The Centers for Medicare & Medicaid Services (CMS) released a fact sheet describing adjustments that have been made or that CMS will be making to certain CMS Innovation Center Models to address the COVID-19 public health emergency. On the topic of telehealth, one adjustment allows Independence at Home model practices to utilize telehealth to meet quality metric requirements for two (of the six required) measures. Models addressed in the fact sheet may also include rural providers. Read more here.

The Robert Wood Johnson Foundation (RWJF) released a brief for state and local leaders with considerations for health equity in the public health response to the pandemic.  Read more here.

By Tim Marema

There’s a perception out there that rural residents are less concerned about the pandemic. A national poll says otherwise. Read the article here.

Pennsylvania Governor Wolf’s Administration outlined the potential impact of ending the March 6 disaster declaration while clarifying that the legislature cannot end it unilaterally. The disaster declaration aids in speeding up the state’s response to the pandemic and provides protections for businesses, workers and residents. Importantly, ending the disaster declaration would not end any orders issued by the Secretary of Health that set guidelines for business operations.

Last night, the General Assembly voted to end the disaster declaration with many members claiming their actions ended the business guideline orders. That is not true. Not only does any concurrent resolution need to come to the Governor for approval or disapproval, but the disaster declaration is separate from the orders signed by Secretary of Health Dr. Rachel Levine under the Disease Prevention Act that include provisions for business reopening and for worker and building safety. Those orders remain in place. The legislature did nothing to end those.

Rather, the legislature chose to attempt to end the disaster declaration – a measure that would ostensibly end protections passed for businesses, workers, and residents.

If the declaration were to end, these protections would go away:

• Burdensome eligibility requirements for more than a million Unemployment Compensation claimants would immediately go back into effect, and employers across the commonwealth would no longer receive relief from charges.
• Certification requirements under the public-school code and child protective services law would end.
• A school meal eligibility waiver, which has allowed more than 300 meal sites to open for distribution of food to school-age children in need, would end.
• Telehealth and other health care services provided by out-of-state providers for Pennsylvanians would end.
• Utility assistance for thousands of families and individuals would end, leaving people without water or electricity.
• Hospitals and alternative care sites would no longer be able to add capacity or repurpose facilities (i.e., beds) without having to abide by the 60-day notice requirement.
• License renewal and training requirement suspensions for health care professionals, child care workers, direct care workers, direct support professionals, among other professional groups who provide life sustaining services to our children, seniors, and vulnerable residents would end, meaning all of these workers would need to choose between not returning to work until those credentials could be renewed or trainings completed and the option of returning to work with the understanding that they are practicing out of compliance with Pennsylvania law and regulation, very well opening themselves up to personal liability.
• PennDOT waivers for commercial motor vehicle weight limitations and permitting requirements for the transport and delivery of agricultural feed, food, and dairy products, fuel, pharmaceuticals, and medical supplies to assist in supply chain challenges would end and motor carriers would be restricted in their ability to directly assist in supporting emergency relief efforts necessary to respond to the pandemic.
• Mortgage foreclosure and eviction moratoriums that offer protection to vulnerable Pennsylvanians at risk of losing their homes during the pandemic would end.

In addition to these immediate waiver and legislative enactments being removed, ending the disaster declaration also would remove many practical aspects of the state’s response to this disaster, including the authority to activate the National Guard to help with nursing homes; deploying commonwealth personnel, services and distributing supplies and equipment; implementing emergency funding; suspending rules and regulations that would hinder or delay necessary action in coping with the emergency; and using all available resources of the commonwealth government and its political subdivisions to deal with the emergency.

The state could also lose federal public and individual disaster assistance, and any additional state funding sources available through transfer of unused General Fund dollars.

During a state of emergency declared by the governor, commonwealth agencies and departments may implement their emergency assignments without regard to procedures required by other laws pertaining to performing their work, entering into contracts, purchasing supplies and equipment, and employing temporary workers.

Pennsylvania Governor Tom Wolf announced that beginning Wednesday, June 10, five more COVID-19 drive-thru testing sites will open in Walmart parking lots across the state.

Quest Diagnostics and Walmart are working with the Pennsylvania Department of Health to provide testing for residents living in areas with limited access. On Friday, June 5, five testing sites opened at Walmart locations in Clarion, Erie, Montoursville, Clearfield and Hermitage to test Pennsylvanians for COVID-19.

Beginning tomorrow these sites will be open on Monday, Wednesday and Friday from 7:00 AM to 9:00 AM to test up to 50 registered patients daily. Registration is required one day in advance. There is no COVID-19 testing inside Walmart stores or Quest Diagnostics Patient Service Centers.

