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COVID-19 Update: April 3, 2020

The following is the latest COVID-19 information from Pennsylvania state and federal regulators and others as of 4:00 p.m. on Friday, April 3.

Pennsylvania Update

The Governor Wolf/Department of Health Daily Briefing

  • Governor Wolf recommended that all Pennsylvanians wear masks outside the home. He elaborates on this recommendation in a news release.
  • The Department of Health offers guidance on homemade masks on its web site.
  • The number of new COVID-19 cases rose 16 percent over yesterday’s total of new cases.
  • 63 Pennsylvania counties now have at least one case, as do 12 percent of the state’s nursing homes.
  • State-wide deaths have climbed past 100.
  • 78 percent of hospitalized patients have been 50 years of age or older and 50 percent have been more than 65.
  • 241 patients have been treated in ICUs and 147 have required the assistance of a ventilator.
  • 419 of the state’s total cases have been health care workers – just less than five percent of total cases.

Department of Health

The Department of Health has updated its guidance to hospitals to include information on steps hospitals should take when a need arises to use new space or alter or renovate existing space in their response to COVID-19.  Department approval is not needed to take these actions as long as hospitals maintain the documentation discussed in the guidance document.

Department of Human Services

DHS’s today announced the launch of a statewide support and referral helpline that will operate 24/7 to assist Pennsylvanians struggling with anxiety and other challenging emotions due to the COVID-19 emergency and refer them to community-based resources that can further help to meet individual needs.  The toll-free number for the helpline, which is up and running, is 1-855-284-2494.  For TTY, dial 724-631-5600.

Department of State

The Department of State has issued a temporary waiver of the requirement that applicants for a temporary respiratory therapist permit be within 30 days of their anticipated graduation date.  Instead, for the duration of the COVID-19 emergency, students in respiratory care education programs who wish to apply for a temporary permit must be within 90 days of their anticipated graduation date.  Those impending graduates who already applied for a full license but cannot take their exam because of the closure of test centers may now apply for a temporary permit.

Federal Update

Department of Labor

The Labor Department has published a program letter with a summary of key unemployment insurance provisions of the CARES Act and guidance regarding temporary emergency state staffing flexibility.

Federal Communications Commission

The FCC has adopted a $200 million telehealth program to support provider responding to the COVID-19 crisis.  The money will help providers purchase telecommunications, broadband connectivity, and devices necessary for providing telehealth services.  See the FCC’s news release and its formal report and order.

Centers for Disease Control and Prevention

Food and Drug Administration

Centers for Medicare & Medicaid Services

Department of Health and Human Services

  • HHS’s Office of Civil Rights has announced that it will not impose penalties for violations of certain provisions of the HIPAA privacy rule against health care providers or their business associates for the good faith uses and disclosures of protected health information by business associates for public health and health oversight activities during the COVID-19 nationwide public health emergency.  See the Office of Civil Rights announcement of this temporary policy and a pre-publication version of the formal notice of this policy that will appear shortly in the Federal Register.
  • Along with the Department of Justice, HHS has announced that the two agencies have ordered the distribution of medical supplies that in their judgment were being hoarded.  The federal government paid fair market value for 192,000 N95 masks, nearly 600,000 pairs of medical grade gloves, and 130,000 other types of masks, surgical gowns, disinfectant towels, and other supplies and is sending these supplies to the New Jersey Department of Health, the New York state Department of Health and the New York City Department of Health and Mental Hygiene.

The White House

President Trump has invoked the Defense Production Act to compel companies to undertake the manufacture of N95 respirators and ventilators.

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

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

(To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.)

 

Filed under: Uncategorized

COVID-19 Update: April 2, 2020

COVID-19-related developments in Pennsylvania as of 4:30 p.m. on Thursday, April 2.  To receive this daily update directly, sign up for our mailing list at  info@pasafetynet.org.

Pennsylvania Update

Secretary Levine’s Daily Briefing

  • Safety-Net Association of Pennsylvania logoThe number of new COVID-19 cases yesterday rose 26 percent over the previous day.
  • The number of cases among health care workers rose 21 percent over yesterday and accounts for approximately five percent of all COVID-19 cases state-wide.
  • Approximately 10 percent of the state’s nursing homes have at least one case.
  • Growth is especially strong in Philadelphia and its surrounding counties and in northeastern Pennsylvania.
  • The hospitalization rate remains about 10 percent.
  • Right now, Secretary Levine said, hospitals are coping well across the state.
  • Two field hospitals are being established by the federal government: one in Philadelphia and one in Montgomery County.  Decisions about field hospitals are made by the federal government, not the state.
  • People entering Pennsylvania from New York City are asked to self-quarantine for 14 days.
  • The state is aware that some pharmacies are now experiencing shortages of chloroquine and hydroxychloroquine for off-brand use in fighting COVID-19 and is working to ensure an adequate supply for people who use these drugs for approved uses.

Department of Human Services

During the course of the COVID-19 public health emergency, the state’s CHIP program is permitting families that are unable to provide verification of application or renewal verification the ability to self-attest to the information on the application and to enroll children prior to initial payments during the COVID-19 emergency.  Families are still responsible for paying premiums, coverage for those renewing will not be interrupted, and the managed care plans will still verify the information on such applications.

