Rural Health Information Hub Latest News

A Message from State Oral Health Coalition about COVID-19

As the reach of the COVID-19 pandemic intensifies around the state, the PA Coalition for Oral Health (PCOH) is increasingly concerned about access to emergency dental care for everyone in Pennsylvania who may need it. We applaud Governor Wolf for prohibiting elective dental procedures in his statement around life-sustaining businesses last week. It may be increasingly difficult for people to find care as restrictions are announced, and we do have concerns that very few offices in the state will be able to continue providing emergency dental treatment. We are addressing these concerns to those in leadership and continue to work towards a solution to offer palliative care and emergency treatment in the safest manner possible to all who need it.

“What Constitutes a Dental Emergency” 
American Dental Association

“Infection Control Guidelines for Healthcare Personnel” 
Centers for Disease Control and Prevention

“Guidance on COVID-19 for Dental Health Care Personnel in Pennsylvania” 
Pennsylvania Department of Health

USDA Implements Immediate Measures to Help Rural Residents, Businesses and Communities Affected by COVID-19

WASHINGTON, March 25, 2020 – USDA Rural Development has taken a number of immediate actions to help rural residents, businesses and communities affected by the COVID-19 outbreak. Rural Development will keep our customers, partners, and stakeholders continuously updated as more actions are taken to better serve rural America.

OPPORTUNITIES FOR IMMEDIATE RELIEF

Rural Housing Service

Single-Family Housing

Effective March 19, borrowers with USDA single-family housing Direct and Guaranteed loans are subject to a moratorium on foreclosure and eviction for a period of 60 days. This action applies to the initiation of foreclosures and evictions and to the completion of foreclosures and evictions in process.

Guaranteed Loan Program:

• Guaranteed Loan borrowers who are in default or facing imminent default due to a documented hardship can have payments reduced or suspended by their lender for a period not to exceed 12 months delinquency. Once the hardship is resolved, the lender can modify the loan to cure the delinquency or make up the missed payments based on the borrower’s individual circumstances.

• Guaranteed Loan servicing questions should be directed to: sfhgld.program@usda.gov.

Direct Loan Program:

  • USDA has waived or relaxed certain parts of the application process for Single-Family Housing Direct Loans, including site assessments, and has extended the time period that certificates of eligibility are valid.
  • A Direct Loan borrower who is experiencing a reduction of income by more than 10 percent can request a Payment Assistance package to see if he/she is eligible for payment assistance or for more assistance than currently received.
  • Moratorium Assistance is available for Direct Loan borrowers experiencing medical bill expenses (not covered by insurance) or job loss because of COVID-19. Qualifying borrowers can receive a moratorium on house payments for a period of time, repaid at a later date.
  • Direct Loan questions should be directed to USDA’s Customer Service Center at 800-414-1226 (7:00 a.m.-5:00 p.m. Eastern Time Monday-Friday) or https://www.rd.usda.gov/contact-us/loan-servicing. Call volume and wait times are high at this time.

Multi-Family Housing

Multi-Family Housing is taking several steps to help owners, management agents and tenants maintain quality housing during the COVID-19 outbreak. Specifically, three immediate steps are effective for Section 515 Multi-Family properties:

  • Tenant certifications due March 31, April 30 and May 31 for Multi-Family properties have been extended to June 30 with no late fees or overage charges, as allowed in Multi-Family guidance (HB-3-3560, Chapter 4, Section 4.11). This extension will allow for additional time to complete needed certifications while avoiding face-to-face meetings as recommended by the Centers for Disease Control and Prevention (CDC). • Late fees on Section 515 mortgages will be waived, subject to waiver authority in 7 CFR 3560.403 (c)(3).
  • Section 515 Annual Financial Statements due March 31 will be extended 30 days, as per Multi-Family guidance (HB-2-3560 Chapter 4, Section 4.16-H). USDA is exploring whether a longer extension is appropriate and will provide further guidance.
  • Current policy states that owners must process an interim recertification at the tenant’s request if there is a change in income of $50 or more per month. The owner should already have this policy in writing and apply it consistently. To the maximum extent possible, we encourage all owners to work with all tenants with impacted income to adjust rent payments.
  • USDA encourages all owners to work with impacted residents and families to adjust rent payments, enter into forbearance agreements, and lessen the impact on affected residents. At this time, no additional subsidy funding has been made available. If borrowers are temporarily unable to make loan payments, the Agency may waive late fees and enter into an official workout plan.

