 months (as opposed to 24 months as proposed by the House). We thank our Senate champions, Senator Portman (R-OH) and Senator Cardin (D-MD) for working with us to ensure this key change. We thank both our Senate and House partners for their work on this important legislation in response to the July 2019 Office of the Inspector General (OIG) reports and look forward to working with CMS on effective implementation.

For additional information on this article, please click here.

Overview of year-end congressional package

This article is a high level overview on the combination omnibus-coronavirus relief package that is expected to be passed by Congress on December 21, 2020. The approximately 5500 page bill, The Consolidated Appropriations Act, 2021 (Omnibus and Coronavirus Relief Bill) directly or indirectly impacts most every part of the aging services continuum. This package provides another, long-awaited round of coronavirus relief, funds the government through September 30, 2021, and includes a number of other priorities for aging services providers. There will be several more articles on the package forthcoming.

For additional information on this article, please click here.

COVID-19 vaccine billing update

The United States Food and Drug Administration (FDA) has recently issued an emergency authorization (EUA) for two investigational monoclonal antibody therapy treatments for cases of mild to moderate COVID-19 in adults who are at high risk for progressing to more severe cases.

Nursing facilities will be permitted to administer the treatment, and they will also be permitted to contract with other entities to administer the treatment.

Here is what members need to know about billing for the Monoclonal treatment and the COVID-19 vaccines:

• The vaccine and Monoclonal treatment will be billed to Medicare Part B. It is not covered under Part D.
• Both the vaccine and Monoclonal treatment can be roster billed, similar to the flu and pneumonia vaccine.
• The administration of the vaccine and the administration of the Monoclonal Antibody treatment may be billed.

NOTE: The EUAs for COVID-19 monoclonal antibody treatments bamlanivimab, and casirivimab and imdevimab (administered together), contain specific requirements for administration that are considerably more complex than for other services that are billed using roster billing. CMS has stated that it expects that health care providers will maintain appropriate medical documentation that supports the medical necessity of the service. This includes documentation that supports that the terms of the applicable EUA are met, including that it is being used for the treatment of mild to moderate COVID-19 for a patient that is at high risk for progressing to severe COVID-19 and/or hospitalization. The documentation should also include the name of the practitioner who ordered or made the decision to administer the infusion, even in cases where claims for these services are submitted on roster bills.

• The drugs themselves may not be billed. Since the initial vaccine and treatments provided will be provided at no cost, the drugs then, may not be billed to Medicare. This is expected to be the case for the duration of the COVID-19 public health emergency. Once the public health emergency is over, Medicare is expected to set pricing for the vaccines and treatments.
• Do not include on your Medicare A claims. These are carved out of the Medicare Part A bundle and are not subjected to consolidated billing. The facility or an outside provider may bill Medicare Part B even if resident is in a skilled Medicare A stay.
• Providers who provide the monoclonal treatment to Medicare Advantage Plans enrollees should submit the claims to Original Medicare for 2020 and 2021.
• Revenue code for vaccine administration-0771
• CMS has not yet released a revenue code for the infusion of the Monoclonal treatment.
• CMS has not dictated a distinct diagnosis code for the COVID-19 Vaccine. It has been recommended to use Z23 (Encounter for immunization). This may change as more information becomes available.
• For the Antibody treatment you should use the ICD-10 code for COVID-19, U07.1

Below is a listing of the CPT codes for the COVID-19 Vaccines and the Monoclonal Antibody Treatment:

• COVID-19 vaccines:
• 91300 Pfizer SARSCOV2 VAC 30 MCG/0.3 ML IM-EFFECTIVE DATE (TBD)
• 0001A Administration Fee Pfizer SARSCOV2 30 MCG/0.3 ML -1ST DOSE
• 0002A Administration Fee Pfizer SARSCOV2 30 MCG/0.3 ML-2ND DOSE
• 91301 Moderna SARSCOV2VAC 100MCG/0.5 ML IM-EFFECTIVE DATE (TBD)
• 0011A Administration Fee Moderna SARSCOV2 100 MCG/0.5 ML-1ST DOSE
• 0012A Administration Fee Moderna SARSCOV2 100 MCG/0.5 ML-2ND DOSE
• Monoclonal antibodies treatment:
• Q0239 BANLANIVIMAB 700 MG INJECTION-ELY LILY-EFFECTIVE DATE November 20
• M0239 BANLANIVIMAB-IV FUSION-INCLUDES POST ADMIN MONITORING
• Q0243 CASIRIVIMAB & IMDEVIMA-INJECTION-REGENERON-EFFECTIVE DATE November 21
• M0243 CASIRIVIMAB & IMDEVIMA-INFUSION-REGENERON-EFFECTIVE DATE November 21

Upcoming Medicaid changes (MITS)

The Ohio Department of Medicaid (ODM) is modernizing its systems and processes to better manage the program. This will roll out in two steps:

• A technology transformation to streamline provider enrollment and claims administration through a modular system which will ultimately replace the Medicaid Information Technology System (MITS) used today.

