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SNAP Asks Wolf to Sign COVID-19 Liability Protection Bill

Sign a bill to provide vital liability protection to health care providers during the COVID-19 emergency, SNAP asked Pennsylvania Governor Tom Wolf in a letter the association delivered to the governor yesterday.

Safety-Net Association of Pennsylvania logoIn the letter, SNAP wrote that

Medical professionals and hospitals on the frontlines should be permitted to use their clinical judgment without risk or fear from civil liability for decisions made in good faith. House Bill 1737, which was recently sent to your desk for consideration, would provide civil liability protections for the medical decisions made in caring for Pennsylvania’s citizens during the COVID-19 disaster declaration. This legislation would protect hospitals and providers from questionable lawsuits and the financial harm they could cause, especially at a time when hospitals have experienced significant financial stress.

Go here to see SNAP’s letter to Governor Wolf about Pennsylvania House Bill 1737.

Filed under: Coronavirus, COVID-19

New Report on the Health of Children in PA

The health of children in Pennsylvania is the subject of a new report published by the Pennsylvania Partnership for Children.

The report, “The 2020 State of Children’s Health Care in Pennsylvania:  Unlocking Access to a Healthy Childhood,” includes the following major findings:

  • Pennsylvania has the 8th highest number of uninsured kids in the nation, with nearly 128,000 children who do not have health
  • Pennsylvania’s uninsured rate for children increased slightly from 4.4% to 4.6%, signaling movement in the wrong direction.
  • The most recent uninsured data from the S. Census Bureau was captured prior to the current COVID-19 pandemic, meaning more Pennsylvania kids headed into the public health emergency without basic health coverage.
  • Factors such as age, poverty level, race and ethnicity and geographic region impact children’s access to health insurance. In Pennsylvania:
    • Children younger than six years of age and children from low-income families are more likely to be uninsured.
    • Children who identify as American Indian and Alaska Native, Asian, Black or African American, or White have increasing uninsured rates compared to the prior
    • Children who identify as Hispanic or Latino children, Some Other Race, or Two or More Races have decreasing uninsured rates compared to the prior year.

Learn more from the report “The 2020 State of Children’s Health Care in Pennsylvania:  Unlocking Access to a Healthy Childhood.

Filed under: Uncategorized

COVID-19 Update: Thursday, November 19

The following is the latest COVID-19 information from the state and federal governments as of 3:30 p.m. on Thursday, November 19.

Pennsylvania Update

Department of Health

The Department of Health has released its “COVID-19 Interim Vaccination Plan.”  Among other considerations, the plan addresses:

  • The phased approach the state proposes for administering vaccines to different segments of the population.
  • Provider recruitment and enrollment.
  • The readiness of the state’s health care infrastructure to play its planned role in administering vaccines.
  • Vaccine allocation, storage, and distribution.
  • Information technology and record-keeping considerations.
  • Regulatory considerations.
  • Public outreach.
  • Vaccine program communication.

During a Thursday afternoon news briefing, Secretary Levine made the following points about the planned vaccine program and other aspects of the state’s response to COVID-19.

  • Vaccines will be administered in three phases:  first, to health care personnel, people age 65 and older, high-risk individuals, and residents of congregate settings; second, other vulnerable populations and people with high-risk conditions; and third, the rest of the state’s population.
  • The state will make a special effort to work through mass vaccination clinics, FQHCs, and other groups to ensure outreach to at-risk people who do not participate regularly in the health care system.
  • In the beginning, it may be difficult to receive the Pfizer vaccines in some rural areas that lack hospitals with the capacity to store those vaccines, so residents of such areas may need to travel a bit to get vaccinated until other vaccines become available.
  • The state currently has adequate testing capacity and hospital beds the turnaround time on test results is much shorter than it was in the past.
  • The Secretary has confidence in the capacity of the state’s hospitals to handle the increased caseload of COVID-19 patients, does not plan to order them to suspend non-urgent procedures, but has contingency plans if the situation merits more drastic action.
  • Distribution of the monoclonal antibody bamlanivimab to hospitals will begin later this week.

Department of Health – by the numbers

  • Pennsylvania’s number of COVID-19 cases today surpassed 288,000.
  • For the third consecutive day, the state surpassed its previous high for the number of new cases in a single day.
  • More than 9500 Pennsylvanians have now died from COVID-19.  Daily death figures are now much higher than they have been since May.
  • The number of COVID-19 patients currently breathing with the help of a ventilator has nearly tripled since November 1.
  • More than 600 Pennsylvanians are currently in hospital intensive care units being treated for COVID-19.
  • 16 percent of hospital adult ICU beds are currently unoccupied, as are 16 percent of medical/surgical beds, 38 percent of pediatric beds, 15 percent of pediatric ICU beds, and 35 percent of airborne isolation unit beds.  These percentages translate into 663 available adult ICU beds, 3188 available medical/surgical beds, 297 available pediatric beds, 50 available pediatric ICU beds, and 893 airborne isolation beds.  The number of available adult beds has fallen slightly in recent days while the number of available pediatric beds has risen slightly.

