With the support from the National Rural Health Association, 41 senators and 81 representatives wrote a letter to HHS Secretary Azar urging the administration to fairly distribute aid to rural hospitals and health clinics. Under the CARES Act, the HHS Secretary has flexibility in how the $100 billion fund will be allocated to struggling providers. The lawmakers requested that funding be provided to rural hospitals quickly, as many are running low on money while preparing for the coronavirus. NRHA is concerned that large health systems (who also need help) will consume the funds due to small rural providers’ inability to compete for the funds. We are advocating for a rural set-aside to be established within these funds to ensure that rural providers can access this important, much-needed funding.

Daily Yonder

By Craig Settles

Rural America already has a shortage of hospital beds. Telehealth could help move some patients to a new type of facility powered by broadband. New temporary regulations in response to COVID-19 will allow the change.

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Daily Yonder

By Bill Bishop, Tim Marema and Jan Pytalski

The novel coronavirus continues to spread across rural America, according to data USA Facts has compiled from state health authorities. Yesterday, April 1, an additional 58 rural counties reported their first Covid-19 cases.

The impact of the novel coronavirus varies across the rural landscape. On average, there were 14.1 cases of COVID-19 for every 100,000 rural residents. That rate is well below the national rate of 55.9 cases per 100,000 residents.

But most of us don’t live in an “average” county. There are 80 rural counties with infection rates above the national average (shown in red in the map). And some rural counties have COVID-19 infection rates among the highest in the country.

Some of the highest rates are in Rocky Mountain ski counties. (The Yonder reported this phenomenon last week.)  Blaine County, Idaho, has a COVID-19 infection rate of 1,164 per 100,000. For comparison, the Bronx in New York City reported a rate of 598.6, the highest tally of any central city area.

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Fred Ullrich, BA; and Keith J. Mueller, PhD

While the majority of confirmed COVID-19 cases in the United States are found in urban centers, rural areas are not free of cases. As of April 1, 2020, there were a total of 234,040 cases and 5,398 deaths identified in counties (data provided by USAFacts.org), with 8,866 cases and 206 deaths (about 3.8 percent of both) reported in non-metropolitan counties.

This RUPRI data brief shows the current nonmetropolitan and metropolitan spread of the disease, and the associated map shows how the disease has spread over time.

Click to down the updated maps, and the “progression” of cases throughout the country.

https://rupri.public-health.uiowa.edu/publications/policybriefs/2020/COVID%20History/

New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Video

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

CMS approved its 45th Medicaid waiver to the District of Columbia, delivering urgent regulatory relief to ensure the District 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 waivers requests in record time. The waivers support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

CMS also approved an additional state waiver amendment request for Oklahoma to give emergency flexibilities in their programs that care for the elderly and people with disabilities, bringing the total to 18 approvals across 16 states.

Section 1135 Waivers  

1915(c) Appendix K Waivers

 Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients.

Guidance

April 5, 2020

Under her authority as Secretary of the Department of Health to take any disease control measure appropriate to protect the public from the spread of infectious disease, Dr. Rachel Levine today signed an order providing direction for maintaining and cleaning buildings for businesses authorized to maintain in-person operations under her and the governor’s life-sustaining business orders announced March 19.

According to the Building Safety Measures order, “Cleaning, disinfecting, and other maintenance and security services performed by building service employees are critical to protecting the public health by reducing COVID-19 infections in the commonwealth.”

The measures outlined in the order are for owners of buildings of at least 50,000 square feet used for commercial, industrial or other enterprises, including but not limited to facilities for warehousing, manufacturing, commercial offices, airports, grocery stores, universities, colleges, government, hotels, and residential buildings with at least 50 units.

In addition to maintaining pre-existing cleaning protocols, the order outlines these new protocols:

• Clean and disinfect high-touch areas routinely in accordance with CDC guidelines, in spaces that are accessible to customers, tenants, or other individuals.
• Maintain pre-existing cleaning protocols established in the facility for all other areas of the building.
• Ensure that the facility has a sufficient number of employees to perform the above protocols effectively and in a manner that ensures the safety of occupants and employees.
• Ensure that the facility has a sufficient number of security employees to control access, maintain order, and enforce social distancing of at least 6 feet, provided the security employees are otherwise responsible for such enforcement.

