Grocery and convenience store workers are considered essential to ensure an accessible food supply. Employers and employees should be aware of and follow the prevention measures to protect against COVID-19. The service these employees are providing to Pennsylvanians is exemplary, and we must all take measures to protect these employees so they can continue to stay healthy.

This guidance can and should be implemented in all life-sustaining businesses whenever applicable to protect employees and customers or clients.

Grocery stores and convenience store owners and management should review and consider implementing the following recommendations into standard operating procedures to protect employees.

Customer Protective Controls:

• Enforce social distancing in lines to separate customers by six feet whenever possible but allowing families to stay
• Visual cues may be helpful to implement social distancing in lines or other areas of the store. For example, tying a ribbon or using a bright piece of tape on the floor every six feet throughout the store can help customers keep a six-foot distance between themselves whenever
• Install floor markings to require customers to stand behind, until it’s time to complete the transaction.
• Consider limiting the number of people in the store at one time. Consider implementing the “nightclub model” of setting a maximum capacity and assigning staff to manage the number of people entering. Once maximum capacity has been reached, staff can allow more customers inside as others leave to maintain the maximum capacity and help customers shop safely. It is recommended to also encourage social distancing if lines form.
• Consider setting special hours for vulnerable populations, such as the elderly or immuno-compromised. Recommend allowing these populations to enter the store earliest in the day to reduce chances of exposure and ensure access to
• Whenever possible, encourage customers to call ahead or place orders online so that staff can select and pack up groceries for customers to pick up or have
• Encourage customers to come prepared with a list and to avoid touching objects that they do not plan to
• Ensure customers who use SNAP have access to the same delivery services and pick up options whenever possible. Consider waiving delivery fees for these customers during the COVID-19 mitigation

 Employee Protective Controls:

 Consider altering store hours to allow for increased cleaning and re-stocking without customers

• Cross-train employees and rotate staff between cashier, stocking, and other duties, to limit mental fatigue in adhering to social distancing
• Consider asking customers to bag their own groceries if possible, to limit contact with employees and divert bagging staff to other
• If customers provide their own bags, restrict employees from handling them, and either bag in plastic, or have customers bag their own
• Consider installing sneeze-guards at cashier
• Schedule hand washing breaks every 30-60 minutes. Employees should wash hands with soap and water for at least 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and
• Assign a relief person to step in for cashiers so they can wash their hands with soap for a full 20 seconds. Provide hand lotion so workers’ hands don’t
• Consider providing hand sanitizer at cash registers for staff and customer use in between
• If paying in cash or using coupons, recommend asking customers to place the coupons and money down on the signing shelf to eliminate any hand to hand contact with the cashier. The cashier will then put the receipt in the

Facility Sanitation:

• Understand the difference between cleaning, disinfecting, and
  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to
  • For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be
  • Products with EPA-approved emerging viral pathogens are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, ).
• Increase cleaning and sanitation practices, focusing on customer high-contact objects and surfaces. Surfaces include, but are not limited to:
  • Carts and baskets
  • Customer service counter
  • Self-checkout counters and equipment
  • All touchscreen equipment (computers, iPads, drink machines)
  • Produce scales
  • Display cooler and freezer doors and handles
  • Counter tops at deli counters
  • Salad / food bars, coffee grinders, bulk food dispensing units for items such as nuts and candy
  • Condiments (salt/pepper shakers)
  • Public and employee restroom fixtures including soap dispenser plate, towel dispenser handles, door handles, baby changing stations
  • Trash receptacle touch points
• Increase cleaning and sanitation practices, focusing on employee high-contact objects and surfaces. Surfaces include, but are not limited to:
  • Food preparation area door handles and push plates, including refrigeration and freezer walk-in plastic curtains
  • Oven and microwave doors
  • Handsink fixtures
  • Dispenser handles
  • Ice scoops
  • 3-compartment sink and mop sink fixtures
  • Cleaning tools and buckets
  • Employee break rooms and
• Consider suspending self-service salad bars, olive bars, and hot food bars. Consider having employees provide service to customers or prepackaging
• Provide a safe barrier for customers or employees handling utensils such as bakery tissue paper or disposal gloves and consider cleaning utensils every 2 hours rather than the 4 hours required under Food Code
• Ensure sneeze guards are in place where required and sanitized
• Strictly enforce the Food Code requirement to prohibit employee bare hand contact with ready-to-eat
• Schedule cashier station sanitation breaks to allow for cleaning of belts, shelves, ATM pads, order separation bars, and other high touch
• Take the opportunity to clean and disinfect shelves and display cases before

