March 30, 2020

At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) issued an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. CMS sets and enforces essential quality and safety standards for the nation’s healthcare system, and is the nation’s largest health insurer serving more than 140 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and Federal Exchanges.

Made possible by President Trump’s recent emergency declaration and emergency rule making, these temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. This allows hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility.

The changes complement and augment the work of FEMA and state and local public health authorities by empowering local hospitals and healthcare systems to rapidly expand treatment capacity that allows them to separate patients infected with COVID-19 from those who are not affected. CMS’s waivers and flexibilities will permit hospitals and healthcare systems to expand capacity by triaging patients to a variety of community-based locales, including ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories. Transferring uninfected patients will help hospital staffs to focus on the most critical COVID-19 patients, maintain infection control protocols, and conserve personal protective equipment (PPE).

“Every day, heroic nurses, doctors, and other healthcare workers are dedicating long hours to their patients. This means sacrificing time with their families and risking their very lives to care for coronavirus patients,” said CMS Administrator Seema Verma. “Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible. This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly.”

Other temporary CMS waivers and rule changes dramatically lessen administrative burdens, knowing that front line providers will be operating with high volumes and under extraordinary system stresses.

CMS recently approved hundreds of waiver requests from healthcare providers, state governments, and state hospital associations in the following states: Ohio; Tennessee; Virginia; Missouri; Michigan; New Hampshire; Oregon; California; Washington; Illinois; Iowa; South Dakota; Texas; New Jersey; and North Carolina. With today’s announcement of blanket waivers, other states and providers do not need to apply for these waivers and can begin using the flexibilities immediately.

Administrator Verma added that she applauds the March 23, 2020, pledge by America’s Health Insurance Plans (AHIP) to match CMS’s waivers for Medicare beneficiaries in areas where in-patient capacity is under strain. “It’s a terrific example of public-private partnership and will expand the impact of Medicare’s changes,” Verma said.

CMS’s temporary actions announced today empower local hospitals and healthcare systems to:

• Increase Hospital Capacity – CMS Hospitals Without Walls:

CMS will allow communities to take advantage of local ambulatory surgery centers that have canceled elective surgeries, per federal recommendations. Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.

CMS will now temporarily permit non-hospital buildings and spaces to be used for patient care and quarantine sites, provided that the location is approved by the State and ensures the safety and comfort of patients and staff. This will expand the capacity of communities to develop a system of care that safely treats patients without COVID-19, and isolate and treat patients with COVID-19.

CMS will also allow hospitals, laboratories, and other entities to perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital. This will both increase access to testing and reduce risks of exposure. The new guidance allows healthcare systems, hospitals, and communities to set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment.

In addition, CMS will allow hospital emergency departments to test and screen patients for COVID-19 at drive-through and off-campus test sites.

During the public health emergency, ambulances can transport patients to a wider range of locations when other transportation is not medically appropriate. These destinations include community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers, and any locations furnishing dialysis services when an ESRD facility is not available.

Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surge during the public health emergency.

In addition, hospitals can bill for services provided outside their four walls. Emergency departments of hospitals can use telehealth services to quickly assess patients to determine the most appropriate site of care, freeing emergency space for those that need it most. New rules ensure that patients can be screened at alternate treatment and testing sites which are not subject to the Emergency Medical Labor and Treatment Act (EMTALA) as long as the national emergency remains in force. This will allow hospitals, psychiatric hospitals, and critical access hospitals (CAHs) to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19.

• Rapidly Expand the Healthcare Workforce:

Local private practice clinicians and their trained staff may be available for temporary employment since nonessential medical and surgical services are postponed during the public health emergency. CMS’s temporary requirements allow hospitals and healthcare systems to increase their workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community as well as those licensed from other states without violating Medicare rules.

These healthcare workers can then perform the functions they are qualified and licensed for, while awaiting completion of federal paperwork requirements.

CMS is issuing waivers so that hospitals can use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state’s emergency preparedness or pandemic plan. These clinicians can perform services such as order tests and medications that may have previously required a physician’s order where this is permitted under state law.

CMS is waiving the requirements that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician. This will allow CRNAs to function to the fullest extent allowed by the state, and free up physicians from the supervisory requirement and expand the capacity of both CRNAs and physicians.

CMS also is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients.

CMS will also allow healthcare providers (clinicians, hospitals and other institutional providers, and suppliers) to enroll in Medicare temporarily to provide care during the public health emergency.

