- USDA and EPA Strengthen Partnership to Improve Access to Modern and Affordable Wastewater Infrastructure for People in Rural America
- 'I Went Into Medicine to Help My Community': Nez Perce Doctor Speaks on Rural Health Care and Building a Future for the Next Generation
- Using Virtual Care Tech to Curb Care Barriers in Rural South Carolina
- Research and Analysis: Rural Internet Subscribers Pay More, New Data Confirms
- Focus on Fellows: Checking in with Three Rural Leaders
- In Texas' Panhandle, a Long-Awaited Oasis for Mental Health Care Is Springing Up
- A Reason to Care: How Students Choose Rural Health
- A Prescription for Better Rural Nutrition
- City-Based Scientists Get Creative to Tackle Rural-Research Needs
- Public Payment of Dialysis Treatment Has Changed the Rural Healthcare Marketplace
- How the Bad River Tribe Flipped the Script on the Native American Opioid Crisis
- Reps. Sewell, Miller Introduce the Bipartisan Assistance for Rural Community Hospitals (ARCH) Act on National Rural Health Day
- Western Alaska Salmon Crisis Affects Physical and Mental Health, Residents Say
- How Telehealth Is Bringing Specialist Care to the North Country
- Could a Solution to Provide Legal Care in Alaska Work in Rural Minnesota?
On March 27, CMS issued an electronic toolkit regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities. Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS over the last week in response to the National Health Emergency. Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.
On March 22, 2020, CMS announced relief for clinicians, providers, hospitals and facilities participating in quality reporting programs in response to the 2019 Novel Coronavirus (COVID-19). This memorandum and factsheet supplements and provides additional guidance to health care providers with regard to the announcement. CMS has extended the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline from March 31 by 30 days to April 30, 2020. This and other efforts are to provide relief to clinicians responding to the COVID-19 pandemic. In addition, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30, 2020 deadline.
You can find a copy of the memo here: Memo
You can find a copy of the fact sheet here: Fact Sheet
On March 28, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers, to ensure they have the resources needed to combat the 2019 Novel Coronavirus (COVID-19). This program expansion, which includes changes from the recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act, is one way that CMS is working to lessen the financial hardships of providers facing extraordinary challenges related to the COVID-19 pandemic, and ensures the nation’s providers can focus on patient care.
You can find a copy of the fact sheet here: www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf
You can find a copy of the press release here: https://www.cms.gov/newsroom/press-releases/trump-administration-provides-financial-relief-medicare-providers
On March 27, in keeping with its commitment to ensure states have the necessary tools to respond to the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) approved an additional five state Medicaid waiver requests under Section 1135 of the Social Security Act (Act), bringing the total number of approved Section 1135 waivers for states to thirty four. The waivers offer states new flexibilities to focus their resources on combatting the outbreak and providing the best possible care to their Medicaid beneficiaries. These waivers support President Trump’s commitment to operating a COVID-19 response that is locally executed, state managed and federally supported. All Section 1135 approval letters will be posted here as they are issued. Additional information about all of the Section 1135 Waivers that CMS has approved can be found here.
CMS approved waivers for the following states today:
CMS provides guidance to states on how to apply for Section 1135 waivers through the Medicaid Disaster Response Tool Kit, which can be found here. To further the agency’s efforts, CMS has developed checklists and tools to expedite requests and approvals for waivers and other commonly requested flexibilities. CMS will continue to expeditiously review and approve, as appropriate, all Section 1135 waivers and other requests that the agency receives to ensure that we are providing our state partners with the maximum flexibility they need to care for their Medicaid beneficiaries during the public health emergency.
These waivers, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website. Additionally, CMS has launched a dedicated, Medicaid.gov, COVID-19 resource page that will be continually updated with relevant information.
March 27, 2020
WASHINGTON – USDA Rural Development has launched a COVID-19 resource page to keep our customers, partners, and stakeholders continuously updated on actions taken by the Agency to help rural residents, businesses, and communities impacted by the COVID-19 outbreak.
Visit www.rd.usda.gov/coronavirus for information on Rural Development loan payment assistance, application deadline extensions, and more.
Grocery and convenience store workers are considered essential to ensure an accessible food supply. Employers and employees should be aware of and follow the prevention measures to protect against COVID-19. The service these employees are providing to Pennsylvanians is exemplary, and we must all take measures to protect these employees so they can continue to stay healthy.
This guidance can and should be implemented in all life-sustaining businesses whenever applicable to protect employees and customers or clients.
