Agriculture Secretary Russell Redding today announced that the Department of Agriculture has received approval to continue operating the Disaster Household Distribution program, through The Emergency Food Assistance Program (TEFAP), to provide food to Pennsylvanians adversely affected by COVID-19 mitigation efforts. Originally approved by the USDA on March 27, the Disaster Household Distribution program, set to expire the end of May, has been approved through June 25.

The waiver eliminates the need for individuals to verify financial eligibility upon arrival at a food bank or pantry. Those in need of food through June 25 simply need to show up and receive their food. In addition to removing barriers for Pennsylvanians to access food, the waiver allows the Department of Agriculture and its partners to distribute USDA Foods – including meats, vegetables, fruits, canned goods, cereal, rice, pasta, eggs, milk, and more – to those in need.

The department estimates that in 2020, the Bureau of Food Assistance will move more than $80 million of USDA foods through Pennsylvania’s charitable food system in all 67 counties, with the state’s allocation of TEFAP funding from USDA. In 2019, nearly $50 million was allocated to the purchase of USDA Foods. The additional allocation for 2020 comes through the Families First Coronavirus Response Act and the CARES Act, in addition to an increase in funding through continued trade mitigation efforts by USDA.

In addition to accessing these USDA Foods and foods procured by the food bank, Pennsylvanians are now able to access fresh, local foods through the Farmers to Families Food Box program. Food banks around the state have begun to hold events to distribute fresh products from USDA-approved distributors, including 17 Pennsylvania-based contractors providing milk and other dairy products, pork, chicken, and fresh produce. Pennsylvanians interested in receiving a box through the Farmers to Families Food Box program should contact their local food bank for distribution information.

Continuing its analysis on the impact of the COVID-19 pandemic on Pennsylvania, the Institute of State and Regional Affairs (ISRA) at Penn State Harrisburg has released new data examining Pennsylvanians’ trust in key public figures to provide information related to the coronavirus, finding that while generally, Pennsylvanians trusted state leaders to provide information more than national leaders, political affiliation played a large part in levels of public trust.

Catch up on all of ISRA’s COVID-19 reports at: https://covid-pasdc.hub.arcgis.com/

Today, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) unveiled enhanced enforcement for nursing homes with violations of longstanding infection control practices. This announcement builds on the previous actions CMS has taken to ensure the safety and security of America’s nursing homes as the nation battles coronavirus disease 2019 (COVID-19), and is a key step in the Trump Administration’s Guidelines for Opening Up America Again.

“The Trump Administration is taking consistent action to protect the vulnerable,” said CMS Administrator Seema Verma. “While many nursing homes have performed well and demonstrated that it’s entirely possible to keep nursing homes patients safe, we are outlining new instructions for state survey agencies and enforcement actions for nursing homes that are not following federal safety requirements.”

The enhanced and targeted accountability measures are based on early trends in the most recent data regarding incidence of COVID-19 in nursing homes, as well as data regarding the results of the agency’s targeted infection control inspections. CMS is increasing enforcement (e.g., civil money penalties (CMPs)) for facilities with persistent infection control violations, and imposing enforcement actions on lower level infection control deficiencies to ensure they are addressed with increased gravity.

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided additional funding to CMS for necessary survey and certification work related to COVID-19, of which $80 million in new resources will be available for states to increase surveys. To ensure effective oversight is achieved, CMS will allocate the CARES Act funding based on performance-based metrics. States that have not completed 100 percent of focused infection control surveys of their nursing home by July 31, 2020 will be required to submit a corrective action plan to their CMS location outlining the strategy for completion of these surveys within 30 days.  If, after the 30-day period, states have still not performed surveys in 100 percent of nursing homes, their CARES Act fiscal year 2021 allocation may be reduced by 10 percent.  Subsequent 30-day extensions could result in an additional 5 percent reduction. These funds would then be redistributed to those states that completed 100 percent of their focused infection control surveys by July 31.

Utilizing the CARES Act funding, states will be required to perform on-site surveys of nursing homes with previous COVID-19 outbreaks and will be required to perform on-site surveys (within three to five days of identification) of any nursing home with new COVID-19 suspected and confirmed cases.

To help nursing homes implement infection control best practices, CMS will provide technical assistance through Quality Improvement Organizations (QIOs). CMS and the Centers for Disease Control and Prevention (CDC) will continue to monitor the data it receives through the new nursing home COVID-19 surveillance system to identify nursing homes with outbreaks and work with Governor’s offices and states to keep nursing home residents safe.

