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May 8, 2020: REVISED Guidance on COVID-19 for Dental Health Care Personnel in Pennsylvania
May 8, 2020
The Pennsylvania Department of Health (Department) is revising healthcare community guidance to reflect Governor Wolf’s strategic phased reopening plan, particularly related to performing non-urgent procedures. There is still no data available to assess the risk of COVID-19 transmission during dental procedures; however, there is a better understanding of which procedures have increased risk of transmission and how to utilize Personal Protective Equipment (PPE) to reduce the risk. Therefore, the Governor and the Secretary of Health have revised their business closure orders issued on March 19, 2020, as subsequently amended, to remove the prohibition on “elective,” i.e., non-urgent and non-emergent, dental procedures.
All providers licensed by the Pennsylvania State Board of Dentistry should adhere to the following operating protocols state-wide.
Each dental provider should apply their clinical judgment along with their knowledge of the incidences of COVID-19 cases in their area, the needs of their patients and staff, and the availability of necessary supplies to assess whether to re-engage in the provision of non-urgent and non-emergent dental care. For example, if a clinician determines that lack of treatment will result in irreversible damage to a patient, the clinician should pursue treatment with the appropriate level of PPE per Occupational Health and Safety Administration (OSHA) and CDC Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response guidance relative to PPE. Providers should routinely consult the CDC guidance when providing care, noting that recommendations and guidance could change frequently.
Providers may perform non-aerosolizing, non-urgent and non-emergent care only if proper PPE, per OSHA guidance, is available for all dental care practitioners, including dental hygienists. Procedures that create a visible spray that contain large particle droplets of water should not be performed because they are considered aerosol generating; however, as a last resort when clinically necessary, aerosol generating procedures are allowed, only if proper PPE, per OSHA guidance, is available for all dental care practitioners including dental hygienists, since not all patients who have COVID-19 are symptomatic, i.e., they could be asymptomatic or pre-symptomatic. The Department of Health and the Pennsylvania Emergency Management Agency are not currently prioritizing dental practices for PPE distribution, so proper PPE must be secured by the practice.
If infection control protocols outlined by the CDC and OSHA cannot be followed, the procedure should not be done.
All patients should be screened for symptoms of COVID-19, such as temperature over 100.4 degrees Fahrenheit, cough or other symptoms, before arriving at the practice, social distancing should be maintained while in the practice, and patients should wash or sanitize hands frequently and wear a mask when not undergoing treatment. Tele-dentistry should continue to be employed when possible as patients might be able to be treated virtually with antibiotics and pain medication. Please remember to continue to use proper opioid guidelines in the dental practice, per clinical judgment.
PATIENTS SUSPECTED OF CONFIRMED TO HAVE COVID-19
The Department is aware that many dental practices will not be able meet the stringent infection prevention and control requirements for treating patients suspected or confirmed to have COVID-19. If emergency dental care is medically necessary for a patient who has, or is suspected of having, COVID-19, airborne precautions (an isolation room with negative pressure relative to the surrounding area and use of an N95 filtering disposable respirator for persons entering the room) should be followed. In these cases, dental treatment should be provided in a hospital or other facility that can treat the patient using the appropriate precautions.
ADDITIONAL RESOURCES:
- Check the CDC and the Pennsylvania Department of Health websites regularly for updates.
- Visit the Pennsylvania Department of Labor and Industry website for valuable information regarding unemployment compensation for DHCP staff.
- In order to stay up-to-date with this and other public health issues, please sign up for the Pennsylvania Health Alert Network (PA-HAN) at https://han.pa.gov
Access the press release here: Guidance on COVID-19 for Dental Health Care Personnel in Pennsylvania
New Website Launched: Telehealth.HHS.gov
The U.S. Dept of Health and Human Services (HHS) recently launched a new telehealth website for patients and providers. The patient information explains telehealth, such as what to expect during a visit, what kinds of care may be available, and how to access telehealth options. The provider information offers help with preparing patients for telehealth, telehealth workflow, policy changes due to COVID-19, billing and reimbursement.
DOL Temporarily Extends COBRA Deadlines During the COVID-19 Crisis
In response to the COVID-19 crisis, the U.S. Department of Labor (DOL) released a new rule that temporarily extends the period in which eligible employees can elect COBRA health insurance coverage. The ruling also extends the deadline for eligible employees to begin making COBRA premium payments and it extends the time for plan participants to file benefit claims or appeal denied claims. On May 4, the DOL and IRS jointly published Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak. The DOL also posted a new set of COVID-19 FAQ’s for Participants and Beneficiaries to help both employees and employers navigate the new rule.
HHS Posts Workforce Virtual Toolkit
The Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR) has posted a Workforce Virtual Toolkit through the ASPR’s Technical Resources, Assistance Center, and Information Exchange (TRACIE). “COVID-19 Workforce Virtual Toolkit: Resources for Healthcare Decision-Makers Responding to COVID-19 Workforce Concerns” includes pages of resources for:
- Workforce surge planning and volunteer matching
- Liability protections
- Licensure
- Scope of practice expansions
- Healthcare workforce training resources
- Workforce protection resources
- Workforce resilience/sustainability resources
You can also share your resources for other health care organizations to use.
