Rural Health Information Hub Latest News

ARC’S COVID-19 Update

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 power.arc.gov 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 www.arc.gov/coronavirus, 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.

Appalachian Communities Respond to COVID-19

As the COVID-19 Pandemic continues, communities across Appalachia are banding together to pool resources and ideas for resilience. Here are some inspiring examples:

  • LaunchTN, an ARC partner, is providing a variety of resources including state government contacts for health, small business needs, and other support services. Check out their website for more information.
  • To help individuals and small-business owners in eastern Kentucky, Shaping Our Appalachian Region (SOAR), another ARC partner, has created thereisafuture.org/covid19 to encourage partners to “be aware not afraid.” The site also includes a survey for local businesses and organizations in Eastern Kentucky.

Non-profit Rural Action and ACEnet are organizing the Athens County Response Fund to provide support to Athens County businesses, employees and organizations in Ohio. The funds are intended to complement the work of other local efforts to ensure all aspects of the outbreak are addressed.

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

The Appalachian Regional Commission announced 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:/www.arc.gov/coronavirus

Senate Passes Stimulus Package, but Will it Help People with Disabilities?

Washington, D.C., March 26 – Last night Senate leaders voted unanimously to move forward on the $2 trillion-dollar emergency stimulus bill meant to help our nation respond to the COVID-19 pandemic. The bill, originally called the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), now goes to the House of Representatives for a vote. If passed, then it will go to the President’s desk to become law.

You can read more about the bill on the Senate Appropriations Committee website HERE.

However, what does this mean for the millions of American living with disabilities? What provisions will specifically impact or help the disability community? What help is there for actual people with disabilities who are uniquely at-risk to the impact of the virus?

RespectAbility and a host of other disability advocacy organizations have been working around the clock to answer these questions for the past several days. Those that lobby have been fighting hard to include key provisions into the law that will help the more than 56 million Americans with disabilities.

These efforts resulted in 12 explicit references to disabilities/people with disabilities in the final text of the bill, which can be accessed online. They are on pages 186-187, 192-193, 330-331, 741-742, 759-760 and 870-871.

How will this bill help me as an individual with disabilities?

The most direct way that the CARES Act will help individuals with and without disabilities who are struggling right now is through recovery rebates for individuals. This will be a one-time cash payment sent from the government to all U.S. residents who are not a dependent of another taxpayer, and have a Social Security Number with adjusted gross income up to $75,000 ($150,000 if you are married), with a phaseout for incomes between $75,000 and $99,000, ($150,000-$198,000 if you are married).

The amount of that check will be $1,200 for eligible individuals and $2,400 for people who are married, plus $500 per dependent child. This is being characterized as a rebate, which means it will NOT be counted against the asset limits faced by people with disabilities if spent within 12 months of receipt.

However, as it is currently crafted, people with disabilities who are on Supplemental Security Income (SSI) will have to file their taxes. This could create a major burden for many of the poorest people with disabilities and other low-income communities, many of whom will find access to filling out the forms a challenge. See page 144 of the bill for more details. Disability organizations already are preparing to push for clarity and guidance from the government on this issue.

How will this bill impact workers with disabilities and others who may have lost their jobs?

This bill includes major changes and supports for the unemployment insurance (UI) system under the U.S. Department of Labor (DOL). Unemployed workers with and without disabilities will receive $600 increase in the weekly checks. The bill also creates a Pandemic Unemployment Assistance (PUA) that expands UI coverage. Critically that coverage has been expanded to include self-employed workers, gig workers and independent contractors.

This is great news for many people with disabilities who engage in the gig economy, drive for Uber, or run their own small businesses.

The bad news is that the Pandemic Unemployment Compensation only extends to July. Given the uncertainties of the virus and the economy, whether that will be enough time remains an open question.

It also is unclear how this will play out in individual circumstances. We were contacted by an individual who currently works part time at income level that allows him to continue to collect SSI and/or SSDI. Interestingly, the bill passed by the Senate adds $600 per week to the unemployment payment regardless of the amount of the lost income, and so he is rightfully concerned that if he follows the instructions from his job, from which he was just furloughed, and files for unemployment, he will lose these important benefits because his income from unemployment will be too high.