The testing sites that will open on June 10 include:

• Walmart Supercenter parking lot, 167 Hogan Blvd, Mill Hall, PA
• Walmart Supercenter parking lot, 21920 Route #119, Punxsutawney, PA
• Walmart Supercenter parking lot, 50 Foster Brook Blvd, Bradford, PA
• Walmart Supercenter parking lot, 10 Kimberly Ln, Cranberry, PA
• Walmart Supercenter parking lot, 2901 Market St, Warren, PA

Additional testing sites will be announced in upcoming days and will be listed on the department’s website.

LDI Virtual Seminar Eyes Coronavirus’ Spread Through America’s Hinterlands

The eighth virtual “Experts at Home” seminar convened by the University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) focuses on the impact of the COVID-19 pandemic in rural America. New evidence suggests that rural populations are at heightened risk for contracting the virus due to factors such as age, race/ethnicity, and prevalence of multiple chronic health conditions. The seminar brought together experts from academia and top government positions to discuss the unique challenges the pandemic poses for the health and economies of the country’s rural areas.

View Webinar

Becker’s Hospital Review

Progress on containing COVID-19’s spread continues to vary drastically across regions, states and cities.

As the incubation period for COVID-19 is up to 14 days, most states have yet to report a potential surge in cases linked to nationwide protests against police violence.

What’s clear is the pandemic is loosening its grasp on major urban areas and ramping up in more rural areas, according to The Washington Post. Cases have increased in at least 22 states over the past two weeks, according to a June 9 analysis by The New York Times. Fourteen states have also had a record-high seven-day average of new coronavirus cases since June 1, according to data tracked by the Post.

Below is a snapshot of what COVID-19’s spread looks like across the U.S., as of June 9.

West

More COVID-19 cases have been confirmed in Oregon over the past week than any other time since the pandemic began, according to data from the Oregon Health Authority. The state reported 620 confirmed or presumed infections in the past week, with the state’s largest daily case total reported June 7 at 146 cases. The spike began the week ending May 31, when new COVID-19 cases in Oregon increased by 18 percent (353 cases) compared to the previous week. Between June 5-8, 26 counties in Oregon were able to enter Phase 2 of reopening, KGW reported.

COVID-19 cases in California hit 3,094 new daily cases June 5, the state’s second highest daily count after 3,705 cases reported May 30. Recently, some counties have resisted Gov. Gavin Newsom’s distancing orders and reopened sections of the economy, according to The Guardian.

Washington reported 442 new confirmed cases of COVID-19 on June 6, the most daily cases since April 10, according to KOMO News. The state has acquired sufficient supplies to expand COVID-19 testing and better monitor Washington’s 39 counties as they ease social distancing restrictions, Gov. Jay Inslee said June 4, according to The Seattle Times. As of June 8, all employees in the state must wear face coverings, with some exceptions for certain jobs or individuals with medical conditions, according to King 5.

Southwest

COVID-19 cases hit record-high numbers in Arizona in late May. The state reported more than 700 cases daily between May 26-29, the largest single-day increases seen since the pandemic started. However, known deaths have been decreasing since late May, with less than 10 deaths occurring daily between May 29 and June 2. On June 6, Cara Christ, MD, Arizona Department of Health Services director, sent a letter to hospitals urging them to “fully activate” emergency plans, according to AZ Central.

Meanwhile, COVID-19 cases and deaths are steadily increasing in Texas. The state reported 1,949 new cases May 31, marking the highest single-day increase seen since the pandemic’s start. Texas also reported a record number of related hospitalizations, with 1,935 people admitted June 8. Ten counties are reporting increased case counts because of testing at prisons or meatpacking plants, according to the Texas Department of State Health Services. On June 3, Gov. Greg Abbott announced the third phase of reopening, which includes increasing capacity and opening additional businesses and activities.

Nevada reported 194 new cases June 5, marking the largest single-day increase seen since May 22, when the state saw a record 255 cases. The cumulative death toll has also been rising since the start of the pandemic, although the state reported no new deaths between June 5 and June 7.

Northeast

New York reported 35 COVID-19 deaths June 5 — the lowest figure seen in eight weeks, according to The New York Times. The daily death toll has been steadily declining since New York reported nearly 800 deaths daily in late March and early April, according to state data. New York also reported a record-low number of hospitalizations last week.

The number of new cases, deaths and hospitalizations have significantly fallen in New Jersey since April. The state reported 356 new cases June 8, representing the 10th consecutive day in which new cases remained under 1,000. The state is set to enter phase 2 of its reopening June 15, which will allow restaurants to offer outdoor dining and nonessential businesses to open at half capacity, according to nj.com.

