AUDIENCE:

Licensees subject to Chapter 20 of Title 55 of the Pennsylvania Code.

PURPOSE:

To announce that the Pennsylvania Department of Human Services (DHS) had resumed annual inspections of programs licensed under Article IX or X of the Human Services Code, 62 P.S. §§ 901-922, 1001-1088 and 55 Pa. Code Chapter 20.

BACKGROUND:

On March 6, 2020, Governor Tom Wolf issued a Proclamation of Disaster Emergency (“the Disaster Proclamation”) to enable agencies to respond promptly to address the 2019 Novel Coronavirus (COVID-19) pandemic. With the Governor’s authorization as conferred in the Disaster Proclamation, on March 30, 2020, DHS announced that it “will not be conducting any annual licensing inspections until Governor Wolf lifts the current Proclamation of Disaster Emergency for COVID-19 or until such other time set by DHS” to support the Commonwealth’s efforts to prevent transmission and spread of COVID-19. In doing so, DHS suspended 62 P.S. §§ 911(a)(2) and 1016, to the extent those statutory provisions may be interpreted to require annual on-site visits, and the regulation at 55 Pa. Code Ş 20.31 (relating to annual inspection), which explicitly requires that DHS conduct an “on-site inspection of a facility or agency at least once every 12 months.”

DISCUSSION:

There are over 17,000 licensed settings across the Commonwealth that provide care and services to infants, toddlers, young children, individuals with mental illness, individuals with an intellectual disability or autism, and older adults.

DHS is responsible for enforcing licensing regulations intended to protect the health and safety of people who are served in licensed settings. Enforcement is primarily achieved by conducting annual on-site inspections of each setting to ensure that the licensee is in full compliance with
all applicable regulatory requirements. Regulatory requirements are applied and enforced by the following DHS program offices:

• Office of Child Development and Early Learning (OCDEL)
• Office of Children, Youth and Families (OCYF)
• Office of Developmental Programs (ODP)
• Office of Long-Term Living (OLTL)
• Office of Mental Health and Substance Abuse Services (OMHSAS)

DHS remains committed to preventing and containing the spread of COVID-19. As the Commonwealth reopens in accordance with the Governor’s Process to Reopen Pennsylvania, DHS has resumed annual on-site inspections of licensed settings. To balance the need to contain the COVID-19 virus with the responsibility for regulatory oversight and enforcement of licensed settings, DHS may apply alternative techniques for annual inspections that do not require an on-site presence in the licensed setting and when an in-person presence in the facility may contribute to the spread of COVID-19, e.g., a participant, consumer, or staff person has tested positive or is suspected to have COVID-19 in the past 21 days.

Alternative techniques include, but are not limited to, the use of videotelephony and file-sharing applications that will allow for real-time observations of conditions at the licensed setting. Use of these techniques will ensure that regulatory compliance is maintained in a manner that does not contribute to the spread of COVID-19. Additional information regarding the application of these techniques for annual inspections will be communicated to the field by DHS program office before the inspections takes place.

This suspension will remain in place only while the Disaster Proclamation remains in effect or such other time as DHS directs. DHS will continue to conduct complaint, incident, and protective services investigations on-site.

CONTACT
Please contact your regional licensing office for any questions.

July 23, 2020

The Trump administration has renewed the public health emergency for the coronavirus, ensuring that critical resources to fight the pandemic can continue while much of the country battles rising caseloads.

The news will come as relief to health care groups who worried that President Donald Trump would let the emergency declaration lapse when it was set to expire July 25, despite previous assurances from top administration officials it would be renewed.

The background: HHS Secretary Alex Azar declared the coronavirus a public health emergency in late January, shortly after Covid-19 emerged in the U.S., and the declaration was previously extended in April. Azar on Thursday evening announced through Twitter that he signed a renewal.

The emergency powers have helped the administration usher in a massive scale-up of telehealth visits, emergency approval of new drugs and tests and new flexibility for government-run health insurance programs. They have also let cash-strapped state and local health departments deploy federally funded personnel to focus on the virus.

Governors and health groups, nervous that Trump would end the emergency as he pushed for faster reopenings, for weeks had been urging the administration to authorize an extension, warning the pandemic response would be hampered without it. Vice President Mike Pence and Azar earlier this month told governors the emergency would likely be extended but had stopped short of providing a firm commitment.