• A simplified credentialing process for independent medical providers who wish to enroll in Medicaid’s program.

In 2016, the Centers for Medicare and Medicaid issued guidance on enhanced federal funding related to Medicaid Information Technology (IT) in both Medicaid Management Information Systems (MMIS) and Medicaid Eligibility and Enrollment (E&E) Systems. The agency also revised the conditions and standards state Medicaid IT systems must meet to qualify for enhanced federal funding. It urged states to leverage proven, commercial-off-the-shelf technology solutions and adopt a modular approach to technology upgrades.

ODM responded by creating the Ohio Medicaid Enterprise System (OMES) – a modular technology framework that integrates the critical capabilities and functionality of today’s siloed systems.

On March 8, 2021, ODM will launch the first component of the OMES platform -- the Provider Network Management (PNM) module – as well as a new provider portal. Together these tools will ease the administrative requirements for enrollment and revalidation.

The PNM module will allow providers to submit change requests online vs. submitting by mail or e-mail. Its single-entry provider portal will streamline:

• Claims submissions
• Prior authorization requests
• Costing reports, and
• Eligibility verifications

ODM is in the early stages of provider outreach. In coming weeks, more information will be shared about what these changes mean to providers and how providers will need to prepare. ODM plans to send surveys to a randomized group of providers to identify the needs and concerns in managing this change. Results will then shape how ODM informs and trains providers for a successful, on-time transition.

Vaccination roll-out challenges emerge

While news of the hospitals’ success with the vaccination roll-out began this week, nursing homes and assisted living providers have already begun experiencing delays with the roll-out. LeadingAge Ohio was alerted by our members that their original scheduled vaccination clinic dates in December were being pushed back into January, some as far as late January without a specific date provided. The reason provided by the pharmacy partner was lack of staffing to administer the vaccine, in particular, an insufficient number of pharmacists to administer the vaccine in spite of their hiring campaign. When asked if nurses from the facilities could assist in the roll-out, it was shared that the board of pharmacy requires the pharmacies to only use a pharmacist or, per recent approval, a pharmacy technician. Of the 260 nursing homes in the Cincinnati and Dayton region assigned to this pharmacy, only 41 will receive vaccinations by the end of the year. The hiring and training of pharmacy technicians are now beginning for this pharmacy company which should ramp up vaccination schedules sometime in January. LeadingAge Ohio is working to determine whether this is a pharmacy specific situation or one for which advocacy is needed to increase the breadth of staff able to administer the vaccine.

Communication from the pharmacies has been another area of concern expressed by our members. Some facilities have not received their initial outreach by their pharmacy partner or are unable to reach their assigned contact. Some facilities have received an initial communication but have not received their initial clinic date. Communication received on the requirements for clinic set ups and consent approval varies between the participating pharmacy groups. 

We understand that a vaccination program is only as effective as its ability to get vaccines in arms. We are pleased to share that the Governor’s office is being attentive to this concern. LeadingAge Ohio will be reporting back on additional details. We are asking members to share your challenges with the vaccination roll-out by emailing those details to the COVID19@leadingageohio.org mailbox if you have not already reached out to us this week. When you write, let us know who your pharmacy partner is, if your clinic dates have been changed, if you are having difficulties with communication, and if you have not received your initial clinic date. If you are experiencing other challenges or concerns other than what is listed, please let us know. We are advocating on behalf of all post-acute providers and your voice and experiences are critical to hear.

Vaccine process challenges communicated to state

This morning Ohio’s long-term care associations met with Director McElroy to discuss challenges that are emerging across the sector related to Ohio’s vaccine distribution plan. We described challenges members have shared which include: lack of communication from the pharmacies (i.e. still waiting to hear if a facility is actually scheduled), confusing information received from the pharmacy (for example, receiving many emails within a short timeframe with changing dates/times/Clinic IDs), no response from a pharmacy hotline, and uncertainty as to where and to whom to direct questions and in some cases, conflicting answers to important operational questions.

The state is meeting with the four pharmacies representing Ohio’s Pharmacy Partnership and promised to raise each area of concern for best ‘next steps’. The state appreciated hearing of the concerns, and is working diligently to ensure that vaccines are distributed as quickly as possible, as efficiently as possible, in as orderly a process as possible, in an effort to stop the surge and save older Ohioans’ lives. We will communicate responses to the challenges and recommendations for troubleshooting as soon as they are received. Please continue to report challenges to COVID19@leadingageohio.org.

State-mandated testing frequency increasing for all Assisted Living, for some Nursing Facilities              

Ohio Department of Aging (ODA) Director Ursel McElroy announced to the associations today that effective immediately the testing cadence in all assisted living facilities will increase to once per week; residents’ testing will continue to be on an as-needed strategic basis. The testing cadence in all nursing homes will increase to twice weekly; the majority of the state’s nursing homes are already testing at this cadence.

