The Centers for Disease Control and Prevention (CMS) has announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19)

CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs.  For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report.

CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.

You can find a copy of the press release here:  https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting

CMS will continue monitoring the developing COVID-19 situation and assess options to additional relief to clinicians, facilities, and their staff so they can focus on caring for patients.

The Trump Administration has released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of tools available to maximize responsiveness to state needs. The agency has created four checklists that together will make up a comprehensive Medicaid COVID-19 federal authority checklist to make it easier for states to receive federal waivers and implement flexibilities in their program.

The tools include:

• 1115 Waiver Opportunity and Application Checklist
• 1135 Waiver Opportunity and Application Checklist
• 1915(c) Appendix K Template
• Medicaid Disaster State Plan Amendment Template

You can find a copy of the press release here: https://www.cms.gov/newsroom/press-releases/trump-administration-releases-covid-19-checklists-and-tools-accelerate-relief-state-medicaid-chip

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

American Society of Health-System Pharmacists (ASHP) has completed an evaluation of the evidence related to proposed treatments for people with COVID-19.  It also includes an assessment of the evidence around supportive treatments and selected chronic medications that may be used in this population.  The table will be updated regularly as new evidence becomes available. 

The Appalachian Regional Commission (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, 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.

The Pennsylvania Department of Human Services (DHS) is committed to serving vulnerable populations every day, and that commitment will not waiver in the face of an emergency.  In order to assure protection of those who are in a DHS licensed setting, staff in DHS licensed settings and our DHS licensing staff, DHS will be taking steps to address the current situation.

This communication applies to all facilities licensed by the DHS and includes the following program offices:

• Office of Developmental Programs (ODP)
• Office of Children, Youth and Families (OCYF)
• Office of Child Development and Early Learning (OCDEL)
• Office of Mental Health and Substance Abuse Services (OMHSAS)
• Office of Long-Term Living/Bureau of Human Service Licensing (BHSL)

1. From March 16 to March 30, DHS will not be conducting any annual licensing inspections. Any inspections scheduled for this timeframe will be completed as soon as possible once normal operations resume.
2. Licensing staff will continue to conduct on-site investigations for any serious incident or complaint during this time period.
3. If a facility currently has a provisional license or its revoked license is under appeal, an on-site visit may occur as necessary during this time.
4. Currently, DHS is not able to send out annual license renewals. As such, if during this time you would have received a renewed license packet then your existing license is still valid.
5. As previously announced, childcare centers and group childcare homes located outside of a residence must close unless they have applied for a waiver to continue to operate.  Group childcare homes located in a residence and family childcare homes may choose to operate without a waiver or may voluntarily close.
6. In the coming days, DHS will be issuing guidance on specific regulations that will be suspended under the authority of the Governor’s Proclamation of Disaster Emergency issued on March 6, 2020, to help providers in dealing with the current emergency and maintain a healthy environment for those they serve and their employees.
7. DHS is currently and will continue to evaluate future needs and plans for how we will conduct licensing and will support those we license. As we develop this future guidance, we will keep you informed.
8. As you have questions on any issues, please contact your regional office licensing representative. DHS staff continue to work during this time period, and you should contact the regional office using their phone number or email.
9. In addition to following the protocol at the Department of Health’s website (https://www.health.pa.gov/topics/disease/coronavirus/Pages/Coronavirus.aspx), if a facility has a person diagnosed with COVID-19, it needs to be reported to your licensing regional offices.

Developed and released by Justice for Migrant Women; Farmworker Justice; League of United Latin American Citizens (LULAC), MAFO, A National Partnership of Farmworker & Rural Organizations; Migrant Legal Action Program; National Migrant & Seasonal Head Start Association; PCUN, Oregon’s Farmworker Union; United Farm Workers Foundation; UMOS; Unidos US; Association of Farmworker Opportunity Programs; and National Farmworker Ministry

We represent the interests of the estimated two to three million farmworkers who are employed throughout the United States. Farmworkers feed the world through their labor, bringing fruits, vegetables and other crops to homes across the nation. Their work is critical, yet they and their work have not been properly valued. Farmworkers earn poverty wages, work under substandard conditions and face a myriad of health and other issues due to their living and employment conditions.