Federal Update

Provider Relief Fund

The Provider Relief Fund web page has been updated with the following notice:

The application deadline for the Provider Relief Fund Phase 3 General Distribution was Nov. 6, 2020. You must have submitted your Taxpayer Identification Number (TIN) for validation by 11:59 p.m. ET on Nov. 6, 2020 for Phase 3 relief funds. If you submitted your TIN for validation by the deadline and your TIN is validated by Nov. 13, you will be able to proceed with submitting your revenue documentation to complete your application by 11:59 p.m. ET on Nov. 27, 2020.

The Provider Relief Fund FAQ has been updated with three new questions and one modified question.

  • (pp. 15-16)  Will the Provider Relief Fund limit qualifying expenses for capital equipment purchases to 1.5 years of depreciation, or can providers fully expense capital equipment purchases?  (Added 11/18/2020)

Expenses for capital equipment and inventory may be fully expensed only in cases where the purchase was directly related to prevent, prepare for and respond to the coronavirus.  Examples of these types of equipment and inventory expenses include ventilators, computerized tomography scanners, and other intensive care unit- (ICU) related equipment put into immediate use or held in inventory; masks, face shields, gloves, gowns; biohazard suits; general personal protective equipment; disinfectant supplies.

  • Can providers include the entire cost of capital facilities projects as eligible expenses, or will eligible expenses be limited to the depreciation expense for the period?  (Added 11/18/2020)

Expenses for capital facilities may be fully expensed only in cases where the purchase was directly related to preventing, preparing for and responding to the coronavirus. Examples of these types of facilities projects include upgrading a heating, ventilation, and air conditioning (HVAC) system to support negative pressure units; retrofitting a COVID-19 unit; enhancing or reconfiguring ICU capabilities; leasing or purchasing a temporary structure to screen and/or treat patients; leasing a permanent facility to increase hospital or nursing home capacity.

  • (p. 16)  Do providers report total purchase price of capital equipment or only the depreciated value?  (Modified 11/18/2020)

Providers who use accrual or cash basis accounting may report the relevant depreciation amount based on the equipment useful life, purchase price and depreciation methodology otherwise applied. Providers may report an expense for items purchased with a useful life of 12 months or less if in accordance with their existing accounting policies.  For additional information on capital depreciation, please refer to the other Frequently Asked Questions related to capital equipment and capital facility projects.

  • (pp. 24-25)  Providers may have significant fluctuations in year-over-year net patient revenues due to settlements or payments made to third parties relating to care delivered outside the reporting period (2019-2020). Should Provider Relief Fund recipients exclude from the reporting of net patient revenue payments received for care not provided in 2019 or 2020?  (Added 11/18/2020)

Provider Relief Fund recipients shall exclude from the reporting of net patient revenue payments received or payments made to third parties relating to care not provided in 2019 or 2020.

Centers for Medicare & Medicaid Services

Department of Health and Human 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

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

Filed under: Coronavirus, COVID-19

SNAP Seeks Help From End-of-Year Federal Legislation

Eliminate Medicaid disproportionate share hospital cuts (Medicaid DSH), appropriate additional resources for the Provider Relief Fund, and extend the current suspension of the two percent sequestration of Medicare spending, the Safety-Net Association of Pennsylvania asked members of Pennsylvania’s congressional delegation in a letter SNAP sent earlier this week.

Safety-Net Association of Pennsylvania logoThe request comes as Congress returns to Washington to take up the funding of the federal government at a time when authorization for spending under a continuing resolution ends on December 11.  In addition to addressing federal funding, Congress also may consider COVID-19 legislation.

Learn more from SNAP’s letter to Pennsylvania’s congressional delegation.

Filed under: COVID-19, DSH hospitals, Federal Medicaid issues, Safety-Net Association of Pennsylvania

COVID-19 Update: Tuesday, November 17

The following is the latest COVID-19 information from the state and federal governments as of 3:45 p.m. on Tuesday, November 17.

Pennsylvania Update

The Wolf Administration/Department of Health

The Wolf administration and Department of Health announced new COVID-19 mitigation efforts in the face of growing numbers of new cases.  See their announcement here.  The new effort consists of four components.

  • A memorandum to acute-care hospitals presenting projections that the state could run out of ICU beds in December.  It urges hospitals to act now, on their own, to address capacity planning and elective procedures matters.
  • An order requiring anyone who visits from another state to have a negative COVID-19 test within 72 hours prior to entering Pennsylvania.  If someone cannot get a test or chooses not to, they must quarantine for 14 days upon arrival in Pennsylvania.  Pennsylvanians visiting other states are required to have a negative COVID-19 test within 72 hours prior to returning to the state or to quarantine for 14 days upon return to Pennsylvania.  The order does not apply to those who cross state boundaries for work or to receive medical care.  It takes effect on Friday, November 20.
  • A strengthened order addressing the wearing of masks stating that masks must  be worn indoors and outdoors when people are away from their home.  When outdoors, they must wear masks if they are not able to remain at least six feet away from anyone not in their household the entire time they are outdoors.  When indoors, masks are required even if people are physically distant from individuals not in their household.  This means that even if people are able to be six feet apart, they will need to wear a mask while inside if with people other than members of their household.  This order applies to every indoor facility, including homes, retail establishments, gyms, doctors’ offices, public transportation, and anywhere food is prepared, packaged, or served.
  • The departments of Health and Education issued recommendations for colleges and universities to implement a testing plan for when students return to campus following breaks and holidays.

