- In a Rural California Region, a Plan Takes Shape to Provide Shade from Dangerous Heat
- New Native American Health Alliance to Address Physician Shortages in Tribal Communities
- How NRHA, USDA Are Helping Rural Hospitals
- Hundreds of Thousands of US Infants Every Year Pay the Consequences of Prenatal Exposure to Drugs, a Growing Crisis Particularly in Rural America
- Rural Maternal Health Series Webinars
- Federally Qualified Health Centers Can Make the Switch to Value-Based Payment, But Need Assistance
- New Program Aims to Boost Tribal Access to Care, but Advocates Says More Can Be Done
- Tribal Schools to Get 24/7 Behavioral Health Crisis Line
- As More Rural Hospitals Stop Delivering Babies, Some Are Determined to Make It Work
- PCORI Advisory Panels: Panel Openings
- Tribes in Washington Are Battling a Devastating Opioid Crisis. Will a Multimillion-Dollar Bill Help?
- HHS Launches Postpartum Maternal Health Collaborative
- FACT SHEET: Biden-Harris Administration Releases Annual Agency Equity Action Plans to Further Advance Racial Equity and Support for Underserved Communities Through the Federal Government
- Rural Emergency Medical Team Touts Using Whole Blood to Help Save Lives
- New Black-Owned Freight Farm in Rural Minnesota to Tackle Food Insecurity, Health Inequities
Using data from 245 health centers that completed a voluntary weekly Health Center COVID-19 Survey, researchers at the Centers for Disease Control and Prevention (CDC) reviewed trends in telehealth use, including by U.S. Census region and urban/rural classifications, during a 20-week period. Study results underscore the need to sustain expanded telehealth use among health centers and to continue to address barriers to telehealth adoption, particularly in the South and rural geographies. Find more information here.
The U.S. Department of Health & Human Services (HHS) seeks input from Federally-recognized Indian Tribes/American Indian and Alaska Native (AI/AN) Tribes, Tribal organizations, Tribal-serving organizations, Tribal Colleges and Universities, and AI/AN—serving institutions of higher education to guide the development of a new Center for Indigenous Innovation and Health Equity.
A new resource collection website, AID in PA, has recently launched. The site was created in partnership with the Pennsylvania Department of Human Services Office of Developmental Programs, PA HCQUs, ASERT, and Temple University. The site provides resource collections designed specifically for the ID/A communities, their parents and caregivers, professionals and the communities across Pennsylvania. The site is home to a variety of topics.
AID in PA began in response to the COVID-19 pandemic of 2020. ODP knew it was a time of particular need for the ID/DD/A communities of Pennsylvania. The original goal was to arm self-advocates and those who support them with the necessary information to navigate and cope with a global health crisis, but has since grown to offering guidance and support through a multitude of challenges facing the ID/DD/A communities such as healthy sexuality and trauma support and recovery.
Explore the resources available on the AID in PA site.
From the PA State Data Center
According to analysis of the 2019 American Community Survey (ACS) 5-Year Estimates Public Use Microdata Sample (PUMS), women accounted for at least 80 percent of graduates in eight degree fields with at least 10,000 graduates.
Of those 25 years of age and over with a Bachelor’s degree or higher, nine-out-of-ten graduates of Communication Disorders Science, Early Childhood Education, Nursing, and Family and Consumer Science are women. Women accounted for less than 20 percent of graduates in six degree fields with at least 10,000 graduates, mainly engineering fields.
Click here to see female representation across all degree fields with at least 10,000 graduates.
Eases Care Coordination, Resource Connections for Health Care and Social Service Systems
Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller announced the selection of a vendor for Resource Information and Services Enterprise – or RISE PA – an upcoming statewide resource and referral tool. RISE PA is a collaborative effort between multiple state agencies, counties, and local non-profits and community organizations, health care, and social services providers. Aunt Bertha, the selected vendor, will create an interactive online platform that will serve as a care coordination system for providers including, health care and social services organizations and a closed-loop referral system that will report on the outcomes of the referrals. It will also serve as an access point to search and obtain meaningful information to help Pennsylvanians find and access the services they need to achieve overall well-being and improve health outcomes.
