The National Rural Health Association (NRHA) is here to be responsive to the needs of their members during the COVID-19 pandemic. Their commitment is to provide their members with the latest information and resources available to help them provide care for the patients of rural America. Additionally, NRHA’s advocacy team continues to fight to make sure that members have the resources and abilities needed to control and manage this pandemic. NRHA will continue to:

1. Provide access to the latest COVID-19 federal information fact sheets, and resources. They have launched a COVID 19 Resource page linked here;
2. Continue their advocacy fight with the Administration and Congress to ensure rural providers have the resources needed to both provide patient care and protect their workforce. Here is what NRHA is fighting for (also attached via Connect);
3. Provide an open-forum on NRHA Connect to allow real-time discussions of best practices, open concerns and shared information; and
4. Be the rural voice. NRHA continues to work with federal leadership, as well as national, state and local media to outline the needs of their members, in this unprecedented time.

NRHA’s online Grassroots Forum has generated quite a bit of feedback on issues relevant theiro you, our members. In summary, the thread included these topics:

• Section 1135 waiver process
• Waiver of the 72-hour rule (does it apply to Swing Beds?)
• Rural Health Clinics (RHC) as an originating site for virtual E&M visits and billing for same?
• Emergency licensure of physicians and other health care professionals to meet workforce needs for a growing demand for services
• Personal Protective Equipment (PPE) availability, stock outs of essential supplies

Before you share information about COVID19, make sure you are getting your information from reliable sources. For information about the disease, symptoms and resources, the best source is the Centers for Disease Control and Prevention. Their website is located at  https:// www.cdc.gov/coronavirus/2019-nCoV/index.html.

eXtension is providing the Extension Response to COVID19 and Resources for Extension Professionals Working Online. The purpose of this website is to provide a means through which Extension educators and administrators can share with their Cooperative Extension colleagues various resources and guides about teaching and working virtually, and provide a listing of current institutional responses to COVID-19. The current list of resources is just a beginning; it needs your additional contributions and expertise. Visit their website at https://virtual.extension.org/?utm_source=eXtension%20People%20Directory%20List&utm_campaign=0e60f19b34-EMAIL_CAMPAIGN_10_8_2018_16_31_COPY_01&utm_m­edium=email&utm_term=0_ce656dc9a5-0e60f19b34-53497099.

Webinar: What Ag Producers Need to Know about COVID19

Coronavirus has gained attention worldwide as an emerging infectious disease. This webinar is intended to share evidence-based information about COVID19 and to help agricultural producers identify strategies for responding on their farm.  Thursday, April 2nd at 12:00 PM—1:00 PM CDT. Click HERE to register.

With states taking actions such as closing bars and restaurants or banning large gatherings to fight the spread of the coronavirus, the personal-finance website WalletHub today released its report on the Most Aggressive States Against the Coronavirus as well as accompanying videos.

To identify which states are taking the largest actions to combat coronavirus, WalletHub compared the 50 states and the District of Columbia across 35 key metrics. The data set ranges from tested cases of COVID-19 per capita and state legislation on the pandemic to the uninsured population and share of the workforce in affected industries. Below, you can see highlights from WalletHub’s report, along with a Q&A with WalletHub analysts.

Note: Rankings reflect data available as of 5 p.m. ET on March 16, 2020.

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

The HHS Secretary declared a public health emergency, which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus is available. Learn about blanket waivers issued by CMS. These waivers prevent gaps in access to care for beneficiaries impacted by the emergency.

See the press release outlining our announcement.

On March 16, 2020, President Donald Trump asked hospitals to activate their emergency preparedness plans and declared the COVID-19 outbreak a national emergency, which will allow HHS to give providers more flexibility.  “I’m also asking every hospital in this country to activate its emergency preparedness plan so that they can meet the needs of Americans everywhere,” Trump said.

Ambassador Debbie Birx, the Trump administration’s coronavirus response coordinator, said that hospital emergency preparedness plans could include delaying elective procedures to ensure availability of hospital beds.

The emergency declaration, in conjunction with the administration’s prior designation of COVID-19 as a public health emergency on January 31, frees up to $50 billion in federal disaster relief funding, Trump said, and provides the HHS secretary with more authority to waive some Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements.

Trump highlighted that the HHS secretary will have authority to waive several requirements hospitals had voiced concerns about, including the 3-day hospital stay requirement for skilled nursing facility coverage; limits on numbers of beds and length of stay in Critical Access Hospitals; requirements that providers have a license in the state in which they are providing services if they have an equivalent license in another state; HIPAA requirements that could be an obstacle to telemedicine accessibility; and easing restrictions on where certain patients can be treated within a hospital.

“We’ll remove or eliminate every obstacle necessary to deliver our people the care that they need, and that they’re entitled to. No resource will be spared, none whatsoever,” Trump said.

It is unclear precisely how much money would be available for which purposes, but the government has wide discretion in how federal emergency funds are spent, said Georgetown University adjunct law professor and Avalere consultant Nick Diamond.

