COVID-19 has impacted nearly every aspect of the world we are living in and enrollment is not exempt from the impact. Here are some actions that do or will have an effect on enrollment:

• State Waiver Request for Reduction of Administrative Burden. The Pennsylvania Department of Human Services (DHS) submitted an 1135 Waiver to ease some of the administrative burden and procedures for Medicaid, Medicare and CHIP in Pennsylvania, tapping into the authority and temporary flexibility given when a disaster and public health emergency are declared.
• County Assistance Offices (CAOs). CAOs are closed to the public but operating. CAOs do not currently have a policy for telework. Staff shifts have been adjusted and staggered to allow processing of applications to continue.
• Marketplace Open Enrollment. Last week, Gov. Wolf sent a formal letter to the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services requesting the federal marketplace,Healthcare.gov, be re-opened to individuals who are uninsured or underinsured in response to the COVID-19 outbreak. Other states have joined the push for this administration to make significant changes to allow for additional enrollment opportunities. In addition, nine states, who operate their own state-based Marketplaces, have issued special enrollment periods with some ending as late as June for uninsured consumers.
• Enrollment Assistance. Navigators, Certified Application Counselors and enrollment assisters are permitted to assist consumers remotely and virtually, permitted prior consent is obtained in accordance with CMS Guidance. Questions, contact Tia Whitaker, Statewide Director for Outreach and Enrollment at the Pennsylvania Association for Primary Care.

Using new temporary rules allowing for remote voting, the House and Senate unanimously approved, and Governor Wolf indicated he will sign, a proposal to move Pennsylvania’s April 28 primary to June 2. The bill also provides flexibility for counties to consolidate polling places as an additional safety precaution.

CMS has been hosting regular calls with a variety of clinicians, hospitals, and other facilities in an effort to keep stakeholders updated on our COVID-19 efforts.  As we know not everyone is available to attend the calls live, we are happy to share that you can access recordings of the calls along with transcripts on the following link: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts. We will continue to host calls and share information through our list serves and media.

To keep up with the important work of the White House Coronavirus Task Force in response to COVID-19, visit https:/www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

The Pennsylvania Department of Education (PDE) announced that it received waiver approval from the U.S. Department of Agriculture (USDA) to allow schools to provide free meals to all children during statewide COVID-19 mitigation efforts.

The waiver builds on the USDA approval announced Saturday for the Pennsylvania Department of Agriculture to provide critical food supplies through the state’s network of food banks, food pantries, and pop-up distribution sites. The approval allows the Department of Agriculture and its partners to more efficiently distribute a variety of foods – including meats, vegetables, fruit, canned goods, cereal, rice, pasta, eggs, and more – to those most affected by the closure of non-life sustaining businesses in Pennsylvania.

Pennsylvania Governor Tom Wolf announced the approval of part of his request to the President for a major disaster declaration to support state, county and local response to the COVID-19 outbreak in Pennsylvania.

Under the major disaster declaration, state, county and municipal governments, as well as eligible private non-profits can receive reimbursement for up to 75 percent of eligible expenses related to the response to the COVID-19 outbreak. Eligible expenses can include but are not limited to costs associated with paying overtime, or materials and equipment purchases. The declaration also provides direct federal assistance, which provides federal materials and supplies to support state and local response efforts.

In the coming weeks, staff from the Pennsylvania Emergency Management Agency will reach out to potential applicants to view the application process and necessary documentation. As the response period for the COVID-19 outbreak is continuing, the process will take weeks. All reimbursements are handled electronically.

Governor Wolf said his request for other federal aid remains under consideration. His letter to the President included the following Individual Assistance programs: Disaster Unemployment Assistance, Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program; and Statewide Hazard Mitigation.

Following President Trump’s signing of the historic Coronavirus Aid, Relief, and Economic Security (CARES) Act, SBA Administrator Carranza and Treasury Secretary Mnuchin today announced that the SBA and Treasury Department have initiated a robust mobilization effort of banks and other lending institutions to provide small businesses with the capital they need. The CARES Act establishes a new $349 billion Paycheck Protection Program. The Program will provide much-needed relief to millions of small businesses so they can sustain their businesses and keep their workers employed. More information can be found below and on Treasury’s CARES Act website: https://home.treasury.gov/cares.

Assistance for American Workers and Families

In the weeks immediately after the passage of the CARES Act, Americans will see fast and direct relief in the form of Economic Impact Payments. For more information, CLICK HERE.

Assistance for Small Businesses

The Paycheck Protection Program prioritizes millions of Americans employed by small businesses by authorizing up to $349 billion toward job retention and certain other expenses.