Rural Utilities Service

  • On March 20, 2020, USDA extended for 60 days the deadline for Telecommunications and Electric Program borrowers and grantees to submit their annual CPA audit. In most cases, such audits are due to the agency by April 30, 2020.
  • USDA is waiving borrower covenant requirements for loan agreement financial ratios for the period from Jan. 1, 2020, through Dec. 31, 2020. Additionally, USDA is waiving all financial reporting requirements associated with existing Rural Utilities Service (RUS) loan and grant covenants beginning Jan. 1, 2020 through June 30, 2020.
  • The RUS Administrator has delegated authority to the RUS Telecommunications, Electric, and Water and Environmental Programs to consider requests to waive certain site inspection requirements during the current COVID-19 National Emergency.
  • Applicants will be able to use alternative methods to notify the public, such as through videoconferences, teleconferences and public notices on websites and in local newspapers, as a substitute for the public meeting notification requirement for water and waste projects.
  • On a case-by-case basis, USDA will help Electric Program borrowers gain access to obligated funds more quickly at current low interest rates by considering extensions of loan terms (within statutory limits); considering requests to move obligated funds between the Electric Program’s six budget purposes where the new purpose has cleared environmental review; and by considering Temporary Normal Inventory (TNI) requests.

For assistance, please contact:

Rural Business-Cooperative Service

Beginning immediately, through July 31, 2020, USDA Business and Industry Loan Guarantees (B&I) and Rural Energy for America Program (REAP) Guaranteed lenders may assist borrowers experiencing temporary cash flow issues by deferring payments for a period no longer than 120 days. The lender must notify The Agency in writing of any payment deferments. Written notification to the Agency will meet the standard for concurrence until July 31, 2020. A response from the Agency is not required. This guidance applies to ALL borrowers that had a current repayment status as of March 1, 2020.

  • If the guaranteed loan has been sold on the secondary market, the secondary market holder and lender must agree to the deferment actions being taken. The Agency will expect a written agreement from both parties in these instances.

RBCS intermediary borrowers continue to have authority to service loan portfolios independent of USDA. Intermediary borrowers participating in these programs may approve loan payment deferrals may to their borrowers without USDA approval. These programs are: Ø Intermediary Relending Program (IRP)

  • Rural Business Development Grant (RBDG)
  • Rural Economic Development Loan and Grant (REDL and REDG)
  • Rural Microentrepreneur Assistance Program (RMAP)

For existing Intermediary Relending Program (IRP) and Rural Economic Development Loan (REDL) borrowers, the Agency is committed to maintaining well-capitalized intermediary lenders and will work with you on loan servicing requests on a case-by-case basis to make sure you remain a pillar in our rural business communities.

EXTENSION OF APPLICATION DEADLINES

USDA is extending the application window for the following programs:

Rural Business-Cooperative Service

  • USDA extended the application deadline for the Rural Business Development Grant (RBDG) program to no later than April 15, 2020. Contact the Rural Development office for the deadline in your state. USDA announced the extension in an Unnumbered Letter posted March 19, 2020.
  • USDA extended the application deadline for the Rural Energy for America Program (REAP) to April 15, 2020. For additional information, see page 16925 of the March 25, 2020, Federal Register.

USDA is an equal opportunity provider, employer and lender.

Pennsylvania Food Assistance Programs and Resources, Encourage Volunteerism to Keep Life-Sustaining Food Services Available 

Pennsylvania Governor Wolf’s administration reminded Pennsylvanians of food assistance resources available and what actions it is taking to ensure access to food does not stop in spite of the COVID-19 mitigation efforts. 

Pennsylvanians who need help feeding themselves or their family should find and contact their local food bank or pantry through Feeding Pennsylvania and Hunger-Free Pennsylvania. 

