As part of the National Institute for Occupational Safety and Health’s (NIOSH) efforts to keep our stakeholders up to date on the CDC and NIOSH COVID-19 response, below is a summary of new information posted this week.

General Resources 

Critical Infrastructure Sector Response Planning Guidance 
This guidance is on COVID-19 response planning for the critical infrastructure sector. Maintaining critical infrastructure operations during the COVID-19 pandemic is imperative for both public health and safety as well as community well-being. A COVID-19 response plan can help critical infrastructure employers prevent or slow the spread of COVID-19 in their workplaces and continue their essential business functions.

This guidance supplements the existing CDC Guidance for Implementing Safety Practices for Critical Infrastructure Workers Who May Have Had Exposure to a Person with Suspected or Confirmed COVID-19.

Coping with Job Stress and Building Resilience During the COVID-19 Pandemic Fact Sheets
This new guidance for employees and healthcare personnel and first responders provides ways to recognize symptoms of stress, tips to cope and enhance resilience, and where to go for help. The COVID-19 pandemic has changed the way we work, whether you are going into work or are working from home. Fear and anxiety about this disease can be overwhelming, and workplace stress can lead to burnout. 

Fatigue in the Workplace Fact Sheet
This new fact sheet has information on strategies that workers and employers can use to manage workplace fatigue and work safely during COVID-19. The fact sheet includes tips to improve sleep and what to do if you feel too tired to work safely. It also has steps employers should take to reduce workplace fatigue for workers.

Respirator Purchasing Resources 

Factors to Consider when Planning to Purchase Respirators From Another Country
This guidance provides information for potential purchasers of international respirators in making informed procurement and distribution decisions to keep their workers safe. When NIOSH approves a respirator, the user can be confident that the device will provide the expected level of protection, as long as it fits properly and is worn correctly. But when there is a shortage of NIOSH-approved filtering facepiece respirators (FFRs), as we are experiencing during the COVID-19 pandemic, other reliable options must be found.

Industry Specific Resources

Long-haul Truck Drivers Fact Sheet
This fact sheet identifies these potential exposures to help drivers and their employers prevent the spread of respiratory illness. Long-haul truck drivers may be at risk for exposure to the virus that causes COVID-19. Potential exposures include close contact with others, including other drivers.

For More Information

For more information, please visit the COVID-19 webpage. To stay up to date on new developments, sign up for the COVID-19 newsletter.

As part of the ongoing White House Task Force efforts taken in response to coronavirus disease 2019 (COVID-19), following is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions. To keep up with the important Task Force work being done 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.   CMS updates these resources on an ongoing basis throughout the day; the information below is current as of May 11, 2020 at 10:00 a.m. ET.

CMS Releases Additional Waivers for Hospitals and Other Facilities

CMS continues to release waivers for the healthcare community that provide the flexibilities needed to take care of patients during the COVID-19 public health emergency (PHE). CMS recently provided additional blanket waivers for the duration of the PHE that:

• Expand hospitals’ ability to offer long-term care services (“swing beds”);
• Waive distance requirements, market share, and bed requirements for Sole Community Hospitals;
• Waive certain eligibility requirements for Medicare-Dependent, Small Rural Hospitals (MDHs); and
• Update specific life safety code requirements for hospitals, hospice, and long-term care facilities.

Emergency Declaration Blanket Waivers

Telehealth Video: Medicare Coverage and Payment of Virtual Services

CMS updated a video that answers common questions about the expanded Medicare telehealth services benefit during the COVID-19 public health emergency. New information includes how CMS adds services to the list of telehealth services, additional practitioners that can provide telehealth services, and the distant site services that Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can provide. Further, the video includes information about audio-only telehealth services, telehealth services that hospitals, nursing homes and home health agencies can provide, along with how to correctly bill for telehealth services.

Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing

CMS published information for pharmacies and other suppliers that wish to enroll in Medicare temporarily as independent clinical diagnostic laboratories to help address the need for COVID-19 testing. Interested pharmacies and suppliers will need to apply for a Clinical Laboratory Improvement Amendments (CLIA) certificate. CMS wants to ensure that laboratories located in the United States applying for a CLIA certificate are able to begin testing for COVID-19 as quickly as possible.