Tips for Managers

 Actively encourage sick employees to stay home:

• Sick employees should follow CDC-recommended steps. Employees should not return to work until the criteria to discontinue home isolation are met, in consultation with healthcare providers and state and local health
• Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential

Consider screening employees for coronavirus symptoms each day in a way that protects their confidentiality and send home employees if symptomatic. Employers should have a plan to screen employees or volunteers every day. This could include implementing a thermometer station at the employee entrance. Employees or volunteers who appear to have symptoms (i.e., fever, cough, or shortness of breath) upon arrival at work or who become sick during the day should immediately be separated from other employees, customers, and visitors and sent home.

If an employee is confirmed to have COVID-19 infection, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). The fellow employees should then self-monitor for symptoms (i.e., fever, cough, or shortness of breath).

Be aware that some employees may be at higher risk for serious illness, such as older adults and those with chronic medical conditions. Consider minimizing face-to-face contact between these employees or assign work tasks that allow them to maintain a distance of six feet from other workers, customers and visitors.

Provide COVID-19 prevention disease training to all employees, and specific training on new store protocols related to COVID-19 protective measures. Educate employees on the steps to protect themselves and to reduce the spread of COVID-19. Post CDC guidelines in breakrooms and discourage employees with key symptoms from coming to work.

Social distancing recommendations must be met (i.e., limit contact of people within 6 feet from each other). Consider: only operating every other register or check-out lane, ensuring work space between workers is at least 6 feet, staggering work schedules if possible, limiting in-person meetings, ensuring break areas accommodate social distancing.

• Support your employees by relaxing all existing production standards and productivity monitoring systems for the duration of this event. Talk to staff regularly to ensure their feedback is being heard and concerns are being addressed as able.
• Explore scheduling adaptations to accommodate childcare arrangements.
• For employee working overtime and shift work, make sure that there are at least 12 hours from the end of one shift to the beginning of the next shift so that employees working extra hours have plenty of time to travel to and from home and get 8 hours of sleep.
• Be alert for and do not tolerate racism or discrimination against workers or customers.
• Consider paid leave time to cover the quarantine, isolation and COVID-19 related illnesses for your employees. Consider waiving any waiting or accrual period outlined in leave time policy or union contract.
• Put up signage about the changes in business model and practices so customers know what to expect and how to protect themselves.
• Explore ways to reduce handling of paper coupons, including substitutes that will not present a hardship to customers.
• Consider waiving grocery pick-up fees for customers to avoid in-store crowds. Encourage the use of credit cards over cash.

Tips for Employees

Retail food workers are among the heroes of the COVID-19 pandemic response. We need to protect the health of retail food workers throughout the duration of the pandemic. Employees can take steps to protect themselves at work and at home.

Retail food workers are feeling the pressure of trying to keep shelves stocked. They are working faster, skipping breaks, and working more hours. Stress, fatigue, and constant exposure to the public can make retail workers more vulnerable. Take breaks! Other people’s urgency is real, but it cannot come at the expense of your health.

