FOR IMMEDIATE RELEASE
April 9, 2020

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) today temporarily suspended a number of rules so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs as they fight to save lives during the 2019 Novel Coronavirus (COVID-19) pandemic.

These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses. The new waivers sharply expand the workforce flexibilities CMS announced on March 30.

CMS sets and enforces essential quality and safety standards for the nation’s healthcare system that supplement State scope-of-practice and licensure laws for healthcare workers. CMS has continuously examined its regulations to identify areas where Federal requirements may be more stringent than State laws and requirements. The changes CMS is announcing today will ensure that healthcare facilities across the nation can expand their staffs and organize them in the most efficient way possible to handle the incoming surge of COVID-19 patients.

Hospitals and health systems throughout the U.S. are seeing increases in patient volumes, leading to significant challenges in delivering vital services. Allowing clinicians to practice to the full scope of their licenses is critical to address staffing needs during the public health emergency.

As a result of CMS’s action:

• Doctors can now directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. Remotely located physicians, coordinating with nurse practitioners at rural facilities, will provide staffs at such facilities additional flexibility to meet the needs of their patients.
• Nurse practitioners, in addition to physicians, may now perform some medical exams on Medicare patients at skilled nursing facilities so that patient needs, whether COVID-19 related or not, continue to be met in the face of increased care demands.
• Occupational therapists from home health agencies can now perform initial assessments on certain homebound patients, allowing home health services to start sooner and freeing home-health nurses to do more direct patient care.
• Hospice nurses will be relieved of hospice aide in-service training tasks so they can spend more time with patients.

“It’s all hands on deck during this crisis,” said CMS Administrator Seema Verma. “All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic.”

CMS’s workforce changes apply immediately and address supervision, licensure and certification, and other limitations in healthcare settings including Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and Hospice. These actions are part of the unprecedented array of temporary regulatory waivers and new rules issued recently by CMS and intended to help the American healthcare system respond to COVID-19.

CMS is the nation’s largest health insurer, serving more than 140 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and Federal Exchanges.

On March 30, CMS issued an unprecedented array of temporary regulatory waivers and new rules to allows hospitals and healthcare systems to deliver services at other community-based locations to make room for COVID-19 patients needing acute care in their main facilities. The changes complement and augment the work of FEMA and state and local public health authorities by empowering hospitals and healthcare systems to rapidly expand treatment capacity and separate infected from uninfected patients. CMS’s waivers and flexibilities will permit patients to be triaged to a variety of community-based locales, including ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories. Transferring uninfected patients will help hospital staffs to focus on the most critical COVID-19 patients, maintain infection control protocols, and conserve personal protective equipment (PPE).

In recent weeks, CMS also has temporarily:

• Permitted physicians whose privileges will expire to continue practicing at a hospital, and allowed new physicians to begin working prior to full hospital medical staff/governing body review and approval.
• Lifted regulatory requirements regarding hospital personnel qualified to perform specific respiratory care procedures, allowing these professionals to operate to the fullest extent of their licensure;
• Waived federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants so they can work at rural hospitals as long as they meet state licensure requirements, allowing for maximum staffing flexibility at such facilities
• Allowed physicians and non-physician practitioners to use telehealth technology to care for patients at long-term care facilities, rather than having to treat patients there in person.
• Waived certain training and certification requirements for nurse’s aides at long term care facilities, to help address potential staffing shortages during the pandemic;
• Waived paperwork requirements so that hospital doctors can use more verbal, rather than written medical orders;

For a complete list of workforce flexibilities that CMS has permitted in recent weeks and years, go to: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

For a fact sheet detailing additional information on the waivers announced today and previously, go to: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

These actions, 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 COVID19, 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.

April 9, 2020

Here is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions taken in response to the COVID-19 virus, as part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, click here www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website. CMS updates these resources on an ongoing basis throughout the day; the information below is current as of April 9, 2020 at 2:30 p.m.

CMS Approves Over $51 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week

CMS delivered more than $51 billion to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19) to ensure they have the resources they need to combat this pandemic. This is an increase from the $34 billion that CMS announced in an earlier press release. Processing times for a request of an accelerated or advance payment is now four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has already approved over 21,000 of the 32,000 requests it received from health care providers and suppliers seeking accelerated and advance payments. Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.

Earlier Press Release

Note:  Payments are now up to $51 billion. CMS approved over 21,000 of 32,000 requests received.

CMS Issues New Wave of Infection Control Guidance to Protect Patients and Healthcare Workers from COVID-19

CMS issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more.