The Pennsylvania Department of Human Services (DHS) is continuing to process applications and benefit renewals for the Supplemental Nutrition Assistance Program (SNAP).  Emergency SNAP applications can be expedited and issued in five days. Pennsylvanians can apply for SNAP online at www.compass.state.pa.us. 

DHS will continue to process application and renewal benefits, so people should continue to send in paperwork as usual. But, for anyone currently on SNAP who misses a deadline, who is not able to submit the paperwork or complete an interview or provide verifications for any reason during this emergency, DHS will ensure their SNAP benefit continues. DHS submitted a waiver request to the federal Food and Nutrition Service (FNS) to ensure this continuity in benefits.  

The Pennsylvania Department of Agriculture has provided resources for Pennsylvanians to access emergency food assistance during COVID-19 mitigation, including locations of food banks and food pantries that are assisting individuals and families during this time. And to ensure that food banks and community feeding organizations remain operable with healthy volunteers, the department provided guidance for ways to limit contact while providing their essential services. 

Businesses who have resources to help feed and shelter Pennsylvanians in need are encouraged to fill out this survey to assist the task force as they look to direct resources. Any Pennsylvanian who is suddenly in need of food should complete this survey so the task force can better understand where resources should be directed 

Third Stimulus Package on Track to be Signed on March 24

The Senate package, expected to soon be passed by the Senate and then the House, promises a Marshall Plan for hospitals with possibly as much as $130 billion in immediate emergency relief for hospitals and rapid help on accessing needed supplies such as ventilators, masks, COVID-19 tests, and workforce.

Billions of additional dollars were included for hospitals because of your efforts. Also included are $150 million in rural HRSA grants, temporary relief from devastating sequestration cuts, a 15% increase in COVID-19 Medicare PPS reimbursement rates, and a critical $1 billion for tribes and IHS funding.

Rural providers will also have access to a $562 million small business emergency relief fund to keep doors open. It is unclear exactly how the healthcare system funding will be distributed, as legislative text has not yet been released.

HHS Awards $100 Million to Health Centers for COVID-19 Response

March 24, 2020

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded $100 million to 1,381 health centers across the country with funding provided by the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020.  HRSA-funded health centers may use the awards to address screening and testing needs, acquire medical supplies and boost telehealth capacity in response to the Coronavirus Disease 2019 (COVID-19) pandemic.

On Friday, March 6, 2020, President Trump signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, which provides $8.3 billion in emergency funding for federal agencies to respond to the COVID-19 outbreak, including $100 million for HRSA-funded health centers. Recognizing the urgency of the situation, and the important role health centers play in communities nationwide, HHS is making this funding for health centers available immediately.

“HRSA-funded health centers have been and will be critical players in our national response to the COVID-19 pandemic,” said HHS Secretary Alex Azar. “The new grants we’re releasing today are a rapid injection of resources secured by President Trump from Congress in the supplemental funding bill, building on the strong investments HHS has made in health centers over the years. President Trump has emphasized a whole-of-government, whole-of-America response to the pandemic, and these grants will help health centers, which know the needs and resources of their communities best, to play their part.”

The funding supports health centers across the country in their emergency planning and response efforts. The awards will give health centers the flexibility to meet the evolving COVID-19 needs in their respective communities including but not limited to, expanding COVID-19 screening and testing capacity, purchasing supplies such a personal protective equipment (PPE) and providing safety education.

“HRSA-funded health centers provide high-quality primary care services to 28 million people in the United States. That is 1 in 12 people nationwide. These grantees operate 13,000 service delivery sites that are lifelines to services and networks of resources in their communities every day, and especially during a crisis,” said HRSA Administrator Tom Engels. “HRSA-funded health centers will receive this funding as quickly as possible so they can maintain their ability to deliver quality primary health care services to their patients while responding to developing needs in their communities.”

For a list of award recipients, visit https://bphc.hrsa.gov/emergency-response/coronavirus-covid19-FY2020-awards.