• Take extra hand washing breaks. Wash hands often with soap and water for at least 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water. Keep in mind that everything you scan at the cash register was handled by multiple people including customers; and that you handle money, coupons, and credit cards or store cards. Use the hand scanner for store cards, if possible.
• Consider sanitizing hands in between checking out each customer if sanitizer is available. Whether sanitizer is available or not, take your hand washing breaks. There is no substitute for proper hand washing.
• If sanitizer is available for customer use, encourage customers to use after touching pads, pens, or other items around the register during checkout. Whenever possible, limit customers’ touching items around the register.
• Avoid touching your eyes, nose, and mouth with unwashed hands. Secure your hair, to avoid having to touch your face to adjust stray hairs. Make a concerted effort to keep your hands away from your face, eyes, nose and mouth while working.
• Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues in the trash and immediately wash hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer containing at least 60% alcohol. Learn more about coughing and sneezing etiquette on the CDC website.
• Clean AND disinfect frequently touched objects and surfaces such as workstations, keyboards, telephones, handrails, and doorknobs. Dirty surfaces can be cleaned with soap and water prior to disinfection. To disinfect, use products that meet EPA’s criteria for use against SARS-CoV- 2external icon, the cause of COVID-19, and are appropriate for the surface.
• If you use a cellphone, remember that you touch it with your hands and hold it against your face. Use a disinfecting wipe on it regularly and before you take it home where family members might use it.
• Do not use other workers’ phones, work tools, or share food or beverages. Clean and disinfect communal tools before and after use.
• Take care of your own health. Get plenty of sleep. Get the flu shot, keep all your other vaccinations up-to-date, including tetanus.
• Immediately notify your manager if you feel unwell before, during, or after a shift. If you are sick, please stay home.

The Pennsylvania Department of Health has finalized COVID-19 infographics and social graphics that can be downloaded from the department’s social media resources page.

CMS has taken several recent actions in response to the Coronavirus Disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts.  A summary of recent CMS activities can be found here:  https://www.cms.gov/newsroom/press-releases/cms-news-alert-march-26-2020

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 CMS News Room and Current Emergencies Website.

March 26, 2020

Harrisburg, PA – Pennsylvania Governor Tom Wolf announced the creation of a new web portal that will expedite the procurement of critical medical supplies for Pennsylvania’s health care system during the COVID-19 pandemic.

“The commonwealth, and the nation, is facing an unprecedented and uncertain time, and as we work to flatten the curve we must also ramp up efforts to provide Pennsylvania’s health care system with the critical supplies it needs to treat individuals with COVID-19,” said Gov. Wolf. “By consolidating the efforts of various state agencies, we will streamline the procurement process and allow these supplies to get to our health care providers and medical professionals as quickly as possible.”

The Commonwealth of Pennsylvania Critical Medical Supplies Procurement Portal was developed through a joint effort between the Pennsylvania Emergency Management Agency, the Department of Health, the Department of General Services, and the Department of Community and Economic Development to source the most needed supplies for medical providers, emergency responders, and health care professionals.

The Portal is for manufacturers, distributors and other suppliers to inform us of supplies available for purchase and will allow us to more quickly and efficiently procure these supplies for hospitals and medical facilities across Pennsylvania.

Links for the Expansion of Supply Chain Capacity and Manufacturing Innovation and Donations will also be available very soon for those organizations who wish to inform the commonwealth of their expanded supply chain and manufacturing capacity or to donate goods and services for distribution across Pennsylvania.

Most needed personal professional equipment includes: surgical/procedure masks, N95/N99 Form Fitting Respirators, face masks with integrated shields, Powered Air Purifying Respirators (PAPR), and alcohol-based hand rubs. Needed hospital supplies include: ventilators with PEEP functionality, ventilator circuits, endotracheal tubes, and hospital gowns. Needed lab supplies include: UVT 3 mL with flocked flex minitip and Nasopharyngeal (NP) flocked swabs and viral transport media tubes (1-3 mL). Needed diagnostic supplies include: Roche MagNA Pure 96 DNA and Viral NA small volume kits, Roche MagNA Pure 96 system fluid and tips, Roche MagNA Pure 96 external lysis buffer, and Biomerieux NuciSENS EasyMAG extraction system and supplies.

