Rural Health Information Hub Latest News

Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”). The recommendations are intended for use by professionals who manage respiratory protection programs in healthcare institutions to protect health care workers from job-related risks of exposure to infectious respiratory illnesses.

Supplies of N95 respirators can become depleted during an influenza pandemic (1-3) or wide-spreadoutbreaks of other infectious respiratory illnesses.(4) Existing CDC guidelines recommend a combination of approaches to conserve supplies while safeguarding health care workers in such circumstances. These existing guidelines recommend that health care institutions:

  • Minimize the number of individuals who need to use respiratory protection through the preferential use of engineering and administrative controls;
  • Use alternatives to N95 respirators (e.g., other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, powered air purifying respirators) where feasible;
  • Implement practices allowing extended use and/or limited reuse of N95 respirators, when acceptable; and
  • Prioritize the use of N95 respirators for those personnel at the highest risk of contracting or experiencing complications of infection.

This document focuses on one of the above strategies, the extended use and limited reuse of N95 respirators only; please consult the CDC or NIOSH website for guidance related to implementing the other recommended approaches for conserving supplies of N95 respirators.

There are also non-emergency situations (e.g., close contact with patients with tuberculosis) where N95 respirator reuse has been recommended in healthcare settings and is commonly practiced.(5-9) This document serves to supplement previous guidance on this topic.

New Specimen Collection Codes for Laboratories Billing for COVID-19 Testing

Clinical diagnostic laboratories: To identify and reimburse specimen collection for COVID-19 testing, CMS established two Level II HCPCS codes, effective with line item date of service on or after March 1, 2020:

  • G2023 – Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
  • G2024 – Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source

These codes are billable by clinical diagnostic laboratories.

Billing for Professional Telehealth Services During the Public Health Emergency

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for non-traditional telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with the Place of Service (POS) equal to what it would have been in the absence of a PHE, along with a modifier 95, indicating that the service rendered was actually performed via telehealth. As a reminder, CMS is not requiring the “CR” modifier on telehealth services. However, consistent with current rules for traditional telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:

  • Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier
  • Furnished for diagnosis and treatment of an acute stroke, use G0 modifier

Traditional Medicare telehealth services professional claims should reflect the designated POS code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site. There is no change to the facility/non-facility payment differential applied based on POS. Claims submitted with POS code 02 will continue to pay at the facility rate.

There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.

Deadline Extended to Review and Comment on Rural Maternal Health Care

CMS’s Office of Minority Health has announced that the deadline has been extended to submit comments to a Request for Information (RFI) to seek public comments regarding rural maternal and infant health care.

Through the Centers for Medicare & Medicaid Services Office of Minority Health, CMS is seeking information related to opportunities to improve access, quality, and outcomes before, during, and after pregnancy, and to develop and refine programs and policies that ensure all rural women have access to high quality maternal health care that results in optimal health.

To review the RFI, please visit

Responses to this RFI will be used to inform future discussions among stakeholders and future work by CMS toward the development and refinement of programs and policies that ensure rural women have access to high quality maternal health care that results in optimal health outcomes.

CMS encourages all stakeholders to review the RFI at and submit comments to Comments will be collected until Sunday, May 31 at 11:59pm ET.

For more information and updates about this RFI, please visit the CMS Rural Health website at or email questions to

ARC COVID-19 Update: March 26, 2020

The Appalachian Regional Commission (ARC) is carefully and continually monitoring the COVID-19 situation as it is impacting the Appalachian Region. ARC staff, who are now primarily working from home, are diligently continuing to process and administer grants, new applications, progress reports, and payment requests as they are received.

We are assisting grantees whom are unable to meet project goals or timelines due to the current situation. If you are a current ARC grantee experiencing such challenges, please email your ARC project coordinator and state program manager as soon as possible for help with needed accommodations regarding your project’s deliverables, timelines, budget, or other operations. (When emailing, please put your ARC project number in the subject line. This will make responding to your request easier).

To support the health and safety of our partners, grantees, and communities, we have also made the following adjustments:

  •  We have extended the application deadline for the Appalachian Entrepreneurship Academy to March 31, 2020. Should this program, or the ARC/ORNL Summer STEM program, need to be modified further, an announcement will be made in mid-April.
  • We have extended the deadline for POWER applications to April 24, 5 pm ET. Additional revisions can also be made to applications already submitted to during this thirty day extension.
  • We are convening the Appalachian Leadership Institute virtually through online learning modules in lieu of the upcoming field seminars scheduled for Beckley, West Virginia and Boone, North Carolina.
  • We have postponed Envision Appalachia: Community Conversations for ARC’s New Strategic Plan. Our intent is to restart our strategic planning process at a time when we can gather in-person to discuss our Region’s future.

We will be posting any additional ARC operational updates on, and in forthcoming issues of In The Region.

This is a challenging time for our communities, our Region, and our country. Please continue to check with state and federal authorities for health-related guidance and information.

