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COVID-19 Update: April 13, 2020

The following is the latest COVID-19 information from Pennsylvania state and federal regulators, legislators, and others as of 4:00 p.m. on Monday, April 13.

Pennsylvania Update

Governor Wolf

  • Last week Governor Wolf signed an executive order to facilitate the targeted distribution of COVID-19 personal protective equipment and supplies among Pennsylvania health care providers. The Department of Health has published an FAQ on this executive order.  The state also has published a survey for health care providers to complete to help it identify current resources.  All covered entities – including hospitals – are required to report inventories of the specified supplies, equipment, and pharmaceuticals by 11:59 p.m. on Thursday, April 16.  The state will update and direct completion of the survey in the future as needed.
  • Governor Wolf today announced that he and the governors of New York, New Jersey, Connecticut, Delaware, and Rhode Island will create a multi-state council to “…develop a fully integrated regional framework to gradually lift the states’ stay at home orders while minimizing the risk of increased spread of the [COVID-19] virus.” See the governor’s announcement here.

General Assembly

Harrisburg, PA capital buildingOver the weekend, House Speaker Michael Turzai changed the House of Representatives’ session schedule to hold a non-voting session day today and a voting session day tomorrow in an effort to enable Republicans to move forward with relief efforts for businesses related to the COVID-19 crisis.  There has been speculation that if a quorum is present the Speaker may seek to suspend temporary House rules permitting remote voting to ease the passage of Republican-sponsored relief measures for businesses affected by limits on their ability to operate during the COVID-19 emergency.  The House also has canceled its session for Wednesday and Thursday of this week.

Both the House and Senate are scheduled to return to session on May 4.

Daily Department of Health COVID-19 Briefing

  • In the past few days the number of newly reported COVID-19 cases has declined slightly, leading Department of Health Secretary Levine to declare that “social distancing is working.” The new case increase, she explained, is now linear rather than exponential, although she warned that Pennsylvania may not yet have reached its peak.
  • 1179 health care workers have been diagnosed with COVID-19, which is about four percent of the total state case count.
  • 1688 residents of 215 long-term-care facilities have tested positive as well.
  • Currently 2205 people are in hospitals to be treated for COVID-19 and 665 of them are on ventilators.
  • Across the state, 44 percent of acute-care beds and 38 percent of ICU beds remain unoccupied and nearly 70 percent of ventilators are available for use.
  • The state still lacks testing supplies so only those who are symptomatic are being tested. Secretary Levine hopes to do population-based testing in the future but does not expect to be able to do it in the near future.
  • Serology testing is not available at this time.
  • Governor Wolf spoke to Vice President Pence this morning and reports that the state will be receiving a shipment of N95 masks later this week.
  • Eventually the state hopes to follow up on those who have been discharged from hospitals after being treated for COVID-19 but is not doing that now.
  • While there have been published reports of people who seem to have recovered from COVID-19 suffering relapses, Pennsylvania has not seen any such cases yet.
  • When asked if the state planned to take any additional measures to help hospitals, Secretary Levine pointed to the health care provider money in the federal CARES Act and the $450 million loan program Governor Wolf announced last week.
  • During her Saturday briefing, Secretary Levine said that Philadelphia and southeastern Pennsylvania have enough acute-care beds, ICU beds, and ventilators right now.
  • She also said there could be a surge in southeastern and northeastern Pennsylvania over the next week, with possible surges in western and southeastern Pennsylvania coming later.

Hospital Emergency Loan Program

Late last week Governor Wolf announced a $450 million Hospital Emergency Loan Program.  The state’s Department of Community and Economic Development, which is administering the program, describes it as follows:

The Hospital Emergency Loan Program (HELP) was established to provide critical working capital bridge financing to hospitals located within the Commonwealth that are adversely impacted by the coronavirus (COVID-19) outbreak. The loan funds are intended to provide a short-term financing solution for hospitals until federal grant funding through the Coronavirus Aid Relief, and Economic Security (CARES) Act is received by the hospitals. The program is administered by the Pennsylvania Department of Community and Economic Development (DCED) through the Pennsylvania First Program (PA First).