Department of Health

Department of Health – by the numbers

  • Pennsylvania’s number of COVID-19 cases today surpassed 275,000.
  • In 11 of the past 15 days, Pennsylvania has surpassed its previous high for the number of new cases in a single day.
  • More than 9300 Pennsylvanians have now died from COVID-19.  Daily death figures are now generally higher than they have been since May.
  • More than 30,000 residents of long-term-care facilities and more than 6100 people who work in those facilities have contracted COVID-19.  Those figures encompass 1162 facilities in 63 of Pennsylvania’s 67 counties.
  • More than 13,600 health care workers in the state have contracted COVID-19.
  • The number of people currently hospitalized with COVID-19 has nearly doubled since November 1.
  • The number of COVID-19 patients currently breathing with the help of a ventilator has more than doubled since November 1.
  • Nearly 600 Pennsylvanians are currently in hospital intensive care units being treated for COVID-19.
  • 19 percent of hospital adult ICU beds are currently unoccupied, as are 17 percent of medical/surgical beds, 38 percent of pediatric beds, 12 percent of pediatric ICU beds, and 35 percent of airborne isolation unit beds.  These numbers have barely changed since the last update.  The percentages translate into 782 available adult ICU beds, 3412 available medical/surgical beds, 316 available pediatric beds, 41 available pediatric ICU beds, and 943 airborne isolation beds.
  • The state-wide positivity rate on COVID-19 tests rose from 6.9 percent last week to 9.6 percent this week, according to the state’s early warning monitoring dashboard.
  • A positivity rate greater than five percent is considered “concerning,” Department of Health Secretary Levine has explained in the past.
  • All but five Pennsylvania counties now have positivity rates greater than five percent.
  • 59 of the state’s 67 counties are considered to be in “substantial transmission status.”
  • Of the confirmed cases reported between November 1 and November 7, 16 percent responded to contact tracers’ questions about whether they spent time at a business establishment.  Of those who answered, 18 percent said they visited a business establishment 14 days prior to onset of symptoms.  Among them:
    • 53 percent reported going to a restaurant
    • 26 percent reported going to some other business establishment
    • 11 percent reported going to a bar
    • 12 percent reported going to a gym/fitness center
    • seven percent (reported going to a salon/barbershop
    • 9 percent said they had attended a mass gathering or other large event 14 days prior to onset of symptoms.

Overall, these numbers are slightly better than those from the previous week.

City of Philadelphia

In the face of growing numbers of new local COVID-19 cases, the city of Philadelphia has announced new mitigation efforts addressing businesses and business activities, recreational facilities and activities, retail and other consumer businesses, and more.  The announcement also details enterprises that will continue under current guidelines.  See the city’s announcement here and find further information here.  The new guidelines take effect on November 20 and continue until at least through January 1, 2021.

Federal Update

Provider Relief Fund

The Provider Relief Fund web page has been updated with the following notice:

The application deadline for the Provider Relief Fund Phase 3 General Distribution was Nov. 6, 2020. You must have submitted your Taxpayer Identification Number (TIN) for validation by 11:59 p.m. ET on Nov. 6, 2020 for Phase 3 relief funds. If you submitted your TIN for validation by the deadline and your TIN is validated by Nov. 13, you will be able to proceed with submitting your revenue documentation to complete your application by 11:59 p.m. ET on Nov. 27, 2020.

Department of Health and Human Services

  • HHS’s Office of the Assistant Secretary for Preparedness and Response has posted information about high-flow nasal cannulation, an oxygen therapy that is a non-invasive resuscitation therapy for COVID-19 patients.  HHS has purchased kits to use when administering this therapy and health care facilities can work through their local and state health departments to secure a supply.  Go here to learn more about the therapy and how to acquire supplies.
  • HHS’s Office of the Assistant Secretary for Preparedness and Response presents a speaker series focused on how the COVID-19 pandemic can affect health care professional stress and resilience.  Topics in this series include acute and chronic stressors, identifying at-risk employees, and fostering resilience.  Go here for further information.
  • HHS has entered into partnerships with large chain pharmacies and networks that represent independent pharmacies and regional chains to improve access to eventual COVID-19 vaccines.  Participating pharmacies will counsel customers about vaccines and order and administer vaccines at no cost to those customers.  Learn more in this HHS announcement.