Massachusetts reported a large spike in new COVID-19 cases June 1 after conducting a retrospective review of state data since March 1. Of the 3,840 new cases reported, 3,514 were newly probable and 326 were newly confirmed, according to Boston 7 News. Overall, the state has seen a sustained decline in new cases throughout May, according to a New York Times analysis.

Southeast

Florida saw a large spike in new COVID-19 infections last week amid a steady increase in testing capacity. After reporting just 606 cases June 1, Florida had more than 1,000 new infections daily between June 3 and June 7. This marks the state’s longest sustained increase since early April. The state also reported 1,419 new infections June 4 — the largest single-day increase seen since the Florida health department started publishing COVID-19 data in March, according to the Miami Herald.

COVID-19 hospitalizations started falling in Mississippi in early June. However, the state reported a record 498 new cases June 8, the highest single-day increase seen since May 30 when 439 cases were reported, according to the Sun Herald.

North Carolina reported 1,370 new cases June 6, the highest daily increase seen during the pandemic, according to WSOC-TV. The previous record was set just a day prior when the state saw 1,289 new cases. North Carolina also reported 739 hospitalizations June 8, surpassing the previous record of 717 hospizaltions reported June 5, according to The News & Observer.

Midwest

Wisconsin reported no new COVID-19 deaths June 8 for the first time since May 17, reports CBS affiliate WSAW-TV. The number of people hospitalized with the virus also fell to a three-week low June 3, according to Urban Milwaukee. The state reported 203 new cases June 8, down from 733 on May 29. Wisconsin also performed a record 16,451 tests June 3, of which 483 were positive.

The rate of new COVID-19 cases and the number of people requiring intensive care continues to decline in Minnesota. The state reported 388 new infections June 7, the second-lowest daily increase since April 28, according to the StarTribune. In addition, 199 patients were being treated for COVID-19 in ICUs, marking the lowest total since May 13.

On June 9, 2020, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing a) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens. The safety net distribution will occur this week.

“Healthcare providers who focus on treating the most vulnerable Americans, including low-income and minority patients, are absolutely essential to our fight against COVID-19,” said HHS Secretary Alex Azar. “HHS is using funds from Congress, secured by President Trump, to provide new targeted help for America’s safety-net providers and clinicians who treat millions of Medicaid beneficiaries.”

HHS is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers, including those disproportionately impacted by this pandemic.

ENHANCED PROVIDER RELIEF FUND PORTAL

On Wednesday, HHS is launching an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.

The initial General Distribution provided payments to approximately 62 percent of all providers participating in state Medicaid and CHIP programs. The Medicaid and CHIP Targeted distribution will make the Provider Relief Fund available to the remaining 38 percent. HHS has already provided relief funding to over one million providers, and today’s announcement is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins.

Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers serving Medicaid/CHIP beneficiaries possibly eligible for this funding, include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities, and other home and community-based services providers.

To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding.

More information about eligibility and the application process is available at www.hhs.gov/coronavirus/cares-act-provider-relief-fund/…

$10 BILLION ALLOCATION FOR SAFETY NET HOSPITALS

HHS is announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens, recognizing the incredibly thin margins these hospitals operate on. This payment is being sent directly to these hospitals via direct deposit.

This payment is going to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. Qualifying hospitals will have:

• A Medicare Disproportionate Payment Percentage (DPP) of 20.2 percent or greater;
• Average Uncompensated Care per bed of $25,000 or more. For example, a hospital with 100 beds would need to provide $2,500,000 in Uncompensated Care in a year to meet this requirement;
• Profitability of 3 percent or less, as reported to CMS in its most recently filed Cost Report.

Recipients will receive a minimum distribution of $5 million and a maximum distribution of $50 million.

ADDITIONAL PROVIDER RELIEF FUND UPDATES

• On Monday, June 8, 2020, HHS sent communications to all hospitals asking them to update information on their COVID-19 positive-inpatient admissions for the period January 1, 2020, through June 10, 2020. This information will be used to determine a second round of funding to hospitals in COVID-19 hotspots to ensure they are equitably supported in the battle against this pandemic. To determine their eligibility for funding under this $10 billion distribution, hospitals must submit their information by June 15, 2020 at 9:00 PM ET.
• HHS is working on an additional allocation to distribute relief broadly to dentists.

For updated information and data on the Provider Relief Fund, visit hhs.gov/providerrelief

On June 8, 2020, HHS posted additional FAQs.  One set provides additional/updated data on the number of COVID-19 cases for the period of January 1, 2020 through June 10, 2020 (see pages 27-28).  HHS is preparing for a second distribution for High Impact Area funding and is seeking updated data.  The data must be input into the portal no later than 9:00 PM Eastern Time on Monday June 15, 2020.  The FAQ document can be accessed at www.hhs.gov/sites/default/files/…