Questions on the portal can be directed to the Department of General Services at RA-procinternet@pa.gov.

For the most up-to-date information on COVID-19, Pennsylvanians should follow www.governor.pa.gov and www.doh.pa.gov.

MEDIA CONTACT:Lyndsay Kensinger, RA-GVGOVPRESS@pa.gov; Casey Smith,  casesmith@pa.gov

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ARC is carefully and continually monitoring the COVID-19 situation as it is impacting the Appalachian Region. ARC staff, who are now primarily working from home, are diligently continuing to process and administer grants, new applications, progress reports, and payment requests as they are received.

We are assisting grantees whom are unable to meet project goals or timelines due to the current situation. If you are a current ARC grantee experiencing such challenges, please email your ARC project coordinator and state program manager as soon as possible for help with needed accommodations regarding your project’s deliverables, timelines, budget, or other operations. (When emailing, please put your ARC project number in the subject line. This will make responding to your request easier).

To support the health and safety of our partners, grantees, and communities, we have also made the following adjustments:

• We have extended the application deadline for the Appalachian Entrepreneurship Academy to March 31, 2020. Should this program, or the ARC/ORNL Summer STEM program, need to be modified further, an announcement will be made in mid-April.
• We have extended the deadline for POWER applications to April 24, 5 pm ET. Additional revisions can also be made to applications already submitted to power.arc.gov during this thirty day extension.
• We are convening the Appalachian Leadership Institute virtually through online learning modules in lieu of the upcoming field seminars scheduled for Beckley, West Virginia and Boone, North Carolina.
• We have postponed Envision Appalachia: Community Conversations for ARC’s New Strategic Plan. Our intent is to restart our strategic planning process at a time when we can gather in-person to discuss our Region’s future.

We will be posting any additional ARC operational updates on www.arc.gov/coronavirus, and in forthcoming issues of In The Region.

This is a challenging time for our communities, our Region, and our country. Please continue to check with state and federal authorities for health-related guidance and information.

As the COVID-19 Pandemic continues, communities across Appalachia are banding together to pool resources and ideas for resilience. Here are some inspiring examples:

• LaunchTN, an ARC partner, is providing a variety of resources including state government contacts for health, small business needs, and other support services. Check out their website for more information.
• To help individuals and small-business owners in eastern Kentucky, Shaping Our Appalachian Region (SOAR), another ARC partner, has created thereisafuture.org/covid19 to encourage partners to “be aware not afraid.” The site also includes a survey for local businesses and organizations in Eastern Kentucky.

Non-profit Rural Action and ACEnet are organizing the Athens County Response Fund to provide support to Athens County businesses, employees and organizations in Ohio. The funds are intended to complement the work of other local efforts to ensure all aspects of the outbreak are addressed.

The Appalachian Regional Commission announced two new tools documenting the spread of COVID-19 at the regional and county levels. 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 March 26th, at 1:30 pm (ET), there were 1,686 confirmed cases in 208 Appalachian counties.

The second tool, 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.

These resources are available at https:/www.arc.gov/coronavirus

Washington, D.C., March 26 – Last night Senate leaders voted unanimously to move forward on the $2 trillion-dollar emergency stimulus bill meant to help our nation respond to the COVID-19 pandemic. The bill, originally called the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), now goes to the House of Representatives for a vote. If passed, then it will go to the President’s desk to become law.

You can read more about the bill on the Senate Appropriations Committee website HERE.

However, what does this mean for the millions of American living with disabilities? What provisions will specifically impact or help the disability community? What help is there for actual people with disabilities who are uniquely at-risk to the impact of the virus?

RespectAbility and a host of other disability advocacy organizations have been working around the clock to answer these questions for the past several days. Those that lobby have been fighting hard to include key provisions into the law that will help the more than 56 million Americans with disabilities.

These efforts resulted in 12 explicit references to disabilities/people with disabilities in the final text of the bill, which can be accessed online. They are on pages 186-187, 192-193, 330-331, 741-742, 759-760 and 870-871.

