COVID-19 update for Monday, April 27 as of 3:30 p.m.

Pennsylvania Update

Department of Health

The Department of Health has issued guidance on the terms under which hospitals can begin performing elective procedures again and under which ambulatory surgical facilities may begin performing elective procedures again.

Department of Health Daily Briefing

• The number of newly reported cases has declined for the third consecutive day.
• 2394 positive tests have been among health care workers and 7037 have been among residents of 441 long-term-care facilities.
• 2799 people are currently hospitalized for COVID-19 and 615 of them are on ventilators.
• 47 percent of the state’s hospital beds and 40 percent of its ICU beds are currently unoccupied and nearly 70 percent of its ventilators are not in use.
• Secretary Levine discussed the criteria for the state to reopen regions.  She cautioned against too great a focus on the number of cases per 100,000 population and explained that to reopen, regions also would need a certain level of testing capacity, enough personal protective equipment, have enough hospital staff to handle any surge in cases, and not be operating under crisis standards of care.
• The state is doing well in finding more testing materials for the state lab and Secretary Levine said more needs to be done to make this supply chain more reliable and to do the same for others that perform tests as well.

Governor Wolf

The Wolf administration has issued a news release elaborating on the data-driven and qualitative measures that will be used to determine when individual regions of the state will be permitted to reopen.

Federal Update

Department of Health and Human Services

• Last Friday HHS deposited its second tranche of CARES Act funding in hospitals’ bank accounts.  We have contacted HHS to inquire about the specifics of the funding formula, whether there are additional future attestation requirements, the timing for the next round of payments, and more.

In the meantime, providers that received Provider Relief Payments in either round of funding should visit the CARES Act General Distribution Portal, where you will be able to provide data that HHS may use to calculate payment distributions from the Provider Relief Fund.  (Other useful resources:  the CARES Act Provider Relief Fund web page and an FAQ on the General Distribution Portal.  Also, please note: the General Distribution Portal is not the same as the Attestation Portal.)

Specifically, the portal is collecting the following four pieces of information:

1. a provider’s “Gross Receipts or Sales” or “Program Service Revenue” as submitted on its federal income tax return;
2. the provider’s estimated revenue losses in March 2020 and April 2020 due to COVID;
3. a copy of the provider’s most recently filed federal income tax return; and
4. a listing of the tax identification numbers any of the provider’s subsidiary organizations that have received relief funds but that DO NOT file separate tax returns.

In addition, providers can submit separate applications for CARES Act funding for any additional entities that received Provider Relief Fund payments and that also filed a separate tax return for 2017, 2018, or 2019.  See the provider relief fund page and FAQ for further details.

• HHS has updated its CARES Act Provider Relief Fund web page. Included is a new update on the distribution of remaining funds designated for providers in the CARES Act and what providers need to do to receive their share of these funds.  It also reminds providers that they must agree to the terms and conditions of this funding through the CARES Act Provider Relief Fund Payment Attestation Portal.
• HHS’s Health Resources and Services Administration (HRSA) this afternoon opened a web portal through which providers can submit claims for payment for COVID-19-related services they have provided to uninsured patients.  As described in an HHS news release,

Health care providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020 can request claims reimbursement through the program electronically and will be reimbursed generally at Medicare rates, subject to available funding. Steps will involve: enrolling as a provider participant, checking patient eligibility, submitting patient information, submitting claims, and receiving payment via direct deposit.

To participate, providers must attest to the following at registration:

• You have checked for health care coverage eligibility and confirmed that the patient is uninsured. You have verified that the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage, and no other payer will reimburse you for COVID-19 testing and/or care for that patient
• You will accept defined program reimbursement as payment in full.
• You agree not to balance bill the patient.
• You agree to program terms and conditions and may be subject to post-reimbursement audit review.

The new web page also includes information about covered services, claims submission, and claims reimbursement.

