July 23rd Newsletter - Sachs Policy Group

State Updates

Governor Cuomo Announces Additional States Added to Travel Advisory, Steady Numbers in New York State

Today (July 23^rd), Governor Cuomo held a press conference during which he announced that COVID-19 hospitalizations, infections, and deaths generally remain stable across New York State. There were 706 total hospitalizations yesterday, the lowest since March 18^th, and 13 deaths related to COVID-19. Of the 69,698 individuals tested yesterday, 811 (1.16 percent) were positive. The infection rate in New York City was 1.3 percent. The Governor also announced the results of COVID-19tests conducted on incarcerated individuals over age 55, which found that 77 of the 3,922 individuals tested were positive (1.9 percent). All individuals tested were asymptomatic.

On July 21^st, Governor Cuomo announced that 10 additional states meet metrics to qualify for the State’s travel advisory due to significant community spread of COVID-19. The new states are: Alaska, Delaware, Indiana, Maryland, Missouri, Montana, North Dakota, Nebraska, Virginia, and Washington.

Minnesota has been removed from the list. Travelers returning to New York from these states and the other 21 states on the travel advisory will be required to quarantine for 14 days. The Governor’s July 21st and 22nd press releases are available here and here (July 23rd is not available yet).

Governor Cuomo Issues Executive Order 202.53

On July 21^st, Governor Cuomo signed Executive Order 202.53 (available here) that extends several previously issued directives through August 20^th, including provisions that:

Authorize licensed pharmacists to order tests to detect SARS-CoV-2 or its antibodies, and to administer COVID-19 tests after completion of appropriate training.
Permit licensed pharmacists to be designated as a qualified health care professional for the purpose of directing a clinical service laboratory to test patients for COVID-19 or its antibodies.
Allow physicians to order COVID-19 tests for self-collection, without otherwise having an initial physician-patient relationship with the patient.
Allow clinical laboratories to accept and examine specimens for COVID-19 testing from personnel of nursing homes and adult care facilities without a prescription or order from an authorized ordering source, and to report the results of such tests to the appropriate operators and administrators of the nursing home or adult care facility.
Authorize the Commissioner of Health to suspend or revoke the operating certificate of any skilled nursing facility or adult care facility if that facility has not complied with regulations or directives from the State Department of Health (DOH).
Allow the Commissioner of Health to approve and certify temporary dedicated birthing sites operated by birthing hospitals and birthing centers that are currently licensed.
Require Article 28 facilities to allow any patient giving birth to have present with them for the labor, delivery, and remaining duration of the patient’s stay a support person and/or a doula who does not have symptoms of COVID-19.
Permit the resumption of elective surgeries and procedures in accordance with criteria and guidance issued by DOH.
Continue to close schools for in-person instruction, with the exception of special education.

The Order also stipulates that, while New York City was approved to enter Phase 4 of reopening on July 20^th, indoor common portions of retail shopping malls and low-risk indoor arts and entertainment will continue to be closed in the region.

Updated Guidance Documents

Recently released New York State and City guidance documents are listed below:

Supplement to Interim Guidance for Office-Based Work During the COVID-19 Public Health Emergency for Health Care Facilities and Their Office Sites (7.22.20)

COVID-19 Updates (7.20.20)
Interim Guidance for Office-Based Work During the COVID-19 Public Health Emergency (7.17.20)

Federal Updates

White House and Senate Republicans Unveil Next COVID-19 Spending Proposal

The White House and Republican Senators have reached an agreement on their proposal for the next COVID-19 spending package, which will serve as a starting point for negotiations with Senate Democrats. The proposal includes:

$235 billion total to the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, which will fund testing, vaccine research and distribution, training, and other aspects, including an additional $25 billion for the Provider Relief Fund;
An as-yet undetermined amount for economic stimulus payments;
An extended unemployment benefit, reduced from the current $600 per month;
A revised Paycheck Protection Program (PPP), which includes a streamlined loan forgiveness process, a second round of PPP loans for businesses under 300 workers or within the SBA size threshold for their industry that can demonstrate 50% lost revenue compared with a reference period, and a new working capital loan that serves as an alternative to a second round of PPP;
A number of health care provisions, such as the Medicare Part B premium not increasing in 2021, and an extension of the telehealth reimbursement policies through the end of 2021; and,
Liability protections via an exclusive federal cause of action that applies to litigation against any business, non-profit, school, medical provider, or medical professions arising from COVID-19.