A new survey has been created for assisted living providers to indicate their choice of testing approach (e.g. one week PCR followed by one week of BinaxNOW, etc.) on the ODA/ODH website. A facility could choose to have the state-supported testing continue every other week as it is currently scheduled, supplementing with its own testing tools on the alternating weeks; it could choose to have state support for every week; or it could choose to opt-out of any support from the state.   

Note: Assisted living facilities on shared campuses with nursing facilities will be given the choice of aligning testing days, e.g. if the NF is testing on Tuesday and Friday, the assisted living could choose either Tuesday or Friday as its testing date.

As with nursing facilities, if the assisted living facility is receiving any shipments of BinaxNOW tests directly from the Department of Health & Human Services, the state will offset its shipment of supplies to the facility accordingly.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered
• LeadingAge Ohio urges Governor to include Home Care, Hospice in vaccine priorities
• HHS/ASPR COVID-19 outpatient therapeutics mini-series
• Home Health and Hospice COVID-19 test reporting responsibilities
• ODH to review CDC’s new quarantine guidance
• What the Media Said about End of Life Care this week

You asked:

As we approach the end of the year, we are trying to schedule supervisory visits for all of our hospice field nurses that we were not able to complete earlier in the year. Are there any COVID flexibilities allowed this year related to the requirement for nurse supervisory visits?

We answered:

The Centers for Medicare & Medicaid Services (CMS) has provided a flexibility regarding annual training of all staff to assess their skills and competence and provide in-service training and education programs where required. This has been postponed until the end of the first full quarter after the public health emergency (PHE) concludes. All staff need orientation, but a flexibility regarding annual competency training has been issued until after the PHE. CMS has never required an annual supervisory visit for all staff, but if an annual supervisory visit has been part of the skills assessment according to agency policy, then that has been postponed until after the PHE.

Also, CMS has issued a flexibility to forgo the hospice aide’s annual onsite supervisory visit until no later than 60 days after the expiration of the PHE. 

A link to all the hospice flexibilities as well as the verbiage regarding annual training and hospice aide supervisory visits can be found here. (Hospice waivers are on a pages 22-23)

• Annual Training

CMS is modifying the requirement at 42 CFR §418.100(g)(3), which requires hospices to annually assess the skills and competence of all individuals furnishing care and provide in-service training and education programs where required. Pursuant to section 1135(b)(5) of the Act, we are postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. This does not alter the minimum personnel requirements at 42 CFR §418.114. Selected hospice staff must complete training and have their competency evaluated in accordance with unwaived provisions of 42 CFR Part 418.

• Workforce

Training and Assessment of Aides: CMS is waiving the requirement at 42 CFR §418.76(h)(2) for Hospice and 42 CFR §484.80(h)(1)(iii) for HHAs, which require a registered nurse, or in the case of an HHA a registered nurse or other appropriate skilled professional (physical therapist/occupational therapist, speech language pathologist) to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. In accordance with section 1135(b)(5) of the Act, we are postponing completion of these visits. All postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the PHE.

LeadingAge Ohio urges Governor to include Home Care, Hospice in vaccine priorities

LeadingAge Ohio President/CEO Kathryn Brod sent a letter to the DeWine administration on December 3 regarding the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practice’s (ACIP’s) decision on December 1 to prioritize health care workers for Phase 1A vaccine access. The letter urges the Administration to consider home care and hospice health care workers in the Phase 1A priority.

HHS/ASPR COVID-19 outpatient therapeutics mini-series

With its first offering on Wednesday, December 9, from 12:00 - 1:00PM (and offered on additional dates as well), the Assistant Secretary for Preparedness and Response (ASPR) and Project Echo, out of the University of New Mexico School of Medicine, will be offering a free mini-series. The series will provide a deep dive on new and emerging COVID-19 outpatient therapeutics, including monoclonal antibodies. The goal of this mini-series is to equip clinicians with the appropriate knowledge, resources, and tools needed to initiate and scale administration of these therapies and reduce strain on the U.S. healthcare system.

Topics to be covered include:

• Clinical trials and drug efficacy
• Best practices from the field (e.g., workflows, training, IT)
• Priority settings (e.g., nursing homes, federally qualified health centers)
• Ethical issues (e.g., equitable access, prioritization of highest-risk patients)
• Considerations for use of vaccine and therapeutics

Register online and select one of several available dates for the session.

Home Health and Hospice COVID-19 test reporting responsibilities

On its December 1 all-member Q&A Call, LeadingAge Ohio’s policy team fielded questions from home health and hospice members related to reporting requirements for the Abbott BinaxNOW tests they received from the federal government.

Home health and hospice agencies who are conducting staff COVID-19 antigen testing via Abbott BinaxNOW tests or other means, need to report both positive and negative test results to the Ohio Department of Health (ODH) on a daily basis. ODH has published updated guidance on COVID-19 laboratory testing reporting requirements on the Electronic Laboratory Reporting (ELR) website. Home health and hospice agencies will need to register the name of their agency here. Once approved by ODH, your agency will be included in the lab reporting web portal for aggregate count submissions. The web portal link will be provided after registration.