Department of State

Revenue Department

Financial paperworkPennsylvania tax revenues were $294.6 million short of official estimates in March, or 6.2 percent, according to figures released Wednesday by the Department of Revenue.  This is the first glimpse of the fiscal challenge the state will face in the coming months as a result of COVID-19.  Total General Fund revenues for the year are now $45.6 million, or 0.2 percent, below estimate.  It is worth noting that March is traditionally the largest revenue month during the fiscal year.  In addition to the potential for lost revenue over the next few months, the extension of filing deadlines for personal income tax will shift a significant amount of revenue to the next fiscal year.

Federal Update

Centers for Disease Control and Prevention

Centers for Medicare & Medicaid Services

Department of Health and Human Services

The department’s Agency for Healthcare Research and Quality will be spending $7.5 million to evaluate health system response to the COVID-19 pandemic.  The money is divided into two pools:  $5 million to evaluate innovations and challenges in rapidly expanding telehealth in response to COVID-19 and $2.5 million to active agency grant recipients and cooperative agreements.

Federal Emergency Management Agency

Food and Drug Administration

For researchers, the FDA has developed quality-controlled reference sequence data for the SARS-CoV-2 reference strain in the U.S.

Department of Labor

The Department of Labor has published a temporary rule describing the benefits under the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, both of which were part of the Families First Coronavirus Response Act, which was signed into law on March 18.  The law reimburses private employers with fewer than 500 employees with tax credits for the cost of providing employees with paid leave for specific reasons related to COVID-19.  The law enables employers to keep their workers on their payrolls while also ensuring that workers are not forced to choose between their paychecks and public health measures.  For more, see a Department of Labor news release describing the new temporary rule and view the rule itself here.

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

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

 

 

Filed under: Uncategorized

Interview With Department of Health Secretary Rachel Levine

The Central Penn Business Journal has published an interview with Pennsylvania Department of Health Secretary Rachel Levine, who is leading the state’s response to the COVID-19 pandemic.  Read that interview here.

Filed under: Uncategorized

COVID-19 Update: April 1, 2020

Coronavirus update for April 1, 2020.  COVID-19-related developments in Pennsylvania as of 4:30 p.m. on Wednesday, April 1.  To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.

State Update

Daily Briefing by Secretary of Health Levine and Governor Wolf

  • The number of new COVID-19 cases yesterday rose 27 percent over the previous day.
  • All deaths so far are adults.
  • 286 health care workers have tested positive for COVID-19 (out of more than 5805 positive tests state-wide).
  • Governor Wolf extended his stay-at-home order to the entire state; it will remain in effect through April 30. See the announcement and the secretary of health’s amended order.

Department of Human Services

Critical Medical Supplies Procurement

The state’s departments of General Services, Community and Economic Development, and Health and the Pennsylvania Emergency Management Agency have established a “critical medical supplies procurement portal” on which they list the personal protection equipment and hospital supplies the state seeks to purchase.  The target audience for the site is manufacturers, distributors, and suppliers, all of which are invited to contact the Department of General Services if they have any of the supplies the state seeks.  The current list consists of the following:

Personal Protection Equipment (PPE)

  • Surgical/Procedure Masks
  • N95/N99 Form Fitting Respirators
  • Face masks with integrated shield
  • Powered Air Purifying Respirator, PAPRs
  • Alcohol Based Hand Rub

Hospital Supplies

  • Ventilators with PEEP Functionality
  • Ventilator Circuits
  • Endotracheal Tubes
  • Hospital Gowns

Lab Supplies

  • UVT 3 mL with flocked flex minitip
  • Nasopharyngeal (NP) flocked swabs and viral transport media tubes (1-3 mL)

Diagnostics Supplies and Instruments

  • Roche MagNA Pure 96 DNA and Viral NA Small Volume Kits
  • Roche MagNA Pure 96 System Fluid and Tips
  • Roche MagNA Pure 96 External Lysis Buffer
  • Biomerieux NuciSENS EasyMAG extraction system and supplies

Federal Update

Medicaid DSH

The following is a revised schedule of Medicaid DSH allotment cuts.

  Before CARES After CARES
FFY 2020 $4 Billion $0
FFY 2021 $8 Billion $4 Billion
FFY 2022 $8 Billion $8 Billion
FFY 2023 $8 Billion $8 Billion
FFY 2024 $8 Billion $8 Billion
FFY 2025 $8 Billion $8 Billion
Total $44 Billion $36 Billion

Centers for Disease Control Prevention

The CDC has updated its guidance on responsible actions when among people who have been or may have been exposed to COVID-19.

Food and Drug Administration

The FDA has updated its reporting on the steps it is taking to accelerate the development of novel therapies for COVID-19 through its Coronavirus Treatment Acceleration Program.

The FDA has updated its list of current and resolved drug shortages and continuations.  There are currently 148 drugs on the list.  Yesterday the FDA posted information regarding shortages of hydroxychloroquine and chloroquine due to a significant surge in demand.

The FDA has issued two additional emergency use authorizations for COVID-19 diagnostics, for a total of 22 authorized tests.

State Department

The State Department has posted a message for foreign medical professionals with approved U.S. non-immigrant or immigrant visa petitions or certificates of eligibility in approved exchange visitor programs or who are already in the U.S. and would like to apply to stay.

The Joint Commission

The Joint Commission has posted a notice expressing support for permitting health care workers to bring their own standard face masks or respirators to use at work when their employers cannot “routinely provide access to protective equipment…”

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

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.

