As our members continue to provide high quality care to Ohio’s vulnerable populations, LeadingAge Ohio is urging everyone to review the following resources on control and prevention of Coronavirus (COVID-19).

A REMINDER TO ALL MEMBERS

Check LeadingAge's FAQs and Resources on COVID-19 Vaccines and Issues Surrounding Vaccinations frequently. The most recent update includes Q&A on implications of mandating the vaccine for staff.

COVID19@leadingageohio.org

If you have a question, concern, or want to share resources regarding COVID-19, we have a dedicated email account. Send a message to COVID19@leadingageohio.org, and we will get back to you quickly. As always, feel free to email or call any LeadingAge Ohio staff individually.

Can't find what you're looking for? Be sure and use the search feature at the bottom of our website.

Recent Updates
Communications
Education & Webinars
Policies & Regulations
Provider Setting Specific
Toolkits & Guidance
You Asked... We Answered

Recent Updates

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.

Testing Resources

Lab Capacity Dashboard

The new dashboard provides self-reported information about labs that can run tests, including hours of operation, types of tests they accept, estimated turn-around time, and locations.

LeadingAge Resources

Pandemic Playbook

An interactive collection of insight, wisdom, and critical lessons LeadingAge members have learned about serving older adults during a catastrophic health crisis.

Coronavirus Resources

Visit this page regularly for current information, tools, and resources to help LeadingAge members plan for and respond to COVID-19.

Have you listened to The Mentor's Voice?

Have you listened to LeadingAge’s new podcast, The Mentor’s Voice? Published twice a month, on Tuesdays, this podcast provides students and young professionals an opportunity to candidly learn from leaders In the field of aging. The goal is to disseminate wisdom and knowledge to emerging leaders and to inspire and inform their career journey.

On Tuesday, December 15, hear from special guest Sean Kelly, President and CEO of Kendal.

Follow the podcast on LinkedIn, Instagram, and Facebook. Subscribe wherever you listen to podcasts!

Communications

Vaccination Information/Resources

Daily Reports

LeadingAge (National) Resources

All Member Webinar Recordings

Crisis Communications Toolkit

Templates/Talking Points

Press Releases

COVID Advocacy Initiatives

Miscellaneous

Home Health & Hospice News

Home Health and Hospice Newsletter: January 19, 2021

Home Health and Hospice Newsletter

In Today's Newsletter

You asked... We answered regarding RNs or MDs performing rapid tests
You asked... We answered regarding how long to wait for testing someone who previously tested positive
2022 Requests for Applications for the Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component Webinar - RESCHEDULED
HHS announces longer grace period on PRF reporting
Vaccine education resources available
Web-based training opportunities from CMS
CDC Report: Allergic reactions to the vaccine
LeadingAge 2021 Policy Action Forum: January 27 at 2:00PM
2021 Membership Renewal: Update your staff contacts
What the Media Said About End of Life Care This Week

You asked:

We spoke to another hospice and they said the Ohio Department of Health (ODH) and The Joint Commission (TJC) have been citing organizations for having staff that were not an RN or MD perform the rapid COVID tests. Specifically, the tests that ODH distributed. Any truth to this?

We answered:

LeadingAge Ohio reached out to an ODH representative to ask about citing hospice programs for not having a RN or MD perform rapid COVID tests and received the following response:

ODH is not aware that any of our surveyors have cited COVID specimen collections. There are no personnel requirements for specimen collection and specimen collection is not regulated in Ohio. The Joint Commission may have their own requirements, but ODH is not citing deficiencies for who is preforming COVID tests.

You asked:

We are required to test twice weekly for the ECFs in hospice. We are now seeing our nurses test positive for COVID the second time, which puts them off again. We are also hearing that we should not be testing for COVID for up to 90 days after testing positive, but I cannot find this in our state/ECF requirements. Should we be waiting to test someone who has had COVID up to 90 days after testing positive?

We answered:

The CDC is very clear Heath Care Providers (HCP) should not be getting tested for 90 days after testing positive for COVID-19. If a staff member has recovered and later becomes symptomatic with symptoms consistent with COVID, then they should be tested. Please refer to the references below from the CDC:

2022 Requests for Applications for the Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component Webinar - RESCHEDULED

The “2022 Requests for Applications for the Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component” webinar originally scheduled for Thursday, January 14 has been moved to Thursday, January 28 from 4:00-5:00PM. If a member has already registered for this presentation, there is no need to take additional action. To register for this event, please follow these instructions.

HHS announces longer grace period on PRF reporting

The U.S. Department of Health and Human Services (HHS) announced last week that providers who received more than $10,000 in Provider Relief Fund (PRF) payments will now have a longer grace period to report how they used the funding. This decision was made after Congress passed the Coronavirus Response and Relief Supplemental Appropriations Act late last year, which boosted the Provider Relief Fund by an additional $3 billion.

The reporting portal was slated to open last Friday, January 15, with an original deadline of February 15. The agency did not establish a new deadline, so PRF recipients who received funding greater than $10,000 should still register on the portal. Today’s update does not apply to funds from: Nursing Home Infection Control, Rural Health Clinics Testing, and COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured recipients.

See McKnight’s write up on this breaking news.

Vaccine education resources available

Last week, LeadingAge Ohio members had the opportunity to hear Willow Brook Christian Communities’ team members describe their efforts that led to an 88% employee uptake of the vaccine.

Two key areas highlighted in the conversation include: 1) the value of having a trusted medical voice speak to the facts surrounding the vaccine and 2) the importance of knowing where there are leaders/managers that may be an obstacle to employees' acceptance. Willow Brook’s multiple communications (FAQ and memos) are available for all members to use (see “Employee Vaccine Information”).

The link to yesterday's all-member call with Willow Brook can be accessed here as well as in the LeadingAge Ohio COVID-19 hub. The COVID hub contains other vaccine-related resources such as:

VIDEO: City of Columbus Dr. Roberts COVID Vaccine PSA, a brief 4-minute video that provides education for residents, family members and staff.
FAQs and Resources on COVID-19 Vaccines and Issues Surrounding Vaccinations (Updated 1/8/21)
LeadingAge Ohio All Member Q & A: Member experiences from the first pharmacy partnership vaccine clinics (12/16/20)
LeadingAge Vaccine Resources

Web-based training opportunities from CMS

The Centers for Medicare & Medicaid Services (CMS) is offering web-based training courses that provide an overview of the following topics:

From Data Elements to Quality Measures – Cross-Setting QRP Web-Based Training

This course provides a high-level overview of how data elements within CMS patient/resident assessment instruments are used to construct quality measures (QMs) across post-acute care (PAC) settings. The PAC settings included are those covered under the CMS Quality Reporting Programs (QRPs) for Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Skilled Nursing Facilities (SNFs). Information covered will include a short review of the QRPs’ cross-setting quality measures (QM), how data elements feed into these cross-setting QMs, how QMs are calculated and appear on QM reports, and how to access and use this data for quality improvement.

