Pennsylvania Governor Tom Wolf announced that $96 million in state grants have been awarded to 4,933 Pennsylvania small businesses that were impacted by the COVID-19 public health crisis and subsequent business closure order.

Businesses in every Pennsylvania county received grants in this first of two rounds of funding, and 2,512 grants – or 51 percent – were awarded to historically disadvantaged businesses.

“As we continue to address this public health crisis, it’s critical that we also focus on our state’s economic recovery and supporting our small businesses across the state, which continue to be impacted by our necessary mitigation efforts,” Gov. Wolf said. “This funding will go a long way to help small businesses, including historically disadvantaged businesses, at a time when they need it most.”

The COVID-19 Relief Statewide Small Business Assistance funding was developed in partnership with state lawmakers and allocated through the 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) distributed the funds to the Pennsylvania Community Development Financial Institutions (CDFIs), which are administering the grants through three programs: $100 million for the Main Street Business Revitalization Program, $100 million for the Historically Disadvantaged Business Revitalization Program, and $25 million for the Loan Payment Deferment and Loss Reserve Program.

“The COVID-19 pandemic unexpectedly affected small businesses across the commonwealth, an unfortunate circumstance that could not have been predicted or prepared for,” said DCED Secretary Dennis Davin. “However, through the collective action of the Wolf Administration, the General Assembly, and the CDFI Network, Pennsylvania’s hardest hit and most at-risk businesses will be able to access the funding they need to shore up their resources and regain sound financial footing as we move into recovery.”

The second and final round of funding is open starting today through 11:59 PM on Friday, August 28. Eligible applicants not awarded in the first round do not need to reapply and will be rolled into the next round for consideration. More information on the COVID-19 Relief Statewide Small Business Assistance Program, including how to apply, is available on DCED’s website.

“The PA CDFI Network targeted these funds to reach the smallest and most vulnerable businesses across the state and we received an immense response with close to 50,000 applications submitted in the first round and more than $860 million in total requests,” said Daniel Betancourt, chairman of the PA CDFI Network and President & CEO of Community First Fund. “We are grateful to be part of this first step with Governor Wolf and the Pennsylvania Legislature to get much needed resources to the small businesses that have been so adversely impacted by the pandemic.”

The grants may be used 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.

On July 31, 2020, HHS announced that certain Medicare providers would be given another opportunity to receive additional Provider Relief Fund payments. These are providers who previously missed the June 3, 2020 deadline to apply for additional funding equal to 2 percent of their total patient care revenue from the $20 billion portion of the $50 billion Phase 1 General Distribution, including many Medicaid, Children’s Health Insurance Program (CHIP), and dental providers with low Medicare revenues. In addition, certain providers who experienced a change in ownership, making them previously ineligible for Phase 1 funding, will also be given an opportunity to apply for financial relief.

Starting [August 10th], these eligible providers may now submit their application for possible funds by August 28, 2020. This deadline aligns with the extended deadline for other eligible Phase 2 providers, such as Medicaid, Medicaid managed care, CHIP, and dental providers.

Latest Eligible Providers for Phase 2 General Distribution Funding

• Providers who were ineligible for the Phase 1 General Distribution because:
  • They underwent a change in ownership in calendar year 2019 or 2020 under Medicare Part A; and
  • Did not have Medicare Fee-For-Service revenue in 2019.
• Providers who received a payment under Phase 1 General Distribution but:
  • Missed the June 3 deadline to submit revenue information – including many Medicaid, CHIP, and dental providers with low Medicare revenues that assumed they were ineligible for additional distribution targeted at Medicare providers or had planned to apply for a Medicaid and CHIP specific distribution; or
  • Did not receive Phase 1 General Distribution payments totaling approximately 2 percent of their annual patient revenue.
• Providers who previously received Phase 1 General Distribution payment(s), but rejected and returned the funds and are now interested in reapplying.

Again, all eligible providers will only receive funding of up to 2 percent of their reported total revenue from patient care. Therefore, for providers who have already received a Phase 1 General Distribution payment from HHS, the previous amount received and kept will be taken into account when determining the eligible amount for Phase 2 General Distribution payment. All payment recipients must accept HHS’s terms and conditions and may be subject to auditing to ensure the data provided to HHS for payment calculation are accurate.

HHS has been hosting a series of informational webinars to address questions and support providers through the application process. The next provider and provider organization webinar will be held on Thursday, August 13, 2020. Register by clicking here.

For the latest information on the Provider Relief Fund Program, visit: hhs.gov/providerrelief.

The Trump Administration today announced it is further transforming the nation’s rural health care system by unleashing innovation through new funding opportunities that will increase access and improve quality. The Community Health Access and Rural Transformation (CHART) Model delivers on President Trump’s Executive Order from last week on Improving Rural Health and Telehealth Access as well as the President’s Medicare Executive Order and CMS’s Rethinking Rural Health initiative. Collectively, the Administration aims to ensure individuals in rural America have access to high quality, affordable health care.