Centers for Medicare & Medicaid Services

• CMS has announced that it is re-evaluating the amounts it will have available for Part A providers with new and pending applications under its Accelerated Payment Program and is suspending its Advance Payment Program for Medicare Part B suppliers effective immediately.  Now that Congress has appropriated $175 billion for the grant-style “Provider Relief Fund,” CMS is shifting away from the cash advance approach of the Advance and Accelerated Payment Programs.  Part B suppliers will no longer be able to apply for the Advance Payment Program and CMS will be re-evaluating the amounts available for Part A providers with new and pending applications under the Accelerated Payment Program.  Previously, Part A and Part B providers were able to request an advance on Medicare fee-for-service payments up to a maximum value of six months’ worth of payments.  See CMS’s news release explaining its shift in approach and an updated fact sheet on the Accelerated and Advance Payment Programs.
• CMS has updated its FAQ on Medicare fee-for-service billing.  In particular, the updated FAQ provided more specific information about use of the condition code “DR” and the modifier “CR” for claims for which Medicare payment is conditioned on the premise of a formal waiver.
• CMS has informed state governments that it will hold constant the inspection domain of the Nursing Home Compare site due to the prioritization and suspension of certain surveys during the COVID-19 emergency to ensure that the rating system provides fair information for consumers.

Centers for Disease Control and Prevention

• The CDC has updated its information for clinicians on therapeutic options for COVID-19 patients.

Food and Drug Administration

• The FDA has issued a news release reiterating the importance of close patient supervision for off-label use of anti-malaria drugs to mitigate the known risks of those drugs.
• The FDA will host a virtual town hall for clinical laboratories and commercial manufacturers that are developing or have developed diagnostic tests for COVID-19 on Wednesday, April 29 at 12:15 (eastern).
• The FDA has issued emergency use authorizations (EUAs) for two COVID-19 serology tests (here and here) and for a reagent to be used in such serology tests.

Occupational Safety and Health Administration

• OSHA has issued interim enforcement guidance on reusing disposable N95 filtering face piece respirators that have been decontaminated.

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

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

COVID-19 update for Friday, April 23 as of 4:00 p.m.

Attention:  Health Care Providers

HHS has extended until 3:00 p.m. (eastern) on Saturday, April 25 the deadline for providers to submit data that will be used to determine how it will allocate the $10 billion it will be distributing to providers hit especially hard by COVID-19.  Providers that have been targeted for possible assistance from this pool have already been notified of the need to submit data, although such notice does not assure funding.

State Update

Department of Health Daily Briefing

• After a week of declines in the number of new COVID-19 cases, the daily case count has returned to its higher levels of one to two weeks ago.
• More than 6000 residents of 418 long-term-care facilities located in 40 of the state’s counties have tested positive for COVID-19, as have more than 700 people who work at those facilities.
• More than 2000 of the Pennsylvanians who have tested positive for COVID-19 are health care workers.
• 2746 people are currently hospitalized with COVID-19 and 662 of them are on ventilators.
• 47 percent of the state’s acute-care beds and 40 percent of its ICU beds are currently unoccupied and nearly 70 percent of its ventilators are not in use at this time.

Department of Health

The Department of Health has issued a notice to hospitals reminding them that they are required to promptly notify any first responder agency that is known to have transported a patient determined to be positive for COVID-19 and that they must do so as soon possible and no later than 48 hours after the determination.  This requirement is the same as that called for in the Ryan White HIV/AIDS Treatment Extension Act of 2009.

Insurance Department

The state Insurance Department has published COVID-19 guidance regarding volunteer physicians, podiatrists, and certified nurse midwives practicing under a reactivated license.  The notice addresses the medical malpractice insurance obligations of such volunteers depending on where they practice during the COVID-19 pandemic.

Pennsylvania Health Law Center

The Pennsylvania Health Law Center has launched a “COVID-19 Resource Center.”  While it has useful information, its primary target audiences appears to be consumers and those who work with consumers.