As the House still needs to pass its version of the bill before being sent to the President for signature, we hope that this seemingly unintended result, as well as other confusions, will be resolved in conference. RespectAbility will keep you up-to-date.

How will this bill help caregivers or people who need paid sick leave?

Unfortunately, this bill does not include any additional provisions to help workers who do not already receive paid sick leave or who are now receiving sick leave through the earlier Families First Coronavirus Response Act.

People with disabilities must know they are secure in this time of crisis. Thus, further advocacy is needed to cover these gaps in coverage and ensure that family members who need to take leave in order to meet the critical needs of their loved ones are covered.

How will this bill impact students with disabilities who are now learning from home?

Teachers and special educators are facing significant challenges around how to provide a free, appropriate public education to students with disabilities when you can only connect through a computer screen. The bill will give states more than $30 billion dollars to provide Emergency Education Relief grants to help teachers and students with and without disabilities to make the switch to online learning and virtual classrooms. See pages 192 and 193 for more details.

These grants will specifically help teachers meet the needs of students with disabilities in these trying times. Likewise, some of those funds can be used to provide summer learning, supplemental after-school programs and online learning for students with disabilities. Details on pages 759-760.

Disability advocates had been very concerned that the original bill included several provisions waivers from the explicit requirements of laws such as Individuals with Disabilities Education Act (IDEA). The new version of the bill requires the Secretary of Education to report to Congress within 30 days about where, how and why waivers are being used and students with disabilities are accessing online learning. See pages 741 and 742 for more details.

How will this bill help organizations serving people with disabilities?

The bill would specifically distribute $955 million for Aging and Disability Services Programs under the mandate of the Administrative on Community Living (ACL). That money will go to support nutrition programs providing people with disabilities and older Americans with food deliveries as well as direct support for family caregivers.

That amount also includes $50 million dollars for aging and disability resource centers across the country as well as $85 million dollars for Centers for Independent Living (CILs). Pages 330 and 331 for those interested. Further, the bill invests $15 million to support housing specifically for people with disabilities.

Addressing the critical issue of Direct Support Professionals (DSPs) who help people with disabilities, the CARES Act crucially will now allow state Medicaid programs to pay for DSPs to help people with disabilities who end up in the hospital. This should provide some reassurance for people with disabilities who need support for activities of daily living, but many other needs regarding DSPs and maintenance of the DSP workforce through this crisis remain unaddressed.

What is missing from the bill?

The CARES Act does not address the life or death issue of medical rationing facing the disability community in this moment of crisis. As the crisis intensified in Italy, the government rationed healthcare away from people with disabilities. This approach already is illegal under American law, but it still happens, nonetheless. In this time of crisis, the state and local leaders making on the ground decisions need to hear a clear message about treating people with disabilities equally.

Lastly, the bill does nothing to support some of the most vulnerable people with disabilities in America today. The bill contains no mention whatsoever about immigrants (with or without disabilities) or people who are incarcerated. Census Bureau data shows that there are more than 44 million immigrants living in the United States and out of that number, up to 6 million are probably living with a disability. How are they going to be helped or harmed by this bill? There are no clear answers yet. Likewise, there is no relief or support for the estimated 750,000 people with disabilities who are currently imprisoned.

In the meantime, the staff at RespectAbility will continue monitoring this situation and encourage you to make your voices heard to your elected officials. If you have specific questions about this Bill, please email or call your members of Congress. Locate your U.S. senators’ contact information and find your U.S. representative’s websites.

If you would like to know more about how COVID-19 is impacting the disability community, we encourage you to review and make use of the following resources and materials:

RespectAbility will continue to provide updates and insights on these issues at www.respectability.org/covid-19.