Small businesses and eligible nonprofit organizations, Veterans organizations, and Tribal businesses described in the Small Business Act, as well as individuals who are self-employed or are independent contractors, are eligible if they also meet program size standards.

• For a top-line overview of the program CLICK HERE
• If you’re a lender, more information can be found HERE
• If you’re a borrower, more information can be found HERE
• The application for borrowers can be found HERE

Press Release: With $349 Billion in Emergency Small Business Capital Cleared, Treasury and SBA Begin Unprecedented Public-Private Mobilization Effort to Distribute Funds (HERE)

Press Release: Treasury Encourages Businesses Impacted by COVID-19 to Use Employee Retention Credit (HERE)

How is FEMA adding Critical Supplies to the Supply Chain?  Right now, FEMA is expediting movement of critical supplies from the global market to medical distributors in various locations across the U.S.  Each flight contains critical personal protective equipment (PPE), to include gloves, gowns, goggles, and masks in varying quantities.

Four strategies to address Supply Chain needs are being pursued concurrently:

1. Preservation to limit unnecessary use of PPE and other supplies.
2. Acceleration of industrial manufacturing is required to help meet the urgent demand placed on the market.
3. Expansion of the industry is taking place.
4. Allocation of critical resources based on data-informed decisions.

On the Acceleration piece, I want to highlight the following updates:

• FEMA is expediting movement of critical supplies from the global market to medical distributors in various locations across the U.S.
• As an example of this effort, FEMA coordinated an air bridge for flights from Asia beginning Sunday, March 29 which delivered 80 tons of much needed PPE supplies to New York, New Jersey and Connecticut.

FEMA Delivering 80 Tons of PPE to NY, NJ and CT

• The second flight landed in Chicago this morning. Ohio is likely tomorrow.  FEMA has scheduled additional flights and is adding more daily.
• Each flight will contain critical PPE (gloves, gowns, goggles, and masks) in varying quantities. FEMA will not have detailed visibility on the amount of PPE until the flights are loaded overseas.
• Upon arrival, PPE will be provided, in varying quantities, first to medical distributors in areas of greatest need; then, the remainder will be infused into the broader U.S. supply chain. Prioritization will be given to hospitals, health care facilities, and nursing homes around the country.
• Additionally, in some cases, the federal government may purchase some of the supplies to be used to replenish the Strategic National Stockpile (SNS) or to provide to states with any identified and unmet needs.
• To address the anticipated ventilator shortage across the nation, the task force has implemented a similar strategy, leveraging the strengths of the commercial industry Including numerous vendors, such as General Electric, Phillips, Medtronic, Hamilton, Zoll, ResMed, Hillrom and Vyair, to produce 20,000 ventilators over the next two months with the potential to add 100,000 by end of June. This represents a significant increase in velocity as the normal annual market is 30,000 per year.
• As a reminder, to expedite purchasing, FEMA issued a request for quotation for vendors who have needed medical equipment and supplies to sell to the agency.

Admiral Brett Giroir & Surgeon General Jerome Adams Release Letter on Optimizing Ventilator Use: Last night, the Assistant Secretary of Health and US Surgeon General issued an open letter on strategies for optimizing ventilator use including use of guidance on co-venting. In the letter, they note that ventilation of two patients with one ventilator should only be considered as an absolute last resort, but for those clinicians in crisis situations, the letter outlines how ventilator splitting can be performed strictly for two patients who are both either infected or free of the virus. We know that practices like this are currently being used in some hospitals. In that vein, we strive to provide additional information to support patient-provider decision making during times of crisis standards of care. We recognize that these decisions must be made on an individual institution, care-provider, and patient level. This is a reflection of how HHS and FEMA are working with multiple partners: healthcare systems, academic institutions, professional medical societies, and the National Academies of Science, Engineering and Medicine to develop crisis standards of care strategies for ventilator support when resources are limited.

Expanding Availability of PPE and Sterilizers and Disinfectant Devices: FDA issued guidance to help expand the availability of surgical apparel for health care professionals, including gowns, hoods, and surgeon’s and patient examination gloves during the pandemic. They also released guidance to expand the availability and capability of sterilizers, disinfectant devises and air purifiers during the pandemic. The devices include those intended to make devices sterile, kill pathogens or other microorganisms and kill pathogens or microorganisms in the air. This policy reflects FDA’s commitment to ease burdens on health care providers and facilities as they face COVID-19.

CMS Granting Key Flexibilities – Worth Including Twice:  Yesterday, CMS released an array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The new rules allow hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility. CMS also posted a complete summary of the flexibilities provided to all physicians and clinicians to help clarify current allowable and billable practices. CMS also approved two additional Section 1135 waivers today, bringing the total of approved waivers to 40 states.