Federal Update

Centers for Medicare & Medicaid Services

• CMS has launched a COVID-19 partner toolkit that includes links to almost all activity involving the federal response to the COVID-19 crisis.
• CMS has launched a new toolkit to help states navigate COVID-19 health workforce issues.
• CMS has issued two new section 1135 waivers to states this week. Go here to see them and other 1135 waivers the agency has issued since the beginning of the COVID-19 pandemic.

Centers for Disease Control and Prevention

• The CDC has posted a human infection with COVID-19 person under investigation and case report form.
• The CDC has posted a guide on the use of personal protective equipment when caring for COVID-19 patients.
• The CDC has posted updated guidance for different types of health care facilities dealing with COVID-19.
• The CDC has published clinical care guidance about COVID-19 for health care professionals.
• The CDC has posted information about assessing risk factors for severe COVID-19 illness.
• The CDC has posted guidance on water-borne transmission of COVID-19.
• The CDC has published interim guidance for public health and health care professionals managing people with COVID-19 in home care and isolation who have pets or other animals.
• The CDC has shared conventional, contingency, and crisis strategies for the use of elastomeric respirators.

Food and Drug Administration

• The FDA has published guidance on its enforcement policy for imaging systems during the COVID-19 emergency.
• The FDA has unveiled its enforcement policy for remote digital pathology devices during the COVID-19 emergency.
• The FDA has issued an emergency use authorization (EUA) for a specific commercial device for use to treat lung failure when used as an adjunct to non-invasive or invasive mechanical ventilation.
• The FDA has issued an EUA for a specific commercial blood purification system, including for use in continuous renal replacement therapy.

National Institutes of Health

• The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has shared its plan for accelerating research to diagnose, prevent, and treat COVID-19.

The White House

• Alabama, Alaska, and Delaware have been added to the list of states that the federal government has authorized to use the National Guard to assist with their COVID-19 response, with 100 percent of the cost of this assistance paid by the federal government.

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

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

COVID-19 update for Thursday, April 23 as of 5:00 p.m.

Pennsylvania Update

Governor Wolf

On Wednesday night Governor Wolf addressed the state about his plan to gradually reopen Pennsylvania and its economy.  While the governor had previously announced some reopenings, he outlined general parameters for authorizing additional steps and further business activity.

Reopening the state, he said, would be based on a three-phase approach and guidelines for attempting to maintain control of COVID-19:  to make sure that case counts are under control and that the population of the regions identified for possible reopening have fewer than 50 cases per 100,000 residents over 14 days before people can return to work.  Target dates for some reopenings may change, he said, if conditions and case counts change, but the goal is to begin on May 8.

Governor Wolf emphasized that continued social distancing and use of masks is imperative and that reopening would not be state-wide but would be on a regional basis, depending on their conditions.  He will be making the decisions about regional reopenings, he said, and not local or county officials, and those decisions will be data-driven.  Based on current conditions, he said, reopening is most likely to start in northern central Pennsylvania and the northwestern part of the state, but that has not yet been decided.

The governor also said the Department of Health has been talking to hospital industry representatives about resuming non-urgent elective procedures.

Learn more about Governor Wolf’s plan here.

Department of Human Services

• DHS has written to the federal Centers for Medicare & Medicaid Services to request Medicaid state plan amendments in response to the COVID-19 emergency.  The amendments include suspension of co-payments for screening, diagnosis, and treatment for COVID-19; benefit flexibility to authorize the use of additional cough and cold suppressant products; suspension of prior authorization requirements for certain services and for the permitted supply of covered outpatient drugs; and more.
• DHS has also written to CMS to request approval of its disaster relief state plan amendment to seek flexibilities in how the state operates its Children’s Health Insurance Program (CHIP).  These flexibilities include:
• allowing enrollees to receive services beyond their certification period by extending CHIP renewal deadlines;
• temporarily delaying acting on certain changes in circumstances;
• accepting self-attestation and conduct post-enrollment verification;
• allowing individuals to provide a reasonable explanation of inconsistencies in lieu of requiring paper documentation;
• extending deadlines for submitting verification at renewal;
• temporarily suspending application of co-payments related to COVID-19 testing, screening, and treatment services; and
• temporarily delaying payment of premiums (and/or delay payment of premium balance).
• DHS has published an announcement listing the functions managed by its Office of Developmental Programs that it is suspending state-wide until further notice.  Previously, these functions had been suspended for a limited period of time.

