On March 13, 2020, President Trump declared the 2019 Novel Coronavirus Disease (COVID-19) situation a national emergency, which allows CMS to waive certain federal requirements in the Medicare, Medicaid, and CHIP programs to ensure continued access to quality of care for all Medicare beneficiaries pursuant to section 1135(b) of the Social Security Act (Act). To streamline the section 1135 waiver request and approval process, CMS is continuously issuing a number of blanket waivers for many Medicare provisions, which primarily affect requirements for individual facilities, such as hospitals, long term care facilities, home health agencies, and so on. These waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration and DO NOT require a request to be sent to the 1135waiver@cms.hhs.gov mailbox or that notification be made to any of CMS’s regional offices.

The Act permits certain small, rural hospitals to enter into a swing bed agreement, under which the hospital can use its beds, as needed, to provide either acute or skilled nursing facility (SNF) care. As defined in the regulations, a swing bed hospital is a hospital or CAH participating in Medicare that has CMS approval to provide post-hospital SNF care and meets certain requirements. To qualify for SNF-level services, a beneficiary must have been hospitalized in a participating or qualified hospital or participating CAH for medically necessary inpatient hospital or inpatient CAH care for at least 3 consecutive calendar days, not counting the date of discharge.

CMS is waiving this 3-day prior hospitalization for coverage of a SNF stay, noted above, in the newly issued rules and waivers. This waiver provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations or are otherwise affected by COVID-19. This waiver applies to swing bed hospitals, which are hospitals or CAHs participating in Medicare that have CMS approval to provide post-hospital SNF care and meets certain requirements. See Swing Bed Factsheet located at https://www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/SwingBedFactsheet.pdf to learn more about hospitals who may provide swing bed services. Currently, there is no waiver modifying the definition of a swing bed hospital and rules that were not amended as a result of 1135 waivers are still in place.

The recently released summary of the “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers” which is located on the website page at https://www.cms.gov/about-cms/emergency-preparednessresponse-operations/current-emergencies/coronavirus-waivers, is a listing of helpful website resources.

CMS is continuously issuing additional waivers and flexibilities, and it is vital to stay updated.

Please visit https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page for more of CMS’ actions concerning COVID-19.

Additionally, please browse our MLN Connects at https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive to keep abreast of changes and updates impacting the provider community.

Agencies Implement Legislation Guaranteeing Coverage of COVID-19 Diagnostic Testing, Including Antibody Testing, and Certain Related Services without Cost Sharing for Enrollees in Private Health Coverage

The Centers for Medicare & Medicaid Services (CMS), together with the Departments of Labor and the Treasury, issued guidance today to ensure Americans with private health insurance have coverage of 2019 Novel Coronavirus (COVID-19) diagnostic testing and certain other related services, including antibody testing, at no cost.  As part of the effort to slow the spread of the virus, this guidance is another action the Trump Administration is taking to remove financial barriers for Americans to receive necessary COVID-19 tests and health services, as well as encourage the use of antibody testing that may help to enable health care workers and other Americans to get back to work more quickly.

“It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” said Administrator Seema Verma. “Today’s action under the leadership of President Trump allows millions of Americans to access the vital health services they need to fight COVID-19, including antibody testing once it becomes widely available.”

In March, representatives of major health insurance companies met with President Trump, where they voluntarily committed to covering COVID-19 testing without cost sharing such as copays and coinsurance.  Building on this commitment, today’s guidance implements the recently enacted Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, which require that private health issuers and employer group health plans cover COVID-19 testing and certain related items and services furnished during the COVID-19 pandemic, with no out-of-pocket expenses.

Specifically, today’s announcement implements the requirement for group health plans and group and individual health insurance to cover both diagnostic testing and certain related items and services provided during a medical visit with no cost sharing. This includes urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test. Covered COVID-19 tests include all FDA-authorized COVID-19 diagnostic tests, COVID-19 diagnostic tests that developers request authorization for on an emergency basis, and COVID-19 diagnostic tests developed in and authorized by states. It also ensures that COVID-19 antibody testing will also be covered. Once broadly available, a COVID-19 antibody test could become a key element in fighting the pandemic by providing a more accurate measure of how many people have been infected and potentially enabling Americans to get back to work more quickly.