Please click here to access the web-based training.

Section M: Skin Conditions – Assessment and Coding of Pressure Ulcers/Injuries Web-Based Training

This course provides an overview of the assessment and coding of pressure ulcers/injuries. This 90-minute course is intended for providers in Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs), and is designed to be used on demand anywhere you can access a browser. The course is divided into six sections and includes interactive exercises to test your knowledge related to the assessment and coding of pressure ulcers/injuries.

Please click here to access the web-based training.

If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Home Health Quality Help Desk.

CDC Report: Allergic reactions to the vaccine

The Centers for Disease Control and Prevention (CDC) has released a Morbidity and Mortality Weekly Report (MMWR) on Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine in the US. From December 14 through December 23, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination. Locations administering COVID-19 vaccines should adhere to CDC guidance for use of COVID-19 vaccines, including screening recipients for contraindications and precautions, having the necessary supplies available to manage anaphylaxis, implementing the recommended post-vaccination observation periods, and immediately treating suspected cases of anaphylaxis with intramuscular injection of epinephrine.

LeadingAge 2021 Policy Action Forum: January 27 at 2:00PM

LeadingAge is hosting its live virtual 2021 Policy Action Forum on January 27 at 2:00PM to look ahead at how LeadingAge will continue to support aging services providers from across the continuum. Attendees will get an inside view of how politics influences the sector, especially with a new Congress and Administration coming into power, and will hear from LeadingAge leadership about the path for advocacy and policy in the year ahead.

Speakers include health policy expert, Dr. Adaeze Enekwechi; LeadingAge’s board chair, Carol Silver Elliott; LeadingAge President Katie Smith Sloan; and LeadingAge Senior Vice President of Public Policy Ruth Katz.

OSHA’s Respiratory Protection Program: What you need to know

On Thursday, January 28 at 12:00PM, the Johnson Kendall Johnson (JKJ) Control Team will be holding a one-hour open discussion to address the following:

Required components of an OSHA compliant respiratory protection program;
Recent OSHA citations in healthcare (respiratory protection, PPE, HazCom);
Recording COVID-19 cases on the OSHA 300 log; and
Electronic submission of OSHA 300A (March 2nd deadline).

The discussion will be followed by a Q&A session. To register for this free webinar, please click here.

2021 Membership Renewal: Update your staff contacts

2021 membership renewal is in full swing. Invoices for 2021 dues were emailed in mid-December. A new year may mean new staff, and members should ensure LeadingAge Ohio has up-to-date staff contacts in its database to maximize your membership benefits and supports.

If you have any questions regarding your LeadingAge Ohio membership, please call Director of Member Experience Jennifer Taylor at jtaylor@leadingageohio.org or (614) 545-9028.

What the Media Said About End of Life Care This Week – January 19, 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: January 12, 2021

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

HHN 011221

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:

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

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).

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).

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

Home Health and Hospice Newsletter: January 5, 2021

Home Health and Hospice Newsletter

In Today's Newsletter

You asked... We answered regarding best resources for what data needs to be collected and reported
RCD monthly provider webinar schedule for 2021
2021 hospice mock survey schedule filling up
Additional COVID-19 testing options available through Ethos Laboratories
ODH releases vaccine communication toolkit
Ohio COVID-19 vaccine preparedness office weekly update for December 29
LeadingAge Ohio all-member call recording available
Medicare FFS Claims: 2% payment adjustment (sequestration) suspended through March
CDC releases new vaccine information for general public

You asked:

We are now receiving regular shipments of the BinaxNOW tests and would like to start using them to test staff who are going into ECFs. We have gotten approval from CLIA. Can you point me in the right direction of the best resources for exactly what data needs to be collected and where it needs to be reported?

We answered:

Any entity conducting antigen testing must report the findings and will need to register with Ohio to report. The federal requirement to report is listed below, with the requirements to report to ODH and links to the website that speaks to Ohio’s requirement for reporting and how to do so listed next. Finally, there is a link to the CDC webpage that talks about reporting.

Federal Information:

The Coronavirus Aid, Relief, and Economic Security (CARES) Act and its June 4 implementation guidance require every CLIA certified COVID-19 testing site to report every diagnostic and screening test result (both positive and negative results) performed to detect SARS-CoV-2 or to diagnose a possible case of COVID-19 (e.g., molecular, antigen, antibody) to the appropriate state or local public health department, based on the individual’s residence. Laboratories that currently report directly to CDC should continue sending these data to CDC. Email questions to DLSinquiries@cdc.gov.

State of Ohio COVID-19 Laboratory Testing Report

The Ohio Department of Health, has asked all laboratories conducting business in Ohio and testing for COVID-19 to report aggregate testing results, by 11:00 am each day.

For the purpose of this request, COVID-19 laboratory testing information from Ohio patients include aggregate reporting of: positive, pending, negative, indeterminate, and invalid test results. Also include the total number of patients with pending tests and tests not been performed. (e.g. improper or insufficent specimen). These are for tests performed in-house and it excludes tests sent out to reference laboratories. This is in addition to the regular reporting of positive laboratory results to the Ohio Department of Health per existing rule.

Instructions and guidance on completing this form can be found in our Frequently Asked Questions.

Persons in charge of any laboratory that examines specimens of human origin for evidence of COVID-19 infection shall electronically report within twenty-four (24) hours the results of all such examination, including, but not limited to: positive, negative, invalid, and inconclusive results.

Laboratory results should be electronically reported according to the protocols outlined below.

The Director’s Journal Entry may be accessed here.

Any entity performing any type of COVID-19 testing of human origin must register the name of their laboratory or facility here. Once approved by the Ohio Department of Health (ODH), your facility will be included in the lab reporting web portal for aggregate count submissions. The web portal link will be provided after registration.

The Director’s Order may be accessed here.