“The law affords a lot of flexibility for funds to be used in concert with some of the waivers, so there is a possibility for reimbursement for services provided by providers in some of their response efforts,” Diamond said.

The American Hospital Association, American Medical Association and American Nurses Association on Thursday wrote a letter to Vice President Mike Pence, who heads the White House coronavirus response effort, asking for an emergency declaration.

“Physicians, nurses, first responders, and other healthcare professionals across the country are on the front lines in this effort, and streamlining critical processes is vitally important to prevent the further spread of COVID-19,” AMA President Dr. Patrice Harris said in a statement.

Trump also said the administration is in discussions with pharmacies and retailers to set up drive-through testing sites in locations determined by public health officials.

Sen. Rick Scott (R-Fla.), a former Florida governor and health system executive, said he told President Donald Trump on a phone call Thursday that Scott wanted an emergency declaration to provide funding for mobile COVID-19 testing sites to minimize exposure for healthcare workers in primary care and hospital settings who may not have sufficient personal protective equipment.

“I have talked to a lot of hospitals inside and outside the state, and their main concern is how do we make sure they don’t lose their workers?” Scott said.CMS Administrator Seema Verma said Friday that the agency will issue guidance instructing nursing homes to restrict all visitors and non-essential personnel, with exceptions including end-of-life situations.

Senate Democrats had also called upon the administration to declare a national emergency under the Stafford Act.

“Calling for a national emergency under the Stafford Act would free up lots of FEMA’s resources to help states and localities. Why he hasn’t done it is a mystery. We need him to do it, and do it now,” Senate Minority Leader Chuck Schumer (D-N.Y.) said on the Senate floor on Thursday.

Additional guidance on what types of waivers the Trump administration will allow is expected soon. Similar authorities to those outlined by Trump were invoked in the 2009 H1N1 pandemic.

• For updates on the Novel Coronavirus Disease 2019 (COVID-19), refer to the Centers for Disease Control and Prevention’s (CDC’s) dedicated website. Also available in Spanish.  CDC.gov/Coronavirus/2019-ncov
• For local information and for recommendations on community actions designed to limit exposure to COVID-19, check with your state and local public health authorities https://go.usa.gov/xdFg4
• For guidance and instruction on specific prevention activities relative to your faith community’s tradition and practices, refer to your national and regional denominations.

Additional Resources

• Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission.
• Interim Guidance: Get Your Mass Gatherings or Large Community Events Ready for Coronavirus Disease 2019 (COVID-19)
• Interim Guidance: Get Your Community- and Faith-Based Organizations Ready for Coronavirus Disease 2019 (COVID-19)
• Preventing COVID-19 Spread in Communities including guidance for homes, schools, and workplaces
• Track efforts by the federal government, the following websites have been launched:
• English: USA.gov/Coronavirus
• Spanish: https://gobierno.USA.gov/Coronavirus

Guidance to Prepare Homeless Shelters

People experiencing homelessness are an especially vulnerable population. CDC released guidance on March 9, to help homeless shelters plan, prepare, and respond to COVID-19. The guidance can be found here.

Guidance for School Settings UPDATED

CDC’s Coronavirus Disease-2019 (COVID-19) interim guidance for school settings.

On March 16, 2020, the Centers for Medicare & Medicaid Services (CMS) is posting a fact sheet to the CMS.gov website to aid Medicare providers with information relating to the pricing of both the CDC and non CDC tests.  You can find the fact sheet here:  https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf

Additionally, CMS will be tweeting about this new information.  Tweets can be found below. We encourage relevant stakeholders to retweet.

• Medicare will be covering  #COVID19 tests, and there is generally no copay for original #Medicare – deductible applies. @CMSGov is also permitting #MedicareAdvantage plans to waive cost sharing for these tests.
• #Medicare’s initial payment for the @CDCgov test will be about $36 & non-CDC tests will be around $51. These prices may vary slightly depending on the local Medicare Administrative Contractor (MAC). View the full price by MAC list here:  https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf

Earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work CMS is doing in response to COVID-19, please visit the Current Emergencies Website.

On March 16, 2020, as part of the broader Trump Administration announcement on Friday, the Centers for Medicare & Medicaid Services (CMS) announced critical new measures designed to keep America’s nursing home residents safe from the 2019 Novel Coronavirus (COVID-19). The measures take the form of a memorandum and is based on the newest recommendations from the Centers for Disease Control and Prevention (CDC). It directs nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities inside nursing homes. The new measures are CMS’s latest action to protect America’s seniors, who are at highest risk for complications from COVID-19. While visitor restrictions may be difficult for residents and families, it is an important temporary measure for their protection.

You can find the press release here: https://www.cms.gov/newsroom/press-releases/cms-announces-new-measures-protect-nursing-home-residents-covid-19

And the Memo Nursing Home Guidance QSO-20-14 –NH here: https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf

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