Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities
Section 5160-3-80 - Health care isolation centers

(1) ) "Congregate settings" include nursing facilities, residential care facilities, assisted living facilities, and other designated facilities where individuals reside and receive services.

(2) "COVID-19 care needs" are the following levels of clinical care needed by an individual with an active or convalescent COVID-19 infection or who has other health care needs and necessitates quarantine following exposure to COVID-19:

(3) "COVID-19 level of care" is a level of care comparable to that needed for admission to a nursing home, a COVID-19 diagnosis (tested or probable), and a physician order.

(4) "Health care facility" is a licensed or certified facility that provides medical care.

(5) "Health care isolation center (HCIC)" is a setting that provides a COVID-19 level of care or a quarantine level of care. The HCIC will serve both individuals post hospitalization who are not ready to return to their prior residence due to medical care and isolation or quarantine needs, and individuals who cannot receive needed care in their congregate setting but whose level of need does not rise to the level of hospitalization. HCICs should not be used for clinically stable individuals who can be treated safely where they live, including a nursing facility.

(6) "Quarantine level of care" means a level of care comparable to that needed for admission to a nursing home, exposure to COVID-19 which necessitates quarantine, and a physician order.

(1) Physically discrete space which is a separate building or wing; and

(2) Approval by Ohio department of health (ODH)

(1) HCICs will separate individuals with COVID-19 exposure from individuals with probable or positive COVID-19 diagnoses;

(2) Admission to HCIC isolation units is limited to individuals who either have a positive COVID-19 test result or a probable COVID-19 diagnosis;

(3) HCICs may serve as a step-down setting after a hospital stay if necessary, to maintain isolation or quarantine needs and meet clinical needs;

(4) Individuals admitted to the HCIC will have the following:

(5) HCICs will not accept individuals who are clinically stable and who can safely be served in their home, including a congregate setting. The determination that an individual can be safely served at home or in a congregate setting will be made in accordance with guidelines issued by ODH;

(6) The operator of an HCIC will coordinate hospital transfers and discharge from the HCIC using the processes created in the regional public health hospital zone;

(7) HCICs are responsible for discharge planning, including the following:

(8) An HCIC will coordinate with the regional public health zone triage official when an individual is transferred to the hospital;

(9) Individuals treated at HCICs are not candidates for experimental or novel therapies, such as untested drugs or multi-patient ventilator use.

(1) HCICs will have dedicated full time infection control personnel available twenty-four hours per day, seven days per week;

(2) The staffing plan will not create staff shortages at other facilities or home and community-based services providers operated by the HCIC operator;

(3) Staff working in the HCIC can only work in the HCIC on a single calendar day during the time the HCIC is open.

(4) If an HCIC has a quarantine unit and an isolation unit, separate staff will be dedicated to each unit.

(1) The HCIC will have access to all medications prescribed for their patients, including oxygen, bronchodilators and associated supplies;

(2) Primary responsibility for meeting personal protective equipment (PPE) needs rests with the HCIC. Existing regional public health hospital zones are responsible for assisting the HCIC in meeting medication and supply needs, as appropriate;

(3) All personnel at HCICs will wear extended and re-use masks in accordance with state guidance;

(4) The HCIC will have adequate supplies of PPE in accordance with current procurement plans and protocols;

(1) An HCIC providing isolation services will be capable of meeting complex health care needs for individuals with respiratory illnesses, including in some instances, ventilator care;

(2) Have a separate entrance for the isolation unit;

(3) If one or more individuals are using ventilators, the HCIC will have an on-site respiratory therapist in the HCIC twenty-four hours per day, seven days per week;

(4) If providing ventilator care, the HCIC will meet physical plant, including back-up power sources, and staffing levels and prerequisites necessary to provide services to individuals using ventilators;

(5) The HCIC will have access twenty-four hours per day, seven days per week, including via telehealth, to a pulmonologist or clinician who can help manage individuals with COVID-19.

(1) HCICs will comply with the rules, guidelines, and protocols related to COVID-19 issued by CMS, the centers for disease control (CDC), and ODH including the following:

(2) ODH may approve a waiver of capacity limits on behalf of CMS to increase the number of individuals that may receive services in an HCIC, including relicensing rooms previously delicensed, converting single rooms to double rooms, and repurposing common space to create a multi-bed ward for the period of time the facility is operated as an HCIC;

(3) Any necessary ODH surveys will be completed before requests for approval as an HCIC are considered.

(4) Requests for approval will be considered in the following priority order:

(5) HCICs will comply with all nursing facility standards and any additional standards determined by ODH or ODM.

(6) All applicable certification standards continue to apply with the exception of the thirty day notice prior to discharge.

(7) ) Additional oversight of HCICs will be performed by ODH and includes but is not limited to, check-in phone calls, notification of admissions and discharges, and technical assistance.

(1) HCICs will be reimbursed for services provided to individuals eligible for full medicaid benefits for dates of service on or after an ODH approved application using a tiered flat per diem rate system that matches reimbursement to the COVID care needs related to the COVID-19 diagnosis or exposure.

(2) Per diem rates for HCICs are established by the department of medicaid and published at https://medicaid.ohio.gov/Portals/0/COVID19/HCIC-Billing-Guidance.pdf.

(3) If an individual admitted to an HCIC from a hospital qualifies for a medicare covered nursing facility stay, the HCIC will bill medicare as the primary payer. Notwithstanding rule 5160-3-64 of the Administrative Code, the operator of the HCIC may submit a claim for the difference between the medicare payment received and the appropriate HCIC per diem rate set forth in paragraph (H)(2) of this rule.

(4) Reimbursement for individuals enrolled in managed care plans will be determined by ODM and the managed care plans;

(5) Patient liability, if applicable, applies to HCIC payments;

(6) Franchise permit fees pursuant to Chapter 5168. of the Revised Code will apply as follows:

(7) ODM will identify any additional cost report accounts or schedules that are needed to appropriately capture the costs, revenues and utilization related to HCICs.

(8) If an individual receiving services in an HCIC is a resident of a nursing facility, the nursing facility can bill for leave days in accordance with section 5165.34 of the Revised Code. This includes the nursing facility where the individual resides when the HCIC is contained in the nursing facility of residence.

(9) Individuals receiving care in an HCIC that are not already eligible for medicaid may apply for medicaid coverage. The HCIC will not be reimbursed by the medicaid program for individuals who are not eligible for medicaid. Patient liability will be calculated based on the financial information provided by the individual through the attestation process.

(1) An HCIC using certified beds added as surge capacity will exist no longer than the federal authority allowing for temporary expansion bed capacity for the care and treatment of residents with COVID-19 expires. A certified bed increase granted to an HCIC will be temporary. The beds will not be sold or transferred between nursing facilities.

(2) HCICs are providers added to the medicaid program solely for purposes of meeting the quarantine and isolation needs of individuals infected by the COVID-19 virus.