The following is the latest COVID-19 information from Pennsylvania state and federal officials and others as of 4:15 p.m. on Tuesday, April 7.

Pennsylvania Update

Department of Health Daily Briefing

• Secretary Levine acknowledged that many cases are undercounted. In many situations, providers encounter patients who have all of the symptoms, conclude that they have COVID-19, but do not order testing.  This is standard practice.
• All 67 Pennsylvania counties now have experienced cases.
• Yesterday saw more than six times as many deaths as the day before and the number of deaths state-wide has more than doubled since last Friday.
• Secretary Levine said there is a significant increase in deaths among patients with comorbidities.
• 664 health care workers have been diagnosed with COVID-19, as have 674 residents of long-term-care facilities across the state.
• 51 percent of hospital beds and 40 percent of ICU beds in the state remain unoccupied and 70 percent of ventilators are not currently in use.
• Other states have released data on race and cases and deaths but Pennsylvania has not done so yet because hospitals are not always providing this data. Secretary Levine said the department is looking for ways to gather this information.
• The mass testing sites in Philadelphia and Montgomery County will close after Friday. They were established by the federal government, which informed the state that it is withdrawing its funding and supplies at that time.

Department of Health

• The Department of Health has issued an alert to health care providers, facilities, and professional organizations giving them specific guidance to give to patients they are evaluating for COVID-19, those who have been diagnosed with COVID-19, and those who have been in recent contact with people who have been diagnosed with COVID-19. The department also has issued a close contact check list providers can use and a guide to self-isolation they can review with patients waiting for COVID-19 test results.
• The department has published an alert on the universal use of masks by health care workers and staff in congregate care settings, including which types of individuals should wear which types of masks.

Department of Human Services

• DHS has posted an announcement to administrators, brokers, and transit agencies that participate in the Medical Assistance Transportation Program presenting precautions necessary to ensure the safe provision of non-emergency medical transportation, including the need for drivers and passengers to wear face masks. The announcement also offers revised criteria for whether beneficiaries need to be transported or whether telehealth might be an appropriate alternative to a medical visit; it also describes how to screen would-be passengers for symptoms that suggest they may have COVID-19, in which the request for transportation should be denied and the individual advised to contact his or her medical provider.

DHS has posted questions and answers from its April 1 COVID-19 webinar. Below are selected highlights:

Q:  Will DHS reimburse for telehealth home health services? If so, which home health services will be eligible for reimbursement?

A:  Additional guidance is forthcoming that will clarify that home health providers are able to perform initial certifications and 60-day recertification visits via telemedicine and will identify which services can be provided using telemedicine. Services like home health aide services related to activities of daily living must be provided in-person, and therefore would not be able to be provided using telemedicine.

Q:  How will providers bill for the protective personal protective equipment (PPE) within the waiver? Will PPE be paid per patient, and which codes should be used?

A:  PPE will be treated as medical supplies through the Omnibus Budget Reconciliation Act (OBRA), Appendix K waiver submitted by the Office of Long-Term Living (OLTL). For the Office of Developmental Programs (ODP), payment for operational needs and supplies is included in the MA fee paid for residential services. For individuals who live in private homes, Specialized Supplies is a benefit under ODP waivers that can cover some PPE. Specific billing instructions for the Community HealthChoices (CHC) waiver should be answered by the CHC Managed Care Organizations (MCOs). Billing guidance for the OBRA waiver is forthcoming.

PPE was not added to Medicaid fee-for-service (FFS) through the 1135 waiver. PPE is not billable under the Medical Assistance (MA) FFS program. Payment for operational needs and supplies is included in the MA fee paid for the service. Providers should follow the Department of Health guidance for securing PPE. To access this guidance, please visit: https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/COVID-19%20Guidance%20PPE.pdf

Q:  Will DHS continue to process Medical Assistance (MA) renewals even after the determination that participants will not be terminated?

A:  MA renewals will continue to be mailed. DHS encourages applicants to complete the renewal if they are able. However, participants who do not complete their renewal or are unable to complete one will not have their case closed. In addition, cases open as of March 18 will not close for any reason other than voluntary withdraw, move out of state, or death.

Q:  Are CAOs still able to process applications and adequately ensure the integrity/validity of information submitted?