The ODH guidance explains the specific reporting requirements before and after secure file validation has been achieved. While long-term-care facilities also need to submit point-of-care testing data to CDC’s National Healthcare Safety Network (NHSN), home health and hospices do not. Their only recurrent reporting requirements are to ODH.

Additionally, as before, if a home health or hospice agency has a patient or staff member who tests positive, they must contact the local health department so they can initiate contact tracing. If you have any questions regarding reporting of COVID-19 test results, please contact Anne Shelley at ashelley@leadingageohio.org.

ODH to review CDC’s new quarantine guidance

Current quarantine standards for nursing homes and assisted living providers includes a time frame of 14 days. This week, the Centers for Disease Control (CDC) released updated quarantine guidance that reduces this time frame, but states still have the authority to determine whether they will follow CDC guidance. The Ohio Department of Health (ODH) has communicated that providers are to continue with the 14 day time frame until they have had time to review the newest guidance and make a recommendation for Ohio.

The CDC’s Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing guidance is as follows:

Local public health authorities determine and establish the quarantine options for their jurisdictions. CDC currently recommends a quarantine period of 14 days. However, based on local circumstances and resources, the following options to shorten quarantine are acceptable alternatives.

• Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.
• With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.

• When diagnostic testing resources are sufficient and available, then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.
• With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.

In both cases, additional criteria (e.g., continued symptom monitoring and masking through Day 14) must be met and are outlined in the full text. LeadingAge Ohio anticipates ODH will release its guidance in the coming week, so members should watch the COVID-19 report for further guidance

What the Media Said About End of Life Care This Week – December 7, 2021

While 2020 may be synonymous with COVID, compassionate care for those who have been struggling has brought hospice providers across the country an opportunity to shine light on the core of what hospice is truly about, the right care, at the right time in the right place. Throughout the pandemic hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews countless articles and media venues to share with our members the buzz in the industry.

Home Health and Hospice Newsletter

In Today's Newsletter

• LeadingAge Ohio all-member Q&A on Thursday: Send questions early
• More on the holidays and celebrating safely; participate in survey through Thursday
• Patient liability changes became effective November 2
• Provider relief funds reporting requirements
• Scholarship applications being accepted thru December 31
• LeadingAge bestows the Award of Honor for 2020... And it's you!
• The return of What the Media Said About End of Life Care This Week – November 16, 2020
• You asked... We answered

LeadingAge Ohio all-member Q&A on Thursday: Send questions early

This Thursday, November 19 at 9:30AM, LeadingAge Ohio will host its bi-monthly all-member webinar focused entirely on member questions and answers. These Q&A webinars are held on the first and third Thursday of the month.

During the unscripted, 30-minute webinar, LeadingAge Ohio policy and regulatory experts will field questions related to testing, telehealth, visitation, vaccination and other fast-moving topics. Join Kathryn Brod, Anne Shelley, Stephanie DeWees and Susan Wallace to hear Q&A on survey expectations, visitation logistics, testing processes, reporting and more.

Members are encouraged to send advance questions to the COVID-19 mailbox so research can be completed if needed. Alternately, members will be able to chat in questions during the webinar.  Registration is required, but there is no fee to participate.

More on the holidays and celebrating safely; participate in survey through Thursday

In the Monday edition of Today's COVID-19 Report, we featured tips from the Centers for Disease Control Prevention (CDC) on safe holiday gatherings and travel. This hot topic remains at the top of the dialogue with LeadingAge Ohio members, as cases soar while the holiday season approaches. On Monday, LeadingAge released an article that reviewed member solutions for a COVID-safe Thanksgiving and the CDC also released a companion article.

LeadingAge continues to gather members’ ideas and solutions for the complex circumstance of how to encourage families to reconnect and reunite safely over the holidays, without unduly exposing the people we serve to COVID-19. To this extent, LeadingAge has released a survey, and we encourage all LeadingAge Ohio members to participate. The Community Holiday Plan Survey will be live through Thursday, and the hopes are to find and add more solutions and member resources to a growing list. 

Patient liability changes became effective November 2

This week, the Ohio Department of Medicaid (ODM) shared changes related to how it is now managing patient liability. According to ODM's Rachel Hopmoen, Eligibility Policy Section Chief, the recent Interim Final Rule reinterpreted certain requirements contained in the Families First Coronavirus Relief Act (FFCRA); FFCRA requires states to maintain continuous enrollment in order to qualify for the enhanced federal medical assistance percentage (FMAP) match. Previous to the interim rule, state Medicaid departments were prohibited from terminating Medicaid enrollment or increasing patient liability when an individual’s income changed.

The reinterpretation will allow ODM to do two things: first, it will allow Medicaid to move individuals from one eligibility category to another in some instances. Second, it will allow states to increase patient liability based on a change in income. Ohio hopes to release state guidance regarding this change by Thanksgiving, so that ODM can make changes to patient liability at the same time as cost-of-living-adjustment (COLA) changes.  