Given this reality and the onset of the global COVID-19 pandemic, we are gravely concerned about the health and welfare of the farmworker community, their families and the security of our entire food supply. While political leaders are swiftly taking measures in order to contain the outbreak, slow the spread of the virus and save lives, decisions are being made that have an impact on the lives and livelihoods of workers, including farmworkers.

Among these, measures have been taken to close schools, businesses and international borders to address this health crisis. We are grateful for all of those who are addressing this issue at all levels of government, not to mention those who are on the frontlines battling it. It is our hope that as these plans are being devised, farmworkers are not forgotten or left behind. To this end, we seek to raise concerns around some of the risks to the farmworker community should sweeping policies be enacted or procedures adopted without care to the unique concerns of differing communities.

We feel that it is urgent to raise some of the pressing issues here.

Health

While farmworkers are susceptible to the COVID-19, as with the general population, there are unique health considerations to account for, including:

• Many farmworkers often lack access to handwashing facilities with soap and water at work, making it difficult for them to routinely wash their hands as is necessary to prevent contracting or spreading of the virus.
• Farmworkers often move and work in groups, and travel in vehicles with large numbers of workers, making the social distancing requirements difficult, if not impossible, to comply with.

Access to Medical Care

Farmworkers often lack access to preventative medical assistance, health insurance and medical treatment:

• If farmworkers become ill with the COVID-19, there is concern that there are insufficient funds to provide the necessary treatment.
• Farmworkers may not have the financial resources to seek medical attention or insurance to cover the costs of their care.
• Farmworkers may not live near or have access to transportation to get them to a medical facility.
• If they are able to seek medical attention, farmworker community members may confront language barriers that make it difficult for them to get the care they need.

Housing

Farmworker housing conditions pose another concern and risk factor for potential transmission and spread of the COVID-19 within the farmworker community, especially for workers who are living in farmworker labor camps, shared dwellings and for those who are homeless. The close proximity of individuals in overcrowded dwellings is of deep concern:

• Despite the fact that there are existing housing regulations that dictate the dwelling conditions for farmworkers, particularly migratory workers, farmworkers across the nation live in homes that are overcrowded, sometimes with multiple inhabitants sleeping and living in one room.
• Many farmworkers share bathing, restroom and cooking facilities among multiple, unrelated workers.
• Some farmworkers even lack potable water, bathing facilities and soap in camp housing.  These conditions could easily give way to the spread of the COVID-19 and could potentially result in transmission to dozens and, potentially, hundreds of workers at one camp or facility.

While we are concerned about the health risks to farmworkers and their families, farmworkers also play an important role in food safety and seek the education, training and protections needed to assure the safety of our food supply.

Employment

Layoffs due to business disruptions, quarantines, illness, and stay-at-home or isolation orders from city, state or federal officials could have immense financial consequences for the farmworker community:

• Farmworkers, unlike other professionals, are not afforded the same safety nets that would permit them to miss a day, let alone multiple weeks, of work.
• Most farmworkers are not entitled to unemployment benefits, and therefore, unemployment insurance is an unrealistic option for workers whose employers may be forced to shut down on a short- or long-term basis.
• Where state or local governments issue orders to stay at home but contain exceptions for agricultural workers to produce our food, there should be special consideration of the risks that such decisions of the government pose to farmworkers and their family members.
• Workers who become sick or have to care for a sick relative do not have paid leave to allow them to care for themselves or their loved ones.
• Even where paid leave laws are in place, there is concern that these laws will not be enforced.
• Workers lack guarantees that will help ensure that they maintain their jobs if they are forced to take time off for illness or to care for sick family members.
• Some farmworker-serving programs receive funds to run employment centers for workers. Federal funding guidelines require them to stay open and in operation, which poses a risk to the workers applying for jobs, as well as those who work at the employment centers.
• Farmworkers who receive Temporary Assistance for Needy Families (TANF) financial benefits for their families are required to show that they are applying for jobs, which means that many of them regularly visit employment centers in person to apply. Large numbers of workers visit these centers daily, placing the job applicants, as well as the job center employees at potential risk.  For farmworkers, missing a day of work or an entire paycheck could mean the difference between being able to feed their families or go hungry, despite the fact that their work brings food to family tables across our nation.

