- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- Public Inspection: CMS: Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- CMS: Request for Information; Health Technology Ecosystem
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- State: 60-Day Notice of Proposed Information Collection: J-1 Visa Waiver Recommendation Application
- Public Inspection: CMS: Request for Information: Health Technology Ecosystem
- HHS: Request for Information (RFI): Ensuring Lawful Regulation and Unleashing Innovation To Make American Healthy Again
- VA: Solicitation of Nominations for the Appointment to the Advisory Committee on Tribal and Indian Affairs
- GAO Seeks New Members for Tribal and Indigenous Advisory Council
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- Telehealth Study Recruiting Veterans Now
- USDA Delivers Immediate Relief to Farmers, Ranchers and Rural Communities Impacted by Recent Disasters
- Submit Nominations for Partnership for Quality Measurement (PQM) Committees
Congress, Administration Reach Deal on COVID-19 Funding
The Senate passed a $484 billion deal for small businesses and hospitals today after cash for sorely needed loans dried up last week. Congress and the Administration have agreed on a $484 billion COVID-19 relief package to provide funding to small businesses and hospitals and for testing. The proposal includes $310 billion for the Paycheck Protection Program, which was depleted. Read full story.
Rural Cases Increase by a Third over the Last Week
The broad trend is that rural counties are adding cases at a slightly faster rate than urban counties, although the number of rural cases remains only about 6% of the U.S. total.
That’s slightly faster than the metropolitan growth rate of about 23%. The growth continues a familiar trend as the rural infection rate inches up relative to the metropolitan rate.
As the rural infection rate climbs relative to the metropolitan rate, rural cases are becoming a slightly larger percentage of the nation’s overall Covid-19 cases. On Monday, April 13, rural cases constituted 4.1% of all Covid-19 cases in the U.S. On Sunday, April 19, they were 4.7% The growth is small but steady.
Seventy-nine rural counties had their first case of Covid-19 from April 13 to 19. There are still 410 rural counties, out of about 2,000, that do not have a case of the virus.
Beyond these large trends, the spread of the virus is an ever-growing collection of local events, in most cases unique to specific people and places.
The largest increase in rural cases during the last week occurred in Marion County, Ohio, where an outbreak at a state prison caused the case count to rocket from 91 to 1,743. Marion, with a population of about 65,000, now has the highest number of cases in the state.
In the Midwest, outbreaks seem tied to meat-processing plants. Marshall County, Iowa, the site of a Swift pork plant, saw its cases increase from 37 to 118 last week. Ford County, Kansas, increased from 16 to 127 cases. In Dodge City, the county seat, National Beef closed its plant from April 16 to April 21 to install safety gear and take other measures. Cargill also confirmed cases of coronavirus at its plant.
Parts of Indian Country are being hit hard. McKinley County, New Mexico, added 172 cases of Covid-19 last week, nearly doubling the number it had on April 13. The county’s population is 75% Native American and includes parts of the Navajo Nation and Pueblo of Zuni. Arizona counties in the region also saw dramatic increases. Navajo County, Arizona, grew by more than 100 cases to a total of 459, and Apache County, Arizona, doubled its cases, growing from 89 to 178.
The rural South continued to see significant increases, with a band of counties running from East Texas across Louisana, Mississippi, Alabama, southwest Georgia, and the coastal regions of South Carolina and North Carolina.
Moore County in Texas, however, said its nearly five-fold increase in cases came from better means of testing. An Amarillo television station reports that the county has rapid coroavirus test that can return results in 15 minutes.
“Whenever we first got these tests, we brought them here to Moore County, and then we tested them against our own known … positive and negative patients, and we had 100 percent accuracy,” Steve Agle, the general surgeon at the local hospital, told KFDA television news. The county judge said Moore County is the only one in the state to use the test and report numbers from them.
Rural America Could Be Weeks away from Peak in Coronavirus Cases
Two infectious-disease experts say reopening industries that don’t allow social distancing could cause hotspots.
While larger urban areas may be seeing the number of coronavirus cases slow, cases in rural areas are just beginning, two experts said during a briefing from the Infectious Diseases Society of America Tuesday.
During the 45-minute long briefing, Dr. Angela Hewlett, associate professor, Department of Internal Medicine, University of Nebraska Medical Center, and Dr. Andrew T. Pavia, chief of the Division of Pediatric Infectious Diseases, University of Utah School of Medicine, told reporters that rural communities are beginning to see outbreaks of the coronavirus that differed from those seen in more urban communities, and that the outbreaks in rural America are far from reaching their peak.
Pavia said that disparities between rural communities and urban communities prior to the outbreak of COVID-19 in the U.S. may mean the disease will be a part of rural communities for a long time to come.
“The health disparities between big cities and rural communities means we may see long, sustained outbreaks in rural areas for weeks and months to come,” he said. “The resources in rural communities are just not the same.”
Smaller hospitals with staff that is not as adequately trained, coupled with existing health issues in the community and in some cases poverty conditions, all contribute to how well rural communities are able to contain and combat the disease.
While Hewlett said rural communities are much better at social distancing, the culture of those communities may contribute to outbreaks. From large community gatherings to large industries providing jobs in close quarters to the community, the way rural communities thrive may be a part of how easily it is spread, she said.
The number of cases of the disease in rural communities could continue to rise for weeks, she said. It may be two or three more weeks before many rural communities see their case numbers peak, she said.
In states like South Carolina, Texas, Tennessee and Georgia, where governors are pushing to slowly open up their state’s economies in coming days, how those economies open up could have an impact on the health of rural communities, as well, they said.
If the jobs that start up again are ones that put social distancing and other protective measures in place – like agriculture – things could go well, Pavia said.
