The following is the latest COVID-19 information from the state and federal governments as of 3:00 p.m. on Thursday, November 5.

Pennsylvania Update

Department of Health

The Department of Health updated its hospital guidance to clarify that hospitals must test COVID-19 patients prior to discharge to another facility and communicate those test results to the receiving facility prior to discharge.

In response to an increase of new COVID-19 cases in Huntingdon County, the Department of Health contracted for drive-through and indoor testing clinics in the county from October 29 through Monday, November 2.

During a news conference this week, Secretary Levine noted that Pennsylvania is now seeing more COVID-19 “long-haulers”:  people who continue to experience COVID-19 symptoms over a period of months.

Even though current case counts in Pennsylvania are higher than they were during the earlier days of the pandemic, fewer people are hospitalized with the disease, fewer are being treated on ventilators, and fewer are dying.  Secretary Levine attributes these improvements to better medical care, more experience treating COVID-19 patients, and better therapeutics.  In addition, long-term-care facilities are doing a better job of preventing and limiting outbreaks.  She attributed this improvement in part to the help those facilities are receiving through the state’s Regional Response Health Collaborative program.

She also noted that cases are less concentrated among elderly Pennsylvanians than in the pandemic’s early days and that younger people are better equipped to fight the disease.

The state recently released data that illustrates this change:

• In north central Pennsylvania, approximately seven percent of cases in April were among people ages 19 to 24 while that same age group accounted for approximately 28 percent of cases in October.
• In northeastern Pennsylvania, that figure rose from six percent of cases in April to approximately 16 percent of cases in October.
• In southeastern Pennsylvania it rose from nearly five percent of cases in April to nearly 14 percent of cases in October.
• In southeastern Pennsylvania it rose from approximately five percent of cases in April to nearly 12 percent of cases in October.
• In northwestern Pennsylvania it rose from nearly seven percent of cases in April to approximately 14 percent of cases in October.
• In south central Pennsylvania it rose from approximately seven percent of cases in April to approximately 12 percent of cases in October.

The state is still struggling with people unwilling to cooperate with contact tracers when they are informed that they have COVID-19, Secretary Levine continued.  Only 24 percent are currently doing so.

Among those who are cooperating, in the past week more than half of those people said they had been in a restaurant or “large business” or mass gathering setting in the past two weeks.

Department of Health COVID-19 Vaccine Planning

Last week we introduced you to an executive summary of Pennsylvania’s COVID-19 vaccination plan.  Today, Secretary Levine held a news briefing to provide additional information about Pennsylvania’s plan.  According to a report in the York Daily Record, Secretary Levine said that the state intends to distribute the vaccines in phases and that “In the first phase, when vaccine doses are likely to be limited, high-risk workers in health care settings, first responders, other essential workers, people with pre-existing health conditions and adults in long-term care are likely to be prioritized.”  Learn more from the York Daily Record article.

Department of Health – by the numbers

• Pennsylvania’s number of COVID-19 cases recently surpassed 220,000.  The past week has seen the highest number of new cases on a daily basis since the pandemic began and Thursday’s new case count was the state’s new single-day high.
• The number of new cases in Pennsylvania during the week ending October 29 was 43 percent higher than the previous week.
• With today’s latest figures, the death count now exceeds 8900.
• Of that number, 61 percent have been residents of long-term-care facilities.
• Overall, nearly 27,000 residents of long-term-care facilities and more than 5800 people who work in those facilities have contracted COVID-19.  Those figures encompass 1100 facilities in 63 of Pennsylvania’s 67 counties.
• More than 12,700 health care workers in the state have contracted COVID-19.
• The number of people currently hospitalized with COVID-19 is higher than it has been at any time since May.
• The number of COVID-19 patients currently breathing with the help of a ventilator is higher than it has been since mid-June.
• 20 percent of hospital adult ICU beds are currently unoccupied, as are 18 percent of medical/surgical beds, 33 percent of pediatric beds, 12 percent of pediatric ICU beds, and 37 percent of airborne isolation unit beds.
• The state-wide positivity rate on COVID-19 tests rose from five percent two weeks ago to six percent last week.
• A positivity rate greater than five percent is considered “concerning,” Secretary Levine explained during her news briefing, adding that currently, 40 counties have rates higher than five percent.  Only 30 counties were at that level the previous week, she added.
• According to the early warning dashboard released weekly by the governor and Department of Health, the following counties are currently experiencing “substantial level of transmission” of COVID-19:  Armstrong, Berks, Blair, Bradford, Cambria, Centre, Crawford, Dauphin, Delaware, Franklin, Fulton, Huntingdon, Indiana, Lackawanna, Lawrence, Lebanon, Lehigh, Luzerne, Mifflin, Philadelphia, Schuylkill, Tioga, Venango, Westmoreland, Wyoming, and York.