“No one person or provider can help a person fully address all of their needs on their own, and that is okay. We want to make sure that we are focused on how to promote a more holistic approach to health and well-being and that we are ensuring that individuals’ and families’ needs are met through the delivery of the right service at the right time,” said Secretary Miller. “RISE PA will allow us to break down walls in the health care and social service system and improve health outcomes and quality of life for Pennsylvanians at a time when a seamless connection is needed more than ever.”
The COVID-19 pandemic has emphasized the urgent need for an easily accessible, person-centric system to assist the public in locating resources and to efficiently and effectively connect individuals with critical services such as food, housing, transportation, child care, and employment programs, as well as many other needed critical services and forms of assistance. This tool will supplement in-person interactions between social services organizations and clients and help ease access to services and supports beyond normal business hours.
Aunt Bertha was selected through a Request for Expressions of Interest (RFEI) issued in July 2020. The RISE PA implementation plan includes an initial regional launch starting with the following counties: Adams, Berks, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Perry, and York Counties during the first quarter of 2021.
“This is a monumental achievement that will have a huge impact on the people we serve throughout the commonwealth. It would not have been possible without the hard work from staff and stakeholders from multiple sectors and disciplines both in and outside of state government,” said Dan Jurman, executive director of the Governor’s Office of Advocacy and Reform and co-chair of the Resource and Referral Tool Advisory Committee. “This is the first consequential step toward having “no wrong door” for residents of Pennsylvania who are looking for help, and to being able to use data in real-time to make the kind of meaningful improvements that will help us do just that; not only help them, but empower and equip them to not need our help over and over again.”
Once implemented, anyone in Pennsylvania will be able to access this tool from their personal computers, tablets, and mobile devices to find information about services and resources, and self-refer to participating agencies. RISE PA will also allow service providers to assess an individual’s needs during a physician’s office or emergency department visit, when receiving case management services, or seeking assistance from a community-based organization, among others. The tool will also gather data that can help the commonwealth and its partners better understand the needs of Pennsylvanians and identify service gaps across the state. By looking at critical social determinants of health, including employment, child care, transportation, food security, access to health care, and housing stability, commonwealth agencies and partners at the county and local level can help the people we serve achieve better long-term health outcomes and maximize the impact of health care dollars.
“This is a huge leap forward for the health and well-being of Pennsylvanians,” Emily L. Katz, co-chair of the Resource and Referral Tool Advisory Committee and interim executive director of Pennsylvania’s Medicaid Managed Care Organizations (PAMCO). “Through this effort, Pennsylvanians will have access to an online tool which will immediately connect families to the resources they need.”
Individuals, service providers, government agencies, caregivers, educational institutions, faith-based groups, and advocates will be able to use this tool to help navigate the system of resources, and work together to reduce duplication of services as well as the time it takes for individuals to receive much-needed services. RISE PA will allow service providers to bridge the gaps that make service continuity and follow-up on referrals difficult
“Governor Wolf and this Administration have worked since day one to ease access to health care and services that can improve quality of life for people across Pennsylvania,” said Secretary Miller. “RISE PA is a continuation of this commitment, and we look forward to implementing it across Pennsylvania and helping people as they navigate across systems and organizations so they know that they are not alone on their path to a better life.”
Regional webinars will be held. See below for further information:
RISE PA Stakeholder Webinars
Lehigh/Capital Zone – Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York counties
Please register for RISE PA Stakeholder Webinar on Mar 12, 2021 – 10:00 AM EST at: https://attendee.gotowebinar.com/register/6812541473384862735
After registering, you will receive a confirmation email containing information about joining the webinar.
Southeast Zone – Bucks, Chester, Delaware, Montgomery and Philadelphia counties
Please register for RISE PA Stakeholder Webinar on Mar 16, 2021 – 1:00 PM EST at: https://attendee.gotowebinar.com/register/5285032849869277455
After registering, you will receive a confirmation email containing information about joining the webinar.
Southwest Zone – Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Green, Indiana, Lawrence, Somerset, Washington and Westmoreland counties
Please register for RISE PA Stakeholder Webinar on Mar 19, 2021 – 10:00 AM EST at: https://attendee.gotowebinar.com/register/4742881258399010831
After registering, you will receive a confirmation email containing information about joining the webinar.
