The following is the latest COVID-19 information from the state and federal governments as of 4:30 p.m. on Friday, April 17.

Pennsylvania Update

Daily COVID-19 Briefing

During today’s COVID-19 briefing, Governor Wolf addressed the subject of “reopening” Pennsylvania following the limits he has placed on the state’s residents and its businesses, community life, and social interactions in response to the COVID-19 crisis.  He emphasized the need to continue social distancing, said his administration has been working for weeks to develop plans for reopening the state, and explained that any such effort would be data-driven and local and regional, as opposed to state-wide.  He mentioned the importance of doing more to support the health care system and said that any reopening must ensure the state’s continued ability to respond to COVID-19 challenges if they re-emerge.  What he described today, he said, was a framework for future action, and he said he would provide more details next week.

In the meantime, his office released three documents in support of his plans:  one on relief, reopening, and recovery; one on businesses; and one on health care.

From the Department of Health’s daily update news release on the COVID-19 crisis:

• After several days of more modest numbers, new COVID-19 cases rose considerably yesterday and deaths remain high.
• More than half of all COVID-19 deaths in Pennsylvania to date have been among residents of 321 different long-term-care facilities.

Department of Health

The department has updated its March 24 interim infection prevention and control recommendations for patients in health care settings who have COVID-19 or are under investigation for COVID-19.  The new guidance explains that “As community transmission intensifies within a region, healthcare facilities may consider foregoing contact tracing for exposures in a healthcare setting in favor of universal source control for HCP and screening for fever and symptoms before every shift, as well as the end of every work shift…”

The Department of Health sent a letter to hospitals reminding them that the CARES Act requires each provider of a diagnostic test for COVID-19 to publicize the cash price of the test on a public internet website of the provider.

Department of Human Services

DHS has updated its March 20 guidance to reflect that it will not be conducting any annual licensing inspections for entities licensed by its Office of Developmental Programs, Office of Child Development and Early Learning, Office of Long-Term Living/Bureau of Human Services Licensing, and Office of Children, Youth and Families until Governor Wolf lifts his current disaster emergency proclamation or until such other time determined by DHS.

DHS has issued a memorandum to HealthChoices physical health managed care organizations about telemedicine guidelines related to COVID-19.  This memo clarifies issues related to HIPAA compliance in the use of communication technology and the use of out-of-state practitioners and supersedes a similar memo DHS sent to the HealthChoices plans last month.

Department of State

The Department of State has waived certain administrative requirements for graduate medical trainees during the COVID-19 emergency.  Until this waiver was implemented, medical residents with graduate medical trainee licenses who wished to work elsewhere, in addition to where they were serving as residents, needed to provide to the state a detailed written statement of the medical services they would be providing beyond the parameters of the graduate medical trainee program and receive a board evaluation of their training and education.  This required statement has now been temporarily waived.

Pennsylvania Congressional Delegation

Ten Democratic members of Pennsylvania’s congressional delegation have written to Health and Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services Administrator Seema Verma to complain that the manner in which they have allocated the first $30 billion of the $100 billion designated for hospital and health care providers in the federal CARES Act “…disadvantages Pennsylvania and many of our key providers in several ways.”  Go here for a link to the letter.

Federal Update

The White House

• President Trump has unveiled “Guidelines for Opening Up America Again,” a three-phase approach to reopening the economy.  Find that plan here.
• President Trump has signed a memorandum authorizing the use of the National Guard by governors in five more states to help with their response to the COVID-19 emergency, with the cost of National Guard assistance to be assumed 100 percent by the federal government.  The five states are Iowa, Kansas, Maine, Nebraska, Oklahoma, and Vermont.

Centers for Medicare & Medicaid Services

• In the latest edition of its online publication MLN Matters, CMS outlines new and expanded flexibilities for rural health clinics and federally qualified health centers during the COVID-19 emergency.

Food and Drug Administration

• The FDA has issued an emergency use authorization (EUA) for the use of a new commercial test to diagnose prior infection by the virus that causes COVID-19.
• The FDA issued guidance to help expand the availability of telethermographic systems used for body temperature measurements for triage use for the duration of the COVID-19 emergency.
• The FDA added content to the question-and-answer appendix in its guidance document “Conduct of Clinical Trials of Medical Products during COVID-19 Public Health Emergency.”

Centers for Disease Control and Prevention

• The CDC has updated its COVID-19 guidance to pharmacists and pharmacies.