Per the President’s Executive Order, the CHART Model also ties payment to value, increases choice and lowers costs for patients. CHART will empower rural communities to develop a system of care to deliver high quality care to their patients by providing support through new seed funding and payment structures, operational and regulatory flexibilities and technical and learning support.

“The Trump Administration has placed an unprecedented priority on improving the health of the one in five Americans who live in rural areas,” said CMS Administrator Seema Verma. “The CHART Model represents our next opportunity to make investments that will transform the rural health care system, allowing us to use every lever to support all Americans getting access to high-quality care where they live.”

Americans living in rural areas have worse health outcomes and higher rates of preventable diseases than the over 57 million Americans living in urban areas. Impediments such as transportation challenges disproportionately impact rural Americans and their access to care. Rural providers also experience challenges. For example, many rural healthcare facilities experience health care workforce shortages, and operate on thin margins and over 126 rural hospitals have closed since 2010. Many rural hospitals also have difficulty recruiting and retaining medical professionals to rural areas. Meanwhile, value-based payment models have accelerated nationally, though rural health care providers have been slow to adopt these models.

Percentage of hospitals with negative operating margins is between 44-52% (February 2020): https://protect2.fireeye.com/url?k=65c59613-39918f6f-65c5a72c-0cc47adc5fa2-e4799de251b79272&u=https://www.chartis.com/forum/wp-content/uploads/2020/02/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf

Providers interested in the CHART Model have two options for participation:

Community Transformation Track

The Trump Administration is investing up to $75 million in seed money to allow up to 15 rural communities to participate in the Community Transformation Track. The upfront investment empowers communities to implement care delivery reform, provide predictable capitated payments, and offer operational and regulatory flexibilities to build a sustainable system of care. Through these flexibilities, health care providers across the community will be able to pursue care transformation such as expanding telehealth to allow the beneficiary’s place of residence to be an originating site and waiving certain Medicare hospital conditions of participation to allow a rural outpatient department and emergency room to be paid as if they were classified as a hospital. The model also allows participant hospitals to waive cost-sharing for certain Part B services, provide transportation support, and gift cards for chronic disease management.

In September, CMS will select up to 15 rural communities to participate in this track, with the winners being announced in early 2021 and the model starting in Summer 2021.

Accountable Care Organization (ACO) Transformation Track

This track offers upfront investment to assist rural healthcare providers in improving outcomes and quality for rural beneficiaries. This track builds on the success of the ACO Investment Model (AIM), which has saved $382 million over three years. Providers participating in the ACO Transformation Track will enter into two-sided risk arrangements as part of the Medicare Shared Savings Program (MSSP) and may use all waivers available in the MSSP program. CMS anticipates releasing a Request for Applications in the Spring 2021 and selecting up to 20 rural ACOs to participate in this track starting in January 2022.

Today’s announcement builds on CMS’s previous actions to strengthen the rural healthcare delivery system and improve the health of rural Americans. Specifically, CMS has:

• As directed by President Trump’s Executive Order on Improving Rural and Telehealth Access, CMS took steps in the CY 2021 Physician Fee Schedule Proposed Rule published on August 4, 2020 to extend the availability of certain telemedicine services after the COVID-19 public health emergency ends, giving Medicare beneficiaries more convenient ways to access healthcare particularly in rural areas.
• Increased the wage index for low wage index hospitals, including many rural hospitals. The wage index is an adjustment to Medicare payments for local labor costs. This should support low wage index hospitals’ efforts to improve quality, attract more talent, and improve patient access.
• Reduced the minimum required level of supervision for hospital outpatient therapeutic services furnished by all Critical Access Hospitals (CAHs) from direct supervision to general supervision. General supervision means that the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. This provides more flexibility to rural hospitals, particularly CAHs, in providing care for their patients.

For more information, please visit: https://innovation.cms.gov/initiatives/chart-model/

Many Were Unable to Access Adequate Personal Protective Equipment, and People of Color Account for a Disproportionate Share of Deaths Among Those Profiled So Far

A new interactive database from KFF’s Kaiser Health News (KHN) and Guardian US reveals that many of the more than 900 U.S. health care workers who have died in the fight against COVID-19 worked in facilities with shortages of protective equipment such as gowns, masks, gloves and face shields. People of color and nurses account for a disproportionate share of deaths among those profiled so far.

The two news organizations have identified 922 workers who likely died of COVID-19 after helping patients during the pandemic, and have published profiles of 167 workers whose deaths have been confirmed as part of the “Lost on the Frontline” reporting project, which began this spring. The project aims to document the life of every health care worker who falls victim to the virus and shine a light on the workings — and failings — of the U.S. health care system during a global pandemic.