Go here for a more detailed description of the program and go here to apply for a loan.

Children’s Health Insurance Program

The state’s CHIP program has announced changes in its program requirements that seek to ease access to CHIP and keep families enrolled in CHIP during the duration of the COVID-19 emergency.

Pennsylvania Hospitals and the CARES Act

Pennsylvania Senator Pat Toomey’s office reports that the state’s hospitals will receive $1.2 billion of the $30 billion now being distributed by the federal government to hospitals and health care providers.  The $30 billion comes from $100 billion that the CARES Act designated for health care providers.  A second round of funding is expected.

Pennsylvania Department of Labor and Industry

The Wolf administration has issued a news release summarizing the new federal unemployment compensation benefits established under the CARES Act, including eligibility and payment information.

Federal Update

Department of Health and Human Services

Centers for Medicare & Medicaid Services

Department of Labor

Food and Drug Administration

Centers for Disease Control and Prevention

National Institutes of Health

Medicaid and CHIP Payment and Access Commission

  • MACPAC has written to CMS administrator Seema Verma to express its concern that the manner in which CMS has chosen to distribute $30 billion of the $100 billion designated in the CARES Act for hospitals and health care providers “…does not account for the real and pressing concerns of safety-net providers that are on the frontlines of serving the nation’s poorest and most vulnerable people…” MACPAC also asks Ms. Verma to “…ensure that safety-net providers, including hospitals considered deemed disproportionate share hospitals (DSH) for the purpose of Medicaid payment…children’s hospitals, and other providers serving Medicaid and other low-income patients have access to federal funds made available through the CARES Act without delay.”  See the MACPAC letter here.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

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

 

2020-04-14T06:00:15+00:00April 14th, 2020|Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus|Comments Off on COVID-19 Update: April 13, 2020
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SNAP Asks HHS for More Coronavirus Grants

Private safety-net hospitals should be among high-volume Medicaid providers that receive priority consideration in the distribution of additional grants from the CARES Act, SNAP has written in a letter to Centers for Medicare & Medicaid Services Administrator Seema Verma.

Safety-Net Association of Pennsylvania logoWith CMS already conceding that high-volume Medicaid providers may be shortchanged in the initial distribution of funds from the $100 billion designated for hospitals and health care providers in the CARES Act, SNAP asked Ms. Verma to “…acknowledge the special needs of these hospitals and the roles they play in their communities by ensuring that they will receive much-needed assistance in the second round of grants as well.”

See SNAP’s letter here.

2020-04-12T06:00:57+00:00April 12th, 2020|Coronavirus, COVID-19, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off on SNAP Asks HHS for More Coronavirus Grants
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SNAP Asks PA Delegation for More COVID-19 Funding

More federal funding is needed for hospitals that serve especially high proportions of Medicaid patients and patients insured by government programs, the Safety-Net Association of Pennsylvania has written to members of the state’s congressional delegation.Safety-Net Association of Pennsylvania logo

This is especially important now, SNAP emphasized in its letter, because of new plans to use some of the $100 billion designated for hospitals and health care providers in the federal CARES Act to pay instead for care for uninsured patients who contract COVID-19.  Those payments, which SNAP supports, do not address the needs for which the original $100 billion was designated:  to help hospitals – including Pennsylvania safety-net hospitals – with the cost of the investments they made to prepare for the expected influx of COVID-19 patients and to help them with cash flow challenges arising from the loss of revenue associated with suspending elective procedures.

See SNAP’s letter to Pennsylvania’s congressional delegation here.

