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Guidance: Intermediate Care Facilities

Update for requesting prior authorization for bed hold days during the COVID-19 state of emergency in Ohio. 5/18/2020 Click here to view

Attention Intermediate Care Facilities Providers:

As the Ohio Department of Developmental Disabilities (DODD) responds to coronavirus (COVID-19), please continue to exercise flexibility to ensure the health and safety of Ohioans with developmental disabilities and their families. DODD appreciates the unique role that intermediate care facilities for individuals with intellectual disabilities (ICFs) providers of service and direct support professionals (DSPs) play throughout the developmental disabilities system.

The following information gives recommendations and guidance on important issues for ICF providers and is effective immediately.

Emergency Response

DODD encourages ICF providers to ensure that people with developmental disabilities and DSPs are familiar with and follow recommendations from the Centers for Disease Control and Prevention (CDC) and the Ohio Department of Health (ODH) related to social distancing and personal hygiene.

DODD encourages ICF providers to take all steps necessary to follow guidelines for social distancing, including limiting the delivery of services in community settings when appropriate.

DSPs should be familiar with the agency’s emergency response plan.

ICF providers are encouraged to ensure that a person-centered approach to services is maintained by communicating with people receiving services, their families, guardians, and DSPs to keep them updated on how they can stay safe during this state of emergency.

With respect to visitation in ICFs, the Ohio Director of Health issued an order that requires the following: (Note: ICFs are included in “Homes.”)

  1. Restrict access to all Homes only to those personnel who are absolutely necessary for the operation of the Homes. People who are "absolutely necessary for the operations of the Homes" include, but may not be limited to, home staff, contracted and emergency healthcare providers, contractors conducting critical on-site maintenance, and governmental representatives and regulators and their contractors. No visitors of residents shall be admitted to any Home, except for end-of-life situations.
  2. Restrict access to all Homes only to those personnel who have been screened for COVID-19 each time they enter Homes. Screening guidance is available from the U.S. Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services, as well as from the Ohio Department of Health. Screening should include questions about exposure to COVID-19 and assessing visitors and personnel for cough, shortness of breath, and body temperatures of 100.0 degrees and higher. This order does not apply in exigent circumstances, to emergency medical services, first responders, and similarly situated individuals.
  3. Restrict access to all Homes to as few points of entry as is possible, with the Ohio Department of Health recommending one point of entry. This does not apply to emergency ingress or egress of facilities.
  4. Restrict access to all Homes only to those persons who produce legal federal- or state-issued identification, other satisfactory identification, or are a known person, and provide the Homes with business telephone numbers and addresses. It is the responsibility of the Homes to log such information, maintaining it for at least six months.
  5. Allow residents to discharge from Homes at any time and in accordance with applicable state and federal law, understanding that residents that then return to the Homes while this Order is in effect are subject to the directives above.

DODD recognizes that these requirements may seem excessive for small ICFs and ICFs that do not serve elderly or medically compromised people, but they currently are required for all ICFs.

The department anticipates that the Centers for Medicare and Medicaid Services (CMS) soon may issue ICF-specific guidelines for COVID-19, at which time DODD will amend this guidance to reflect CMS direction. Until that time, DODD recommends that ICFs study and use the current CDC guidelines for long-term care facilities. Please check this link frequently, as the CDC guidelines are often updated.

The guidelines cover

  • education of residents and families,
  • infection control supplies,
  • screening of staff for potential infection,
  • visitors,
  • managing residents with respiratory infection,
  • additional measures to reduce potential for spread within the facility,
  • and additional measures if there are COVID-19 cases in the facility or surrounding community.

Surveys

ODH has resumed ICF annual certification surveys. If the facility is due for their licensure review, ODH will complete this at the time of the annual certification survey.

Initial and three-year Ohio Developmental Disabilities Profile (ODDP) reviews are on hold through the state of emergency.

Options Counseling

Options counseling by CareStar and pre-admission counseling has been postponed until further notice.

Level of Care

Level of care redeterminations are postponed until after June 1, 2020.

Discharge Notices

Thirty days’ notice of discharge is still required per current rules. It is also required that each ICF provider has an emergency response plan that includes shelter-in-place and quarantine areas.

If a resident leaves the facility and is unable to return to the facility for a reason related to COVID-19, the facility may not issue an emergency discharge, but may postpone the person’s return to the facility. In this event, the facility may give a 30-day discharge notice, but must maintain the open bed for the person to return to after the quarantine period.