CDC Interim Guidance for Antigen Testing for SARS-CoV-2

https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html

Regulatory Requirements for Using Antigen Tests for SARS-CoV-2

FDA regulates in vitro diagnostic devices and has provided recommendations and information regarding EUA requests for COVID-19 diagnostic tests in the Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency (Revised) (“Policy for COVID-19 Tests”) and the EUA templates referenced in that policy. COVID-19 assays and test systems used for diagnostic or screening testing, including those for antigen testing, must have received an EUA from FDA or be offered under the policies in FDA’s Policy for COVID-19 Tests. Any antigen test for SARS-CoV-2 authorized for use by FDA is included on FDA’s list of In Vitro Diagnostics.

Laboratory and testing professionals who conduct diagnostic or screening testing for SARS-CoV-2 with antigen tests must also comply with Clinical Laboratory Improvement Amendments (CLIA) regulations. Any laboratory or testing site that intends to report patient-specific test results must first obtain a CLIA certificate and meet all requirements to perform that testing. For more information, see CMS’ How to Obtain a CLIA Certificate. CMS has provided additional information on enforcement discretion for the use of SARS-CoV-2 point-of-care testing on asymptomatic individuals.

RCD monthly provider webinar schedule for 2021

Ohio home health providers are invited to join Palmetto GBA for the Monthly Review Choice Demonstration (RCD) webinars. These webinars will provide up-to-date RCD information and give members a chance to ask any questions. Webinar sessions will be held from 11:00AM - 12:00PM.

Please review the schedule to select the date for the webinar session you want to attend.

2021 hospice mock survey schedule filling up

The Centers for Medicare & Medicaid Services (CMS) has temporarily put hospice recertification surveys on hold, but there is anticipation these surveys will resume shortly after the Public Health Emergency is over or possibly even before. LeadingAge Ohio has the ability to conduct hospice mock surveys which review all hospice conditions of participation (CoP’s) that are covered on survey. The benefit of the mock survey is to help programs prepare for an actual survey and receive instruction and education on how to meet the CoP’s if they are not currently in compliance.

If you are interested in discussing a mock survey for your organization, please contact Anne Shelley at ashelley@leadingageohio.org.

Additional COVID-19 testing options available through Ethos Laboratories

Ethos Laboratories is a Clinical Laboratory Improvement Amendments (CLIA) Certified and CAP Accredited Laboratory providing testing options for Adult Day, and other member organizations, who may not have a medical director or other medical professionals that can provide testing authorization. Ethos comes highly recommended by a Cincinnati-area LeadingAge Ohio member and they are offering Federal Drug Administration (FDA) Emergency Use Authorization (EUA) COVID-19 PCR testing.

Ethos EUA Approval and a FAQ on collection is available for review. Ethos shared additional items for LeadingAge Ohio members:

Ethos provides a 48 Hour Turnaround Time on Results
Ethos provides free courier service or UPS overnight shipping
Ethos can provide a collector at no charge to actually administer the testing for sites that are large and in need of assistance
All supplies and shipping charges are covered by Ethos
Ethos will bill insurance, for those without insurance Ethose will bill the HRSA under the CARES Act, with no cost to the facility or those they test
Ethose provides an easy to use portal for online ordering and report review
Ethos can provide Medical Authority to those that need it for ordering

For additional information, please contact Todd Bladel at todd@ethos-labs.com.

ODH releases vaccine communication toolkit

The Ohio Department of Health (ODH) has released a preliminary toolkit that has been developed with talking points, language tips, social media language, and trusted resources to help you better communicate about the safe, effective COVID-19 vaccines that have arrived in Ohio. This initial kit will be expanded with additional resources, but is being provided now to support your immediate needs.

Ohio COVID-19 vaccine preparedness office weekly update for December 29

The Ohio Department of Health (ODH) would like to share the most recent Ohio COVID Office Weekly Update with LeadingAge Ohio members.

Included in this week's update:

Phase 1B announced
Moderna vaccine storage and handling guidance
New COVID-19 maps

LeadingAge Ohio all-member call recording available

Yesterday morning, LeadingAge Ohio held an all-member call featuring guests from Otterbein Lebanon and Jennings who discussed their first vaccine clinic experiences.

To hear a recording of yesterday's call, please click here.

Medicare FFS Claims: 2% payment adjustment (sequestration) suspended through March

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.

CDC releases new vaccine information for general public

The Centers for Disease Control and Prevention (CDC) has now posted a variety of materials for the general population on COVID-19 vaccines. The materials include “8 Things You Need to Know About the COVID-19 U.S. Vaccination Program,” “When Vaccine Supply is Limited, Who Gets Vaccinated First?,” “What to Expect at Your Appointment to Get Vaccinated for COVID-19,” “Benefits of Getting a COVID-19 Vaccine,” “Different COVID-19 Vaccines,” and “Ensuring the Safety of COVID-19 Vaccines in the United States.”

Home Health and Hospice Newsletter: December 22, 2020

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: December 15, 2020

Home Health and Hospice Newsletter

In Today's Newsletter

You asked... We answered
LeadingAge Ohio All-Member Q & A: December 16 at 4:00PM
Vaccine next step for home care providers
HOSPICE Act passes House
Homecare workforce bills
Transportation services free for Ohio Medicaid Managed Care Members
COVID-19 vaccination overview update
Members share vaccine education resources for staff, residents, families
COVID-19 vaccine education: Addressing health inequities
Antigen testing update causes spike in daily cases
What the Media Said about End of Life Care this week

You asked:

Can an Ohio Advance Directive document (Living Will or Healthcare Power of Attorney) be witnessed virtually if there is are audio/visual capabilities available so the witness can see and hear the individual signing the document?

We answered:

LeadingAge Ohio reached out to an attorney who is very familiar with the Ohio Advance Directives and they said the Living Will and Healthcare Power of Attorney could be witness virtually with the following stipulations. Each Advance Directive must be witnessed by 2 people who watch the individual draft and sign the document, and determine the individual is of sound mind and not under duress at the time the document is signed. The two witnesses must be watching at the same time as the individual signs but do not have to be in the same room or location.

Once the individual signs the document, then the document must physically get to the two witnesses who then sign the original document the principal signed, one witness at a time. It can be a logistic problem but is certainly doable. The responsibility of the witnesses has not changed, but it may be done a little differently now due to COVID-19.

LeadingAge Ohio All-Member Q & A: December 16 at 4:00PM

LeadingAge Ohio will host its bi-monthly all-member webinar focused entirely on member questions and answers, Wednesday at 4:00PM.