But opening up the wrong businesses could cause an uptick in cases and small micro-outbreaks, Hewlett said.
“We have to be really careful about this,” she said. “I agree that this should be a local- or state-level decision, but there is a way to do this right.”
Re-opening industrial sites which supply jobs to rural communities may not be a good idea, Pavia said, because of the close contact workers have with one another. That contact could end up spreading the disease again.
“Opening up industries in rural facilities – I just don’t know how you open those up and open them up safely,” he said.
Both doctors said rural communities need enhanced testing, enhanced contact tracing before they open up again.
Pennsylvania Governor’s Administration Encourages Residents to Support Local Restaurants with CarryoutPA.com
The Pennsylvania Department of Community and Economic Development’s (DCED) Tourism Office encourages Pennsylvanians to support local restaurants by visiting the CarryoutPA website, which offers a comprehensive list of restaurants offering takeout, curbside, or delivery services during the state’s stay-at-home order.
CarryoutPA.com was developed by the Pennsylvania Restaurant and Lodging Association (PRLA) to serve as a go-to resource for dine-out options in support of the commonwealth’s restaurant industry, which accounts for 10 percent of jobs statewide. Pennsylvania restaurants that would like to be added to the registry can register here.
Pennsylvania Department of Agriculture Outlines Updated Farm Labor Requirements, Advocates for Skilled Labor to Ensure Food Supply
The Pennsylvania Department of Agriculture provided farmers who provide housing to their workforce – be it domestic, migrant, or guest H-2A workers – with enhanced requirements for seasonal farm labor to maintain a healthy agriculture workforce to ensure necessary farm labor can continue during COVID-19 mitigation in Pennsylvania. The Wolf Administration continues to advocate for a safe, skilled agriculture workforce to perform essential duties to keep Pennsylvania’s food supply chain strong.
Pennsylvania is home to more than 360 permitted Seasonal Farm Labor Camps with nearly 4,300 workers. The workers in these camps are primarily migrant workers – sourced by their company – or H-2A workers – sourced federally. Even before COVID-19 hit Pennsylvania, the Department of Agriculture’s Bureau of Food safety oversaw the Seasonal Farm Labor Camps where these guest workers reside. The Seasonal Farm Labor Act and regulation sets standards for conditions of work, living quarters, occupancy, camp sanitation, food facilities, fire protection, and safety of farm workers. In addition to these required standards, the department has issued additional requirements for employers to follow to mitigate against COVID-19 for their workforce.
The following are some examples of necessary provisions to maintain the health and safety of seasonal farm workers:
- Per CDC recommendations, there should be a minimum of six feet between beds;
- Beds should be positioned so that workers sleep head-to-toe to limit exposure to respiratory droplets;
- Provide workers with cloth face masks to wear while in housing;
- Ensure bathrooms and other sinks are consistently stocked with soap and drying materials for adequate handwashing;
- Provide hand sanitizer when soap and water are not available;
- Ensure high contact surfaces are cleaned and sanitized on a routine basis with EPA-registered disinfectants;
- Ensure essential supplies for cleaning and sanitizing are available in all living quarters and worksites;
- Designate an individual responsible for maintaining routine cleaning.
In addition to these additional requirements to keep workers from getting sick with COVID-19, the Modified Seasonal Farm Labor Camp Requirements include steps to take if an employee is diagnosed with COVID-19.
CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19
As the United States continues to face the unprecedented public health emergency from the COVID-19 pandemic, the tide is turning and some areas throughout the country are seeing a decline in cases. As states and localities begin to stabilize, CMS is issuing guidance on providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with low and stable incidence of COVID-19. This is part of Phase 1 in the Trump Administration’s Guidelines for Opening Up America Again. The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures.
Using Telehealth to Fight Infectious Disease
Telehealth has gained traction recently due to the opportunities in care and convenience it offers to both patients and providers. One of telehealth’s most relevant features, given the current COVID-19 crisis, is its ability to support social distancing and quarantine precautions. In a March 23, 2020 article “Using Telehealth to Fight Infectious Disease,” Athenahealth highlights a Utah-based health system’s use of telehealth to combat the dangers of inappropriate antibiotic prescribing and the challenge of managing infectious diseases in remote areas. Additional telehealth resources are available on the athenahealth’s health care technology knowledge hub webpage.
Innovative State Responses to the Opioid Crisis
Recently there has been an increase in federal funding to help mitigate the opioid crisis. This funding has allowed some health centers to create and expand partnerships with housing authorities in their communities. This brief provides creative treatment ideas to work with patients who have opioid use disorder (OUD) and struggle with homelessness and includes ways to partner with various housing services to best help your patients.
COVID-19 Resources for Non-English-Speaking People
The COVID-19 Health Literacy Project provides translations of essential information about COVID-19 in more than 35 languages. Harvard faculty has vetted all of the information in this project that was started by a medical student at Harvard. Patients with limited English proficiency are likely to be at higher risk for COVID-19 and its complications. These translational materials, along with a guidance article, Culturally and Linguistically Competent Care from ECRI, can help provide health centers with the information needed to communicate with those patients whose first language is not English and other patients with diverse cultural needs.
Contact Tracing – Guidance on this Path Out of Isolation
Contact tracing is what is now on everyone’s radar in order to help in the next step to begin to open up the country. Contact tracing is a process designed to halt the chain of transmission of an infectious pathogen–like the coronavirus–and slow community spread. When someone tests positive for an infectious disease, they become a “case.” Public health workers then reach out to the case to make sure they have what they need and that they are self-isolating. They will then figure out who they had contact with who may be at risk of infection, too. NPR recently released a guide on the basics of the process and how it might help society restart after the current wave of coronavirus cases.