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COVID-19 Update: Thursday, November 5

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:

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.”

PA Safety Net Admin2020-11-10T21:03:49+00:00November 6th, 2020|Coronavirus, COVID-19|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its November 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

How the renewal of the federal COVID-19 public health emergency declaration extends key Medicaid protections.
State planning for children with complex needs.
State efforts to connect people to COVID-19 testing and care.
An upcoming webinar about challenging Medicaid and Community HealthChoices waiver service denials.

Read about these subjects and more in the Pennsylvania Health Law Project’s November 2020 newsletter.

PA Safety Net Admin2020-11-17T15:00:32+00:00November 4th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

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

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:
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

PA Safety Net Admin2020-11-17T15:00:17+00:00November 2nd, 2020|Coronavirus, COVID-19|Comments Off

CMS’s Verma Visits Western PA

COVID-19 was the primary subject on the minds of health care executives who met with Centers for Medicare & Medicaid Services Administrator Seema Verma in western Pennsylvania on Tuesday.

Among the issues discussed at a health care forum were the concerns of hospital administrators about rising COVID-19 case counts and their worries over the adequacy of supplies of available hospital beds, drugs, and personal protective equipment in the near future; steps like enhanced access to telehealth that CMS has made available for Medicare beneficiaries to help them during the pandemic; the work – and continued existence – of the Regional Response Health Collaboratives that support long-term-care facilities fighting COVID-19 outbreaks and the possibility that those collaboratives may expire in December; and more.

Learn more about Ms. Verma’s visit to Pennsylvania in the Pittsburgh Business Times article “Hospital, nursing home execs tell CMS administrator they need more help.”

PA Safety Net Admin2020-10-29T06:00:49+00:00October 29th, 2020|Coronavirus, COVID-19|Comments Off

Health Secretary Discusses Status of COVID-19 in PA

Pennsylvania Health Secretary Rachel Levine, M.D., held a news conference on Monday to discuss the status of the COVID-19 public health emergency in the state and answer questions from reporters.

During the news conference, Secretary Levine discussed the recent increase in the number of new COVID-19 cases in the state, the age groups that are seeing increases, the status of COVID-19 in schools, the state’s prospects for containing the virus’s spread, the changing nature of the virus’s impact on those who contract it, the upcoming holiday season, and more. Read about what Secretary Levine had to say in this Pennsylvania Capital-Star article and another account of her news conference in the Pittsburgh Tribune-Review.

PA Safety Net Admin2020-10-28T06:00:31+00:00October 28th, 2020|Coronavirus, COVID-19|Comments Off

COVID-19 Update: Monday, October 26

The following is the latest COVID-19 information from the state and federal governments as of 3:45 p.m. on Monday, October 26.

Pennsylvania Update

Governor Wolf

Governor Wolf has written to President Trump asking him to work with Congress to provide funding to enable the state to continue its Regional Response Healthcare Collaborative Program (RRHCP) for which current funding expires on December 31. The RRHCP is a partnership between the state’s departments of Human Services and Health and the Pennsylvania Emergency Managemental Agency through which selected Pennsylvania health systems work with long-term-care facilities that are vulnerable to the COVID-19 pandemic by providing assistance with preparation, prevention, response, and education.

Department of Health

The Department of Health has published an executive summary of the state’s plan to distribute and administer COVID-19 vaccines in Pennsylvania once such vaccines become available. Among other matters, the plan identifies critical populations and addresses vaccine provider enrollment, storage and handling, communication, and safety concerns.
The Department of Health has issued a training PowerPoint to assist skilled nursing facilities with capacity and testing reporting requirements.
The Department of Health has updated its FAQ on drugs for treating COVID-19.
The Department of Health has issued a health advisory titled “Additional Factors to Determine Close Contacts of Persons with COVID-19” with recommendations for implementing new guidance from the CDC on the identification and quarantine of close contacts.
The state has begun distributing its second allotment of COVID-19 antigen test kits provided by the federal government to Clinical Laboratory Improvement Amendments (CLIA)-certified institutions in Berks, Huntingdon, Union, and Westmoreland counties.
During a Monday news conference, Secretary Levine called for an extension of the authorization for the Pennsylvania National Guard to help with the state’s COVID-19 response.