National Institutes of Health

• The NIH has announced the launch of a public-private partnership to speed the development of COVID-19 vaccine and treatment options.

National Health Services Corps

• The National Health Service Corps and Nurse Corps has updated its FAQ for National Health Service Corps and Nurse Corps participants and approved sites.

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

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The following is the latest COVID-19 information from the Pennsylvania and federal governments and others as of 4:00 p.m. on Thursday, April 16.

Pennsylvania Update

Daily COVID-19 Briefing

• The number of new COVID-19 cases has remained relatively steady for the past four days and well below where it was a week ago.
• But the death toll remains higher than it has been in Pennsylvania for most of the past month.
• 1401 people with COVID-19 are health care workers.
• 2503 COVID-19 patients are currently in hospitals, 664 of them on ventilators.
• As of today, 41 percent of the state’s acute-care hospital beds and 37 percent of its ICU beds are unoccupied and nearly 70 percent of its ventilators are not currently in use.
• The state is now providing negative test result numbers on a county-by-county basis; included in those figures are gender breakdowns.
• While race and ethnicity data remains elusive, the Department of Health is working on this providers and is now presenting data on positive test results and deaths by race (scroll down about halfway).
• The state will not give retailers more time to comply with the new requirement that employees and customers all wear masks.
• The Department of Health recommends that people riding public transportation wear masks but is not requiring it.
• When asked, Secretary Levine would not reject the possibility of some form of stay-at-home requirement extending into the fall but reiterated her past explanation that the disease will determine the time line.

Department of Human Services

DHS has updated its guidance on the use of the CR modifier and the DR condition code for COVID-19 disaster/emergency-related claims.

Department of Health

The federal Department of Health and Human Services Office of Civil Rights has resolved a civil rights complaint against Pennsylvania over complaints that the state’s interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines would discriminate against the disabled if the state needed to begin triaging access to critical care and ventilators.  Pennsylvania has revised those standards to the Office of Civil Rights’ satisfaction.

Department of State

The Department of State has expanded “clinical clerk” services during the COVID-19 emergency.  Under ordinary circumstances, clinical clerks may serve only patients in hospital settings.  Under this waiver, clinical clerks will be assigned to work in hospitals but may provide services by phone to other health care settings.  The objective of this change is to facilitate the use of medical students as clinical clerks with the understanding that they will work under the supervision of MDs and DOs.

Federal Update

Department of Health and Human Services

• HHS has established a portal for recipients of CARES Act funding designated for hospitals and health care providers to attest to their acceptance of the terms and conditions of these grants. Recipients must complete this attestation within 30 days of receipt of a grant.

Centers for Medicare & Medicaid Services

• CMS has updated its list of blanket waivers for health care providers. CMS updates this document regularly, with the latest update including changes in Medicare reimbursement for acute-care hospitals, long-term care hospitals, and inpatient rehabilitation facilities required by the CARES Act.

Federal Emergency Management Agency

• FEMA, working with the Department of Health and Human Services through the FEMA Healthcare Resilience Task Force, has developed a “COVID-19 Hospital Resource Package” that addresses such issues as hospital surge, crisis standards of care, staffing surge and resilience, workforce protection, regulatory relief, equipment supply surge, and telemedicine.

Food and Drug Administration

• The FDA has published guidance for a temporary policy for the compounding of certain drugs for hospitalized patients by outsourcing facilities during the COVID-19 emergency.
• The FDA has published guidance on its enforcement policy for digital health devices for treating psychiatric disorders during the COVID-19 emergency. The purpose of this policy is to reduce direct contact between providers and patients.
• The FDA has published an overview of its response to COVID-19, summarizing the information resources it has prepared, its work involving medical products and therapeutics, and the guidance policies it has published.
• The FDA has issued an emergency use authorization (EUA) for two specific commercial serology tests to detect the presence of COVID-19 antibodies. Those EUAs can be found here and here.
• The FDA has issued an EUA for the emergency use of a specific commercial product for use in decontaminating compatible N95 and N95-equivalent masks for single-user reuse by health care personnel.
• The FDA has updated its FAQs on home-use blood glucose meters used within hospitals during the COVID-19 pandemic.
• The FDA is calling on people who have recovered from COVID-19 to donate plasma to be used in the development of blood-related therapies. Convalescent plasma is an antibody-rich product that is thought to limit the severity or shorten the length of illness caused by COVID-19.

