Rural Health Information Hub Latest News

HHS Updates COVID-19 Test Results Guidance


The U.S. Department of Health and Human Services (HHS) updated its guidance on reporting COVID-19 test results. This updated guidance will go into effect on April 4, 2022. Specifically, beginning April 4, 2022, COVID-19 testing facilities that test under a CLIA certificate of waiver are no longer required to report NEGATIVE results for tests authorized for use under a CLIA certificate of waiver, which includes PCR and antigen tests. Find the guidance here.

Preparing for the End of the COVID-19 Public Health Emergency: What Partners Need to Know 

CMS is committed to ensuring access to comprehensive health care coverage by providing partners with guidance and resources as they plan for the eventual end of the COVID-19 Public Health Emergency (PHE) and the Medicaid continuous coverage condition established under the Families First Coronavirus Response Act. Since the beginning of the Administration, the Department of Health and Human Services (HHS) has committed that it will provide states with 60 days of notice before any planned expiration or termination of the PHE to give states as much lead time as possible. In line with that commitment, CMS will be communicating early and often with states and other partners to support planning and coordination of this unwinding process. This communication is a part of that ongoing outreach.


CMS has created a new Unwinding homepage with additional tools and resources.

  • On this page, you can find the new Communications Toolkit and graphics to help partners begin reaching out to Medicaid and Children’s Health Insurance Program (CHIP) enrollees so that they are prepared for the upcoming renewal, along with several other unwinding resources.
  • The toolkit and graphics are available in both English and Spanish.


On March 3, 2022, the Centers for Medicare & Medicaid Services (CMS) provided states with additional guidance and tools as they plan for whenever the COVID-19 Public Health Emergency (PHE) does conclude. When the PHE does eventually end, states will be required, over time, to redetermine eligibility for all people enrolled in Medicaid and CHIP. The recently released guidance will help states keep consumers connected to coverage by either renewing individuals’ Medicaid or CHIP eligibility or transferring them to other health insurance options.


Right now, partners can help prepare for the renewal process by educating people with Medicaid and CHIP coverage about the upcoming changes. People with Medicaid & CHIP coverage should:

  1. Update their contact information with their State Medicaid or CHIP program; and
  2. Look out for a letter from their state about completing a renewal form.


There are three main messages that partners should focus on now when communicating with people that are enrolled in Medicaid and CHIP.

  1. Update your contact information – Make sure [Name of State Medicaid or CHIP program] has your current mailing address, phone number, email, or other contact information. This way, they’ll be able to contact you about your Medicaid or CHIP coverage.
  2. Check your mail – [Name of State Medicaid or CHIP program] will mail you a letter about your Medicaid or CHIP coverage. This letter will also let you know if you need to complete a renewal form to see if you still qualify for Medicaid or CHIP.
  3. Complete your renewal form (if you get one) – Fill out the form and return it to [Name of State Medicaid or CHIP program] right away to help avoid a gap in your Medicaid or CHIP coverage.

Sample social media posts, graphics, and drop-in articles that focus on these key messages can be found in the Communications Toolkit. The Unwinding homepage will continue to be updated as new resources and tools are released.

For more information, please contact us:

As US Nears 1 Million COVID Deaths, One Hard-Hit Pennsylvania County Grapples With Unthinkable Loss

The United States is nearing 1 million deaths from COVID — an almost incomprehensible number of lives lost that few thought possible when the pandemic began. Pennsylvania’s Mifflin County offers a snapshot into how one hard-hit community, with over 300 dead, is coping.

Connie Houtz didn’t think  would be that bad.

She’d seen many people in this rural hamlet in central Pennsylvania get infected yet recover within a few days. She did not get vaccinated because she worried about how a new vaccine, developed in record time, might affect her heart condition.

Last October, her youngest son, 45-year-old Eric Delamarter, developed a chest cold. He put off going to the doctor because he had customers waiting at his shop where he repaired cars, she said. When he finally went to the emergency room at Geisinger Lewistown Hospital, he was diagnosed with pneumonia and COVID.

Within a few days, Houtz’s oldest son, 50-year-old Toby Delamarter, had also been admitted to the hospital with the virus and shortness of breath.

Less than two weeks later, both of her sons were dead. Neither had been vaccinated.

“Even though it does not seem fair and does not seem right, down the road we will find a reason for why things happen,” said Houtz, 71, as she sat at her kitchen table.

Eric and Toby Delamarter are two of the roughly 300 people who have died of COVID in Mifflin County, where cows grazing in pastures and Amish horse and buggies are frequent sights. The county 60 miles northwest of Harrisburg leans heavily Republican — 77% of votes cast in 2020 were for Donald Trump — and the former president’s downplaying of covid-19 found fertile ground there.

Mifflin has one of the highest COVID death rates among U.S. counties with at least 40,000 people, according to government data compiled by Johns Hopkins University — 591 deaths per 100,000 residents as of mid-March, compared with 298 deaths nationally.

The United States is nearing 1 million deaths from COVID — a number that few thought possible when the pandemic began.

