COVID-19 Update: April 21, 2020

COVID-19 update for April 21 as of 5:00 p.m.

Pennsylvania Update

SNAP Advocacy

Safety-Net Association of Pennsylvania logo Today SNAP wrote to members of Pennsylvania’s congressional delegation to ask them to support new COVID-19 and economic relief legislation that was expected to include $75 billion for hospitals. See SNAP’s letter here. The Senate has voted to approve the legislation and the house is expected to take it up on Thursday. More detail about the bill’s contents is included in the federal update.

General Assembly

Today the House and Senate met to consider bills related to COVID-19 and to position legislation for FY 2020-21 budget negotiations. Most notable of the votes today was final passage of S.B. 857, which would authorize health care providers to use telemedicine and require insurers to provide coverage and reimbursement for these services. Over the last several months this bill stalled in the Senate due to controversial amendments added by House Republicans to restrict the use of telemedicine for certain abortion-related services. Circumstances related to the COVID-19 pandemic have elevated the importance of ensuring access to telemedicine services, and today the Senate voted to concur in those controversial House amendments, along a party-line vote, and send the legislation to the governor. The governor is expected to veto the bill.

Daily COVID-19 Briefing

The Department of Health new daily case counts are now the sum of two figures: “confirmed” cases that have been determined by testing plus cases that have been ruled “probable” because of an individual’s symptoms and recent contact with someone who has a confirmed case of COVID-19.
Death counts are now being presented in a similar fashion: “confirmed” deaths of patients who tested positive for COVID-19 plus “probable” cases for which a patient’s death certificate lists COVID-19 as a cause contributing to death but for which no COVID-19 test was administered.
As a result, the death figures are rising significantly. They do not, however, reflect a sudden increase in daily deaths; instead, they are the result of after-the-fact reconciliation of case data.
More than half of all deaths have been residents of long-term-care facilities.
The state is working to get antibody testing materials but is first evaluating the array of test products, which appear to be of varying quality.
Antibody testing is now available through Quest.
Secretary Levine said she would like to do much more testing across the state, including through more mass testing sites and other sources.
Rite Aid, she noted, is now doing COVID-19 testing.
40 percent of ICU beds across the state are currently unoccupied.
On the whole, the state’s hospitals are doing well. Some are more challenged, especially in Philadelphia and the surrounding counties.
As a result of this challenge, an alternate site of care at Temple University has now opened to serve COVID-19 patients who are on the road to recovery but need to remain hospitalized. This is being done to free hospital beds for more seriously ill COVID-19 patients.
Secretary Levine discussed the process of permitting hospitals to resume non-urgent procedures, explaining that this reflects a need to balance the desire to limit patients’ exposure to COVID-19 with the medical needs of patients who need procedures that are essential to their health. Decisions about when and how to begin resuming non-urgent procedures will be made in consultation with the hospital industry.

Department of Human Services

DHS has published its answers to the questions asked by stakeholders and interested parties during its April 15 COVID-19 webinar. Find that document here.

Two things are especially noteworthy in the information DHS provided.

First, DHS is still evaluating whether to take advantage of the CARES Act provision enabling states to temporarily expand Medicaid coverage to cover COVID-19 testing for uninsured individuals at 100 percent federal match.

Second, DHS is internally finalizing its request to CMS to alter its Medicaid State Plan to respond to the public health emergency. The so-called Disaster SPA will include the following:

The Medicaid Disaster SPA is currently under internal review and will be submitted in the near future. When the Disaster SPA is submitted, DHS will be requesting the following:

