On June 9, 2020, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing a) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens. The safety net distribution will occur this week.

“Healthcare providers who focus on treating the most vulnerable Americans, including low-income and minority patients, are absolutely essential to our fight against COVID-19,” said HHS Secretary Alex Azar. “HHS is using funds from Congress, secured by President Trump, to provide new targeted help for America’s safety-net providers and clinicians who treat millions of Medicaid beneficiaries.”

HHS is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers, including those disproportionately impacted by this pandemic.

ENHANCED PROVIDER RELIEF FUND PORTAL

On Wednesday, HHS is launching an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.

The initial General Distribution provided payments to approximately 62 percent of all providers participating in state Medicaid and CHIP programs. The Medicaid and CHIP Targeted distribution will make the Provider Relief Fund available to the remaining 38 percent. HHS has already provided relief funding to over one million providers, and today’s announcement is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins.

Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers serving Medicaid/CHIP beneficiaries possibly eligible for this funding, include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities, and other home and community-based services providers.

To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding.

More information about eligibility and the application process is available at www.hhs.gov/coronavirus/cares-act-provider-relief-fund/…

$10 BILLION ALLOCATION FOR SAFETY NET HOSPITALS

HHS is announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens, recognizing the incredibly thin margins these hospitals operate on. This payment is being sent directly to these hospitals via direct deposit.

This payment is going to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. Qualifying hospitals will have:

• A Medicare Disproportionate Payment Percentage (DPP) of 20.2 percent or greater;
• Average Uncompensated Care per bed of $25,000 or more. For example, a hospital with 100 beds would need to provide $2,500,000 in Uncompensated Care in a year to meet this requirement;
• Profitability of 3 percent or less, as reported to CMS in its most recently filed Cost Report.

Recipients will receive a minimum distribution of $5 million and a maximum distribution of $50 million.

ADDITIONAL PROVIDER RELIEF FUND UPDATES

• On Monday, June 8, 2020, HHS sent communications to all hospitals asking them to update information on their COVID-19 positive-inpatient admissions for the period January 1, 2020, through June 10, 2020. This information will be used to determine a second round of funding to hospitals in COVID-19 hotspots to ensure they are equitably supported in the battle against this pandemic. To determine their eligibility for funding under this $10 billion distribution, hospitals must submit their information by June 15, 2020 at 9:00 PM ET.
• HHS is working on an additional allocation to distribute relief broadly to dentists.

For updated information and data on the Provider Relief Fund, visit hhs.gov/providerrelief

On June 8, 2020, HHS posted additional FAQs.  One set provides additional/updated data on the number of COVID-19 cases for the period of January 1, 2020 through June 10, 2020 (see pages 27-28).  HHS is preparing for a second distribution for High Impact Area funding and is seeking updated data.  The data must be input into the portal no later than 9:00 PM Eastern Time on Monday June 15, 2020.  The FAQ document can be accessed at www.hhs.gov/sites/default/files/…

Pennsylvania Governor Tom Wolf announced that his administration launched an enhanced dashboard to pull Pennsylvania’s COVID-19 data and information together to inform Pennsylvanians. The dashboard further enhances data on demographics of cases, demographics of deaths and the reopening status.

The dashboard includes eight different tabs:

• Pennsylvania case data;
• County data – with a dropdown menu for specific counties;
• Case data by ZIP code;
• Hospital preparedness information;
• Case demographic information, including cases by gender, ethnicity, age and race;
• Death demographic information, including deaths by gender, ethnicity, race, age and deaths by place;
• Testing information; and
• Reopening status information.

This dashboard complements the county dashboard, available here, to provide the most up-to-date data available.

Pennsylvania Governor Tom Wolf announced a $225 million statewide grant program to support small businesses that were impacted by the COVID-19 public health crisis and subsequent business closure order.

The funding was developed in partnership with state lawmakers and allocated through the recently enacted state budget, which included $2.6 billion in federal stimulus funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, of which $225 million was earmarked for relief for small businesses.

The Department of Community and Economic Development (DCED) will distribute the funds to the Community Development Financial Institutions (CDFIs), which will then administer the funding in the form of grants.

Eligible businesses will be able to use the grants to cover operating expenses during the shutdown and transition to re-opening, and for technical assistance including training and guidance for business owners as they stabilize and relaunch their businesses.