CMS COVID-19 Stakeholder Calls 

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Nursing Homes

Wednesday, November 18 at 4:30 – 5:00 PM (eastern)

Toll Free Attendee Dial-In:  833-614-0820

Access Passcode:  1335116

Audio Webcast link:  go here

Centers for Disease Control and Prevention

Food and Drug Administration

  • The FDA has updated its guidance on investigational COVID-19 convalescent plasma.  The updated guidance extends the period of enforcement discretion through the end of February 2021.  This extension will permit continued access to convalescent plasma for the treatment of hospitalized COVID-19 patients while blood establishments develop the necessary operating procedures to manufacture the plasma consistent with the emergency use authorization.  The guidance also includes a new recommendation that authorized COVID-19 convalescent plasma not be collected from individuals who have received an investigational COVID-19 vaccine.
  • The FDA has updated its FAQs on the development of COVID-19 tests.
  • The FDA has established a new webpage, A Closer Look at COVID-19 Diagnostic Testing, to provide health care providers and other public health professionals, including those who might purchase COVID-19 tests, with more technical information and resources.

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

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

Filed under: Coronavirus, COVID-19

COVID-19 Update: Friday, November 13

The following is the latest COVID-19 information from Pennsylvania’s state government as of 2:00 p.m. on Friday, November 13.

Department of Health

The Department of Health updated its guidance for providers on the counseling of patients evaluated for or diagnosed with COVID-19 to self-isolate and identify persons with whom they were in close contact in the 48 hours before symptom onset.  A COVID-19 Close Contact Worksheet and COVID-19 Patient Instructions for Self-Isolation While Awaiting Laboratory Results accompanied the guidance.

Department of Health – by the numbers

  • Pennsylvania’s number of COVID-19 cases today surpassed 250,000.
  • At the height of the pandemic in the spring, Pennsylvania never exceeded 2000 new cases in a single day.  On October 22 the state reached that mark for the first time and five days later it rose past 2500.  On November 6 the state climbed past 3000 new cases in a single day for the first time and then, quickly, past 4000 in one day on November 7 and past 5000 yesterday.  The number has now risen for five consecutive days, to an all-time high today.
  • More than 9200 Pennsylvanians have now died from COVID-19.  Daily death figures are now generally higher than they have been since May.
  • Nearly 29,000 residents of long-term-care facilities and more than 6000 people who work in those facilities have contracted COVID-19.  Those figures encompass 1144 facilities in 63 of Pennsylvania’s 67 counties.
  • More than 13,300 health care workers in the state have contracted COVID-19.
  • The number of people currently hospitalized with COVID-19 has doubled since late last month.
  • The number of COVID-19 patients currently breathing with the help of a ventilator has done the same.
  • Nearly 500 Pennsylvanians are currently in hospital intensive care units being treated for COVID-19.
  • 18 percent of hospital adult ICU beds are currently unoccupied, as are 15 percent of medical/surgical beds, 35 percent of pediatric beds, nine percent of pediatric ICU beds, and 36 percent of airborne isolation unit beds.
  • The state-wide positivity rate on COVID-19 tests rose from 6.1 percent last week to 6.9 percent this week.
  • A positivity rate greater than five percent is considered “concerning,” Department of Health Secretary Levine has explained in the past.
  • According to the early warning dashboard released weekly by the governor and Department of Health, counties with especially high positivity rates during the week of October 25 were led by Bedford (17.5 percent), Indiana (14 percent), Armstrong (13.1 percent), Franklin (12.3 percent), Lawrence (12.2 percent), Bradford (12.1 percent), Wyoming (12 percent), and Venango (11.8 percent).
  • That same dashboard shows the following counties currently experiencing “substantial levels of community transmission” of COVID-19:  Adams, Armstrong, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Carbon, Centre, Clarion, Crawford, Dauphin, Delaware, Elk, Franklin, Fulton, Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Mercer, Mifflin, Montgomery, Northampton, Northumberland, Philadelphia, Schuylkill, Tioga, Union, Venango, and Wyoming.

Of the confirmed cases reported between October 25 and October 31, 21 percent responded to contact tracers’ questions about whether they spent time at a business establishment.  Of those who answered, 18.7 percent said they visited a business establishment 14 days prior to onset of symptoms.  Among them:

  • 55 percent reported going to a restaurant
  • 26 percent reported going to some other business establishment
  • 13 percent reported going to a bar
  • 12 percent reported going to a gym/fitness center
  • eight percent (reported going to a salon/barbershop

In addition, 18.9 percent of respondents said they had attended a mass gathering or other large event 14 days prior to onset of symptoms.

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

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

Filed under: Coronavirus, COVID-19

COVID-19 Update: Thursday, November 5

The following is the latest COVID-19 information from the state and federal governments as of 3:00 p.m. on Thursday, November 5.

Pennsylvania Update

Department of Health

The Department of Health updated its hospital guidance to clarify that hospitals must test COVID-19 patients prior to discharge to another facility and communicate those test results to the receiving facility prior to discharge.