For more information about COVID-19, visit http://coronavirus.gov/.

Licensed Health Care Practitioners Can Provide Telemedicine Services to Pennsylvanians During Coronavirus Emergency

March 23, 2020

Harrisburg, PA — Health care professionals licensed under any of the Department of State’s Bureau of Professional and Occupational Affairs (BPOA) licensing boards can provide services to patients via telemedicine during the coronavirus emergency.

“Telemedicine provides health care professionals flexibility to continue treating their patients while following best practices on social distancing as outlined by the Department of Health,” Secretary Boockvar said. “The department requested, and Governor Wolf granted us, the authority to allow health care professionals from out-of-state to treat Pennsylvania residents using telemedicine, when appropriate, due to COVID-19.”

This new guidance applies to the following boards:

  • Chiropractic
  • Dentistry
  • Medicine
  • Nursing
  • Optometry
  • Pharmacy
  • Podiatry
  • Psychology
  • Osteopathic Medicine
  • Nursing Home Administrators
  • Occupational Therapy Education and Licensure
  • Physical Therapy
  • Social Workers, Marriage and Family Therapists, and Professional Counselors
  • Examiners in Speech-Language Pathology and Audiology
  • Veterinary Medicine

Currently, no Pennsylvania law prohibits the practice of telemedicine.

Additionally, the department is working with the governor’s office, the Department of Health and Department of Human Services to identify regulations and requirements that can be suspended to give medical providers and facilities the flexibility they need to respond to the crisis. We will publish these notifications on our website as they become available.

Governor Wolf also granted the department’s request for a suspension to allow licensed practitioners in other states to provide services to Pennsylvanians via the use of telemedicine, without obtaining a Pennsylvania license, for the duration of the emergency. Out-of-state practitioners must:

  • be licensed and in good standing in their home state, territory or country.
  • provide the Pennsylvania board from whom they would normally seek licensure with the following information prior to practicing telemedicine with Pennsylvanians:
    • their full name, home or work mailing address, telephone number and email address; and
    • their license type, license number or other identifying information that is unique to that practitioner’s license, and the state or other governmental body that issued the license.

Please submit the information requested above to the appropriate board resource account listed on the BPOA website.

All practitioners using telemedicine in Pennsylvania must remain informed on all federal and state laws, regulations and guidance regarding telemedicine, including a practitioner’s obligations under the Health Insurance Portability and Accountability Act (HIPAA) and  recent guidance provided by the U.S. Department of Health and Human Services.

Authorization to engage in telemedicine from a professional licensing standpoint is separate and apart from any insurance coverage/payment issues that fall under the Department of Health, the Department of Human Services, the Department of Insurance, or any other state or federal agency.

The Department of Human Services issued guidance for Behavioral Health Services Telemedicine  here. The Department of Drug and Alcohol Programs released Telehealth guidance for their programs and providers here.

MEDIA CONTACT:  Wanda Murren, 717-783-1621

Rural Global Health and the COVID-19 Pandemic

In these trying times of the COVID-19 pandemic, it’s important to remember that we’re part of a global community of rural health professionals all fighting this virus together. The National Rural Health Association (NRHA) and its Global Health Committee offer this perspective of opinion from the Australian National Rural Health Commissioner and Editor-in-Chief of Rural and Remote Health, Dr. Paul Worley. He provides insight into our collective efforts towards building rural community health infrastructure in the wake of pandemic. Dr. Worley describes four levels of integration with expected outcomes that are required so that rural systems of care can operate most effectively. Amazingly, these levels of integration and hopeful outcomes are consistent with NRHA’s approach in its advocacy, education, and research. Let’s work together across the globe to make this a reality for all rural communities.

Link: www.rrh.org.au/journal/article/5976

CMS Approves Medicaid Section 1135 Waivers for 11 Additional States in Response to COVID-19

In keeping with its commitment to ensure states have the necessary tools to respond to the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) has approved an additional 11 state Medicaid waiver requests under Section 1135 of the Social Security Act (Act), bringing the total number of approved Section 1135 waivers for states to 13. The waivers were approved within days of states’ submitting them, and offer states new flexibilities to focus their resources on combatting the outbreak and providing the best possible care to Medicaid beneficiaries in their states. These waivers support President Trump’s commitment to operating a COVID-19 response that is locally executed, state managed and federally supported.

