Stateline, Pew

The nation’s pandemic hotspots have shifted to rural communities, overwhelming small hospitals that are running out of beds or lack the intensive care units for more than one or two seriously ill patients.

And in much of the Midwest and Great Plains, hospital workers are catching the virus at home and in their communities, seriously reducing already slim benches of doctors, nurses and other professionals needed to keep rural hospitals running.

Nationwide, positive coronavirus cases started rising in mid-September as children and college students returned to school, more businesses reopened and more people started resuming daily activities outside of their homes. Wisconsin and other less populous states became the new hotspots.

This week, per capita rates of COVID-19 were highest in North Dakota, followed by South Dakota, Montana, Wisconsin, Nebraska, Idaho, Utah, Wyoming, Iowa, Arkansas and Illinois. Hospitalization rates also were rising in those states and others.

Health care experts expect that a seasonal spike in flu and pneumonia, combined with a steady rise in COVID-19 cases, will swamp many health care systems, particularly in rural areas.

Wisconsin recently opened a 530-bed field hospital on state fairgrounds in Milwaukee that was set up in the early days of the pandemic but sat unused until now. Last week, 50 beds were readied for patients, and the staff was working on transfers with hospitals that were hitting their capacity limits. The number of hospitalized COVID-19 patients in the state tripled in the last 30 days.

In Oklahoma City and the surrounding area, no ICU beds were available last week, according to the University of Oklahoma. The lack of beds required medical professionals in those already understaffed hospitals to spend hours on the phone arranging patient transfers to other Oklahoma hospitals.

Fewer than 20 ICU beds were available in the entire state of North Dakota, according to state data. That meant patients had to be transferred hundreds of miles, in some cases to South Dakota and Montana.

Read more.

As a fall resurgence of COVID-19 becomes more evident in Pennsylvania and across the country, Pennsylvania Governor Tom Wolf and Sec. of Health Dr. Rachel Levine today presented an update on the COVID-19 Early Warning Monitoring System Dashboard and case data, and asked Pennsylvanians to unite against COVID.

“The fall resurgence is here,” Gov. Wolf said. “And while we must always take this deadly virus seriously, now is the time for all of us to double down on our efforts to keep ourselves and those around us safe. We’ve seen what happens when masks aren’t worn and social distancing isn’t practiced – people get sick, so we need to stay vigilant and work together to stop the spread of COVID-19.”

Last week, Dr. Levine introduced the team of public health experts leading the work to make sure all Pennsylvanians are as protected as possible from both COVID-19 and influenza. The team is prepared for the resurgence, is managing a robust testing plan, preparing for vaccine distribution when a vaccine is available, and working to track influenza (flu) cases across the state.

“Our data, including case counts, hospitalizations and percent positivity reflect the fall resurgence occurring,” Secretary Levine said. “The department and the Wolf Administration are working continuously to ensure we are prepared for this resurgence and to protect Pennsylvanians. We all must unite to protect ourselves and loved ones from COVID-19 by washing our hands, wearing a mask, social distancing, avoiding large gatherings and downloading the COVID Alert PA app.”

Dr. Levine also presented the latest data from the state’s COVID-19 Early Warning Monitoring System Dashboard, which tracks the level of community transmission as a basis for the recommendations for Pre-K to 12 schools to determine instructional models; data on cases among 5-18-year-olds; cases that reported visiting a business among potential locations where exposures may have occurred; and updated travel recommendations.

The dashboard is designed to provide early warning signs of factors that affect the state’s mitigation efforts. The data available on the early warning monitoring dashboard includes week-over-week case differences, incidence rates, test percent-positivity, and rates of hospitalizations, ventilations and emergency room visits tied to COVID-19.

This week’s update compares the period of October 9 – October 15 to the previous seven days, October 2 – October 8.

As of Thursday, October 15, the state has seen a seven-day case increase of 8,723; the previous seven-day increase was 7,398, indicating a 1,325-case increase across the state over the past week.  The statewide percent-positivity went up to 4.3% from 3.9% last week.

“COVID is tough, but together, Pennsylvanians are tougher,” Gov. Wolf said. “The last seven and a half months have shown us that when we unite, we can defeat this virus. Pennsylvanians came together to stop COVID in its tracks and we can do it again and stop this fall resurgence in its tracks if we stand united against COVID.

“You matter, and so do your actions. When we make good choices and follow health and safety measures, we see results. Let’s work together to stop the spread.

Modern Healthcare reported on Oct. 13, 2020, that 2020 Census undercounts would impact funding for more than 50 healthcare and healthcare-related programs, including Medicaid and Medicare Part B, according to an analysis by the George Washington Institute of Public Policy. The response rate for the 2020 census has declined because of the COVID-19 pandemic. A one percent undercount, for example, could cost states up to one dollar in federal Medicaid funds on every $100 spent, according to a 2018 report by Reamer.

The United States is “facing a whole lot of trouble” as coronavirus cases continue to surge across the country heading into the cold winter months, Dr. Anthony Fauci, the nation’s top infectious disease expert, told CNBC on Monday. The U.S. reported more than 44,600 new cases on Sunday and the seven-day average rose to over 49,200 new cases per day, up more than 14 percent compared with a week ago, according to an analysis of data compiled by Johns Hopkins University. Average daily cases were up by more than five percent in 36 states and the District of Columbia.