2020-04-10T13:00:10+00:00April 10th, 2020|Coronavirus, COVID-19|Comments Off on SNAP Asks PA Delegation for More COVID-19 Funding
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COVID-19 Update: April 9, 2020

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

Pennsylvania Update

Safety-Net Association of Pennsylvania logoSNAP Advocacy for Additional COVID-19 Funding for Safety-Net Hospitals

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

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

Department of Health Daily Briefing

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

Department of Human Services

Department of Drug and Alcohol Programs

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

Federal Update

Centers for Medicare & Medicaid Services

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

See an  updated list of the section 1135 waivers CMS has granted to help states and health care providers respond to the COVID-19 crisis.

National Institutes of Health

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

Department of Health and Human Services

Food and Drug Administration

Federal Emergency Management Agency

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

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

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

2020-04-09T17:22:15+00:00April 9th, 2020|Coronavirus, COVID-19|Comments Off on COVID-19 Update: April 9, 2020
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COVID-19 Update, April 7, 2020

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

Pennsylvania Update

Department of Health Daily Briefing

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

Department of Health

Department of Human Services

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

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

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

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

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

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

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

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

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

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

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

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

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

Department of Aging

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

Department of State

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

General Assembly

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

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

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

Federal Update

Department of Labor

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

Centers for Medicare & Medicaid Services

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

Food and Drug Administration

Centers for Disease Control and Prevention

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

Substance Abuse and Mental Health Services Administration

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

Department of Health and Human Services

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

White House

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

National Association of Medicaid Directors

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

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

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

 

2020-04-07T17:29:51+00:00April 7th, 2020|Coronavirus, COVID-19|Comments Off on COVID-19 Update, April 7, 2020
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COVID-19 Update: April 6, 2020

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

Pennsylvania Update

The Governor Wolf/Department of Health Daily Briefing

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

Department of Health

Department of Human Services

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

Office of the Treasury

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

Federal Update

Centers for Medicare & Medicaid Services

Food and Drug Administration

Occupational Safety and Health Administration

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

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

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

The White House

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

American Medical Association

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

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

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

2020-04-06T17:39:05+00:00April 6th, 2020|Coronavirus, COVID-19|Comments Off on COVID-19 Update: April 6, 2020
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COVID-19 Update: March 31, 2020

Coronavirus Update: March 31, 2020.

COVID-19-related developments in Pennsylvania as of 4:00 p.m. on Tuesday, March 31.  To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.

State Update

Governor Wolf                                                                                                     

Today, Governor Wolf announced that the President approved part of his request for a major disaster declaration to support state, county, and local responses to COVID-19.  Included in the approved requests are reimbursement of up to 75 percent of eligible expenses (staff overtime, supplies, equipment) related to COVID-19 response for all levels of state government and private non-profits that qualify and direct federal assistance for materials and supplies to state and local governments.  Staff from the Pennsylvania Emergency Management Agency will be contacting potential applicants in the coming weeks.

The governor also expanded his ‘Stay at Home’ order to include seven more counties to mitigate the spread of the virus:  Cameron, Crawford, Forest, Franklin, Lawrence, Lebanon, and Somerset counties until April 30 for all 33 affected counties.

State Daily COVID-19 Briefing

  • There are now positive cases of COVID-19 in 60 of Pennsylvania’s 67 counties.
  • Five percent of the total 4,843 cases are affected health care workers while fewer than one percent are nursing home-related.
  • The administration continues to monitor the impact of the virus on New York and to prepare Pennsylvania for the expected surge of positive cases by stockpiling supplies, providing regulatory relief for health care professionals, seeking health care volunteers, and monitoring the availability of ICU and nursing home beds throughout the state.
  • About 40 percent of the licensed ICU beds in the state are still unoccupied.  The Department of Health continues to monitor the availability of ventilators as well.

Department of Health

The Department of Health released interim guidance on licensing and survey activities consistent with the guidance issued by CMS calling for states to prioritize provider survey and certification activities during the pandemic.