This change will only affect individuals on or after November 2, and will not affect accumulated assets resulting from changes in income since the beginning of the pandemic. ODM confirmed that the Centers for Medicare & Medicaid Services (CMS) has not yet issued guidance on what to do retroactively, but they anticipate there will be a period of time allowed for assets to be spent. Once the guidance is complete, ODM will create provider communications.

Provider relief funds reporting requirements

LeadingAge, in conjunction with CliftonLarsonAllen (CLA), will be hosting a webinar at 2:00PM on December 2 to outline how members can maximize use of payments received from the Provider Relief Fund while complying with current reporting requirements.

For more information and/or to register, please click here.

Scholarship applications being accepted thru December 31

While COVID has delayed many opportunities to come together, the LeadingAge Ohio Foundation’s commitment to support members in the opportunities to “grow our own” through employee scholarships has never been stronger. For 2020, the Foundation Board has allocated funds to support the General Scholarship Fund. The Aging Services General Scholarship is awarded for up to $1,500 for an individual desiring to advance their careers in aging services fields, including nursing (i.e., those wishing to move from STNA to LPN, or LPN to RN, etc.); as well as dietary, activities, maintenance, therapy and other professional lines. Visit the LeadingAge Ohio website for all the details on eligibility, criteria and more. Applications are being accepted through December 31, 2020.

If you have questions or inquiries regarding the 2020 scholarship program, please contact Jennifer Taylor, Director Member Experience, at jtaylor@leadingageohio.org or by calling 614-545-9028. 

LeadingAge bestows the Award of Honor for 2020... And it's you!

Every year, LeadingAge bestows the Award of Honor on an individual from within its membership who has provided nationally significant, transformative leadership in aging services. This person shows vision, mission, compassion, and courage every day of the year.

LeadingAge President and CEO, Katie Smith Sloan, had the privilege to announce that this year’s Award of Honor recipient would not be just one person; instead, this year’s award of honor is bestowed upon every staff member of every member of LeadingAge. Every State-Testing Nursing Assistant (STNA), housekeeper, service coordinator, dining server, cook, nurse, therapist, dishwasher, social worker, and every administrator, manager, and receptionist. Everyone. Your dedication keeps people thriving, families together, and communities intact. 

LeadingAge Ohio strongly urges all reading Today’s COVID-19 Report to take a moment and watch this video, and also strongly urges you to share with your fellow colleagues.

What the Media Said About End of Life Care This Week – November 16, 2020

While 2020 may be synonymous with COVID, compassionate care for those who have been struggling has brought hospice providers across the country an opportunity to shine light on the core of what hospice is truly about, the right care, at the right time in the right place. Throughout the pandemic hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews countless articles and media venues to share with our members the buzz in the industry.

Ohio Department of Health (ODH)

Testing

• Nursing Home COVID-19 Testing Updates Slide presentation (9/23/20)
• Nursing Home COVID-19 Testing Updates Recording Link (9/23/20)

• Ohio County Emergency Management Directory (4/28/20)
• LTSS Final PPE Pre-Surge Planning Toolkit (4/15/20)
• Find Your Local Health Department

Coronavirus.ohio.gov  
Ohio Coronavirus Hotline (staffed 7 days a week 9 a.m. to 8 p.m.) - 1-833-4-ASK-ODH

Ohio Department Of Health Bureau Of Survey And Certification Quarterly Reports
2019 Nursing Home Survey And Enforcement Actions
July 28, 2020 Update on Testing in Ohio Nursing Homes Webinar Recording
July 28, 2020 Webinar Presentation Slides

ODH Nursing Home Provider Call Recording (7/15/20) 

Ohio Public Health Advisory System

The Public Health Advisory Alert System is a color-coded system designed to supplement existing statewide orders through a data-driven framework to assess the degree of the virus’ spread and to engage and empower individuals, businesses, communities, local governments, and others in their response and actions.

Director's Order for Facial Coverings in Butler, Cuyahoga, Franklin, Hamilton, Huron, Montgomery, and Trumbull Counties in Level 3 Public Health Advisory (7/8/20)

Nursing Home Visitation Director's Order (7/2/20)

• Nursing Home Testing Order Guidance 
  • Nursing Home COVID-19 Testing Updates Slide presentation (9/23/20)
  • Nursing Home COVID-19 Testing Updates Recording Link (9/23/20)
  • COVID Testing for Nursing Facilities June 23 webinar recording 
  • COVID Testing for Nursing Facilities June 23 webinar slides
  • ODH Guidelines for Testing of Nursing Home Residents and Staff
  • COVID-19 Testing in Ohio Nursing Facilities Frequently Asked Questions
  • Nursing Facility Transfer Protocol
  • Contingency and Crisis Facility Staffing Guidance
  • Bridge Team Guidance and Information Document
  • Zone and Region Map by County
  • Nursing Facility Hospital Partner List
    