Media Contact: 

Lauren Appelbaum, VP for Communications, RespectAbility

LaurenA@RespectAbility.org, 202-591-0703

Rural Health Care Implications in the $2 Trillion COVID-19 Relief Legislation: The Coronavirus Aid, Relief, and Economic Security Act

From the National Rural Health Association (NRHA)

The Senate has passed the third in a series of bills in response to COVID-19 (S. 3548/H.R. 748). The House is expected to take action on the legislation later this week. In the language, there is $127 billion to the Assistant Secretary for Preparedness and Response to include $100 billion in grants to hospitals and other Medicare and Medicaid suppliers to cover unreimbursed health care related expenses or lost revenue related to COVID-19. Additional funding includes $275 million to HRSA to support rural hospitals and critical access hospitals and telehealth, $200 million to CMS to assist nursing homes and $955 million to the Administration for Community Living to support nutrition programs and home and community-based services. Here are the Appropriations Sections in full and a Appropriations Summary. Note: This list is not exhaustive, as NRHA’s full analysis of the bill continues. Please see a list of important provisions below.  Read the full bill here.

Public Health and Social Services Emergency Fund

  • The legislation would make available $100 billion to reimburse eligible health care providers for health care-related expenses or lost revenues not otherwise reimbursed that are directly attributable to COVID-19. Eligible providers are defined as public entities, Medicare- or Medicaid enrolled suppliers and providers, and other for-profit and non-profit entities as specified by the Health and Human Services (HHS) Secretary. Funding would be on a rolling basis through “the most efficient payment systems practicable to provide emergency payment.”

Hospital Payments

  • Sec. 3719. Expansion of the Medicare Hospital Accelerated Payment Program During The COVID-19 Public Health Emergency: This section would expand, for the duration of the COVID-19 emergency period, an existing Medicare accelerated payment program. Hospitals, especially those facilities in rural and frontier areas, need reliable and stable cash flow to help them maintain an adequate workforce, buy essential supplies, create additional infrastructure, and keep their doors open to care for patients. Specifically, qualified facilities would be able to request up to a six-month advanced lump sum or periodic payment. This advanced payment would be based on net reimbursement represented by unbilled discharges or unpaid bills. Most hospital types could elect to receive up to 100 percent of the prior period payments, with Critical Access Hospitals able to receive up to 125 percent. Finally, a qualifying hospital would not be required to start paying down the loan for four months and would also have at least 12 months to complete repayment without a requirement to pay interest.

Support for Health Care Providers

  • Sec. 3211. Supplemental awards for health centers: Provides $1.32 billion in supplemental funding to community health centers on the front lines of testing and treating patients for COVID-19.
  • Sec. 3212. Telehealth network and telehealth resource centers grant programs: Reauthorizes HRSA grant programs that promote the use of telehealth technologies for health care delivery, education and health information services. Telehealth offers flexibility for patients with, or at risk of contracting, COVID-19 to access screening or monitoring care while avoiding exposure to others.
  • Sec. 3213. Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Grant Programs: Reauthorizes HRSA grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services. Rural residents are disproportionately older and more likely to have a chronic disease, which could increase their risk for more severe illness if they contract COVID-19.
  • Sec. 3216. Flexibility for members of National Health Service Corps during emergency period: Allows the Secretary of HHS to reassign members of the NHSC to sites close to the one which they were originally assigned, with the member’s agreement, in order to respond to the COVID-19 public health emergency.

Small Business Loans:

  • Sec. 1102. Title I – Small Business Administration loan program provides a maximum of $10 million loans. Defines eligibility as small business, 501(c) (3) non-profit, 501(c)19, or certain tribal groups with not more than 500 employees (unless there is a higher industry standard). Sec. 1106 includes loan forgiveness provisions. Borrower shall be eligible for loan forgiveness equal to the amount spent by the borrower during an 8-week period of payroll costs, interest payment on mortgage, rent or lease. Amounts forgiven may not exceed the principal amount of the loan. Eligible payroll costs do not include salaries that exceed $100,000.
  • Also waives borrower and lender fees, waives “credit elsewhere” test, and waives collateral and personal guaranteed requirements. Maximum interest rate of 4% and no pre-payment penalties Complete deferment of loan repayment is deferred by 6 months.