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 related to all things compliance, including infection control, testing, surveys, reporting requirements, and other fast-moving topics.

Members still have time to 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.

Vaccine next step for home care providers

Per information received from a call with the Ohio Department of Health (ODH) yesterday, home care providers should reach out to their local health department (LHD) to discuss vaccine roll-out for their staff and clients. Each LHD will likely have procedures that are specific to their staffing and scheduling capabilities.

HOSPICE Act passes House

On December 8, the Helping Our Senior Population in Comfort Environments Act or HOSPICE Act (H.R. 5821) passed out of the U.S. House of Representatives as part of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (H.R. 2477). The HOSPICE Act was developed in response to the July 2019 Office of Inspector General (OIG) reports that identified several concerns in the hospice program related to the survey process and quality of care. LeadingAge and partners VNAA/ElevatingHOME worked in coalition with other hospice stakeholders to formulate joint recommendations for the Congressional staff that worked on the legislation, many of which impacted the final version of this bill. LeadingAge will continue to work with the Senate to advocate for some key changes.

Homecare workforce bills

LeadingAge met with staff from Senator Angus King’s office last week to discuss the three bills introduced to support and advance the home care workforce, a topic that is so important but often ignored. The bills have bipartisan support, even the bill that increases FMAP, which is a huge step forward. “The Mollie Baldwin Upskilling of Personal and Home Care Aides Act” (S. 4942) provides a stable pool of funding for both local governments and non-governmental agencies to expand existing training models that bring new home care workers into the industry; “The Career Advancement for Direct Support Aid Workers (CADSAW) Act” (S. 4940) would create funding through HRSA to help individuals already working within the home healthcare field with opportunities to pursue increased education and training to facilitate career advancement, think career ladders; and “The Direct Support Worker Training Reimbursement Act” (S.4943) provides enhanced Federal matching payments (FMAP) for direct support worker training programs at a 75% rate, similar to the rate for medical personnel.

Transportation services free for Ohio Medicaid Managed Care Members

As Ohio continues to grapple with the COVID-19 crisis, the Ohio Medicaid Managed Care Plans are working hard to ensure their most vulnerable citizens maintain reliable access to food resources.

To that end, Ohio’s five Medicaid Managed Care Plans (Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage, and United Heathcare Community Plan) provide their members with no-cost transportation services to and from food banks, food pantries, food clinics, and grocery stores as part of their plan benefit. This transportation benefit is for Managed Care recipients only and does not apply to MyCare Ohio recipients.

This transportation service is essential to many of the health plan’s members and the plans are encouraging members to contact their respective health plan to get the transportation services they need. Each health plan continues to do everything possible to tell their members about this transportation benefit and how to use it.

By undertaking this united effort on behalf of every Ohio Medicaid Managed Care member, the health plans are hoping to get food on the table for Ohioans in need during this unprecedented health crisis.

Please share this resource document listing the transportation benefits provided by each Managed Care Plan with all Ohioan’s who are recipients of one of these health plans. The document also contains contact information for each plan and instructions on how the transportation services can be scheduled for those in needed.

COVID-19 vaccination overview update

LeadingAge Ohio attended the first meeting of the DeWine Administration’s Priority Populations Workgroup to address vaccine distribution. Attached is the presentation from the meeting.

As a reminder, facilities that have not received a communication from the Pharmacy Partnership’s pharmacy to which they have been assigned (CVS, Walgreens, PharmScript or Absolute) should email Haylee Dunahay, Director of Coalitions at Office of Ohio Governor Mike Dewine, immediately at Haylee.Dunahay@Governor.ohio.gov.

Members share vaccine education resources for staff, residents, families

Because of the speed with which this vaccine was developed, an unusually high portion of Ohioans have expressed skepticism related to the vaccine’s efficacy and safety. While many questions related to Ohio’s long-term care vaccination distribution plan remain unanswered, LeadingAge Ohio members have begun staff, resident and family education efforts in earnest. Jennings has shared a letter they plan to use within their community, which other members may adapt for their own use.

If you have resources you have developed that you would like to share, please send them to the COVID-19 mailbox.

COVID-19 vaccine education: Addressing health inequities

On Monday’s all-member LeadingAge call, Karyne Jones, LeadingAge national board member and Chief Executive Officer of the National Caucus and Center on Black Aging, Inc. (NCBA), discussed the Vaccine Education and Equity Project. Launched last week, the goal of the 75+ organizations that make up the project is to build confidence in vaccines and vaccine technology, including what we know and what we still need to learn. The work will contribute to addressing health inequities, generally and in relation to COVID.

Antigen testing update causes spike in daily cases

On Monday, Governor DeWine discussed the Ohio Department of Health (ODH) aligning with the Centers for Disease Control and Prevention’s (CDC) current case definition. In August, the CDC changed the case definition to include case counts of positive antigen test results without additional verification. Ohio has continued to manually verify these test results using additional epidemiological data, such as a known positive contact or symptom onset.

On December 8, ODH began including antigen tests without an epidemiological link in the total case count. This resulted in a one-day spike in reported cases from pending positive antigen cases.

“After understanding more about the antigen testing, the CDC changed their definition. Our epidemiologists have alerted us that they are no longer able to keep up with the manual verification process of antigen testing because there is so much COVID-19 spread in Ohio,” said Governor DeWine. “Antigen tests have become a bigger part of our overall picture of understanding COVID-19, and it’s important to capture that information.”

Not all pending cases will be translated into new cases. Cases will be checked and duplicate records will be removed. Cases will also be assigned to their appropriate onset date.

Home Health and Hospice Newsletter: December 8, 2020

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: November 24, 2020

Home Health and Hospice Newsletter

In Today's Newsletter

You asked... We answered
CMS to retire the original Compare Tools on December 1
Hospice Election Statement Addendum educational opportunities; register early
Home health and hospice members requested to complete testing and PPE information form to potentially receive Abbot BinaxNOW cards
Home health and hospice town hall on December 10
Care Compare Quarterly Refresh – November 2020
LeadingAge Ohio issues press release with holiday suggestions for families with older adult loved ones

From all of us at LeadingAge Ohio... We wish you hope, joy, peace, good health and love as we approach the Thanksgiving holiday!

You asked:

If a patient has identified an attending physician, who will also be acting as the patient’s hospice physician, are two verbal certifications required for this patient? For instance, one signature from the hospice physician, who is also the attending physician, and one signature from a second hospice physician?