Department of Health – by the numbers

Pennsylvania’s COVID-19 case count has now surpassed 195,000. 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. This includes the three highest single-day new case counts since the pandemic began.
With today’s latest figures, the death count now nears 8700. Daily death counts are now generally lower than they were in the spring.
Overall, more than 30,000 residents and employees of long-term-care facilities have contracted COVID-19. Those figures encompass 1049 facilities in 63 of Pennsylvania’s 67 counties.
More than 12,000 health care workers in the state have contracted COVID-19.
The state-wide positivity rate for COVID-19 tests is now five percent, up from 4.2 percent last week; 30 counties are currently above five percent. Counties with what the state calls “concerning” positivity rates including Huntingdon (12 percent), Bradford (11.2 percent), Lawrence (9.0 percent), Lebanon (8.7 percent), and Westmoreland (8.4 percent).
According to the state’s weekly data dashboard, Berks, Bradford, Centre, Elk, Huntingdon, Lackawanna, Lawrence, Lebanon, Luzerne, Mifflin, Montour, Northumberland, Philadelphia, Schuylkill, and Westmoreland counties are in a “substantial” level of community transmission. Allegheny County is now in a low level of community transmission.
The rate of response to contact tracing efforts is not very good, but Secretary Levine reports that among those who have recently been diagnosed with COVID-19 and who responded to inquiries about their recent whereabouts, 55 percent said they had visited a restaurant in the past two weeks and 13 percent said they had visited a bar.
Over the past two weeks more than 2000 cases have been diagnosed among school-aged children. This reflects a change in the nature of who is contracting COVID-19: while the numbers are up in all age groups, such cases are more common in people under the age of 50 than they were in the spring and early summer.
Labs are reporting an average of 34,000-35,000 test results a day.
The number of people currently hospitalized with COVID-19 is more than twice what it was on October 1.
Secretary Levine said that the number of hospitalized COVID-19 patients generally lags behind case count trends by about two weeks and can therefore be expected to continue rising in the coming weeks.
The number of COVID-19 patients currently breathing with the help of a ventilator also is up significantly this month.
But Secretary Levine explained that far fewer hospitalized COVID-19 patients are assisted by ventilators now than they were during the pandemic’s early days. Back in the spring, roughly 30 percent of hospitalized COVID-19 patients in Pennsylvania were assisted by ventilators; now, only about 10 percent are.
She attributed this decline to how much providers have learned over the past few months about how to care for COVID-19 patients. Both treatment and therapeutics have improved since the spring. Patients continue to get very sick but the health care delivery system is better equipped to treat them.
25 percent of hospital adult ICU beds are currently unoccupied, as are 22 percent of medical/surgical beds, 36 percent of pediatric beds, 13 percent of pediatric ICU beds, and 40 percent of airborne isolation unit beds. These figures are similar to what they were a week ago.

Department of Human Services

DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) published a memorandum in August informing behavioral health managed care organizations, county mental health/intellectual disability offices, and behavioral health providers that specified state regulatory provisions have been temporarily suspended during the COVID-19 disaster emergency declaration period. OMHSAS has now re-issued this memorandum to update signature requirements for treatment and service plans. The notice applies to inpatient psychiatric services, outpatient psychiatric services, intensive behavioral health services, outpatient drug and alcohol services, mental health procedures, partial hospitalization, intensive case management, psychiatric rehabilitation services, community residential rehabilitation services, and long-term structured residences.

Federal Update

Provider Relief Fund: Webcast on Phase 3 General Distribution

Applications for the Provider Relief Fund Phase 3 general distribution are now being accepted by HHS. HHS will hold a webcast on Monday, November 2 at 3:00 p.m. (eastern) for interested parties. Go here to register for the webcast and to submit questions. Providers considering applying for Phase 3 general distribution funds that did not view the previous webcast should participate in this one in anticipation of the November 6 application deadline. Also available are a fact sheet and a presentation about the Phase 3 general distribution.