Education and Childcare

Like families across the nation, farmworker parents are concerned about school and childcare closures:

• If schools and childcare centers are closed, there is a strong possibility there will be no childcare available to support working parents. Migrant and Seasonal Head Start (MSHS) centers, a federally-funded program established in 1969 across 38 states, are being asked to close their doors despite parents’ continued need to work in the fields. Program closures leave nearly 20,000 families and 30,000 children without guaranteed access to educational early care, important nutritional needs, and healthcare needs.
• Few families have the financial means to pay for quality, alternative childcare, which may be limited in rural communities.
• Failure to have viable childcare options will require parents to miss work in order to care for their children, which will result in less income for the family.
• If one parent is forced to stay home from work, this will likely result in an unbalanced negative impact on farmworker women, who are likely to bear the brunt of these childcare responsibilities.
• Single parents may be at a loss for childcare options altogether, either resulting in forced time away from work or making the decision to choose alternative, unregulated child care arrangements that may be inferior and dangerous.
• A particular concern is that parents might feel compelled to take their children to work with them in the fields, which could result in exposure to the virus, pesticides and other treacherous conditions.

Immigration and Migration

The large majority of America’s farmworkers are immigrants; they work hard to achieve the American Dream but are often living and working in difficult circumstances. More than half of farmworkers in our nation are undocumented, and many live in mixed-status families and communities. Our broken immigration system presents a threat to farmworkers’ health and safety:

• Undocumented or farmworkers living in mixed-status families may be afraid to seek medical attention if they become ill for fear of immigration action against them and their families.
• There is a risk that undocumented farmworkers or workers who are working in the US on an H-2A guestworker visa may not qualify for stimulus aid, health or other kinds of insurance that may become available to aid those who are impacted by this illness.
• At present time, it is unclear as to whether guest worker visas may be revoked and workers returned to their countries of origin prior to the end of their contract, not to mention whether incoming workers will be permitted to fulfill contracts that they have been recruited for given the current situation.
• There are concerns that restrictions might be placed on ground travel, either through the potential for a state or national quarantine, which would make it impossible and, potentially even unlawful, for farmworkers to migrate to follow the agricultural stream for work.

Violence and Exploitation

Farmworkers already face high rates of violence and exploitation at work, including gender-based violence and labor exploitation:

• The existing circumstances related to the pandemic are ripe for both violence and exploitation against farmworkers due to the increased levels of stress, anxiety and feelings of helplessness, coupled with the overall vulnerability of this population.
• Domestic violence, sexual violence and human trafficking are all real threats against farmworkers during this time of instability.
• Labor recruiters or contractors might feel more empowered to cheat workers out of their wages or commit other violations against them because they know that workers are desperate to keep their jobs, particularly when so much financial instability exists.

While the list of concerns related to the COVID-19 and its potential impact on the farmworker community is lengthy, there are also solutions that exist to limit the impact that this virus could have on farmworkers, their families, consumers and other community members. Even though farmworkers have been denied many of the basic protections afforded to other workers and workforces in the past, political leaders must take into account the ongoing and emerging needs of the farmworker community. These priorities must be considered as protocols, policies and programs are being developed to create an all-community plan to address, curb and end the COVID-19 pandemic.

Medscape, March 20, 2020

The Diversion Department of the US Department of Justice has reminded providers that the Ryan Haight Act of 2008 provides an exemption for most waivered providers prescribing Medication Assisted Treatment (MAT) to practice telemedicine while treating patients with Opioid Use Disorder (OUD). Please be sure to read the information here to learn more.

As C0VID-19 affects numerous facets of our society, it impacts individuals and their mental health in very different ways. We are all feeling uncertainty and anxiety about what could happen with this pandemic, and those feelings are very normal to experience. If you have a mental health disorder, you may be consumed with constant worry and fear or your depression symptoms may be heightened due to social distancing. The Centers for Disease Control and Prevention (CDC) has created a webpage with healthy coping skills, information for parents on how to ease the anxiety in children, and many other resources that can be helpful during this time.

Doximity, the medical professional social media platform with an effective but expensive recruitment feature, has pledged to help fill COVID-19-related MD/DO needs. Doximity will distribute these jobs or volunteer opportunities on its network free of charge. To take advantage of this offer you need to fill out the form. Doximity will distribute your job post to appropriate clinicians based on your location, specialty and any additional requirements. They will send applicants and responses directly to the contact information you provide on the form.