In response to an increase of new COVID-19 cases in Huntingdon County, the Department of Health contracted for drive-through and indoor testing clinics in the county from October 29 through Monday, November 2.

During a news conference this week, Secretary Levine noted that Pennsylvania is now seeing more COVID-19 “long-haulers”:  people who continue to experience COVID-19 symptoms over a period of months.

Even though current case counts in Pennsylvania are higher than they were during the earlier days of the pandemic, fewer people are hospitalized with the disease, fewer are being treated on ventilators, and fewer are dying.  Secretary Levine attributes these improvements to better medical care, more experience treating COVID-19 patients, and better therapeutics.  In addition, long-term-care facilities are doing a better job of preventing and limiting outbreaks.  She attributed this improvement in part to the help those facilities are receiving through the state’s Regional Response Health Collaborative program.

She also noted that cases are less concentrated among elderly Pennsylvanians than in the pandemic’s early days and that younger people are better equipped to fight the disease.

The state recently released data that illustrates this change:

  • In north central Pennsylvania, approximately seven percent of cases in April were among people ages 19 to 24 while that same age group accounted for approximately 28 percent of cases in October.
  • In northeastern Pennsylvania, that figure rose from six percent of cases in April to approximately 16 percent of cases in October.
  • In southeastern Pennsylvania it rose from nearly five percent of cases in April to nearly 14 percent of cases in October.
  • In southeastern Pennsylvania it rose from approximately five percent of cases in April to nearly 12 percent of cases in October.
  • In northwestern Pennsylvania it rose from nearly seven percent of cases in April to approximately 14 percent of cases in October.
  • In south central Pennsylvania it rose from approximately seven percent of cases in April to approximately 12 percent of cases in October.

The state is still struggling with people unwilling to cooperate with contact tracers when they are informed that they have COVID-19, Secretary Levine continued.  Only 24 percent are currently doing so.

Among those who are cooperating, in the past week more than half of those people said they had been in a restaurant or “large business” or mass gathering setting in the past two weeks.

Department of Health COVID-19 Vaccine Planning

Last week we introduced you to an executive summary of Pennsylvania’s COVID-19 vaccination plan.  Today, Secretary Levine held a news briefing to provide additional information about Pennsylvania’s plan.  According to a report in the York Daily Record, Secretary Levine said that the state intends to distribute the vaccines in phases and that “In the first phase, when vaccine doses are likely to be limited, high-risk workers in health care settings, first responders, other essential workers, people with pre-existing health conditions and adults in long-term care are likely to be prioritized.”  Learn more from the York Daily Record article.

Department of Health – by the numbers

  • Pennsylvania’s number of COVID-19 cases recently surpassed 220,000.  The past week has seen the highest number of new cases on a daily basis since the pandemic began and Thursday’s new case count was the state’s new single-day high.
  • The number of new cases in Pennsylvania during the week ending October 29 was 43 percent higher than the previous week.
  • With today’s latest figures, the death count now exceeds 8900.
  • Of that number, 61 percent have been residents of long-term-care facilities.
  • Overall, nearly 27,000 residents of long-term-care facilities and more than 5800 people who work in those facilities have contracted COVID-19.  Those figures encompass 1100 facilities in 63 of Pennsylvania’s 67 counties.
  • More than 12,700 health care workers in the state have contracted COVID-19.
  • The number of people currently hospitalized with COVID-19 is higher than it has been at any time since May.
  • The number of COVID-19 patients currently breathing with the help of a ventilator is higher than it has been since mid-June.
  • 20 percent of hospital adult ICU beds are currently unoccupied, as are 18 percent of medical/surgical beds, 33 percent of pediatric beds, 12 percent of pediatric ICU beds, and 37 percent of airborne isolation unit beds.
  • The state-wide positivity rate on COVID-19 tests rose from five percent two weeks ago to six percent last week.
  • A positivity rate greater than five percent is considered “concerning,” Secretary Levine explained during her news briefing, adding that currently, 40 counties have rates higher than five percent.  Only 30 counties were at that level the previous week, she added.
  • According to the early warning dashboard released weekly by the governor and Department of Health, the following counties are currently experiencing “substantial level of transmission” of COVID-19:  Armstrong, Berks, Blair, Bradford, Cambria, Centre, Crawford, Dauphin, Delaware, Franklin, Fulton, Huntingdon, Indiana, Lackawanna, Lawrence, Lebanon, Lehigh, Luzerne, Mifflin, Philadelphia, Schuylkill, Tioga, Venango, Westmoreland, Wyoming, and York.

Department of Human Services

DHS is no longer requiring non-nursing home providers to submit interim reporting on their CARES ACT/Act 24 spending.  Interim reports would have been due on November 6 and are still required of nursing homes.

DHS’s Office of Long-Term Living and Office of Developmental Programs (ODP) have updated their guidance on COVID-19 for personal care homes, assisted living residences, and private intermediate-care facilities.

