COVID-19 Update: April 20, 2020

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

Pennsylvania State Map 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