MLN Matters Article

CMS Gives States Additional Flexibility to Address Coronavirus Pandemic

CMS has approved over 175 requests for state relief in response to the COVID-19 pandemic, including recent approvals for Alabama, Alaska, California, District of Columbia, Georgia, Maine, Massachusetts, Minnesota, Mississippi, Montana, Nebraska, New Mexico, Oregon, South Carolina, Rhode Island, Tennessee, Virginia, and Wisconsin. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of waivers, amendments, and Medicaid state plan flexibilities, including support for programs that care for the elderly and people with disabilities. CMS developed a toolkit to expedite the application and review of each request and has approved these requests in record time. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

Section 1135 Waivers

Section 1115(a) Waivers

1915(c) Waiver Appendix K Amendments

Medicaid State Plan Amendments

CHIP State Plan Amendments

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press.

Calls recordings and transcripts are posted on the CMS podcast page at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts

CMS COVID-19 Office Hours Calls (Tuesdays and Thursdays at 5:00 – 6:00 PM Eastern)

Office Hour Calls provide an opportunity for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

• Increase Hospital Capacity – CMS Hospitals Without Walls;
• Rapidly Expand the Healthcare Workforce;
• Put Patients Over Paperwork; and
• Further Promote Telehealth in Medicare

This week’s Office Hours:

Tuesday, May 12^th at 5:00 – 6:00 PM Eastern

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 8968295

Audio Webcast link: https://protect2.fireeye.com/url?k=7284b5e6-2ed1bc36-728484d9-0cc47a6a52de-d8cf01adf6a4f976&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2000

 

Thursday, May 14^th at 5:00 – 6:00 PM Eastern

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 5688374

Audio Webcast link: https://protect2.fireeye.com/url?k=8e984964-d2cc5018-8e98785b-0cc47adc5fa2-09e654c541269c0b&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2112

 

Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM Eastern)

Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters.

This week’s Lessons from the Front Lines:

Friday, May 15^th at 12:30 – 2:00 PM Eastern

Toll Free Attendee Dial-In: 877-251-0301; Access Code: 8983296

Web Link: https://protect2.fireeye.com/url?k=13db3037-4f8f191c-13db0108-0cc47a6d17cc-3e08fb388e16c445&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2045

 

Weekly COVID-19 Care Site-Specific Calls

CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

Home Health and Hospice (Tuesdays at 3:00 PM Eastern)

Tuesday, May 12^th at 3:00 – 3:30 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 9503927
Audio Webcast Link: https://protect2.fireeye.com/url?k=f55f72e4-a90a7bf7-f55f43db-0cc47adb5650-1c0b21c06c679912&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1877

 

Nursing Homes (Wednesdays at 4:30 PM Eastern)

Wednesday, May 13^th at 4:30 – 5:00 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 2675207
Audio Webcast Link: https://protect2.fireeye.com/url?k=e2c79f73-be9296a3-e2c7ae4c-0cc47a6a52de-790ece838430947d&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2024

 

Dialysis Organizations (Wednesdays at 5:30 PM Eastern)

Wednesday, May 13^th at 5:30 – 6:00 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 6772827
Audio Webcast Link: https://protect2.fireeye.com/url?k=0b50982f-5705913c-0b50a910-0cc47adb5650-129c86a45284e40f&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2102

 

Nurses (Thursdays at 3:00 PM Eastern)

Thursday, May 14^th at 3:00 – 3:30 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 4279137
Audio Webcast Link: https://protect2.fireeye.com/url?k=c68eebd6-9adbe2c5-c68edae9-0cc47adb5650-907c909196c9b9a2&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2107

To keep up with the important work the White House Task Force is doing in response to COVID-19 click here: https://protect2.fireeye.com/url?k=36fa2226-6aae0b0d-36fa1319-0cc47a6d17cc-2d06c219f858d641&u=http://www.coronavirus.gov/. For information specific to CMS, please visit the Current Emergencies Website.

While hospitalizations related to COVID-19 have started to decelerate in some cities, it could take the virus weeks to peak in more rural communities. CNBC reports on the challenges in rural communities, especially the outbreaks happening at factories deemed essential. Health experts worry that once the virus starts to spread in rural areas, it could expand rapidly. The National Rural Health Association’s Vice President of Government Affairs explains in the article that, “Faith-based or community organizations, school activities, everybody goes to the same high school football game. Everybody kind of knows each other and stays in close contact, so it can potentially spread very, very rapidly.”

As the COVID-19 outbreak continues to tax hospitals throughout the country, there is a growing concern that many hospitals, in particular rural hospitals, may not have the reserve to remain fiscally viable. A new Health Affairs blog explores the vulnerable state rural providers were in prior to the pandemic, and the capacity for rural providers to deal with a surge of patients. Because most rural hospitals operate on razor thin margins, high margin services such as elective surgery keep them afloat. For many rural hospitals, canceling these profitable services to cope with the outbreak may be the tipping point for financial catastrophe.

