COVID-19 Update: March 26, 2020
The following is a summary of the major COVID-19-related developments in Pennsylvania as of 5:00 on March 26.
Pennsylvania Update
Governor Wolf
House Bill 1232, which includes up to $50 million to help with the state’s COVID-19 response, is now on Governor Wolf’s desk and he is expected to sign it tomorrow, when he also is expected to sign three other bills the legislature passed late yesterday:
- HB 68 – amends the rules of unemployment compensation during an emergency declaration such as easing work search requirements and extending the length of time that benefits are available.
- SB 422 – amends the election code to move the Pennsylvania primary election to June 2, 2020.
- SB 751 – amends the school code to protect employees and address various changes in state education requirements.
Department of Health
Secretary Levine has ordered ambulatory surgical facilities to report on specific items for the purpose of managing supplies and equipment. Portions of the survey are to be updated each day, including the number of procedures they perform and their remaining supplies of personal protective equipment. Click here for a copy of the survey, which was also shared by the department via email to facility administrators. Click here to view the Secretary’s order.- More information is now available to assist hospitals with complying with Secretary Levine’s March 25 order that they report three times a day on specific data regarding hospital facilities, beds, supplies, equipment, and staffing. Data will be collected using the Essential Elements of Information (EEI) tool in the Knowledge Center – Health Incident Management System (KC-HIMS). Hospitals needing onboarding for the Knowledge Center should contact the HAP Readiness Coordinator for their regional health care coalition; that contact information is at the bottom of the webpage here.
- During her daily briefing, Department of Health Secretary Levine reported the following:
- More than twice as many new cases today as yesterday.
- Cases hold steady at about 10 percent requiring hospitalization.
- Of nearly 1700 cases so far, 56 required ICU and 32 needed ventilators.
- 46 percent of new cases fall in the 25-40 age group.
- The state is focused on standards of care and is not contemplating triage for patients getting all the care they need.
- Those standards of care may evolve as the number of cases rises and the state adds more beds, whether that means new hospital beds or places like ambulatory surgery centers and hotels where people can receive post-acute care when they no longer need acute care. The Department of Health is working to find such additional beds.
- The state is doing “everything we can” to support hospitals.
- Among other measures, Pennsylvania has distributed 678,000 N-95 masks, 380,000 pairs of gloves, and 744,000 goggles and face protectors to hospitals and providers. The federal government is replenishing the state’s supplies and the state is also looking to purchase more of its own.
Department of Human Services
The Department of Human Services (DHS)’ Office of Mental Health and Substance Abuse Services has sent an FAQ to HealthChoices behavioral health managed care organizations, fee-for-service providers, and county mental health authorities on the subject of behavioral health Medicaid programs and the COVID-19 crisis. Find that FAQ here.- DHS has submitted a section 1135 waiver request to the federal Centers for Medicare & Medicaid Services. Such requests seek temporary exemption from federal Medicaid requirements. Pennsylvania’s request covers requirements involving Medicaid authorization, long-term services and supports, fair hearings, provider enrollment, reporting and oversight, and other matters. See the state’s 1135 waiver request here.
- DHS’s Office of Child Development and Early Learning has issued guidance to child care advisors to help them keep children, their families, and staff safe during the COVID-19 emergency. Find that guidance here.
- The federal government approved Pennsylvania’s request to extend the time that people are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps). The state also will be submitting a waiver to enable many college students, currently ineligible for such benefits, to participate in SNAP.
- DHS has published its latest COVID-19 stakeholder update. Find it
Department of State
The Department of State has provided guidance for doctors prescribing chloroquine and hydroxychloroquine and pharmacists dispensing it. See that language here.
Federal Update
Department of Health and Human Services
- The Department of Health and Human Services (HHS) will be publishing a “Notice of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures” in the Federal Register on March 30. The notice gives the Secretary of HHS authority to designate such materials as scarce and to invoke prohibitions against hoarding them. The notice, which is not a regulation and expires in four months, lists specific medical supplies to which it applies. Find the notice here.
