Becker’s Hospital Review

Progress on containing COVID-19’s spread continues to vary drastically across regions, states and cities.

As the incubation period for COVID-19 is up to 14 days, most states have yet to report a potential surge in cases linked to nationwide protests against police violence.

What’s clear is the pandemic is loosening its grasp on major urban areas and ramping up in more rural areas, according to The Washington Post. Cases have increased in at least 22 states over the past two weeks, according to a June 9 analysis by The New York Times. Fourteen states have also had a record-high seven-day average of new coronavirus cases since June 1, according to data tracked by the Post.

Below is a snapshot of what COVID-19’s spread looks like across the U.S., as of June 9.

West

More COVID-19 cases have been confirmed in Oregon over the past week than any other time since the pandemic began, according to data from the Oregon Health Authority. The state reported 620 confirmed or presumed infections in the past week, with the state’s largest daily case total reported June 7 at 146 cases. The spike began the week ending May 31, when new COVID-19 cases in Oregon increased by 18 percent (353 cases) compared to the previous week. Between June 5-8, 26 counties in Oregon were able to enter Phase 2 of reopening, KGW reported.

COVID-19 cases in California hit 3,094 new daily cases June 5, the state’s second highest daily count after 3,705 cases reported May 30. Recently, some counties have resisted Gov. Gavin Newsom’s distancing orders and reopened sections of the economy, according to The Guardian.

Washington reported 442 new confirmed cases of COVID-19 on June 6, the most daily cases since April 10, according to KOMO News. The state has acquired sufficient supplies to expand COVID-19 testing and better monitor Washington’s 39 counties as they ease social distancing restrictions, Gov. Jay Inslee said June 4, according to The Seattle Times. As of June 8, all employees in the state must wear face coverings, with some exceptions for certain jobs or individuals with medical conditions, according to King 5.

Southwest

COVID-19 cases hit record-high numbers in Arizona in late May. The state reported more than 700 cases daily between May 26-29, the largest single-day increases seen since the pandemic started. However, known deaths have been decreasing since late May, with less than 10 deaths occurring daily between May 29 and June 2. On June 6, Cara Christ, MD, Arizona Department of Health Services director, sent a letter to hospitals urging them to “fully activate” emergency plans, according to AZ Central.

Meanwhile, COVID-19 cases and deaths are steadily increasing in Texas. The state reported 1,949 new cases May 31, marking the highest single-day increase seen since the pandemic’s start. Texas also reported a record number of related hospitalizations, with 1,935 people admitted June 8. Ten counties are reporting increased case counts because of testing at prisons or meatpacking plants, according to the Texas Department of State Health Services. On June 3, Gov. Greg Abbott announced the third phase of reopening, which includes increasing capacity and opening additional businesses and activities.

Nevada reported 194 new cases June 5, marking the largest single-day increase seen since May 22, when the state saw a record 255 cases. The cumulative death toll has also been rising since the start of the pandemic, although the state reported no new deaths between June 5 and June 7.

Northeast

New York reported 35 COVID-19 deaths June 5 — the lowest figure seen in eight weeks, according to The New York Times. The daily death toll has been steadily declining since New York reported nearly 800 deaths daily in late March and early April, according to state data. New York also reported a record-low number of hospitalizations last week.

The number of new cases, deaths and hospitalizations have significantly fallen in New Jersey since April. The state reported 356 new cases June 8, representing the 10th consecutive day in which new cases remained under 1,000. The state is set to enter phase 2 of its reopening June 15, which will allow restaurants to offer outdoor dining and nonessential businesses to open at half capacity, according to nj.com.

Massachusetts reported a large spike in new COVID-19 cases June 1 after conducting a retrospective review of state data since March 1. Of the 3,840 new cases reported, 3,514 were newly probable and 326 were newly confirmed, according to Boston 7 News. Overall, the state has seen a sustained decline in new cases throughout May, according to a New York Times analysis.

Southeast

Florida saw a large spike in new COVID-19 infections last week amid a steady increase in testing capacity. After reporting just 606 cases June 1, Florida had more than 1,000 new infections daily between June 3 and June 7. This marks the state’s longest sustained increase since early April. The state also reported 1,419 new infections June 4 — the largest single-day increase seen since the Florida health department started publishing COVID-19 data in March, according to the Miami Herald.

