COVID-19 Update: March 23, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania as of March 23, 2020 at 4:00 p.m.

Pennsylvania Legislature

The governor and General Assembly agreed to postpone the Pennsylvania primary from April 28 until June 2.  We anticipate this agreement to be formalized within the coming week.  The House met to consider this issue today in non-voting session and are scheduled for voting session tomorrow.  The Senate remains at a twelve-hour call of the President Pro Tempore.

Pennsylvania Administration

Department of Health Daily Update

Governor Wolf announced stay at home orders for residents in Philadelphia, Allegheny, Bucks, Chester, Delaware, Montgomery, and Monroe counties, urging residents in those areas to shelter in place and only leave home for something that is life sustaining, such as grocery shopping or health care needs.

Department of Health Secretary Levine discussed ongoing conversations with hospitals and health systems about capacity and supply needs, noting that about 40 percent of the state’s 3,400 intensive care beds are still available. Levine is working with providers to examine the entire care continuum’s capacity to continuing serving patients, exploring options like repurposing ambulatory surgical center beds or hotel rooms for post-acute services.

Pennsylvania has not gone as far as asking hospitals to increase bed capacity by 50 percent, as Governor Cuomo of New York recently ordered in that state.  Instead, the three pillars of Pennsylvania’s COVID response at this time are:  1) prevention/mitigation 2) testing availability, and 3) preparing hospitals and health systems for surge (PPE, beds, ventilators, etc.)

Secretary Levine and Governor Wolf’s biggest concerns at the moment are, respectively, the continued exponential rise in new confirmed COVID-19 cases and the need to buy time to increase the capacity of the health care system to respond to this crisis so we’re not overwhelmed.

Department of Human Services

Since Friday, the Department of Human Services (DHS) has issued the following two new guidance documents on its provider resources web page:

DHS also shared a response to stakeholder questions regarding its overall responses to the COVID-19 outbreak so far.  One point of interest to health care providers is that DHS plans to submit an 1135 waiver within the coming week.

The Office of Long Term Living released a Long-Term Care Facility Toolkit.  The suite of documents comprising the kit can be downloaded from the announcement page here.

DHS shared a document describing temporary changes to the 1915(c) waiver under which the Community HealthChoices program operates. A copy of the document describing the changes can be downloaded here.

 Supply Chain

As providers continue to use necessary supplies and procurement of additional supplies is disrupted, we want to remind you of the supply chain protocol as described by HAP:

  • Confirm that your facility has exhausted its normal procurement channels.
  • If the item is not available, confirm the availability of the item through the health care coalitions’ mutual aid component.
  • If the item is not available via mutual aid through the health care coalitions, your facility may be eligible to consider use of county, state or strategic national stockpile resources.
  • Facility sends unmet needs request to county emergency manager—following normal resource tracking.
  • Pennsylvania Emergency Management Agency forwards to department operation center.
  • Section chief will coordinate with incident commander to identify the overall risk.
  • Operations section will approve/decline based on crisis clinical need.

Licensure Guidelines

Several DHS program offices have relaxed requirements related to licensure.  The details of the temporary alterations are available here.

The Pennsylvania Department of State has also issued notices of suspension of several license requirements.  Details of the suspensions are available here.

Federal Update

Congress

The Senate on Sunday evening rejected a COVID-19 stimulus bill negotiated between Senate Republicans and the White House.  While Treasury Secretary Steve Mnuchin continues to negotiate this bill with Senate minority leader Chuck Schumer, House Speaker Nancy Pelosi is expected to introduce an alternative proposal later today.  This House proposal is rumored to be more generous to hospitals than the Senate bill.  As of this writing, however, the House proposal is not yet available.

HHS Office of Civil Rights

The Department of Health and Human Services’ Office of Civil Rights has published a six-page telehealth fact sheet that addresses what patients can be served by telehealth, where HIPAA fits in the delivery of telehealth, locations where providers can deliver telehealth services, and the communications products and software that are acceptable for the delivery of care via telehealth.  Find that fact sheet here.

Centers for Medicare & Medicaid Services

  • The Centers for Medicare & Medicaid Services (CMS) explains that no modifier is needed to bill for telehealth under the nation-wide waiver.  This is a clarification of past information issued by CMS and can be found in the agency’s MLN Matters publication, which is here.
  • CMS has announced relief for clinicians, providers, hospitals, and facilities participating in quality reporting programs.  It is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs for upcoming measure reporting and data submission for those programs.  Read CMS’s news release announcing the policy change here and look for more specific guidance soon.
  • On Sunday CMS released COVID-19 checklists and tools for use by state Medicaid and CHIP programs.  These four tools will enable states to seek emergency administrative relief, make temporary modifications to Medicaid eligibility and benefit requirements, relax rules to ensure that individuals with disabilities and the elderly can be served in their homes, and modify payment rules to support health care providers affected by the outbreak.  In addition, the president has called on states to permit Medicaid beneficiaries to receive services through telehealth.  See the news release announcing it here.  This package of tools includes 1115 Waiver Opportunity and Application Checklist, 1135 Waiver Checklist, 1915(c) Appendix K Template, Medicaid Disaster State Plan Amendment Template.  Further information about all of these tools can be found here.
  • While not directed at providers, CMS has published information about state Medicaid plan flexibilities.  See it here.
  • In the face of this crisis, hospitals and others are interested in finding faster ways to enroll Medicare providers.  Find a CMS FAQ on this subject here.

CMS publishes a running list of its guidance, regulatory changes, and more associated with COVID-19 on its “current emergencies” web page.  That page is updated daily, or as needed, and you can find it here.

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) published guidance in two areas over the weekend.

The CDC maintains a web page with general resources about COVID-19.  That page is here.

Food and Drug Administration

The Food and Drug Administration (FDA) published six updates over the weekend.  New updates from Friday through today:

And the FDA’s general COVID-19 resources page can be found here.

Resources to Consult

Pennsylvania Department of Human Services

Pennsylvania Department of Health

Centers for Disease Control and Prevention