Centers for Disease Control and Prevention

• The CDC has updated its interim guidance and resources for laboratory professionals working with specimens from persons under investigation for COVID-19.
• The CDC has collected and updated various resources for hospitals and health care professionals preparing for patients with suspected or confirmed COVID-19.

National Institutes of Health

• The NIH has announced that its own study has validated three methods for sanitizing N95 masks for reuse.

Industry Groups

• The American Medical Association and American Hospital Association have prepared their own guidance for physicians working at home during the COVID-19 pandemic.

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

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The following is the latest COVID-19 information from Pennsylvania state and federal officials as of 4:00 p.m. on Wednesday, April 15.

Pennsylvania Update

Governor Wolf

• The governor’s office issued a news release today in which it announced that it is “…offering taxpayers increased flexibility, additional time to meet their tax obligations, and a pause on several of its standard enforcement actions.”  Go here to see the news release with more details about the specific changes.
• Governor Wolf has established a COVID-19 Response Task Force for Health Disparity to look into and address how COVID-10 affects minorities.  Lieutenant Governor John Fetterman will serve as its chairman.

Daily COVID-19 Briefing

• The number of new COVID-19 cases has declined for the third consecutive day.
• But yesterday’s death toll was among the highest since the pandemic began.
• 1327 health care workers have tested positive for COVID-19.
• Health Department staff took a “deep dive” on the data on the status of COVID-19 in long-term-care facilities and has significantly increased both the case and the death totals in those facilities to 3316 residents of such facilities with COVID-19 and 324 deaths attributed to the disease.  The latter figure accounts for nearly one-half of all COVID-19 deaths state-wide.
• 2392 people are currently hospitalized with COVID-19 and 662 are on ventilators.
• 41 percent of the state’s acute-care beds and 39 percent of its ICU beds are currently unoccupied and nearly 70 percent of its ventilators are currently not in use.
• Both Secretary Levine and Governor Wolf said that Pennsylvania is “bending the curve.”
• Governor Wolf expressed opposition to the bill passed by the state House that would give county governments greater authority over which businesses can remain open during the COVID-19 emergency but when asked did not say he would veto the bill.
• A new mass testing site will open on the premises of the Mohegan Sun casino in Wilkes-Barre.
• The Montgomery County mass testing site has relocated and opened.
• Secretary Levine said she did not know why hospital uncompensated care rose in 2019, as reported today by the Pennsylvania Health Care Cost Containment Council, but she said she is not worried about the impact of COVID-19 on this year’s total because the federal government has said it will pay for care for uninsured people suffering from COVID-19.

Department of Health

• Secretary Levine has issued an order directing public health safety measures for businesses permitted to maintain public operation during the COVID-19 emergency.  The order encompasses “…certain actions to be taken by employers and their employees to protect their health and lives, the health and lives of their families, and the health and lives of the residents of the Commonwealth who depend upon their services.  Special consideration is required to protect not only customers, but the workers needed to run and operate these establishments.”
• Earlier this week Secretary Levine wrote to industry leaders directing them to specific web pages within the Department of Health’s web site for updated information, guidance, alerts, and more.  There are separate sites for:
  • hospitals
  • nursing homes
  • home care agencies, home health agencies, and hospices

Department of Human Services

DHS’s Office of Long-Term Living has issued clarification guidance for Pennsylvania’s pre-admission screening resident review (PASRR) process for nursing homes.  This clarification comes in the wake of guidance from the CMS Center for Clinical Standards and Quality that addresses a blanket waiver CMS has issued indicating that nursing facilities will not be cited for non-compliance with federal PASRR requirements.   While Pennsylvania requested and received approval from CMS that would permit the state to suspend the PASSR assessment process for 30 days, the state has decided to continue performing PASRR activities through remote means and will only invoke the blanket waiver on a case-by-case basis.  See the clarification guidance for further details.

General Assembly

The Senate met to consider S.B. 613 on concurrence in amendments passed in the House yesterday.  During debate, Senate Republicans pointed to the bill’s requirement that businesses comply with CDC guidance for mitigating exposure to COVID-19 before reopening while Senate Democrats argued that the timing of this legislation would detract from the mitigation efforts of the governor and Secretary of Health.  The bill was passed by the Senate along party lines and now goes to the governor for action.

S.B. 327 was also considered on concurrence in amendments from the House.  The bill was amended in the Senate today to delegate authority to counties to develop emergency mitigation plans for businesses.  Senate Democrats expressed concern about this amendment not establishing a statewide, uniform approach to addressing the pandemic.  The bill was adopted along party lines and will return to the House for its concurrence with the Senate’s additional amendments.