Filed under: Uncategorized

PA Gets 1135 Medicaid Waiver

Pennsylvania has gained permission to circumvent certain federal Medicaid regulations and requirements for the duration of the COVID-19 public health emergency.

Bookshelf with law booksUnder the declaration of a national state of emergency, the Department of Health and Human Services is authorized to waive or modify Medicare and Medicaid regulations; these are known as section 1135 waivers.  In this case, the federal Centers for Medicare & Medicaid Services has issued a section 1135 waiver to Pennsylvania for its Medicaid program to:

  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend pre-admission screening and annual resident review (PASRR) level I and level II assessments for 30 days
  • Temporarily suspend Medicaid fee-for-service prior authorization requirements.
  • Delay state fair hearings and appeal timelines.
  • Enroll new providers in the state’s Medicaid program if they are enrolled by Medicare or by another state Medicaid program
  • Pay nursing facilities, intermediate care facilities, and others for the delivery of services outside of their walls, at unlicensed facilities, if COVID-19 necessitated the evacuation of their own facilities.

These waivers will last until the end of the declared public health emergency.

Learn more by reading the state’s application for the section 1135 Medicaid waiver and the federal government’s response to that request.

Filed under: Uncategorized

COVID-19 Update: March 31, 2020

Coronavirus Update: March 31, 2020.

COVID-19-related developments in Pennsylvania as of 4:00 p.m. on Tuesday, March 31.  To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.

State Update

Governor Wolf                                                                                                     

Today, Governor Wolf announced that the President approved part of his request for a major disaster declaration to support state, county, and local responses to COVID-19.  Included in the approved requests are reimbursement of up to 75 percent of eligible expenses (staff overtime, supplies, equipment) related to COVID-19 response for all levels of state government and private non-profits that qualify and direct federal assistance for materials and supplies to state and local governments.  Staff from the Pennsylvania Emergency Management Agency will be contacting potential applicants in the coming weeks.

The governor also expanded his ‘Stay at Home’ order to include seven more counties to mitigate the spread of the virus:  Cameron, Crawford, Forest, Franklin, Lawrence, Lebanon, and Somerset counties until April 30 for all 33 affected counties.

State Daily COVID-19 Briefing

  • There are now positive cases of COVID-19 in 60 of Pennsylvania’s 67 counties.
  • Five percent of the total 4,843 cases are affected health care workers while fewer than one percent are nursing home-related.
  • The administration continues to monitor the impact of the virus on New York and to prepare Pennsylvania for the expected surge of positive cases by stockpiling supplies, providing regulatory relief for health care professionals, seeking health care volunteers, and monitoring the availability of ICU and nursing home beds throughout the state.
  • About 40 percent of the licensed ICU beds in the state are still unoccupied.  The Department of Health continues to monitor the availability of ventilators as well.

Department of Health

The Department of Health released interim guidance on licensing and survey activities consistent with the guidance issued by CMS calling for states to prioritize provider survey and certification activities during the pandemic.

DOH also shared a guidance document from CMS, counseling state surveyors on how providers can limit the transmission of the virus and a CMS memo specifically related tor limiting the spread within dialysis facilities.

Department of Human Services, Office of Children Youth and Families

The Office of Children, Youth, and Families (OCYF) has developed these linked recommendations for entities operating as a Child Residential and Day Treatment Facility.

Department of Human Services, Office of Mental Health and Substance Abuse Services

The Office of Mental Health and Substance Abuse Services (OMHSAS) issued guidance for County Emergency Behavioral Health/Disaster Crisis Outreach and Referral Teams.  That guidance can be found here.

In addition, the office shared documents from the Center for the Study of Traumatic Stress related to the psychological effects of quarantine.  One for helping homebound children, one directed at Public Health leaders, and one directed at health care providers.

Yesterday the federal Centers for Medicare & Medicaid Services (CMS) published a major update of Medicare and Medicaid regulations that included blanket waivers of a large number of Medicare and Medicaid regulations and requirements.  The following is a summary of the major aspects of this new regulation.

Federal Update

New Policies and Waivers From Medicare and Medicaid Regulations and Requirements

CMS has introduced dozens of changes that involve waivers from current regulations and requirements.  A comprehensive, 26-page CMS document describing these changes can be found here and below are the highlights organized into four broad categories:

  • increasing hospital capacity (what CMS calls “hospitals without walls”)
  • expanding the health care workforce
  • increasing the use of telehealth in Medicare
  • reducing paperwork

Increasing Hospital Capacity

  • CMS is waiving the enforcement of section 1867(a) of EMTALA to permit hospitals to screen patients at off-site locations to help prevent the spread of COVID-19.
  • CMS is waiving certain requirements under the Medicare conditions of participation allow for flexibilities during hospital and psychiatric hospital surges, permitting non-hospital buildings/space to be used for patient care and quarantine sites.
  • For the duration of the public health emergency, CMS is waiving certain requirements under the Medicare conditions of participation and the provider-based department requirements to permit hospitals to establish and operate as part of the hospital any location meeting those conditions of participation for hospitals that continue to apply during the public health emergency. This waiver also permits hospitals to change the status of their current provider-based department locations to the extent necessary to address the needs of hospital patients.
  • CMS is waiving requirements to permit acute-care hospitals to house acute-care inpatients in excluded distinct part units, such as excluded distinct part unit inpatient rehabilitation facilities or inpatient psychiatric facilities, where the distinct part unit’s beds are appropriate for acute-care inpatients.
  • CMS is permitting acute-care hospitals with excluded distinct part inpatient psychiatric units to relocate inpatients from the excluded distinct part psychiatric unit to acute-care beds and units as a result of a disaster or emergency.
  • CMS is permitting acute-care hospitals with excluded distinct part inpatient rehabilitation units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct part rehabilitation unit to an acute-care bed and unit.
  • CMS is waiving certain physical environment requirements. Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements to allow for a non-skilled nursing facility building to be temporarily certified and available for use by a skilled nursing facility in the event there are needs for isolation processes for COVID-19-positive residents, which may not be feasible in the existing skilled nursing facility structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults.
  • CMS is waiving certain conditions of participation and certification requirements for opening a nursing facility if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.
  • CMS is waiving requirements to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity.