Provider Relief Fund: Financial Reporting

Last week we reported on HHS’s updating of its most recent Provider Relief Fund financial reporting instructions that broadened how fund recipients may use those funds. That report was accompanied by an HHS policy memorandum and amended reporting requirements. For providers interested in how HHS is defining parent entities in this update, the amended reporting requirements document includes the following explanation:

Reporting Entity: Entity (at the Tax Identification Number (TIN) level) that received one or more PRF [Provider Relief Fund] payments, or an entity that meets the following three criteria: 1) is the parent of one or more subsidiary billing TINs that received General Distribution payments, 2) has providers associated with it that were providing diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 on or after January 31, 2020, and 3) is an entity that can otherwise attest to the Terms and Conditions. If the entity has subsidiary TINs that received General Distribution payments, regardless of whether the subsidiary or Reporting Entity formally attested to accepting the payment within the provider portal, the Reporting Entity may report on and direct the use of General Distribution payments. However, if a subsidiary TIN received a Targeted Distribution payment, 1 the subsidiary TIN must report use of funds for that payment, and the parent organization that reports on a subsidiary’s General Distribution payment cannot also report on (or transfer) the subsidiary’s Targeted Distribution payment.

Department of Health and Human Services

Four weeks after HHS announced that it would distribute 150 million state-of-the-art Abbott BinaxNOW COVID-19 tests nationally to assist with states’ reopening efforts, states have begun to report back to HHS about how they are choosing to distribute the rapid, point-of-care tests. Of the states that have provided preliminary reports, the BinaxNOW allocations are largely being sent to local health departments, K-12 schools and institutes of higher education, nursing homes, hospitals, and correctional facilities. Learn more from this HHS announcement about the status of the distribution and states’ responses to it.
HHS’s Office of the Inspector General has updated its work plan for COVID-19-related audits, evaluations, and inspections.

CMS COVID-19 Stakeholder Calls

CMS hosts recurring stakeholder engagement sessions to share information about the agency’s response to COVID-19. These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer participants an opportunity to ask questions of CMS and other subject matter experts. Two such calls remain this month.

CMS COVID-19 Office Hours Call

Tuesday, October 27 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 2394789

Audio Webcast link: go here to register for the call

Nursing Homes Call

Wednesday, October 28 at 4:30 – 5:00 PM (eastern)

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 5587022
Audio Webcast Link: go here to register for the call

Conference lines are limited, so CMS encourages interested parties to join via audio webcast. To listen to the audio files and read the transcripts for other COVID-19 stakeholder calls, visit CMS’s podcast and transcripts page.

Food and Drug Administration

The FDA has approved the antiviral drug Veklury (remdesivir) for treatment of COVID-19 requiring hospitalization for use in adult and pediatric patients 12 years of age and older and weighing at least 40 kilograms (about 88 pounds).
The FDA has consolidated its existing resources for stakeholders to easily find information about drug and biologics development and manufacturing, including for products to diagnose, cure, mitigate, treat, or prevent COVID-19 and for other critically needed products to treat symptoms of COVID-19 or to provide supportive care to those with COVID-19. Go here to find the consolidated guide to these resources.

Centers for Disease Control and Prevention

The CDC has updated its flow chart for the management of health care workers who have been exposed to an individual with COVID-19.
The CDC has updated its summary of considerations for the use COVID-19 testing in nursing homes.
The CDC has updated its guidance on the diagnosis, evaluation, and infection prevention and control practices for neonates with suspected or confirmed COVID-19 infection or known COVID-19 exposure, including birth to a mother with suspected or confirmed COVID-19.
The CDC has updated its recommended strategies for optimizing provider supplies of disposable medical gloves.
The CDC’s weekly morbidity and mortality weekly report offers new Veterans Health Administration research on the risk for in-hospital complications associated with COVID-19 and influenza from October 1, 2018 to May 31, 2020.
The CDC’s weekly morbidity and mortality report offers new research on COVID-19-related hospitalizations of health care workers in 13 states between March 1 and May 31.

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

PA Safety Net Admin2020-10-27T06:00:20+00:00October 27th, 2020|Coronavirus, COVID-19|Comments Off

Update on Regional Response Health Collaboratives

A recent Wolf administration news release offered an update on the work of the state’s Regional Response Health Collaboratives.