In March 2020, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that based on modeling of the pace of the coronavirus’s spread in the U.S. at that time, “between 100,000 and 200,000” people may die from COVID.

Reaching a million deaths seemed even more improbable when safe and effective vaccines came onto the market in December 2020. More than 60% of the 977,000 deaths have occurred since then.

Mifflin County offers a snapshot into how one hard-hit community moved from skepticism about the scientific reality of the COVID virus, and then about the vaccine, to coping with unbearable loss and processing the trauma. Roughly 8 in 10 deaths nationwide from April to December 2021 were among the unvaccinated, according to the latest analysis of data from 23 states and New York City and Seattle by the Centers for Disease Control and Prevention.

Read more.

A Study Finds Even Mild COVID-19 Causes Brain Damage

New research on the impact of COVID-19 on cognitive functioning and the brain is the first to reveal striking differences in areas of the brain based on scans taken before and after a coronavirus infection. Researchers identified COVID-19 associated brain damage months after infection, including in the region linked to smell, and shrinkage in size equivalent to as much as a decade of normal aging. Read more.

End of the COVID-19 Public Health Emergency: Medicaid/CHIP ‘Unwinding Period’ Tools and Guidance

The Centers for Medicare and Medicaid Services (CMS) compiled a webpage with state resources for the ‘unwinding period’ when the Public Health Emergency (PHE) provisions for continuous Medicaid/CHIP coverage will terminate. Recent guidance for state programs establishes a 12-month period for re-determinations of eligibility after the end of the PHE. It is anticipated that millions of people nationwide will lose coverage including many in rural communities. On this webpage CMS has provided state Medicaid/CHIP programs with toolkits for planning an orderly transition for individuals losing Medicaid/CHIP eligibility to affordable private offerings under state health exchanges.

See the resource compilation webpage here:  Unwinding and Returning to Regular Operations after COVID-19 | Medicaid

Pennsylvania Distributing No Cost OTC COVID-19 Rapid Tests for Vulnerable Populations

In order to close gaps in COVID-19 equity across the Commonwealth, the Pennsylvania Department of Health is providing OTC COVID-19 rapid tests at no cost to vulnerable populations across the Commonwealth and is seeking partners to help distribute tests in high-need communities. Partners can request tests via online form here: OTC Test Request Form. Any questions for the COVID-19 Testing Team should also be submitted using this form.

Participating organizations/entities must:

  • Be able to receive delivery of and store tests on-site
  • Determine test pickup times/dates, and local distribution strategy
  • Communicate test availability to local vulnerable populations

Please note:

  • Test quantity allocated is dependent on DOH’s supply on hand and submitting a request does not guarantee fulfillment
  • Priority will be given to sites that can access high-need populations, e.g.,
    • Areas with high social vulnerability index
    • Limited COVID-19 testing alternatives
  • Request fulfillment is limited to 2 requests per month
  • For organizations that will broadly distribute to greater communities, we will periodically update the testing website (COVID-19 Testing | PA.GOV) to list location/time/dates for distribution

Social Vulnerability:

  • Social vulnerability refers to the resilience of communities (the ability to survive and thrive) when confronted by external stresses on human health, stresses such as natural or human-caused disasters, or disease outbreaks. Reducing social vulnerability can decrease both human suffering and economic loss. Socially vulnerable populations include those who have special needs, such as, but not limited to, people without vehicles, people with disabilities, older adults, and people with limited English proficiency. The Social Vulnerability Index includes the following themes and social factors:
    • Socioeconomic status (below poverty, unemployed, low/no income, no high school diploma)
    • Household composition & disability (aged 65 or older, aged 17 or younger, older than age 5 with a disability, single-parent households)
    • Minority status & language (minority, speak English “less than well”)
    • Housing type & transportation (multi-unit structures, mobile homes, crowding, no vehicle, group quarters)
  • Additional information from CDC on the Social Vulnerability Index can be found here: CDC/ATSDR SVI Frequently Asked Questions (FAQ) | Place and Health | ATSDR

Health Experts Urge Against COVID-19 Complacency: 12 Calls to Action in New 136-page Plan

A team of 53 epidemiologists, pharmacologists, virologists, immunologists and policy experts published a 136-page report on the heels of the new COVID-19 preparedness plan released by the White House. Their plan shares similarities with that from the Biden administration but also differences, such as broadening the nation’s response to include all major respiratory viruses.

The group behind “A Roadmap for Living with COVID” is led by Ezekiel Emanuel, MD, PhD, vice provost for global initiatives at the University of Pennsylvania in Philadelphia and former advisory board member of the now-dissolved COVID-19 panel that guided President Joe Biden’s transition into office. The group includes former officials from both Republican and Democratic administrations. Find the complete listing of authors, contributors and reviewers here.

“The shift to the next normal should not induce complacency, inaction or premature triumphalism,” the authors note in their executive summary, which does not mention the Biden administration’s March 2 COVID-19 preparedness plan by name.