Department of Health Daily Briefing

• Secretary Levine explained the difference between confirmed cases of COVID-19 and probable cases and between confirmed deaths from COVID-19 and probable deaths from COVID-19.  She said that in both situations, “probable” means the cases are under investigation.
• “Probable” classifications account for only about two percent of cases.
• Investigation of probable deaths has led the state to reduce its COVID-19 death count by 201 from yesterday.
• Secretary Levine responded to numerous questions about Governor Wolf’s plan for reopening Pennsylvania.
• When making decisions about regional reopenings the state will be using confirmed data, not probable data.
• She stressed that reopening parts of Pennsylvania will be on a regional basis and not a county-by-county basis.  The state has not yet completely defined the regions it will use for this purpose.
• When determining whether regions meet the cases per 100,000 population criterion for reopening, cases in long-term-care facilities will be counted because employees enter and exit those facilities.
• The Department of Health is currently formulating its plan for future contact tracing.
• When deciding whether to reopen regions, factors such as the availability of testing, an adequate supply of hospital beds, contact tracing capabilities, and other considerations will figure in the governor’s decisions.
• Those regions will need to have enough testing capacity to accommodate a loosening of the current, strict criteria for who can be tested for COVID-19.
• Amid concern about how many COVID-19 patients end up needing dialysis, the Department of Health will be exploring the adequacy of the current supply of dialysis machines.

Department of Health

With long-term-care facilities now accounting for approximately 50 percent of COVID-19 deaths in Pennsylvania. The Department of Health’s web site now tracks cases and deaths associated with nursing homes and personal care homes.  Go here and scroll about two-thirds of the way down the page.

Department of Community and Economic Development

The Department of Community and Economic Development has established a business-to-business exchange through which health care organizations seeking N95 masks, fabric and other masks, surgical and procedure masks, and thermometers can identify and do business with Pennsylvania companies that sell such supplies.

Pennsylvania Emergency Management Agency

The Wolf administration has launched an online portal for individuals, corporations, and community organizations to inform others about critical medical supplies available for donation during the COVID-19 pandemic.

Federal Update

Congress

The House has passed H.R. 266, the $384 billion COVID-19 relief/economic stimulus bill  that includes $75 billion for health care providers and $25 billion for testing.

Department of Health and Human Services

• Providers that received an email from CMS on Sunday night informing them that they are in a COVID-19 hotspot were directed to register their information through https://www.teletracking.com/ by noon on Saturday, April 25.  Doing so does not guarantee eligibility for a share of the $10 billion that CMS announced yesterday that it would be distributing among providers that have been hit hard by COVID-19 but failing to provide the requested information will exclude providers from eligibility.  Only providers that received the Sunday night email from CMS can submit the information to the site.
• The Department of Health and Human Services has updated its CARES Act Provider Relief Fund web page to include new information about how it intends to distribute the final $70 billion of the $100 billion designated for hospitals in the CARES Act.  It also describes its distribution methodology and timetable for distribution in this news release.
• HHS’s Office of the Inspector General has updated its FAQ addressing the application of its administrative enforcement authority to arrangements directly connected to the COVID-19 emergency.