We answered:

No, if a hospice patient chooses to have the hospice physician act as their attending physician, then only one physician signature is required on the Certification of Terminal Illness (CTI) and only one verbal certification is required for this patient. LeadingAge Ohio has reached out to Palmetto GBA in that past about this situation and Palmetto representatives have suggested if only one physician is signing the CTI, then the hospice should make a note on the CTI that the hospice physician is also acting as the attending physician for this patient. That way there will be no confusion for a reviewer who might be auditing this record that only one physician signature is required in this instance, should this chart be pulled for an audit.

Please see the citation below from the hospice Conditions of Participation. If you have any questions regarding hospice CTI’s please contact Anne Shelley at ashelley@leadingageohio.org.

418.22 Certification of terminal illness

(c) Sources of certification. (1) For the initial 90-day period, the hospice must obtain written certification statements (and oral certification statements if required under paragraph (a)(3) of this section) from:

(i) The medical director of the hospice or the physician member of the hospice interdisciplinary group; and

(ii) The individual's attending physician if the individual has an attending physician. The attending physician must meet the definition of physician specified in §410.20 of this subchapter.

(2) For subsequent periods, the only requirement is certification by one of the physicians listed in paragraph (c)(1)(i) of this section.

(3) Exceptions. (i) If the hospice cannot obtain the written certification within 2 calendar days, after a period begins, it must obtain an oral certification within 2 calendar days and the written certification before it submits a claim for payment.

CMS to retire the original Compare Tools on December 1

In early September, the Centers for Medicare & Medicaid Services (CMS) released Care Compare on Medicare.gov, which streamlines eight original health care compare tools. Since then, facilities have had the opportunity to use and familiarize themselves with Care Compare while having the option to use the original compare tools, too.

The eight original compare tools – like Nursing Home Compare, Hospital Compare, Physician Compare – will be retired on December 1, ending this transition period. If you haven’t been using Care Compare, you are urged to:

Use Care Compare on Medicare.gov and encourage people with Medicare and their caregivers to start using it, too. Go to Medicare.gov and choose “Find care”.

Update any links to the eight original care tools on your public-facing websites so they’ll direct your audiences to Care Compare.

Care Compare offers a new design that makes it easier to find the same information that’s on the original compare tools. It gives patients and caregivers one user-friendly place to find cost, quality of care, service volume, and other CMS quality data to help make informed health care decisions.

Please remember that when the eight original compare tools are retired, information about health care providers and CMS quality data will remain on Care Compare, as well as via download on the Provider Data Catalog on CMS.gov. Fully transitioning to these tools does not change how CMS measures quality.

Hospice Election Statement Addendum educational opportunities; register early

The hospice Medicare Administrative Contractor's (MACs) (i.e. NGS, CGS & Palmetto GBA) have worked collaboratively to develop and offer two upcoming live educational sessions regarding the Hospice Election Statement Addendum.

Below are links for both sessions that you can register through. Just a reminder that although the National Government Services (NGS) is offering these courses, these events are being presented collaboratively by all MACs and live webinar events have limited seating; therefore providers should register ASAP to ensure that they do not miss out on this important educational event.

To register, click on the date that best works for you:

December 10, 2020 at 3:00PM EST

January 19, 2020 at 3:00PM EST

Home Health and Hospice members requested to complete testing and PPE information form to potentially receive Abbot BinaxNOW cards

LeadingAge continues its work to secure Abbott BinaxNOW tests from the federal government through the COVID-19 Rapid Point of Care Test Distribution initiative and monitoring and reporting on PPE supply chains for home health and hospice members. As a result of these efforts, LeadingAge has successfully secured tests for a number of members and discussed PPE needs that have been emphasized to major suppliers like McKesson and MedLine.

LeadingAge is requesting all home health and hospice members fill out this form by November 27. The sooner members fill out the form, the sooner LeadingAge can work to advocate for testing supplies to be sent. This form is only to be filled out regarding your home health and hospice staff and patients served. LeadingAge wants to reiterate that unless a copy of the CLIA certificate is submitted along with filling out the form, your organization will not be eligible to receive tests.

Home health and hospice town hall on December 10

On Thursday, December 10 from 1:00PM to 2:00PM, LeadingAge and Visiting Nurses Association of America (VNAA) and ElevatingHOME (EH) are hosting a standalone town hall event for all home health and hospice members. LeadingAge looks forward to a great conversation with home health and hospice members that provides valuable feedback as 2021 policy priorities are developed.

You can register for the Home Health and Hospice Town Hall at this registration link.

Care Compare Quarterly Refresh – November 2020

The November 2020 quarterly refresh for the Hospice Quality Reporting Program is now available on Care Compare. Care Compare is the recently launched, streamlined redesign of eight existing Centers for Medicare & Medicaid Services (CMS) healthcare compare tools on Medicare.gov, including Hospice Compare.

Please note that public reporting of hospices’ data will freeze after the November 2020 refresh, due to the temporary exemption to the Hospice Quality Reporting Program (HQRP) data submission requirements in responding to the COVID-19 Public Health Emergency (PHE). This means that following the November 2020 refresh, the data publicly reported will be held constant through the November 2021 refresh. Further, no Provider Preview Reports will be issued for those refreshes that continue to display the constant or frozen data. For additional information on COVID-19 PHE data exemption, please see the Hospice COVID-19 Public Reporting Tip Sheet in the Downloads section of the HQRP Requirements and Best Practices webpage.

LeadingAge Ohio issues press release with holiday suggestions for families with older adult loved ones

With Thanksgiving less than one week away and cases surging in Ohio, LeadingAge Ohio yesterday shared ideas for family gatherings that involve older adult loved ones via a press release, particularly those who require long-term services and supports or reside in a congregate care setting. The recommendations were issued in an open letter to friends and family of older Ohioans, penned by Kathryn Brod and shared with LeadingAge Ohio members earlier in the week.

“The challenges of 2020 have been unprecedented, and there is no doubt that Ohioans are worn down by the repeated obstacles to visiting with older loves ones,” stated Kathryn Brod. “Despite this fatigue, fresh vigilance is required as we approach the holidays with an out-of-control case count. While the temptation is strong to enjoy the holidays as usual, extra precaution and creativity are required as we continue the fight against COVID-19 and care for this most at-risk group of Ohioans.”

The letter urged Ohioans with older adult loved ones, especially those who live in a congregate care setting or suffer from serious illness, to consider finding new ways to celebrate the holidays this year. It also shared that if a family insists on having their loved one come home for the holiday, it is likely the loved one’s long-term care facility will require transmission-based precautions upon their return or other measures to protect both residents and staff.

