This site serves as a pre-publication notice of interim final rule with comment period from the Health Resources and Services Administrations and Centers for Medicare and Medicaid Services giving flexibility to those providing services to Medicare, Medicaid, Basic Health Program, and Exchange beneficiaries in order to respond effectively to the COVID-19 pandemic. It provides a table outlining flexibilities and the dates in which they are applicable, including those for providers and facilities in rural areas. This interim rule is effective upon publication in the Federal Register, which is scheduled for May 8, 2020. Comments are due within 60 days of publication. Find the site here.

In rural settings, Community Health Workers (CHWs) act as liaisons between providers and consumers, providing culturally-appropriate health education, making referrals for health and social services, and advocating for individuals and communities within the health service system.  This free online training from the global public health organization, Medical Care Development (known as MCD), covers the various roles CHWs can take in combating the spread of the coronavirus.

The Association of State and Territorial Health Officials (ASTHO) is providing a free online course for entry-level COVID-19 contact tracers.  Contact tracing is a control measure for preventing further spread of disease.  The training will be augmented by protocols specific to state and local jurisdictions and focus on building knowledge for remote contact tracing.

Recently, CMS issued a Memorandum that conveys information in response to inquiries from hospitals and Critical Access Hospitals (CAHs) concerning implications of COVID-19 for their compliance with the Emergency Medical Treatment and Labor Act (EMTALA). The memo was revised to include additional guidance related to the establishment of drive through testing sites, clarification of expectations in relation to the triage process and the medical screening examination, and use of telehealth. Among other topics, the memo address transfers to and from rural hospitals.

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On April 30, CMS updated its MLN Matters® Special Edition Article is for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) during the COVID-19 Public Health Emergency for services provided to Medicare beneficiaries. The update provides additional details about the new payment for telehealth services, cost-sharing related to COVID-19 testing, additional telehealth flexibilities, and the revision of the bed count methodology for determining the provider-based RHCs exemption to the RHC payment limit.

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If a health care provider is eligible to participate in the Medicare Promoting Interoperability Program, they must successfully demonstrate meaningful use of their certified electronic health record (CEHRT) each year to avoid a downward payment adjustment. Eligible hospitals and CAHs may be exempted from the Medicare downward payment adjustment if they can show that compliance with the requirement for being a meaningful EHR user would result in a significant hardship. To be considered for an exception (to avoid a downward payment adjustment), eligible hospitals and CAHs must complete and submit a Hardship Exception Application. CMS recently extended the deadline to September 1 for hospitals (previously July 1). The deadline to submit a Hardship Exception Application is November 30 for CAHs.

On April 30, CMS issued another round of regulatory waivers and rule changes during the COVID-19 Public Health Emergency. These changes build on temporary regulatory waivers and new rules CMS announced March 30 and April 10. Highlights of the waivers and rule changes include flexibilities to increase hospital capacity, health care workforce changes, efforts to reduce administrative burden, and a number of expansions of telehealth in Medicare. For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage.

The Centers for Disease Control and Prevention (CDC) provides daily updates and guidance. New this week: 1) updated guidance on caring for someone sick at home; 2)  an interactive map with the number of cases and deaths for each state, and 3) a recording of La Vida Durante la Pandemia del Coronavirus, an all-Spanish webcast from April 29.  CDC also does regular clinical calls for public health emergency response, called Clinician Outreach and Communication Activity (COCA).

Pursuant to the Governor’s authorization, as conferred in the Proclamation of Disaster Emergency issued on March 6, 2020 and the Governor’s Order to Enhance Protections for Health Care Workers issued on May 6, 2020, all statutory and regulatory provisions or portions thereof, that would impose an impediment to implementing the guidance outlined below are suspended. Said suspensions will remain in place throughout the duration of the Governor’s Proclamation.

The Bureau of EMS issues the following guidance as it relates to the utilization of out of state EMS personnel, as detailed below:

• EMS providers that hold an active credential with another state’s EMS certifying body, or whom hold an active certification with the National Registry of Emergency Medical Technicians, may practice in Pennsylvania on the sole basis of that certification. This suspends requirements found at 35 Pa. C.S. § 8113 and 28 Pa. Code § 1021.21.
• Individuals holding an out-of-state certification and are practicing in Pennsylvania with a licensed Pennsylvania EMS agency should not exceed the scope of practice or training that they received and are credentialed to perform in their home state. However, regardless of the scope of their home state, they may not exceed the established Pennsylvania Scope of Practice
• Prior to utilizing individuals whom do not hold Pennsylvania EMS certification, Pennsylvania EMS agencies should make a good faith effort to verify that the individual holds the credentials that they claim to hold, and should document what those efforts entailed. All NREMT certifications can be verified online at www.nremt.org in addition, many states have online verification options as well. Please visit https://www.nremt.org/rwd/public/states/state-ems-agencies, select the state you are trying to verify, then click the green button that says verify a state license. If available, you will be taken to that state’s certification portal. Please note, this is not an option for every state.
• Irrespective of certification level, the EMS agency medical director must approve all individuals with an out-of-state credential prior to their service with a Pennsylvania EMS agency.
• For the purposes of PCR documentation, any out of state provider should be entered with their name, and OOS as the certification number
• This guidance does not apply to out-of-state individual providers who are operating under an EMS service/vehicle licensed in another state. Pursuant to EMSIB 2020-09 Out of State Licensed EMS Agencies out-of-state EMS agencies may operate within Pennsylvania pursuant to the laws and regulations of the state in which they are licensed.

Please address any questions to your Regional EMS Council.

Pennsylvania Governor Tom Wolf was joined by Attorney General Josh Shapiro to announce that he signed an executive order that protects Pennsylvanians from foreclosures or evictions through July 10. The action builds on a Pennsylvania Supreme Court order which closed court eviction proceedings until May 11 and ensures no renter or homeowner will be removed from their home for 60 more days.

In almost all circumstances, renters and homeowners are required to continue making monthly payments. If you are a Pennsylvanian struggling to make your monthly payments, you should contact your landlord or mortgage servicer immediately.

The Wolf Administration provided recommendations last week to stem foreclosures, evictions and help people experiencing homelessness. The Department of Human Services activated the commonwealth’s Sheltering Taskforce and is working with local and state partners to coordinate resources for people without housing. The Department of Community and Economic Development is also accepting applications for Emergency Solutions Grants to assist with the rapid rehousing of people experiencing homelessness, street outreach, homelessness prevention, and emergency shelter activities.

PHFA is also taking action to help homeowners and renters. The agency has stopped foreclosures and evictions and is offering forbearances with late fee waivers to homeowners with a PHFA mortgage who are experiencing a financial hardship because of COVID-19. PHFA also developed a list of renters’ rights and responsibilities to clarify the situation for apartment residents and is working with landlords and property managers to distribute it to renters. PHFA is also encouraging Low-Income Housing Tax Credit building managers to be flexible on rent payments and to waive late fees for tenants whose employment has been affected by the crisis.