ODP has issued guidance to individuals, families and designated persons, licensed and enrolled providers of ODP residential services, and all interested parties on developing visitation policies in ODP residential settings to protect residents, staff, and visitors from COVID-19.

Federal Update

Provider Relief Fund

  • A reminder that applications for Phase 3 general distribution payments are due Friday, November 6.
  • HHS has updated the Provider Relief Fund FAQ with two modified items; the second bullet below addresses the deadline for Phase 3 applications.
    • p. 6 – Does HHS intend to recoup any payments made to providers not tied to specific claims for reimbursement, such as the General or Targeted Distribution payments? ( Modified 11/5/2020)

The Provider Relief Fund and the Terms and Conditions require that recipients be able to demonstrate that lost revenues and increased expenses attributable to COVID-19, excluding expenses and losses that have been reimbursed from other sources or that other sources are obligated to reimburse, exceed total payments from the Relief Fund. Provider Relief Fund payment amounts that have not been fully expended on the combination of healthcare expenses and lost revenues attributable to coronavirus by the end of the final reporting period, must be returned to HHS. HHS reserves the right to audit Relief Fund recipients in the future to ensure that this requirement is met and collect any Relief Fund amounts that were made in error or exceed lost revenue or increased expenses due to COVID-19. Failure to comply with the Terms and Conditions may be grounds for recoupment.

  • p. 41 – Tax Identification Number (TIN) Validation Process

When is the deadline to submit an application? (Modified 11/5/2020)

The deadline to submit an application under Phase 3 – General Distribution is November 6, 2020 at 11:59 PM EST for those that have had their TIN validated in Phase 2 or received funds as part of Phase 1. Any entity that has not yet received any General Distribution payments must submit their TIN for validation by November 6, 2020 at 11:59 PM EST. If the TIN is validated by November 13, 2020 at 11:59 PM EST, the entity will have until November 27, 2020 at 11:59 PM EST to submit an application.

Department of Health and Human Services

  • HHS’s Office of the National Coordinator for Health Information Technology (ONC) has posted FAQs about the information-blocking provisions of the regulation it published last week extending until April of 2021 the agency’s deadline for complying with its information-blocking requirements.  Find those FAQs here.

Centers for Medicare & Medicaid Services

  • CMS’s online publication MLN Connects directs providers and others to its COVID-19 vaccine toolkit for information about preparing to administer such vaccines when they become available.
  • CMS has updated its provider-specific fact sheets on new COVID-19-related waivers and flexibilities for the following providers:

Centers for Disease Control and Prevention

Food and Drug Administration

Congressional Research Service

 

Filed under: Coronavirus, COVID-19

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The October 2020 MACPAC meeting opened with a panel discussion on restarting Medicaid eligibility redeterminations when the public health emergency ends.  It included Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities; René Mollow, deputy director for health care benefits and eligibility at the California Department of Health Care Services; and Lee Guice, director of policy and operations at the Department for Medicaid Services, Kentucky Cabinet for Health and Family Services.

After a break, Commissioners heard a panel discussion with Kevin Prindiville, executive director at Justice in Aging; Mark Miller, executive vice president of healthcare at Arnold Ventures; and Charlene Frizzera, senior advisor at Leavitt Partners, on creating a new program for dually eligible beneficiaries. Later, staff presented preliminary findings from a mandated report on non-emergency medical transportation. The day concluded with a report on nursing facility acuity adjustment methods.

On Friday, the day began with a session on access to mental health services for adults in Medicaid. It was followed by a related panel discussion on mental health services with Sandra Wilkniss, director of complex care policy and senior fellow at Families USA; Melisa Byrd, senior deputy director for the District of Columbia Department of Health Care Finance; and Dorn Schuffman, director of the CCBHC Demonstration Project at the Missouri Department of Mental Health.

Next, the Commission considered the merits of extending Medicaid coverage for pregnant women beyond 60 days postpartum. Staff then provided an update on a statutorily required analysis of disproportionate share hospital (DSH) allotments, as well as an analysis of addressing high-cost drugs and the challenges they present to Medicaid.

The meeting concluded with comment on the Secretary’s report to Congress on Reducing Barriers to Furnishing Substance Use Disorder (SUD) Services Using Telehealth and Remote Patient Monitoring for Pediatric Populations under Medicaid. The Commission decided to send a letter to Congress and the Secretary commenting on this report.

Supporting the discussion were the following briefing papers:

  1. Mandated Report on Non-Emergency Medical Transportation: Work Plan and Preliminary Findings
  2. Changes in Nursing Facility Acuity Adjustment Methods
  3. Access to Mental Health Services for Adults in Medicaid
  4. Considerations in Extending Postpartum Coverage
  5. Required Annual Analysis of Disproportionate Share Hospital (DSH) Allotments
  6. Addressing High-Cost Drugs and Pipeline Analysis
  7. Comment on Secretary’s Report to Congress on Reducing Barriers to Substance Use Disorder Services Using Telehealth for Pediatric Populations under Medicaid

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to Pennsylvania safety-net hospitals.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Find its web site  here.

