The Pennsylvania Department of Health (Department) has received questions and requests for guidance from hospitals, health systems, and their representatives on their responses to Coronavirus Disease-2019 (COVID-19) and whether measures being implemented or contemplated are compliant with the statutory and regulatory requirements under the jurisdiction of the Department.  The Department is providing the guidance as an update to the guidance issued on March 21, 2020.

UPDATED Guidance on Hospital Responses to COVID-19

Daily Yonder

Every part of the country will feel the economic fallout from the coronavirus crisis. But the small and isolated rural areas that lagged during the economic boom may fare better, relatively speaking, in the aftermath of the pandemic.

Those places tend to be less tied to global and financial markets. With little population density, they are less conducive to virus transmission. So far, states such as Wyoming, the Dakotas, Nebraska and Iowa have reported far fewer COVID-19 cases than New York and other states with large cities.

“If you are a somewhat more isolated economy that does not attract as much visitation from either outside the U.S. or even domestically, you are less vulnerable,” said Adam Kamins, an economist and director at Moody’s Analytics, in a webinar last month.

The states least affected by the huge spike in unemployment claims are largely rural. They include West Virginia, Arkansas and Georgia. In part, that’s because those states have taken less dramatic steps to slow the spread of the virus. Among them, only West Virginia issued a stay-at-home order before the end of March.

Nevertheless, “the industries that have been hard hit are just not as prevalent in rural areas,” said Ernie Goss, an economics professor at Creighton University in Omaha, Nebraska. He cited the relative lack of retail and hospitality businesses in Corn Belt states.

Economists rank regions as economically vulnerable to coronavirus fallout based on demographic and economic factors, including their number of COVID-19 cases, connection to international travelers, reliance on tourism, population density and reliance on global trade, according to a Moody’s Analytics analysis.

Read more.

Daily Yonder

Coronavirus Infection Rate, April 5

The novel coronavirus continued its march across rural America over the weekend. By Sunday night, April 5, two-thirds of rural counties had at least one case. Just over 200 rural counties have reported a death attributable to COVID-19.

The map above shows the spread of the virus and deaths as of Sunday night, April 5. Click on individual counties for more information, or explore a larger version of the map here.

• Green: Rural counties with no cases (665 counties)
• Orange: Rural counties with cases of COVID-19 (1,109 counties)
• Red: Rural counties with deaths (203 counties)
• Pink: Urban with no cases (61 counties)
• Gray: Urban with cases (575 counties)
• Black: Urban with deaths (528 counties)

These figures likely under-report the presence of the disease, according to a study by researchers at the University of Texas. They estimate that even in counties that report no COVID-19 cases, there is a 9 percent chance that the virus is present in that community.

If a county has one case, the Texas researchers predict that there is a 51 percent chance that the virus is spreading through the community.

From April 1 to 5, an additional 172 rural counties reported a case of coronavirus infection. Only 665—or about a third—of rural counties have yet to report a case of COVID-19. Only 61 urban counties—5 percent of all metro counties—say they have yet to find a COVID-19 case.

The number of reported COVID-19 cases continues to increase slightly faster in rural counties than in urban areas. Over the weekend (Friday through Sunday, April 3-5), cases in rural counties increased by 26 percent. Nationally, COVID-19 cases increased by 22 percent in the same time period.

In rural counties, there were 80 deaths reported over the weekend attributed to COVID-19.

Parts of rural America aren’t seeing the booms like in New York, D.C., and other urban areas, but cases in those parts of the country are now speeding up. Yet, more remote areas also tend to be the places that are already struggling in terms of what their health systems can bear.

Click here to see maps from the New York Times on the spread of COVID-19 in rural America.

Nonprofits DirectEmployers Association and the National Association of State Workforce Agencies (NASWA), announced the launch of NeedAJobNow.USNLx.com, a job site dedicated to providing a centralized location for displaced workers to access employment opportunities from U.S. corporations with immediate hiring needs due to the novel coronavirus (COVID-19). Powered by the National Labor Exchange (NLx), the site houses jobs from vetted employers in all industries and provides an opportunity for Americans to return to work and gain meaningful employment.