DOH also shared a guidance document from CMS, counseling state surveyors on how providers can limit the transmission of the virus and a CMS memo specifically related tor limiting the spread within dialysis facilities.

Department of Human Services, Office of Children Youth and Families

The Office of Children, Youth, and Families (OCYF) has developed these linked recommendations for entities operating as a Child Residential and Day Treatment Facility.

Department of Human Services, Office of Mental Health and Substance Abuse Services

The Office of Mental Health and Substance Abuse Services (OMHSAS) issued guidance for County Emergency Behavioral Health/Disaster Crisis Outreach and Referral Teams.  That guidance can be found here.

In addition, the office shared documents from the Center for the Study of Traumatic Stress related to the psychological effects of quarantine.  One for helping homebound children, one directed at Public Health leaders, and one directed at health care providers.

Yesterday the federal Centers for Medicare & Medicaid Services (CMS) published a major update of Medicare and Medicaid regulations that included blanket waivers of a large number of Medicare and Medicaid regulations and requirements.  The following is a summary of the major aspects of this new regulation.

Federal Update

New Policies and Waivers From Medicare and Medicaid Regulations and Requirements

CMS has introduced dozens of changes that involve waivers from current regulations and requirements.  A comprehensive, 26-page CMS document describing these changes can be found here and below are the highlights organized into four broad categories:

  • increasing hospital capacity (what CMS calls “hospitals without walls”)
  • expanding the health care workforce
  • increasing the use of telehealth in Medicare
  • reducing paperwork

Increasing Hospital Capacity

  • CMS is waiving the enforcement of section 1867(a) of EMTALA to permit hospitals to screen patients at off-site locations to help prevent the spread of COVID-19.
  • CMS is waiving certain requirements under the Medicare conditions of participation allow for flexibilities during hospital and psychiatric hospital surges, permitting non-hospital buildings/space to be used for patient care and quarantine sites.
  • For the duration of the public health emergency, CMS is waiving certain requirements under the Medicare conditions of participation and the provider-based department requirements to permit hospitals to establish and operate as part of the hospital any location meeting those conditions of participation for hospitals that continue to apply during the public health emergency. This waiver also permits hospitals to change the status of their current provider-based department locations to the extent necessary to address the needs of hospital patients.
  • CMS is waiving requirements to permit acute-care hospitals to house acute-care inpatients in excluded distinct part units, such as excluded distinct part unit inpatient rehabilitation facilities or inpatient psychiatric facilities, where the distinct part unit’s beds are appropriate for acute-care inpatients.
  • CMS is permitting acute-care hospitals with excluded distinct part inpatient psychiatric units to relocate inpatients from the excluded distinct part psychiatric unit to acute-care beds and units as a result of a disaster or emergency.
  • CMS is permitting acute-care hospitals with excluded distinct part inpatient rehabilitation units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct part rehabilitation unit to an acute-care bed and unit.
  • CMS is waiving certain physical environment requirements. Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements to allow for a non-skilled nursing facility building to be temporarily certified and available for use by a skilled nursing facility in the event there are needs for isolation processes for COVID-19-positive residents, which may not be feasible in the existing skilled nursing facility structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults.
  • CMS is waiving certain conditions of participation and certification requirements for opening a nursing facility if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.
  • CMS is waiving requirements to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity.

