Raising awareness about health insurance options for Pennsylvania families is necessary so children do not go without health insurance. Keeping children covered is more important than ever during the COVID-19 pandemic. Providers can encourage patients and their families to enroll in public health insurance options like Medicaid and the Children’s Health Insurance Program (CHIP). Providers can also share the family flyer with their patients which instructs families about how they can sign up for health insurance.

Click here to download the fact sheet.
Click here to download the family flyer.

Agency outlines flexibilities to maximize Acute Hospital Care at Home, Ambulatory Surgical Centers to decompress hospitals treating COVID-19 patients

The Centers for Medicare & Medicaid Services (CMS) outlined unprecedented comprehensive steps to increase the capacity of the American health care system to provide care to patients outside a traditional hospital setting amid a rising number of coronavirus disease 2019 (COVID-19) hospitalizations across the country. These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed. Building on CMS’s previous actions to expand the availability of telehealth across the nation, these actions are aimed at allowing health care services to be provided outside a hospital setting while maintaining capacity to continue critical non-COVID-19 care, allowing hospitals to focus on the increased need for care stemming from public health emergency (PHE).

“We’re at a new level of crisis response with COVID-19 and CMS is leveraging the latest innovations and technology to help health care systems that are facing significant challenges to increase their capacity to make sure patients get the care they need,” said CMS Administrator Seema Verma. “With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond.”

Acute Hospital Care at Home

In March 2020, CMS announced the Hospitals Without Walls program, which provides broad regulatory flexibility that allowed hospitals to provide services in locations beyond their existing walls. Today, CMS is expanding on this effort by executing an innovative Acute Hospital Care At Home program, providing eligible hospitals with unprecedented regulatory flexibilities to treat eligible patients in their homes. This program was developed to support models of at-home hospital care throughout the country that have seen prior success in several leading hospital institutions and networks, and reported in academic journals, including a major study funded by a Healthcare Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI).

The program clearly differentiates the delivery of acute hospital care at home from more traditional home health services. While home health care provides important skilled nursing and other skilled care services, Acute Hospital Care at Home is for beneficiaries who require acute inpatient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis.

To support these efforts, CMS has launched an online portal https://qualitynet.cms.gov/acute-hospital-care-at-home to streamline the waiver request process and allow hospitals and healthcare systems to submit the necessary information to ensure they meet the program’s criteria to participate. CMS will also closely monitor the program to safeguard beneficiaries by requiring hospitals to report quality and safety data to CMS on a frequency that is based on their prior experience with the Hospital At Home model.

Ambulatory Surgical Center Flexibility

As part of Hospital Without Walls, CMS also previously announced regulatory flexibility that allowed ASCs – facilities that normally provide same-day surgical care – the ability to be temporarily certified as hospitals and provide inpatient care for longer periods than normally allowed, with the appropriate staffing in place. ASCs are normally subject to a requirement that patients only remain in their care for less than 24 hours or require admission to a regular hospital.

CMS is announcing an update to that regulatory flexibility, clarifying that participating ASCs need only provide 24-hour nursing services when there is actually one or more patient receiving care onsite. The program change provides ASCs enrolled as hospitals the ability to flex up their staffing when needed and provide an important relief valve in communities experiencing hospital capacity constraints, while not mandating nurses be present when no patients are in the ASC. The flexibility is available to any of the 5732 ASCs throughout the country seeking to participate and will be immediately effective for the 85 ASCs currently participating in the Hospital Without Walls initiative. CMS expects this flexibility will allow these and additional ASCs enrolled as hospitals to serve as an added access point that will allow communities to maintain surgical capacity and other life-saving non-COVID-19, like cancer surgeries. Allowing these types of treatments to occur in designated ASCs enrolled as hospitals while hospitals are managing any surges of COVID-19 would allow vulnerable patients to receive this needed care in settings without known COVID-19 cases.

The announcement builds upon the critical work by CMS to expand telehealth coverage to keep beneficiaries safe and prevent the spread of COVID-19. CMS has expanded the scope of Medicare telehealth to allow Medicare beneficiaries across the country to receive telehealth services from any location, including their homes. CMS also added over 135 services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. The flexibilities announced today, and the aggressive action taken by CMS to remove barriers to telehealth, ensure patients and providers have options when receiving and providing care given the challenges and additional stress placed on hospitals and the health care system during the COVID-19 PHE.