• Put Patients over Paperwork:

CMS is temporarily eliminating paperwork requirements and allowing clinicians to spend more time with patients. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously Medicare only covered them under certain circumstances.

During the public health emergency, hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation. Hospitals will also have more time to provide patients a copy of their medical record.

CMS is providing temporary relief from many audit and reporting requirements so that providers, healthcare facilities, Medicare Advantage health plans, Medicare Part D prescription drug plans, and states can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.

This is being done by extending reporting deadlines and suspending documentation requests which would take time away from patient care.

• Further Promote Telehealth in Medicare:

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.

These temporary changes will ensure that patients have access to physicians and other providers while remaining safely at home.

Providers can bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth. New as well as established patients now may stay at home and have a telehealth visit with their provider.

CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.

CMS is making it clear that clinicians can provide remote patient monitoring services to patients with acute and chronic conditions, and can be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.

In addition, CMS is allowing physicians to supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.

For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient

For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

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

With the U.S. stock market having lost over 20 percent of its value and the U.S. government passing a historic $2 trillion stimulus package, WalletHub today released a report on the State Economies Most Exposed to Coronavirus, as well as accompanying videos.

To identify which states are most vulnerable economically, WalletHub compared the 50 states and the District of Columbia across 10 key metrics. The data set ranges from the share of employment by small businesses to the share of a state’s GDP coming from highly affected industries and increases in unemployment insurance claims. Below, you can see highlights from WalletHub’s report as well as a Q&A with WalletHub analysts.

Economic Exposure to Covid-19 in Pennsylvania (1=Best, 25=Avg.):

• 16^th – GDP Generated by High-Risk Industries as Share of Total State GDP
• 20^th – Share of Employment from Highly Impacted Industries
• 10^th – Increase in Number of Unemployment Insurance Initial Claims
• 20^th – Share of Workers Working from Home
• 30^th – Share of Workers with Access to Paid Sick Leave
• 3^rd – State Rainy Day Funds as Share of State Expenditures
• 10^th – State Fiscal Condition Index

To view the full report and your state’s rank, please visit:
https://wallethub.com/edu/state-economies-most-exposed-to-coronavirus/72631/

On Monday, March 30,, at President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) today is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Made possible by President Trump’s recent emergency declaration and emergency rule making, these temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. This allows hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility.

Learn more about the announcement by joining our national stakeholder call on Tuesday, March 31^st at 12:00 PM EST to discuss the announcement. Here also is the webcast link:   https://protect2.fireeye.com/url?k=56ba1b23-0aee3208-56ba2a1c-0cc47a6d17cc-5cccd974ae4ce7ee&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1754

The changes complement and augment the work of FEMA and state and local public health authorities by empowering local hospitals and healthcare systems to rapidly expand treatment capacity that allows them to separate patients infected with COVID-19 from those who are not affected.

CMS’s temporary actions announced today 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

You can find a copy of the full press release here:  https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19

For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient

For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

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

On March 29, 2020, Pennsylvania Governor Tom Wolf requested a major disaster declaration from the President through the Federal Emergency Management Agency to provide additional support for state, county and municipal governments and certain nonprofits, as well as individuals who are struggling during the COVID-19 outbreak.

The request for a major disaster declaration, if approved, will provide the same emergency protective measures available under the nationwide emergency proclamation; the following Individual Assistance programs: Disaster Unemployment Assistance, Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program; and Statewide Hazard Mitigation.

Today, at President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) today is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Made possible by President Trump’s recent emergency declaration and emergency rule making, these temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. This allows hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility.

The changes complement and augment the work of FEMA and state and local public health authorities by empowering local hospitals and healthcare systems to rapidly expand treatment capacity that allows them to separate patients infected with COVID-19 from those who are not affected.

CMS’s temporary actions announced today 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

You can find a copy of the full press release here:  https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19

For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient

For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

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

On March 27, 2020, Congress passed and the President signed the CARES Act, a $2 trillion relief package that provides much needed economic relief for American families and businesses who are hurting through no fault of their own. This legislation will provide assistance to America’s heroic healthcare workers who are on the frontlines of this outbreak, including $100 billion which will go to healthcare providers, including hospitals on the front lines of the COVID-19 pandemic, $27 billion which will go to bolstering life-saving capabilities, including developing vaccines and the development, purchase, and distribution of critical supplies and $45 billion which will go to the Federal Emergency Management Agency Disaster Relief Fund, more than doubling the amount available to support the President’s Emergency and Disaster Declarations to empower State, local, and tribal leaders to effectively respond.