Expanding the Health Care Workforce

  • CMS is waiving current requirements to permit physicians whose privileges will expire to continue practicing at the hospital and for new physicians to be able to practice before full medical staff/governing body review and approval to address workforce concerns related to COVID-19.  CMS also is waiving requirements about details of the credentialing and privileging process.
  • CMS is waiving the requirement that Medicare patients be under the care of a physician.
  • CMS is waiving requirements that a certified registered nurse anesthetist (CRNA) work under the supervision of a physician. CRNA supervision will be at the discretion of the hospital and state law.
  • CMS is waiving the requirement that a skilled nursing facility and nursing facility may not employ anyone for longer than four months unless they meet current training and certification requirements. CMS is not waiving the requirement that such facilities ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs.
  • CMS is waiving the requirement that physicians and non-physician practitioners must perform in-person visits for nursing home residents and will permit visits to be conducted, as appropriate, via telehealth options.
  • CMS is temporarily waiving requirements that out-of-state practitioners be licensed in the state where they are providing services when they are licensed in another state. CMS will waive the physician or non-physician practitioner licensing requirements when the following four conditions are met:
    • must be enrolled as such in the Medicare program;
    • must possess a valid license to practice in the state which relates to his or her Medicare enrollment;
    • is furnishing services – whether in person or via telehealth – in a state in which the emergency is occurring to contribute to relief efforts in his or her professional capacity; and,
    • is not affirmatively excluded from practice in the state or any other state that is part of the 1135 emergency area.
    • This does not have the effect of waiving state or local licensure requirements or any requirement specified by the state or a local government as a condition for waiving its licensure requirements.
  • CMS has a toll-free hotline for physicians and non-physician practitioners and Part A-certified providers and suppliers establishing isolation facilities to enroll and receive temporary Medicare billing privileges. CMS is waiving the following screening requirements:
    • application fee,
    • criminal background checks associated with fingerprint-based criminal background checks,
    • site visits,
    • postpone all revalidation actions,
    • allow licensed providers to render services outside of their state of enrollment,
    • expedite any pending or new applications from providers,
    • allow physicians and other practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location, and
    • allow opted-out physicians and non-physician practitioners to terminate their opt-out status early and enroll in Medicare to provide care to more patients.
  • CMS has issued blanket waivers of sanctions under the Stark Act.  The blanket waivers may be used now without notifying CMS.  Individual waivers of sanctions under section 1877(g) of the Act may be granted upon request.  For more information, go here and here.

Increasing the Use of Telehealth in Medicare

  • CMS is waiving the requirement that physicians and non-physician practitioners must perform in-person visits for nursing home residents and will permit visits to be conducted, as appropriate, via telehealth options.
  • Clinicians can provide virtual check-in services to new and established patients.
  • CMS will pay for telephone evaluation and management services provided by physicians and the same services provided by qualified non-physician health care providers. These services may be used for telephone-only evaluation and management services.
  • Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists can perform e-visits via telehealth.
  • Limits have been lifted for subsequent inpatient visits, subsequent skilled nursing visits, and critical care consult codes.
  • Physicians may provide supervision virtually using real-time audio/visual technology for services that require direct supervision by a physician or other type of practitioner.
  • For additional information on new flexibilities in the use of telehealth for Medicare patients, go here.