Azar spokesperson Michael Caputo previously tried to knock down concerns the administration would let the emergency expire. “Enough already. @HHSGov expects to renew the Public Health Emergency due to COVID-19 before it expires,” Caputo tweeted a month ago.

What’s next: Public health emergencies last for 90 days, so the latest renewal will expire in late October without another extension. Trump at that point may be eager to tout victory over the coronavirus, but the expiration will come at the start of a flu season that federal health experts believe could be especially dangerous with the coronavirus still circulating.

The Pennsylvania Liquor Control Board (PLCB) issued clarifying guidance for licensees to reinforce the targeted statewide mitigation efforts at bars and restaurants in response to the recent rise in COVID cases. The Pennsylvania Department of Heath also recently updated frequently asked questions about the orders.

The clarifying PLCB guidance for restaurant, retail dispenser, and hotel licensees (whether offering indoor or outdoor seating); club and catering club licensees; brewery, distillery, limited distillery, winery, and limited winery licensees; and golf course licensees is summarized below:

• Sales of alcohol for on-premises consumption are only permissible as part of a larger transaction that includes a meal purchase. The term “meal” is defined in section 406 of the Pennsylvania Liquor Code as “food prepared on the premises, sufficient to constitute breakfast, lunch or dinner.” The definition expressly states that a snack, such as pretzels, popcorn, chips, or similar food, does not meet the definition of a meal.
• A customer who wishes to consume alcohol on premise must also purchase a meal; a group of customers who wish to consume alcohol on premises may do so as long as a meal is part of the purchase made by the group.
• Additional drinks may be purchased while the customer is consuming the meal, but no further drinks may be purchased after the meal is finished.
• Bar service of food and/or alcohol is prohibited.
• For Pennsylvania manufacturers (breweries, distilleries, and wineries), meals may be provided by the licensee or by a third party, such as a food truck.
• Casinos may no longer provide drink service on the casino floor.
• If a club does not sell food, either directly or through a concessionaire, it cannot use its liquor license.
• The governor’s additional order directing targeted mitigation measures specifically prohibits businesses that meet the definition of a “nightclub” under the Clear Indoor Air Act from operating.

View the PLCB guidance

View frequently asked questions about the targeted mitigation orders

Enforcement of the order is occurring through the Pennsylvania State Police and local law enforcement, the Liquor Control Board, and the Department of Agriculture.

For restaurants and bars, social distancing, mask-wearing and other mitigation measures must be employed to protect workers and patrons. In addition, occupancy is limited to 25 percent of the fire-code maximum occupancy for indoor dining, or 25 persons for a specific indoor event or gathering in a restaurant. The maximum occupancy limit includes staff.

Events and gatherings must adhere to the gathering limitations outlined previously, and below:

• Indoor events and gatherings of more than 25 persons are prohibited;
• Outdoor events and gatherings of more than 250 persons are prohibited; and
• The maximum occupancy limit includes staff.

The July 15 order also includes targeted mitigation efforts for other businesses, including a requirement to conduct operations remotely through individual teleworking of employees. Where telework is not possible, employees may conduct in-person business operations, provided that the business fully complies with all aspects of the business safety order, the worker safety order, and the masking order.

Police Bureau of Liquor Control Enforcement, the Department of Drug and Alcohol Programs, other state agencies, and local municipalities across the state. For more information about the PLCB, visit lcb.pa.gov.

Program (SNAP) funds to purchase groceries online through select retailers. This flexibility allows SNAP recipients to purchase groceries from home, which can help limit trips out of the home as Pennsylvania sees rising cases of COVD-19. Last month, the Pennsylvania Department of Human Services (DHS) launched the pilot program overseen by the United States Department of Agriculture (USDA) that allows SNAP recipients to purchase groceries online through participating retailers approved by the USDA.

“We are pleased that Pennsylvanians have the ability to purchase groceries online using their SNAP benefits, and we encourage any SNAP recipients to use online purchasing when possible to support social distancing and help keep themselves and their family safe from COVID-19,” said DHS Secretary Miller. “This pilot has been a success so far, and I would encourage retailers to reach out to Food and Nutrition Service to join this program to provide even more opportunities for Pennsylvanians to purchase groceries online using SNAP.”