New West Zone – Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango and Warren counties
Please register for RISE PA Stakeholder Webinar on Mar 23, 2021 – 10:00 AM EST at: https://attendee.gotowebinar.com/register/2176859713193096463
New East Zone – Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming counties
Please register for RISE PA Stakeholder Webinar on Mar 30, 2021 – 10:00 AM EST at: https://attendee.gotowebinar.com/register/8320073070135742991
As the Biden administration accelerates a plan to use pharmacies to distribute COVID-19 vaccines, significant areas of the country lack brick-and-mortar pharmacies capable of administering the protective shots.
A recent analysis by the Rural Policy Research Institute found that 111 rural counties, mostly between the Mississippi River and the Rocky Mountains, have no pharmacy that can give the vaccines. That could leave thousands of vulnerable Americans struggling to find vaccines, which in turn threatens to prolong the pandemic in many hard-hit rural regions.
And in those areas without pharmacies, rural residents may have to drive long distances to get shots, and do so twice for two-dose vaccines. An analysis by the University of Pittsburgh School of Pharmacy and the West Health Policy Center found that 89% of Americans live within 5 miles of a pharmacy. But more than 1.6 million people must travel more than 20 miles to the nearest pharmacy, which can mean facing difficult weather and road conditions in remote areas.
“If pharmacies are closed, especially in places where there’s no other health care provider, then you’ve got essentially a health care desert,” said Michael Hogue, president of the American Pharmacists Association. “You have to be dependent on either a mobile clinic coming in from another area to provide vaccines, or the citizens are going to have to drive farther to get a vaccine.”
So far, with a limited quantity of doses and strict limitations on who is eligible, that hasn’t been a problem. But as vaccination opens up to the general public and supplies of the vaccines increase, local health departments may be overwhelmed with demand and may need to offload the task of vaccinating local residents to other health care providers.
“It’s probably not playing out yet because we’re not getting enough supply,” said Keith Mueller, director of the Rural Policy Research Institute’s Center for Rural Health Policy Analysis. “That means we have some time for those local health departments to figure this out: Who in my radius, if you will, has the capacity to administer vaccines?”
From 2003 to 2018, 1,231 independent rural pharmacies closed, Mueller’s team found, leaving some 630 rural communities with no retail drugstore. The changing economics in the pharmacy industry did them in, a combination of national pharmacy chains expanding and consolidating, big-box stores and supermarkets opening their own competing pharmacies and pharmacy benefit managers eating into small-pharmacy profits. Mail-order options siphoned off business. And you can’t get vaccines in the mail.
In many towns, those pharmacies represented the last bastion of health care in their communities. Now more than ever, residents are feeling the void.
“We have no medical infrastructure,” said DeAnne Gallegos, a spokesperson for the San Juan County health department in southwestern Colorado. “We don’t even have a doctor.”
With the closest pharmacy located in a neighboring county an hour away in Durango, vaccinations in San Juan County have been handled by the public health director and two nurses. They hold weekly vaccination clinics if they get any doses. As of Feb. 18, the health department had fully vaccinated 298 of its 700 residents.
Counties are allocated doses based on their year-round populations, but the health department hopes to vaccinate out-of-staters who visit as well. San Juan County deals with an influx of tourists and second-home owners coming from states such as Texas, Arizona and Florida, where the pandemic has hit harder and vaccination rates are lagging. So the health department could end up vaccinating more than 200% of San Juan County’s official population to keep COVID out.
“Our attitude is, no matter what your driver’s license or your ZIP code says, if you are living within our tightknit community, that is someone we hope the state would allow us to bring into the fold,” Gallegos said. But that stresses what she called the frail structure the department had in the first place.
“It’s our responsibility to make appointments, manage the data, make contact, receive phone calls,” Gallegos said. “When you don’t have the staff or the budget to hire additional staff, that also makes it very difficult.”
Farther east, Custer County hasn’t had a pharmacy for years. Only recently, a pharmacist who lives in the county but works in an adjacent county an hour away has started delivering prescriptions to Custer residents when she returns home after each shift. But she can’t bring vaccines home from work.
