While many primary care practices are struggling to keep their doors open during the pandemic, others are leveraging it as an opportunity to innovate. Commonwealth Fund researchers looked at three practices that have gotten creative in how they reach patients and deliver care. These providers have benefited from investments made prior to the pandemic in remote monitoring tools, telehealth and texting platforms to identify high-risk patients. Read, Primary Care as a Bulwark Against COVID-19: How Three Innovative Practices Are Responding.

Gabriel Perna | April 24, 2020

The ongoing struggles of rural health care in America are not a secret to anyone in this industry.  

In 2019, a record 19 rural hospitals closed. Thus far in 2020, nine hospitals have already closed and the COVID-19 pandemic, with its devastating impact on hospital operating margins, threatens to make it a much more staggering amount.  

Financial resources dedicated to providers in the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act will help, rural health advocates say. The National Rural Health Association says that half of rural hospitals and providers operated at a financial loss before the pandemic. The loss of revenue from the pandemic meant hundreds were at risk of closure before the funding came in. 

But the funding from Congress hasn’t come without hiccups or concerns. There were complaints that the initial $30 billion to be distributed from HHS didn’t give enough to rural providers. HHS said the next round will be geared towards rural health providers, but America’s Essential Hospitals, a trade group for vulnerable health systems and hospitals, has concerns about how the agency targets its funding dollars.  

“Targeting will require complete and accurate data, and we have concerns about technical problems providers now face as they try to comply with the department’s request for targeting data. We call on the department to extend its data submission deadline until it has resolved these technical issues and clearly and publicly communicated how it will use this information,” stated Bruce Siegel, MD, President and CEO of America’s Essential Hospitals. The group also wants HHS to minimize the application process to streamline funding.  

Read more.

In response to the increased need for providing telehealth due to COVID-19, CMS has given additional consideration to telehealth services in HHS-operated risk adjustment for issuers in the individual and small group health insurance markets inside and outside the Marketplaces. CMS’ new guidance clarifies which telehealth services are valid for HHS-operated risk adjustment data submission in light of the COVID-19 pandemic.

Frequently Asked Questions

CMS issued a letter thanking clinicians for their ongoing efforts to treat patients and combat COVID-19 and shared additional details on the new Merit-Based Incentive Payment System (MIPS) improvement activity. As announced earlier this month, clinicians who participate in a COVID-19 clinical trial and report their findings to a clinical data repository or registry many now earn credit in MIPS under the Improvement Activities performance category for the 2020 performance period by attesting to this new activity.

Dear Clinician Letter

CMS has approved 140 requests for state relief in response to the COVID-19 pandemic, including recent approvals for Arkansas, Hawaii, Kentucky, Massachusetts, Minnesota, Montana, Oklahoma, Oregon, South Dakota, Tennessee, Virginia, and Wyoming. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of waivers, amendments, and Medicaid state plan flexibilities, including for programs that care for the elderly and people with disabilities. CMS developed a toolkit to expedite the application and review of each request and has approved these requests in record time. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

 Section 1135 Waivers

Section 1115(a) Waivers 

1915(c) Waiver Appendix K Amendments

Medicaid State Plan Amendments

CHIP State Plan Amendments

By Bill Bishop and Tim Marema

In the first jobs report after the pandemic forced widespread shutdowns, rural employment dropped 1.2% from February to March. Metropolitan counties fared worse, with a drop of 1.9% of total employment.

Read more

By Tim Marema

A rural county’s economic type seems to have a strong impact on how quickly the coronavirus is spreading. Hotspot counties with meatpacking plants or prisons have infection rates much higher than the national average.

Read more.

Ths pandemic has spotlighted the need for fresh fruits and vegetables. Pennsylvania’s hardworking farmers, farm workers, farmers market operators, and others in the agricultural industry have shown their commitment to ensuring residents across the commonwealth have access to these products.

Here is a list of all the operating farmers markets across Pennsylvania.

Balancing economic benefits and public health risks, Governor Tom Wolf today announced the reopening of 24 counties in the northwest and north-central regions of the state, moving them from red to yellow beginning at 12:01 a.m., Friday, May 8.

Counties Moving to Yellow Reopening:

The 24 counties that will move from red to yellow on May 8 are: Bradford, Cameron, Centre, Clarion, Clearfield, Clinton, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, Lycoming, McKean, Mercer, Montour, Northumberland, Potter, Snyder, Sullivan, Tioga, Union, Venango, and Warren.

These counties were deemed ready to move to a reopening – or yellow phase – because of low per-capita case counts, the ability to conduct contact tracing and testing, and appropriate population density to contain community spread.

All reopening decisions follow the six standards outlined in the governor’s plan to reopen Pennsylvania. These include adhering to:

• Data-driven and quantifiable criteria to drive a targeted, evidence-based, regional approach to reopening.
• Clear guidance and recommendations for employers, individuals, and health care facilities and providers for assured accountability.
• Adequate and available personal protective equipment and diagnostic testing.
• A monitoring and surveillance program that allows the commonwealth to deploy swift actions for containment or mitigation.
• Protections for vulnerable populations such as limitations on visitors to congregate care facilities and prisons.
• Limitations on large gatherings unrelated to occupations.

Please find the full plan here.

The HHS Health Insurance Marketplace provides a list of resources for Federally-facilitated Marketplace assisters to help consumers are experiencing life changes, like loss of job-based coverage and shifts in income.

For information on reporting changes to the Marketplace, see these resources:

• Marketplace coverage & Coronavirus
• Which changes to report to the Marketplace
• How to report changes to the Marketplace
• Changes in Circumstances – January 2018 (slides)

For information on Special Enrollment Periods, see these resources:

• Enroll in or change 2020 plans — only with a Special Enrollment Period
• Special Enrollment Period (SEP) Overview for the Federally-facilitated Marketplace – April 12, 2019 (slides)
• Complex Cases: Navigating Eligibility for SEPs and Resolving SVIs and DMIs – February 2020 (slides)

For information about transitioning from job based coverage to other forms of coverage (including Medicaid and COBRA), see these resources:

• Tip Sheet on Health Coverage Option for Employers Helping their Employees During the COVID-19 National Emergency
• Marketplace Information for Businesses Impacted by COVID-19
• Health coverage options if you’re unemployed
• Losing Job-based Coverage
• Medicaid & CHIP coverage
• COBRA coverage and the Marketplace
• COBRA Continuation Coverage Questions and Answers
• Complex Case Scenarios – Preventing Gaps in Health Care Coverage Mini-Series: Transitioning from Employer-Sponsored Coverage to Other Health Coverage – June 5, 2015 (slides)

For guidance related to Coronavirus Disease 2019 (COVID-19), qualified health plans (QHPs) and other private market coverage, see: Coronavirus Disease 2019 (COVID-19) Guidance.

Need additional help? Refer to the Assister Technical Assistance Resource Page for more information about Marketplace eligibility and enrollment. If you need additional assistance, Navigators can reach out to their Project Officers with questions and CACs can contact the CAC inbox at CACquestions@cms.hhs.gov