On May 20, 2020, the U.S. Department of Health and Human Services (HHS) through the Health Resources and Services Administration (HRSA) provided $225 million to Rural Health Clinics (RHCs) for COVID-19 testing.  These investments will support over 4,500 RHCs across the country to support COVID-19 testing efforts and expand access to testing in rural communities. Rural Health Clinics are a special designation given to health care practices in underserved rural areas by the Centers for Medicare and Medicaid Services (CMS) that help ensure access to care for rural residents.

This funding is through the Paycheck Protection Program and Health Care Enhancement Act that President Trump signed into law on Friday, April 24, 2020 which specifically directed these monies to be allocated to RHCs. HRSA funded RHC organizations based on the number of certified clinic sites they operate, providing nearly $50,000 per clinic site.

“Today’s funding provides rural health clinics with resources and flexibility to boost their testing capabilities to fight COVID-19,” said HHS Secretary Alex Azar. “Further expanding testing capacity, including at RHCs, is a crucial element of safely reopening our country and helping Americans return to work and school. A safe reopening is vital for Americans’ health and well-being, and especially so for those living in rural areas, who may have struggled with access to healthcare long before COVID-19 and found care even harder to access during this crisis.”

HRSA is also awarding $500,000 to support technical assistance efforts to the RHCs as they expand testing capabilities.  This includes activities such as conducting webinars, providing resources and guidance for implementation and management of testing programs.

To view a state-by-state breakdown of this funding, visit: www.hrsa.gov/rural-health/coronavirus/…

By Seema Verma

Administrator, U.S. Centers for Medicare & Medicaid Services

If you have Medicare and want to be tested for coronavirus disease 2019 (COVID-19), the Trump Administration has good news.

Medicare covers tests with no out-of-pocket costs. You can get tested in your home, doctor’s office, a local pharmacy or hospital, a nursing home, or a drive-through site. Medicare does not require a doctor’s order for you to get tested.

Testing is particularly important for older people and nursing home residents, who are often among the most vulnerable to COVID-19. Widespread access to testing is a critical precursor to a safe, gradual reopening of America.

When a vaccine for COVID-19 is developed, Medicare will cover that, too.

For Medicare beneficiaries who are homebound and can’t travel, Medicare will pay for a trained laboratory technician to come to your home or residential nursing home to collect a test sample. (This doesn’t apply to people in a skilled nursing facility on a short-term stay under Medicare Part A, as the costs for this test, including sample collection, are already covered as part of the stay.)

If you receive Medicare home health services, your home health nurse can collect a sample during a visit. Nurses working for rural health clinics and federally qualified health clinics also can collect samples in beneficiaries’ homes under certain conditions.

Or you can go to a “parking lot” test site set up by a pharmacy, hospital, or other entity in your community.

We’re doing similar things in the Medicaid program, giving states flexibility to cover parking-lot tests as well as tests in beneficiaries’ homes and other community settings.

We also implemented the Families First Medicaid eligibility option, which allows states to cover uninsured citizens’ testing costs with no cost-sharing. Individuals should contact their state Medicaid agency to apply for this coverage.

Both Medicare and Medicaid cover serology or antibody tests for COVID-19. These tests can help identify who has been exposed to the virus.

Medicare generally covers the entire cost of COVID-19 testing for beneficiaries with Original Medicare. If you’re enrolled in a Medicare Advantage health plan, your plan generally can’t charge you cost-sharing (including deductibles, copayments, and coinsurance) for COVID-19 tests and the administration of such tests.

In addition, Medicare Advantage plans may not impose prior authorization or other utilization management requirements on the COVID-19 test or specified COVID-19 testing-related services for the duration of the COVID-19 public health emergency.

We have also required that private health issuers and employer group health plans cover COVID-19 testing, and certain related items and services, with no cost-sharing during the pandemic. This includes items and services that result in an order for, or administration of, a COVID-19 diagnostic test in a variety of medical settings, including urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office.

From day one, President Trump has worked to ensure that cost is no barrier to being tested for COVID-19, and to make testing as widely and easily available as possible. As a result of these actions, we’ve seen a surge in testing among Medicare beneficiaries. Robust and widespread testing is of paramount importance as we begin easing back into normal life.

The Health Resources and Services Administration (HRSA) launched the “COVID-19 Uninsured Program Portal” where health care providers who have conducted COVID-19 testing of uninsured individuals for COVID-19 or provided treatment to uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020 can request claims for reimbursement. HRSA also developed a video overview of the program.

Click here for more information.
Click here to watch the overview video.