To see the guidance, visit: https://www.cms.gov/files/document/FFCRA-Part-42-FAQs.pdf

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

USDA’s COVID-19 Federal Rural Resource Guide Lists Federal Programs That Can Help Rural Communities, Organizations and Residents Impacted by COVID-19

WASHINGTON, April 13, 2020 – U.S. Secretary of Agriculture Sonny Perdue today unveiled a one-stop-shop of federal programs that can be used by rural communities, organizations and individuals impacted by the COVID-19 pandemic. The COVID-19 Federal Rural Resource Guide (PDF, 349 KB) is a first-of-its-kind resource for rural leaders looking for federal funding and partnership opportunities to help address this pandemic.

“Under the leadership of President Trump, USDA is committed to being a strong partner to rural communities preparing for and impacted by COVID-19,” Perdue said. “This resource guide will help our rural leaders, whether they are in agriculture, education, health care or any other leadership capacity, understand what federal assistance is available for their communities during this unprecedented time.”

USDA has taken many immediate actions to assist farmers, ranchers, producers, rural communities, and rural-based businesses and organizations impacted by the COVID-19 pandemic. For more information on these actions, visit www.usda.gov/coronavirus.

With 35 percent of small business owners saying their business cannot survive more than three months in current conditions, WalletHub today released its report on the States with the Most Affected Small Businesses due to Coronavirus, along with accompanying videos.

To identify the states in which businesses are hit hardest by COVID-19, WalletHub compared the 50 states and the District of Columbia across 12 key metrics. Our data set ranges from the share of small businesses operating in highly affected industries to small-business credit conditions and the state’s small-business friendliness. Below, you can see highlights from WalletHub’s report and a Q&A with WalletHub analysts.

COVID-19 Impact on Small Business in Pennsylvania (1=Most Affected, 25=Avg.):

• 43^rd – Share of Small Businesses Operating in High-Risk Industries
• 51^st – Share of Small-Business Employees Operating in High-Risk Industries Among Total Small-Business Employees
• 35^th – Share of Consumer Expenditures Related to High-Risk Industries
• 20^th – Share of Businesses with E-commerce Sales Activity
• 36^th – Business Vitality
• 37^th – Average Annual Federal Small-Business Funding per GDP
• 30^th – Small-Business Credit Conditions
• 33^rd – Total Amount of Small-Business Loans per Small-Business Employee

To view the full report and your state’s rank, please visit:
https://wallethub.com/edu/states-with-the-most-affected-small-businesses-due-to-coronavirus/72977/

Agricultural producers now have more time to repay Marketing Assistance Loans (MAL) as part of the U.S. Department of Agriculture’s implementation of the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020. The loans now mature at 12 months rather than nine, and this flexibility is available for most commodities.

Eligible commodities include barley, chickpeas (small and large), corn, cotton (upland and extra-long staple), dry peas, grain sorghum, honey, lentils, mohair, oats, peanuts, rice (long and medium grain), soybeans, unshorn pelts, wheat, wool (graded and nongraded); and other oilseeds, including canola, crambe, flaxseed, mustard seed, rapeseed, safflower, sunflower seed, and sesame seed. Seed cotton and sugar are not eligible

Harrisburg, PA – The Pennsylvania Department of State announced that it has issued 30 licensing waivers since March 17 to allow licensed professionals, facilities and trainees to respond to the COVID-19 disaster declaration.

“During this unprecedented emergency, the Department of State is committed to reducing as many burdens as possible for licensees to practice and serve Pennsylvanians,” Secretary of State Kathy Boockvar said.  “We’ve included a wide spectrum of professionals in these temporary waivers, recognizing that each professional we can empower to help is another critical part of the solution to ending this crisis.”

Among the changes in place during the COVID-19 emergency:

• Licensed health care practitioners may provide services via telemedicine
• Temporary licenses for out-of-state health care practitioners will be expedited
• Extended all upcoming license renewal deadlines including healthcare and non-healthcare professionals
• Recently retired health care practitioners may temporarily reactivate their licenses more easily and without reactivation fees
• Suspended certain in-person continuing-education requirements to allow increased use of online or distance learning
• Authorized the use of electronic notarization and loosened restrictions on in person requirements for notaries handling estate documents such as wills, living wills, and powers of attorney, as well as other types
• Extended filing deadlines for charitable nonprofit organizations

“The Department of State is working with the governor’s office, the Department of Health and the Department of Human Services to identify additional requirements that can be suspended to give licensed professionals and others the flexibility they need during the COVID-19 pandemic,” Secretary Boockvar said.