How will this bill help me as an individual with disabilities?

The most direct way that the CARES Act will help individuals with and without disabilities who are struggling right now is through recovery rebates for individuals. This will be a one-time cash payment sent from the government to all U.S. residents who are not a dependent of another taxpayer, and have a Social Security Number with adjusted gross income up to $75,000 ($150,000 if you are married), with a phaseout for incomes between $75,000 and $99,000, ($150,000-$198,000 if you are married).

The amount of that check will be $1,200 for eligible individuals and $2,400 for people who are married, plus $500 per dependent child. This is being characterized as a rebate, which means it will NOT be counted against the asset limits faced by people with disabilities if spent within 12 months of receipt.

However, as it is currently crafted, people with disabilities who are on Supplemental Security Income (SSI) will have to file their taxes. This could create a major burden for many of the poorest people with disabilities and other low-income communities, many of whom will find access to filling out the forms a challenge. See page 144 of the bill for more details. Disability organizations already are preparing to push for clarity and guidance from the government on this issue.

How will this bill impact workers with disabilities and others who may have lost their jobs?

This bill includes major changes and supports for the unemployment insurance (UI) system under the U.S. Department of Labor (DOL). Unemployed workers with and without disabilities will receive $600 increase in the weekly checks. The bill also creates a Pandemic Unemployment Assistance (PUA) that expands UI coverage. Critically that coverage has been expanded to include self-employed workers, gig workers and independent contractors.

This is great news for many people with disabilities who engage in the gig economy, drive for Uber, or run their own small businesses.

The bad news is that the Pandemic Unemployment Compensation only extends to July. Given the uncertainties of the virus and the economy, whether that will be enough time remains an open question.

It also is unclear how this will play out in individual circumstances. We were contacted by an individual who currently works part time at income level that allows him to continue to collect SSI and/or SSDI. Interestingly, the bill passed by the Senate adds $600 per week to the unemployment payment regardless of the amount of the lost income, and so he is rightfully concerned that if he follows the instructions from his job, from which he was just furloughed, and files for unemployment, he will lose these important benefits because his income from unemployment will be too high.

As the House still needs to pass its version of the bill before being sent to the President for signature, we hope that this seemingly unintended result, as well as other confusions, will be resolved in conference. RespectAbility will keep you up-to-date.

How will this bill help caregivers or people who need paid sick leave?

Unfortunately, this bill does not include any additional provisions to help workers who do not already receive paid sick leave or who are now receiving sick leave through the earlier Families First Coronavirus Response Act.

People with disabilities must know they are secure in this time of crisis. Thus, further advocacy is needed to cover these gaps in coverage and ensure that family members who need to take leave in order to meet the critical needs of their loved ones are covered.

How will this bill impact students with disabilities who are now learning from home?

Teachers and special educators are facing significant challenges around how to provide a free, appropriate public education to students with disabilities when you can only connect through a computer screen. The bill will give states more than $30 billion dollars to provide Emergency Education Relief grants to help teachers and students with and without disabilities to make the switch to online learning and virtual classrooms. See pages 192 and 193 for more details.

These grants will specifically help teachers meet the needs of students with disabilities in these trying times. Likewise, some of those funds can be used to provide summer learning, supplemental after-school programs and online learning for students with disabilities. Details on pages 759-760.

Disability advocates had been very concerned that the original bill included several provisions waivers from the explicit requirements of laws such as Individuals with Disabilities Education Act (IDEA). The new version of the bill requires the Secretary of Education to report to Congress within 30 days about where, how and why waivers are being used and students with disabilities are accessing online learning. See pages 741 and 742 for more details.

How will this bill help organizations serving people with disabilities?

The bill would specifically distribute $955 million for Aging and Disability Services Programs under the mandate of the Administrative on Community Living (ACL). That money will go to support nutrition programs providing people with disabilities and older Americans with food deliveries as well as direct support for family caregivers.