A:  CAOs are staffed and completing the essential work necessary to ensure individuals who are eligible receive benefits. The online COMPASS application tool allows clients to apply for benefits, compete renewals, provide required verifications, and report changes remotely without needing to come to a CAO in-person. CAO staff can accept information provided through COMPASS and take appropriate actions. Additionally, clients with smart phones can access the COMPASS mobile app – myCOMPASSPA – to report changes, upload documents, complete semi-annual renewals, and view benefit status.

Clients are also contacting the customer service centers, which are making changes and updates to client case records as necessary. Clients in Philadelphia with questions or information to report about their case should call the Philadelphia Customer Service Center at 215-560-7226. Clients in all other counties can call the Statewide Customer Service Center at 1-877-395-8930. Call volumes and wait times are likely to be high, and we appreciate the public’s patience with the dedicated commonwealth employees working to assist clients under stressful circumstances.

Clients can also apply for Medicaid benefits by telephone through our contracted consumer service center at 1-866-550-4355.

Department of Aging

The Department of Aging has issued guidance informing operators of facilities that serve older adults that the Identogo/Idemia sites that facilitate the FBI background checks of individuals who work at such facilities may remain open as life-sustaining businesses during the COVID-19 crisis; that there is no change in the background check requirements or processes for applicants seeking employment in such facilities; and that there are circumstances under which individuals who are unable to obtain FBI background checks because of the closure of some Identogo/Idemia sites may qualify for provisional hiring.  See the guidance here.

Department of State

The Department of State has temporarily changed certain licensing requirements for nursing home administrators, accountants, barbers, and cosmetologists during the COVID-19 crisis.  Under a waiver the governor has granted, certain deadlines for obtaining state licenses have been extended until after the COVID-19 emergency disaster declaration ends.

General Assembly

This week the House and Senate are meeting remotely for caucus and committee meetings and to position budget vehicles and vote on crisis response legislation.  Today Chairman Saylor offered amendments to S.B. 327 in an Appropriations Committee meeting that would:

• attempt to foster inter-branch governmental cooperation by creating a COVID-19 Cost and Recovery Task Force;
• attempt to reduce future financial obligations by requiring the Treasury Department to conduct a review of all outstanding state debt obligations and to identify refinancing options to reduce state costs; and
• attempt to ensure direct communication between the governor and the legislature by requiring the governor to provide legislative leadership with a list of provisions of law that he has waived related to the COVID-19 response and continue to notify them within one day of any additional waivers he might invoke.

The bill as amended in the Appropriations Committee passed along party lines on the House floor this afternoon.  The bill was sent to the Senate for its concurrence to the House amendments.

Federal Update

Department of Labor

The Department of Labor has published an advisory on unemployment insurance provisions of the CARES Act.  While the advisory memo is directed to state workforce agencies, it includes detailed information about program eligibility and benefits.

Centers for Medicare & Medicaid Services

• The Families First Coronavirus Response Act (the second major COVID-19 bill, adopted March 18) waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services. The latest edition of the CMS publication MLN Matters summarizes the services for which cost-sharing is waived, the types of providers to which the waived cost-sharing applies, and the coding those providers need to do to get paid.  Find the explanation here.
• CMS has published a “Dear Clinician” letter with guidance for physicians that they may bill for e-visits for both existing and new patients; previously published guidance suggested that they could bill only for existing patients but this policy has been revised. The letter also offers guidance for how to code such telehealth visits.
• CMS has updated its recommendations for non-emergent elective medical services and treatment. These recommendations supersede previous guidelines.
• Earlier today CMS hosted a call to discuss CMS waivers and COVID-19 response. Find the slides used during that presentation here.
• CMS will hold a special open door forum tomorrow, April 8, at 1:30 p.m. to discuss its actions to improve access to telehealth during the COVID-19 crisis. This one-hour call is open to everyone:  the dial-in number is 1-888-455-1397, the passcode is 3535324, and participants are asked to call in at 1:15 p.m.
• On April 3, CMS Administrator Seema Verma, Deborah Birx, MD, White House Coronavirus Task Force, and officials from the FDA, CDC, and FEMA participated in a call on COVID-19 flexibilities. During the call physicians presented best practices from their COVID-19 experiences.