The full letter and press release can be viewed online. Members should use this information as a tool when communicating with families and residents over the holidays.

What the Media Said About End of Life Care This Week – November 23, 2020

Home Health and Hospice Newsletter: November 17, 2020

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

Home Health and Hospice Newsletter: November 10, 2020

Home Health and Hospice Newsletter

In Today's Newsletter

You asked... We answered
CMS issues guidance on hospice election addendum
Home infusion therapy supplier enrollment information released
CMS updates hospice claims processing instructions
DeWine names new leadership team to ODH
CDC offers suggestions on safe holiday gatherings and travel
The return of What the Media Said About End of Life Care This Week – November 9, 2020

You asked... We answered

You asked:
One of our hospice patients is positive for COVID-19 in a nursing facility. Is there an exemption saying a nursing facility can skill them for COVID-19 isolation and we can keep the patient on hospice and bill Medicare concurrently?

We answered:
Currently, there is no exemption saying a nursing facility can skill a resident for COVID-19 and the resident also remain on the hospice Medicare benefit. Hypothetically nothing in the billing guidelines precludes a nursing facility to skill a resident for COVID-19 and bill a 07 condition code (unrelated to hospice) if the hospice can determine, by way of their documentation, the residents COVID-19 is not related to the resident’s terminal condition. LeadingAge Ohio believes there would be very few cases where COVID-19 does not play into the demise of a hospice resident, therefore COVID-19 would be considered a diagnosis related to their terminal condition.

In most cases, if it is the resident/family’s desire to be skilled for COVID-19, then the resident would have to revoke from hospice while they are being skilled and then be readmitted to hospice when they are no longer being skilled for COVID-19.

CMS issues guidance on hospice election addendum

The long awaited guidance regarding the hospice election addendum has finally been released by the Centers for Medicare & Medicaid Services (CMS). Transmittal 10437: Manual Updates Related to the Hospice Election Statement and the Implementation of the Election Statement Addendum contains updates to the Medicare Benefit Policy manual and to business requirements related to the hospice election statement and implementation of the election statement addendum in accordance with the FY2020 Hospice Wage Index and Payment Rate Update final rule. The transmittal includes revised citations to the Medicare Benefit Policy Manual, Chapter 9 related to the election statement and addendum as well as examples of the timing of providing the election statement to hospice patients/representatives. The effective date for these changes was October 1, 2020 (the start of the fiscal year) and the implementation date for this change request is December 9, 2020.

Questions related to the hospice addendum may be directed to Anne Shelley at ashelley@leadingageohio.org.

Home infusion therapy supplier enrollment information released

The Centers for Medicare & Medicaid Services (CMS) updated the enrollment policies for home infusion therapy (HIT) suppliers with Transmittal 10434/Change Request (CR) 11954. Providers have been anxiously awaiting these instructions to be provided to the Medicare Administrative Contractors (MACs), but CMS needed to wait until the CY2021 home health final rule was released. That final rule was released at the end of last week (see NAHC coverage of this rule here, and upcoming webinar information here), and this CR posted the following day. It updates the enrollment instructions in Chapter 10 of the Medicare Program Integrity Manual, Publication 100-08.

The Medicare home infusion therapy services benefit covers the professional services, including nursing services, furnished in accordance with the plan of care, patient training and education (not otherwise covered under the durable medical equipment benefit), remote monitoring, and monitoring services for the provision of home infusion therapy and home infusion drugs furnished by a qualified home infusion therapy supplier. Section 1861(iii)(3)(D)(i) of the Act defines a “qualified home infusion therapy supplier” as a pharmacy, physician, or other provider of services or supplier licensed by the state in which supplies or services are furnished.

A qualified home infusion therapy supplier must furnish infusion therapy to individuals with acute or chronic conditions requiring administration of home infusion drugs; ensure the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis; be accredited by an organization designated by the Secretary; and meet other such requirements as the Secretary deems appropriate, taking into account the standards of care for home infusion therapy established by Medicare Advantage (MA) plans under Part C and in the private sector.

Per the CR, providers wanting to enroll as HIT suppliers can do so beginning on or after November 1, 2020. This involves completion and submission of the CMS Form 855-B. The enrollment fee is applicable and approved HIT suppliers will need to go through revalidation every 5 years consistent with other provider types. Providers are concerned about the timeframe for processing the applications since the Medicare home health benefit will no longer cover certain HIT services beginning January 1, 2021.

Providers must also be accredited by an approved accrediting organization for HIT services prior to being approved as a Medicare Part B HIT supplier. Accreditation must be received in order for the CMS Form 855B application to be processed. Applicants will be processed under the limited-risk category.

An entity wishing to furnish HIT services to Medicare beneficiaries must enroll as a HIT provider. Such providers must meet the following requirements:

Obtain and maintain a valid TIN and NPI at the organizational level.
The home infusion therapy supplier must be currently and validly accredited as such by a CMS-recognized home infusion therapy supplier accreditation organization in order to enroll and remain enrolled in Medicare. The CMS-recognized home infusion therapy supplier accreditation organizations include the Joint Commission (TJC), the Utilization Review Accreditation Commission (URAC), the Accreditation Commission for Health Care (ACHC), the Community Health Accreditation Partner (CHAP), the National Association Boards of Pharmacy (NABP), and the Compliance Team (TCT).
The home infusion therapy supplier must be compliant with § 414.1515 and all provisions of 42 CFR Part 486, subpart I in order to enroll and maintain Medicare enrollment.
The home infusion therapy supplier must certify via the CMS-855B application that the home infusion therapy supplier meets and will continue to meet the specific requirements for enrollment described in §424.68 and Part 424, subpart P.
Prospective (newly enrolling) home infusion therapy suppliers must pass application screening upon initial enrollment and revalidate at a limited categorical risk level per § 424.518(a).
Pay an application fee at initial enrollment, revalidation and when adding a practice location.

NAHC Report, Nov 4, 2020

CMS updates hospice claims processing instructions

The Centers for Medicare & Medicaid Services (CMS) recently updated the hospice chapter of the Medicare Claims Processing Manual, changing the billing and processing instructions.

Change Request (CR) 12026 clarifies that in order for the Notice of Termination/Revocation (NOTR) to be accepted into the system, an election period must be established. If the notice of election, which creates the hospice election period, is not submitted and posted before the NOTR, the NOTR will be rejected.