See below for updates for releases from March 27:

Continued Efforts to Expedite Testing: Initially, nasopharyngeal swab were the only recommended swabs to be used for diagnostic testing of COVID-19. Subsequently, FDA identified a number of other swabs that were available to collect samples. Now, FDA has newly released information that recommends for symptomatic patients, nasal swabs could be used that access just the front of the nose rather than the depth of the nasal cavity. This would provide COVID-19 testing that is more comfortable for patients, allows self-collection of samples at collection sites, and that can be performed with a simpler and more readily available swab.

Expansion of Diagnostics to Test for COVID-19: During the COVID-19 pandemic, the FDA has worked with more than 220 test developers who have said they will be submitting emergency use authorizations (EUA) requests to FDA for tests that detect the virus. To date, 17 emergency use authorizations have been issued for diagnostic tests, including the AvellinoCoV2 test, which is a real-time RT-PCR test intended for the qualitative detection of nucleic acid from SARS-CoV-2 in nasopharyngeal and oropharyngeal swab specimens collected from individuals suspected of COVID-19 by their healthcare provider. Additionally, FDA has been notified that more than 100 laboratories have begun testing under the policies set forth in our COVID-19 Policy for Diagnostic Tests for Coronavirus Disease-2019 during the Public Health Emergency Guidance. The FDA also continues to keep its COVID-19 Diagnostics FAQ up to date.

Expanding Face Masks for General Use and Conserving N95 for Health Care Workers: FDA issued an immediately in effect guidance on an Enforcement Policy for Face Masks and Respirators During the COVID-19 Public Health Emergency. The FDA believes the policy set forth in this guidance may help address urgent public health concerns by helping to expand the availability of general use face masks for the general public and particulate filtering facepiece respirators (including N95 respirators) for health care professionals.

Repurposing Ventilators: FDA has issued guidance allowing ventilators from outpatient surgical centers and clinics to be modified by changing a vent. This policy will assist states with being able to identify a whole new range of ventilators that could be easily converted, add to their supply, and focused at the point of the need in their states. Anesthesiologists Patient Safety Foundation (APSF)/American Society of Anesthesiologists (ASA) has issued guidance on purposing anesthesia machines as ICU ventilators.

Maintaining Essential Health Services During an Outbreak: The WHO released Operational Guidance for Maintaining Essential Health Services During an Outbreak. This document provides guidance on a set of targeted immediate actions that countries should consider at national, regional, and local level to reorganize and maintain access to high-quality essential health services for all.

Public-Private Partnership to Develop a New Screening Tool: In partnership with the White House Coronavirus Task Force, the Department of Health and Human Services, and the Centers for Disease Control and Prevention (CDC), Apple released an app and website that guides Americans through a series of questions about their health and exposure to determine if they should seek care for COVID-19 symptoms.  The screening tool provides CDC recommendations on next steps including guidance on social distancing and self-isolating, how to closely monitor symptoms, recommendations on testing, and when to contact a medical provider.

Extending the Supply of and Providing Consumer Information on Hand Sanitizer: FDA issued guidance for the temporary manufacture of ethanol products by firms that manufacture alcohol for incorporation into alcohol-based hand sanitizer products. The FDA posted questions and answers related to consumer use of hand sanitizer during the COVID-19 public health emergency. The FDA wants to make consumers aware of the steps the agency is taking to increase the supply of hand sanitizer during this public health emergency. The questions also discuss hand washing, expiration dates and other frequently asked questions by consumers on hand sanitizer.

Avoid All Non-Essential International Travel: CDC issued a travel warning today for all individuals to avoid all non-essential international travel in an effort to curb the ongoing transmission of COVID-19.

CMS Continuing to Provide State Flexibilities: CMS has now approved 34 Section 1135 Medicaid waivers in states. CMS also approved 8 state requests to invoke emergency flexibilities in their programs that care for the elderly and people w/ disabilities in their homes & communities.

Providing Telehealth Resources for Long-Term Care and Nursing Home Facilities: CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. This toolkit will aid and provide information to facilities utilizing the new telehealth flexibilities.

HRSA Gives Flexibilities to Grantees: HRSA has adopted all 13 administrative flexibilities outlined as available by OMB and has released an FAQ on these flexibilities for grantees.