Food and Drug Administration

• The FDA has published final guidance on its enforcement policy for extracorporeal membrane oxygenation and cardiopulmonary bypass devices during the COVID-19 emergency.  The objective of this guidance is to help expand the availability of devices used in extracorporeal membrane oxygenation (ECMO) therapy by informing caregivers that the FDA will not object to modifications to the indications or design of specific FDA-cleared or approved devices listed in the guidance.
• The FDA has posted final guidance on its enforcement policy for infusion pumps and accessories during the COVID-19 emergency.  The purpose of this guidance is to help expand the availability and remote capabilities of infusion pumps and their accessories during the COVID-19 pandemic.
• The FDA has published guidance on its enforcement policy for remote ophthalmic assessment and monitoring devices during the COVID-19 crisis.  The purpose of this guidance is to make possible greater use of telehealth during the COVID-19 emergency.

Centers for Disease Control and Prevention

The CDC will soon be providing $186 million in funding for additional resources for state and local jurisdictions to support their response to the COVID-19 emergency.  Funding will be for lab equipment, supplies, staff, and more for areas considered “hot zones” for COVID-19 and to enhance COVID-19 surveillance and tracking.  The news release announcing this new funding notes that “CDC will use existing networks to reach out to state and local jurisdictions to access this initial funding.”

Substance Abuse and Mental Health Services Administration

SAMHSA will fund $110 million in emergency grants to provide treatment for substance use disorders/serious mental illness during the coronavirus pandemic.  The purpose of the emergency grants is to provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults, with funding to be provided to states, territories, and tribes.

Department of Health and Human Services

HHS has announced that it will purchase for the Strategic National Stockpile the new COVID-19 test that produces results in less than 13 minutes.  HHS will provide the tests to public health labs in every state and territory and to Indian Health Services sites.

White House

President Trump has signed a memorandum directing the Department of Defense and Department of Homeland Security to make available the National Guard to the states of Georgia, Hawaii, Indiana, Missouri, New Hampshire, New Mexico, Ohio, Rhode Island, Tennessee, and Texas and the territory of the U.S. Virgin Island to provide emergency assistance with addressing the COVID-19 crisis and for the Federal Emergency Management Agency to pay 100 percent of the cost of such assistance.

National Association of Medicaid Directors

The National Association of Medicaid Directors has written to CMS and the Office of Management and Budget (OMB) urging them “…to allow states to make retainer payments to essential Medicaid providers through Section 1115 waivers during this emergency.”  See the letter here.

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

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

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The following is the latest COVID-19 information from Pennsylvania state and federal regulators and others as of 4:30 p.m. on Monday, April 6.

Pennsylvania Update

The Governor Wolf/Department of Health Daily Briefing

• The number of newly diagnosed COVID-19 cases in Pennsylvania has remained relatively constant for the past three days. Secretary Levine said this gives her “hope” but is not yet indicative of a bending of the curve.
• The number of COVID-19-related deaths is not so constant: it has more than doubled since last Wednesday.
• 598 health care workers have now tested positive for COVID-19, as have 518 patients in nursing homes across the state.
• Two weeks ago Secretary Levine ordered hospitals to submit certain utilization data to the Department of Health daily. From this data she reported that 51 percent of hospital beds and 40 percent of ICU beds are currently unoccupied and 70 percent of ventilators are still not in use.
• 533 Pennsylvania COVID-19 patients have required ventilator care to date. This is more than three times the number reported on Friday (147).
• Pennsylvania has more than 5000 ventilators in hospitals today. This is more than the state realized its hospitals had.  The state still has a stockpile of ventilators to share and expects more to arrive shortly.
• In response to a question, Secretary Levine said that federal coronavirus response coordinator Deborah Birks, MD probably mentioned Pennsylvania as a next possible COVID-19 hot spot because of the combination of continued large numbers of new cases, rising death totals, and proximity to New York and New Jersey, both of which are hot spots.
• In response to a question, Governor Wolf said while the state has not provided case data for municipalities, such a possibility is now being discussed.
• In response to a question, Governor Wolf acknowledged that the state’s revenue projections for the current fiscal year have “fallen to pieces” and the state is doing everything it can to reduce operating expenses. He said he hoped federal stimulus money will help and that he will be working with the legislature to address next year’s budget.