Press Release

Coronavirus-Related Medicare Scam Alert Blog

The Social Security Administration featured a guest blog from CMS Administrator Seema Verma reminding Medicare beneficiaries to be vigilant and take precautions to avoid falling victim to healthcare fraud during the coronavirus pandemic.

Social Security Matters Blog

Artificial Intelligence Health Outcomes Challenge Pause

CMS will temporarily pause the Artificial Intelligence Health Outcomes Challenge and restart the Challenge on Monday, June 29, 2020. In the coming weeks, CMS will distribute a more detailed timeline for the remaining stages of the Challenge.

Artificial Intelligence Health Outcomes Challenge

Emergency Triage, Treat, and Transport (ET3) Model Implementation Date Delay

As CMS seeks to support the community of organizations that are responding to the COVID-19 public health emergency, CMS will delay the start of the ET3 Model from May 1, 2020 until Fall 2020. Selected applicants have been notified and will be required to complete a revised Participation Agreement reflecting the new implementation date.

ET3 Web Page

CMS Approves Additional State Medicaid Waivers and Amendments to Give States Flexibility to Address Coronavirus Pandemic

CMS continues to deliver urgent regulatory relief to ensure states can quickly and effectively care for their most vulnerable citizens during the COVID-19 crisis. For the first time, CMS has approved a COVID-related Children’s Health Insurance Program (CHIP) Disaster Amendment that brings relief for CHIP-covered children living in Maine. In addition, CMS approved COVID-related Medicaid Disaster Amendments that bring relief to North Dakota, Rhode Island, and Wyoming. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of state plan flexibilities. CMS also authorized amendments to ensure emergency flexibilities in programs that care for the elderly and people with disabilities, including most recently in Delaware, Hawaii, Mississippi, New York, and North Dakota. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

All told, CMS has approved 49 emergency waivers, 26 state amendments, 7 COVID-19 related Medicaid Disaster Amendments and the first CHIP COVID-related Disaster Amendment in record time. States are using a toolkit CMS developed to expedite the application and approval of Medicaid state waivers and State Plan Amendments.

Medicaid State Plan Amendments

Section 1135 Waivers

1915(c) Appendix K Waivers

CHIP State Plan Amendments

Rural hospitals have long worked under the extra challenge of navigating uncertain government funding to deliver health care to a population that is statistically older, poorer and sicker than much of the country. This outbreak will only make things worse for those struggling hospitals. Hospitals news comes out of California and Georgia, as well.

Access a number of articles here.

With the U.S. experiencing an extremely high number of initial unemployment claims, WalletHub today released updated rankings for the States with the Biggest Increases in Unemployment Due to Coronavirus, along with accompanying videos.

To identify which states have experienced the largest unemployment increases, WalletHub compared the 50 states and the District of Columbia across two key metrics. These metrics compare initial unemployment claim increases for the week of March 30, 2020 to both the same week in 2019 and the first week of 2020. Below, you can see highlights from the report, along with a WalletHub Q&A.

Increase in Pennsylvania Unemployment Due to Coronavirus (1=Worst, 25=Avg.):

• 2449.82% increase in the Number of Unemployment Insurance Initial Claims – from 11,127 the week of April 1, 2019 to 283,718 the week of March 30, 2020. 11^th lowest increase in the U.S.
• 939.34% increase in the Number of Unemployment Insurance Initial Claims – from 27,298 in the first week of the year to 283,718 the week of March 30, 2020. 8^th lowest increase in the U.S.

By Alaa Elassar, CNN

A small clinic in central Pennsylvania has set up drive-through coronavirus testing that accommodates horse and buggies for its local Amish and Mennonite communities.

The Central Pennsylvania Clinic in Belleville, a town known for its majority Amish and Mennonite population, is one of the only coronavirus testing facilities in the area.  The clinic’s founder and medical director, Dr. D. Holmes Morton, collaborated with Regina Lamendella, the co-founder of a start-up which detects and diagnoses infectious diseases, to develop a new way to test for the virus.

Medical personnel at the clinic collect the swab samples before sending them to the lab at Lamendella’s company, Contamination Source Identification (CSI), to be processed. Since launching drive-through testing on April 1, the clinic provided nearly 65 coronavirus tests.

While the clinic is also utilizing the currently available FDA-approved RT-qPCR test, Lamendella said the test has “as little as 66% sensitivity” and can fail to detect the virus in asymptomatic carriers.  So the lab developed and validated their own test that uses rapid, untargeted mRNA sequencing — along with the virus’ RT-qPCR to quickly and accurately detect the virus. “Our test, the CSI-Dx test system, directly detects the viral genome of Covid-19,” Lamendella, who is also a biology professor at Juniata College, told CNN.