The funds will be available through three programs:

• $100 million for the Main Street Business Revitalization Program for small businesses that experienced loss as a result of the governor’s March 19, 2020 order relating to the closure of all non-life-sustaining businesses and have or will incur costs to adapt to new business operations related to COVID-19;
• $100 million for the Historically Disadvantaged Business Revitalization Program for small businesses that experienced loss as a result of the business closure order, have or will incur costs to adapt to new business operations related to COVID-19, and in which socially and economically disadvantaged individuals own at least a 51 percent interest and also control management and daily business operations.
• $25 million for the Loan Payment Deferment and Loss Reserve Program, which will allow the CDFIs the opportunity to offer forbearance and payment relief for existing portfolio businesses that are struggling due to the impact of COVID, as well as shore up the financial position of the CDFIs that are experiencing significant increased defaults in their existing loan portfolios.

In a Health Affairs blog, the Center for Health Care Strategies (CHCS) outlines opportunities for Medicaid to address health disparities experienced by communities of color and exacerbated by COVID-19. CHCS notes that given Medicaid’s role in providing care to low-income communities, including many Black and Hispanic communities, and the disproportionate impact of COVID-19 on these individuals, Medicaid programs have the opportunity to address many of these disparities by leveraging existing and new authorities, enabled through recent COVID-19 federal regulatory flexibilities.

COVID-19 is impacting the U.S. healthcare system in unprecedented and complex ways. Some segments of the healthcare system are responding to a surge of patients with COVID-19 and experiencing higher costs. Other sectors of the healthcare system are seeing a different impact: fewer patients seeking care due to social distancing and limits on elective procedures. A new blog from the National Association of Medicaid Directors (NAMD) explores early insights from Medicaid leaders on healthcare utilization during COVID-19 and lays out the questions Medicaid directors are still trying to answer. The blog post notes two items that involve FQHCs:

• Social distancing and the closure or limited capacities of outpatient practices reduced Medicaid service use in many categories in March and April, including primary care services at federally qualified health centers. Depending on the state and service category, declines ranged anywhere from 10 to 90 percent.
• Service utilization may be slowly increasing. A few states are seeing an uptick in service use, which may be the result of more telehealth adoption, as well as easing of social distancing measures and increased access to personal protective equipment for providers. For example, one state saw an uptick in primary care services at community health centers, likely because of telehealth adoption.

The full blog post is available here.

Even before the term COVID-19 had entered our vocabulary, burnout, stress and anxiety were significant issues in the workplace, and society generally. Throw the pandemic’s mental health impact into the mix, and work-related stress is likely to reach staggering levels in the coming months.

• The economy is now a significant source of stress for 70% of Americans
• The government’s response to the crisis is causing stress in 67% of Americans
• More than 1/3 of Americans have displayed clinical signs of anxiety, depression or both since the pandemic began
• Only 50% of employers are comfortable discussing mental health issues
• Nearly one in five Americans say they have a physical reaction when thinking about the outbreak
• In a March Pew study, 18% said they had experienced nervousness or anxiety most or all of the time during the past week
• Text messages to a SAMHSA disaster distress hotline increased more than 1000% last month
• Mental health is poorest among those unemployed for six months or more
• The long-term psychological consequences of collective traumas can last a decade or more
• Pandemic stress is significantly higher in young people

Read more.

The Pennsylvania Department of Health (DOH) issued these Health Alerts this week related to the COVID-19 pandemic:

• 510 – 06-01-UPD: Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. This guidance has been updated to simplify the determination of risk exposures warranting work restriction.
• 509 – 5-29-UPD: Testing Guidance for COVID-19 in Long-term Care Facilities Residents and Healthcare Personnel: This version of PA-HAN-509 has been updated to reflect a correction to the email address for DOH licensed facilities to request support for COVID-19 testing: RADHCOVIDTESTING@pa.gov.

Visit the DOH 2020 Health Alerts, Advisories and Updates website for the most recent information.

The Department of Health (DOH) has revised their healthcare community guidance to reflect Gov. Wolf’s strategic phased reopening plan and align with current clinical best practices, particularly related to performing non-urgent dental procedures. With dental having unique characteristics that warrant specific infection control considerations, the Governor and Secretary of Health have revised their business closure orders issued on March 19, 2020 and have removed the prohibition on non-urgent and non-emergent dental procedures. All Centers for Disease Control & Prevention (CDC) guidelines will need to be adhered to and it is still up to the professional judgment of the health center’s dental clinicians to determine just what procedures will be performed. Read the entire updated Pennsylvania guidance. PACHC will continue to monitor for updates that may impact health center dental operations.