Grocery stores and convenience store owners and management should review and consider implementing the following recommendations into standard operating procedures to protect employees.
Customer Protective Controls:
- Enforce social distancing in lines to separate customers by six feet whenever possible but allowing families to stay
- Visual cues may be helpful to implement social distancing in lines or other areas of the store. For example, tying a ribbon or using a bright piece of tape on the floor every six feet throughout the store can help customers keep a six-foot distance between themselves whenever
- Install floor markings to require customers to stand behind, until it’s time to complete the transaction.
- Consider limiting the number of people in the store at one time. Consider implementing the “nightclub model” of setting a maximum capacity and assigning staff to manage the number of people entering. Once maximum capacity has been reached, staff can allow more customers inside as others leave to maintain the maximum capacity and help customers shop safely. It is recommended to also encourage social distancing if lines form.
- Consider setting special hours for vulnerable populations, such as the elderly or immuno-compromised. Recommend allowing these populations to enter the store earliest in the day to reduce chances of exposure and ensure access to
- Whenever possible, encourage customers to call ahead or place orders online so that staff can select and pack up groceries for customers to pick up or have
- Encourage customers to come prepared with a list and to avoid touching objects that they do not plan to
- Ensure customers who use SNAP have access to the same delivery services and pick up options whenever possible. Consider waiving delivery fees for these customers during the COVID-19 mitigation
Employee Protective Controls:
Consider altering store hours to allow for increased cleaning and re-stocking without customers
- Cross-train employees and rotate staff between cashier, stocking, and other duties, to limit mental fatigue in adhering to social distancing
- Consider asking customers to bag their own groceries if possible, to limit contact with employees and divert bagging staff to other
- If customers provide their own bags, restrict employees from handling them, and either bag in plastic, or have customers bag their own
- Consider installing sneeze-guards at cashier
- Schedule hand washing breaks every 30-60 minutes. Employees should wash hands with soap and water for at least 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and
- Assign a relief person to step in for cashiers so they can wash their hands with soap for a full 20 seconds. Provide hand lotion so workers’ hands don’t
- Consider providing hand sanitizer at cash registers for staff and customer use in between
- If paying in cash or using coupons, recommend asking customers to place the coupons and money down on the signing shelf to eliminate any hand to hand contact with the cashier. The cashier will then put the receipt in the
- Understand the difference between cleaning, disinfecting, and
- If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to
- For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be
- Products with EPA-approved emerging viral pathogens are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, ).
- Increase cleaning and sanitation practices, focusing on customer high-contact objects and surfaces. Surfaces include, but are not limited to:
- Carts and baskets
- Customer service counter
- Self-checkout counters and equipment
- All touchscreen equipment (computers, iPads, drink machines)
- Produce scales
- Display cooler and freezer doors and handles
- Counter tops at deli counters
- Salad / food bars, coffee grinders, bulk food dispensing units for items such as nuts and candy
- Condiments (salt/pepper shakers)
- Public and employee restroom fixtures including soap dispenser plate, towel dispenser handles, door handles, baby changing stations
- Trash receptacle touch points
- Increase cleaning and sanitation practices, focusing on employee high-contact objects and surfaces. Surfaces include, but are not limited to:
- Food preparation area door handles and push plates, including refrigeration and freezer walk-in plastic curtains
- Oven and microwave doors
- Handsink fixtures
- Dispenser handles
- Ice scoops
- 3-compartment sink and mop sink fixtures
- Cleaning tools and buckets
- Employee break rooms and
- Consider suspending self-service salad bars, olive bars, and hot food bars. Consider having employees provide service to customers or prepackaging
- Provide a safe barrier for customers or employees handling utensils such as bakery tissue paper or disposal gloves and consider cleaning utensils every 2 hours rather than the 4 hours required under Food Code
- Ensure sneeze guards are in place where required and sanitized
- Strictly enforce the Food Code requirement to prohibit employee bare hand contact with ready-to-eat
- Schedule cashier station sanitation breaks to allow for cleaning of belts, shelves, ATM pads, order separation bars, and other high touch
- Take the opportunity to clean and disinfect shelves and display cases before
Tips for Managers
Actively encourage sick employees to stay home:
- Sick employees should follow CDC-recommended steps. Employees should not return to work until the criteria to discontinue home isolation are met, in consultation with healthcare providers and state and local health
- Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential
Consider screening employees for coronavirus symptoms each day in a way that protects their confidentiality and send home employees if symptomatic. Employers should have a plan to screen employees or volunteers every day. This could include implementing a thermometer station at the employee entrance. Employees or volunteers who appear to have symptoms (i.e., fever, cough, or shortness of breath) upon arrival at work or who become sick during the day should immediately be separated from other employees, customers, and visitors and sent home.