Instead, a public health nurse who was due to retire at the end of 2020 decided to stay on to vaccinate residents with the help of another nurse and retired health care workers who maintained their licenses. According to Custer County Public Health Agency Director Dr. Clifford Brown, they have vaccinated more than 630 of the county’s 5,200 residents. In an ideal world, they could have handed off the task to a pharmacy. “We do feel the pinch,” Brown said. “I wake up about 3 o’clock in the morning thinking about, how in the world are we going to stretch things to cover for this day?”
Pharmacies offer distinct advantages as vaccine providers. Hospitals, which didn’t traditionally vaccinate the general public, have had to create programs to distribute their allocated doses.
In Colorado, pharmacies give over a million flu shots a year, said Emily Zadvorny, executive director of the Colorado Pharmacists Society, and, particularly in smaller towns, have a much closer relationship with their customers than larger health care providers do. She pointed to a pharmacist in Kiowa County, Colorado, who pulled a list of all his customers age 70 and up and called each of them to schedule their covid vaccinations.
“They have so much more capacity than they have supplies,” Zadvorny said. “It’s just a slow process of ramping up.”
Even where pharmacies exist, it’s been a challenge for independent drugstores to participate in the covid vaccine rollout. For influenza, pneumonia or shingles vaccines, stores typically order as many doses as they think they can sell, which get delivered alongside the pills they distribute.
The COVID vaccines, on the other hand, are being distributed through a national program that comes with a significant learning curve for pharmacies. The federal Centers for Disease Control and Prevention partnered with 21 pharmacy chains, including four networks of independent community pharmacies that give smaller drugstores more purchasing power. According to the National Community Pharmacists Association, those four networks include about 8,000 of the 21,000 community pharmacies nationwide. Pharmacies that are not part of those networks can apply to be vaccine providers in their states.
“The biggest hurdle for most pharmacies is just getting approved,” said Kyle Lancaster, pharmacy director for Our Valley Pharmacy, a three-pharmacy chain in rural Lincoln County, Wyoming.
Our Valley applied to federal and state health agencies and had to upgrade its freezers with digital data loggers, which upload the pharmacies’ refrigerator and freezer temperatures and report them directly to the CDC.
Most small pharmacies like his, he said, had been limited to the Moderna vaccine, which has less stringent temperature requirements than Pfizer’s version. The Johnson & Johnson vaccine, which was recently approved, would be even easier for rural pharmacies to handle.
Lancaster said he’s unsure how many doses of the vaccine his chain will get or when.
Those uncertainties leave residents such as Nan Burton, 63, worried about how to get vaccinated. Last year, she and her husband decided to ride out the pandemic in their vacation home in Lincoln County, trading apartment living in Seattle for the wide-open, physically distanced spaces of Star Valley Ranch, about 8 miles from the nearest Our Valley branch. With plans to retire fully next year, now they’re staying for good.
So far, Lincoln County — more than three times the size of Rhode Island — has vaccinated about 2,500 of its nearly 20,000 residents, mainly through the local hospital. But with no major chain pharmacies in the region, the county must wait for independent community pharmacies, such as Our Valley, to get up to speed.
Burton said she and her husband have little choice but to wait and hope that the vaccine distribution logistics are sorted out. They’d be willing to drive hours to get a vaccine if they knew they weren’t taking it away from someone else in need.
“Until there’s some kind of a national push to do outreach to rural communities, I think we’re going to be in trouble,” Burton said.
The National Maternal and Child Oral Health Resource Center (OHRC) published “Integrating Oral Health Care into Primary Care: A Resource Guide.” This guide features resources to help health professionals, program administrators, and others implement oral health care integration in materials, programs, and systems of care. It features descriptions and links to materials on surveillance, policy, practice guidance, practice tools, professional education and training, and program development.
Pennsylvania Secretary of Agriculture Russell Redding notified farmland owners in 25 Pennsylvania counties that they are eligible to receive disaster relief assistance from the United States Department of Agriculture (USDA) due to losses caused by drought that occurred during the 2020 crop year.
“I encourage Pennsylvania farmers who have experienced loss from mother nature’s unpredictably to check with their local Farm Service Agency to see how they can help,” said Redding. “Our farmers are resilient, battling both disaster and the ongoing COVID-19 pandemic and disaster. These farmers can now breathe a sigh of relief.”