Since April 19, 2020, CMS has required nursing homes to inform, residents, their families, and representatives of COVID-19 cases in their facilities. For the first time, nursing homes are required to report COVID-19 cases and deaths directly to the CDC on an ongoing basis as the result of an unprecedented CMS regulatory requirement issued on May 1, 2020. The Trump Administration implemented the new reporting requirement to develop a robust federal disease surveillance system to quickly identify problem areas and inform future infection control actions. The reporting requirement applies to long-term care facilities only (also known as skilled nursing facilities and nursing facilities, and generally as nursing homes). By law, CMS regulates and oversees nursing homes, which are certified to provide Medicare and/or Medicaid skilled nursing facility services. Therefore, the data does not include COVID-19 data from assisted living facilities, which are not regulated at the federal level.

As of May 24, 2020, about 12,500 nursing homes – approximately 80 percent of the 15,400 Medicare and Medicaid nursing homes – had reported the required data to the CDC. These facilities reported over 60,000 confirmed COVID-19 cases and almost 26,000 deaths. Of the nursing homes that reported data, approximately one in four facilities had at least one COVID-19 case, and approximately one in five facilities had at least one COVID-19 related death.  Early analysis shows that facilities with a one-star quality rating were more likely to have large numbers of COVID-19 cases than facilities with a five-star quality rating. CMS will take enforcement action against the nursing homes that have not reported data into the CDC as required under CMS participation requirements.

CMS will post the underlying CDC-collected data on a link on Nursing Home Compare later this week, so the public can view general information of how COVID-19 has impacted nursing homes in a user-friendly format. The data will be broken down by state, number of residents and number of staff.  The data will be searchable by facility name and will be downloadable so researchers and other stakeholders can perform their own in-depth analysis.  CMS will update the data weekly. CMS will also post a link to the data on the home page of the Nursing Home Compare website so patients, residents, and families can easily find it. Nursing Home Compare is a valuable tool for patients, residents, and families to understand the quality of nursing homes and to support their healthcare decisions. Adding this information only increases its value and reinforces CMS’s commitment to transparency.

CMS is ratcheting up penalties for noncompliance with infection control to help prevent backsliding, improve accountability, and ensure prompt compliance. Since February 2020 CMS has provided over 13 guidance documents and facts sheets pertaining to infection control and conducted weekly calls with nursing homes to share best practices from the field. The enhanced enforcement actions will increase penalties for nursing homes have had past infection control deficiencies.

As part of CMS’s response to the COVID-19 pandemic, the agency prioritized the types of nursing home inspections that take place. On March 4, 2020 CMS prioritized inspections to allow inspectors to focus on the most serious health and safety threats like infectious diseases and abuse. On March 23, CMS suspended certain inspections to increase our focus on preventing the spread of COVID-19. Since March 4, CMS and its network of state-based inspectors have conducted over 8,300 surveys with the results of a total of 5,700 available today. There is currently wide variation in the number of focused infection control surveys of nursing homes performed by states, between 11.4 percent and 100 percent, with a national average of approximately 54.1 percent. CMS plans to post the results of the inspections later this week, on a monthly basis as they are completed.

All of this information are being used to strengthen CMS enforcement action going forward, such that nursing homes are held accountable for resident care. Older Americans are particularly vulnerable to complications arising from the virus and nursing home residents have been uniquely affected. The Trump Administration is intensely focused on protecting this population, but it ultimately falls to the nursing homes themselves to ensure they provide care compliant with essential health and safety requirements.

CMS is also providing additional support and technical assistance to low performing nursing homes through its QIOs. QIOs are organizations composed of health quality experts and clinicians that have experience in helping healthcare provider to improve the quality of care delivered to people with Medicare. CMS has now charged the QIOs to focus their efforts on providing education and training to all nursing homes in the country.  This will include weekly National Infection Control Training, which focuses on all aspects of infection control, prevention and management to help nursing homes prevent the transmission of COVID-19.

QIOs are also providing direct assistance to small and rural nursing homes and those serving vulnerable populations in areas where access to care is limited. The QIOs will help them understand and comply with CMS and CDC reporting requirements and, in some cases, they will provide on-site support to help nursing homes that have been identified as having the greatest needs in infection control. CMS will be working with Governors’ offices to direct QIOs to those nursing homes that have significant needs and have had outbreaks. QIOs will help these facilities create an action plan and implement specific steps to establish a strong infection control and surveillance program.