That amount also includes $50 million dollars for aging and disability resource centers across the country as well as $85 million dollars for Centers for Independent Living (CILs). Pages 330 and 331 for those interested. Further, the bill invests $15 million to support housing specifically for people with disabilities.

Addressing the critical issue of Direct Support Professionals (DSPs) who help people with disabilities, the CARES Act crucially will now allow state Medicaid programs to pay for DSPs to help people with disabilities who end up in the hospital. This should provide some reassurance for people with disabilities who need support for activities of daily living, but many other needs regarding DSPs and maintenance of the DSP workforce through this crisis remain unaddressed.

What is missing from the bill?

The CARES Act does not address the life or death issue of medical rationing facing the disability community in this moment of crisis. As the crisis intensified in Italy, the government rationed healthcare away from people with disabilities. This approach already is illegal under American law, but it still happens, nonetheless. In this time of crisis, the state and local leaders making on the ground decisions need to hear a clear message about treating people with disabilities equally.

Lastly, the bill does nothing to support some of the most vulnerable people with disabilities in America today. The bill contains no mention whatsoever about immigrants (with or without disabilities) or people who are incarcerated. Census Bureau data shows that there are more than 44 million immigrants living in the United States and out of that number, up to 6 million are probably living with a disability. How are they going to be helped or harmed by this bill? There are no clear answers yet. Likewise, there is no relief or support for the estimated 750,000 people with disabilities who are currently imprisoned.

In the meantime, the staff at RespectAbility will continue monitoring this situation and encourage you to make your voices heard to your elected officials. If you have specific questions about this Bill, please email or call your members of Congress. Locate your U.S. senators’ contact information and find your U.S. representative’s websites.

If you would like to know more about how COVID-19 is impacting the disability community, we encourage you to review and make use of the following resources and materials:

• https://www.respectability.org/2020/03/covid-19-key-issues-resources/
• https://acl.gov/COVID-19

RespectAbility will continue to provide updates and insights on these issues at www.respectability.org/covid-19.

Media Contact: 

Lauren Appelbaum, VP for Communications, RespectAbility

LaurenA@RespectAbility.org, 202-591-0703

From the National Rural Health Association (NRHA)

The Senate has passed the third in a series of bills in response to COVID-19 (S. 3548/H.R. 748). The House is expected to take action on the legislation later this week. In the language, there is $127 billion to the Assistant Secretary for Preparedness and Response to include $100 billion in grants to hospitals and other Medicare and Medicaid suppliers to cover unreimbursed health care related expenses or lost revenue related to COVID-19. Additional funding includes $275 million to HRSA to support rural hospitals and critical access hospitals and telehealth, $200 million to CMS to assist nursing homes and $955 million to the Administration for Community Living to support nutrition programs and home and community-based services. Here are the Appropriations Sections in full and a Appropriations Summary. Note: This list is not exhaustive, as NRHA’s full analysis of the bill continues. Please see a list of important provisions below.  Read the full bill here.

Public Health and Social Services Emergency Fund

• The legislation would make available $100 billion to reimburse eligible health care providers for health care-related expenses or lost revenues not otherwise reimbursed that are directly attributable to COVID-19. Eligible providers are defined as public entities, Medicare- or Medicaid enrolled suppliers and providers, and other for-profit and non-profit entities as specified by the Health and Human Services (HHS) Secretary. Funding would be on a rolling basis through “the most efficient payment systems practicable to provide emergency payment.”

Hospital Payments

• Sec. 3719. Expansion of the Medicare Hospital Accelerated Payment Program During The COVID-19 Public Health Emergency: This section would expand, for the duration of the COVID-19 emergency period, an existing Medicare accelerated payment program. Hospitals, especially those facilities in rural and frontier areas, need reliable and stable cash flow to help them maintain an adequate workforce, buy essential supplies, create additional infrastructure, and keep their doors open to care for patients. Specifically, qualified facilities would be able to request up to a six-month advanced lump sum or periodic payment. This advanced payment would be based on net reimbursement represented by unbilled discharges or unpaid bills. Most hospital types could elect to receive up to 100 percent of the prior period payments, with Critical Access Hospitals able to receive up to 125 percent. Finally, a qualifying hospital would not be required to start paying down the loan for four months and would also have at least 12 months to complete repayment without a requirement to pay interest.