The roadmap is centered upon 12 calls to action:

1. Expand the focus of U.S. preparedness and response from COVID-19 to major respiratory viruses, including flu and RSV infection, with the interim goal to reduce annual deaths below the worst influenza season of the last decade.

2. Create, maintain and disseminate a transparent infectious disease dashboard to guide the public and policymakers at national, state and local levels on the introduction, modification and lifting of public health measures.

3. Strengthen testing, surveillance and data infrastructure. This includes production capacity for 1 billion at-home rapid tests per month, test-to-treat infrastructure that links testing to medical consults and treatment, and the establishment of infrastructure to rapidly collect and analyze data on population immunity.

4. Regulate the improvement and monitoring of indoor air quality. The group calls for the administration to direct the Environmental Protection Agency and Occupational Safety and Health Administration to create standards that protect workers from inhalation exposure.

5. Direct and fund HHS, including the NIH and FDA, to accelerate the development of new, more effective therapeutics, particularly multi-drug oral antivirals and next-generation vaccines that offer better, broader and longer-lasting protection. The authors want the administration to direct and fund HHS to achieve a vaccination rate of at least 85 percent by the end of 2022, which would include CMS reimbursing clinicians for discussing vaccinations with patients who are insured by Medicare and Medicare.

6. Shift the goal of U.S. contributions to the global vaccination effort from stopping infections through population vaccination coverage alone to improving the distribution and administration infrastructure necessary to fully vaccinate the most vulnerable.

7. Strengthen research on long COVID-19. The authors urge for coordinated and expanded research to answer questions on its frequency, risk factors, prognosis and benefits of vaccines and therapies for long COVID-19 within the next year, along with support for individuals experiencing the condition.

8. Create a permanent cadre of community health workers who will support populations highly susceptible to adverse outcomes from respiratory viruses.

9. Expand and support the healthcare workforce. Calls to action include greater pay, health benefits, tuition assistance, loan forgiveness and safe working conditions for workers. The group wants industrywide incentives to accelerate the adoption of automation for routine paperwork and chores, and the extension and expansion of temporary regulatory flexibilities that allowed healthcare organizations to operate telehealth and hospital-at-home programs throughout the pandemic.

10. Create a new post to fight biosecurity pandemic threats. The yet-to-be post, deputy assistant to the president for national security affairs and biosecurity, would sit within the National Security Council and be responsible for the preparation and response to any biosecurity and pandemic threats, including foreign and domestic sources of anti-science misinformation.

11. Redesign U.S. public health communications to regain public trust in a fast-moving, deeply polarized environment to promote the best health outcomes for Americans. The proposed redesign includes the creation of a Joint Information and Communication Center to oversee the sharing of infectious disease data, and infrastructure for dissemination of public health messages.

12. Roll out policies and programs to enable schools and child care facilities to remain open and safe for in-person learning and care without need for special public health mitigation measures. These measures include improved air filtration and expanded school nurse programs.

“Unfortunately, health crises in the United States are often followed by collective amnesia,” the authors contend, saying the roadmap is a plan for the United States to get to the next normal while building the systems and infrastructure needed to reduce risk of another pandemic and the consequences if one does occur.

Both “A Roadmap for Living with COVID” and the new COVID-19 preparedness plan released by the White House March 2 approach planning with a focus on living alongside the virus while continuing to combat it. The Biden administration’s 96-page plan is built around four goals: (1) protect against and treat COVID-19, (2) prepare for new variants, (3) prevent economic and educational shutdowns and (4) vaccinate the world. Read more about its contents here.

CMS Issues Guidance for Medicaid Programs on “Unwinding Period” for PHE Continuous Coverage Provisions

The Centers for Medicare and Medicaid Services (CMS) has issued guidance for state Medicaid Programs setting out how an ‘unwinding period’ for PHE continuous coverage provisions could proceed:

The guidance establishes a 12-month period during which Medicaid programs could complete re-determinations of enrollees afforded continuous coverage during the PHE:

The guidance will permit states to conduct a more aggressive re-determination effort. States could, potentially, begin re-determinations as soon as 60-days prior to any announced PHE termination, with loss of enrollee coverage, based upon review, to commence as early as 60-days after the end of the PHE.

CDC Updates Guidance on Timing for Pfizer and Moderna Primary Series

This week the Centers for Disease Control and Prevention (CDC) added considerations for an 8-week interval between the first and second doses of a primary mRNA vaccine schedule for some patients.

They added the following language to their Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States webpage:


An 8-week interval may be optimal for some people ages 12 years and older, especially for males ages 12 to 39 years. A shorter interval (3 weeks for Pfizer-BioNTech; 4 weeks for Moderna) between the first and second doses remains the recommended interval for: people who are moderately to severely immunocompromised; adults ages 65 years and older; and others who need rapid protection due to increased concern about community transmission or risk of severe disease.


The webpage contains more details. It also links to Guidance for COVID-19 vaccination for people who are moderately or severely immunocompromised (and require a 3-dose primary series).