Department of Human Services

DHS is no longer requiring non-nursing home providers to submit interim reporting on their CARES ACT/Act 24 spending.  Interim reports would have been due on November 6 and are still required of nursing homes.

DHS’s Office of Long-Term Living and Office of Developmental Programs (ODP) have updated their guidance on COVID-19 for personal care homes, assisted living residences, and private intermediate-care facilities.

ODP has issued guidance to individuals, families and designated persons, licensed and enrolled providers of ODP residential services, and all interested parties on developing visitation policies in ODP residential settings to protect residents, staff, and visitors from COVID-19.

Federal Update

Provider Relief Fund

• A reminder that applications for Phase 3 general distribution payments are due Friday, November 6.
• HHS has updated the Provider Relief Fund FAQ with two modified items; the second bullet below addresses the deadline for Phase 3 applications.
  • p. 6 – Does HHS intend to recoup any payments made to providers not tied to specific claims for reimbursement, such as the General or Targeted Distribution payments? ( Modified 11/5/2020)

The Provider Relief Fund and the Terms and Conditions require that recipients be able to demonstrate that lost revenues and increased expenses attributable to COVID-19, excluding expenses and losses that have been reimbursed from other sources or that other sources are obligated to reimburse, exceed total payments from the Relief Fund. Provider Relief Fund payment amounts that have not been fully expended on the combination of healthcare expenses and lost revenues attributable to coronavirus by the end of the final reporting period, must be returned to HHS. HHS reserves the right to audit Relief Fund recipients in the future to ensure that this requirement is met and collect any Relief Fund amounts that were made in error or exceed lost revenue or increased expenses due to COVID-19. Failure to comply with the Terms and Conditions may be grounds for recoupment.

• p. 41 – Tax Identification Number (TIN) Validation Process

When is the deadline to submit an application? (Modified 11/5/2020)

The deadline to submit an application under Phase 3 – General Distribution is November 6, 2020 at 11:59 PM EST for those that have had their TIN validated in Phase 2 or received funds as part of Phase 1. Any entity that has not yet received any General Distribution payments must submit their TIN for validation by November 6, 2020 at 11:59 PM EST. If the TIN is validated by November 13, 2020 at 11:59 PM EST, the entity will have until November 27, 2020 at 11:59 PM EST to submit an application.

Department of Health and Human Services

• HHS’s Office of the National Coordinator for Health Information Technology (ONC) has posted FAQs about the information-blocking provisions of the regulation it published last week extending until April of 2021 the agency’s deadline for complying with its information-blocking requirements.  Find those FAQs here.

Centers for Medicare & Medicaid Services

• CMS’s online publication MLN Connects directs providers and others to its COVID-19 vaccine toolkit for information about preparing to administer such vaccines when they become available.
• CMS has updated its provider-specific fact sheets on new COVID-19-related waivers and flexibilities for the following providers:

• Home Health Agencies
• Physicians and Other Practitioners
• Ambulances
• Hospitals
• Teaching Hospitals, Teaching Physicians and Medical Residents
• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities
• Hospices
• Inpatient Rehabilitation Facilities
• Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals
• Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
• Laboratories
• End Stage Renal Disease (ESRD) Facilities
• Durable Medical Equipment
• Participants in the Medicare Diabetes Prevention Program
• Medicare Advantage and Part D Plans
• Medicare Shared Savings Program Participants