Centers for Medicare & Medicaid Services

• CMS has issued an FAQ on utilization management flexibilities health insurers can offer to mitigate the impact of COVID-19 on health care providers.
• CMS has updated its guidance to Medicare Advantage organizations, Part D sponsors, and Medicare-Medicaid plans to further expand on a number of flexibilities they may implement during COVID-19 public health emergency to support efforts that can help curb the spread of the virus and to help ensure Medicare Advantage and Part D enrollees do not experience disruptions in care or disruptions in pharmacy and prescription drug access.
• CMS has updated its guidance for infection control and prevention of COVID-19 for home health agencies and religious non-medical health care institutions that make home health visits, including those that enter non-Medicare-licensed facilities.
• CMS has established a new toolkit for states to help accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the COVID-19 pandemic.
• CMS has extended the comment period for stakeholder response to its proposed rule titled “Medicare Program:  Comprehensive Care for Joint Replacement Model Three-Year Extension and Changes to Episode Definition and Pricing,” which was published on February 24.  The comment deadline, originally April 24, is now June 23.

Centers for Disease Control and Prevention

• The CDC has published information about how health care providers can optimize their supply of personal protective equipment.
• The CDC has posted strategies or options to optimize supplies of disposable N95 masks in health care settings when there is a limited supply.
• The CDC has updated its guidance on the decontamination of filtering facepiece respirators using contingency and crisis capacity strategies.
• The CDC has published information about contact tracing and COVID-19.
• The CDC has posted a tool for individuals to assess and manage their risk based on different exposures to COVID-19.
• The CDC has updated its FAQ on children and COVID-19.
• The CDC has published information for health care providers about pregnant women and COVID-19.

Food and Drug Administration

• The FDA has announced an enforcement policy for the use of non-invasive fetal and maternal monitoring devices to support patient monitoring during the COVID-19 crisis to expand the availability and capabilities of those devices.
• The FDA has issued an emergency use authorizations (EUAs) for monitors intended for use in hospitals to monitor adult, pediatric, and neonate patients having or suspected of having COVID-19.
• The FDA has issued EUAs for two new tests (here and here) to detect COVID-19.
• The FDA has issued guidance on its temporary policy regarding accredited third-party certification program on-site observation and certification requirements during the COVID-19 emergency.

National Governors Association

• The National Governors Association has published “Roadmap to Recovery:  A Public Health Guide for Governors.”  The 38-page document presents the organization’s plan for reopening states in a manner that preserves public safety and confidence.

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

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

The following is the latest information from state and federal regulators and others as of 4:30 p.m. on Monday, April 20.

Pennsylvania Update

Governor Wolf

Governor Wolf today announced that he was extending his stay-at-home order through May 8, at which time the state may, depending on the status of spread of COVID-19, begin permitting some industries and businesses to resume operations while still observing social distancing guidelines.  Pennsylvania’s liquor stores have begun curbside pick-up and online auto sales will be permitted to resume, with notaries doing their work online.  Construction projects would be permitted to resume on May 8.  The administration is exploring permitting some retailers to engage in curbside pick-ups but the governor acknowledged that this presented different challenges in different places.  He said the reopening of the state’s economy would be regional rather than state-wide, that some things that may be realistic in Cameron County may not be feasible in Philadelphia, and that all reopening efforts would be contingent on the progress of the COVID-19 pandemic between now and May 8.  He did not speak about anything involving health care other than to note that social distancing appears to have been effective in preventing the health care system from becoming overwhelmed at the height of the crisis.

In addition, today Governor Wolf signed S.B. 841 into law, providing flexibilities for businesses.  The bill reauthorizes the Health Care Cost Containment Council (PHC4) and requires that it study the impact of COVID-19 on hospitals and health systems.  It also:

• permits local governments to conduct remote public meetings;
• provides property tax relief by permitting taxing districts to waive late fees and penalties for property taxes paid by December 31, 2020;
• permits school districts to renegotiate contracts with service providers to ensure payment of personnel and fixed costs during the school closure; and
• permits remote notarization of documents.

Governor Wolf vetoed S.B. 613, which would have immediately reopened the state and ended the governor’s stay-in-place orders.