• Ohio Plan for Nursing Facility Testing Webinar Slides (6/2/20)
• Updated ODH COVID-19 Testing Guidance(6/2/20)
• Signed Health Order Amending Non-essential Surgeries and Procedures (6/2/20)
• Posters and Signs
• Urgent Health Advisory- Ohioans Protecting Ohioans (5/20/20)
• Director Acton's Order that Rescinds and Modifies Portions of the Stay Safe Ohio Order (5/20/20)
• Guidelines and Best Practices for Restaurant and Bar Re-opening (5/8/20)
• COVID-19 Release of Protected Health Information to Ohio's First Responders
• Health Care Isolation Center Plan (4/16/20)
• Health Care Isolation Center Requirement Application  (4/16/20)
• Director's Order to Facilities to Notify Residents, Guardians and Sponsor of Positive or Probable Cases of COVID-19 (4/15/20)
• Standardized Surveillance Case Definition and Reporting Update (4/8/20)
• Economic Resources for Individuals and Families (4/8/20)
• Key Points for COVID-19 in Long-term Care Settings
• Guidance for Discontinuing Transmission-Based Precautions in COVID-19 Patients
• Key Points for COVID-19 in Assisted Living Facilities
• Guidance on How to Request Resources through Your County EMA (4/4/20)
• Updated COVID-19 Guidance for Long Term Care Facilities regarding Personnel Access (4/4/20)
• ODH Updated COVID-19 Guidance on Hospice Visitation (4/3/20)
• PPE Contingency Planning (4/3/20)
• Strategies for Optimizing PPE (4/3/20)
• PPE Printable Instructions and Videos (NEW)
• Guidance for Utilizing and Optimizing Personal Protective Equipment (4/1/20)
• Instructions for Medical/Surgical Mask Use and Reuse (NEW)
• Instructions for N95 Respirator Mask (NEW)
• Updated ODH Laboratory Testing for COVID-19 (4/1/20)
• ODH Updated Guidance for Testing (4/1/20)
• Microbiology Specimen Submission Form and COVID Example Specimen Submission Form
• ODH Notice on Fingerprinting (3/31/20)
• Hospital Preparedness Regions and Healthcare Zones
• ODH Director's Order for Performing COVID-19 Testing (4/1/20)
• Latest Press Conference Slides
• Stay At Home Order Frequently Asked Questions (Versión en español)
• Sign reminders on the spread of germs and handwashing (ODH)
  • Stop the spread of germs
  • Wash your hands
• Public Health Orders

Ohio Department of Aging

Ohio Department of Aging

• Summary Assessment of Older Ohioans- Executive Summary (June 2020)
• Summary Assessment of Older Ohioans- Full Report (June 2020)
• Staying Connected Check-in Service 
  • The Ohio Department of Aging is offering a FREE, daily check-in by phone for Ohioans age 60 or older. This service can also connect seniors with aging network information and support.

Department of Health and Human Services (HHS)

Provider Relief NF Infection Control Payment Terms and Conditions 

CARES Act Provider Relief Fund Payment Portal

• Application Instructions to Apply for Funding
• CARES Act Provider Relief Fund Application
• Terms and Conditions of Acceptance of Funds: Required Attestation

Department of Housing and Urban Development (HUD)

• HUD Guidance: Electronic Signature, Transmission and Storage - Guidance for Multifamily Assisted Housing Industry Partners (5/26/20)

Mental Health Resources for Providers

Mental Health Resources for Providers

Our emotional health is as important as our physical health yet too often it is the last thing we consider when it comes to "staying healthy."  Below are some resources to help providers navigate the daily challenges of compassion fatigue and maintain a healthy mind, heart, body and soul.

Everyone Knows What Grief Is Now: Five Ways Hospice-Based Grief Experts Can Support Patients and Families in the COVID-19 Era

White paper by the National Hospice Cooperative.  Special thanks to Patti Anewalt, Director of Pathways Center for Grief & Loss in Mount Joy, PA., Diane Synder Cowan, Director of grief services at Hospice of the Western Reserve in Cleveland, OH., and Lisa Balster, Director of patient & family support services at Ohio’s Hospice of Dayton for their contributions and sharing of experience.

Grieving Alone and Together - Free Guide

The Funeral Service Foundation, in cooperation with COVID-19 Crisis Response Fund, developed this guide to addresses the challenges of grieving a loved one’s death during the COVID-19 pandemic, including the nature of grief; traumatic loss and its triggers; ambiguous losses; and the risk of disenfranchised grief. Click here to download the guide for free.

Tips for Staff Social and Emotional Wellbeing

Support the Front

Free Virtual Support Groups and Resources for Healthcare Professionals on the Frontlines of COVID-19

ARTICLES

Laughter is the Best Medicine (HelpGuide.org)

Staff Members Emotional Well-Being (Johns Hopkins)

How to Lead Through a Crisis (Center for Creative Leadership)

WEBINARS

Enhancing Provider Resilience in the Face of COVID-19 (Barry Jacobs)

Enhancing Provider Resilience in the Face of COVID-19 Recording

PODCASTS

The 21 Best Meditation Podcasts to Listen to in 2020

Top Mental Health Podcasts To Listen To Right Now: Best Of 2020!