“With this test, we’re able to see the entire viral genome and how it’s changing and what strains are floating around. Keeping up with that evolution of the pathogen is going to be very important because we know the type of pathogen it is, an RNA virus, can change very quickly.”

While most coronavirus tests currently available take “approximately one week” for results to become available, Lamendella said her lab returns test results in 19 hours or less, thanks to their RAPID-Dx data analysis tool, developed by co-founder Justin Wright.  And unlike most testing facilities, the CSI lab is also equipped and staffed to perform and process several hundred tests every day.

 Expanding testing to asymptomatic carriers

Although most hospitals only test patients with severe symptoms of Covid-19, Lamendella and Morton are doing their best to identify asymptomatic carriers of the virus who don’t know they’re positive.  “We all know from experience that the epidemic is really perpetuated by people who are relatively asymptomatic but still infectious,” Morton told CNN.

“What we’re trying to do is get ahead of the infection in this area by offering testing at low costs, particularly within the Amish community. This is also to educate them about the risk of having gatherings, whether its church or weddings or funerals.”

Recent studies suggest 25% to 50% of coronavirus carriers don’t have symptoms. Coronavirus is also twice as contagious as the flu; a person with coronavirus can infect “4 to 10 other people,” Morton said, adding that this means social gatherings could turn fatal, fast. For communities like the Amish and Mennonites, who regularly hold large social gatherings, it is critical to educate them on the importance of maintaining social distancing precautions — as well as the importance of getting tested.

“They are an especially at-risk community. Culturally they’re somewhat isolated from the news media. So they aren’t constantly watching the news or reading the newspaper, while those of us who are immersed in the news have become remarkable well-informed scientifically,” Morton, who specializes in genetic disorders of Amish and Mennonite children, said.

“Another thing that makes them vulnerable is how social they are. When they have church, they have 300 people crowded together in a little farmhouse. From the point of view of an infection like this, this is a disaster.”

CSI now hopes to partner up with other local hospitals and clinics who don’t have access to the lab’s specialized research equipment to continue expanding the availability of coronavirus testing.

There are more than 14,900 confirmed coronavirus cases in Pennsylvania. The entire state is under a stay at home order through April 30. The virus has topped over 398,000 cases throughout the country, and nearly 13,000 people have died.

 

Harrisburg, PA – Among myriad actions to support Pennsylvania’s health care system during the COVID-19 pandemic, Governor Tom Wolf signed an order to provide critical aid to hospitals with targeted PPE and supplies distribution.

“Combatting a pandemic means we all have to work together and that means we need to make the best use of our medical assets to ensure the places that need them most have them,” Gov. Wolf said. “Today, I am signing an order that will allow us to transfer supplies and information between medical facilities to both high-population, high-impact areas and lower population areas that might not have as many existing medical resources.

“This will also prevent sick Pennsylvanians from having to choose which hospital to go to for fear that some have less access to equipment than others and it will help us make use of every ventilator, every piece of PPE, and every medical worker.”

The order will ensure the efficient allocation and effective use of critical medical resources, such as N95 face masks, ventilators, respirators, face shields, safety goggles, disinfectants and other sanitizing solutions by hospitals in the state.

The order reads, that “despite the voluntary efforts of health care providers and despite the exhaustive work of commonwealth agencies to procure PPE and other medical resources from private industry to support Pennsylvania’s health care workers, facilities and emergency responders, a critical shortage of PPE, pharmaceuticals and other medical resources remains.”

The governor consulted with Sec. of Health, Dr. Rachel Levine, and Randy Padfield, director of the Pennsylvania Emergency Management Agency (PEMA), in developing the order to ensure all commonwealth resources are harnessed to meet the imminent surge of COVID-19 cases and to prevent overwhelming the health care system.

The order mandates that private, public and quasi-public health care providers and facilities, as well as manufacturers, distributors and suppliers of PPE, pharmaceuticals and other medical resources located within the commonwealth, submit current inventory quantities of PPE, pharmaceuticals and other medical resources to PEMA within five days of today’s order. Health care providers and facilities are further ordered to provide written reports detailing facility health care needs and other pertinent information in the form, manner and frequency directed by PEMA.

PEMA will make arrangements with other commonwealth agencies to reimburse facilities for PPE and other supplies and equipment, then arrange for supplies to be allocated to where they are needed most.

“I commend Pennsylvania’s medical facilities for their efforts so far in helping to shift resources toward the fight against COVID-19,” Gov. Wolf said. “Many are already working together to shift resources among facilities, both public and private, and many of our medical facilities have shifted resources internally.”

Also today, the Department of Health launched a new hospital preparedness dashboard that provides county-level information, including the number of available beds and ventilators in use at facilities across the state. The dashboard also provides an overview of the capacity of the state’s entire health care system.