The UNC Sheps Center reports that two rural hospitals in Florida have closed amid the COVID-19 pandemic and converted to off-campus emergency departments. Both Shands Live Oak Regional Medical Center and Shands Starke Regional Medical Center were CAHs that were part of a sale and required to cease all non-emergency services by May 1^st. Both are now operating as off-campus emergency departments of Lake City Medical Center and North Florida Regional Medical Center. The total number of rural hospital closures since 2010 is now 130, and 2020 is on-track to surpass last year’s record number of closures.

The U.S. Department of Agriculture (USDA) approved the purchase of $1.2 billion of boxed agricultural products as part of the Coronavirus Farm Assistance Program (CFAP), Farmers to Families Food Box Program. The list of contracts can be found on USDA’s website, and we have requested that USDA provide a list of PA companies – we will be sure to share with you as soon as we get the full list, but congratulations in advance to all PA farms and processors who were awarded funds.

Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller announced an Emergency Assistance Program (EAP) to help low-income families who lost wages experiencing financial challenges due to the COVID-19 pandemic. Families who qualify will be eligible for a one-time payment to assist them in meeting basic needs and help them secure more stable financial footing in the future.

The program will use existing Temporary Assistance for Needy Families (TANF) funds to provide support to low-income families who qualify. The program will be open to families with a child under the age of 18 or a woman who is currently pregnant. In order to qualify, families must have at least one person in the household who was employed as of March 11, 2020 and experienced an hour or wage reduction of at least 50 percent for two weeks or more or lost employment entirely due to the public health crisis.

Families must meet income limits of 150 percent of the Federal Poverty Guidelines and have no more than $1,000 in a savings or checking account.

Qualifying families will be issued a one-time grant equal to two months of TANF benefits. The average monthly TANF grant for a family of three is $403, so a qualifying family of three would receive a one-time grant of $806 through the program. Information on monthly grants by household size and county is available online here. Funds will be issued through an electronic benefit transfer (EBT) card.

Pennsylvanians can apply for Medicaid, the EAP, the Supplemental Nutrition Assistance Program (SNAP), the Children’s Health Insurance Program (CHIP), and other public assistance programs at any time through DHS’ online COMPASS application at www.compass.state.pa.us. Those who prefer to submit paper applications can mail documents to their local County Assistance Office (CAO) or leave documents in a CAO’s secure drop box, if available. CAOs are still closed to the public, but mail and drop boxes are being monitored so applications can be processed.

Pursuant to the Governor’s authorization, as conferred in the Proclamation of Disaster Emergency issued on March 6, 2020 and the Governor’s Order to Enhance Protections for Health Care Workers issued on May 6, 2020, all statutory and regulatory provisions or portions thereof, that would impose an impediment to implementing the guidance outlined below are suspended. Said suspensions will remain in place throughout the duration of the Governor’s Proclamation.

The Bureau of EMS issues the following guidance as it relates to the utilization of out of state EMS personnel, as detailed below:

• EMS providers that hold an active credential with another state’s EMS certifying body, or whom hold an active certification with the National Registry of Emergency Medical Technicians, may practice in Pennsylvania on the sole basis of that certification. This suspends requirements found at 35 Pa. C.S. § 8113 and 28 Pa. Code § 1021.21.
• Individuals holding an out-of-state certification and are practicing in Pennsylvania with a licensed Pennsylvania EMS agency should not exceed the scope of practice or training that they received and are credentialed to perform in their home state. However, regardless of the scope of their home state, they may not exceed the established Pennsylvania Scope of Practice
• Prior to utilizing individuals whom do not hold Pennsylvania EMS certification, Pennsylvania EMS agencies should make a good faith effort to verify that the individual holds the credentials that they claim to hold, and should document what those efforts entailed. All NREMT certifications can be verified online at www.nremt.org in addition, many states have online verification options as well. Please visit https://www.nremt.org/rwd/public/states/state-ems-agencies, select the state you are trying to verify, then click the green button that says verify a state license. If available, you will be taken to that state’s certification portal. Please note, this is not an option for every state.
• Irrespective of certification level, the EMS agency medical director must approve all individuals with an out-of-state credential prior to their service with a Pennsylvania EMS agency.
• For the purposes of PCR documentation, any out of state provider should be entered with their name, and OOS as the certification number
• This guidance does not apply to out-of-state individual providers who are operating under an EMS service/vehicle licensed in another state. Pursuant to EMSIB 2020-09 Out of State Licensed EMS Agencies out-of-state EMS agencies may operate within Pennsylvania pursuant to the laws and regulations of the state in which they are licensed.

Please address any questions to your Regional EMS Council.