Expanding the Health Care Workforce

  • CMS is waiving current requirements to permit physicians whose privileges will expire to continue practicing at the hospital and for new physicians to be able to practice before full medical staff/governing body review and approval to address workforce concerns related to COVID-19.  CMS also is waiving requirements about details of the credentialing and privileging process.
  • CMS is waiving the requirement that Medicare patients be under the care of a physician.
  • CMS is waiving requirements that a certified registered nurse anesthetist (CRNA) work under the supervision of a physician. CRNA supervision will be at the discretion of the hospital and state law.
  • CMS is waiving the requirement that a skilled nursing facility and nursing facility may not employ anyone for longer than four months unless they meet current training and certification requirements. CMS is not waiving the requirement that such facilities ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs.
  • CMS is waiving the requirement that physicians and non-physician practitioners must perform in-person visits for nursing home residents and will permit visits to be conducted, as appropriate, via telehealth options.
  • CMS is temporarily waiving requirements that out-of-state practitioners be licensed in the state where they are providing services when they are licensed in another state. CMS will waive the physician or non-physician practitioner licensing requirements when the following four conditions are met:
    • must be enrolled as such in the Medicare program;
    • must possess a valid license to practice in the state which relates to his or her Medicare enrollment;
    • is furnishing services – whether in person or via telehealth – in a state in which the emergency is occurring to contribute to relief efforts in his or her professional capacity; and,
    • is not affirmatively excluded from practice in the state or any other state that is part of the 1135 emergency area.
    • This does not have the effect of waiving state or local licensure requirements or any requirement specified by the state or a local government as a condition for waiving its licensure requirements.
  • CMS has a toll-free hotline for physicians and non-physician practitioners and Part A-certified providers and suppliers establishing isolation facilities to enroll and receive temporary Medicare billing privileges. CMS is waiving the following screening requirements:
    • application fee,
    • criminal background checks associated with fingerprint-based criminal background checks,
    • site visits,
    • postpone all revalidation actions,
    • allow licensed providers to render services outside of their state of enrollment,
    • expedite any pending or new applications from providers,
    • allow physicians and other practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location, and
    • allow opted-out physicians and non-physician practitioners to terminate their opt-out status early and enroll in Medicare to provide care to more patients.
  • CMS has issued blanket waivers of sanctions under the Stark Act.  The blanket waivers may be used now without notifying CMS.  Individual waivers of sanctions under section 1877(g) of the Act may be granted upon request.  For more information, go here and here.

Increasing the Use of Telehealth in Medicare

  • CMS is waiving the requirement that physicians and non-physician practitioners must perform in-person visits for nursing home residents and will permit visits to be conducted, as appropriate, via telehealth options.
  • Clinicians can provide virtual check-in services to new and established patients.
  • CMS will pay for telephone evaluation and management services provided by physicians and the same services provided by qualified non-physician health care providers. These services may be used for telephone-only evaluation and management services.
  • Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists can perform e-visits via telehealth.
  • Limits have been lifted for subsequent inpatient visits, subsequent skilled nursing visits, and critical care consult codes.
  • Physicians may provide supervision virtually using real-time audio/visual technology for services that require direct supervision by a physician or other type of practitioner.
  • For additional information on new flexibilities in the use of telehealth for Medicare patients, go here.