USDA reviewed the Loss Assessment Reports and determined that there were sufficient production losses to warrant a Secretarial natural disaster designation. Six Pennsylvania counties are designated as primary natural disaster areas, in two separate disaster designations.
Designation Number 1:
Drought that occurred June 1, 2020, through November 30, 2020
- Primary Counties: Centre, Clearfield, Clinton, Elk, Jefferson
- Contiguous Counties: Armstrong, Blair, Cambria, Cameron, Clarion, Forest, Huntingdon, Indiana, Lycoming McKean, Mifflin, Potter, Union, Warren
Designation Number 2:
Drought that occurred June 6, 2020, through November 17, 2020
- Primary County: Cumberland
- Contiguous Counties: Adams, Dauphin, Franklin, Perry, York
A Secretarial disaster designation makes farm operators in primary counties and those counties contiguous to such primary counties eligible to be considered for certain assistance from the federal Farm Service Agency (FSA), provided eligibility requirements are met. This assistance includes FSA emergency loans.
Eligible farmers can apply for loans for up to eight months from the date of a Secretarial disaster declaration, and should contact their local FSA office for assistance. More information on USDA’s disaster assistance program, including county lists and maps, can be found at disaster.fsa.usda.gov.
March 15 is the federal deadline to enroll in crop insurance, and the droughts of 2020 are a stark reminder of the role crop insurance plays in mitigating risks. Those who took steps to enroll in crop insurance and guard against the risk, weathered the drought. Those who did not, are now looking at emergency loans like those afforded through the disaster declaration.
“While this designation is a welcome sigh of relief for many Pennsylvania farmers, it’s not something that should be relied on,” added Redding. “As farmers, we’re well aware that we cannot control the weather. But we can manage our risk, and that’s why I also encourage Pennsylvania farmers to enroll in crop insurance prior to the March 15 deadline.”
The Pennsylvania Agricultural Business Development Center, established as part of the Pennsylvania Farm Bill, is available to provide advice and council to Pennsylvania farmers for their Risk Management opportunities.
Risk is an important consideration of the farming business. The uncertainties inherent in weather, yields, prices, global markets, biological pathogens, and other factors that impact farming can cause wide swings in farm income. Risk management involves choosing among alternatives that strengthen the resiliency of agriculture operations.
For more about the Pennsylvania Farm Bill visit agriculture.pa.gov/pafarmbill.
Pennsylvania Agriculture Secretary Russell Redding announced the opening of the 2020-21 PA Farm Bill’s $500,000 Urban Agriculture Grant Program to grow agricultural infrastructure in urban food deserts to improve access to fresh, local food and provide opportunities for hands-on learning and community-building.
“In 2020 we saw the sad result of the reality of food apartheids as people in urban communities without access to fresh, nutritious food were disproportionately affected by COVID-19,” said Redding. “Nutrition and health – strong immune systems and susceptibility to disease – are inextricably linked. COVID-19 compounded upon years of lack of access to nutritious food and minority urban communities were hit hard by the pandemic.
“The Urban Ag Program aims to increase access to fresh and nutritious food while simultaneously providing opportunities for personal and community growth through shared purpose and passion,” said Redding.
The Urban Agriculture Grant Program will provide grants to improve agriculture infrastructure in urban areas, the aggregation of product, sharing of resources, and support for community development efforts.
Two types of grants can be awarded: “microgrants” and “collaboration” grants. Microgrants of up to $2,500 in matching funds can be used for one-time projects or a single entity applicant. Collaboration grants (up to $50,000 in matching funds) demonstrate cooperative or regional efforts which share resources, aggregate agricultural products or producers, promote the sharing of resources among agricultural entities, and support community development.
Redding was joined by state Senator Sharif Street (D-Philadelphia), champion for the Urban Ag Program legislation in Governor Tom Wolf’s inaugural Pennsylvania Farm Bill, and Frank Sherman, co-managing director for First Light Project who received a grant in the last round to initiate their pilot farm to grow food for Philadelphia while simultaneously addressing a need for jobs, food, ag education, and improved health and well-being in the community.