Centers for Disease Control and Prevention

• The CDC has updated its interim infection prevention and control recommendations for health care personnel during the COVID-19 emergency.
• The CDC has updated its guidance for the management and clinical care of patients with confirmed cases of COVID-19.
• The CDC has updated its clinical guidelines for the collection, handling, and testing of clinical specimens from persons with confirmed or suspected cases of COVID-19.
• The CDC has updated its COVID-19 FAQs.
• The CDC has updated its explanation of its role in serology testing and has updated its guidance on the use of serology testing.
• The CDC has updated its guidance for pharmacists and pharmacy technicians working in community pharmacies during the COVID-19 emergency.  The updated guidance focuses on protecting both pharmacy staff and customers.
• The CDC has updated its information regarding considerations for optimizing providers’ supplies of powered air-purifying respirators.
• The CDC has updated its guidance on considerations for wearing masks.
• The CDC has published data about the impact of COVID-19 on pregnancy.
• The CDC’s weekly morbidity and mortality report presents new research on the impact of engaging in telework on the incidence of positive COVID-19 tests among symptomatic patients at outpatient facilities.
• The CDC’s weekly morbidity and mortality report presents research on birth and infant outcomes following confirmed COVID-19 infections during pregnancy.
• The CDC has published a request for information in which it states that it seeks “…to partner with one or more organizations that have the infrastructure, capability, scalability, and safeguards to enable centralized public health laboratory data reporting from testing entities to state and large local health departments, with a focus on multi-state, large regional, and state-wide reporting entities.”  Find the CDC request for information here.

Food and Drug Administration

• The FDA has alerted clinical laboratory staff and health care providers that false positive results can occur with antigen tests for the rapid detection of COVID-19.  The FDA is aware of reports of false positive results associated with antigen tests used in nursing homes and other settings and continues to monitor and evaluate these reports and other available information about device safety and performance.

Congressional Research Service

• The Congressional Research Service has updated its report “The COVID-19 Health Care Provider Relief Fund.”
• The Congressional Research Service has updated its report “COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and Treatment.”

The following is the latest COVID-19 information from the state and federal governments as of 2:45 p.m. on Friday, October 30.

Pennsylvania Update

Department of Health

The Department of Health updated its hospital guidance to clarify that hospitals must test COVID-19 patients prior to discharge to another facility and communicate those test results to the receiving facility prior to discharge.

In response to an increase of new COVID-19 cases in Huntingdon County, the Department of Health has contracted for a drive-through and indoor testing clinic in the county.  Testing will be available at the Huntingdon Plaza, Suite 7505, R. 22 and S. 4th Street in Huntingdon beginning on October 29 and running until Monday, November 2.  The tests are free and no appointment is needed.

Department of Health – by the numbers

• Pennsylvania’s COVID-19 case count recently surpassed 200,000.  The daily total has been in four figures every day this month except for one, which has not happened since the early months of the pandemic.
• Four times in the last nine days the state has totaled more than 2000 new cases – the first times the daily total has exceeded 2000 in any one day since the beginning of the pandemic.
• With today’s latest figures, the death count now exceeds 8700.
• Of that number, 61 percent have been residents of long-term-care facilities.
• Overall, nearly 26,000 residents of long-term-care facilities and more than 5600 people who work in those facilities have contracted COVID-19.  Those figures encompass 1063 facilities in 63 of Pennsylvania’s 67 counties.
• More than 12,200 health care workers in the state have contracted COVID-19.
• The number of people currently hospitalized with COVID-19 is more than twice what is was on October 1 and is at its highest level since June 2.
• The number of COVID-19 patients currently breathing with the help of a ventilator also is more than twice what it was on October 1 and is at its highest level since mid-June.
• 20 percent of hospital adult ICU beds are currently unoccupied, as are 16 percent of medical/surgical beds, 31 percent of pediatric beds, 11 percent of pediatric ICU beds, and 38 percent of airborne isolation unit beds.  The medical/surgical and medical/surgical ICU bed figures are similar to what they have been in recent weeks but both pediatric figures are lower than they have been recently.

Department of Human Services

DHS’s Office of Long-Term Living and Office of Developmental Programs have updated their guidance on COVID-19 for personal care homes, assisted living residences, and private intermediate-care facilities.