Reducing Paperwork

  • CMS is waiving various requirements that limit and define the use and documentation of verbal orders in a hospital.
  • CMS is waiving reporting requirements when patients who have passed away required soft restraints prior to their death.  If restraints were a factor in the death, the usual reporting requirements apply.
  • CMS is waiving the current requirements for providing “detailed information” in discharge planning as long as discharging hospitals continue to provide the data patients and their families need to make decisions about appropriate post-acute care.  This does not waive the requirement that patients have all of the necessary medical information they need for their post-acute setting.
  • While maintaining the discharge planning requirements that ensure that patients are discharged to an appropriate setting with the necessary medical information, CMS is waiving some of the specific components of discharge information acute-care hospitals are ordinarily required to provide.
  • CMS is waiving requirements involving the organization and staffing of medical records departments and requirements for the form and content of medical records and is allowing for flexibility in completion of medical records within 30 days following discharge from a hospital.
  • CMS is waiving the requirements for hospitals to provide information about their advance directive policies to patients.
  • CMS is waiving the requirement that hospitals participating in Medicare and Medicaid must have a utilization review plan that meets specified requirements. CMS is waiving the entire utilization review condition of participation.
  • CMS is waiving – for “surge facilities” only – the requirement that the emergency services function operate according to written policies and procedures during surge periods.
  • CMS is waiving the requirement that hospital emergency preparedness policies and procedures include specified elements for the emergency preparedness communication plans of hospitals when a hospital is a surge site.
  • CMS is waiving requirements for hospital quality assessment and performance improvement programs that address the scope of the program, the incorporation and setting of priorities for the program’s performance improvement activities, and integrated quality assurance and performance improvement programs. The requirement that hospitals maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement program remains.
  • CMS is waiving the requirement that providers must have a current therapeutic diet manual approved by the dietitian and medical staff readily available to all medical, nursing, and food service personnel. Such manuals would not need to be maintained at surge capacity sites.
  • CMS is waiving the requirement for nursing staffs to develop and keep current a nursing care plan for each patient and to have policies and procedures in place establishing which outpatient departments are not required to have a registered nurse present.
  • Completed 2019 Occupational Mix Surveys, Hospital Reporting Form CMS-10079, for the Wage Index Beginning FY 2022, are due to the Medicare Administrative Contractors (MACs). CMS is granting an extension for hospitals nationwide affected by COVID-19 until August 3, 2020.
  • CMS is waiving requirements that govern pre-admission screening and annual resident review (PASARR) to permit states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness or intellectual disability should receive the assessment as soon as resources become available.
  • CMS is waiving many paperwork requirements for home health agencies, skilled nursing facilities, nursing facilities, end-stage renal dialysis facilities, home health agencies, and hospices. Find those changes here (pages 9-16).
  • Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) in the fee-for-service program may allow extensions to file an appeal. CMS is allowing MACs and QICs in the fee-for-service program and the MA and Part D independent review entities (IREs) to:
    • waive requests for timeliness requirements for additional information to adjudicate appeals;
    • process appeals even with incomplete appointment of representation forms;
    • process requests for appeals that do not meet the required elements using information that is available; and
    • use all flexibilities available in the appeal process if good cause requirements are satisfied.

Others

  • CMS offers stakeholders examples of section 1135 waivers available to individual providers.  Find those examples here beginning on page 23.
  • CMS is waiving certain patient rights involving copies of medical records, patient visitation limits, and quarantine processes in states that have had more than 50 confirmed COVID-19 cases.

For further information:

To learn more about these changes, you may wish to consult the following resources:

The following is the latest information from the administration and federal regulators as of 4:30 today.

The White House

President Trump has issued a presidential memorandum to the Secretary of Defense and the Secretary of Homeland Security authorizing the use of the National Guard to provide COVID-19-related services to the states of Connecticut, Illinois, Massachusetts, and Michigan, with the federal government to pay 100 percent of the cost of such a deployment.  The federal assumption of 100 percent of this cost expires in 30 days.

Centers for Medicare & Medicaid Services

Department of Health and Human Services

The Department of Health and Human Services has posted a news release in which it outlines the steps it has taken and will be taking to accelerate clinical trials for possible COVID-19 vaccines and to prepare for the manufacture of approved vaccines.

U.S. Public Health Service

The U.S. Public Health Service has issued a letter on optimizing ventilator use during the COVID-19 pandemic.

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

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.

Filed under: Coronavirus, COVID-19, Federal Medicaid issues, Medicare

COVID-19 Update: March 30, 2020

COVID-19-related developments in Pennsylvania as of 4:00 p.m. on Monday, March 30.  To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.

State Update

Governor Wolf

  • On Saturday the governor requested a major disaster declarationfrom the President to provide additional support for state, county, and municipal governments, certain non-profits, and individuals who are struggling during the COVID-19 outbreak.
  • Over the weekend Governor Wolf expanded his ‘Stay at Home’ order to include three more counties to mitigate the spread of the virus:  Beaver, Centre, and Washington counties.  Today, he added four more counties to the order:  Carbon, Cumberland, Dauphin, and Schuylkill counties and extended the order to April 30 for all 26 affected counties.  The governor’s amended order, the secretary of health’s amended order, and the stay at home guidance are available online.
  • Today Governor Wolf announced that all schools and non-life-sustaining businesses will remain closed until further notice.

Governor’s Daily Briefings

  • Four percent of all cases are health care workers.
  • The COVID-19 death rate is now more than 10 percent. All deaths so far have been adults.
  • Over the weekend nine Pennsylvania counties experienced their first cases, so the total is now cases in 59 counties.
  • There are people with COVID-19 in about five percent of the state’s nursing homes (36 out of 695); most of those cases are in southeastern Pennsylvania.
  • Two field hospitals will be established in southeastern Pennsylvania through an effort led by the Federal Emergency Management Agency (FEMA).
  • 40 percent of the state’s ICU beds are currently unoccupied.
  • The state has more than 4000 ventilators in hospitals and other facilities, has an unstated number in its own stockpile, and has purchased more that should be arriving shortly. Governor Wolf said that if the state could add 1400 more ventilators he thinks it would be in good shape.
  • Based on the criteria the state currently employs for who is to be tested, the supply of testing materials in the state is adequate for now.
  • Governor Wolf said there has been no discussion about limiting or prohibiting New Yorkers from entering Pennsylvania.
  • The governor acknowledged reports of residents of New York coming to Pennsylvania for health care and specifically mentioned reports of increased newborn deliveries in Philadelphia by women from New York. He offered no numbers.  He said no hospitals have reported an unmanageable surge of patients as a result.
  • Governor Wolf said that he and his staff are still trying to figure out how much money the latest stimulus law will bring to Pennsylvania and when that money might arrive.  It will come in a lot of buckets, he said.  They expect about $5 billion but have no idea yet on how it might be allocated.