The interactive tool — the nation’s most comprehensive independent database of health care workers who have lost their lives — can be searched by factors such as race and ethnicity, age, occupation, location and whether the workers had adequate access to protective gear. The database is freely available to help local news organizations profile workers in their communities who have lost their lives fighting the pandemic. The profiles include medical professionals like doctors, nurses and paramedics, and others working at hospitals, nursing homes and other medical facilities, including aides, administrative employees, and cleaning and maintenance staff.

Key themes have emerged from the lives and deaths of the 167 workers whose profiles are in the database so far, including:

• At least 52 (31%) had inadequate personal protective equipment (PPE).
• At least 103 (62%) were identified as people of color.
• Sixty-four (38%) were nurses, the largest single group, but the total also includes physicians, pharmacists, first responders and hospital technicians, among others.
• Ages ranged from 20 to 80, with 21 people (13%) under 40, including eight (5%) under 30. Seventy-seven people — or 46% — were 60 or older.
• At least 53 workers (32%) were born outside the U.S., including 25 (15%) from the Philippines.

Exclusive stories by the project reporters have revealed that many health care workers are using surgical masks that are far less effective and have put them in jeopardy. Emails obtained via a public records request showed that federal and state officials were aware in late February of dire shortages of PPE. Medical workers began to resort to parking-lot deals and DIY projects to get protective gear themselves.

Last month, KHN reported that health workers who contracted the coronavirus and their families are now struggling to access death benefits and workers’ compensation. The Guardian today examines health care workers under age 30 who died from COVID-19.

Information about health care workers is crowdsourced from family, friends and colleagues of fallen health care workers, as well as reported through traditional means. The project is an independent and comprehensive source of information about these workers, the importance of which is underscored by the recent Trump administration decision to divert hospitals’ data about COVID-19 cases away from the Centers for Disease Control to the federal Department of Health and Human Services.

KHN and the Guardian are calling for family members, friends and colleagues of health workers to share information, photos and stories about their loved ones and co-workers who died on the front lines via this form.

KHN and the Guardian invite news organizations across the country to partner in the effort. All content from the series is available free to other news organizations to republish.

About KFF and KHN

Filling the need for trusted information on national health issues, KFF (Kaiser Family Foundation) is a nonprofit organization based in San Francisco. KHN (Kaiser Health News) is a nonprofit news service covering health issues. KHN is an editorially independent program of KFF and, along with Policy Analysis and Polling, is one of the three major operating programs of KFF. KFF is not affiliated with Kaiser Permanente.

With support from the Federal Office of Rural Health Policy, the National Rural Health Resource Center serves as a national rural health knowledge center, providing technical assistance, information, tools and resources.  This collection will be updated regularly with information from national and federal sources.  The Center also provides a guide for COVID-19 Funding Sources Impacting Rural Providers.

On August 3, the President issued an Executive Order that seeks to improve health care in rural areas by expanding access to telehealth.  Within 30 days of the order, the U.S. Department of Health & Human Services (HHS) will launch a new payment model and develop strategies for improving the physical and communications health care infrastructure available in rural areas.  HHS will submit a report with existing and upcoming initiatives to reduce regulatory burden on providers, improve maternity morbidity and mortality, and improve mental health care.  Within 60 days of the order, HHS will review specified temporary measures put in place during the public health emergency (PHE) and propose a regulation to extend these measures, as appropriate, beyond the duration of the PHE

This week, CMS released proposed updates to how physician and other service providers are reimbursed by Medicare.  In addition to several technical updates to how payment rates are set, CMS is proposing to add several telehealth services to their current list as well as to the list under the COVID-19 public health emergency; to allow direct supervision to be provided using real-time, interactive audio and video technology; and to make permanent the public health emergency waiver allowing nurse practitioners (NPs), clinical nurse specialists (CNSs), physician assistants (PAs), and certified nurse-midwives (CNMs) to supervise the performance of diagnostic tests. CMS is also proposing revisions to simplify coding and billing requirements for Evaluation and Management (E/M) visits including office/outpatient visits.

The Food and Drug Administration (FDA) has expanded its list of dangerous hand sanitizers. The more than 100 brands on the list contain methanol, which “can be toxic when absorbed through the skin or ingested.” Since June, several such products have been recalled by manufacturers and pulled from store shelves. Read more.

23 million Americans are at risk of eviction and exposure to the shelter system due to the pandemic, the AP reports, citing the Aspen Institute. The latest Census Bureau Household Pulse Survey found last week that more than 26.5 percent of American adults 18 or older questioned said they were not able to make last month’s rent or mortgage payment and had little or no confidence they could pay next month, the AP notes. While many lower-income Americans initially got by on credit cards and stimulus checks, those options are now gone, leaving many in a huge financial hole. Of note, the Pennsylvania Supreme Court dismissed a lawsuit by landlord advocates that challenged Gov. Tom Wolf’s statewide order against banning evictions during the coronavirus pandemic.