A copy of the press release can be found here:  https://www.cms.gov/newsroom/press-releases/cms-approves-medicaid-section-1135-waivers-11-additional-states-response-covid-19

These waivers, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

CMS Announces Findings at Kirkland Nursing Home and New Targeted Plan for Healthcare Facility Inspections in light of COVID-19

On March 23, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the preliminary results of a recent inspection of the Life Care Center nursing home in Kirkland, Washington – the epicenter of the 2019 Novel Coronavirus (COVID-19) outbreak in that state. The inspection, which the Agency conducted with the Washington Department of Social & Health Services, has helped inform CMS’s national strategy for keeping patients safe in nursing homes and other healthcare facilities. In keeping with the Trump Administration’s aggressive moves to combat further spread of COVID-19, CMS is also utilizing flexibilities allowed by President Trump’s Emergency Declaration to announce an enhanced, focused inspection process, informed in part by the Agency’s experiences on the ground in Kirkland, and close coordination and input from the Centers for Disease Control and Prevention (CDC). This focused inspection process will be provided to all inspectors and facilities, and used on a national scale. Critically, this focused inspection process includes a self-assessment tool for providers to employ.

You can find a copy of the press release here: – https://www.cms.gov/newsroom/press-releases/cms-announces-findings-kirkland-nursing-home-and-new-targeted-plan-healthcare-facility-inspections  Please note that links to the guidance can be found in the press release.

You can find a copy of the fact sheet here:   – https://www.cms.gov/newsroom/fact-sheets/kirkland-washington-update-and-survey-prioritization-fact-sheet

And Talking Points- CMS Administrator Seema Verma’s Remarks as Prepared for Delivery:  Updates on  Healthcare Facility Inspections in light of COVID-19– https://www.cms.gov/newsroom/press-releases/cms-administrator-seema-vermas-remarks-prepared-delivery-updates-healthcare-facility-inspections

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

Most Aggressive States Against the Coronavirus – WalletHub Study

With states taking actions such as closing non-essential businesses, banning even small gatherings, and ordering people to shelter in place to fight the spread of the coronavirus, WalletHub today released updated rankings on the Most Aggressive States Against the Coronavirus, as well as accompanying videos.

To identify which states are taking the largest actions to combat coronavirus, WalletHub compared the 50 states and the District of Columbia across 46 key metrics. The data set ranges from tested cases of COVID-19 per capita to school closures, ICU beds, and shelter-in-place policies. Below, you can see highlights from WalletHub’s report, along with a summary of the largest rank changes from our previous report and a Q&A with WalletHub analysts.

States with Most Aggressive Measures

States with Least Aggressive Measures

1. California 42. Missouri
2. Rhode Island 43. South Dakota
3. Maryland 44. Nebraska
4. New Hampshire 45. Montana
5. New Jersey 46. Oklahoma
6. Connecticut 47. Arkansas
7. New York 48. Idaho
8. Maine 49. Tennessee
9. Colorado 50. Nevada
10. Louisiana 51. Mississippi

Note: Rankings reflect data available as of 2 p.m. ET on March 23, 2020.

Biggest Changes in Rank from the Previous Report

  • Hawaii moved from rank 45 to rank 11, up 34 positions. One reason is that the state has increased its number of tests administered per 100,000 residents by 400 times, from 0.49 to 211.74.
  • Colorado moved from rank 35 to rank 9, up 26 positions. This is due in part to the fact that the state has increased prevention measures and announced statewide closures of schools, bars and restaurants.
  • Maine moved from rank 33 to rank 8, up 25 positions. Maine has improved its aggressiveness against coronavirus by banning gatherings of 10 participants or more as well as closing restaurants and bars, among other measures.

To view the full report and your state or the District’s rank, please visit:
https://wallethub.com/edu/most-aggressive-states-against-coronavirus/72307/