Granting Financial Relief for Medicare Providers – Worth Repeating: Over the weekend, CMS provided financial relief to Medicare providers by expanding their accelerated and advance payment program to help ensure that they have resources needed to combat COVID-19. Accelerated and advance Medicare payments provide emergency funding and addresses cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.  The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers.

Updating Guidance for Labs: CDC updated their laboratory guidance for handling and processing specimens associated with COVID-19 to include environmental specimen testing guidance related to procedures that concentrate viruses.

Determining if You Are At Higher Risk for Severe Illness: CDC updated their webpage for people who are at higher risk for severe COVID-19 illness.

Providing Guidance for Healthcare Professionals: CDC added to their FAQ document for healthcare professionals additional information on drugs and investigational therapies to address common questions and misperceptions on available and approved drugs to treat COVID-19. CDC also released guidelines and a decision algorithm for how to guide care advice and messages with evaluating and triaging potential patients.

Obtaining Funding from FEMA for Emergency Medical Care Activities: The FEMA COVID-19 Emergency Protective Measures Fact Sheet included a list of eligible emergency medical care activities. This fact sheet provides additional guidance related to the eligibility of emergency medical care activities as an emergency protective measure under the Emergency Declaration and any Major Disaster Declaration authorizing Public Assistance (PA) for COVID-19.

Addressing Questions on Non-Congregate Sheltering: Non-congregate sheltering may be necessary for health and medical-related needs, such as isolation and quarantine of certain populations resulting from the public health emergency. FEMA released an FAQ document on non-congregant sheltering and how states can apply to receive approval for them.

Preparing Outpatient Hemodialysis Facilities for COVID-19 Patients: CDC released updated guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Outpatient Hemodialysis Facilities. This information is provided to clarify COVID-19 infection prevention and control (IPC) recommendations that are specific to outpatient hemodialysis facilities. Recommendations are listed for screening and triage of patients.

Addressing Considerations for Clinical Trials: The FDA issued an updated guidance, Conduct of Clinical Trials of Medical Products during COVID-19 Pandemic, with an appendix adding questions and answers on this subject. This guidance is intended for industry, investigators and institutional review boards and was issued because we recognize that the COVID-19 pandemic may impact the conduct of clinical trials of medical products, including drugs, devices and biological products.

Granting Flexibilities to ACF Recipients: In a memo to all of their grantees, ACF shared information to assure their grantee and recipient communities that to the extent possible they will provide short-term relief for administrative, financial management, and audit requirements in their human services programs.

Ensuring Providers Can Practice at Health Centers and Free Clinics: HRSA has released information on updated Federal Tort Claims Act policies for providers in health centers and free clinics to enable them to treat patients in these settings in an effort to prevent, prepare or respond to COVID-19.

Supporting Governors in Crisis States: The President released a memo that provides additional support to Governors in Connecticut, Illinois, Massachusetts and Michigan, allowing them to use the National Guard with 100% federal support.

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”). The recommendations are intended for use by professionals who manage respiratory protection programs in healthcare institutions to protect health care workers from job-related risks of exposure to infectious respiratory illnesses.

Supplies of N95 respirators can become depleted during an influenza pandemic (1-3) or wide-spreadoutbreaks of other infectious respiratory illnesses.(4) Existing CDC guidelines recommend a combination of approaches to conserve supplies while safeguarding health care workers in such circumstances. These existing guidelines recommend that health care institutions:

• Minimize the number of individuals who need to use respiratory protection through the preferential use of engineering and administrative controls;
• Use alternatives to N95 respirators (e.g., other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, powered air purifying respirators) where feasible;
• Implement practices allowing extended use and/or limited reuse of N95 respirators, when acceptable; and
• Prioritize the use of N95 respirators for those personnel at the highest risk of contracting or experiencing complications of infection.

This document focuses on one of the above strategies, the extended use and limited reuse of N95 respirators only; please consult the CDC or NIOSH website for guidance related to implementing the other recommended approaches for conserving supplies of N95 respirators.

There are also non-emergency situations (e.g., close contact with patients with tuberculosis) where N95 respirator reuse has been recommended in healthcare settings and is commonly practiced.(5-9) This document serves to supplement previous guidance on this topic.

Clinical diagnostic laboratories: To identify and reimburse specimen collection for COVID-19 testing, CMS established two Level II HCPCS codes, effective with line item date of service on or after March 1, 2020:

• G2023 – Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
• G2024 – Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source

These codes are billable by clinical diagnostic laboratories.