On April 21, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule for the FY 2021 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). The proposed rule includes a 2.9 percent payment increase ($270 million total) which rural areas will experience as an average increase of 3.2 percent. CMS is also proposing to amend the regulations to remove the post-admission physician evaluation requirement and to allow non-physician practitioners to perform certain requirements that currently a rehabilitation physician must perform. The rule also includes a five percent cap on wage index decreases and adopts the most recent Office of Management and Budget statistical area delineations with 34 urban counties becoming rural and 47 rural counties becoming urban.  Comments are due on Juen 15, 2020.

On March 30, the Centers for Medicare & Medicaid Services (CMS) issued an array of temporary regulatory waivers and new rules in response to the 2019 Novel Coronavirus (COVID-19) pandemic. CMS’s actions are designed to increase hospital capacity, rapidly expand the health care workforce, and further promote telehealth in Medicare. This interim final rule with comment period includes updates specific to rural health clinics and federally qualified health centers. A full list of CMS waivers and flexibilities for COVID-19 response is available online.  Comments are due on June 1, 2020.

By Bryce Oates

The bill contains provisions meant for rural America, but critics believe it misses an opportunity to expand crucial federal programs like SNAP, or extend protections for vulnerable groups, like farmworkers, meatpackers, and family farms.

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By Brianna Bailey

Eight nurses are the overwhelming majority of employees who remain at Haskell County Community Hospital in Oklahoma. The future of the 25-bed hospital, which has been whittled down to operating only an emergency room since 2019, is increasingly grim.

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By Bryce Oates

Recreation counties’ reliance on tourism and outdoor recreation may pose an existential threat to some of their publicly funded healthcare systems.

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The National Institute for Occupational Safety and Health (NIOSH) has published new respirator information and guidance:

• Understanding the Use of Imported Non-NIOSH-Approved Respirators
  The CDC and FDA have determined additional respirator options to protect healthcare workers during the pandemic when respirator shortages are reported across the nation. If a healthcare facility needs more filtering facepiece respirators, employers should understand these options. One to consider in a time of shortage is non-NIOSH approved respirators manufactured internationally. This NIOSH Science Blog provides information on how to determine the reliability of imported respirators, NIOSH’s efforts to assess imported respirators, and how to tell if a respirator is NIOSH-approved.
• NIOSH Respirator Assessments to Support the COVID-19 Response: Assessment Results
  NIOSH has begun sampling respirators received from other countries and from stockpiles, along with respirators that have gone through decontamination cycles (without the respirator being contaminated). These preliminary assessments will inform respirator users whether the products meet similar filtration performance requirements as those for NIOSH-approved N95 respirators. Results of this testing are now being posted to the NIOSH website and include a summary and report for each model tested.
• Powered Air-Purifying Respirators and Elastomeric Respirators Guidance
  CDC has released guidance for optimizing the supply of powered air-purifying respirators (PAPRs) and for using reusable elastomeric particulate respirators. The guidance aims to provide respiratory protection options to healthcare practitioners as a component of a formally developed and implemented written respiratory protection program. These guidance materials address conventional, contingency, and crisis surge use and maintenance practices. They will assist respiratory protection program managers, health officials, and other program leaders responsible for developing and implementing policies and procedures to prevent pathogen transmission, including those developed to prevent the spread of the virus that causes COVID-19.

For more information, please visit the COVID-19 webpage. To stay up to date on new developments, sign up for the COVID-19 newsletter.

The National Institute for Occupational Safety and Health (NIOSH) has published resources for businesses and specific industries.

General Business Frequently Asked Questions
CDC has provided answers to frequently asked questions (FAQs) that build on the Interim Guidance for Businesses and Employers and Guidance for Critical Infrastructure Workers. Answers address suspected or confirmed cases of COVID-19, reducing the spread of COVID-19 in the workplace, healthy business operations, cleaning and disinfection, and critical infrastructure. These FAQs are not intended for healthcare facilities; CDC has provided separate Guidance for Healthcare Settings.