Telehealth:

  • Sec. 3701. Health Savings Accounts for Telehealth Services: This section would allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible, increasing access for patients who may have the COVID-19 virus and protecting other patients from potential exposure.
  • Sec. 3703. Expanding Medicare Telehealth Flexibilities: This section would eliminate the requirement in Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (Public Law 116-123) that limits the Medicare telehealth expansion authority during the COVID-19 emergency period to situations where the physician or other professional has treated the patient in the past three years. This would enable beneficiaries to access telehealth, including in their home, from a broader range of providers, reducing COVID-19 exposure.
  • Sec. 3704. Allowing Federally Qualified Health Centers and Rural Health Clinics to Furnish Telehealth in Medicare: This section would allow, during the COVID-19 emergency period, Federally Qualified Health Centers and Rural Health Clinics to serve as a distant site for telehealth consultations. A distant site is where the practitioner is located during the time of the telehealth service. This section would allow FQHCs and RHCs to furnish telehealth services to beneficiaries in their home. Medicare would reimburse for these telehealth services based on payment rates similar to the national average payment rates for comparable telehealth services under the Medicare Physician Fee Schedule. It would also exclude the costs associated with these services from both the FQHC prospective payment system and the RHC all-inclusive rate calculation.
  • Sec. 3706. Allowing for the Use of Telehealth during the Hospice Care Recertification Process in Medicare: Under current law, hospice physicians and nurse practitioners cannot conduct recertification encounters using telehealth. This section would allow, during the COVID-19 emergency period, qualified providers to use telehealth technologies in order to fulfill the hospice face-to face recertification requirement.

Other Medicare Provisions:

  • Sec. 3709. Increasing Provider Funding through Immediate Medicare Sequester Relief: This section would provide prompt economic assistance to health care providers on the front lines fighting the COVID-19 virus, helping them to furnish needed care to affected patients. Specifically, this section would temporarily lift the Medicare sequester, which reduces payments to providers by 2 percent, from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care. The Medicare sequester would be extended by one-year beyond current law to provide immediate relief without worsening Medicare’s long-term financial outlook.
  • Sec. 3710. Medicare Add-on for Inpatient Hospital COVID-19 Patients: This section would increase the payment that would otherwise be made to a hospital for treating a patient admitted with COVID-19 by 20 percent. It would build on the Centers for Disease Control and Prevention (CDC) decision to expedite use of a COVID-19 diagnosis to enable better surveillance as well as trigger appropriate payment for these complex patients. This addon payment would be available through the duration of the COVID-19 emergency period.
  • Sec. 3713. Eliminating Medicare Part B Cost-Sharing for the COVID-19: Vaccine This section would enable beneficiaries to receive a COVID-19 vaccine in Medicare Part B with no cost-sharing.
  • Sec. 3718. Preventing Medicare Clinical Laboratory Test Payment Reduction: This section would prevent scheduled reductions in Medicare payments for clinical diagnostic laboratory tests furnished to beneficiaries in 2021. It would also delay by one year the upcoming reporting period during which laboratories are required to report private payer data

Community Health Centers

  • Sec. 3831. Extension for Community Health Centers, the National Health Service Corps, and Teaching Health Centers that Operate GME Programs: This section extends funding for the three programs until November 20th, 2020.

Indian Health Services

  • Includes an additional $1 billion for the Indian Health Services to remain available until September 30, 2021, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for public health support, electronic health record modernization, telehealth and other information technology upgrades, Purchased/Referred Care, Catastrophic Health Emergency Fund, Urban Indian Organizations, Tribal Epidemiology Centers, Community Health Representatives, and other activities to protect the safety of patients and staff (pg. 718).

Medicaid

  • Sec. 3720. Providing State Access to Enhanced Medicaid FMAP: This section would amend a section of the Families First Coronavirus Response Act of 2020 (Public Law 116-127) to ensure that states are able to receive the Medicaid 6.2 percent FMAP increase.
  • Sec. 3801. Extension of Physician Work Geographic Index Floor: This section would increase payments for the work component of physician fees in areas where labor cost is determined to be lower than the national average through December 1, 2020.
  • Sec. 3811. Extension of Money Follows the Person Demonstration Program: This section would extend the Medicaid Money Follows the Person demonstration that helps patients transition from the nursing home to the home setting through November 30, 2020.
  • Sec. 3813. Delay of Disproportionate Share Hospital Reductions: This section would delay scheduled reductions in Medicaid disproportionate share hospital payments through November 30, 2020.
  • Sec. 3715. Providing Home and Community-based Support Services during Hospital Stays: This section would allow state Medicaid programs to pay for direct support professionals, caregivers trained to help with activities of daily living, to assist disabled individuals in the hospital to reduce length of stay and free up bed
  • Sec. 3813. A 6-month delay in Medicaid DSH cuts. The last delay would have expired May 23rd, 2020 but is delayed through November 30th, 2020.