Support for Health Care Providers

• Sec. 3211. Supplemental awards for health centers: Provides $1.32 billion in supplemental funding to community health centers on the front lines of testing and treating patients for COVID-19.
• Sec. 3212. Telehealth network and telehealth resource centers grant programs: Reauthorizes HRSA grant programs that promote the use of telehealth technologies for health care delivery, education and health information services. Telehealth offers flexibility for patients with, or at risk of contracting, COVID-19 to access screening or monitoring care while avoiding exposure to others.
• Sec. 3213. Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Grant Programs: Reauthorizes HRSA grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services. Rural residents are disproportionately older and more likely to have a chronic disease, which could increase their risk for more severe illness if they contract COVID-19.
• Sec. 3216. Flexibility for members of National Health Service Corps during emergency period: Allows the Secretary of HHS to reassign members of the NHSC to sites close to the one which they were originally assigned, with the member’s agreement, in order to respond to the COVID-19 public health emergency.

Small Business Loans:

• Sec. 1102. Title I – Small Business Administration loan program provides a maximum of $10 million loans. Defines eligibility as small business, 501(c) (3) non-profit, 501(c)19, or certain tribal groups with not more than 500 employees (unless there is a higher industry standard). Sec. 1106 includes loan forgiveness provisions. Borrower shall be eligible for loan forgiveness equal to the amount spent by the borrower during an 8-week period of payroll costs, interest payment on mortgage, rent or lease. Amounts forgiven may not exceed the principal amount of the loan. Eligible payroll costs do not include salaries that exceed $100,000.
• Also waives borrower and lender fees, waives “credit elsewhere” test, and waives collateral and personal guaranteed requirements. Maximum interest rate of 4% and no pre-payment penalties Complete deferment of loan repayment is deferred by 6 months.

Telehealth:

• Sec. 3701. Health Savings Accounts for Telehealth Services: This section would allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible, increasing access for patients who may have the COVID-19 virus and protecting other patients from potential exposure.
• Sec. 3703. Expanding Medicare Telehealth Flexibilities: This section would eliminate the requirement in Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (Public Law 116-123) that limits the Medicare telehealth expansion authority during the COVID-19 emergency period to situations where the physician or other professional has treated the patient in the past three years. This would enable beneficiaries to access telehealth, including in their home, from a broader range of providers, reducing COVID-19 exposure.
• Sec. 3704. Allowing Federally Qualified Health Centers and Rural Health Clinics to Furnish Telehealth in Medicare: This section would allow, during the COVID-19 emergency period, Federally Qualified Health Centers and Rural Health Clinics to serve as a distant site for telehealth consultations. A distant site is where the practitioner is located during the time of the telehealth service. This section would allow FQHCs and RHCs to furnish telehealth services to beneficiaries in their home. Medicare would reimburse for these telehealth services based on payment rates similar to the national average payment rates for comparable telehealth services under the Medicare Physician Fee Schedule. It would also exclude the costs associated with these services from both the FQHC prospective payment system and the RHC all-inclusive rate calculation.
• Sec. 3706. Allowing for the Use of Telehealth during the Hospice Care Recertification Process in Medicare: Under current law, hospice physicians and nurse practitioners cannot conduct recertification encounters using telehealth. This section would allow, during the COVID-19 emergency period, qualified providers to use telehealth technologies in order to fulfill the hospice face-to face recertification requirement.