COVID-19 hospitalizations started falling in Mississippi in early June. However, the state reported a record 498 new cases June 8, the highest single-day increase seen since May 30 when 439 cases were reported, according to the Sun Herald.

North Carolina reported 1,370 new cases June 6, the highest daily increase seen during the pandemic, according to WSOC-TV. The previous record was set just a day prior when the state saw 1,289 new cases. North Carolina also reported 739 hospitalizations June 8, surpassing the previous record of 717 hospizaltions reported June 5, according to The News & Observer.

Midwest

Wisconsin reported no new COVID-19 deaths June 8 for the first time since May 17, reports CBS affiliate WSAW-TV. The number of people hospitalized with the virus also fell to a three-week low June 3, according to Urban Milwaukee. The state reported 203 new cases June 8, down from 733 on May 29. Wisconsin also performed a record 16,451 tests June 3, of which 483 were positive.

The rate of new COVID-19 cases and the number of people requiring intensive care continues to decline in Minnesota. The state reported 388 new infections June 7, the second-lowest daily increase since April 28, according to the StarTribune. In addition, 199 patients were being treated for COVID-19 in ICUs, marking the lowest total since May 13.

On June 9, 2020, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing a) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens. The safety net distribution will occur this week.

“Healthcare providers who focus on treating the most vulnerable Americans, including low-income and minority patients, are absolutely essential to our fight against COVID-19,” said HHS Secretary Alex Azar. “HHS is using funds from Congress, secured by President Trump, to provide new targeted help for America’s safety-net providers and clinicians who treat millions of Medicaid beneficiaries.”

HHS is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers, including those disproportionately impacted by this pandemic.

ENHANCED PROVIDER RELIEF FUND PORTAL

On Wednesday, HHS is launching an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.

The initial General Distribution provided payments to approximately 62 percent of all providers participating in state Medicaid and CHIP programs. The Medicaid and CHIP Targeted distribution will make the Provider Relief Fund available to the remaining 38 percent. HHS has already provided relief funding to over one million providers, and today’s announcement is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins.

Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers serving Medicaid/CHIP beneficiaries possibly eligible for this funding, include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities, and other home and community-based services providers.

To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding.

More information about eligibility and the application process is available at www.hhs.gov/coronavirus/cares-act-provider-relief-fund/…

$10 BILLION ALLOCATION FOR SAFETY NET HOSPITALS

HHS is announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens, recognizing the incredibly thin margins these hospitals operate on. This payment is being sent directly to these hospitals via direct deposit.

This payment is going to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. Qualifying hospitals will have:

• A Medicare Disproportionate Payment Percentage (DPP) of 20.2 percent or greater;
• Average Uncompensated Care per bed of $25,000 or more. For example, a hospital with 100 beds would need to provide $2,500,000 in Uncompensated Care in a year to meet this requirement;
• Profitability of 3 percent or less, as reported to CMS in its most recently filed Cost Report.

Recipients will receive a minimum distribution of $5 million and a maximum distribution of $50 million.

ADDITIONAL PROVIDER RELIEF FUND UPDATES

• On Monday, June 8, 2020, HHS sent communications to all hospitals asking them to update information on their COVID-19 positive-inpatient admissions for the period January 1, 2020, through June 10, 2020. This information will be used to determine a second round of funding to hospitals in COVID-19 hotspots to ensure they are equitably supported in the battle against this pandemic. To determine their eligibility for funding under this $10 billion distribution, hospitals must submit their information by June 15, 2020 at 9:00 PM ET.
• HHS is working on an additional allocation to distribute relief broadly to dentists.

For updated information and data on the Provider Relief Fund, visit hhs.gov/providerrelief

On June 8, 2020, HHS posted additional FAQs.  One set provides additional/updated data on the number of COVID-19 cases for the period of January 1, 2020 through June 10, 2020 (see pages 27-28).  HHS is preparing for a second distribution for High Impact Area funding and is seeking updated data.  The data must be input into the portal no later than 9:00 PM Eastern Time on Monday June 15, 2020.  The FAQ document can be accessed at www.hhs.gov/sites/default/files/…

Pennsylvania Governor Tom Wolf announced that his administration launched an enhanced dashboard to pull Pennsylvania’s COVID-19 data and information together to inform Pennsylvanians. The dashboard further enhances data on demographics of cases, demographics of deaths and the reopening status.