Daily COVID-19 Briefing

• With a one-day exception, the number of new cases reported daily has continued to decline in recent days and fell into three figures yesterday for the first time this month.
• Despite this, the death count continues to rise, although this rise can be attributed in part to a more careful analysis of death reports and decisions to link some deaths to COVID-19 that were not previously categorized that way. The overall state death toll from COVID-19 now exceeds 1200, all of them adults.
• Data on COVID-19 cases in Pennsylvania is now available on the department’s web site at the county level and at the zip code level.
• 3057 Pennsylvanians are currently hospitalized with COVID-19 and 645 of them are now on ventilators.
• 42 percent of acute-care hospital beds and 36 percent of ICU beds are currently unoccupied and nearly 70 percent of ventilators are currently available for use.
• Secretary Levine reported that the state’s hospitals are doing well and are not overwhelmed with COVID-19 patients although she noted that hospitals in the southeastern part of the state have higher-than-usual daily censuses but are still doing well.

Department of Health

• The department has issued an FAQ about the Secretary’s order directing public health safety measures for businesses permitted to maintain in-person operations.
• The department has issued interim guidelines for the implementation of practices to safeguard the health of employees who work in life-sustaining businesses.

• The department posted an FAQ on staffing resources for nursing care facilities during the COVID-19 crisis in response to requests for guidance on what staffing measures can be implemented or contemplated during the crisis. In addition, guidance is now available for facilities that wish to expand their number of beds or convert closed wings or entire facilities to support COVID-19 patients or residents. Because this latter guidance is available only through a subscription-only department message board and cannot be reached through a direct link, it is presented in its entirety below:

If a facility wishes to expand the number of beds or convert closed wings or entire facilities to support COVID-19 patients or residents, first review PA-HAN 496, Universal Message Regarding Cohorting of Residents in Skilled Nursing Facilities. If the facility’s planned strategy appears to conform with PA-HAN 496, submit a request to the Department of Health’s (Department) field office (list below). Each request will be considered on a case-by-case basis, and dialogue with the facility will occur to acquire all details needed to render a decision. To ensure the Department has the necessary information to enter into that dialogue, include at a minimum the following (if applicable) with the request:

Number of beds and/or residents impacted, including whether residents will be moved initially

Whether the beds are Medicare or Medicaid (including proof of approval from the Department of Human Services to expand the number of MA beds, if applicable)

Location and square footage (with floor plan and pictures, if appropriate)

Available equipment

Staffing levels and plan for having adequate staffing for the duration

Plan for locating residents (including care of vulnerable residents (such as dementia residents)

Description of how residents with COVID-19 will be handled (e.g., moving within the facility, admitted from other facilities, admitted from the hospital)

Plan for discontinuing use of any new, altered or renovated space upon the expiration of the Governor’s Proclamation of Disaster Emergency issued on March 6, 2020

Upon submission of the request, a representative from the Department will reach out to the facility’s contact person to discuss next steps. Questions regarding this process can be directed to the appropriate field office.

Field Office Contacts:

Michele Gresko MGRESKO@pa.gov – Scranton Field Office
Traci Duncan tduncan@pa.gov – Williamsport Field Office
Rose Martin ROMARTIN@pa.gov – Lehigh Valley Field Office
Ellen Fuller elfuller@pa.gov – Lionville Field Office
Jennifer Lyons jelyons@pa.gov – Jackson Field Office
Mary Anne Bennis mbennis@pa.gov – Norristown Field Office
Heidi McKay hmckay@pa.gov – Norristown Field Office
Kiera Price kieprice@pa.gov – Harrisburg Field Office
Renee Bergamaschi rbergamasc@pa.gov – Johnstown Field Office
Denise Scolieri dscolieri@pa.gov – Pittsburgh Field Office
Lil Agostinella – LAGOSTINEL@pa.gov – Pittsburgh Field Office

Department of Human Services

• DHS has issued a document addressing Medicaid eligibility during the COVID-19 emergency reminding providers that as authorized by the governor, anyone who was eligible for Medicaid in Pennsylvania as of March 18 will remain eligible until the end of the current emergency. Providers that encounter problems with eligibility issues when using the state’s Medicaid eligibility verification system (EVS) should advise the individual they are attempting to serve to contact their local county assistance office.
• DHS has re-posted a memo it sent to HealthChoices physical health managed care plans in March conveying the same message.