The House has added tomorrow, April 16, as a non-voting session day and April 20 and 21 as voting session days.  The Senate stands in recess until the call of the President Pro Tempore.

Federal Update

The White House

• Yesterday President Trump announced the creation of the Dynamic Ventilator Reserve program through which health care providers with a surplus of ventilators will be able to share their reserves with hospitals that need additional ventilators.  Hospitals, the president noted when discussing this program, are already doing this, and he said the federal government will develop a reserve of ventilators to support this program.  Interested parties can learn more here.

Centers for Medicare & Medicaid Services

• CMS has published a notice describing new waivers for inpatient prospective payment system hospitals, long-term-care hospitals (LTCHs), and inpatient rehabilitation facilities (IRFs) required by the CARES Act.
  • For acute-care hospitals, the waiver addresses coding for COVID-19 patients and increases relative weights for DRGs for those patients retroactive to January 27, thereby increasing payments 20 percent.
  • For IRFs, the waiver eliminates the requirement that Medicare Part A patients receive at least 15 hours of therapy a week.
  • For LTCHs, the waiver temporarily pays all LTCH cases through the LTCH prospective payment system retroactive to January 27 and modifies the calculation of the LTCH 50 percent rule, thereby increasing some LTCH payments.
• CMS has announced that it will nearly double payments for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 tests.

Health Resources and Services Administration

HRSA is temporarily waiving fees for skilled health care practitioner license queries of the National Practitioner Data Bank to facilitate the deployment of workforce resources.

Food and Drug Administration

• The FDA has updated its FAQs on diagnostic testing for COVID-19.
• The FDA has issued an emergency use authorization for the use of a specific commercial technology to assist in weaning patients determined by health care providers to be at high risk of weaning failure off breathing assistance machines requiring intubation for no more than 30 days.

Centers for Disease Control and Prevention

• The CDC has updated its interim guidance for collecting, handling, and testing clinical specimens for patients with COVID-19 and those suspected of having COVID-19.
• The CDC has updated its COVID-19 infection control guidance.

Medicare Payment Advisory Commission

• MedPAC has written to CMS administrator Seema Verma asking her not to use data from 2020 when evaluating the performance of Medicare accountable care organizations (ACOs); to allow a three-year extension of the NextGen ACO model through 2023; and to delay the start of the innovation direct contracting model by at least a year.

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

New resource:

PA Health Alert Network

The health alerts published on this page include emergency-related information the Department of Health wishes to communicate to public health agencies, health care providers, hospitals, and emergency management officials.

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

The following is the latest COVID-19 information from Pennsylvania state and federal regulators as of 4:30 on Thursday, April 9.

Pennsylvania Update

SNAP Advocacy for Additional COVID-19 Funding for Safety-Net Hospitals

Yesterday SNAP wrote to Centers for Medicare & Medicaid Services administrator Seema Verma asking her to give special consideration to high-volume Medicaid hospitals in the distribution of additional grants from the $100 billion designated for hospitals and health care providers in the CARES Act. The previous day, Ms. Verma publicly acknowledged that the first round of that funding, to be received by hospitals later this week, may not have been entirely fair to high-volume Medicaid providers and said CMS would address shortcoming that when it plans its next round of CARES Act grants.  Find that letter here, on SNAP’s web site.

SNAP also wrote yesterday to every member of the Pennsylvania congressional delegation, asking them to work with their colleagues to ensure that additional funds for safety-net hospitals are included in any future COVID-19-related legislation.  Find that letter here.

Department of Health Daily Briefing

• For the first time in five days the number of reported cases rose significantly: 18 percent.
• But new deaths were less than one-third of those from the previous day.
• 1058 residents of 168 long-term-care facilities have now tested positive.
• As have 850 health care workers.
• 2033 Pennsylvanians are currently hospitalized with COVID-19, still about 11 percent of the total cases.
• 600 are on ventilators.
• 45 percent of the state’s acute-care beds and 37 percent of its ICU beds remain unoccupied and 70 percent of its ventilators are currently available for use.
• The state will soon be sharing more specific information about the precise location of cases with county emergency management officials.
• The state plans to work with home health care associations to ensure that home health care workers assigned to care for COVID-19 patients in their homes have appropriate personal protective equipment.
• Secretary Levine believes social distancing is working, noting that the curve is no longer rising as much. Problems remain, though, in southeastern and northeastern Pennsylvania.
• A mass testing site is planned for northeastern Pennsylvania and a field hospital will be established in East Stroudsburg.
• Amid reports that ventilator use is not as effective as originally expected, Secretary Levine said the state has no formal standards for the use of ventilators in the care of COVID-19 patients and is leaving those decisions to individual doctors.