“We are working to create more ways to get as much data as possible to the community,” Dr. Levine said.

The dashboard can be found in the COVID-19 section of health.pa.gov.

Read Governor Wolf’s order as a PDF here or on Scribd.

Guidance will aid clinicians in various healthcare settings to prevent and mitigate the spread

Under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) has issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more.

The guidance is designed to empower local hospitals and healthcare systems, helping them to rapidly expand their capacity to isolate and treat patients infected with COVID-19 from those who are not. Critically, the guidance released today includes new instructions for dialysis facilities as they work to protect patients with End-Stage Renal Disease (ESRD), who, because of their immunocompromised state and frequent trips to health care settings, are some of the most vulnerable Americans to complications arising from COVID-19. The guidance is part of the unprecedented array of temporary regulatory waivers and new policies CMS issued on March 30, 2020 that gives the nation’s healthcare system maximum flexibility to respond to the COVID-19 pandemic.

“CMS is helping the healthcare system fight back and keep patients safe by equipping providers and clinicians with clear guidance based on CDC recommendations that reemphasizes and reinforces longstanding infection control requirements,” said CMS Administrator Seema Verma.

The guidance is particularly timely for dialysis facilities. Dialysis facilities care for immunocompromised Americans who require regular dialysis treatments and are therefore particularly susceptible to complications from the virus. Today’s updated guidance has multiple facets, including the option of providing Home Dialysis Training and Support services – to help some dialysis patients stay home during this challenging time – and establishment of Special Purpose Renal Dialysis Facilities (SPRDFs), which can allow dialysis facilities to isolate vulnerable or infected patients. These temporary changes allow for the establishment of facilities to treat those patients who tested positive for COVID-19 to be treated in separate locations.

In addition to dialysis facilities, the infection control guidance affects a broad range of settings including hospitals, Critical Access Hospitals (CAHs), psychiatric hospitals, Ambulatory Surgical Centers (ASCs), Community Mental Health Centers (CMHCs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Outpatient Physical Therapy or Speech Pathology Services (OPTs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs).

For hospitals, psychiatric hospitals and CAHs, the revised guidance, for example, provides expanded recommendations on screening and visitation restrictions, discharge to subsequent care locations for patients with COVID-19, recommendations related to staff screening and testing, and return-to-work policies.

Similarly, for hospitals and CAHs, the revised guidance on the Emergency Medical Labor and Treatment Act (EMTALA) includes a detailed discussion of: patient triage, appropriate medical screening and treatment; the use of alternate testing sites; telehealth; and appropriate medical screening examinations performed at alternate screening locations, which are not subject to EMTALA, as long as the national emergency remains in force. This step will allow hospitals and CAHs to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19.

For outpatient clinical settings, such as ASCs, FQHCs, and others, guidance discusses recommendations to mitigate transmission including screening, restricting visitors, cleaning and disinfection, and closures, and addresses issues related to supply scarcity, and Federal Drug Administration (FDA) recommendations. In addition, CMS encourages ASCs and other outpatient settings to partner with others in their community to conserve and share critical resources during this national emergency.

Updated guidance for ICF/IIDs, and PRTFs include practices related to screening of visitors and outside health care service providers, community activities, staffing, and more.

CMS will continue to monitor and review the impact of the COVID-19 pandemic on the clinicians, providers, facilities and programs, and will update regulations and guidance as needed.

To view the latest updates to these CMS guidance documents on infection control, go to: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

For information on the COVID-19 waivers and guidance, and the Interim Final Rule, released on March 30, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

These actions, 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.

WASHINGTON, April 8, 2020 – USDA Rural Development has taken a number of immediate actions to help rural residents, businesses and communities affected by the COVID-19 outbreak. Rural Development will keep our customers, partners, and stakeholders continuously updated as more actions are taken to better serve rural America.

Read the full announcement to learn more about the opportunities USDA Rural Development is implementing to provide immediate relief to our customers, partners, and stakeholders.

The COVID-19 pandemic has underscored now more than ever how incarceration and health are inextricably linked. The Robert Wood Johnson Foundation (RWJF) has included incarceration among 35 illustrative measures being used to track progress toward building a Culture of Health in America. To further explore incarceration as a key measure of health in the United States, on April 2, the Culture of Health blog published a timely post by RWJF’s Carolyn Miller and Doug Yeung of RAND. The post looks at the important effects of incarceration on health and health equity for prisoners, families and communities.

The post also includes a reference and link to a recent issue of the American Journal of Public Health, supported by RWJF, that sheds light on new research that broadens our understanding of how incarceration negatively influences possibilities of hope, happiness, sense of security, and other critical components of well-being.