The dashboard includes eight different tabs:

• Pennsylvania case data;
• County data – with a dropdown menu for specific counties;
• Case data by ZIP code;
• Hospital preparedness information;
• Case demographic information, including cases by gender, ethnicity, age and race;
• Death demographic information, including deaths by gender, ethnicity, race, age and deaths by place;
• Testing information; and
• Reopening status information.

This dashboard complements the county dashboard, available here, to provide the most up-to-date data available.

Pennsylvania Governor Tom Wolf announced a $225 million statewide grant program to support small businesses that were impacted by the COVID-19 public health crisis and subsequent business closure order.

The funding was developed in partnership with state lawmakers and allocated through the recently enacted state budget, which included $2.6 billion in federal stimulus funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, of which $225 million was earmarked for relief for small businesses.

The Department of Community and Economic Development (DCED) will distribute the funds to the Community Development Financial Institutions (CDFIs), which will then administer the funding in the form of grants.

Eligible businesses will be able to use the grants to cover operating expenses during the shutdown and transition to re-opening, and for technical assistance including training and guidance for business owners as they stabilize and relaunch their businesses.

The funds will be available through three programs:

• $100 million for the Main Street Business Revitalization Program for small businesses that experienced loss as a result of the governor’s March 19, 2020 order relating to the closure of all non-life-sustaining businesses and have or will incur costs to adapt to new business operations related to COVID-19;
• $100 million for the Historically Disadvantaged Business Revitalization Program for small businesses that experienced loss as a result of the business closure order, have or will incur costs to adapt to new business operations related to COVID-19, and in which socially and economically disadvantaged individuals own at least a 51 percent interest and also control management and daily business operations.
• $25 million for the Loan Payment Deferment and Loss Reserve Program, which will allow the CDFIs the opportunity to offer forbearance and payment relief for existing portfolio businesses that are struggling due to the impact of COVID, as well as shore up the financial position of the CDFIs that are experiencing significant increased defaults in their existing loan portfolios.

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press.

Calls recordings and transcripts are posted on the CMS podcast page at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts

CMS COVID-19 Office Hours Calls (Tuesdays at 5:00 – 6:00 PM Eastern)

Office Hour Calls provide an opportunity for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

• Increase Hospital Capacity – CMS Hospitals Without Walls;
• Rapidly Expand the Healthcare Workforce;
• Put Patients Over Paperwork; and
• Further Promote Telehealth in Medicare

This week’s Office Hours:

Tuesday, June 9^th at 5:00 – 6:00 PM Eastern

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 4892554

Audio Webcast link: https://protect2.fireeye.com/url?k=6b9f9bee-37cbb2c5-6b9faad1-0cc47a6d17cc-71d1a27a3efd1e66&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2171

Weekly COVID-19 Care Site-Specific Calls

CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

Home Health and Hospice (Tuesdays at 3:00 PM Eastern)

Tuesday, June 9^th at 3:00 – 3:30 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 7359947 Audio Webcast Link: https://protect2.fireeye.com/url?k=00232b73-5c770258-00231a4c-0cc47a6d17cc-31afca23fe25ca11&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2160

Nursing Homes (Wednesdays at 4:30 PM Eastern)

Wednesday, June 10^th at 4:30 – 5:00 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 9782909 Audio Webcast Link: https://protect2.fireeye.com/url?k=9b60f2d6-c735fbc5-9b60c3e9-0cc47adb5650-5cc8b6ca21a0bb55&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2215

Dialysis Organizations (Wednesdays at 5:30 PM Eastern)

Wednesday, June 10^th at 5:30 – 6:00 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 6553907 Audio Webcast Link: https://protect2.fireeye.com/url?k=cb8280fa-97d69986-cb82b1c5-0cc47adc5fa2-2ac51b79b83598dd&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2225

Nurses (Thursdays at 3:00 PM Eastern)

Thursday, June 11^th at 3:00 – 3:30 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 2863547 Audio Webcast Link: https://protect2.fireeye.com/url?k=842afbda-d87ff2c9-842acae5-0cc47adb5650-f3419d0fb8afb1c7&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2231

To keep up with the important work the White House Task Force is doing in response to COVID-19 click here: https://protect2.fireeye.com/url?k=36fa2226-6aae0b0d-36fa1319-0cc47a6d17cc-2d06c219f858d641&u=http://www.coronavirus.gov/. For information specific to CMS, please visit the Current Emergencies Website.