Pennsylvania State Map Created in July to help long-term-care facilities address their struggles responding to the COVID-19 emergency, the state has six RRHCs led by 11 Pennsylvania health systems. The RRHCs were created to provide clinical, operational, technical, and educational support to long-term-care facilities at a time when COVID-19-related deaths in such facilities accounted for more than 60 percent of all COVID-19 deaths state-wide. With financial backing from the federal CARES Act, the RRHCs support nearly 2000 long-term-care facilities of different types at which more than 127,000 Pennsylvanians currently reside.

The RRHC program is scheduled to end on December 1. State officials have asked the Trump administration for additional funding so the program can continue.

Learn more about the RRHCs, how they work, and what they do in this state news release.

PA Safety Net Admin2020-10-22T10:22:45+00:00October 22nd, 2020|Coronavirus, COVID-19|Comments Off

COVID-19 Update: Tuesday, October 20

The following is the latest COVID-19 information from the state and federal governments as of 2:30 p.m. on Tuesday, October 20.

Pennsylvania Update

Department of Health

The Department of Health has issued its weekly news release updating its COVID-19 contact tracing efforts.
In its weekly guidance wrap-up document, the Department of Health addressed a skilled nursing facility’s question about how to protect respirators from surface contamination to prolong their use.
COVID-19 testing sites have been launched in faith-based settings in communities in Allegheny and Dauphin counties. For more information, including a list of testing sites and when they will be operating, see this Department of Health announcement.

Department of Health – by the numbers

Pennsylvania’s COVID-19 case count so far is just short of 185,000. 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.
With today’s latest figures, the death count now exceeds 8500.
Of that number, 61 percent were residents of long-term-care facilities.
Overall, more than 24,700 residents of long-term-care facilities and more than 5400 people who work in those facilities have contracted COVID-19. Those figures encompass 1028 facilities in 62 of Pennsylvania’s 67 counties.
More than 11,700 health care workers in the state have contracted COVID-19.
The number of people currently hospitalized with COVID-19 is up 65 percent since October 1.
The number of COVID-19 patients currently breathing with the help of a ventilator is up 57 percent since October 1 and is at its highest level since August 20.
21 percent of hospital adult ICU beds are currently unoccupied, as are 19 percent of medical/surgical beds, 36 percent of pediatric beds, 20 percent of pediatric ICU beds, and 39 percent of airborne isolation unit beds. These figures are similar to what they were a week ago.
The weekly news release from the office of the governor and the Department of Health reported that during the week of October 9-15, the number of COVID-19 cases rose 17.9 percent over the previous week and the state-wide positivity rate for COVID-19 tests rose from 3.9 percent to 4.3 percent during the same period.
The highest positivity rates were in Huntingdon (9.9 percent), Westmoreland (8.9 percent), Bradford (8.3 percent), and Lackawanna, Lebanon, and Perry (8.2 percent) counties.
Counties found to have substantial levels of community transmission were Berks, Blair, Bradford, Centre, Huntingdon, Lackawanna, Montour, Schuylkill, Union, and Westmoreland.
Allegheny and Philadelphia counties are considered to have “moderate” rates of community transmission.
Despite this, Philadelphia’s health commissioner reports that every zip code in the city is experiencing an increase in its number of cases, the Philadelphia Inquirer reports.
Eight percent of all cases to date in the 8-15 years-old age group occurred during the week of October 9-15.

Department of Human Services

DHS’s Office of Developmental Programs has updated operational guidance to implement services through Appendix K flexibilities approved for the Community Living, Consolidated and Person/Family Directed Support (P/FDS) Waivers during the COVID-19 pandemic.

Federal Update

Provider Relief Fund

HHS has updated its Provider Relief Fund FAQ with a new question that appears on page 46 and is marked “Added 10/15/2020.” The new question is “An organization has prescription sales as part of its revenue. Can these sales be captured in the data submitted as a part of revenue from patient care?” The answer is “Generally no, prescriptions sale revenue may not be captured as part of revenue from patient care. Only patient care revenues from providing health care, services, and supports, as provided in a medical setting, at home, or in the community may be included. Patient care revenues do include savings obtained by providers through enrollment in the 340B Program.”