Department of State

The Department of State has extended the expiration dates of temporary permits for more health care licenses during the COVID-19 emergency.  The boards and professions to which this temporary waiver applies are:

• State Board of Massage Therapy
• State Board of Physical Therapy – physical therapists, physical therapy assistants
• State Board of Medicine – graduate physician assistants, respiratory therapists, athletic trainers, orthotic fitters, pedorthists, graduate orthotist, provisional orthotist, prosthetist graduate permits, and genetic counselor provisional licenses
• State Board of Osteopathic Medicine – respiratory therapist temporary licenses, athletic trainer temporary licenses, genetic counselor temporary provisional licenses.

Federal Update

Centers for Medicare & Medicaid Services

• CMS has issued guidance on providing non-essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with low and stable incidence of COVID-19. It views this guidance as part of phase one of the administration’s plan to reopen the U.S. economy.  See CMS’s news release on this guidance here and the guidance itself here.  Under this guidance, individual states will determine for themselves when it is appropriate to begin the “reopening” process.  As a practical matter, only Oklahoma, Texas, and Alaska, to our knowledge, have identified concrete dates for commencing the delivery of the described non-essential care.
• To ensure appropriate tracking, response, and mitigation of COVID-19 in nursing homes, CMS is reinforcing an existing requirement that nursing homes must report communicable diseases, health care-associated infections, and potential outbreaks to state and local health departments. In rulemaking that will follow, CMS is requiring facilities to report this data to the Centers for Disease Control and Prevention and Control (CDC) in a standardized format and frequency defined by CMS and CDC.  See CMS’s announcement of its intentions; a memo CMS has sent to state Medicaid agencies; and additional CDC guidance.
• In February, CMS published a rule that would change certain requirements for pre-admission screening and resident review (PASRR) to reflect updates in diagnostic criteria for mental illness and intellectual disability. Because of the COVID-19 emergency, the agency is extending the deadline for stakeholder comment from the current April 20 – today – to May 20.

Department of Health and Human Services

• HHS has published in the Federal Register a notice to inform the public that it is exercising its discretion in how it applies the privacy, security, and breach notification rules under HIPAA and that its Office of Civil Rights will not impose penalties for non-compliance with the regulatory requirements under the HIPAA rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nation-wide public health emergency.

Food and Drug Administration

• The FDA has issued a statement on the various approaches it is currently pursuing to accelerate the development of treatments for COVID-19.
• The FDA has issued a memorandum to manufacturers of face masks, health care personnel, hospital purchasing departments, distributors, and other stakeholders regarding face masks intended for use by the general public, as opposed to health care professionals. The memo addresses the purpose of such masks, how they must be labeled to prevent unauthorized and inappropriate uses, and how they must be labeled to prevent potentially harmful uses.
• The FDA has issued a temporary policy for the compounding of certain drugs for hospitalized patients by pharmacy compounders not registered as outsourcing facilities during the COVID-19 crisis.
• The FDA has issued an emergency use authorization (EUA) for a certain commercial product used to reduce pathogens and inflammatory mediators from the bloodstream of adult patients with COVID-19 and who have been admitted to a hospital intensive care unit with confirmed or imminent respiratory failure.
• The FDA has issued an EUA for a specific commercial qualitative test for the detection of nucleic acids from COVID-19 in nasopharyngeal, nasal, and mid-turbinate nasal swab specimens, bronchoalveolar lavage fluid, and sputum from individuals who are suspected of COVID-19.

Federal Emergency Management Agency

• FEMA has published a notice of exemptions to an April 10 regulation addressing the prioritization and allocation of certain scarce or threatened health and medical resources for domestic use. In the notice, FEMA details specific circumstances under which the ban against the export of certain scarce or threatened materials will not be enforced.

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

(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 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

(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 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

(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 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.)