Reducing Paperwork

  • CMS is waiving various requirements that limit and define the use and documentation of verbal orders in a hospital.
  • CMS is waiving reporting requirements when patients who have passed away required soft restraints prior to their death.  If restraints were a factor in the death, the usual reporting requirements apply.
  • CMS is waiving the current requirements for providing “detailed information” in discharge planning as long as discharging hospitals continue to provide the data patients and their families need to make decisions about appropriate post-acute care.  This does not waive the requirement that patients have all of the necessary medical information they need for their post-acute setting.
  • While maintaining the discharge planning requirements that ensure that patients are discharged to an appropriate setting with the necessary medical information, CMS is waiving some of the specific components of discharge information acute-care hospitals are ordinarily required to provide.
  • CMS is waiving requirements involving the organization and staffing of medical records departments and requirements for the form and content of medical records and is allowing for flexibility in completion of medical records within 30 days following discharge from a hospital.
  • CMS is waiving the requirements for hospitals to provide information about their advance directive policies to patients.
  • CMS is waiving the requirement that hospitals participating in Medicare and Medicaid must have a utilization review plan that meets specified requirements. CMS is waiving the entire utilization review condition of participation.
  • CMS is waiving – for “surge facilities” only – the requirement that the emergency services function operate according to written policies and procedures during surge periods.
  • CMS is waiving the requirement that hospital emergency preparedness policies and procedures include specified elements for the emergency preparedness communication plans of hospitals when a hospital is a surge site.
  • CMS is waiving requirements for hospital quality assessment and performance improvement programs that address the scope of the program, the incorporation and setting of priorities for the program’s performance improvement activities, and integrated quality assurance and performance improvement programs. The requirement that hospitals maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement program remains.
  • CMS is waiving the requirement that providers must have a current therapeutic diet manual approved by the dietitian and medical staff readily available to all medical, nursing, and food service personnel. Such manuals would not need to be maintained at surge capacity sites.
  • CMS is waiving the requirement for nursing staffs to develop and keep current a nursing care plan for each patient and to have policies and procedures in place establishing which outpatient departments are not required to have a registered nurse present.
  • Completed 2019 Occupational Mix Surveys, Hospital Reporting Form CMS-10079, for the Wage Index Beginning FY 2022, are due to the Medicare Administrative Contractors (MACs). CMS is granting an extension for hospitals nationwide affected by COVID-19 until August 3, 2020.
  • CMS is waiving requirements that govern pre-admission screening and annual resident review (PASARR) to permit states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness or intellectual disability should receive the assessment as soon as resources become available.
  • CMS is waiving many paperwork requirements for home health agencies, skilled nursing facilities, nursing facilities, end-stage renal dialysis facilities, home health agencies, and hospices. Find those changes here (pages 9-16).
  • Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) in the fee-for-service program may allow extensions to file an appeal. CMS is allowing MACs and QICs in the fee-for-service program and the MA and Part D independent review entities (IREs) to:
    • waive requests for timeliness requirements for additional information to adjudicate appeals;
    • process appeals even with incomplete appointment of representation forms;
    • process requests for appeals that do not meet the required elements using information that is available; and
    • use all flexibilities available in the appeal process if good cause requirements are satisfied.

Others

  • CMS offers stakeholders examples of section 1135 waivers available to individual providers.  Find those examples here beginning on page 23.
  • CMS is waiving certain patient rights involving copies of medical records, patient visitation limits, and quarantine processes in states that have had more than 50 confirmed COVID-19 cases.

For further information:

To learn more about these changes, you may wish to consult the following resources:

The following is the latest information from the administration and federal regulators as of 4:30 today.

The White House

President Trump has issued a presidential memorandum to the Secretary of Defense and the Secretary of Homeland Security authorizing the use of the National Guard to provide COVID-19-related services to the states of Connecticut, Illinois, Massachusetts, and Michigan, with the federal government to pay 100 percent of the cost of such a deployment.  The federal assumption of 100 percent of this cost expires in 30 days.

Centers for Medicare & Medicaid Services

Department of Health and Human Services

The Department of Health and Human Services has posted a news release in which it outlines the steps it has taken and will be taking to accelerate clinical trials for possible COVID-19 vaccines and to prepare for the manufacture of approved vaccines.

U.S. Public Health Service

The U.S. Public Health Service has issued a letter on optimizing ventilator use during the COVID-19 pandemic.

Food and Drug Administration

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

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

2020-03-31T20:58:06+00:00March 31st, 2020|Coronavirus, COVID-19, Federal Medicaid issues, Medicare|Comments Off on COVID-19 Update: March 31, 2020
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COVID-19 Update: March 30, 2020

COVID-19-related developments in Pennsylvania as of 4:00 p.m. on Monday, March 30.  To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.