- HHS’s Office of Civil Rights has posted notice in response to questions about whether HIPAA requirements permit covered entities to share with law enforcement, paramedics, other first responders, or public health authorities the names or other identifying information of individuals who have been infected with or exposed to COVID-19 without the permission of those individuals. The notice outlines the specific situations under which such disclosure is permitted. See the notice here.
Centers for Medicare & Medicaid Services
The Families First Coronavirus Response Act, signed into law on March 18, includes a temporary 6.2 percentage point increase in the federal medical assistance percentage (FMAP: the rate at which the federal government matches state Medicaid expenditures). A new CMS FAQ provides information about the state Medicaid expenditures to which the increase applies, its applicability to Medicaid DSH payments, the duration of the supplemental funding, and more. Find this FAQ here.- CMS has approved more section 1135 waivers for states.
- CMS has published an FAQ on Medicare provider enrollment relief. Find it here.
- CMS’s Center for Consumer Information & Insurance Oversight has issued a memo to qualified health plans and stand-alone dental plans offered on the federal exchange and state exchanges on the subject of payment and grace period flexibilities associated with the COVID-19 crisis See that memo here.
Food and Drug Administration
- The Food and Drug Administration (FDA) has published guidance for industry and food staff on the enforcement policy for face masks and respirators during the COVID-19 health emergency. Find the guidance document here.
- The FDA has sent a detailed letter to manufacturers and other stakeholders authorizing the emergency use of authorized ventilators, ventilator tubing connectors, and ventilator accessories, including alternative products used as medical devices, during the COVID-19 pandemic subject to the terms detailed in this letter and based on the specific types of equipment and supplies involved as also described in the letter. Find the document here.
Centers for Disease Control and Prevention
- The Centers for Disease Control and Prevention published the following documents relevant to health care providers:
- The Centers for Disease Control and Prevention (CDC) has issued interim clinical guidelines for the management of patients with COVID-19. Find those guidelines here.
- CDC has updated its guidelines for collecting, handling, and testing clinical specimens from persons with COVID-19. Find those updated guidelines here.
- The CDC has developed two checklists that identify key actions that can be taken now to enhance preparedness for potential or confirmed patients with COVID-19. Find them here.
- The CDC has developed a spreadsheet-based model that to help providers plan and optimize their use of personal protective equipment for response to COVID-19. Find a link to that downloadable spreadsheet here.
- The CDC has updated its guidance on the collection and submission of post-mortem specimens from deceased persons under investigation. See the updated guidance here.
National Uniform Billing Committee
The National Uniform Billing Committee, the governing body for forms and codes use in medical claims billing in the United States for institutional providers, has published guidance on claims for COVID-19 treatment. The guidance, which addresses use of the “DR” condition code and use of hospital outpatient bill type for COVID-19 testing locations, can be found here.
Resources to Consult
Pennsylvania Department of Human Services
Pennsylvania Department of Health
Pennsylvania Emergency Preparedness Guide
Centers for Disease Control and Prevention
The Department of Drug and Alcohol Programs (DDAP) has issued a document clarifying the state’s response to federal guidance on the disclosure of patients’ substance abuse disorder records during the telehealth process. See that policy clarification 
The legislature continues to deliberate on a number of measures to respond to the COVID-19 crisis. Among the issues being discussed between the administration and legislature are:
The Food and Drug Administration (FDA) published six updates over the weekend. New updates from Friday through today:
In addition to the resources sought by hospitals everywhere – equipment, supplies, funding for expanded capacity to accommodate patients suffering from COVID-19 – SNAP emphasized three specific types of assistance in its letter to the delegation:
Since yesterday, the Department of Human Services has issued the following four new guidance documents:
Governor’s Order Closing State Businesses
CMS Catastrophic Plan Coverage Guidance 
PACE Prescription Drug Program