Under CDC guidelines, ICFs may be able to treat an infected person or a person under investigation for COVID-19 at the facility if the ICF can implement appropriate infection control precautions per the guidelines (isolation, use of personal protective equipment, etc.). ICFs are not required to discharge a COVID-19 positive person and may allow them to return after hospitalization, subject to appropriate precautions.

Direct Support Professional Training

During the COVID-19 Pandemic, DODD has granted certain flexibilities to certified providers and ICFs regarding the hiring and training of Direct Support Professionals (DSPs). Effective September 1, 2021, providers will be expected to resume full compliance with all rules applicable to the hiring and training of DSPs, except for flexibilities around initial training and First Aid/CPR described below.

Full compliance includes:

  • HSD/GED/rule waiver
    • DODD will temporarily waive the requirement that DSPs must have a high school diploma or GED. This waiver will be effective from September 17, 2021, through September 30, 2022. Employees without a high school diploma or GED cannot be certified to administer medications. Read more.
  • Background checks
    • Employers will be required to initiate all applicable required Background Checks (BCII, FBI, required database checks, etc.) prior to employment.
      • Rule permits an agency to preliminarily employ a DSP for up to 60 days pending receipt of the results of the BCII check, provided the applicant has signed a Criminal
        Notification/Attestation statement prior to employment. Upon receipt of the completed background check, appropriate action must be taken if any disqualifying offenses are revealed.
    • Agencies must continue to enroll persons in Rapback within 14 days of receipt of the BCII check.
      • Previously identified issues related to Rapback enrollment have been reported as resolved.
  • Initial Training
    • DODD will continue to accept condensed initial training through December 31, 2021
      • The condensed initial training must include:
        • Training to recognize and report major unusual incidents (MUIs) and unusual incidents (UIs). The training must include at a minimum the definitions of MUIs and UIs, as well as the agency's procedures for reporting.
        • Universal precautions
        • Training provided or arranged by the agency provider specific to the individual service plan (ISP) of each person the DSP will support.
      • Initial training must always be conducted prior to the DSP providing services.
    • Resuming January 1, 2022, initial training conducted after this date will need to comply with the Agency and Independent Certification rules and/or the Administration of Licensed Facilities rule.
  • First Aid/CPR
    • Staring September 1, 2021, all DSPs must have First Aid/CPR training prior to providing services except for those employed at Facilities subject to OAC 5123:2-3-01 (F) (1)(h-i).
    • First Aid/CPR training that does not include an in-person skills assessment will continue to be accepted through December 31, 2021.
    • Training that includes an in-person skills assessment will again be required effective January 1, 2022.
    • For DSPs who obtain CPR/First Aid training that does not include an in-person skills demonstration prior to January 1, 2022, DODD will accept this as valid training through the certificate’s expiration date. Upon renewal, the DSP will be expected to obtain training that includes the required in-person skills assessment.
  • Medication Administration Certification
    • Medication Administration Certificates that were set to expire between March 9, 2020 and April 1, 2021 were extended until July 1, 2021 by House Bill 404.
    • Any certificates set to expire during that time that have not been renewed have lapsed as of July 2, 2021.
    • All DSPs administering medication must have a current Medication Administration Certificate.
  • ICFs that share DSPs:
    • If ICFs share DSPs, each agency is required to maintain their own personnel record that demonstrates that agency’s compliance with personnel requirements
  • Compliance with all other applicable hiring and training requirements outlined in Ohio Administrative Code Chapter 5123.

Cost Reports

Updated March 27*

ICF providers will automatically be granted an extension to submit their Medicaid year-end cost reports, making all reports due April 28, 2020. With questions, contact Ashley McKinney at ashley.mckinney@dodd.ohio.gov.

Bed Hold Days

DODD will waive the requirement for prior authorization of additional bed hold days as required by OAC 5123:2-7-08, effective March 13, 2020, until further notice. ICF providers will be responsible for entering bed hold days used during this period prior to year-end. Please contact cr-icf@dodd.ohio.gov with any questions.  

DODD Support Teams

In this critical time, everyone will be required to work collaboratively, operate differently, and be proactive to limit the spread of COVID-19. During this state of emergency, DODD fully realizes there are on-the-ground issues that require flexibility from normal operations and additional assistance from the department.

DODD support teams are available and consist of staff ready to help county boards and providers.

DODD has set up a dedicated web page for department communications and links to helpful resources that will advise people with disabilities, their families, service providers, direct support professionals, county boards of developmental disabilities, and the community at large.

For specific questions about COVID-19 and additional information and resources, DODD urges you to use the Ohio Department of Health’s call center. Call 1-833-4-ASK-ODH (1-833-427-5634), or visit coronavirus.ohio.gov.