The CR also:

Adds the most commonly used discharge codes for hospice claims,
Clarifies that occurrence code 42 is not required on the NOTR, since the through date represents the revocation date. Occurrence codes are only necessary on NOTRs when carrying the original revocation date on a correction.

NAHC Report Nov 5, 2020

DeWine names new leadership team to ODH

During his daily press conference yesterday, Governor Mike DeWine announced changes in the leadership of the Ohio Department of Health (ODH), the agency responsible for leading Ohio’s pandemic response. ODH has been without a director since Director Amy Acton resigned in June amid protests of business closures.

The new team includes one new face and several reassignments from other agencies:

Chief Medical Officer, Dr. Bruce Vanderhoff: Former Senior VP and Chief Medical Officer at Ohio Health
Director, Stephanie McCloud: Former Administrator of the Ohio Bureau of Workers’ Compensation
Senior Deputy, Lance Himes: Former ODH Interim Director
Chief of Staff, Kathleen Madden: Former Assistant Director at the Ohio Office of Budget and Management

In his comments, the Governor likened our current stage in the pandemic to “halftime,” saying it is time to bring in a new team to mount an offense.

CDC offers suggestions on safe holiday gatherings and travel

The Centers for Disease Control and Prevention (CDC) offers the following considerations to help protect individuals and their families, friends, and communities from COVID-19 during the upcoming holidays. Celebrating virtually or with members of one's own household poses low risk for spread. In-person gatherings pose varying levels of risk.

Included in the article are highlights on:

Hosting a holiday gathering
Attending a holiday gathering
Holiday travel
What to do during a celebration
After the celebration

The considerations in the article linked above are meant to supplement—not replace—any Ohio health and safety laws, rules, and regulations with which holiday gatherings must comply.

The return of What the Media Said About End of Life Care This Week – November 9, 2020

It’s back! 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.

Education & Webinars

Coronavirus Spotlight Podcasts

LeadingAge Coronavirus Spotlights

Podcast series featuring presentations by LeadingAge members and subject-matter experts who have been guests on the live daily online updates. Listen to these brief but informative podcasts to learn more about how your colleagues are coping with the pandemic.

Policies & Regulations

Telehealth Rule Updated
- Appendix

Ohio Department of Health (ODH)

Center for Disease Control (CDC)

Ohio Department of Aging

Ohio Department of Medicaid (ODM)

Department of Health and Human Services (HHS)

Centers for Medicare & Medicaid Services (CMS)

Department of Housing and Urban Development (HUD)

Guidance by Other Organizations

Provider/Setting Specific

PROVIDER OR SETTING-SPECIFIC RESOURCES

Adult Day/PACE/Senior Centers

Affordable Housing

Affordable Housing

COVID-19 Update and Discussions for Affordable Housing Call Notes [Members Only]

Toolkits/Guidance

Mental Health Resources for Providers

LeadingAge Ohio Partner and Associate Firm Guidance and Updates

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.

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.

Outdoor Visitation

Outdoor Visitation Toolkit

Communication - Outdoor Visitation

The Ohio Department of Health (ODH) has released guidance for outdoor visitation to begin effiective July 20, 2020 in long-term care settings. Below please find resources that can help you plan to implement this guidance in your setting and communicate it to residents, their loved ones, and staff.

We recommend that you provide residents and families with a copy of the ODH guidance on outdoor visitation before scheduling a visit.

If you need assistance, contact Patrick Schwartz at pschwartz@leadingageohio.org or 614.545.9026.

Communication Resources

OHIO DEPARTMENT OF HEALTH GUIDANCE ON OUTDOOR VISITATION

SAMPLE STATEMENT & MESSAGES

SAMPLE RESIDENT/FAMILY LETTER

SAMPLE STAFF MESSAGE

SAMPLE FAQ – RESPONSE TO FAMILY QUESTIONS

SAMPLE RISK ACKNOWLEDGEMENT FORM, INCLUDING RESTRICTIONS & INSTRUCTIONS
(Note: This is a sample form. We strongly recommend you consult with legal counsel as you consider this approach and/or if you decide to use this type of form for outdoor visitation. We also recommend that you provide a copy of the ODH Guidance on Outdoor Visitation to residents and visitors.)

SAMPLE VISITOR SCREENIN G LOG

HANDOUT: OUTDOOR VISITATION – PROVIDER, RESIDENT & FAMILY CRITERIA (One Page Handout)

HANDOUT: OUTDOOR VISITATION – PROVIDER, RESIDENT & FAMILY CRITERIA (Full document)

HANDOUT: BEST PRACTICES FOR OUTDOOR VISITATION

HANDOUT: VISITATION OPTIONS

A PHASED APPROACH TO VISITATION
(Note: This is a high-level overview of a phased-in approach to visitation only. The State of Ohio is currently in Phase 2 of visitation. Work is underway with ODH to develop guidance that would allow for visitation inside your settings as well as more group programming and activities.)

Additional Resources to Consider Regarding Outdoor Visitation

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.

As family and friends reach out to schedule their visit, consider checking the Ohio Public Health Advisory System link to check your current level status and that of the visitor to determine the best date/time to schedule the visit.

SAMPLE TEMPLATE FOR OUTDOOR VISITATION GUIDANCE

SAMPLE FAMILY/FRIENDS VISIT SCREENING TOOL

Kendal at Oberlin has provided a sample template members can use to include your community specific protocols for pre-visit, what to expect upon arrival and ODH and community specific requirements for the visit.

In addition, a sample family and friends visit screening tool to use upon arrival has been provided. Each template is available in Word for edit capabilities.

PRE-VISIT LINKS TO SHARE WITH VISITORS

If you will be allowing pets during the visit

COVID19 and pets

Note: As COVID-19 continues to evolve and new guidance is released from CDC, CMS and ODH, this information is subject to change. We will update these resources as needed and post revised resources to our website: leadingageohio.org/covid

Activity Professionals

Activities Professionals Resource Page

Activity Professionals

This page is designed to serve as a resource for our activity professionals within the LeadingAge Ohio membership. Sharing resources, best practices and more, please send content you would like added to Jennifer Taylor, Director of Member Experience, at jtaylor@leadingageohio.org

Voting Resources

VOTEOHIO.GOV

LeadingAge Civic Action Center

The LeadingAge Civic Action Center allows you to do a search to find out if your resident is registered to vote and if not, what steps to take to make that happen.

