COVID-19 Update: April 14, 2020

The following is the latest COVID-19 information from Pennsylvania state regulators, the Pennsylvania legislature, and federal regulators and others as of 4:00 p.m. on Tuesday, April 14.

Pennsylvania Update

Governor Wolf

Governor Wolf today announced that businesses that collect Pennsylvania sales tax will not have to make accelerated sales tax pre-payments over the next three months. That means businesses that normally have a monthly prepayment requirement will not be charged penalties for missing the prepayment deadline during this three-month period.

Daily COVID-19 Briefing

For the fourth time in the last five days, the number of newly reported cases fell. Today’s total was the lowest in nearly two weeks.
But the death count was the third highest single-day total since the pandemic began. Secretary Levine warned that this could be because of reports still coming in from the weekend.
1250 health care workers have tested positive for COVID-19, as have 1869 residents of 232 long-term-care facilities.
42 percent of acute-care beds and 37 percent of ICU beds remain unoccupied and nearly 70 percent of ventilators are still available for use.
To date, about one percent of the state’s population has been tested for COVID-19, with nearly 20 percent testing positive.
2306 COVID-19 patients are currently in the hospital, 666 of them on ventilators.
Demographic data on race and ethnicity is still proving elusive. (See the paragraph below about the department’s alert on this subject.)
A mass testing site should be opening in East Stroudsburg later this week or next week. It will focus on testing health care workers and seniors. There are not enough testing materials to test those without symptoms.
An alternative care facility in East Stroudsburg will serve patients who are on the road to recovery from COVID-19, to free hospital beds for more seriously ill patients.
In no part of the state are hospitals overwhelmed at this time. The state is keeping a close eye on this.
Yesterday the state shipped a “large push-out” of personal protective equipment to providers.
The secretary attributed the decline in the number of daily tests administered to the closing of the mass testing site in Philadelphia and the temporary closing of the mass testing site in Montgomery County.

Department of Health

The Department of Health, working with the Hospital and Healthsystem Association of Pennsylvania, has published a revised Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines Work on this document started last fall and not in response to the COVID-19 public health emergency and is viewed by the Department of Health as a work in progress that will resume once the current pandemic ends. The purpose of the document, it states, “…is to help guide the allocation of patient care resources during an overwhelming public health emergency of any kind when demand for services dramatically exceeds the supply of resources needed.”
The department has issued an alert to laboratories after identifying a large number of laboratory test results submitted without key variables such as patient date of birth, address, and telephone number. In addition, the alert notes that race and ethnicity data is missing from more than 60 percent of reports submitted. In the alert, the department directs laboratories to include all of this data in the reports they submit to the Department of Health. Recipients of this alert included hospitals, EMS councils, local health jurisdictions, professional organizations, and long-term-care facilities.

Department of Human Services

DHS has issued a memorandum to HealthChoices physical health managed care organizations to introduce a new ICD-10-CM code for COVID-19.
DHS has issued a CHIP policy clarification addressing provider enrollment and revalidation changes during the COVID-19 crisis. The new policy makes it easier for providers not currently enrolled to serve CHIP patients to do so and enables providers who have not re-enrolled to serve CHIP patients to continue doing so.

Department of State

The Department of State has issued a number of pharmacy-related waivers in response to the COVID-19 emergency. The waivers address:
- patient signature requirements for pharmaceuticals
- pharmacy interns about to graduate
- pharmacy intern certificate term limits and pharmacy “resident” guidance
- pharmacist authority to carry out COVID-19 testing
- pharmacy alternative care sites
- increased prescribing limits for nonscheduled legend drugs and schedule V controlled substances
The Department of State has suspended certain supervision requirements for physical therapists, occupational therapists, speech language pathologists, and audiologists during the COVID-19 emergency.

Department of Labor

The state’s Department of Labor has established a new hiring portal on which employers in life-sustaining businesses can advertise job openings. Employers may advertise on the site if they are formally considered life-sustaining businesses and have at least 10 jobs to offer. The process begins with completing an employer intake form. A number of health care entities already list jobs on the site.