Since the beginning of the pandemic, CMS has taken unprecedented and aggressive steps to address the impact of COVID-19.  The importance of ongoing transparency and information sharing has proven to be one of the keys to the battling this pandemic.

To view the state survey memo, visit: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/covid-19-survey-activities-cares-act-funding-enhanced-enforcement-infection-control-deficiencies-and

To view the letter to the Governors, visit: https://www.cms.gov/files/document/6120-letter-governors.pdf

To view a state breakdown of the Nursing Home COVID-19 data, visit: https://www.cms.gov/files/document/6120-nursing-home-covid-19-data.pdf

Battelle is an approved entity for the FDA’s Critical Care Decontamination System, which supports reuse of N95 masks after free decontamination. Health centers are eligible to participate in this program that:

• Allows eligible (non-cellulose) N95 masks to be decontaminated for reuse up to 20 times
• Has no cost to a health center except shipping to-from the decontamination site

To learn more and enroll, the Batelle website outlines the enrollment process and frequently asked questions.

The Pennsylvania Department of Human Services (DHS) issued several Medical Assistance (MA) Bulletins this week. Topics included:

• Bulletin 01-20-07. Pharmacy Services for MA Beneficiaries Related to the COVID-19 Public Health Emergency: The purpose of this bulletin is to advise providers of changes made by DHS to Medical Assistance (MA) pharmacy services to ensure MA beneficiaries maintain access to needed services during the COVID-19 public health emergency.
• Bulletin 01-20-06. Updates to Childhood Nutrition and Weight Management Services: This bulletin is to notify providers enrolled in the MA program of changes to Childhood Nutrition and Weight Management Services (CNWMS) for MA beneficiaries under 21 years of age as a result of the 2020 Healthcare Common Procedure Coding System updates.
• Bulletin 99-20-02. 2020 HCPCS Updates: The purpose of this bulletin is to announce changes to the Medical Assistance Program Fee Schedule as a result of the 2020 Healthcare Common Procedure Coding System (HCPCS) procedure code updates, effective for dates of services on and after May 26, 2020.
• Bulletin 99-20-04. EPSDT Program Periodicity Schedule: This bulletin revises the Pennsylvania’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule and Coding Matrix, effective May 26, 2020.

Visit the DHS Bulletins website for more detailed information.

People who lost their insurance during the COVID pandemic now have until 60 days after the coronavirus national emergency ends to enroll in COBRA. The normal COBRA deadline is 60 days after losing a job.

Late on Thursday, May 28, lawmakers approved SB 1108, which appropriates a substantial portion of the $3.9 billion in federal CARES Act dollars appropriated to Pennsylvania, including $20 million to the Department of Health. Of the $20 million, $10 million is designated for community-based health care centers that receive HRSA grant funding and $10 million for vaccine research. PACHC does not have details yet on how and when the funds will be distributed. The language in the legislation clearly states that “a payment received under this section may only be used to cover necessary COVID-19 related costs, including, but not limited to, those not otherwise reimbursed by Federal, State or another source of funding incurred during the period between March 1, 2020, and November 30, 2020.”

The legislature also approved a five-month PA 2020-21 budget, HB 2387. The approved budget took the 2019-20 budget and cut each line item across the board by 60 percent to account for the five months, which will require lawmakers and the Governor during the next few months to figure out how to pay for the other seven months of 2020-21, along with any additional spending they might want or need to do in excess of the flat funding already approved. The 60 percent cut included the line item for the Primary Health Care Practitioner program. It is expected that both bills will be signed by the Governor.

As stay-at-home restrictions are relaxed, healthcare organizations must strategically plan on how and when to reopen.

• The American Medical Association (AMA) resource, COVID-19: A Physician Practice Guide to Reopening, originally developed for physician practices, can also help health centers prepare to reopen during the COVID-19 pandemic. Strategies and recommendations include compliance with governmental guidance; development of a preopening plan; institution of patient and staff safety measures; a tele-triage program; process to screen patients before in-person visits and limiting non-patient visitors.
• The United Kingdom’s Academy of Medical Royal Colleges released a May 2020 report, Principles for Reintroducing Healthcare Services, outlining six principles for reopening healthcare services. These principles are designed to help increase patient confidence in the healthcare system’s ability to provide care while also decreasing the spread of COVID-19. The six principles address clear messaging to the public that stresses the need to seek medical help for serious conditions; providing the option to seek remote or virtual care when appropriate; utilizing a shared decision-making process; enabling staff to deliver safe, equitable and clinically prioritized care and supporting staff with training and education.