The Department of State website will be updated regularly as additional requirement waiver information becomes available. Licensees with questions should contact their state licensing board via the email addresses on the Department of State website.

News

• CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week
• COVID-19: Dear Clinician Letter
• COVID-19: Non-Emergent, Elective Medical Services and Treatment Recommendations
• Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19
• Multi-Factor Authentication Requirement Delayed for PECOS, I&A, and NPPES
• Open Payments: Pre-Publication Review and Dispute through May 15

Claims, Pricers & Codes

• Pneumococcal Pneumonia Vaccination: Eligibility Transactions Includes DOS Starting April 13

Events

• Ground Ambulance Organizations: Data Collection for Medicare Providers Call — May 7

MLN Matters® Articles

• Supplier Education on Use of Upgrades for Multi-Function Ventilators
• Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) — Revised

Publications

• Civil Rights, HIPAA, and COVID-19
• Medicare Advance Written Notices of Noncoverage — Revised
• Medicare Preventive Services — Revised
• Medicare Preventive Services Poster — Revised

News

• CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week
• COVID-19: Dear Clinician Letter
• COVID-19: Non-Emergent, Elective Medical Services and Treatment Recommendations
• Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19
• Multi-Factor Authentication Requirement Delayed for PECOS, I&A, and NPPES
• Open Payments: Pre-Publication Review and Dispute through May 15

Claims, Pricers & Codes

• Pneumococcal Pneumonia Vaccination: Eligibility Transactions Includes DOS Starting April 13

Events

• Ground Ambulance Organizations: Data Collection for Medicare Providers Call — May 7

MLN Matters® Articles

• Supplier Education on Use of Upgrades for Multi-Function Ventilators
• Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) — Revised

Publications

• Civil Rights, HIPAA, and COVID-19
• Medicare Advance Written Notices of Noncoverage — Revised
• Medicare Preventive Services — Revised
• Medicare Preventive Services Poster — Revised

As part of the National Institute for Occupational Safety and Health’s (NIOSH) efforts to keep our stakeholders up to date on the CDC and NIOSH COVID-19 response, below is a summary of new information posted this week

Industry Specific Resources

• Airline, Airport, and Transit Worker Fact Sheets
  Airline, airport, and transit workers may be at risk for exposure to COVID-19. CDC recommends steps to prevent exposure, which includes everyday actions to prevent the spread of respiratory illness. To learn more, fact sheets are available for airline, airport, and transit workers.

Small Businesses

• Prepare your Small Business and Employees for the Effects of COVID-19
  CDC has developed guidance to help small businesses limit the economic and community impacts of an outbreak of COVID-19. This new guidance provides steps to protect employees and prepare small businesses for disruption. A fact sheet also outlines 10 steps small business employers can take now to protect their employees’ health.

Healthcare Workers

• Strategies for Optimizing the Supply of N95 Respirators
  CDC is working with partners across the global supply chain to evaluate and respond to reported shortages in PPE, particularly N95 respirators. This week, CDC updated guidance on Strategies to Optimize the Supply of N95 Respirators and released an accompanying Summary for Healthcare Facilities.
• Elastomeric Respirators for U.S. Healthcare Delivery During N95 Shortages
  This recorded webinar provides an overview of respiratory protection and guidance surrounding supply shortages. It also provides information on infection prevention measures, strategies for optimizing the supply of N95 respirators, and a broad overview of the use of elastomeric respirators in healthcare.
• Updated Personal Protective Equipment (PPE) Burn Rate Calculator
  CDC designed the PPE Burn Rate Calculator to help healthcare and nonhealthcare systems, such as correctional facilities, track how quickly PPE will be used at those facilities. This week CDC updated the tool, so it can now calculate the average PPE consumption rate per patient. Facilities can enter the number of patients in their facility and track changes in PPE usage as the number of patients fluctuates.

To stay up to date on the response, please visit the COVID-19 webpage or sign up for the COVID-19 newsletter.

The Hill

Rural communities with vacation homes are experiencing outbreaks of the coronavirus at a faster pace than rural areas without seasonal housing, according to a new study, suggesting residents of big cities who flee to the countryside are bringing the virus with them.

The survey found that in rural counties where more than 25 percent of the housing units are inhabited only part time, the average number of COVID-19 cases per capita is more than twice as high as the number of cases in counties where a greater percentage of the population lives there year-round.

Rural communities with high levels of vacation homes even have higher rates of infection than urban counties.

Read more.