Department of Human Services

• DHS’s Office for Civil Rights has issued a “quick tips” document with telemedicine guidelines for COVID-19. The document explains that the Office of Civil Rights will exercise its enforcement discretion regarding compliance with federal HIPAA standards.   It also outlines some of the technologies providers may use when serving patients through telehealth and lists the telehealth services Medicaid fee-for-service will cover during the current health emergency.  Finally, the document notes that guidance regarding the use of COVID-19 CR modifiers and DR condition codes will be forthcoming.
• Another DHS quick tips document describes changes in the prior authorization requirements in the state Medicaid program for certain services during the COVID-19 emergency. According to the document, during the COVID-19 emergency prior authorization requirements are now waived for admission to a variety of types of facilities; it also lists specific services for which prior authorization requirements are not waived.  These temporary policy changes apply to the Medicaid fee-for-services program, the HealthChoices physical health program, and Community HealthChoices.
• Yet another quick tips document describes provider enrollment and revalidation changes during the COVID-19 emergency. The document describes changes both for providers currently enrolled in the Pennsylvania Medicaid program and providers not currently enrolled in that program.
• DHS has issued a CHIP policy clarification explaining that effective immediately, the PRV720 provider revalidation file will be suspended and providers who have not completed their revalidation will not be terminated.
• DHS has announced that during the COVID-19 crisis, use of the Medical Assistance Transportation Program will be limited to patients seeking assistance with urgent medical problems. Patients suspected of having COVID-19 may not be permitted to use the program and will need to seek alternative transportation arrangements.
• DHS’s Office of Long-Term Living has updated its provider guidance on policy changes in the state’s LIFE (Living Independence for the Elderly) program as a result of the COVID-19 emergency.

Department of Drug and Alcohol Programs

DDAP has posted a COVID-19 resource guide for individuals with substance abuse disorder.

Federal Update

Centers for Medicare & Medicaid Services

CMS has issued a news release announcing that it has approved approximately $34 billion for providers through its Accelerated and Advance Payment Program, which was created in the CARES Act.  Note: CMS is now touting this as $51 billion in payments, but has not updated the press release at this time.

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.

National Institutes of Health

The NIH has announced the launch of a clinical trial to evaluate the safety and effectiveness of hydroxychloroquine for the treatment of adults hospitalized with COVID-19.

Department of Health and Human Services

• The Department of Health and Human Services has awarded $1.3 billion to 1387 health centers to help communities detect, prevent, diagnose, and treat COVID-19. See an interactive map that shows the centers awarded grants here.
• HHS has issued guidance that authorizes pharmacists to order and administer COVID-19 tests, including serology tests.
• The Department of Health and Human Services has published a notice in the Federal Register extending until June 21 the public comment period for addressing section 209 of the Pandemic and All-Hazards Preparedness and Advancing Technology Act.
• HHS has released a notice that will be published in the Federal Register explaining that it is exercising its discretion in how it applies HIPAA’s privacy, security, and breach notification rules in connection with good faith participation in the operation of COVID-19 community-based testing sites.
• HHS’s Administration for Community Living has announced that it will award $50 million in contracts to support efforts by Aging and Disability Resource Centers to prevent, prepare for, and respond to the COVID-19 crisis.

Food and Drug Administration

• The FDA has issued a statement on the use of serology tests to use to identify individuals who have overcome COVID-19 and may have immunity to it.
• The FDA recently posted information regarding shortages of hydroxychloroquine and chloroquine to its drug shortages web page  due to a significant surge in demand.
• The FDA has published final guidance to health care professionals and investigators on the administration and study of investigational convalescent plasma collected from individuals who have recovered from COVID-19 and offers recommendations on the collection of COVID-19 convalescent plasma.

Federal Emergency Management Agency

FEMA has posted a notice that it is issuing a temporary rule to allocate certain scarce or threatened materials for domestic use so that these materials may not be exported from the U.S. without the agency’s explicit approval.  These items include ventilators, personal protective equipment, and materials used to make personal protective equipment.

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.)