The proposal does not include any additional money for state and local governments; though they may use Coronavirus Aid, Relief, and Economic Security (CARES) Act money to make up for lost revenues. This is expected to be contested during negotiations with Democrats.

CMS Announces New Nursing Home Initiatives

On July 22^nd, the Centers for Medicare & Medicaid Services (CMS) announced several new initiatives designed to protect nursing home residents from COVID-19. The initiatives include:

$5 billion of the Provider Relief Fund authorized by the CARES Act will be allocated to Medicare-certified long-term care facilities and state veterans’ homes to build nursing home skills and enhance nursing homes’ response to COVID-19, including enhanced infection control.
CMS will begin requiring, rather than recommending, that all nursing homes in states with a 5% positivity rate or greater test all nursing home staff each week.
CMS will provide an online, self-paced, on-demand Nursing Home COVID-19 Training focused on infection control and best practices to all 15,400 nursing homes nationwide, along with specialized technical assistance to nursing homes who have been found to have infection prevention deficiencies in their most recent CMS inspection and had recent COVID-19 cases based upon their data submissions to the Centers for Disease Control and Prevention (CDC).
CMS will release a list of nursing homes with an increase in cases that will be sent to states each week as part of the weekly Governor’s report to ensure states have the information needed to target their support to the highest risk nursing homes.

A press release covering the new initiatives is available here.

HHS OCR Releases COVID-19 Title VI Guidelines

On July 20^th, the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) released guidelines for federally funded health care providers aimed at preventing discrimination based on race, color, and national origin during the pandemic. The document focuses on federal fund recipients’ compliance with the prohibitions against race, color, and national origin discrimination contained in Title VI of the Civil Rights Act of 1964 (Title VI). The guidelines recommend a number of actions, which include, but are not limited to:

Adopting policies to prevent and address harassment or other unlawful discrimination on the basis of race, color, or national origin;
Ensuring that that Community‐Based Testing Sites and Alternate Care Sites are accessible to racial and ethnic minority populations;
Ensuring that individuals from racial and ethnic minority groups are not subjected to excessive wait times, rejected for hospital admissions, or denied access to intensive care units compared to similarly situated non‐minority individuals;
Assigning beds and rooms, without regard to race, color, or national origin;
Assigning staff, including physicians, nurses, and volunteer caregivers, without regard to race, color, or national origin; and,
Appointing individuals to participate as members of a planning or advisory body without exclusions on the basis of race, color, or national origin

The guidelines are available here.

HRSA Webcast for Medicaid, CHIP, and Dental Distribution

The Health Resources and Services Administration (HRSA) will be hosting a webcast on Monday, July 27^th, at 3:00 p.m. regarding the Provider Relief Fund’s Medicaid, CHIP, and Dental Distribution. The webcast will provide further detail about the application process. As a reminder, the application deadline for Medicaid, CHIP, and dentists has been extended to August 3^rd.

Pre-registration for the webcast is available here.

HHS Releases Provider Relief Fund Reporting Requirements Notice

On July 20^th, HHS released a notice stating that Provider Relief Fund recipients who received payments exceeding $10,000 in the aggregate will be required to comply with a specific set of reporting requirements in addition to the original Terms and Conditions. HHS will release instructions regarding these requirements by August 17^th, and the reporting system will become available on October 1^st.

The notice is available here.