Pennsylvania Department of Health

The Department of Health sent a reminder to providers through its message board to report all initial “Activation of Internal/External Emergency Plan.”  Providers may submit additional reports as updates if necessary and must report under ‘Health Department Reportable Disease’ all COVID-19 positive test results for staff and patients including name, date of birth, symptoms (if known), and date of test results.

Department of Human Services

Protocols for Procuring Difficult-to-Source Personal Protective Equipment

The protocol for procuring difficult-to-source PPEs is:

  • Your first contact should be with your regional health care coalition (HCC).  HCC contacts can be found at the bottom of the web page linked here.
  • The HCC may decide to forward a formal request to the County Emergency Management Agency.  Agency contact information can be found here.
  • At that point, the County Emergency Management Agency may submit a resource request to the Pennsylvania Emergency Management Agency (PEMA).

Federal Update

The White House

Centers for Medicare & Medicaid Services

Department of Health and Human Services

The HHS Office of Inspector General (OIG) published a statement regarding the discretion the OIG will employ when investigating any conduct during this emergency that may be subject to OIG administrative enforcement. The office also advised providers to contact the OIG for extension of any OIG investigation deadlines during this time.

Food and Drug Administration

Department of Veterans Affairs

The U.S. Department of Veterans Affairs has published its emergency response plan for the COVID-19 emergency.

Environmental Protection Agency

The EPA has published a memo outlining the discretion it intends to exercise in fulfilling its inspection and compliance efforts during the COVID-19 emergency.

Department of Homeland Security

In a new document with guidance on the essential critical infrastructure workforce, the Department of Homeland Security specifies essential jobs within the workforce during the COVID-19 emergency.

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

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

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Filed under: Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid COVID-19, Uncategorized

COVID-19 Update: March 27, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania as of 4:30 p.m. on March 27.

Pennsylvania Updates

Governor Wolf

  • Today Governor Wolf expanded his ‘Stay at Home’ order to include nine more counties to mitigate the spread of the virus:  Berks, Butler, Lackawanna, Lancaster, Luzerne, Pike, Wayne, Westmoreland, and York counties.  The governor’s amended order, the secretary of health’s amended order, and the stay at home guidance are available online.  The order takes effect for these nine counties tonight at 8:00 p.m. and will continue for all of the affected counties until April 6.
  • Today Governor Wolf approved and signed several bills into law to provide emergency relief to schools (SB 751), unemployment compensation rules (HB 68), delaying the primary election (SB 422), and the $50 million in immediate funding for health care supplies via HB 1232.  We do not yet know how this funding will be distributed but are monitoring it closely.  According to the enabling legislation and a press release Governor Wolf issued yesterday, “The $50 million in funding will be deposited into a restricted account under the governor’s jurisdiction and funds will be used if there are insufficient funds available from the disaster proclamation ‘to buy medical equipment and supplies for health care entities to meet urgent patient and staff needs to address surge demand. Health care entities include hospitals, nursing facilities and emergency medical services’.”

Department of Human Services

  • The Department of Human Services (DHS) has published a reminder that Governor Wolf has signed an executive order prohibiting elective medical and surgical procedures for the duration of the COVID-19 crisis.
  • Pennsylvania has been granted a section 1135 Medicaid waiver by the federal government. Key elements of the waiver address:
    • Temporarily suspending Medicaid fee-for-service prior authorization requirements.
    • Extending pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
    • Suspending Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
    • State Fair Hearing Requests and Appeal Timelines.
    • Provider Enrollment.
    • Provision of Services in Alternative Settings.

These waivers will remain in effect until the current health crisis ends.  See the letter from CMS to the state that explains all of these aspects of the waiver in greater detail.

Department of Health

  • During her daily briefing today, Secretary Levine reported that the number of new COVID-19 cases in Pennsylvania yesterday declined slightly from the day before, although she dismissed this decline as “not statistically significant.”  There are now COVID-19 cases in 50 of Pennsylvania’s 67 counties.  While the number of hospitalizations, ICU cases, and patients put on ventilators remain low, she said those numbers remain in line with trends elsewhere in the country and her department’s own projections.
  • The department has revised its guidance prohibiting the provision of dental treatment except for urgent and emergency services.

Department of State

The Department of State requested, and Governor Wolf granted, an extension for 90 days of certain license renewal deadlines that fall between April 30, 2020, and June 30, 2020.  Affected boards include the State Board of Medicine, State Board of Nursing, and State Board of Examiners of Nursing Home Administrators.  Any associated regulations that establish these dates are temporarily suspended.  While the department will provide guidance encouraging licensees to renew on time, if possible, this waiver ensures that if they miss the deadline their licenses will remain valid and they will have an additional 90 days to renew them.

Federal Updates

Congress

The House of Representatives passed the $2 trillion Coronavirus Aid, Relief, and Economic Security Act passed by the Senate late Wednesday.  It now goes to the president for his signature and he has indicated he will sign it.

President Trump

President Trump sent a letter to governors thanking them for their efforts in fighting the COVID-19 emergency, outlining upcoming federal efforts, and expressing hope for the future.