Federal Update

Provider Relief Fund

• A reminder that applications for Phase 3 general distribution payments are due November 6.
• Another reminder that HHS will hold a webcast about the Phase 3 general distribution on Monday, November 2 at 3:00 p.m. (eastern) for interested parties.  Go here to register for the webcast and to submit questions.  Also available are a fact sheet and a presentation about the Phase 3 general distribution.
• HHS has added or modified 61 questions in its Provider Relief Fund FAQ.  The changes, labeled either “Added 10/28/2020” or “Modified 10/28/2020,” generally address auditing and reporting requirements for the Provider Relief Fund, including accounting for expenses and lost revenue, as well as the sharing of general distribution money among parent and subsidiary entities, executive salary cap calculations, and more.  The modified and added questions and answers offer additional details about many issues so providers should review these changes carefully.  The following excerpts address some specific matters about which providers have inquired:
  • ” Healthcare related expenses attributable to coronavirus may include items such as supplies, equipment, information technology, facilities, employees, and other healthcare related costs/expenses for the calendar year. The classification of items into categories should align with how Provider Relief Fund recipients maintain their records.” [emphasis added]
  • “… providers that already have a cost allocation methodology in place, may allocate normal and reasonable overhead costs to their subsidiaries which may be an eligible expense if attributable to coronavirus and not reimbursed from other sources.”
  • “HHS initially advised providers that once a subsidiary TIN attested to and accepted a General Distribution payment, the money must stay with, and be used by, the subsidiary TIN. However, HHS has received feedback indicating that some subsidiary TINs accepted a General Distribution payment prior to the release of this guidance, and that they would have had their parent TIN accept the money, had they known earlier of HHS’s position. In light of these timing concerns, HHS is revising its prior guidance and clarifying that, for General Distribution payments only, a subsidiary TIN can transfer its General Distribution payment to a parent TIN; this is true even if a subsidiary TIN initially attested to accepting a General Distribution payment. Consistent with other longstanding guidance, the parent TIN may use the money and/or allocate the money to other subsidiary TINs, as it deems appropriate. Regardless of which entity (the parent or subsidiary) attested to the receipt of the General Distribution payments, the parent entity can report on the use of the General Distribution payment as part of the HHS reporting process.”
  • “In accordance with the Terms and Conditions, if you believe you have received an overpayment and expect that you will have cumulative lost revenues and increased costs that are attributable to coronavirus during the COVID-19 public health emergency that exceed the intended calculated payment, then you may keep the payment.”
  • “Providers do not need to be able to prove, at the time they accept a Provider Relief Fund payment that prior and/or future lost revenues and increased expenses attributable to COVID-19 (excluding those covered by other sources of reimbursement) meet or exceed their Provider Relief Fund payment. Instead, HHS expects that providers will only use Provider Relief Fund payments for permissible purposes and if on June 30, 2021, providers have leftover Provider Relief Fund money that they cannot expend on permissible expenses or losses, then they will return this money to HHS.”
  • “The Terms and Conditions associated with each Provider Relief Fund payment do not permit recipients to use Provider Relief Fund money to pay salaries at a rate in excess of Executive Level II which is currently set at $197,300. For the purposes of the salary limitation, the direct salary is exclusive of fringe benefits and indirect costs. The limitation only applies to the rate of pay charged to Provider Relief Fund payments and other HHS awards. An organization receiving Provider Relief Fund payments may pay an individual’s salary amount in excess of the salary cap with non-federal funds” An example aggregate calculation is provided.
  • Again, we strongly encourage providers to review all of the 10/28 additions and modifications of the Provider Relief Fund FAQ.