VIDEOS

YouTube videos: Laughter is the Best Medicine

SONGS AND FLOWERS TO CELEBRATE SPRING

• This “ultimate quarantine playlist” from Emily VanDerWerff, critic at large for Vox, includes 215 songs and lasts 16 hours.
  
  
• Take any of eight “stunning” virtual tours of gardens around the world, from Monet’s Garden in Giverny to Keukenhof in Amsterdam, Kew Gardens in London, and botanic gardens in Chicago, Washington, DC, and Hawaii.

FAMILY RESOURCES

Talking To Kids - COVID-19 Checklist

MISCELLANEOUS RESOURCES

Artful Moments for Frontline Workers

The National Gallery of Art has created a guided meditation for Front Line workers that is free and simple to use. 

Free Crocs for Healthcare workers from Crocs

Social Isolation

Research studies have shown that lack of social connection heightens health risks as much as smoking 15 cigarettes a day or having alcohol use disorder. During a pandemic and otherwise, social isolation is a major problem for older adults. With the surge of social distancing regulations and changing behavior in response to COVID-19, addressing this problem is more important than ever.

As members continue to provide high-quality care to Ohio’s vulnerable populations, LeadingAge Ohio has teamed with its partner Link-age to provide a series of resources and opportunities to help providers tackle social isolation in their communities, offer telehealth solutions, and help older adults as they adapt to this “new normal.”

Social Isolation Resources for Providers

• Identifying Solutions to Embracing Social Connection as a Value Proposition (Pearl Creek Advisors)
• Resident Engagement During Social Isolation (LeadingAge)
• Case Study: Reducing Social Isolation Through Virtual Group Activity (LeadingAge CAST)
• Link-age Virtual Activities for Resident - A compilation of virtual experiences, including tours and performances, to help mitigate the risks associated with social isolation.
• Virtual Activities for Residents 1 (3/18)
• Virtual Activities for Residents 2 (4/1)
• Virtual Activities for Residents 3 (4/22)
• Activities Professionals Resources Page [Member Only]
• Tips for Staff Social and Emotional Well-being

Continuing Support for Activity Professionals

Activity professionals within the LeadingAge Ohio membership have been coming together to offer support, share ideas, and discuss resources in the midst of current COVID-19 restrictions. This group is meeting bi-weekly. 

The next call is scheduled for Thursday, October 29, at 12:30 PM. 

Zoom Fellowship Meeting for Activity Professionals
Thursday, October 29 from 12:30 PM – 1:15 PM

Virtual Meeting Room: Virtual Meeting Room #2

To join the meeting on your computer click this link or paste into a browser:  https://easyconnecthd.zoom.us/j/5250518214?pwd=UUYyMmcxMy9qM2VGU3VVc2FqTVh2dz09 

Meeting ID: 525-051-8214

Meeting Passcode: 698977

Participants who choose to use their phone for the audio Call: 1-646-558-8656 then enter Meeting ID. 

Or Smartphone One Touch: 16465588656,5250518214#

Please contact Jen Taylor at jtaylor@leadingageohio.org if you would like to ensure your activities staff are receiving information on LeadingAge Ohio activities events.

Link-age Suppliers Offering Support for Social Isolation and Telehealth Solutions

Through its network of suppliers and relationship to the Ziegler Link-age Funds, LeadingAge Ohio partner Link-age offers a wide array of technology and telehealth solutions to provide support for social isolation in post-acute care.

• VitalTech: An open platform that enables senior care providers to deliver care and services through a simple and personalized tablet interface. Services offered: remote patient monitoring, health and wellness platform, tablet-based platform through Breezie, and more.

• K4 Connect: Mission-driven technology company integrating the best in technology to serve and empower older adults and individuals living with disabilities. Services offered: smart home automation, wellness-focused devices and apps, staff tools, and more.

• Cosan: Preventative care coordination tool suite to help physicians, healthcare organizations, and payers improve patient outcomes through innovative technology. Services offered: clinical staff support services, preventative services tool suite, AI & therapy services.

• Forefront Telecare: High-quality behavioral telehealth solutions for Medicare populations in rural geographies where care options are limited, such as rural hospitals and skilled nursing facilities. Services offered: clinical and collaborative behavioral telehealth solutions, census-driving care support.

• Caremerge: Leading provider of resident engagement, family communication and EHR/eMAR solutions to the senior living industry. Services offered: crisis communication platform, community and family engagement, senior living EHR/eMAR, and more.

• ThirdEye Health: The nation's largest post-acute telehealth provider. Empowering nursing homes to reduce hospital readmissions and provide higher acuity care. Services offered: telehealth platform, secure video and text messaging for clinical support, 24/7 support.