Industry Specific Resources
CDC has published several fact sheets for workers who may be at risk for exposure to COVID-19. New fact sheets are now available for these specific groups:

• Firefighters and EMS providers
• Food and grocery pick-up and delivery drivers
• Grocery and food retail workers
• Mail and parcel delivery drivers
• Rideshare or ride-for-hire drivers

For more information, please visit the COVID-19 webpage. To stay up to date on new developments, sign up for the COVID-19 newsletter.

On April 17, USDA Secretary Perdue announced the purchase of up to $3 billion in agricultural commodities for interested farmers, food processors, food banks, and other interested partners.

The Agricultural Marketing Service’s Commodity Procurement Program will procure an estimated $100 million per month in fresh fruits and vegetables, $100 million per month in a variety of dairy products, and $100 million per month in meat products. The distributors and wholesalers will then provide a pre-approved box of fresh produce, dairy, and meat products to food banks, community and faith-based organizations, and other non-profits serving Americans in need.

Pennsylvania and its residents need you to participate now, more than ever. By participating in this program, you will get your products to market, help those in needs, and protect Pennsylvania’s agricultural economy. It is vital that you partner with organizations near you that can be found in the State Food Purchase County Lead Agency Directory or The Emergency Food Assistance Program County Lead Agency Directory.

Penn State Extension is also giving information on how to apply.

USDA is moving quickly on this program, applications are due by May 1^st, 2020.

Below are the links to the RFP application and other important documents:

• RFP – ERAcquisition
• RFP Attachment 1 Emergency Aquisition MSCP
• RFP Attachment 2 Compilation of TEFAP sites for AMS
• USDA Webinar and Video

President Trump has signed the Paycheck Protection Program and Health Care Enhancement Act into law. The bill provides $310 billion in funding for the Paycheck Protection Program and makes agricultural enterprises eligible for the Small Business Administration’s (SBA) Economic Injury Disaster Loan (EIDL) program.

However, we expect this funding to run out quickly, as it is first come-first served. While we have not yet seen a formal announcement, we expect these applications to open as early as beginning of next week and that the funds will be exhausted in a matter of days. Below, we have provided the links to apply to these grants and we encourage farmers and other small businesses to establish a relationship with an eligible banking or crediting institution to begin the process.

Please note that unlike PPP, applications for the EIDL program are made directly to SBA.

• Paycheck Protection Program
• Economic Injury Disaster Program
  • Any small business with fewer than 500 employees is eligible to apply—this program is inclusive of sole proprietorships, self-employed individuals, and private contractors.
  • The EIDL advance program will issue grants of up to $10,000 that do not need to repaid.

As a direct result of agriculture and the entire food supply chain being life sustaining, combined with hot spots of COVID-19 in processing facilities, any symptomatic adult working in agriculture – including but not limited to those working in processing and manufacturing facilities, food warehouses, groceries stores, and on-farm labor (seasonal farm labor and H2A workers included) – is approved to receive priority testing if they live and/or work in Montgomery County or northeast Pennsylvania.

Members of Pennsylvania’s agriculture workforce who find themselves symptomatic for COVID-19 are encouraged to follow the steps found in the attachment to this email for priority testing if they live and/or work in Montgomery, Susquehanna, Wyoming, Luzerne, Carbon, Monroe, Pike, Wayne, or Lackawanna counties. There is no cost for testing at these sites, since the test is completed at the PA state public health laboratory.

Those working in agriculture outside of these prioritized regions who are showing symptoms for COVID-19 are encouraged to visit any other approved testing site in Pennsylvania. A full map of locations can be found on the Department of Health’s website.

Symptoms of COVID-19 include fever, cough, shortness of breath, and diarrhea. Symptoms may appear in as few as two days or as long as 14 days after exposure.