Flexibilities related to eligibility determinations by CAOs;
Suspension of copayments for screening, diagnostic and treatment services related to COVID-19;
Coverage for certain cough and cold medications for adults;
Expansion of the outpatient drug day supply limit from 34 day/100 unit to 90 days;
Suspension of annual reassessments related to targeted support management for Individuals with an intellectual disability or autism;
Suspension of the prior authorization requirements for certain services, including:
- Automated utilization reviews for emergency and urgent inpatient admissions;
- First 28 of days of Home Health Services;
- First 30 days of the following medical supplies:
  - Feeding supplies;
  - Respiratory supplies;
  - Urinary catheters;
  - Ostomy supplies; and,
  - Infusion supplies.
- Appliances or equipment that costs more than $600; and,
- Initial prescriptions of oxygen and related equipment.
A 90-day extension of the timeframe to complete cost reconciliation activities for Pennsylvania’s School-Based ACCESS Program (SBAP); and,
Waiver of Public notice requirements related to State Plan submission.

Department of Corrections

In our April 13 update we reported that Pennsylvania Correctional Industries, a business operated by Pennsylvania’s Corrections Department, was taking orders from non-profit organizations for masks and hand sanitizer. Today the department announced that it is no longer fulfilling such orders at this time.

Federal Update

Congress and Administration Agree on Next Aid Package

Congressional leaders and the Trump administration have agreed to provide $75 billion for hospitals as part of a $484 billion COVID-19 and economic relief package. This $75 billion would be addition to the money from the CARES Act and would have the same parameters as the CARES Act money.

The bill also includes $25 billion to research, develop, validate, manufacture, purchase, administer, and expand capacity for COVID-19 tests. Among others, this $25 billion would be distributed as follows:

$11 billion for states, localities, and territories to develop, purchase, administer, process, and analyze COVID-19 tests, increase laboratory capacity, trace contacts, and support employee testing.
$1 billion to the Centers for Disease Control and Prevention for surveillance, epidemiology, lab capacity expansion, contact tracing, public health data surveillance, and the modernization of analytics infrastructure.
$1.8 billion to the National Institutes of health to develop, validate, improve, and implement testing and associated technologies, accelerate research and development of point-of-care testing, and partnerships with other entities.
$1 billion for the Biomedical Advanced Research and Development Authority (BARDA) for advanced research, development, manufacture, production, and purchase of diagnostic, serologic, and other COVID-19 tests and supplies.
$825 million for Community Health Centers and rural health clinics.
Up to $1 billion to pay for testing for the uninsured.

Other major components of the bill include $310 billion to replenish the Paycheck Protection Program and $60 billion for the Small Business Administration’s disaster relief fund.

The Senate has already passed the bill and the House will vote on it on Thursday.

Department of Health and Human Services

HHS announced today that it has distributed nearly $1 billion in CARES Act grants to support older adults and people with disabilities who are living in the community during the COVID-19 emergency. See how much money each state received in this list.

Centers for Medicare & Medicaid Services

CMS has announced that providers that participate in clinical trials testing the use of drugs and biologics to treat COVID-19 and share their clinical data through the Medicare Quality Payment Program will receive credit in CMS’s Merit-Based Incentive Payment System (MIPS). According to a CMS news release, “…clinicians who report this activity will automatically earn half of the total credit needed to earn a maximum score in the MIPS improvement activities performance category, which counts as 15 percent of the MIPS final score.”

Centers for Disease Control and Prevention

The CDC has updated its FAQs for clinical labs performing COVID-19 tests.
The CDC has published interim guidance for implementing safety practices for critical infrastructure workers who may have been exposed to a person with suspected or confirmed COVID-19.
The CDC has posted resources for use in conducting contact tracing to help slow the spread of COVID-19.

Food and Drug Administration

The FDA has posted updated serology/antibody test FAQs.
The FDA has published a fact sheet on serological testing for antibodies to COVID-19.
The FDA has published a letter to health care providers with information on the use of serological (antibody) tests for COVID-19.

Accreditation Association for Ambulatory Health Care

In the wake of CMS’s announcement earlier this month that ambulatory surgery centers would temporarily be permitted to operate as hospitals to increase the capacity of the health care system during the COVID-19 emergency, the Accreditation Association for Ambulatory Health has posted resources for use in facilitating those temporary transitions.