The COVID-19 pandemic has been an unprecedented event that has impacted every part of the globe. All Pennsylvanians – businesses, communities, neighbors – have been affected and the Commonwealth has responded aggressively to the spread of COVID-19.

As stabilization starts to occur, Pennsylvania plans to proceed with returning to work cautiously. On April 22, Pennsylvania Governor Tom Wolf announced his detailed plan for reopening Pennsylvania, categorizing the reopening with three phrases: red, yellow, and green. Phases are based on the conditions in the county, counties, or regions.

The guidance needed for businesses located in green phase counties is provided below.

Green Phase
As regions or counties move into the green phase, most restrictions will be eased, AND THE stay at home and business closure orders WILL REMAIN SUSPENDED to allow PA’s economy to strategically reopen while continuing to prioritize public health.

Work & Congregate Setting Restrictions

• Telework strongly encouraged
• In-person business operations must follow the COVID-19 Business Guidance
• All businesses operating at 50% occupancy in the yellow phase may increase to 75% occupancy
• Child care may open complying with guidance
• Congregate care restrictions in place
• Prison and hospital restrictions determined by individual facilities
• Schools subject to CDC and Commonwealth guidance

Social Restrictions

• Large gatherings of more than 250 prohibited
• Restaurants and bars open at 50% occupancy with continued implementation of the Restaurant Industry Guidance
• Personal care services (including hair salons and barbershops) open at 50% occupancy by appointment only
• Indoor recreation, health and wellness facilities, and personal care services (such as gyms and spas) open at 50% occupancy with appointments strongly encouraged
• All entertainment (such as casinos, theaters, and shopping malls) open at 50% occupancy
• Construction activity may return to full capacity with continued implementation of the Construction Guidance

Requirements for COVID-19 Safety Communication

Businesses conducting in-person operations or serving the public are required to make employees and customers aware of the guidance provided by the Commonwealth to keep people at their establishment safe. Businesses must print, sign and post the “COVID-19 Safety Procedures for Businesses” flyer and post it on their premises in employee common spaces and near the business’s public entrance(s).

The flyer is available in English or Spanish and larger sizes can be found on the DCED website.

PPE & Supplies Directory

As businesses reopen, it is imperative they equip their employees with the necessary personal protective equipment (PPE) to help mitigate the spread of COVID-19 and keep their workers and customers safe.

If your business needs PPE, visit the COVID-19 PPE & Supplies Business-2-Business (B2B) Interchange Directory to connect with manufacturers that have masks, thermometers, hand sanitizer, face shields, medical gowns, and cleaning disinfectants available.

Questions?
For any questions, contact the Pennsylvania Department of Community and Economic Development at 1.866.466.3972 or stay up-to-date with COVID-19 information by visiting the Commonwealth of Pennsylvania Responding to COVID-19 Guide

On behalf of Pennsylvania Governor Tom Wolf, Pennsylvania Department of Community and Economic Development (DCED) Secretary Dennis Davin announced that 133 companies have been approved for funding in the final disbursement of the COVID-19 Working Capital Access Program (CWCA). The latest cohort of businesses to receive funding includes chiropractors, restaurants, breweries and wineries, salons, fitness facilities. Over the course of the program, nearly $61 million was awarded to businesses across Pennsylvania.

In total, 745 businesses were approved for loans totaling $60,722,641.

A list of approved projects can be found on the website. New projects are highlighted in yellow.

DCED continues to update its website with financial and other resources.

The Federal Office of Rural Health Policy (FORHP) has awarded over $11.2 million to 15 recipients for the 2020-2025 Black Lung Clinics Program (BLCP).  The purpose of this program is to reduce the morbidity and mortality associated with occupationally-related coal mine dust lung disease through the provision of quality medical, outreach, educational, and benefits counseling services for active, inactive, retired, and disabled US coal miners.  In an effort to address current disease trends, the program includes an emphasis on Coal Workers’ Pneumoconiosis & Progressive Massive Fibrosis.

Additionally, one cooperative agreement has been awarded to the University of Illinois at Chicago for the Black Lung Data and Resource Center (BLDRC).  The purpose of this program is to strengthen the operations of BLCP recipients through programmatic assistance and improved data collection and analysis related to the health status and needs of U.S. coal miners.