NeedAJobNow.USNLx.com contains over 400,000 job openings and continues to grow daily. While many employers are downsizing their staff, others are significantly increasing their hiring efforts due to current demands. Through this initiative, DirectEmployers and NASWA will assist in bridging the gap between job supply and demand by offering an easy way for job seekers to gain access to current open positions and for employers to fill positions quickly and efficiently during these difficult times.

Economic Relief Bills in Response to the COVID-19 Crisis: Updated links and FAQ’s:

H.R. 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 — (March 4, 2020). Provided $8.3 billion in emergency funding for federal agencies to respond to the coronavirus outbreak related to developing a vaccine, medical supplies, grants for public health agencies, small business loans, and assistance for health systems in other countries. Allowed for temporarily waiving Medicare restrictions and requirements regarding telehealth services.

H.R. 6201: Families First Coronavirus Response Act (FFCRA) — Paid leave provisions are now in effect as of April 1, 2020, and apply to leave taken between April 1, 2020, and December 31, 2020.  Please review the following:

• Department of Labor’s (DOL’s) Q&A to learn important definitions, what it means for your community organization as an employer, and what it means for you as an individual should you need to take leave.
• Guidance Explaining Paid Sick Leave and Expanded Family and Medical Leave for information to employees and employers about how each will be able to take advantage of the protections and relief offered by the FFCRA.  Review the Fact Sheet for Employees, a Fact Sheet for Employers, and a Questions and Answers documents to better understand what benefits are available under this law.

H.R.748: (CARES) Coronavirus Aid, Relief, and Economic Security Act – (March 27, 2020).  Includes direct payments to Americans, an aggressive expansion of unemployment insurance, billions of dollars in aid to large and small businesses, and a new wave of significant funding for the health care industry. Review Coronavirus (COVID-19): Small Business Guidance & Loan Resources and the Also see: FAQ Regarding Participation of Faith-Based Organizations in PPP and EIDL

• Paycheck Protection Program (PPP): An U.S. Small Business Administration (SBA) loan that helps businesses (including non-profits) keep their workforce employed during the Coronavirus (COVID-19) crisis.
• Economic Injury Disaster Loan (EIDL) Emergency Advance: Loan advance providing up to $10,000 of economic relief to businesses that are currently experiencing temporary difficulties. These funds are available to faith communities.
• SBA Express Bridge Loans: Enables small businesses which currently have a business relationship with a SBA Express Lender to access up to $25,000 quickly.
• SBA Debt Relief: The SBA is providing a financial reprieve to small businesses during the COVID-19 pandemic.

Visit www.sba.gov for a list of SBA lenders. There is a funding cap, so the Treasury Department recommends applying as soon as possible.

Additional Resources:

FAQ Regarding Participation of Faith-Based Organizations in PPP and EIDL

Last week the SBA released this FAQ regarding the participation of Faith-based Organizations in the Paycheck Protection Program (PPP) and the Economic Injury Disaster Loan Program (EIDL).

Interim Final Rule Business Loan Program Temporary Changes; Paycheck Protection Program

The SBA also issued an interim final rule regarding the Paycheck Protection Program  under the CARES act.  Faith-based organizations should review page 6, #2 to better understand how they may participate in the program while maintaining their right to exercise their faith according to their tradition’s polity.

Coronavirus Emergency Loans Guide and Checklist for Small Businesses and Nonprofits

The U.S. Chamber of Commerce Foundation’s Coronavirus Emergency Loans Guide and Checklist for Small Businesses and Nonprofits — Starting April 3, small businesses and sole proprietorships can apply for loans through existing SBA lenders. Starting April 10, independent contractors and self-employed individuals can apply for loans through existing SBA lenders. Other regulated lenders will be available to make these loans as soon as they are approved and enrolled in the program.

Accessing Care at Community Health Centers

Federally Qualified Health Centers (FQHCs) may be a viable option for someone in your community seeking medical attention. Health centers are an important component of the national response to the COVID-19 pandemic. Your local Community Health Center can assess whether a patient needs further testing, which may be done over the phone or using telehealth. Individuals may also receive primary health care services at their local health center at a reduced cost or free of charge depending on their economic status.