The order goes into effect at 12:01 a.m., April 6.

View the full order as a PDF here or on Scribd.

Over the past several weeks, the Pennsylvania departments of Community & Economic Development, Health, General Services, and the Pennsylvania Emergency Management Agency have heard from countless manufacturers and other businesses from across the commonwealth about how they can help through their existing means and through new innovative techniques.

Many of you have also reached out to share your challenges, supply chain disruptions and workforce issues, which are impeding your ability to produce more of what is most needed to battle COVID-19.

Earlier today, we announced the creation of the Pennsylvania Manufacturing Call to Action Portal, which will help streamline those requests and facilitate the connections you need to overcome your challenges and provide critical supplies to Pennsylvania.

It is our goal to connect you directly with a dedicated team of case managers who will thoroughly evaluate your company’s needs, seamlessly connecting you with the appropriate resource or partner organization(s) who will provide additional support.

The COVID-10 Cases in Appalachia map displays the current number of confirmed cases of COVID-19 in Appalachia and throughout the United States. Higher numbers of cases are marked by larger dots, while smaller numbers of confirmed cases are represented by smaller dots. By clicking on a location, users can see confirmed COVID-19 cases and any related deaths at the county level. This map is automatically updated throughout the day drawing on data collected by the Johns Hopkins University. Due to frequent changes, it is advised that users refresh their browsers often when viewing the map. As of April 2, 11:15 am (ET), there were 5,433 confirmed COVID-19 cases in 314 Appalachian counties, up from 1,686 confirmed cases in 208 Appalachian counties on March 26.

Explore County-level Coronavirus Impact Planning is a searchable data base offering demographic data snapshots of confirmed COVID-19 cases and deaths in relation to hospital bed counts, population and businesses, and categories of people at risk for COVID-19 in each one of the nation’s counties. By hovering over each statistical icon, users can learn more about the supporting data. COVID-19 related data is updated daily

In response to the national emergency that was declared concerning the COVID-19 outbreak, a new diagnosis code, U07.1, COVID-19, has been implemented, effective April 1, 2020.

As a result, an updated ICD-10 MS-DRG GROUPER software package to accommodate the new ICD-10-CM diagnosis code, U07.1, COVID-19, effective with discharges on and after April 1, 2020, is available on the CMS MS-DRG Classifications and Software webpage.

This updated GROUPER software package (V37.1 R1) replaces the GROUPER software package V37.1 that was developed in response to the new ICD-10-CM diagnosis code U07.0, Vaping-related disorder, also effective with discharges on and after April 1, 2020, that is currently available on the MS-DRG Classifications and Software webpage.

Providers should use this new code, U07.1, where appropriate, for discharges on or after April 1, 2020.  Refer to the updated MLN Matters Articles for additional Medicare Fee-For-Service information:

• Update to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for Vaping Related Disorder and 2019 Novel Coronavirus (COVID-19)
• Update to the Home Health Grouper for New Diagnosis Codes for Vaping Related Disorder and COVID-19
• April 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.1 R1

For detailed information regarding the assignment of new diagnosis code U07.1, COVID-19, under the ICD-10 MS-DRGs, visit the MS-DRG Classifications and Software webpage. The announcement is located under the “Latest News” heading.

For additional information related to the new COVID-19 diagnosis code, visit the CDC website.

CMS recognizes that in these important times, in particular, beneficiaries, health care clinicians, suppliers, and manufacturers are looking for the broadest possible access to ventilators for their care needs.  We are taking a number of steps to increase access to and remind suppliers about certain options available to them and beneficiaries regarding multi-function ventilators.

Effective immediately, CMS is suspending claims editing for multi-function ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime.

For more information on multi-function ventilators, see MLN Matters Special Edition Article SE20012.