Rural Development

  • $20.5 million in new money in rural business loans and grants through the USDA to “prevent, prepare, and respond to COVID-19”
  • $25 million to support the Distance, Learning, and Telemedicine program for rural communities for COVID-19 related care. This increase will help improve distance learning and telemedicine in rural areas of America.
  • $100 million is provided to the ReConnect program to help ensure rural Americans have access to broadband, the need for which is increasingly apparent as millions of Americans work from home across the country.

Other Public Health and Social Services Emergency Fund

  • Increasing the National Stockpile: Provides $16 billion for medical supplies to be deposited in the Strategic National Stockpile.

Hospital Preparedness Program: Provides $250 million available for grants to or cooperative agreements with entities that are either grantees or sub-grantees of the Hospital Preparedness Program authorized in section 7 319C–2 of the Public Health Service Act or that meet such other criteria as the Secretary may prescribe, with such awards issued under such section or section 311 of the act.

NCSL Provides Summary of $2T Stimulus Package

In a move that will immeasurably assist the nation’s states and territories, the U.S. Senate just approved a $2 trillion stimulus package to battle the harmful effects of the COVID-19 pandemic. At this time, the House is expected to approve the bill and send it to the president.  The National Conference of State Legislators (NCSL) wants you to be the first to know how the bill affects the states. Read NCSL’s full summary of the bill here.

NCSL worked closely with Congress and the administration to secure $150 billion in stimulus for state, local and tribal governments. The Coronavirus Aid, Relief, and Economic Security Act, as passed by the Senate, provides immediate and flexible aid for states to weather massive public health and economic challenges.

For states, here are some highlights of the bill:

  • $45 billion for the Disaster Relief Fund for the immediate needs of state, local, tribal and territorial governments to protect citizens and help them respond and recover from the overwhelming effects of the coronavirus.
  • $30 billion for an Education Stabilization Fund for states, school districts and institutions of higher education for costs related to the coronavirus.
  • $4.3 billion, through the Centers for Disease Control and Prevention, to support federal, state and local public health agencies to prevent, prepare for and respond to the coronavirus.

Working on behalf of state legislatures, NCSL advocated to secure these and other provisions of the legislation. NCSL is grateful to Congress and the administration for their recognition of the role states take in leading the economic recovery, as well as aggressively battling the health crisis.

Access NCSL’s full suite of coronavirus resources, updated daily.

Pennsylvania Population Estimates Released for Counties

The U.S. Census Bureau released estimates of the total population as of July 1, 2019 at the county level. The data show that the fastest growing counties since 2010 are Cumberland (+7.6%), Lebanon (+6.1%), Lehigh (+5.6%), Centre (+5.4%), and Chester (+5.2%). Counties with the greatest percentage decreases were Cameron (-12.5%), Cambria (-9.4%), Venango (-7.9%), Susquehanna (-6.9%), and McKean (-6.5%).

By sheer numbers Philadelphia continued to add the most population this decade (+58,052). Philadelphia was followed by Montgomery (+31,075), Lancaster (+26,281), Chester (+25,856), and Lehigh (+19,643). Westmoreland County lost the most population so far this decade (-16,172). Westmoreland was followed by Cambria (-13,503), Erie (-10,856), Fayette (-7,327), and Allegheny (-7,258).

Want to take a closer look?  Find the data at: https://www.census.gov/data/datasets/time-series/demo/popest/2010s-counties-total.html

COVID-19 Highlights Rural Health Care Disparities In Pennsylvania

, WESA-FM

While U.S. cities may be seeing the initial wave of COVID-19 cases, the novel coronavirus is expected to spread to nearly every community in the nation.