Flexibility Regarding Nutrition Labeling: The FDA issued guidance on a Temporary Policy Regarding Nutrition Labeling of Certain Packaged Food During the COVID-19 Public Health Emergency. The FDA is issuing this guidance to provide restaurants and food manufacturers with flexibility regarding nutrition labeling so that they can sell certain packaged foods during the COVID-19 pandemic. For example, restaurants may have purchased ingredients that they can no longer use to prepare restaurant food and instead wish to sell to their customers.

March 27, 2020

HRSA Grant Recipients,

As a nation, we continue to adjust to the impact Coronavirus 2019 (COVID-19) is having on our lives, our communities, our friends and loved ones.

As Federal awarding agencies address recipients and applicants directly affected by COVID-19, we want to assure you that we fully recognize the significant impact this situation is having on you, and we are working as quickly as we can to help relieve some of that burden.

On March 19, 2020, OMB issued Memorandum M-20-17, Administrative Relief for Recipients and Applicants of Federal Financial Assistance Directly Impacted by the Novel Coronavirus (COVID-19) due to Loss of Operations. When compared to OMB’s March 9, 2020, Memorandum (M-20-11), the newer memorandum provides similar administrative relief but to an expanded scope of recipients.

To ease the programmatic difficulties brought about by the COVID-19 pandemic, HRSA is integrating all 13 of the administrative flexibilities provided in the latest OMB memorandum.

So you have information as quickly as possible, we developed a list of Frequently Asked Questions  that addresses the OMB flexibilities. You likely received a link to the FAQs in our March 24, 2020 message to all active HRSA recipients. Please bookmark this page for future reference and watch for updates.

Due to the impact of the COVID-19 outbreak, we want to assure you that HRSA will do our part to help you continue your extraordinary work.

Thank you for your partnership and patience as we work together to ensure our nation’s health and safety. From all of us at HRSA, we wish you, your families and colleagues the best as we continue to monitor the immense impact COVID-19 is having on our country and the world.

If you have questions or concerns, please reach out to your assigned HRSA Project Officer or Grants Management Specialist. They are eager to assist you through this complicated period.

Sincerely,

Tom Engels, Administrator

Health Resources and Services Administration (HRSA)

 

 

As part of the National Institute for Occupational Safety and Health’s (NIOSH) efforts to keep stakeholders up to date on the CDC and NIOSH coronavirus disease 2019 (COVID-19) response, below is a summary of new information posted the the week of March 23, 2020 for workers.

Personal Protective Equipment (PPE) Burn Rate Calculator
CDC recognizes that healthcare and nonhealthcare systems may experience unprecedented strains on demand for PPE due to COVID-19. CDC designed a tool to help healthcare and nonhealthcare systems, such as correctional facilities, track how quickly PPE will be used at those facilities. The tool is based on input provided by healthcare systems on the use of PPE during responses to infectious disease outbreaks.

Guidance for Businesses and Employers

• Interim Guidance for Businesses and Employers to Plan and Respond to Coronavirus Disease 2019 (COVID-19)
  CDC developed guidance to help employers decrease the spread of COVID-19 and lower the impact of COVID-19 on the workplace. This interim guidance may help prevent workplace exposures to COVID-19 in nonhealthcare settings. This guidance also provides planning and response considerations for community spread of COVID-19.
• Environmental Cleaning and Disinfection Recommendations
  Recommendations for the cleaning and disinfection of rooms or areas where individuals with suspected or with confirmed COVID-19 have visited is available on the CDC website. These guidelines are focused on community, nonhealthcare facilities, such as schools, offices, and businesses.

Resources for First Responders and Law Enforcement

• Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States
  Guidance for first responders, including law enforcement, fire services, emergency medical services, and emergency management officials, who anticipate close contact with persons with confirmed or possible COVID-19 in the course of their work.
• What Law Enforcement Personnel Need to Know About Coronavirus Disease 2019
  This new CDC fact sheet provides recommendations for personnel who may come in contact with someone with confirmed or suspected COVID-19.
• Infectious Diseases and Circumstances Relevant to Notification of Emergency Response Employees: Implementation of Sec. 2695 of the Ryan White HIV/AIDS Treatment Extension Act of 2009
  NIOSH has updated the List of Potentially Life-Threatening Infectious Diseases to which Emergency Response Employees May be Exposed to include the addition of COVID-19, the disease caused by the virus SARS-CoV-2, and the definition of “emergency response employee (ERE).” The list and accompanying guidelines, originally published in a 2011 Federal Register notice, are republished in this document with these updates.

To stay up to date on the response please visit the COVID-19 webpage or sign up for the COVID-19 newsletter.