Call your nearest health center or health department to discover their availability for COVID-19 screening and testing. Find a Health Center near your community!

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

CMS approved its 44th state Medicaid waiver delivering urgent regulatory relief to ensure States can quickly and effectively care for their most vulnerable citizens. In light of the urgent and evolving needs of states during the COVID-19 crisis, CMS developed a toolkit to facilitate expedited application and approval of State waiver requests.  More on Section 1135 Waivers and 1915(c) Appendix K Waivers.

How to Help:

FEMA’s Coronavirus Response: How to Help

Everyone has a role to play in the fight against COVID-19 and care of our fellow Americans. Learn how to help if you are a company with medical supplies to donate or sell, a volunteer who is medically trained, or a member of the general public.

You may also want to check with the Local Emergency Management Response Effort in your state.

The Partnership Center is aware of several virtual platforms currently available to harness and connect volunteers to the needs in their immediate community including Aunt Bertha, the Be a Neighbor Campaign through VOMO, CarePortal, and the Nextdoor platform. Also look to your local safety net organizations — such as The Salvation Army, Catholic Charities, or United Way serving your community — for how you may be able to assist with identified needs.

SAMHSA’s Virtual Recovery Support Resources  

In an infectious disease outbreak, when social distancing and self-quarantine are needed to limit and control the spread of the disease, continued social connectedness to maintain recovery is critically important.  This tip sheet describes resources that can be used to virtually support recovery from mental/substance use disorders. It also provides resources to help local recovery programs create virtual meetings.

Please also consider sharing mobile apps that nurture and sustain virtual recovery communities such as Sober Grid, rTribe, Connections, WEconnect, and Nomo for those supporting persons in recovery.  Many of them are free and offer peer coaching support (usually with a fee).

Stroudwater Associates, a rural health care consulting firm based in Portland, ME has created a set of resources for rural hospitals to access support from the CARES Act of 2020.  This resource on the most relevant sources of assistance available to hospitals and health systems as a result of the COVID-19 pandemic, includes Medicare accelerated payments, the Small Business Administration Payroll Protection Program, and other traditional cash management strategies.

Please click here to access the resources.

CMS recently updated recommendations to postpone non-essential surgeries and other procedures to conserve critical healthcare resources and limit exposure of patients and staff to COVID-19. Developed in collaboration with medical societies and associations, the recommendations outline a tiered approach for state and local officials, clinicians, and delivery systems to consider to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition.

Recommendations

CMS posted a letter to clinicians that outlines a summary of actions CMS has taken to ensure clinicians have maximum flexibility to reduce unnecessary barriers to providing patient care during the unprecedented outbreak of COVID-19. The summary includes information about telehealth and virtual visits, accelerated and advanced payments, and recent waiver information.

Letter

• The CARES Act included Medicare telehealth flexibility for FQHCs and RHCs for the duration of the crisis. It authorizes Medicare reimbursement for health centers and rural health clinics as distant sites for the duration of the emergency, not reimbursed at PPS rate but instead “such payment methods shall be based on payment rates that are similar to the national average payment rates for comparable telehealth services under the physician fee schedule under section 1848.”
• Since 2019, FQHCs could bill Medicare for virtual communication services (aka phone calls) using code GOO71. (This is in lieu of the codes 99441, 99442, and 99443, which only those providers who bill under the fee schedule can use.) The payment is around $14, and FQHCs cannot bill for it if the patient had a related evaluation/management service within the previous 7 days or has an on-site appointment within the next 24 hours. These services must be initiated by a patient and as long as the provider responding to the call is an employee or contractor of the health center, he or she does not have to be physically located at the health center while delivering these services. CMS also has an FAQ document on virtual communication.

On March 30 the Centers for Medicare & Medicaid Services (CMS) issued an array of new rules and waivers of federal requirements offering maximum flexibility to respond to the COVID-19 pandemic including a section entitled “Further Promote Telehealth in Medicare.” There is a provider-specific fact sheet on new waivers and flexibilities for FQHCs and RHCs but it does not address telehealth.