General Assembly

Today the House of Representatives met to continue considering legislation that would create a pathway for businesses to reopen despite the governor’s executive order mandating the closure of non-essential businesses. Arguments on the floor and in committee meetings fell along party lines, with Republicans advocating the reopening of businesses and Democrats wanting to continue following the governor’s orders. Ultimately the House passed along party lines SB 613, which primarily provides for the creation of a COVID-19 emergency mitigation plan for businesses.

The House is also expected to pass, in concurrence with Senate amendments, SB 841, which reauthorizes the Pennsylvania Health Care Cost Containment Council (PHC4) Act by adding data collection requirements and other measures in response to the COVID-19 emergency.

The Senate announced today that it will return to session this week to “consider legislation that will provide a safe path for re-opening the state’s economy.” This came in response to Governor Wolf’s announcement yesterday that he is participating in a multi-state effort to begin planning for next steps beyond stay-at-home orders and for re-opening the state’s economy.

Federal Update

Centers for Medicare & Medicaid Services

CMS has posted a new FAQ on the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act). Among other subjects, this FAQ addresses the emergency period described in the Families First law; the new optional Medicaid eligibility group; benefits and cost-sharing for COVID-19-related testing and diagnosis; implications for the CHIP program; implications for the basic health program; changes in federal medical assistance matching funds (FMAP) adopted under the Families First bill; circumstances under which FMAP will be 100 percent; and further information about the CARES Act.
The Kaiser Family Foundation has published a “Medicaid emergency authority tracker” that is an interactive map identifying approved section 1135 waivers, Medicaid disaster relief state plan amendments, and section 1915 Appendix K waivers. The site also offers brief descriptions of the emergency authorizations CMS has granted.
CMS has updated its list of the section 1135 waivers it has granted to states.
CMS has postponed the 2019 benefit year HHS risk adjustment data validation (HHS-RADV) process to enable insurers and providers to focus on COVID-19-related activities.
CMS has advised state survey agency directors about new, temporary flexibility in the transfer or discharge of skilled nursing facility or nursing facility patients for COVID-19-related reasons. In general, if two or more certified long-term-care facilities want to transfer or discharge residents between themselves for the purpose of cohorting, based on their COVID-19 status, they do not need any additional approval to do so. This same flexibility does not apply if one of the two facilities in such transfers is not certified.

Department of Health and Human Services

HHS is issuing an amendment to its declaration under the public readiness and emergency preparedness act for medical counter-measures against COVID-19 to extend liability immunity for activities related to medical counter-measures against COVID-19 authorized under the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act).
HHS has announced that it will collaborate with multiple non-government organizations on the development of convalescent plasma and hyperimmune globulin immunotherapies that would use antibodies from COVID-19 survivors to treat COVID-19 patients.

Drug Enforcement Administration

The DEA has published a letter that grants to the satellite hospitals and clinics of DEA-registered hospitals, under certain conditions, the flexibility to receive and administer certain controlled substances. The DEA also is permitting the distributors of controlled substances to deliver them directly to such facilities.
The DEA is granting a temporary exception to the requirement that only licensed practitioners may sign for the delivery of narcotics at narcotic treatment programs to permit an alternative authorized individual to sign for such deliveries if certain conditions are met.
Under current law, the quantity of controlled substances that registered dispensers of such substances may distribute to other practitioners may not exceed five percent of the total number of dosage units of all controlled substances those individual dispensers distribute in a year. The DEA is now waiving this so-called five percent rule for the duration of the COVID-19 emergency while retaining other distribution-related requirements.

Occupational Safety and Health Administration

OSHA has published its interim enforcement response plan providing instructions and guidance to OSHA staff for handling COVID-19-related complaints, referrals, and severe illness reports.

Food and Drug Administration

The FDA has issued an emergency use authorization (EUA) for a specific commercial infusion pump that, when connected to a nebulizer for tracheal delivery of nebulized medications, allows for prolonged treatment with these medications without additional risks for patients.

American Medical Association