Department of Health and Human Services

Centers for Medicare & Medicaid 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

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

 

Filed under: Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19

COVID-19 Update: March 26, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania as of 5:00 on March 26.

Pennsylvania Update

Governor Wolf

House Bill 1232, which includes up to $50 million to help with the state’s COVID-19 response, is now on Governor Wolf’s desk and he is expected to sign it tomorrow, when he also is expected to sign three other bills the legislature passed late yesterday:

  • HB 68 – amends the rules of unemployment compensation during an emergency declaration such as easing work search requirements and extending the length of time that benefits are available.
  • SB 422 – amends the election code to move the Pennsylvania primary election to June 2, 2020.
  • SB 751 – amends the school code to protect employees and address various changes in state education requirements.

Department of Health

  • Secretary Levine has ordered ambulatory surgical facilities to report on specific items for the purpose of managing supplies and equipment.  Portions of the survey are to be updated each day, including the number of procedures they perform and their remaining supplies of personal protective equipment.  Click here for a copy of the survey, which was also shared by the department via email to facility administrators.  Click here to view the Secretary’s order.
  • More information is now available to assist hospitals with complying with Secretary Levine’s March 25 order that they report three times a day on specific data regarding hospital facilities, beds, supplies, equipment, and staffing.  Data will be collected using the Essential Elements of Information (EEI) tool in the Knowledge Center – Health Incident Management System (KC-HIMS).  Hospitals needing onboarding for the Knowledge Center should contact the HAP Readiness Coordinator for their regional health care coalition; that contact information is at the bottom of the webpage here.
  • During her daily briefing, Department of Health Secretary Levine reported the following:
  • More than twice as many new cases today as yesterday.
  • Cases hold steady at about 10 percent requiring hospitalization.
  • Of nearly 1700 cases so far, 56 required ICU and 32 needed ventilators.
  • 46 percent of new cases fall in the 25-40 age group.
  • The state is focused on standards of care and is not contemplating triage for patients getting all the care they need.
  • Those standards of care may evolve as the number of cases rises and the state adds more beds, whether that means new hospital beds or places like ambulatory surgery centers and hotels where people can receive post-acute care when they no longer need acute care.  The Department of Health is working to find such additional beds.
  • The state is doing “everything we can” to support hospitals.
  • Among other measures, Pennsylvania has distributed 678,000 N-95 masks, 380,000 pairs of gloves, and 744,000 goggles and face protectors to hospitals and providers.  The federal government is replenishing the state’s supplies and the state is also looking to purchase more of its own.

Department of Human Services

  • The Department of Human Services (DHS)’ Office of Mental Health and Substance Abuse Services has sent an FAQ to HealthChoices behavioral health managed care organizations, fee-for-service providers, and county mental health authorities on the subject of behavioral health Medicaid programs and the COVID-19 crisis. Find that FAQ here.
  • DHS has submitted a section 1135 waiver request to the federal Centers for Medicare & Medicaid Services. Such requests seek temporary exemption from federal Medicaid requirements.  Pennsylvania’s request covers requirements involving Medicaid authorization, long-term services and supports, fair hearings, provider enrollment, reporting and oversight, and other matters.  See the state’s 1135 waiver request here.
  • DHS’s Office of Child Development and Early Learning has issued guidance to child care advisors to help them keep children, their families, and staff safe during the COVID-19 emergency. Find that guidance here.
  • The federal government approved Pennsylvania’s request to extend the time that people are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps). The state also will be submitting a waiver to enable many college students, currently ineligible for such benefits, to participate in SNAP.
  • DHS has published its latest COVID-19 stakeholder update. Find it

Department of State

The Department of State has provided guidance for doctors prescribing chloroquine and hydroxychloroquine and pharmacists dispensing it.  See that language here.

Federal Update

Department of Health and Human Services

  • The Department of Health and Human Services (HHS) will be publishing a “Notice of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures” in the Federal Register on March 30.  The notice gives the Secretary of HHS authority to designate such materials as scarce and to invoke prohibitions against hoarding them.  The notice, which is not a regulation and expires in four months, lists specific medical supplies to which it applies.  Find the notice here.
  • HHS’s Office of Civil Rights has posted notice in response to questions about whether HIPAA requirements permit covered entities to share with law enforcement, paramedics, other first responders, or public health authorities the names or other identifying information of individuals who have been infected with or exposed to COVID-19 without the permission of those individuals.  The notice outlines the specific situations under which such disclosure is permitted.  See the notice here.

Centers for Medicare & Medicaid Services

  • The Families First Coronavirus Response Act, signed into law on March 18, includes a temporary 6.2 percentage point increase in the federal medical assistance percentage (FMAP:  the rate at which the federal government matches state Medicaid expenditures).  A new CMS FAQ provides information about the state Medicaid expenditures to which the increase applies, its applicability to Medicaid DSH payments, the duration of the supplemental funding, and more.  Find this FAQ here.
  • CMS has approved more section 1135 waivers for states.
  • CMS has published an FAQ on Medicare provider enrollment relief.  Find it here.
  • CMS’s Center for Consumer Information & Insurance Oversight has issued a memo to qualified health plans and stand-alone dental plans offered on the federal exchange and state exchanges on the subject of payment and grace period flexibilities associated with the COVID-19 crisis  See that memo here.