Filed under: Federal Medicaid issues, Pennsylvania safety-net hospitals

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its November 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

  • How the renewal of the federal COVID-19 public health emergency declaration extends key Medicaid protections.
  • State planning for children with complex needs.
  • State efforts to connect people to COVID-19 testing and care.
  • An upcoming webinar about challenging Medicaid and Community HealthChoices waiver service denials.

Read about these subjects and more in the Pennsylvania Health Law Project’s November 2020 newsletter.

Filed under: Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy

COVID-19 Update: Friday, October 30

The following is the latest COVID-19 information from the state and federal governments as of 2:45 p.m. on Friday, October 30.

Pennsylvania Update

Department of Health

The Department of Health updated its hospital guidance to clarify that hospitals must test COVID-19 patients prior to discharge to another facility and communicate those test results to the receiving facility prior to discharge.

In response to an increase of new COVID-19 cases in Huntingdon County, the Department of Health has contracted for a drive-through and indoor testing clinic in the county.  Testing will be available at the Huntingdon Plaza, Suite 7505, R. 22 and S. 4th Street in Huntingdon beginning on October 29 and running until Monday, November 2.  The tests are free and no appointment is needed.

Department of Health – by the numbers

  • Pennsylvania’s COVID-19 case count recently surpassed 200,000.  The daily total has been in four figures every day this month except for one, which has not happened since the early months of the pandemic.
  • Four times in the last nine days the state has totaled more than 2000 new cases – the first times the daily total has exceeded 2000 in any one day since the beginning of the pandemic.
  • With today’s latest figures, the death count now exceeds 8700.
  • Of that number, 61 percent have been residents of long-term-care facilities.
  • Overall, nearly 26,000 residents of long-term-care facilities and more than 5600 people who work in those facilities have contracted COVID-19.  Those figures encompass 1063 facilities in 63 of Pennsylvania’s 67 counties.
  • More than 12,200 health care workers in the state have contracted COVID-19.
  • The number of people currently hospitalized with COVID-19 is more than twice what is was on October 1 and is at its highest level since June 2.
  • The number of COVID-19 patients currently breathing with the help of a ventilator also is more than twice what it was on October 1 and is at its highest level since mid-June.
  • 20 percent of hospital adult ICU beds are currently unoccupied, as are 16 percent of medical/surgical beds, 31 percent of pediatric beds, 11 percent of pediatric ICU beds, and 38 percent of airborne isolation unit beds.  The medical/surgical and medical/surgical ICU bed figures are similar to what they have been in recent weeks but both pediatric figures are lower than they have been recently.

Department of Human Services

DHS’s Office of Long-Term Living and Office of Developmental Programs have updated their guidance on COVID-19 for personal care homes, assisted living residences, and private intermediate-care facilities.

Federal Update

Provider Relief Fund

  • A reminder that applications for Phase 3 general distribution payments are due November 6.
  • Another reminder that HHS will hold a webcast about the Phase 3 general distribution on Monday, November 2 at 3:00 p.m. (eastern) for interested parties.  Go here to register for the webcast and to submit questions.  Also available are a fact sheet and a presentation about the Phase 3 general distribution.
  • HHS has added or modified 61 questions in its Provider Relief Fund FAQ.  The changes, labeled either “Added 10/28/2020” or “Modified 10/28/2020,” generally address auditing and reporting requirements for the Provider Relief Fund, including accounting for expenses and lost revenue, as well as the sharing of general distribution money among parent and subsidiary entities, executive salary cap calculations, and more.  The modified and added questions and answers offer additional details about many issues so providers should review these changes carefully.  The following excerpts address some specific matters about which providers have inquired:
    • ” Healthcare related expenses attributable to coronavirus may include items such as supplies, equipment, information technology, facilities, employees, and other healthcare related costs/expenses for the calendar year. The classification of items into categories should align with how Provider Relief Fund recipients maintain their records.” [emphasis added]
    • “… providers that already have a cost allocation methodology in place, may allocate normal and reasonable overhead costs to their subsidiaries which may be an eligible expense if attributable to coronavirus and not reimbursed from other sources.”
    • “HHS initially advised providers that once a subsidiary TIN attested to and accepted a General Distribution payment, the money must stay with, and be used by, the subsidiary TIN. However, HHS has received feedback indicating that some subsidiary TINs accepted a General Distribution payment prior to the release of this guidance, and that they would have had their parent TIN accept the money, had they known earlier of HHS’s position. In light of these timing concerns, HHS is revising its prior guidance and clarifying that, for General Distribution payments only, a subsidiary TIN can transfer its General Distribution payment to a parent TIN; this is true even if a subsidiary TIN initially attested to accepting a General Distribution payment. Consistent with other longstanding guidance, the parent TIN may use the money and/or allocate the money to other subsidiary TINs, as it deems appropriate. Regardless of which entity (the parent or subsidiary) attested to the receipt of the General Distribution payments, the parent entity can report on the use of the General Distribution payment as part of the HHS reporting process.”
    • “In accordance with the Terms and Conditions, if you believe you have received an overpayment and expect that you will have cumulative lost revenues and increased costs that are attributable to coronavirus during the COVID-19 public health emergency that exceed the intended calculated payment, then you may keep the payment.”
    • “Providers do not need to be able to prove, at the time they accept a Provider Relief Fund payment that prior and/or future lost revenues and increased expenses attributable to COVID-19 (excluding those covered by other sources of reimbursement) meet or exceed their Provider Relief Fund payment. Instead, HHS expects that providers will only use Provider Relief Fund payments for permissible purposes and if on June 30, 2021, providers have leftover Provider Relief Fund money that they cannot expend on permissible expenses or losses, then they will return this money to HHS.”
    • “The Terms and Conditions associated with each Provider Relief Fund payment do not permit recipients to use Provider Relief Fund money to pay salaries at a rate in excess of Executive Level II which is currently set at $197,300. For the purposes of the salary limitation, the direct salary is exclusive of fringe benefits and indirect costs. The limitation only applies to the rate of pay charged to Provider Relief Fund payments and other HHS awards. An organization receiving Provider Relief Fund payments may pay an individual’s salary amount in excess of the salary cap with non-federal funds” An example aggregate calculation is provided.
    • Again, we strongly encourage providers to review all of the 10/28 additions and modifications of the Provider Relief Fund FAQ.