State of Ohio County Board of Elections Directory

Ohio Secretary of State list options for November 2020 election:

Four weeks of early in-person voting, including convenient evening and weekend hours. (NOTE: check with your specific county board of elections for evening and weekend hours options)
Absentee voting by mail
in person voting on election day

Sample Care Plans

Psychospcial COVID-19 Care Plan - Kendal at Oberlin

Psychosocial well-being related to restricted visitation and CMS ruling regarding no group activities.- COVID Care Plan - Friendship Village of Columbus

COVID-19 Sample Care Plan - Friendship Village of Columbus

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

Funding Opportunities

Ohio Department of Medicaid (ODM) alerted Ohio nursing homes to the availability of Civil Monetary Penalties (CMP) funds to support purchases of electronic devices which facilitate communication and socialization for nursing home residents, including tablets, ipads, and similar devices, as well as accessories such as adaptive accessories, covers to facilitate cleaning between uses, and other items.

CMP grants of up to $3,000/provider may be made to providers that complete an application template provided by Ohio Department of Medicaid (ODM).

Applications should be sent to Amy Hogan, Nursing Facility Policy Administrator atamy.hogan@medicaid.ohio.gov.

List of Activities and Ideas to Address Social Isolation in Older Adults

LeadingAge Ohio has put together various resources, both non-tech and tech related, to help activity professionals with ideas to fight isolation among residents.

Activity Resources for Residents to Combat Isolation (Resources/Links)

Additional Resources

Well Connected by Covia – Connects individuals to virtual classes, conversations, and activities
by phone. Programs available in English and Spanish
o Referral:
(877) 797-7299 (English)
(877) 400-5867 (Spanish)

Lifetime Connections Without Walls by Family Eldercare - Telephone activities program providing
opportunities for older adults to connect with others in their community and across the country
using a telephone conference call system.
o Referral:
(888) 500-6472
lcww@familyeldercare.org

Friendship Line by Institute on Aging - The Friendship Line is both a crisis intervention hotline and
a warmline for non-emergency emotional support calls. It is a 24-hour toll-free line and the only
accredited crisis line in the country for people aged 60 years and older, and adults living with
disabilities.
o Toll-Free Line: (800) 971-0016

Dementia Focused Activities

The Creative Caregiving Guide© was created by the National Center for Creative Aging (NCCA). The Guide is filled with short video lessons that guide users through hands-on learning experiences, from paintings, poetry, music, storytelling, to drama and dance exercises. It is a FREE, community-shared, web-based resource specially designed for family and professional caregivers of adults who live with Alzheimer’s disease and related cognitive disorders.

Using any available computer, tablet, or smartphone you and your care partner can experience caregiving practices that are filled with creativity, connection, and vitality!

The 19 lessons are now housed at Opening Minds through Art (OMA) website, which is based at Scripps Gerontology Center at Miami University in Oxford, OH and can be accessed here.

Take Care of Yourself

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.

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

Additional Resources

Join the #ActivitiesStrong Facebook page

LinkedSenior is proud to offer a comprehensive educational resource toolkit so that the senior living industry can deliver on its promise of meaningful, purposeful resident engagement regardless of a person’s current preferences or cognitive abilities.

Some featured webinars and recordings addressing COVID-19 specifically are highlighted below.

Meaning in the Time of COVID-19: Providing Meaningful Engagements for People Living with Dementia while Isolation, Quarantine and Fear Abound

Resident Engagement and Dementia in the Context of COVID-19

Resident Engagement and COVID-19

Stories from the Frontline – Hear from Resident Engagement Champions

Tech Support and Training

Older Adults Technology Services (OATS)

Mission to help seniors learn and use technology so they could live better in the digital age.

Senior Planet

Join us for 60+ online programs every week to keep learning, connecting, and exploring.

Cyberseniors

Cyber-Seniors’ goal is to bridge the digital divide and connect generations through technology. Explore membership options for your community.

Listed below is a summary of the senior tech-training resources that the Cyber-Seniors solution provides. Several of these resources are also available in Spanish and French.

Accessibility Resources: Helpful tools to assist with common accessibility challenges i.e. dexterity, vision and/or hearing impairment.
Cyber-Seniors 101/Beginner Lessons: Videos, downloadable workbooks & lesson plans for those looking to learn the basics of their device, email, Skype, Facebook & Youtube.
Intermediate & Advanced Tutorials: Over 1200 tutorials on a myriad of topics & websites specifically developed for senior citizens to learn.
Explore the Internet: An additional list of interesting and informative websites curated with seniors in mind.
Scavenger Hunt: A fun way for seniors to practice and get comfortable searching the Internet.
Tech Products & Services: Recommendations for senior-centric tech products and services.
Cyber-Seniors Corner: The CYBER-SENIORS Youtube channel that showcases the wisdom, wit and talents of some remarkable Senior Citizens.
Discussion Forum: A place for users to openly share updates, tips and ask questions.

About LAO

Leadership

Membership

Foundation

Programs

Recognition & Awards

Regulatory

Regulations

Quality (Under Construction)

Reimbursement (Under Construction)

Advocacy

Advocacy

Political Action Committee

Pathways - #plan2ageohio

Education

Education & Events

Leadership Training

Online Learning

2021 Annual Conference & Trade Show

August 4 - 6, 2021

Workforce

Workforce Resources

Careers That Love You Back

Latest News

01/19/2021

01/14/2021

01/12/2021

ERN/United Way Toolkits

Aging 101

Family Resources

Advance Directives

Bereavement

Resource Center

Services

Member Resources

Publications

Resources

Toolkits

Quality

Services

A REMINDER TO ALL MEMBERS

Recent Updates

Vaccination Information/Resources

Testing Resources

LeadingAge Resources

Have you listened to The Mentor's Voice?

Communications

Vaccination Information/Resources

Vaccination Information/Resources

Daily Reports

Daily Reports

Archived COVID-19 News Reports

01/19/2021

01/14/2021

01/12/2021

01/07/2021

01/05/2021

01/04/2021

12/31/2020

12/29/2020

12/24/2020

12/23/2020

12/22/2020

12/19/2020

12/17/2020

12/17/2020

12/16/2020

12/15/2020

12/14/2020

12/11/2020

12/08/2020

12/06/2020

12/03/2020

11/30/2020

11/30/2020

11/24/2020

11/19/2020

11/17/2020

11/16/2020

11/12/2020

Quality
(Under Construction)

Reimbursement
(Under Construction)