COVID-19 Update: April 23, 2020

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

Pennsylvania Update

Governor Wolf

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

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

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

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

Learn more about Governor Wolf’s plan here.

Department of Human Services

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

Department of Health Daily Briefing

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

Department of Health

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

Department of Community and Economic Development

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

Pennsylvania Emergency Management Agency

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

Federal Update

Congress

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

Department of Health and Human Services

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

Centers for Medicare & Medicaid Services

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

Centers for Disease Control and Prevention

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

Food and Drug Administration

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

National Governors Association

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