Centers for Medicare & Medicaid Services

CMS announced that starting January 1, 2021, Medicare will pay $100 for COVID-19 laboratory tests only to laboratories that complete high-throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected. Also effective January 1, 2021, Medicare will pay only $75 for laboratories that take longer than two days to complete these tests.
CMS has updated the document “COVID-19 Frequently Asked Questions on Medicare Fee-for-Service (FFS) Billing” with new questions on pages 12-16 about the creation of new HCPCS codes and add-on payments for laboratory tests using high-throughput technologies.
CMS has updated the article “Medicare Fee-for-Service Response to the Public Health Emergency on the Coronavirus (COVID-19)” in its online publication MLN Matters to clarify the HCPCS codes that critical access hospitals should use in the “Families First Coronavirus Response Act Waives Coinsurance and Deductibles for Additional COVID-19 Related Services” section. It also has clarified the “Skilled Nursing Facility (SNF) Benefit Period Waiver – Provider Information” section of that article to show that the skilled nursing facility waiver applies to swing-bed services in rural hospitals and critical access hospitals. All other information remains the same.
CMS has published the results of its survey on how COVID-19 has affected Medicare beneficiaries’ daily lives and experiences, including the degree to which they have chosen to forego receiving health care, the steps they have taken to avoid contracting COVID-19, their experiences with telemedicine, and more. Learn more from the CMS announcement about the survey, view its data infographic on the survey’s results, and find a public use file detailing the survey results.
CMS has published a list of all recipients of money through its Accelerated and Advance Payments Program, including how much money they received through this program. See the Medicare COVID Accelerated & Advanced Payment Data (ZIP).

Department of Health and Human Services

HHS and the Department of Defense have announced agreements with CVS and Walgreens to provide and administer COVID-19 vaccines to residents of long-term-care facilities nation-wide with no out-of-pocket costs.
Starting October 19, long-term-care facilities may opt into this program and indicate which pharmacy partner their facility prefers to have on-site. Long-term-care facilities are not required to participate in this program and can request to use their current pharmacy contracts to support COVID-19 vaccination. Nursing homes can sign up via the National Healthcare Safety Network and assisted living facilities can sign up via an online survey they will receive.
In support of this action, CMS has posted a document outlining how it will exercise its enforcement discretion to permit pharmacists to bill Medicare directly when they administer COVID-19 vaccines at skilled nursing facilities.
Communities that are part of the federal surge testing effort for COVID-19 now have a new option: a test that uses samples of saliva collected by spitting into a sterile container. The first place where the saliva test will be used is Waco, Texas. See HHS’s announcement of this new option.
HHS’s Office of the Assistant Secretary for Planning and Evaluation has developed a “PPE Preservation Planning Toolkit.”
HHS’s Office of the Assistant Secretary for Planning and Evaluation, in cooperation with the National Emerging Special Pathogen Training and Education Center and Project Echo, holds weekly COVID-19 clinical rounds peer-to-peer virtual communities of practice webinars: EMS – patient care and operations on Mondays at noon (eastern); critical care: life-saving treatment and clinical operations on Tuesdays at noon (eastern); and emergency department: patient care and clinical operations on Thursdays at noon (eastern). Go here to sign up for information on upcoming webinars.

Centers for Disease Control and Prevention

The CDC has updated its information about how providers should report COVID-19-related laboratory data.
The CDC has updated its interim guidance for providing home care to patients with COVID-19 who do not need hospitalization.
The CDC has updated its information about resources for laboratories that perform COVID-19 diagnostic tests.
The CDC’s morbidity and mortality weekly report includes its new research on race, ethnicity, and age trends in persons who died from COVID-19 from May through August.
The CDC’s morbidity and mortality weekly report includes its new research on excess deaths in the U.S. associated with COVID-19 by age, and race and ethnicity from January 26 through October 3, 2020.