The pilot program currently includes four approved retailers: Amazon, the Fresh Grocer, Shoprite, and Walmart, and since the program’s launch, these retailers saw about $6.5 million in online purchases by Pennsylvanians. Retailers that are interested in participating in this program must contact the USDA’s Food and Nutrition Service (FNS) and review the requirements. Retailers that do not wish to join the pilot program can still offer delivery or pick-up flexibility options for SNAP recipients by using mobile EBT processing equipment that would allow customers to pay with SNAP when groceries are delivered or picked up. Farmers’ markets may be able to receive this processing equipment at no cost through a grant opportunity provided by DHS. Online grocery transactions made up only 1.5 percent of total SNAP purchases during the month of June, equating to nearly 87,000 total online food transactions. Walmart (63 percent) and Amazon (29 percent) had the majority of the purchases, while ShopRite and Fresh Grocer experienced transaction activity of over half a million dollars combined.

Only eligible food items normally paid for by SNAP may be purchased from these retailers online with SNAP benefits. Delivery fees, driver tips, and other associated charges may not be paid for with SNAP benefits. This initiative does not include the ability to transact Cash Assistance benefits using the EBT card; therefore, individuals will need to use another method of payment, such as a pre-paid debit card, to cover non-allowable fees. More information on the online program, including a list of locations of participating retailers, can be found here.

Applications for SNAP and other public assistance programs can be submitted online at COMPASS. Those who prefer to submit paper documentation can print the application from the website or request an application by phone at 1-800-692-7462 and mail it to their local County Assistance Office (CAO) or place it in a CAO’s secure drop box, if available. While CAOs remain closed, work processing applications, determining eligibility, and issuing benefits continues. Clients should use COMPASS or the MyCOMPASS PA mobile app to submit necessary updates to their case files while CAOs are closed.

For more information about food assistance resources for people around Pennsylvania impacted by COVID-19 and the accompanying economic insecurity, visit the PA Department of Agriculture Food Security Page.

This week, ARC published a collection of research papers and commentary in The Journal of Appalachian Health about substance use disorder and recovery-to-work efforts in Appalachia. The articles described the process, findings, and insights from ARC’s Substance Abuse Advisory Council (SAAC). Two accompanying commentary pieces offers perspective on how organizations and economic development entities can help combat Appalachia’s opioid epidemic in a way that saves lives, strengthens communities, and bolsters economic growth in the Region.

To read ARC’s articles:

Responding to Appalachian Voices: Steps in Developing Substance-Use Recovery Ecosystems, authored by Bruce Behringer, SAAC Moderator

Listening to Voices in Appalachia: Gathering Wisdom from the Field About Substance-Abuse Recovery Ecosystems, authored by Bruce Behringer, SAAC Moderator

To read ARC’s commentaries:

Perspective on Substance-Abuse Recovery Ecosystem from the Appalachian Regional Commission Federal Co-Chair, authored by Tim Thomas, Federal Co-Chairman at ARC.

Appalachian Regional Commission Recovery Ecosystem Background and Overview, authored by Kostas Skordas, Director of Research and Evaluation at ARC and Andrew Howard, Chief of Staff at ARC.

CDC recently updated their interim guidance for the Discontinuation of Isolation for Persons With COVID-19 Not in Healthcare Settings. This updated guidance recommends using symptom-based criteria instead of a test-based strategy, except in certain circumstances, to determine when to end home isolation of persons with COVID-19.

As part of the unprecedented efforts taken by the Trump Administration, President Trump announced several new CMS initiatives designed to protect nursing home residents from Coronavirus Disease 2019 (COVID-19).

“From the moment the threat of this virus materialized, the Trump Administration has placed a priority on protecting nursing home residents,” said CMS Administrator Seema Verma. “Today’s multi-pronged intervention represents the latest efforts in fulfilling that unwavering commitment. As caseloads continue to increase in areas around the country, it has never been more important that nursing homes have what they need to maintain a sturdy defense against the virus. These measures will help them do exactly that.”

New Funding:

HHS will devote $5 billion of the Provider Relief Fund authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act to Medicare-certified long term care facilities and state veterans’ homes (“nursing homes”), to build nursing home skills and enhance nursing homes’ response to COVID-19, including enhanced infection control. This funding could be used to address critical needs in nursing homes including hiring additional staff, implementing infection control “mentorship” programs with subject matter experts, increasing testing, and providing additional services, such as technology so residents can connect with their families if they are not able to visit. Nursing homes must participate in the Nursing Home COVID-19 Training (described below) to be qualified to receive this funding. This new funding is in addition to the $4.9 billion previously announced to offset revenue losses and assist nursing homes with additional costs related to responding to the COVID-19 public health emergency and the shipments of personal protective equipment provided to nursing homes by the Federal Emergency Management Agency.