Department of Health

• The Department of Health updates its interim guidance for collecting clinical specimens for COVID-19 testing, emphasizing that nasopharyngeal specimens are the “strongly preferred” choice for such testing and outlining acceptable alternatives.
• The department has issued an order addressing the cleaning, disinfecting, and other maintenance and security services that are now required for buildings that have been authorized to remain open during the COVID-19 crisis.
• The department sent a letter to hospital administrators, obstetricians, and midwives strongly encouraging labor and delivery providers to follow recommendations from the World Health Organization and the American College of Obstetricians and Gynecologists when caring for pregnant women during the COVID-19 emergency, including permitting a support person to be present during delivery.

Department of Human Services

• In conjunction with the state Department of Education, DHS has issued a memo to local education agencies that participate in the school-based ACCESS Program encouraging the use of telemedicine during the COVID-19 emergency.
• DHS has published a notice limiting the prescription of hydroxychloroquine in the state’s physical HealthChoices, Community HealthChoices, and Medicaid fee-for-service program to prevent shortages and stockpiling of the drug. DHS reinforced this message in a memo on the same subject to all physical health HealthChoices plans.
• DHS’s Bureau of Managed Care Operations has sent a memo to all physical health HealthChoices managed care organizations with guidelines on performing elective surgeries during the COVID-19 emergency. The MCOs are directed to “continue to accept and review prior authorization requests for inpatient and outpatient elective procedures, elective interventional radiology and dental procedures.  All requests need be reviewed for medical necessity.”  The memo includes criteria for approving surgery under current circumstances.

Office of the Treasury

Pennsylvania’s Treasury Department has announced a bond purchasing program that seeks to provide financial relief to Pennsylvania health care systems.  The program’s objective is to provide liquidity to health care systems while reducing their borrowing costs.

Federal Update

Centers for Medicare & Medicaid Services

• CMS has updated its COVID-19 FAQ for state Medicaid and CHIP programs.  This FAQ covers a variety of subjects, including the use of Appendix K waivers, eligibility and enrollment flexibility, exceptions to timeliness standards, modification of eligibility verification policies, the use of telehealth, the suspension of premiums and other cost-sharing, and more.
• CMS has posted a video providing answers to commonly asked questions about the expanded Medicare telehealth services authorized under its nation-wide section 1135 waiver.
• CMS has published guidance for processing attestations from ambulatory surgical centers that are temporarily enrolling as hospitals during the COVID-19 emergency.
• See an updated list of the section 1135 waivers CMS has granted to help states and health care providers respond to the COVID-19 crisis.

Food and Drug Administration

• The FDA has posted an emergency use authorization (EUA) about circumstances under which selected imported, non-NIOSH-approved disposable filtering facepiece respirators may be used.
• The FDA has published its enforcement policy for clinical electronic thermometers during the COVID-19 emergency.
• The FDA has posted an FAQ on shortages of surgical masks and gowns.  This FAQ addresses current shortages, the reuse of selected materials, the use of products that have not been approved by the FDA, and more.

Occupational Safety and Health Administration

OSHA has provided interim guidance to its regional administrators and state plan designees regarding enforcement discretion to permit the extended use and reuse of respirators, and respirators that are beyond their manufacturers’ recommended shelf life during the COVID-19 emergency.

Department of Health and Human Services/Office of the Inspector General

• The OIG has issued a policy statement regarding the application of certain administrative enforcement authorities due to the COVID-19 crisis.  This statement conveys that the OIG will not impose sanctions under anti-kickback laws related to actions by health care providers that fit under the HHS’s previous waiver of the physician self-referral provisions of the Stark law.  The OIG also has launched a new FAQ on this policy statement to provide additional information.
• The OIG conducted a national survey of hospitals, asking them about the challenges and needs they faced.  See a summary of the survey results here and the full report here.

The White House

During Friday’s coronavirus task force press briefing, national coronavirus response coordinator Deborah Birx, M.D. explained the priority in the distribution of the new COVID-19 test that yields results in 15 minutes.

American Medical Association

The American Medical Association has issued its own “guiding principles” for the protection of current medical students and medical students:  those who are graduating early to help in the fight against COVID-19 and those who are being enlisted, while still in medical school, to participate in the direct care of COVID-19 and suspected COVID-19 patients.

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

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

(To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.)