COVID-19 RURAL DIGEST

MARCH 26, 2020

The emergence of COVID-19 has caused an almost unprecedented amount of change in the framework surrounding rural care. The CORH team is dedicated to providing regular updates on this evolving situation to healthcare leaders across the country.

As the pandemic unfolds, we foresee sending out updates twice a week on Tuesdays and Thursdays with new developments.

As of 3/26/2020, the CDC’s Number of Confirmed Cases of COVID-19: 54,453

See a city-by-city map of confirmed cases: https://coronavirus.jhu.edu/map.html

Seven more states granted Section 1135 Medicaid waivers.

• Indiana, Iowa, Kansas, Kentucky, Missouri, Oregon and Rhode Island all granted waivers.
• These states join the twelve previous states granted waivers.
• Check with state health agencies to determine impact on local practices.
• Read more: https://www.modernhealthcare.com/medicaid/seven-states-score-medicaid-waivers-coronavirus
• Full explanation of waivers: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/1135-Waivers-At-A-Glance.pdf

AMA releases guides to aide reporting during pandemic

• Multi-scenario guide to define payment coding during crisis. Scenarios include:
  • Patient comes to office for E/M visit about COVID-19 and is directed to a testing site
  • Patient comes to office for E/M visit, is tested for COVID-19 during the visit
  • Patient received telehealth visit re: COVID-19, and is directed to come to physician office or physician’s group practice site for testing
  • Patient with COVID-19 receives virtual check-in OR on-line visits via patient portal/e-mail (not related to E/M visit) OR telephone call from qualified nonphysician (those who may not report E/M)
  • More scenarios included in the guides found here.
• Guide on navigating CMS/HHS pandemic regulatory and policy flexibility
  • See full guide here for specific details.
• Resource Center for Physicians
  • See full center here.

COVID-19 continues to worsen around the country; large cities experiencing exponential growth suburban and rural areas expected to follow

• Cities such as New York and New Orleans are the current epicenters of the U.S. pandemic, but fears remain that the future spread of the virus will hit exurban areas hard.
• Read more: http://www.cidrap.umn.edu/news-perspective/2020/03/new-york-notes-dizzying-covid-19-numbers-trump-mulls-lifting-restrictions

CMS announces results of review on hardest hit nursing home

• Review finds that the nursing home failed to act quickly causing residents to be in immediate danger.
• CMS is now prioritizing complaint inspections, targeted infection control inspections, and self-assessments; all other inspections expected to be on hold until the end of pandemic crisis.
• Read the full release: https://www.cms.gov/newsroom/press-releases/cms-announces-findings-kirkland-nursing-home-and-new-targeted-plan-healthcare-facility-inspections

Johns Hopkins researchers develop recommendations for prevent COVID-19 spread in nursing homes

• Researchers recommend:
  • Restriction of visitors per federal guidelines;
  • Integration medical reserve corps or other trained volunteers;
  • Reduction internal activities;
  • Regular cleaning and disinfection of surfaces and equipment;
  • Personal protective equipment mandates and inspections.
• Read full recommendations: http://www.centerforhealthsecurity.org/cbn/2020/cbnreport-03232020.html

CDC Clinician Outreach and Community Activity series focuses on equipping providers with tools to combat COVID-19

• The CDC is providing a series of free, past and future webinar to disseminate information to providers treating COVID-19 patients.
• Find the webinars: https://emergency.cdc.gov/coca/calls/2020/index.asp

HHS announces grants to provide meals to the elderly

• HHS grants $250 million to state, community, and tribal agencies to provide meals to the elderly under Older Americans Act.
• Check with state grant coordination office to understand fund allocation.
• Read more: https://www.hhs.gov/about/news/2020/03/24/hhs-announces-grants-to-provide-meals-for-older-adults.html
• Discover more elder care resources at: https://eldercare.acl.gov/Public/Index.aspx

Many hospitals turning to remote monitoring tools to combat COVID-19 overcrowding

• To increase surge capacity, many hospitals are beginning to use remote monitoring capabilities allowed under new CMS rules.
• Read more: https://www.statnews.com/2020/03/25/coronavirus-hospitals-weigh-remote-patient-monitoring-tools/

Researchers at University of North Carolina point to rural hospitals’ bed underutilization to provide surge capacity during crisis

• Report by UNC researchers note that many rural hospitals operate a number of beds under licensure ability.
• Read full report: http://www.shepscenter.unc.edu/download/19926/
• See NPR tool to compare regional numbers of ICU beds: https://www.npr.org/2020/03/25/819940409/icu-bed-capacity-varies-widely-nationwide-see-how-your-area-stacks-up

CMS, Administration pull back on Medicaid eligibility requirements

• The COVID-19 crisis has caused CMS to delay proposed rule to crackdown on state Medicaid eligibility requirements.
• Current rules expected to stay in place offer wide support for Medicaid payments around COVID-19.
• Read the rule: https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201910&RIN=0938-AU00