Food and Drug Administration

The FDA has re-issued emergency use authorization (EUA) for certain filtering facepiece respirators that are not approved by the Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health.
The FDA has removed epinephrine from the list of drugs that it has authorized for temporary compounding during the COVID-19 emergency. Find the updated list of authorized drugs here.
The FDA will host a virtual town hall for COVID-19 test developers on October 28, 2020 from 12:15 pm – 1:15 pm (eastern). The purpose of this town hall is to help answer technical questions about the development and validation of tests for COVID-19. Go here for information on how to join the event.

Department of Labor

The Department of Labor’s Occupational Safety and Health Administration (OSHA) has published an FAQ on how N95 respirators protect wearers from COVID-19 exposure.

Federal Reserve System

The Federal Reserve System will hold a webinar for its Main Street Lending Program on Wednesday, October 21 at 2:00 (eastern). That program supports lending to small and medium-sized for-profit businesses and non-profit organizations that were in sound financial condition before the COVID-19 pandemic but lack access to credit on reasonable terms. Go here to learn more about the program, sign up for the webinar, and submit questions about the program.

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

Main COVID-19 Page

FAQ

PA Safety Net Admin2020-10-21T06:00:05+00:00October 21st, 2020|Coronavirus, COVID-19|Comments Off

COVID-19 Update: Thursday, October 15

The following is the latest COVID-19 information from the state and federal governments as of 3:00 p.m. on Thursday, October 15.

Pennsylvania Update

Department of Human Services

DHS’s Office of Developmental Programs has issued an FAQ on modifications to medication administration course requirements as a result of the COVID-19 emergency. The audience for this FAQ is Office of Developmental Programs providers whose staff, contractors, or consultants are required by state law to take medication administration training. Due to the COVID-19 pandemic, the Office of Developmental Programs has temporarily permitted staff required to undergo such training to take a modified medication administration course. The FAQ addresses the current state of the training requirement.

Department of Health

The Department of Health has issued new guidance for skilled nursing facilities that replaces guidance issued on September 3 and brings the agency’s guidance in line with recent CMS memoranda. This document is a compendium of all COVID-19-related guidance and recommendations in areas such as testing, visitation, cohorting, and reporting.
The Department of Health announced that the state has begun distributing the first allotment of 250,000 COVID-19 rapid antigen test cards provided by the federal government.
Distribution is beginning with Bradford, Centre, Lebanon, Montour, Northumberland, Schuylkill, and Snyder counties because of the recent high COVID-19 incidence rates in those areas.
The tests are being distributed to Clinical Laboratory Improvement Amendments (CLIA)-certified organizations, including long-term-care facilities, personal care homes and assisted living/intermediate-care facilities, higher education institutions, drug and alcohol and behavioral health treatment centers, state and county correctional facilities, and health care providers such as FQHCs, urgent care centers, pharmacies, and primary care doctors.
Populations targeted for testing with these materials include individuals in congregate care settings, day care workers and clients, K-12 students and adults who work in K-12 settings, college and university students, individuals without permanent housing, food distribution facility employees, food workers, and first responders.
These test kits are separate from and in addition to the tests being provided by the federal government directly to skilled nursing facilities, personal care homes, and historically black colleges and universities.
The Secretary of Health issued an order to laboratories, health care practitioners, health care providers, and facilities reinforcing that all antigen test results, both positive and negative, must be reported to the Department of Health via its reporting system, PA-NEDSS.

Department of Health – by the numbers

The weekly news release from the office of the governor and the Department of Health cited 14 counties as concerns because of their high rate of positive test results: Northumberland (8.6 percent), Centre (7.6 percent), Bradford (7.4 percent), Lebanon (7.4 percent), Lawrence (6.9 percent), Potter (6.3 percent), Westmoreland (6.3 percent), Fulton (6.2 percent), Montour (6.0 percent), Berks (5.9 percent), Indiana (5.9 percent), Huntingdon (5.8 percent), Lackawanna (5.4 percent), and Schuylkill (5.0 percent). It also noted that “Each of these counties bears watching as the state continues to monitor all available data.”
With the increase in cases in Northumberland County, the Department of Health has arranged for an outdoor testing site from October 16-20. The tests are free and appointments are not needed.
The number of new COVID-19 cases has been in four digits in 14 of the 15 days of October – the first time that has happened in more than four months. Today’s new case count is the highest single day figure since at least May.
The number of people currently hospitalized with COVID-19 is up 43 percent since October 1.
The number of COVID-19 patients currently breathing with the help of a ventilator is up 57 percent since October 1 and is at its highest level since August 20.
22 percent of hospital adult ICU beds are currently unoccupied, as are 18 percent of medical/surgical beds, 33 percent of pediatric beds, 13 percent of pediatric ICU beds, and 38 percent of airborne isolation unit beds. These figures are almost identical to what they were a week ago.
More than 11,500 health care workers in the state have contracted COVID-19.