To view the Acute Hospital Care At Home initiative and application, please visit: CMS’: https://qualitynet.cms.gov/acute-hospital-care-at-home

For more on the ambulatory surgical center flexibilities, please see: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/guidance-processing-attestation-statements-ambulatory-surgical-centers-ascs-temporarily-enrolling

To view comments from health systems participating in the Acute Hospital Care at Home, please visit: https://www.cms.gov/files/document/what-are-they-saying-hospital-capacity.pdf

Link to FAQs:
https://www.cms.gov/files/document/covid-hospital-without-walls-faqs-ascs.pdf 

https://www.cms.gov/files/document/covid-acute-hospital-care-home-faqs.pdf

As Pennsylvania experiences a resurgence of COVID-19 cases with significantly higher daily case counts than in the spring and hospitalizations on the rise, the Pennsylvania Governor Wolf’s Administration has identified four new mitigation efforts, which Secretary of Health Dr. Rachel Levine announced on November 17, 2020.

“It is our collective responsibility to protect our communities and our most vulnerable Pennsylvanians from COVID-19 and to continue to work together to get through this pandemic. These targeted mitigation efforts, combined with existing ones, are paramount to saving lives and protecting our economy,” Gov. Wolf said. “The administration will continue to monitor the risks posed by COVID-19 across the commonwealth and will reinstate or institute new targeted mitigation tactics as necessary.”

The efforts announced include:

Protecting Our Health Care System

Dr. Levine issued a memorandum to acute care hospitals outlining expectations to care for Pennsylvanians who need care during the pandemic.

Hospitals are to work through the established health care coalitions and other partnerships to prepare for how they will support one another in the event that a hospital becomes overwhelmed during the pandemic. Hospitals should also be working to move up elective procedures necessary to protect a person’s health and prepare to suspend them if our health care system becomes strained.

Restrictions on elective surgeries put into effect in March and lifted in April were to help with both PPE and bed capacity and were considered successful.

Hospitalizations are increasing, as are ICU patients, and according to modeling from the Institute of Health Metrics and Evaluation, which does not take into account hospitalizations from influenza, Pennsylvania will run out of intensive care beds in December if ICU admissions continue at the current rate.

The same modeling indicates we will have sufficient medical-surgical beds with some uncertainty as to capacity from region to region.

Traveler Testing

Dr. Levine issued an order requiring anyone who visits from another state to have a negative COVID-19 test within 72 hours prior to entering the commonwealth.

If someone cannot get a test or chooses not to, they must quarantine for 14 days upon arrival in Pennsylvania.

Pennsylvanians visiting other states are required to have a negative COVID-19 test within 72 hours prior to their return to the commonwealth or to quarantine for 14 days upon return to Pennsylvania.

This order, which takes effect on Friday, November 20, does not apply to people who commute to and from another state for work or medical treatment.

Strengthened Masking Order

Dr. Levine first issued a masking order on April 15. The order signed today strengthens this initial order with these inclusions:

• Masks are required to be worn indoors and outdoors if you are away from your home.
• When outdoors, a mask must be worn if you are not able to remain physically distant (at least 6 feet away) from someone not in your household the entire time you are outdoors.
• When indoors, masks will now be required even if you are physically distant from members not in your household. This means that even if you are able to be 6 feet apart, you will need to wear a mask while inside if with people other than members of your household.
• This order applies to every indoor facility, including homes, retail establishments, gyms, doctors’ offices, public transportation, and anywhere food is prepared, packaged or served.

Colleges and Universities

The departments of Health and Education issued recommendations for colleges and universities to implement a testing plan for when students return to campus following the holidays.

These recommendations include establishing routine protocols for testing.

Colleges and universities should have adequate capacity for isolation and quarantine and should be prepared to enforce violations of established policies such as mask wearing and physical distancing.

Every college and university should test all students at the beginning of each term, when returning to campus after a break and to have regular screening testing throughout the semester/term.

“We must remain united in stopping COVID-19,” Dr. Levine said. “Wear a mask, wash your hands, stay apart and download the COVID Alert PA app. If you test positive, please answer the call of the case reviewer and provide information that can help protect others. It’s the selfless, right thing to do.”