By Tim Marema and Bill Bishop

Large swaths of rural America had no Covid-19 infections during the month of May. But other parts of rural America were among the hardest hit and deadliest.

Read more

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

CMS Announces Final Payment Notice for 2021 Coverage Year

The final Notice of Benefit and Payment Parameters for the 2021 benefit year, also referred to as the 2021 Payment Notice, minimizes the number of significant regulatory changes to provide states and issuers with a more stable and predictable regulatory framework that facilitates a more efficient and competitive market. These changes further the Administration’s goals of lowering premiums, promoting program integrity, stabilizing markets, enhancing the consumer experience, and reducing regulatory burden.

To view the full press release, go to: 2021 Payment Notice Press Release.

To view the final rule, go to: 2021 Payment Notice Final Rule

To view the fact sheet on the final rule, go to: 2021 Payment Notice Fact Sheet

COVID-19 Federal Response

The federal government is taking action to protect the health and safety of our nation’s patients and providers in response to the coronavirus disease 2019 (COVID-19). There are a number of sources of information about actions being taken across the federal government.

• To keep up with the important work the White House Task Force is doing in response to COVID-19, visit White House Task Force.
• For the latest information about COVID-19 prevention, symptoms, and answers to common questions, visit up-to-date COVID-19 information.
• For information on the actions CMS is taking in response to COVID-19, please visit the CMS News Room and Current Emergencies Website.
• For COVID-19 Guidance for private health insurance issuers and group health plans, visit Coronavirus Disease 2019 (COVID-19) FAQs
• Please see the HealthCare.gov webpage for Marketplace-specific information, visit Marketplace-specific relating to COVID-19

The Center for Consumer Information and Insurance Oversight (CCIIO) COVID-19-Related Guidance

The Departments of Labor, Health and Human Services, and the Treasury issued guidance to implement requirements under the Families First Coronavirus Response Act (FFCRA), and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) that generally require private health issuers and employer group health plans to cover COVID-19 testing, the administration of that testing, and certain related items and services. This coverage must be provided for items and services that are furnished on or after March 18, 2020, with no out-of-pocket expenses, prior authorization or medical management requirements for the duration of the applicable emergency period.  Visit FFCRA and CARES Act FAQs for more information.

Prior to the FFCRA and the CARES Act, CMS released guidance that explains that essential health benefits (EHB) generally includes coverage for the diagnosis and treatment of COVID-19. However, the exact coverage details and cost-sharing amounts for individual services may vary by plan, and some plans may require prior authorization before these services are covered. This guidance remains relevant for any treatment related to COVID-19, as well as diagnostic testing received before March 18, 2020. Please visit EHB Coverage for COVID-19 for more information. As noted above, under FFCRA and the CARES Act private health issuers and group health plans must now cover diagnostic services at no cost and with no prior authorization or medical management requirements

In addition, the Departments provided plans and issuers flexibility to reduce or eliminate cost-sharing for telehealth services, even in cases when a consumer may not have met their deductible. For more information, visit telehealth FAQs.

Lastly, CMS released guidance on payment and grace period flexibilities associated with the COVID-19 outbreak. CMS will exercise enforcement discretion to permit issuers of QHPs and stand-alone dental plans (SADPs) to extend payment deadlines for initial binder payments as well as ongoing premium payments during the period of the COVID-19 national emergency. Visit payment and grace period for more information.

New Guidance on Extension of Timeframes for COBRA and Coverage Appeals

On April 28, 2020, a Department of Labor notice, jointly issued with the Department of the Treasury and Internal Revenue Service, extends certain timeframes affecting participants’ rights to healthcare coverage, portability, and continuation of group health plan coverage under COBRA, and extends the time for plan participants to file or perfect benefit claims or appeals of denied claims. These extensions provide participants and beneficiaries of employee benefit plans sponsored by private sector employers additional time to make important health coverage and other decisions affecting their benefits during the coronavirus outbreak.

CMS released a guidance document concurring with the disaster relief specified by the Department of Labor, the Department of the Treasury and Internal Revenue Service and encouraging states, non-federal governmental plans (such as state and local employee health plans) and issuers offering coverage in connection with a group health plan to enforce and operate, respectively, in a manner consistent with this relief.

For a link to the Department of Labor, Treasury and Internal Revenue Service notice, visit COBRA Timeframes. Visit EBSA guidance for other guidance related to group health plans. For CMS guidance, visit the CMS website.

Economic Impact Payments and Unemployment Benefits

The CARES Act calls for the IRS to make economic impact payments of up to $1,200 per taxpayer and $500 for each qualifying child. If consumers get one of these payments, they don’t need to include it in the income they report on their HealthCare.gov application. These payments don’t impact their eligibility for financial assistance for health care coverage through the Marketplace, or their eligibility for Medicaid or the Children’s Health Insurance Program (CHIP). For more information, visit IRS Coronavirus Tax Relief information.

Unemployment benefits, including the additional $600 per week payments in the CARES Act, are taxable income included in modified adjusted gross income (MAGI). The CARES Act exempted the $600 payment increase from income calculations for purposes of eligibility for Medicaid and CHIP, but did not exempt the $600 per week payment increase for purposes of eligibility for subsidies to purchase health insurance coverage through the Marketplace. Please instruct consumers to report all unemployment payments, including the $600 per week payment increase, on their Marketplace application.

Guidance on Marketplace Coverage and Coronavirus

For more information on topics relating to Marketplace coverage and COVID-19, please visit Marketplace coverage for COVID-19. This page provides information on the following situations:

• If I lost my job or experienced a reduction in hours due to COVID-19
• Coverage start dates with a Special Enrollment Period due to loss in coverage
• If I can’t pay my premiums because of a hardship due to COVID-19
• If I’m enrolled in a Marketplace plan and my income has changed
• If I previously qualified for a Special Enrollment Period, but missed the deadline because I was impacted by the COVID-19 national emergency
• If I want to change my current Marketplace plan or enroll for the first time
• If my child is now living with me after their college sent them home early
• If I get a direct deposit or check from the IRS that is called an economic impact payment

 COVID-19 Partner Toolkit

CMS has developed a toolkit to help you stay informed on CMS and HHS materials available on the COVID-19. Please share these materials, bookmark the page, and check back often for the most up-to-date information.  To listen to the audio files and read the transcripts for the COVID-19 Stakeholder calls, visit the Podcast and Transcripts page. The link to the toolkit and more resources is available at Coronavirus Partner Tool Kit page.

Guidance on Medicaid and CHIP Coverage and Benefits Related to COVID-19

Medicaid and CHIP programs cover a broad range of benefits, which may vary by state. Some benefits are mandatory which means states are required to provide them while other benefits are optional for states to provide.  Visit benefits related to COVID-19 for more information. Specific questions regarding covered benefits should be directed to the respective state Medicaid and CHIP agency. More information is available by contacting your state.

CMS revised MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) to clarify when you must use modifier CR (catastrophe/disaster related) and/or condition code DR (disaster related) when submitting claims to Medicare. The update includes a chart of blanket waivers and flexibilities that require the modifier or condition code.