Approximately one quarter of Pennsylvanians live in rural counties, where populations skew older and poorer than the state average. Health care resources there are stretched thin, with an acute shortage of providers and transportation issues topping a list of complex structural challenges.

“These hospitals that are already struggling to make payroll, to meet the demand in their communities, are now being asked to do a whole new set of tasks,” said Lisa Davis, director of the Pennsylvania Office of Rural Health.

One particular rural health care disparity that COVID-19 highlights is a lack of high-speed internet.

Providers across the country have been ramping up telemedicine visits, so as to promote social distancing. To encourage this, Medicare will temporarily pay clinicians the same reimbursement rate for telehealth services as it pays for in-person visits.

However, the Federal Communications Commission estimates that some 800,000 Pennsylvanians, most of whom live in rural areas, lack high-speed internet access.

“They may have access to the internet, but it might be a very, very slow connection, and it might be inconsistent,” said Davis.

Some have hypothesized that more sparsely populated areas have an advantage over denser communities, as it’s easier to practice social distancing with fewer people around. But there isn’t enough epidemiological data to know if that’s the case.

“The transmission pattern of any infectious disease and any virus is quite variable,” said Dr. Donald Yealy, UPMC’s chief of emergency medicine. “Just being less dense doesn’t make less risk, it means it’s just even less predictable. And predictions are hard anyway.”

In northwest Pennsylvania, Susquehanna County’s NEPA Community Health Center has yet to see any COVID-19 cases. The clinic said it’s currently conserving medical equipment, including soap and hand sanitizer, and has discussed loaning staff to the area’s two critical-access hospitals.

“We don’t have the supplies we need,” said clinic CEO Mary Wetheral. “It’s not if but when we’ll be overwhelmed.”

Wetherall said there are “zero” intensive care unit beds in Susquehanna County, which has a population of approximately 41,000. Instead, area hospitals have what are called high-acuity units. While high-acuity units tend to have a lower patient-to-nurse ratio, it’s still higher than in an ICU.

“Critical access hospitals are not expected to be able to sustain these high acuity patients,” said Wetherall. “Those high acuity beds are where needs are managed…It’s just stabilize [patients] and move them down to the true ICU beds in different hospitals.”

One possible advantage rural Pennsylvania has in the face of COVID-19 is space. Many small Pennsylvania towns have experienced significant population loss. Hospitals built decades earlier have closed due to a lack of patients, and others struggle to remain solvent.

While these empty hospital beds could be put to good use, a lack of providers in rural communities means there might not be enough doctors and nurses to go around.

Phase 3 Coronavirus Legislation Expands Telehealth to RHCs

***This story is developing and will updated as more details become available***

On March 25, 2020, Senate leaders announced a deal on “phase 3” of the COVID-19 legislation, and it includes a key provision expanding the Medicare telehealth services to rural health clinics as the distant site. The legislation now moves to the House for an expedited vote either today or tomorrow.

This victory for rural health clinics comes after weeks of pressure on Congress and the Trump Administration from National Association of Rural Health Clinic (NARHC) and the Rural Health Clinic (RHC) community. It means that as of the date of enactment, RHCs can confidently provide telehealth visits to Medicare patients and know that they will be paid for those telehealth visits.

However, the details of what the exact telehealth payment will be are still to-be-determined. We do know that the payment for the telehealth visit will not be the all-inclusive rate. Instead, the Centers for Medicare and Medicaid Services (CMS) will create a specific payment mechanism for RHCs and Federally Qualified Health Centers (FQHCs) that is based on the average payments under the physician fee schedule. Keep a close eye on NARHC.org for updates and for a webinar as soon as those specifics are finalized.

Due to the Coronavirus, CMS and Congress have greatly expanded the Medicare telehealth benefit to allow Medicare beneficiaries to safely seek care through a video-conference style system.

Before this pandemic, telehealth was only available for rural Medicare beneficiaries, and was typically used to get specialty care from specialists in larger towns and cities. Medicare patients still had to physically go to an “originating site” and thus the convenience was limited. Now however, both of these requirements have been eliminated and all Medicare patients can receive a telehealth visit from the comfort of their home.

Congress and the Administration have also waived the requirement that telehealth visits only be with established patients and Medicare is allowing providers and patients to use popular video chat applications such as Facetime, Facebook Messenger video chat, Google Hangouts video, or Skype.