Food and Drug Administration

  • The Food and Drug Administration (FDA) has published guidance for industry and food staff on the enforcement policy for face masks and respirators during the COVID-19 health emergency.  Find the guidance document here.
  • The FDA has sent a detailed letter to manufacturers and other stakeholders authorizing the emergency use of authorized ventilators, ventilator tubing connectors, and ventilator accessories, including alternative products used as medical devices, during the COVID-19 pandemic subject to the terms detailed in this letter and based on the specific types of equipment and supplies involved as also described in the letter.  Find the document here.

Centers for Disease Control and Prevention

  • The Centers for Disease Control and Prevention published the following documents relevant to health care providers:
  • The Centers for Disease Control and Prevention (CDC) has issued interim clinical guidelines for the management of patients with COVID-19.  Find those guidelines here.
  • CDC has updated its guidelines for collecting, handling, and testing clinical specimens from persons with COVID-19.  Find those updated guidelines here.
  •  The CDC has developed two checklists that identify key actions that can be taken now to enhance preparedness for potential or confirmed patients with COVID-19.  Find them here.
  • The CDC has developed a spreadsheet-based model that to help providers plan and optimize their use of personal protective equipment for response to COVID-19.  Find a link to that downloadable spreadsheet here.
  • The CDC has updated its guidance on the collection and submission of post-mortem specimens from deceased persons under investigation.  See the updated guidance here.

National Uniform Billing Committee

The National Uniform Billing Committee, the governing body for forms and codes use in medical claims billing in the United States for institutional providers, has published guidance on claims for COVID-19 treatment.  The guidance, which addresses use of the “DR” condition code and use of hospital outpatient bill type for COVID-19 testing locations, can be found here.

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

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page FAQ

 

 

 

Filed under: Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid COVID-19

COVID-19 Update: March 25, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania as of 5:15 on March 25.

State Legislature

Today the Senate passed House Bill 1232, as amended, which includes up to $50 million of additional funding to be made available for the state’s COVID-19 response efforts.  The legislation stipulates that funding shall only be used to buy medical equipment and supplies for health care entities to meet urgent patient and staff needs to address surge demand.  It also requires available federal funding and any funding made available through the governor’s disaster proclamation to be used before these funds.  The authority to transfer funds expires on September 30, 2020.

Senate leadership noted that this is the first phase in its crisis response and recognizes that additional funds will likely be needed.  The House is expected to pass the bill as amended today.  The bill will then be signed in both chambers and sent to the governor for consideration and he is expected to sign it.  It would take effect immediately.

The Administration

Governor Wolf

Today the governor added Lehigh and Northampton counties to his stay-at-home order.

Department of Health

Secretary Levine today issued an order requiring hospitals to make daily report of specified data regarding hospital facilities, beds, supplies, equipment, and staffing.  Among the measures hospitals will be required to report daily are available beds, psychiatric beds, number of other beds in facilities, current emergency department capacity, number of COVID-19 patients, expected number of days remaining N-95 masks will last, expected number of days remaining until other personal protective equipment supplies will exhausted, supply of remaining NP specimen collection supplies in days, number of ventilators in facility and in use, and number of employees available for work.  See the secretary’s order here.

Department of Human Services – Office of Medical Assistance Programs

  • The Office of Medical Assistance Programs has issued billing guidance to CHIP managed care organizations on the subject of alternative screening sites related to COVID-19. Find that two-page document here.
  • It issued another policy clarification to CHIP managed care organizations with directions to bypass the prior authorization requirements for chest CT scans for COVID-19 payments. See that policy clarification document here.

Another notice announces a new ICD-10 code for COVID-10 that takes effect on April 1. Find it here.

  • The Office of Medical Assistance Programs has posted an FAQ on Medicaid program coverage of COVID-19 testing and related services. It includes information about what Pennsylvania Medicaid will pay for COVID-19 testing, the services it will cover, and more.  Find it here.

Department of Human Services – Office of Long Term Living

  • The Office of Long Term Living (OLTL) has published guidance on conducting pre-admission screening and resident reviews for applicants to and residents of Medicaid-certified nursing facilities. This includes an explanation of performing such screens by phone or video conference.  See the guidance here.
  • OLTL also has sent a memo to nursing home transition coordination agencies about a new, COVID-19-motivated nursing home transition tenant-based rental assistance process. Find that memo here.
  • OLTL also communicated via its listserv that it is delaying the implementation deadline for electronic visit verification (EVV) until October 1, 2020.

Department of Drug and Alcohol Programs

  • The Department of Drug and Alcohol Programs (DDAP) has issued a document clarifying the state’s response to federal guidance on the disclosure of patients’ substance abuse disorder records during the telehealth process. See that policy clarification here.
  • DDAP has issued a policy bulletin addressing telehealth services for gambling treatment. Find that bulletin here.

Department of State

The Pennsylvania Department of State, which is responsible for licensing many health care providers, has announced new guidelines and processes for reactivating the licenses of retired health care professionals such as doctors, nurses, nurse practitioners, pharmacists, and others.  This new policy supplements previous announcements the department has made on this subject.  Find this updated information here.

Pennsylvania Health Centers Awarded Federal Funds

The federal Health Resources and Services Administration has awarded $100 million in grants to 1381 health centers across the country.  Among them are 43 health centers in Pennsylvania that will share $12.9 million in federal funds.  See a list of those grant recipients here.

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

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

 

 

 

Filed under: Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy

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