ARC has notified our current grantees that they may be able to repurpose remaining balances in their ARC grants to support immediate efforts to combat the COVID-19 crisis in their communities. This allowance to repurpose derives from guidance issued by the Office of Management and Budget (OMB) on April 9, 2020, which directs the federal government to marshal all legally available federal resources to combat the effects of COVID-19. Requests for repurposing should be discussed initially with the State ARC Program Manager and will require final approval by the State Alternate and the ARC Federal Co-Chair. Grantees should not assume that additional funds will be available should the repurposing result in shortages for the implementation of the originally approved grant.

ARC is carefully and continually monitoring the COVID-19 situation as it is impacting the Appalachian Region. We are assisting grantees who are unable to meet project goals or timelines due to the current situation. If you are a current ARC grantee experiencing such challenges, please email your ARC project coordinator and state program manager as soon as possible for help with needed accommodations regarding your project’s deliverables, timelines, budget, or other operations. (When emailing, please put your ARC project number in the subject line. This will make responding to your request easier).

As the COVID-19 pandemic continues, communities across Appalachia are banding together to pool resources and ideas for resilience. Here’s an inspiring example:

In the days following COVID-19 related shutdowns, the Appalachian Impact Fund, the Foundation for Appalachian Kentucky, and the Community Economic Development Initiative for Kentucky (CEDIK) at the University of Kentucky sprung into action. They raised almost half a million dollars, and created the Southeast Kentucky Downtown Business Stimulus Fund to help downtown businesses.

Drawing on ARC POWER support, this revolving loan fund and technical assistance program will support downtown revitalization efforts and entrepreneurial ecosystems across 10 counties in Southeastern Kentucky. The project is a partnership between the Foundation for Appalachian Kentucky and the Community Economic Development Initiative of Kentucky (CEDIK) to form the Appalachian Impact Fund (AIF).

Recently, the White House Office of National Drug Control Policy (ONDCP)  Director James Carroll and Senior Advisor for Rural Affairs Anne Hazlett briefed members of ARC’s Substance Abuse Advisory Council (SAAC) about federal strategies ensuring that Americans struggling with addiction can receive services and support during the COVID-19 crisis. During the briefing call, Carroll said that he is deeply concerned during COVID about the vulnerability of people with substance use disorder to the virus and to relapse in their recovery.  At the same time however, the pandemic has created a big opportunity to make significant policy changes in access to treatment and recovery services through telemedicine.  Lastly, Carroll said that the Administration is deeply committed to ensuring that people are connected to the resources and recovery support systems they need to get well and stay healthy in this critical time.

Offering a regional perspective, SAAC member Karen Kelley, Executive Director of TROSA, a comprehensive recovery program in North Carolina, described how they are readjusting their services to meet health and safety needs, while still providing continuity of care to their clients. Meanwhile, SAAC member Bob Hansen, Director of the Office of Drug Control Policy at West Virginia’s Department of Health and Human Resources described how West Virginia’s Jobs and Hope Initiative has developed a smartphone app to help those in recovery continue to receive needed services.

“It is easy for us to become distracted in the face of COVID-19,” said ARC Federal Co-Chairman Tim Thomas during the briefing. “but it is important to remember to stay focused on the substance abuse crisis, which has become a pandemic on top of a pandemic.”

The Pennsylvania Department of Human Services (DHS) has provided several important child welfare system updates. While the state was planning to implement the Family First Prevention Services Act provisions on October 1, a request was made to the Administration for Children and Families for a formal delay due to impacts of COVID-19 and budgetary concerns. The department was granted this request, which will change the implementation date to July 1, 2021. This change aligns with the state fiscal year and will assist the state and counties to adequately plan for policy and procedural changes. Read the official press release from DHS.

DHS also has provided important data on the impacts of COVID-19 on the child welfare system. Specifically, Childline, the state reporting system of child abuse and neglect, has seen a 50% decrease in calls. This is not indicative of a reduction in child abuse, rather, it reflects a decrease in interactions between children and mandated reporters. Because mandated reporters (such as school personnel and medical staff) are having limited access with children and youth, there is less direct recognition of abusive situations to report.

We encourage anyone who suspects child abuse or neglect to call ChildLine toll-free at 1-800-932-0313. The hotline is available 24 hours a day, seven days a week to receive reports of suspected child abuse.

Pennsylvania Partnerships for Children and other advocates have been seeking data on positive COVID-19 cases for those involved with the child welfare system. As of May 7, positive cases of COVID-19 include:

• 34 youth and 153 staff in 55 Pa. Code 3800 facilities
• Three youth served in family foster or kinship care
• Eight foster or kinship care providers

By Tracy Staley

Rural libraries often provide much-needed services like internet access to their communities. During the coronavirus epidemic, they find creative ways to continue with their mission, but with states pushing for reopening, some find themselves in a tough spot.

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