On Oct. 8, 2020, the U.S. Small Business Administration (SBA) issued interim final rule (IFR) guidance for the Paycheck Protection Program (PPP) that includes small business loan forgiveness relief on amounts of $50,000 or less. In addition, the SBA created a new two-page application form, Form 3508S, and related instructions for borrowers with loans of $50,000 or less. A borrower using this form is exempt from both:

• Any reduction in its loan forgiveness amount on account of full-time equivalent reductions
• Any reduction in its loan forgiveness amount on account of reductions in employee salaries or wages

The rule does not exempt a borrower that is using Form 3508S from submitting the required documentation to substantiate payroll and nonpayroll costs. These requirements (including the requirement that at least 60 percent of the potential forgiveness amount was used for eligible payroll costs) are largely unchanged from the existing ones. A BKD CPAs & Advisors article provides more information on the additional guidance and new lender review responsibilities.

The Pennsylvania Department of Health released Pennsylvania Health Alert 531 – 10/8/20 – ADV on reporting point of care SARS-CoV-2 test results. The U.S. Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUA) for a number of COVID-19 point of care (POC) tests for rapid detection of SARS-CoV-2. These POC tests may be used by both traditional healthcare providers (e.g., hospitals, outpatient providers) and by non-traditional settings that have appropriate CLIA Certificate to conduct this testing. All entities conducting these POC tests are required to report these results, including positive, negative and inconclusive/indeterminate, to public health authorities through PA-NEDSS. Click here to view all the 2020 PA Health Alerts, Advisories and Updates.

The Pennsylvania Department of Health released Pennsylvania Health Alert 532 – 10/8/20 – ADV on point of care antigen test use and interpretation. The availability and use of antigen tests to detect SARS-CoV-2 is increasing. The main advantage of using these antigen tests is the rapid turnaround time for results; however, these tests are not as sensitive as molecular tests. This guidance is designed to describe what an antigen test is and how it differs from PCR testing, some best practices for sites conducting these tests, when point of care (POC) antigen testing should be considered, and circumstances that should be considered when interpreting antigen test results. Click here to view all the 2020 PA Health Alerts, Advisories and Updates.

The Wolf Administration has begun distributing the state’s first allotment of 250,000 COVID-19 antigen test kits provided by the federal government to Clinical Laboratory Improvement Amendments (CLIA)-certified institutions across Pennsylvania. Distribution is starting with Bradford, Centre, Lebanon, Montour, Northumberland, Schuylkill and Snyder counties because of the recent high disease incidence rate in these areas. The Secretary of Health also issued an order to laboratories, healthcare practitioners, healthcare providers and facilities reinforcing that all antigen test results, both positive and negative, are required to be reported to the Department of Health via its reporting system, PA-NEDSS. Click here to learn more.

2020 Health Workforce Field Strength Numbers Increase Access to Primary and Substance Use Disorder Care

Read the full press release

There are now more than 16,000 National Health Service Corps (NHSC) members providing care to more than 17 million Americans. An additional 1.8 million patients are cared for by over 1,700 Nurse Corps clinicians. Nurse Corps also added 135 faculty to its rolls.

NHSC and Nurse Corps programs support the recruitment and retention of dedicated primary care, dental, and behavioral health providers who care for underserved patients daily in high-need areas of the U.S. and its territories.

As part of our commitment to recruiting clinicians interested in serving in underserved areas, we take an active role in connecting clinicians with employment opportunities at approved sites. After a pause this spring and summer, we recently resumed hosting Virtual Job Fairs -a live interactive platform that provides students and clinicians the opportunity to meet with hundreds of recruiters hiring in underserved communities across the country.

Share how we’re making strides to impact health equity and increase access to care for those who need it most. Forward this email and use the graphics below to share with your audiences. Follow and tag us on our NHSC and Nurse Corps Facebook, NHSC and Nurse Corps LinkedIn, and NHSC Twitter accounts.

Thank you all for the hard work you do. Your dedication and support throughout 2020 has helped communities all over the nation get through a very difficult year.

Learn about HRSA’s Coronavirus response at hrsa.gov/coronavirus

The Centers for Medicare & Medicaid Services (“CMS”) appreciates its long-standing partnership with immunizers, including pharmacies, to facilitate the efficient administration of vaccinations, particularly for vulnerable populations in long-term care facilities and other congregate care settings across America. Leveraging immunizers’ capabilities and expertise will play an important role in the Department’s ability to broadly distribute and administer COVID-19 vaccinations, including Medicare beneficiaries.

America is facing an unprecedented challenge. Quickly, safely, and effectively vaccinating our most vulnerable citizens in settings that have accounted for about 30 percent of U.S. COVID-19 deaths is a top-priority mission for the Trump Administration. Unfortunately, many long-term care facilities may not have sufficient capacity to receive, store, and administer vaccines. And some long-term care facility residents cannot safely leave the facility to receive vaccinations.

Outside immunizers can help fill that urgent need and provide onsite vaccinations at skilled nursing facilities (“SNFs”). But to do so during this global emergency, Medicare-enrolled vaccinators must be able to bill directly and receive direct reimbursement from the Medicare program. However, the Social Security Act requires SNFs to bill for certain services, including vaccine administration, even when SNFs rely on an outside vendor to perform the service. See Social Security Act §§ 1862(a)(18), 1842(b)(6)(E).

Therefore, in order to facilitate the efficient administration of COVID-19 vaccines to SNF residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance (collectively, “SNF Consolidated Billing Provisions”). Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.

CMS will exercise such discretion (1) during the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. § 1320b-5(g)) and ending on the last day of the calendar quarter in which the last day of such emergency period occurs; or (2) so long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings—whichever is later. While CMS exercises this enforcement discretion, compliance with SNF Consolidated Billing Provisions is not material to CMS’ decision to reimburse for COVID-19 vaccine administration. If CMS decides in the future to cease exercising this enforcement discretion, CMS will provide public notice in advance and allow at least 60 days for affected outside immunizers to modify their business practices.