Centers for Medicare & Medicaid Services

• CMS has published an interim final rule that calls for several regulatory changes driven by the COVID-19 pandemic.
• All Medicare beneficiaries, including Medicare Advantage participants, will pay nothing for COVID-19 vaccines, as will most Medicaid beneficiaries.  Most private insurers are required to cover the vaccines as well.  Vaccines for the uninsured will be reimbursed in the same manner as care for the uninsured that is reimbursed through the Provider Relief Fund.
• Medicare will make enhanced payments for eligible inpatient cases that involve use of certain new products authorized or approved to treat COVID-19.  The enhanced payments will be equal to the lesser of:  (1) 65 percent of the operating outlier threshold for the claim; or (2) 65 percent of the cost of a COVID-19 stay beyond the operating Medicare payment (including the 20 percent add-on payment under section 3710 of the CARES Act) for eligible cases.
• States will retain their ability to gain an additional, temporary 6.2 percentage point increase in their federal medical assistance percentage (FMAP, the rate at which the federal government matches state Medicaid spending) if they agree to maintain the enrollment of “validly enrolled beneficiaries” through the end of the month in which the COVID-19 public health emergency ends.  States are permitted to make changes in beneficiary coverage, cost-sharing, and post-eligibility treatment of income.
• This rule expands on previous CARES Act requirements that providers of COVID-19 tests publicize the cash prices for such tests, requiring that every provider of COVID-19 diagnostic tests make public on the internet the cash price for a COVID-19 diagnostic test.
• This rule extends the Comprehensive Care for Joint Replacement Program’s Performance Year 5 an additional six months, to September 30, 2021, changes the reconciliation periods for the program, and makes other changes in the program.
  • For further information about this new interim final rule, see the following resources:
  • CMS’s announcement about the new policy
  • the interim final regulation itself
  • a CMS fact sheet
  • a separate CMS fact sheet on the Medicaid enrollment aspects of the regulation
  • for questions about the Comprehensive Care for Joint Replacement model, contact CMS at CJRSupport@cms.hhs.gov.

• CMS has published its annual update of home health payment rates for calendar year 2021.  Included in this rule is a provision that makes permanent changes in home health regulations introduced as temporary in the March 2020 “Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency” Interim Final Rule with Comment.  Under this provision, the temporary ability of home health agencies to use telehealth in the provision of home health care to qualified Medicare beneficiaries is now made permanent.  Learn more about this important change and other aspects of the 2021 home health regulation in this CMS news release.
• CMS has updated its document “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing.”  Updated information on pages 120 and 121 addresses temporary COVID-19 waivers that enable hospitals to provide certain outpatient services in alternative care settings.  Both updates are labeled “New: 10/28/20.”

Department of Health and Human Services

• HHS announced that it will distribute $333 million in first round performance payments to more than 10,000 nursing homes for achieving significant reductions in COVID-19-related infections and deaths between August and September.  Nursing homes will receive September quality incentive payments next week and will have four more opportunities to receive additional incentive payments.  Go here to see CMS’s announcement about the awards and go here to see a state-by-state breakdown of those awards.
• HHS’s Administration for Community Living hosts a monthly webinar series that invites subject matter experts and practitioners from across the home-and-community-based services (HCBS) spectrum to share insights and best practices to develop high-quality HCBS services and programs.  The next webinar will be held on November 12 at 3:00 (eastern) and feature payer and provider industry leaders discussing changes their industries have experienced since the beginning of the COVID-19 emergency and what lies ahead for them.  Several payers and providers will share innovations they used to address COVID.  Go here for more information and to register for the webinar.

Centers for Disease Control and Prevention

• The CDC has updated its guidance on when individuals should quarantine.
• The CDC has updated its interim clinical guidance for managing patients with confirmed COVID-19.
• The CDC has posted several documents on reinfection with COVID-19.  They include:
  • an introduction to the concept of reinfection with COVID-19
  • updated criteria for investigating suspected COVID-19 reinfection
  • an updated protocol for investigating suspected cases of COVID-19 reinfection
• The CDC’s weekly morbidity and mortality report presents new research on COVID-19 mitigation behaviors according to age group in the U.S. between April and June.
• The CDC’s weekly morbidity and mortality report presents new research on trends in the use of telehealth during the emergence of the COVID-19 pandemic from January through March in the U.S.
• The CDC has released its latest COVID-19 science update.  The update includes sections on vaccines, epidemiology, clinical treatment and management, and laboratory science.

Food and Drug Administration

• The FDA has updated its enforcement policy for non-invasive remote monitoring devices used to support patient monitoring during COVID-19 emergency.
• The FDA has approved two generic drugs that facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation:  succinylcholine chloride injection USP 200 mg/10 mL and cisatracurium besylate injection USP 10 mg/5 mL.
• The FDA has updated its Antigen Template for Test Developers that presents the agency’s current recommendations about data and information that should be submitted to the FDA in support of an emergency use authorization request for a COVID-19 antigen test.

Congressional Research Service

The Congressional Research Service has published the new report “COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and Treatment.”

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