Federal Update

Provider Relief Fund

Yesterday HHS held a webinar to provide more detailed information to health care providers about its planned $20 billion CARES Act Provider Relief Fund Phase 3 general distribution. It used this toolkit during the webinar. The deadline for applying for a Phase 3 general distribution is November 6.
During the webinar, providers that have received Provider Relief Fund general distributions in the past were advised that they need to submit an entirely new application to participate in Phase 3 and be eligible to receive any add-on payment that HHS distributes from the funding pool that remains after all applicants have received payments equal to two percent of patient care revenue. There are no details available on how these potential add-on payments might be calculated.
During the webinar HHS offered a point of contact for stakeholders with questions about the Provider Relief Fund and payments for testing and treatment for the uninsured: its Provider Support Line at 866-569-3522 (for TYY, dial 711).

Centers for Medicare & Medicaid Services

CMS has expanded the list of telehealth services that Medicare fee-for-service will pay for during the COVID-19 public health emergency, adding 11 new services to the Medicare telehealth services list. Medicare will begin paying for these services immediately and for the duration of the COVID-19 emergency. These new telehealth services include certain neurostimulator analysis and programming services and cardiac and pulmonary rehabilitation services. Go here to see CMS’s announcement of the newly authorized telehealth services and here for a link to the list of the new services and their billing codes.
CMS has published the document “State Medicaid and CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth” and subtitled it “COVID-19 Version.” The document explains that “This guide is intended to help states identify which aspects of their statutory and regulatory infrastructure may impede the rapid deployment of telehealth capabilities in their Medicaid program. As such, this guide will describe each of these policy areas and the challenges they present below. The toolkit concludes with a list of questions state policymakers can use to ensure they have explored and/or addressed potential obstacles.” It also notes that “CMS encourages states to consider telehealth options as a flexibility in combatting the COVID-19 pandemic and increasing access to care. States are encouraged to facilitate clinically appropriate care within the Medicaid program using telehealth technology to deliver services covered by the state.” CMS also has published a supplement to this guide, “State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth,” and subtitled it “COVID-19 Version: Supplement #1.” This document is dated October 14, 2020.

Centers for Disease Control and Prevention

The CDC has updated its guidance on point-of-care COVID-19 testing.

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

PA Safety Net Admin2020-10-16T06:00:49+00:00October 16th, 2020|Coronavirus, COVID-19|Comments Off

SNAP Asks PA Congressional Delegation to Help Preserve Federal COVID-19 Aid for Hospitals

Protect the COVID-19 aid the federal government has given to Pennsylvania safety-net hospitals and others, SNAP has asked in a letter to members of Pennsylvania’s congressional delegation.

Safety-Net Association of Pennsylvania logo The letter refers to changes in how the federal Department of Health and Human Services wants hospitals to calculate the revenue they lost as a result of COVID-19 – the justification in part for the Provider Relief Fund payments hospitals have received through the CARES Act. In June, HHS told hospitals how to make that calculation but late last month it changed those directions in ways that could force many Pennsylvania safety-net hospitals to return some or even much of the federal aid they received.

In the letter, SNAP asks members of Pennsylvania’s congressional delegation to join a bipartisan letter asking HHS Secretary Alex Azar to restore the June instructions for calculating COVID-19-related lost hospital revenue.

Go here to read SNAP’s message to Congress.

PA Safety Net Admin2020-10-14T11:43:19+00:00October 14th, 2020|Coronavirus, COVID-19, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

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