Other Medicare Provisions:

• Sec. 3709. Increasing Provider Funding through Immediate Medicare Sequester Relief: This section would provide prompt economic assistance to health care providers on the front lines fighting the COVID-19 virus, helping them to furnish needed care to affected patients. Specifically, this section would temporarily lift the Medicare sequester, which reduces payments to providers by 2 percent, from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care. The Medicare sequester would be extended by one-year beyond current law to provide immediate relief without worsening Medicare’s long-term financial outlook.
• Sec. 3710. Medicare Add-on for Inpatient Hospital COVID-19 Patients: This section would increase the payment that would otherwise be made to a hospital for treating a patient admitted with COVID-19 by 20 percent. It would build on the Centers for Disease Control and Prevention (CDC) decision to expedite use of a COVID-19 diagnosis to enable better surveillance as well as trigger appropriate payment for these complex patients. This addon payment would be available through the duration of the COVID-19 emergency period.
• Sec. 3713. Eliminating Medicare Part B Cost-Sharing for the COVID-19: Vaccine This section would enable beneficiaries to receive a COVID-19 vaccine in Medicare Part B with no cost-sharing.
• Sec. 3718. Preventing Medicare Clinical Laboratory Test Payment Reduction: This section would prevent scheduled reductions in Medicare payments for clinical diagnostic laboratory tests furnished to beneficiaries in 2021. It would also delay by one year the upcoming reporting period during which laboratories are required to report private payer data

Community Health Centers

• Sec. 3831. Extension for Community Health Centers, the National Health Service Corps, and Teaching Health Centers that Operate GME Programs: This section extends funding for the three programs until November 20^th, 2020.

Indian Health Services

• Includes an additional $1 billion for the Indian Health Services to remain available until September 30, 2021, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for public health support, electronic health record modernization, telehealth and other information technology upgrades, Purchased/Referred Care, Catastrophic Health Emergency Fund, Urban Indian Organizations, Tribal Epidemiology Centers, Community Health Representatives, and other activities to protect the safety of patients and staff (pg. 718).

Medicaid

• Sec. 3720. Providing State Access to Enhanced Medicaid FMAP: This section would amend a section of the Families First Coronavirus Response Act of 2020 (Public Law 116-127) to ensure that states are able to receive the Medicaid 6.2 percent FMAP increase.
• Sec. 3801. Extension of Physician Work Geographic Index Floor: This section would increase payments for the work component of physician fees in areas where labor cost is determined to be lower than the national average through December 1, 2020.
• Sec. 3811. Extension of Money Follows the Person Demonstration Program: This section would extend the Medicaid Money Follows the Person demonstration that helps patients transition from the nursing home to the home setting through November 30, 2020.
• Sec. 3813. Delay of Disproportionate Share Hospital Reductions: This section would delay scheduled reductions in Medicaid disproportionate share hospital payments through November 30, 2020.
• Sec. 3715. Providing Home and Community-based Support Services during Hospital Stays: This section would allow state Medicaid programs to pay for direct support professionals, caregivers trained to help with activities of daily living, to assist disabled individuals in the hospital to reduce length of stay and free up bed
• Sec. 3813. A 6-month delay in Medicaid DSH cuts. The last delay would have expired May 23^rd, 2020 but is delayed through November 30^th, 2020.

Rural Development

• $20.5 million in new money in rural business loans and grants through the USDA to “prevent, prepare, and respond to COVID-19”
• $25 million to support the Distance, Learning, and Telemedicine program for rural communities for COVID-19 related care. This increase will help improve distance learning and telemedicine in rural areas of America.
• $100 million is provided to the ReConnect program to help ensure rural Americans have access to broadband, the need for which is increasingly apparent as millions of Americans work from home across the country.

Other Public Health and Social Services Emergency Fund

• Increasing the National Stockpile: Provides $16 billion for medical supplies to be deposited in the Strategic National Stockpile.

Hospital Preparedness Program: Provides $250 million available for grants to or cooperative agreements with entities that are either grantees or sub-grantees of the Hospital Preparedness Program authorized in section 7 319C–2 of the Public Health Service Act or that meet such other criteria as the Secretary may prescribe, with such awards issued under such section or section 311 of the act.