State Update

Governor Wolf

  • On Saturday the governor requested a major disaster declarationfrom the President to provide additional support for state, county, and municipal governments, certain non-profits, and individuals who are struggling during the COVID-19 outbreak.
  • Over the weekend Governor Wolf expanded his ‘Stay at Home’ order to include three more counties to mitigate the spread of the virus:  Beaver, Centre, and Washington counties.  Today, he added four more counties to the order:  Carbon, Cumberland, Dauphin, and Schuylkill counties and extended the order to April 30 for all 26 affected counties.  The governor’s amended order, the secretary of health’s amended order, and the stay at home guidance are available online.
  • Today Governor Wolf announced that all schools and non-life-sustaining businesses will remain closed until further notice.

Governor’s Daily Briefings

  • Four percent of all cases are health care workers.
  • The COVID-19 death rate is now more than 10 percent. All deaths so far have been adults.
  • Over the weekend nine Pennsylvania counties experienced their first cases, so the total is now cases in 59 counties.
  • There are people with COVID-19 in about five percent of the state’s nursing homes (36 out of 695); most of those cases are in southeastern Pennsylvania.
  • Two field hospitals will be established in southeastern Pennsylvania through an effort led by the Federal Emergency Management Agency (FEMA).
  • 40 percent of the state’s ICU beds are currently unoccupied.
  • The state has more than 4000 ventilators in hospitals and other facilities, has an unstated number in its own stockpile, and has purchased more that should be arriving shortly. Governor Wolf said that if the state could add 1400 more ventilators he thinks it would be in good shape.
  • Based on the criteria the state currently employs for who is to be tested, the supply of testing materials in the state is adequate for now.
  • Governor Wolf said there has been no discussion about limiting or prohibiting New Yorkers from entering Pennsylvania.
  • The governor acknowledged reports of residents of New York coming to Pennsylvania for health care and specifically mentioned reports of increased newborn deliveries in Philadelphia by women from New York. He offered no numbers.  He said no hospitals have reported an unmanageable surge of patients as a result.
  • Governor Wolf said that he and his staff are still trying to figure out how much money the latest stimulus law will bring to Pennsylvania and when that money might arrive.  It will come in a lot of buckets, he said.  They expect about $5 billion but have no idea yet on how it might be allocated.

Pennsylvania Department of Health

The Department of Health sent a reminder to providers through its message board to report all initial “Activation of Internal/External Emergency Plan.”  Providers may submit additional reports as updates if necessary and must report under ‘Health Department Reportable Disease’ all COVID-19 positive test results for staff and patients including name, date of birth, symptoms (if known), and date of test results.

Department of Human Services

Protocols for Procuring Difficult-to-Source Personal Protective Equipment

The protocol for procuring difficult-to-source PPEs is:

  • Your first contact should be with your regional health care coalition (HCC).  HCC contacts can be found at the bottom of the web page linked here.
  • The HCC may decide to forward a formal request to the County Emergency Management Agency.  Agency contact information can be found here.
  • At that point, the County Emergency Management Agency may submit a resource request to the Pennsylvania Emergency Management Agency (PEMA).

Federal Update

The White House

Centers for Medicare & Medicaid Services

Department of Health and Human Services

The HHS Office of Inspector General (OIG) published a statement regarding the discretion the OIG will employ when investigating any conduct during this emergency that may be subject to OIG administrative enforcement. The office also advised providers to contact the OIG for extension of any OIG investigation deadlines during this time.

Food and Drug Administration

Department of Veterans Affairs

The U.S. Department of Veterans Affairs has published its emergency response plan for the COVID-19 emergency.

Environmental Protection Agency

The EPA has published a memo outlining the discretion it intends to exercise in fulfilling its inspection and compliance efforts during the COVID-19 emergency.

Department of Homeland Security

In a new document with guidance on the essential critical infrastructure workforce, the Department of Homeland Security specifies essential jobs within the workforce during the COVID-19 emergency.

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

Pennsylvania Emergency Preparedness Guide

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.

 

 

 

 

 

 

 

2020-03-30T17:50:01+00:00March 30th, 2020|Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid COVID-19, Uncategorized|Comments Off on COVID-19 Update: March 30, 2020
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COVID-19 Update: March 27, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania as of 4:30 p.m. on March 27.