HHS Payment for COVID-19 Testing & Treatment for the Uninsured Available
The Health Resources and Services Administration (HRSA), through funding from the Family First Cononavirus Relief Act and CARES Act, will provide claims reimbursement to healthcare providers generally at Medicare rates for testing uninsured individuals for COVID-19 and treating uninsured individuals with a COVID-19 diagnosis. Acceptance of claims began May 6 for dates of service retroactive to Feb. 4, 2020 for this population. CMS has not issued a federal Marketplace special enrollment period (SEP) for those who are uninsured, however, special enrollment periods are still available for those who lost coverage or experienced a life event such as divorce or moving. Here’s the timeline:
- February 4 – Retroactive date to request claims reimbursement
- April 27 – Sign up period begins for the program
- April 29 – On-demand training starts
- May 6 – Begin submitting claims electronically
- Mid-May – Begin receiving reimbursement
When submitting claims you must attest that: you have checked for healthcare coverage eligibility and confirmed that the patient is uninsured; you have verified that the patient does not have individual, employer-sponsored, Medicare or Medicaid coverage, and no other payer will reimburse you for COVID-19 testing and/or care for that patient; you will accept defined program reimbursement as payment in full; and you agree not to balance bill the patient. For more, visit the COVID-19 Testing & Treatment Claims for the Uninsured website.
Emergency Cash Assistance in Pennsylvania
The Pennsylvania Department of Human Services shared information about the Emergency Cash Assistance Program opening to families with a child under age 18 or pregnant women making 150 percent of the Federal Poverty Guidelines or less. Families must also meet resource limits and have at least one person who was employed as of March 11, 2020 and lost employment or experienced an hour and wage reduction of at least 50 percent for at least two weeks due to the pandemic. Eligible families will receive a one-time payment equal to two months of the Temporary Assistance for Needy Families (TANF) benefits for their household size, so a family of three would get an average one-time payment of $806. TANF provides financial assistance to help pay for food, shelter, utilities and expenses other than medical. The program will run through June 12.
Medical Assistance Enrollment During the Pandemic
The Pennsylvania Department of Human Services (DHS) reports a decline in Medicaid applications from mid-March until early April, which occurred due to a significant decrease in paper applications. Online applications through COMPASS did increase, but not enough to compensate for the decline in paper applications. The number of paper applications is now beginning to increase to almost the same number of applications submitted prior to the County Assistance Office (CAO) closures to the public. It is important to be aware that:
- CAOs continue to accept and process Medical Assistance applications.
- Consumers are permitted to self-attest to application questions which previously required documented proof.
Those enrolling should always use the notes box on the application to highlight any important information which can assist with processing, such as “I am applying for Medical Assistance for Workers with Disabilities” or “I have a health emergency” and provide specific information.
Immigrant Eligibility for Public Programs
Enrolling immigrants in public programs amid the COVID-19 pandemic with the most recent changes to the Public Charge rules can be quite confusing. Enrollment assisters are tasked with knowing what is available, who is eligible and what implications applying and enrolling may present. Protecting Immigrant Families is a coalition of hundreds of diverse organizations who develop innovative advocacy strategies, distribute educational resources and keep allies informed of all the current and potential policies that impact immigrant families. Protecting Immigrant Families has produced a helpful table with important information for those applying for benefits. Access the most recent table on Immigrant Eligibility for Public Programs here.
Census 2020
The Pennsylvania Department of Health (DOH) is encouraging all citizens of the Commonwealth to participate in Census 2020. DOH is asking providers to encourage their patients, clients, consumers and staff to complete the census to ensure that the Pennsylvania count is accurate and correct. Graphics and other material, including images targeting different organizations to share on social media, a video and a subscription link for updates, can be found at the Census 2020 webpage. Pennsylvania-specific information, sample social media material, material for print and a PowerPoint presentation can be found on the Pennsylvania Census website.
NIOSH Provides COVID-19 Updates
As part of the National Institute for Occupational Safety and Health’s (NIOSH) efforts to keep our stakeholders up to date on the CDC and NIOSH COVID-19 response, below is a summary of new information posted this week.
General Resources
Critical Infrastructure Sector Response Planning Guidance
This guidance is on COVID-19 response planning for the critical infrastructure sector. Maintaining critical infrastructure operations during the COVID-19 pandemic is imperative for both public health and safety as well as community well-being. A COVID-19 response plan can help critical infrastructure employers prevent or slow the spread of COVID-19 in their workplaces and continue their essential business functions.
This guidance supplements the existing CDC Guidance for Implementing Safety Practices for Critical Infrastructure Workers Who May Have Had Exposure to a Person with Suspected or Confirmed COVID-19.
Coping with Job Stress and Building Resilience During the COVID-19 Pandemic Fact Sheets
This new guidance for employees and healthcare personnel and first responders provides ways to recognize symptoms of stress, tips to cope and enhance resilience, and where to go for help. The COVID-19 pandemic has changed the way we work, whether you are going into work or are working from home. Fear and anxiety about this disease can be overwhelming, and workplace stress can lead to burnout.
Fatigue in the Workplace Fact Sheet
This new fact sheet has information on strategies that workers and employers can use to manage workplace fatigue and work safely during COVID-19. The fact sheet includes tips to improve sleep and what to do if you feel too tired to work safely. It also has steps employers should take to reduce workplace fatigue for workers.
Respirator Purchasing Resources
Factors to Consider when Planning to Purchase Respirators From Another Country
This guidance provides information for potential purchasers of international respirators in making informed procurement and distribution decisions to keep their workers safe. When NIOSH approves a respirator, the user can be confident that the device will provide the expected level of protection, as long as it fits properly and is worn correctly. But when there is a shortage of NIOSH-approved filtering facepiece respirators (FFRs), as we are experiencing during the COVID-19 pandemic, other reliable options must be found.
Industry Specific Resources
Long-haul Truck Drivers Fact Sheet
This fact sheet identifies these potential exposures to help drivers and their employers prevent the spread of respiratory illness. Long-haul truck drivers may be at risk for exposure to the virus that causes COVID-19. Potential exposures include close contact with others, including other drivers.
For More Information
For more information, please visit the COVID-19 webpage. To stay up to date on new developments, sign up for the COVID-19 newsletter.