“Pennsylvania agriculture is integral to our ability to keep food resources flowing during COVID. Food banks and urban gardens have been the vanguard against hunger and food insecurity,” said Street. “The Urban Agriculture Grant Program has been vital in providing food resources for 28 projects in 2020. It is encouraging to know that 2021 grant applications will continue to sustain communities across the Commonwealth as we move beyond this health crisis.”
First Light Project uses hydroponic technology on farms throughout the city to grow and sell leafy greens and herbs. They train and employ residents to operate the hydroponic farm, address food insecurity, inspire the community, and support the local economy. First Light used their $37,884 Urban Ag Grant funds to offset the cost of a full-scale hydroponic farm in the Philabundance Warehouse. Upon completion of development, the farm will employ five local community members, four high school interns annually, and is expected to produce nearly 100,000 pounds of produce annually. Of this fresh produce, the farm is committed to donating at least 10 percent directly to community partners to reduce food insecurity in Philadelphia.
“This pandemic has focused our attention on inequities, but it has also sharpened our focus on the important role urban and community gardens play in our commonwealth’s food system,” added Redding. “This funding for urban ag projects will strengthen the resiliency of urban communities across Pennsylvania and the food that grows from these projects will nourish those in need, together breaking down the walls of food apartheid.”
The PA Farm Bill is a comprehensive set of programming and funding for Pennsylvania’s agriculture industry. With the third round of funding proposed in Governor Wolf’s 2021-22 budget, the PA Farm Bill will continue to strengthen the resiliency of the industry so many rely on to sustain life.
For more information about the Pennsylvania Farm Bill visit agriculture.pa.gov/pafarmbill. The Department of Agriculture is actively working to roll out grant programs for the 2020-21 funding. The Ag and Youth Grant Program and Commonwealth Specialty Crop Block Grant Program are open now with their application periods closing on March 5, 2021.
As COVID-19 cases continue to decline and the state’s vaccination plan is amplified, the Wolf Administration announced revised and lifted mitigation restrictions that are effective statewide. Please read the revised mitigation orders below.
“Pennsylvania is taking a measured approach to revising or lifting mitigation orders,” Gov. Wolf said. “The reason we are seeing cases drop can be attributed, in part, to people following the mitigation efforts we have in place. Mask-wearing, social distancing and hand hygiene are making a difference and need to continue even as we see more and more people fully vaccinated. We need to balance protecting public health with leading the state to a robust economic recovery. We are lifting mitigation efforts only when we believe it is safe to do so.”
The revised mitigations restrictions announced today include:
- Revised maximum occupancy limits for indoor events to allow for 15% of maximum occupancy, regardless of venue size. Core public health measures such as face covering (mask-wearing), social distancing, and hand hygiene still must be enforced. The 15% of maximum occupancy is permitted only if attendees and workers are able to comply with the 6-foot physical distancing requirement.
- Revised maximum occupancy limits for outdoor events to allow for 20% of maximum occupancy, regardless of venue size. Core public health measures such as face covering (mask-wearing), social distancing, and hand hygiene still must be enforced. The 20% of maximum occupancy is permitted only if attendees and workers are able to comply with the 6-foot physical distancing requirement.
- Eliminate out-of-state travel restrictions. In November, the Department of Health provided an updated travel order requiring anyone over the age of 11 who visits from another state to provide evidence of a negative COVID-19 test or place themselves in a travel quarantine for 14 days upon entering Pennsylvania. Today, this order was rescinded. The current downward trend of cases nationwide and implementation of testing requirements and universal face covering on public transportation and transportation hubs are reducing the risk that interstate travel is a vector of disease transmission.
Along with these changes, there is caution. Reduced cases, hospitalizations and deaths, and the more than 2.3 million vaccinations are good signs, but the CDC advises that now is not the time to introduce expansive loosening of mitigation efforts known to put people at more risk. New cases of variants continue to appear, and some experts warn of a fourth surge in cases.
The Acting Secretary of Health’s revised order on gatherings can be found here.
The Acting Secretary of Health’s order rescinding travel restrictions can be found here.
Find FAQs for the mitigation order changes here: https://www.health.pa.gov/topics/disease/coronavirus/Pages/Guidance/Targeted-Mitigation-FAQ.aspx