To learn more or to contact any of the Link-age suppliers listed here, reach out to Debbie Hounshell at dhounshell@linkageconnect.org.

As CMS updated visitation guidance for nursing homes, LeadingAge collaborated with Pathway Health on a Visitation During COVID-19 Toolkit for members. The 10 segment toolkit helps an organization navigate visitation guidance through a leader's guide, implementation checklists, competency tools for managers and all staff as well as a pre and post-test for all staff.  The toolkit can be modified or edited to your organization’s needs. The elements of the toolkit also may be used by various providers and service lines in the continuum of care.

1. Visitation General Information
2. Visitation Leaders Guide
3. Visitation Implementation Checklist
4. Resident and Guest Visitation during COVID 19 Policy and Procedure
5. Resident Visitation Competency Checklist Tool  All Staff 
6. Resident Visitation Competency Tool  Leadership and Managment
7. Training Plan Resident Visitation during COVID
8. Post Test Resident Visitation during COVID19
9. Post Test Key Resident Visitation during COVID-19
10. Visitation COVID 19 Training

LeadingAge Ohio understands that, throughout the pandemic, our members have had to constantly share new information and updates – with staff, with family members, and with the greater community. Members may receive a surge of media interest related to how the COVID-19 pandemic is affecting their community. We know that many of our members have already had to respond to difficult questions from the press about outbreaks and COVID-related deaths.

What happens if/when a member community discovers it has widespread COVID-positive residents and staff? What happens when a community experiences losses of residents or staff related to COVID-19?

LeadingAge Ohio wants members to be prepared and has worked with an industry leader, Cleveland-based Hennes Communications, to produce this toolkit. This toolkit provides information on establishing an action plan, describes ways LeadingAge Ohio can support members, and offers communications resources and templates.

We hope this toolkit will be helpful in preparing for crisis communications situations during the pandemic. LeadingAge Ohio will continue in its work to drive an informed coronavirus conversation around the state – highlighting the need for greater support for aging services providers, sharing member stories from the frontlines, and working with state leaders to ensure that LeadingAge Ohio members have access to critical resources.

Crisis Communications Toolkit

LeadingAge Ohio Crisis Communications Toolkit (full pdf version)

The toolkit includes the following:

• Developing an Action Plan 
• Sample Action Plan
• What can LeadingAge Ohio do?
• Communications Resources & Templates

What can LeadingAge Ohio do? 

LeadingAge Ohio is prepared to come alongside providers and assist on communications when COVID spread occurs. LeadingAge Ohio can provide messaging that can help providers tell their side of the story.

LeadingAge Ohio can:

• Assist in proofing an organization’s action plan;
• Join staff huddles assembling the organization’s action plan;
• Align the organization’s message with that of LeadingAge Ohio and other members;
• Assist in answering media requests;
• Send a press release supporting a member who has acted in good faith but still suffered a spread of cases (example in communications resources and templates);
• Connect members to crisis communications material from LeadingAge, including:
  • Communications planning,
  • Communications about positive cases, and
  • Communications about COVID losses;
• Connect members to LeadingAge Ohio staff experts, training, and resources.

We are here to stand by and support our members as they combat the spread of COVID-19.

Communication Resources & Templates

Below is a sample press release that can be sent on behalf of a member by LeadingAge Ohio:

• Sample Press Release

Templates & Resources from LeadingAge

          Communications planning:

• Planning for a COVID-19 Outbreak in Your Community: Crisis Media Plan
• Talking Points: Responding to Negative Views on Aging Services in Pandemic
• Sample Coronavirus Media Talking Points
• Crisis Communications Webinar
  
  Communication regarding testing for COVID-19:
  
  
• Press Release
• Letter to Residents and Families

          Communication of positive cases of COVID-19:

• Press Release
• Letter to Residents and Families
• Letter to Residents and Families - Positive Diagnosis in Staff
• Letter for Essential Workers

          Communication of COVID-19 -related deaths:

• Press Release
• Letter to Residents and Families

Resources & Articles from Hennes Communications

Thank you to Bruce Hennes at Hennes Communications for contributing to this toolkit and license of Crisis Management Today newsletter articles, which are available to all LeadingAge Ohio members below.

• Combating Uncertainty: How to Talk about COVID-19
• Creating a Post-Pandemic Crisis Team
• Why Hiding Or Changing Facts To Protect Against Panic Can Cause One
• Leadership in Action Dr. Amy Acton Director of Ohio's Department of Health
• Mastering the Zoom Apology
• As Coronavirus Spreads Use Smart Communications to Spread Word on Your Plans
• What Can You Do to Help Your Employees Through this Crisis
• What We've Learned So Far: Communicating About COVID-19
• Why People Feel Misinformed Confused and Terrified About the Pandemic

LeadingAge Ohio Contact

Patrick Schwartz
Director of Strategic Communications
pschwartz@leadingageohio.org
330.933.9825