If an employee is confirmed to have COVID-19 infection, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). The fellow employees should then self-monitor for symptoms (i.e., fever, cough, or shortness of breath).
Be aware that some employees may be at higher risk for serious illness, such as older adults and those with chronic medical conditions. Consider minimizing face-to-face contact between these employees or assign work tasks that allow them to maintain a distance of six feet from other workers, customers and visitors.
Provide COVID-19 prevention disease training to all employees, and specific training on new store protocols related to COVID-19 protective measures. Educate employees on the steps to protect themselves and to reduce the spread of COVID-19. Post CDC guidelines in breakrooms and discourage employees with key symptoms from coming to work.
Social distancing recommendations must be met (i.e., limit contact of people within 6 feet from each other). Consider: only operating every other register or check-out lane, ensuring work space between workers is at least 6 feet, staggering work schedules if possible, limiting in-person meetings, ensuring break areas accommodate social distancing.
- Support your employees by relaxing all existing production standards and productivity monitoring systems for the duration of this event. Talk to staff regularly to ensure their feedback is being heard and concerns are being addressed as able.
- Explore scheduling adaptations to accommodate childcare arrangements.
- For employee working overtime and shift work, make sure that there are at least 12 hours from the end of one shift to the beginning of the next shift so that employees working extra hours have plenty of time to travel to and from home and get 8 hours of sleep.
- Be alert for and do not tolerate racism or discrimination against workers or customers.
- Consider paid leave time to cover the quarantine, isolation and COVID-19 related illnesses for your employees. Consider waiving any waiting or accrual period outlined in leave time policy or union contract.
- Put up signage about the changes in business model and practices so customers know what to expect and how to protect themselves.
- Explore ways to reduce handling of paper coupons, including substitutes that will not present a hardship to customers.
- Consider waiving grocery pick-up fees for customers to avoid in-store crowds. Encourage the use of credit cards over cash.
Tips for Employees
Retail food workers are among the heroes of the COVID-19 pandemic response. We need to protect the health of retail food workers throughout the duration of the pandemic. Employees can take steps to protect themselves at work and at home.
Retail food workers are feeling the pressure of trying to keep shelves stocked. They are working faster, skipping breaks, and working more hours. Stress, fatigue, and constant exposure to the public can make retail workers more vulnerable. Take breaks! Other people’s urgency is real, but it cannot come at the expense of your health.
- Take extra hand washing breaks. Wash hands often with soap and water for at least 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water. Keep in mind that everything you scan at the cash register was handled by multiple people including customers; and that you handle money, coupons, and credit cards or store cards. Use the hand scanner for store cards, if possible.
- Consider sanitizing hands in between checking out each customer if sanitizer is available. Whether sanitizer is available or not, take your hand washing breaks. There is no substitute for proper hand washing.
- If sanitizer is available for customer use, encourage customers to use after touching pads, pens, or other items around the register during checkout. Whenever possible, limit customers’ touching items around the register.
- Avoid touching your eyes, nose, and mouth with unwashed hands. Secure your hair, to avoid having to touch your face to adjust stray hairs. Make a concerted effort to keep your hands away from your face, eyes, nose and mouth while working.
- Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues in the trash and immediately wash hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer containing at least 60% alcohol. Learn more about coughing and sneezing etiquette on the CDC website.
- Clean AND disinfect frequently touched objects and surfaces such as workstations, keyboards, telephones, handrails, and doorknobs. Dirty surfaces can be cleaned with soap and water prior to disinfection. To disinfect, use products that meet EPA’s criteria for use against SARS-CoV- 2external icon, the cause of COVID-19, and are appropriate for the surface.
- If you use a cellphone, remember that you touch it with your hands and hold it against your face. Use a disinfecting wipe on it regularly and before you take it home where family members might use it.
- Do not use other workers’ phones, work tools, or share food or beverages. Clean and disinfect communal tools before and after use.
- Take care of your own health. Get plenty of sleep. Get the flu shot, keep all your other vaccinations up-to-date, including tetanus.
- Immediately notify your manager if you feel unwell before, during, or after a shift. If you are sick, please stay home.
The Pennsylvania Department of Health has finalized COVID-19 infographics and social graphics that can be downloaded from the department’s social media resources page.