Pennsylvania Governor Wolf Announces Financial Assistance Available to Small Businesses

March 25, 2020

Harrisburg, PA – Pennsylvania Governor Tom Wolf announced that new funding is available to help small businesses impacted by the novel coronavirus, COVID-19, through a new program under the Pennsylvania Industrial Development Authority’s (PIDA) Small Business First Fund, the COVID-19 Working Capital Access Program (CWCA).  

The Commonwealth Financing Authority (CFA) recently authorized the transfer of $40 million to the Small Business First Fund for CWCA. PIDA authorized making $60 million available to provide loans of $100,000 or less to for-profit businesses with 100 or fewer full-time employees. Funds are expected to become available this week.

As of 12:00 AM, March 25, there are 276 additional positive cases of COVID-19, bringing the statewide total to 1,127 in 44 counties. The Department of Health also reported four new deaths, bringing the statewide death total to 11. County-specific information and a statewide map are available hereAll people are either in isolation at home or being treated at the hospital.

Gov. Wolf has enacted stay-at-home orders for 10 counties: Allegheny, Bucks, Chester, Delaware, Erie, Lehigh, Monroe, Montgomery, Northampton, and Philadelphia counties. The newest order, for Lehigh and Northampton counties, takes effect at 8:00 PM today, Wednesday, March 25. All orders will continue until April 6, 2020.

“My top priority is to save Pennsylvania lives, then save their livelihoods. I am utilizing every resource available to assist Pennsylvania’s business during this incredibly difficult time, and this small business funding availability is a step in the right direction. It will help provide a little peace of mind to hundreds of small business owners and their employees,” Wolf said. “I will continue to develop ways to assist Pennsylvania’s business community, as well as our workforce. I also need every Pennsylvanian to step up and do their part. The best way we can preserve our economic future is by minimizing the spread of COVID-19.”

“In the wake of the unprecedented Coronavirus pandemic, it’s important that state government is trying to respond to all manner of its impacts, and that includes providing support to our small business community,” said Senate Democratic Leader Jay Costa, Jr. “The CFA took necessary and swift action to provide low interest loans to small businesses to help keep them afloat during these difficult times. I commend the leadership of Governor Wolf and the other caucuses of the General Assembly for working together so quickly to come up with a viable plan to provide this assistance.”

For the purposes of this program a retail or service enterprise is defined as a for-profit business entity that is involved in the business-to-business service, business-to-public service, mercantile, commercial, or point of sale retail sectors.  An agricultural producer is defined as a business involved in the management and use of a normal agricultural operation for the production of a farm commodity.  A “farm commodity” is any Pennsylvania-grown agricultural, horticultural, aquacultural, vegetable, fruit, and floricultural product of the soil, livestock and meats, wools, hides, furs, poultry, eggs, dairy products, nuts, mushrooms, honey products and forest products. 

“There’s been major disruption to small businesses and their employees,” said House Democratic Leader Frank Dermody. “This is a bipartisan down payment to get some working capital out quickly. Much more help is needed and we’ll keep working on that.”

Eligible costs include working capital, which for purposes of this program is considered capital used by a small business for operations, excluding fixed assets and production machinery and equipment.

Any eligible working capital cost, as defined above, incurred by the eligible business enterprise three months prior to submission of the loan application will count as an eligible cost toward either the loan amount or, if applicable, the matching investment requirement. Retail / service enterprises are able to incur eligible working capital costs up to six months prior to submission of the loan application.

All loan applications must be submitted through a Certified Economic Development Organization (CEDO). For the list of CEDO’s operating within Pennsylvania, please refer to dced.pa.gov/programs/covid-19-working-capital-access-program-cwca/.

Businesses seeking guidance from DCED can also contact its customer service resource account at ra-dcedcs@pa.gov. For the most up-to-date information on COVID-19, Pennsylvanians should follow www.governor.pa.gov and www.doh.pa.gov.  

MEDIA CONTACTS: Lyndsay Kensinger, RA-GVGOVPRESS@pa.gov
                                   Casey Smith, casesmith@pa.gov