While hospitalizations related to COVID-19 have started to decelerate in some cities, it could take the virus weeks to peak in more rural communities. CNBC reports on the challenges in rural communities, especially the outbreaks happening at factories deemed essential. Health experts worry that once the virus starts to spread in rural areas, it could expand rapidly. The National Rural Health Association’s Vice President of Government Affairs explains in the article that, “Faith-based or community organizations, school activities, everybody goes to the same high school football game. Everybody kind of knows each other and stays in close contact, so it can potentially spread very, very rapidly.”

As the COVID-19 outbreak continues to tax hospitals throughout the country, there is a growing concern that many hospitals, in particular rural hospitals, may not have the reserve to remain fiscally viable. A new Health Affairs blog explores the vulnerable state rural providers were in prior to the pandemic, and the capacity for rural providers to deal with a surge of patients. Because most rural hospitals operate on razor thin margins, high margin services such as elective surgery keep them afloat. For many rural hospitals, canceling these profitable services to cope with the outbreak may be the tipping point for financial catastrophe.

The UNC Sheps Center reports that two rural hospitals in Florida have closed amid the COVID-19 pandemic and converted to off-campus emergency departments. Both Shands Live Oak Regional Medical Center and Shands Starke Regional Medical Center were CAHs that were part of a sale and required to cease all non-emergency services by May 1^st. Both are now operating as off-campus emergency departments of Lake City Medical Center and North Florida Regional Medical Center. The total number of rural hospital closures since 2010 is now 130, and 2020 is on-track to surpass last year’s record number of closures.

The U.S. Department of Agriculture (USDA) approved the purchase of $1.2 billion of boxed agricultural products as part of the Coronavirus Farm Assistance Program (CFAP), Farmers to Families Food Box Program. The list of contracts can be found on USDA’s website, and we have requested that USDA provide a list of PA companies – we will be sure to share with you as soon as we get the full list, but congratulations in advance to all PA farms and processors who were awarded funds.

Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller announced an Emergency Assistance Program (EAP) to help low-income families who lost wages experiencing financial challenges due to the COVID-19 pandemic. Families who qualify will be eligible for a one-time payment to assist them in meeting basic needs and help them secure more stable financial footing in the future.

The program will use existing Temporary Assistance for Needy Families (TANF) funds to provide support to low-income families who qualify. The program will be open to families with a child under the age of 18 or a woman who is currently pregnant. In order to qualify, families must have at least one person in the household who was employed as of March 11, 2020 and experienced an hour or wage reduction of at least 50 percent for two weeks or more or lost employment entirely due to the public health crisis.

Families must meet income limits of 150 percent of the Federal Poverty Guidelines and have no more than $1,000 in a savings or checking account.

Qualifying families will be issued a one-time grant equal to two months of TANF benefits. The average monthly TANF grant for a family of three is $403, so a qualifying family of three would receive a one-time grant of $806 through the program. Information on monthly grants by household size and county is available online here. Funds will be issued through an electronic benefit transfer (EBT) card.

Pennsylvanians can apply for Medicaid, the EAP, the Supplemental Nutrition Assistance Program (SNAP), the Children’s Health Insurance Program (CHIP), and other public assistance programs at any time through DHS’ online COMPASS application at www.compass.state.pa.us. Those who prefer to submit paper applications can mail documents to their local County Assistance Office (CAO) or leave documents in a CAO’s secure drop box, if available. CAOs are still closed to the public, but mail and drop boxes are being monitored so applications can be processed.

Pursuant to the Governor’s authorization, as conferred in the Proclamation of Disaster Emergency issued on March 6, 2020 and the Governor’s Order to Enhance Protections for Health Care Workers issued on May 6, 2020, all statutory and regulatory provisions or portions thereof, that would impose an impediment to implementing the guidance outlined below are suspended. Said suspensions will remain in place throughout the duration of the Governor’s Proclamation.

The Bureau of EMS issues the following guidance as it relates to the utilization of out of state EMS personnel, as detailed below:

• EMS providers that hold an active credential with another state’s EMS certifying body, or whom hold an active certification with the National Registry of Emergency Medical Technicians, may practice in Pennsylvania on the sole basis of that certification. This suspends requirements found at 35 Pa. C.S. § 8113 and 28 Pa. Code § 1021.21.
• Individuals holding an out-of-state certification and are practicing in Pennsylvania with a licensed Pennsylvania EMS agency should not exceed the scope of practice or training that they received and are credentialed to perform in their home state. However, regardless of the scope of their home state, they may not exceed the established Pennsylvania Scope of Practice
• Prior to utilizing individuals whom do not hold Pennsylvania EMS certification, Pennsylvania EMS agencies should make a good faith effort to verify that the individual holds the credentials that they claim to hold, and should document what those efforts entailed. All NREMT certifications can be verified online at www.nremt.org in addition, many states have online verification options as well. Please visit https://www.nremt.org/rwd/public/states/state-ems-agencies, select the state you are trying to verify, then click the green button that says verify a state license. If available, you will be taken to that state’s certification portal. Please note, this is not an option for every state.
• Irrespective of certification level, the EMS agency medical director must approve all individuals with an out-of-state credential prior to their service with a Pennsylvania EMS agency.
• For the purposes of PCR documentation, any out of state provider should be entered with their name, and OOS as the certification number
• This guidance does not apply to out-of-state individual providers who are operating under an EMS service/vehicle licensed in another state. Pursuant to EMSIB 2020-09 Out of State Licensed EMS Agencies out-of-state EMS agencies may operate within Pennsylvania pursuant to the laws and regulations of the state in which they are licensed.

Please address any questions to your Regional EMS Council.