New Resources Documenting COVID-19 Spread in Appalachia in Relation to Rest of Nation Now Available

The Appalachian Regional Commission has released two new tools documenting the spread of COVID-19 at the regional and county levels. The COVID-10 Cases in Appalachia map displays the current number of confirmed cases of COVID-19 in Appalachia and throughout the United States. Higher numbers of cases are marked by larger dots, while smaller numbers of confirmed cases are represented by smaller dots. By clicking on a location, users can see confirmed COVID-19 cases and any related deaths at the county level. This map is automatically updated throughout the day drawing on data collected by the Johns Hopkins University. Due to frequent changes, it is advised that users refresh their browsers often when viewing the map. As of March 26th, at 1:30 pm (ET), there were 1,686 confirmed cases in 208 Appalachian counties.

The second tool, Explore County-level Coronavirus Impact Planning is a searchable data base offering demographic data snapshots of confirmed COVID-19 cases and deaths in relation to hospital bed counts, population and businesses, and categories of people at risk for COVID-19 in each one of the nation’s counties. By hovering over each statistical icon, users can learn more about the supporting data. COVID-19 related data is updated daily.

These resources are available at https:/

USDA Grants Lenders Temporary Exception to Offer Payment Deferrals for Agency Guaranteed Loan Programs

WASHINGTON, March 31, 2020 – USDA Rural Development Deputy Under Secretary Bette Brand announced that USDA is granting lenders a temporary exception to offer payment deferrals for Agency guaranteed loan programs due to the COVID-19 pandemic.

Effective immediately until September 30, 2020, lenders may offer 180-day loan payment deferrals without prior agency approval for Business and Industry Loan Guarantees, Rural Energy for America Program Loan Guarantees, Community Facilities Loan Guarantees, and Water and Waste Disposal Loan Guarantees. For additional information, see page 17721 of the March 31, 2020, Federal Register.

Questions regarding this announcement may be directed to:

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

Counties Without Coronavirus are Mostly Rural, Poor

As the coronavirus rages across the United States, mainly in large urban areas, more than a third of U.S. counties have yet to report a single positive test result for COVID-19 infections, an analysis by The Associated Press shows.

Data compiled by Johns Hopkins University shows that 1,297 counties have no confirmed cases of COVID-19 out of 3,142 counties nationwide. The number of counties without a positive coronavirus case has declined rapidly, dropping from over half as the AP was preparing to publish. Of the counties without positive tests, 85% are in rural areas – from predominantly white communities in Appalachia and the Great Plains to majority Hispanic and Native American stretches of the American Southwest – that generally have less everyday contact between people that can help transmit the virus.

At the same time, counties with zero positive tests for COVID-19 have a higher median age and higher proportion of people older than 60 – the most vulnerable to severe effects of the virus – and far fewer intensive care beds should they fall sick. Median household income is lower, too, potentially limiting health care options.

The demographics of these counties hold major implications as the Trump administration develops guidelines to rate counties by risk of the virus spreading, empowering local officials to revise social distancing orders that have sent much of the U.S. economy into free fall. President Donald Trump on Sunday extended the country’s voluntary national shutdown for a month, significantly changing his tone on the coronavirus pandemic.

Experts in infectious disease see an opportunity in slowing the spread of coronavirus in remote areas of the country that benefit from “natural” social distancing and isolation, if initial cases are detected and quarantined aggressively. That can buy rural health care networks time to provide robust care and reduce mortality.

But they also worry that sporadic testing for coronavirus could be masking outbreaks that – left unattended – might overwhelm rural health networks.

“They’ll be later to get the infection; they’ll be later to have their epidemics,” said Christine K. Johnson, a professor of epidemiology at the University of California, Davis. “But I don’t think they’re going to be protected because there’s nowhere in the U.S. that’s isolated.”

Counties that have zero confirmed COVID-19 cases could raise a red flag about inadequate testing, she said.

“I hope the zeros are really zeros – I worry that they’re not doing enough testing in those regions because they’re not thinking they’re at risk,” she said.

In New Mexico, a state with 2 million residents spanning an area the size of Italy, Democratic Gov. Michelle Lujan Grisham has moved aggressively to contain the coronavirus’ spread with a statewide school shutdown and prohibition on most gatherings of over five people.

Nearly half of the state’s 33 counties are free of any positive coronavirus cases. New Mexico is among the top five states in coronavirus testing per capita, though some virus-free counties aren’t yet equipped with specialized testing sites beyond samplings by a handful of doctor offices.

Torrance County Manager Wayne Johnson said plans are being made for the first three dedicated COVID-19 testing sites in the high-desert county of 15,000 residents that spans an area three times the size of Rhode Island.

A statewide stay-at-home order is keeping many residents from commuting to jobs in adjacent Bernalillo County, the epicenter of the state’s COVID-19 infections.