Centers for Medicare & Medicaid Services

  • CMS has published an interim final rule that calls for several regulatory changes driven by the COVID-19 pandemic.
  • All Medicare beneficiaries, including Medicare Advantage participants, will pay nothing for COVID-19 vaccines, as will most Medicaid beneficiaries.  Most private insurers are required to cover the vaccines as well.  Vaccines for the uninsured will be reimbursed in the same manner as care for the uninsured that is reimbursed through the Provider Relief Fund.
  • Medicare will make enhanced payments for eligible inpatient cases that involve use of certain new products authorized or approved to treat COVID-19.  The enhanced payments will be equal to the lesser of:  (1) 65 percent of the operating outlier threshold for the claim; or (2) 65 percent of the cost of a COVID-19 stay beyond the operating Medicare payment (including the 20 percent add-on payment under section 3710 of the CARES Act) for eligible cases.
  • States will retain their ability to gain an additional, temporary 6.2 percentage point increase in their federal medical assistance percentage (FMAP, the rate at which the federal government matches state Medicaid spending) if they agree to maintain the enrollment of “validly enrolled beneficiaries” through the end of the month in which the COVID-19 public health emergency ends.  States are permitted to make changes in beneficiary coverage, cost-sharing, and post-eligibility treatment of income.
  • This rule expands on previous CARES Act requirements that providers of COVID-19 tests publicize the cash prices for such tests, requiring that every provider of COVID-19 diagnostic tests make public on the internet the cash price for a COVID-19 diagnostic test.
  • This rule extends the Comprehensive Care for Joint Replacement Program’s Performance Year 5 an additional six months, to September 30, 2021, changes the reconciliation periods for the program, and makes other changes in the program.
  • CMS has published its annual update of home health payment rates for calendar year 2021.  Included in this rule is a provision that makes permanent changes in home health regulations introduced as temporary in the March 2020 “Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency” Interim Final Rule with Comment.  Under this provision, the temporary ability of home health agencies to use telehealth in the provision of home health care to qualified Medicare beneficiaries is now made permanent.  Learn more about this important change and other aspects of the 2021 home health regulation in this CMS news release.
  • CMS has updated its document “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing.”  Updated information on pages 120 and 121 addresses temporary COVID-19 waivers that enable hospitals to provide certain outpatient services in alternative care settings.  Both updates are labeled “New: 10/28/20.”

Department of Health and Human Services

  • HHS announced that it will distribute $333 million in first round performance payments to more than 10,000 nursing homes for achieving significant reductions in COVID-19-related infections and deaths between August and September.  Nursing homes will receive September quality incentive payments next week and will have four more opportunities to receive additional incentive payments.  Go here to see CMS’s announcement about the awards and go here to see a state-by-state breakdown of those awards.
  • HHS’s Administration for Community Living hosts a monthly webinar series that invites subject matter experts and practitioners from across the home-and-community-based services (HCBS) spectrum to share insights and best practices to develop high-quality HCBS services and programs.  The next webinar will be held on November 12 at 3:00 (eastern) and feature payer and provider industry leaders discussing changes their industries have experienced since the beginning of the COVID-19 emergency and what lies ahead for them.  Several payers and providers will share innovations they used to address COVID.  Go here for more information and to register for the webinar.

Centers for Disease Control and Prevention

Food and Drug Administration

Congressional Research Service

The Congressional Research Service has published the new report “COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and Treatment.”

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

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

Filed under: Coronavirus, COVID-19

P:(717)234-6970; F:(717)234-6971
2012 Safety-Net Association of Pennsylvania