Pennsylvania Updates

Governor Wolf

  • Today Governor Wolf expanded his ‘Stay at Home’ order to include nine more counties to mitigate the spread of the virus:  Berks, Butler, Lackawanna, Lancaster, Luzerne, Pike, Wayne, Westmoreland, and York counties.  The governor’s amended order, the secretary of health’s amended order, and the stay at home guidance are available online.  The order takes effect for these nine counties tonight at 8:00 p.m. and will continue for all of the affected counties until April 6.
  • Today Governor Wolf approved and signed several bills into law to provide emergency relief to schools (SB 751), unemployment compensation rules (HB 68), delaying the primary election (SB 422), and the $50 million in immediate funding for health care supplies via HB 1232.  We do not yet know how this funding will be distributed but are monitoring it closely.  According to the enabling legislation and a press release Governor Wolf issued yesterday, “The $50 million in funding will be deposited into a restricted account under the governor’s jurisdiction and funds will be used if there are insufficient funds available from the disaster proclamation ‘to buy medical equipment and supplies for health care entities to meet urgent patient and staff needs to address surge demand. Health care entities include hospitals, nursing facilities and emergency medical services’.”

Department of Human Services

  • The Department of Human Services (DHS) has published a reminder that Governor Wolf has signed an executive order prohibiting elective medical and surgical procedures for the duration of the COVID-19 crisis.
  • Pennsylvania has been granted a section 1135 Medicaid waiver by the federal government. Key elements of the waiver address:
    • Temporarily suspending Medicaid fee-for-service prior authorization requirements.
    • Extending pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
    • Suspending Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
    • State Fair Hearing Requests and Appeal Timelines.
    • Provider Enrollment.
    • Provision of Services in Alternative Settings.

These waivers will remain in effect until the current health crisis ends.  See the letter from CMS to the state that explains all of these aspects of the waiver in greater detail.

Department of Health

  • During her daily briefing today, Secretary Levine reported that the number of new COVID-19 cases in Pennsylvania yesterday declined slightly from the day before, although she dismissed this decline as “not statistically significant.”  There are now COVID-19 cases in 50 of Pennsylvania’s 67 counties.  While the number of hospitalizations, ICU cases, and patients put on ventilators remain low, she said those numbers remain in line with trends elsewhere in the country and her department’s own projections.
  • The department has revised its guidance prohibiting the provision of dental treatment except for urgent and emergency services.

Department of State

The Department of State requested, and Governor Wolf granted, an extension for 90 days of certain license renewal deadlines that fall between April 30, 2020, and June 30, 2020.  Affected boards include the State Board of Medicine, State Board of Nursing, and State Board of Examiners of Nursing Home Administrators.  Any associated regulations that establish these dates are temporarily suspended.  While the department will provide guidance encouraging licensees to renew on time, if possible, this waiver ensures that if they miss the deadline their licenses will remain valid and they will have an additional 90 days to renew them.

Federal Updates

Congress

The House of Representatives passed the $2 trillion Coronavirus Aid, Relief, and Economic Security Act passed by the Senate late Wednesday.  It now goes to the president for his signature and he has indicated he will sign it.

President Trump

President Trump sent a letter to governors thanking them for their efforts in fighting the COVID-19 emergency, outlining upcoming federal efforts, and expressing hope for the future.

Department of Health and Human Services

Centers for Medicare & Medicaid Services

Centers for Disease Control and Prevention

Food and Drug Administration

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

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

 

2020-03-27T17:25:53+00:00March 27th, 2020|Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19|Comments Off on COVID-19 Update: March 27, 2020
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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

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page FAQ

 

 

 

2020-03-27T06:00:57+00:00March 27th, 2020|Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid COVID-19|Comments Off on COVID-19 Update: March 26, 2020
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