CMS has taken several recent actions in response to the Coronavirus Disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts. A summary of recent CMS activities can be found here: https://www.cms.gov/newsroom/press-releases/cms-news-alert-march-26-2020
To keep up with the important work the Task Force is doing in response to COVID-19, click here www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website.
DUFUR, Ore. The social distancing rules repeated like a mantra in America’s urban centers, where the coronavirus is spreading exponentially, might seem silly in wide-open places where neighbors live miles apart and “working from home” means another day spent branding calves or driving a tractor alone through a field.
But as the pandemic spreads through the U.S., those living in rural areas, too, are increasingly threatened. Tiny towns tucked into Oregon’s windswept plains and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus, but their main streets are also empty and their medical clinics overwhelmed by the worried.
Residents from rural Alabama to the woods of Vermont to the frozen reaches of Alaska fear the spread of the disease from outsiders, the social isolation that comes when the town’s only diner closes, and economic collapse in places where jobs were already tough to come by.
“Nobody knows what to do and they’re just running in circles, so stay away from me is what I’m saying,” said Mike Filbin, a 70-year-old cattle rancher in Wasco County, Oregon, one of the few parts of the state that has yet to see a case of COVID-19.
“Right now, we’re pretty clean over here, but we’re not immune to nothin’ – and if they start bringing it over, it’ll explode here.”
To make matters worse, some of the most remote communities have limited or no internet access and spotty cellphone service. That makes telecommuting and online learning challenging in an era of blanket school and work closures, and it eliminates the possibility of the FaceTime card games and virtual cocktail hours that urban Americans have turned to in droves to stay connected.
The routine ways that rural Americans connect – a bingo night, stopping in at a local diner or attending a potluck – are suddenly taboo.
“Rural people are reliant on their neighbors and have more confidence and trust in their neighbors,” said Ken Johnson, a senior demographer at the Carsey School of Public Policy and professor of sociology at the University of New Hampshire. “Now you have people who are supposed to self-isolate themselves. What does that mean when people you depend on, in order to help you, are going to put themselves and their families at risk? I don’t know what that will do in rural America.”
Neil Bradshaw, the mayor of Ketchum, Idaho, is starting to see the answer in his own community. The rural resort town has struggled since the arrival of COVID-19, and he fears if the virus lingers too long, it could devastate it. “Our town thrives on people coming to town, and for the first time in our history we are discouraging visitors,” said Bradshaw.
Some communities have pushed back on shutdowns. Leaders from seven Utah counties, for example, sent a letter earlier this week to Gov. Gary Herbert urging a “return to normalcy.”
March 26, 2020
Harrisburg, PA – Pennsylvania Governor Tom Wolf announced the creation of a new web portal that will expedite the procurement of critical medical supplies for Pennsylvania’s health care system during the COVID-19 pandemic.
“The commonwealth, and the nation, is facing an unprecedented and uncertain time, and as we work to flatten the curve we must also ramp up efforts to provide Pennsylvania’s health care system with the critical supplies it needs to treat individuals with COVID-19,” said Gov. Wolf. “By consolidating the efforts of various state agencies, we will streamline the procurement process and allow these supplies to get to our health care providers and medical professionals as quickly as possible.”
The Commonwealth of Pennsylvania Critical Medical Supplies Procurement Portal was developed through a joint effort between the Pennsylvania Emergency Management Agency, the Department of Health, the Department of General Services, and the Department of Community and Economic Development to source the most needed supplies for medical providers, emergency responders, and health care professionals.
The Portal is for manufacturers, distributors and other suppliers to inform us of supplies available for purchase and will allow us to more quickly and efficiently procure these supplies for hospitals and medical facilities across Pennsylvania.
Links for the Expansion of Supply Chain Capacity and Manufacturing Innovation and Donations will also be available very soon for those organizations who wish to inform the commonwealth of their expanded supply chain and manufacturing capacity or to donate goods and services for distribution across Pennsylvania.
Most needed personal professional equipment includes: surgical/procedure masks, N95/N99 Form Fitting Respirators, face masks with integrated shields, Powered Air Purifying Respirators (PAPR), and alcohol-based hand rubs. Needed hospital supplies include: ventilators with PEEP functionality, ventilator circuits, endotracheal tubes, and hospital gowns. Needed lab supplies include: UVT 3 mL with flocked flex minitip and Nasopharyngeal (NP) flocked swabs and viral transport media tubes (1-3 mL). Needed diagnostic supplies include: 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, and Biomerieux NuciSENS EasyMAG extraction system and supplies.
Questions on the portal can be directed to the Department of General Services at RAfirstname.lastname@example.org.