Enhanced Testing:

Building on the initiative HHS announced last week, in which rapid point-of-care diagnostic testing devices will be distributed to nursing homes, and the new funding from the Provider Relief Fund, CMS will begin requiring, rather than recommending, that all nursing homes in states with a 5% positivity rate or greater test all nursing home staff each week. This new staff testing requirement will enhance efforts to keep the virus from entering and spreading through nursing homes by identifying asymptomatic carriers.

More than 15,000 testing devices will be deployed over the next few months to help support this mandate, with over 600 devices shipping this week. Funds from the Provider Relief Fund can also be used to pay for additional testing of visitors.

Additional Technical Assistance & Support:

The Trump administration recently deployed federal Task Force Strike Teams to provide onsite technical assistance and education to nursing homes experiencing outbreaks in an effort to help reduce transmission and the risk of COVID-19 spread among residents. The first deployments took place in 18 nursing homes in Illinois, Florida, Louisiana, Ohio, Pennsylvania and Texas between July 18 and July 20.  The Task Force Strike Teams are composed of clinicians and public health service officials from CMS, the Centers for Disease Control & Prevention (CDC), and the Office of the Assistant Secretary for Health.

The Task Force Strike Teams went into nursing homes based on data they reported to the CDC that indicated an increase in COVID-19 cases. The teams focused on the four key areas of support, including keeping COVID-19 out of facilities, detecting COVID-19 cases quickly, preventing virus transmission, and managing staff. The goal was to determine what immediate actions nursing homes needed to take to help reduce the spread and risk of COVID-19 among residents, and to better understand what federal, state, and local resources nursing homes need to ensure the health and safety of their residents. CMS and its partners plan to use what is learned on the ground to determine remote education and other critical needs to support nursing homes and mitigate future outbreaks.

In addition, CMS, in partnership with the CDC, is rolling out an online, self-paced, on-demand Nursing Home COVID-19 Training focused on infection control and best practices. The training being offered has 23 educational modules and a scenario-based learning modules that include materials on cohorting strategies and using telehealth in nursing homes to assist facilities as they continue to work to mitigate the virus spread in their facilities. This program supplements training already underway to better equip nursing homes to contain and stop the spread of COVID-19. The training is a requirement for nursing homes to receive the additional funding from the Provider Relief Fund Program.

The training will be available to all 15,400 nursing homes nationwide along with specialized technical assistance to nursing homes who have been found to have infection prevention deficiencies in their most recent CMS inspection and had recent COVID-19 cases based upon their data submissions to CDC. A certificate of completion is offered and recognition badges can be downloaded for nursing homes to display on their website.

Weekly Data on High Risk Nursing Homes:

Early on during this pandemic, CMS required nursing homes to inform residents, their families and representatives of COVID-19 cases in their nursing homes. Starting in May, CMS and CDC began collecting weekly data on each nursing home including their number of COVID-19 cases. Now that this data collection process has matured, the White House and CMS will release a list of nursing homes with an increase in cases that will be sent to states each week as part of the weekly Governor’s report to ensure states have the information needed to target their support to the highest risk nursing homes.

This announcement builds on the unprecedented and aggressive actions CMS has taken to address the impact of COVID-19 in nursing homes.

See the full text of this excerpted CMS Press Release (issued July 22), including a list of actions CMS took to address the impact of COVID-19 in nursing homes.

By April Simpson

“As the COVID-19 pandemic battered large, metropolitan areas this spring, rural hospitals prepared to be next on the frontlines. But in order to ready their facilities for a potential surge in patients, those small hospitals had to forgo many of their most profitable operations. Months later, a few rural hospitals are fighting outbreaks. But others have empty beds, further threatening their viability in an era of shrinking health care options for people living in rural communities.” Read the full article here.

By Rob Brown

Selling a company to its employees could be a way to preserve small town and rural businesses with generations of tradition behind them. Rob Brown from Business Ownership Solutions has some advice on how to do it. Read more