June 10, 2020

How the Trump admin wants providers to resume non-Covid care

Daily Briefing

    The Trump administration on Tuesday urged providers in states and regions with no evidence of a resurgence in their growth rates of new coronavirus infections to resume scheduled non-Covid-19 care, even as a top federal health official separately cautioned that the new coronavirus pandemic "isn't over yet."

    Your checklist for resuming elective procedures

    US Covid-19 cases near 2M, death toll tops 112K

    The Trump administration made the push as U.S. officials as of Wednesday morning reported 1,990,100 cases of Covid-19, the disease caused by the new coronavirus—up from 1,970,600 cases as of Tuesday morning.

    As of Wednesday morning, U.S. officials also had reported a total of 112,174 U.S. deaths linked to the new coronavirus—up from 110,966 deaths reported as of Tuesday morning.

    New coronavirus pandemic 'isn't over,' Fauci warns

    As the numbers of new coronavirus infections and related deaths continue to rise throughout the United States and the rest of the world, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during a conference held by the Biotechnology Innovation Organization (BIO) on Tuesday warned that the global Covid-19 pandemic "isn't over yet."

    Fauci noted that while Ebola, SARS, and other infectious diseases have spread around the world in about six months to a year, the new coronavirus "took about a month" to be transmitted worldwide.

    Fauci also noted that outbreaks of other infectious diseases, including Ebola and HIV, have "had a degree of containment and finiteness to them from the very beginning." But "in a period of four months, [the new coronavirus] has devastated the whole world," Fauci said, adding that the question now is, "Where is it going to end? We're still at the beginning of really understanding."

    Trump admin urges providers to resume non-Covid-19 care

    Separately, the Trump administration on Tuesday urged providers in states with no evidence of a spike in Covid-19 growth rates to resume non-Covid-19 care and scheduled procedures.

    CMS Administrator Seema Verma in a statement said, "While telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care." She continued, "Americans need their health care and our health care heroes are working overtime to deliver it safely."

    To help providers restart scheduled procedures and other non-Covid-19 care, CMS released two new guidance documents: one aimed at providers and one aimed at patients.

    In its provider-focused guidance, CMS offers recommendations on how providers can safely restart health care services if their areas have entered the second phase of the White House's gating criteria for reopening. Those criteria include seeing a downward trend in rates of newly confirmed infections from the new coronavirus and cases of Covid-19 over a 14-day period and establishing robust testing programs.

    CMS in the guidance recommends that providers in areas that have entered the second phase of reopening designate separate areas for Covid-19 and non-Covid-19 care to help reduce patients' risk of exposure to the new coronavirus. CMS says providers should consider using separate buildings, floors, or rooms with separate entrances for Covid-19 and non-Covid-19 patients to minimize the risk of transmission.

    In addition, CMS recommends that providers maintain adequate surge capacity in terms of their physical space, protective equipment, testing, staff, and supplies. According to the guidance, providers also should prioritize care for at-risk populations and participate in a registry or national data collection system, such as the National Healthcare Safety Network, to track patient outcomes, effects on systems and facilities, and resource allocation.

    CMS in the guidance also said medical "[s]taff should continue to be routinely screened" for the new coronavirus, "as should others who work in the facility, including physicians, nurses, housekeeping, delivery, and all people who enter the area."

    In its patient-focused guidance, CMS urges patients not to postpone necessary care for potentially serious health conditions or necessary preventive care, including cancer screens and immunizations, in light of the Covid-19 epidemic. The agency recommends patients contact their providers to determine what precautions their providers are taking to prevent the new coronavirus' spread and keep patients safe. For example, CMS notes that some providers may ask patients to wear face masks or coverings, wait for appointments in their cars, undergo a screening for the new coronavirus, and wash their hands to reduce risk of the virus' transmission. Some providers, CMS notes, also may still be limiting visitors.

    However, CMS in the guidance recommends that people at high risk of developing a severe case of Covid-19, including seniors and individuals with certain underlying medical conditions, should continue to stay home and self-isolate "[a]s much as possible." The guidance notes that patients can continue to receive care via telehealth services if their providers offer them.

    Trump admin to distribute $25B to Medicaid, CHIP providers

    Also on Tuesday, HHS announced that, this week, it will distribute $25 billion through the Provider Relief Fund to eligible Medicaid and CHIP providers.

    HHS said it will disburse approximately $15 billion to eligible providers participating in state Medicaid and CHIP programs. According to HHS, 62% of all providers participating in state Medicaid and CHIP programs already have received relief payments through an initial distribution of funds, and the funds distributed this week will go to the remaining 38%.

    HHS said it would launch an enhanced Provider Relief Fund Payment Portal on Wednesday to allow Medicaid and CHIP providers to report their annual patient revenues, which HHS will use as a factor to determine their relief payments, along with information on the number of Medicaid patients providers treat. According to HHS, providers will receive at least 2% of their reported gross revenue from patient care.

    The department said it also will distribute $10 billion this week to safety net hospitals serving vulnerable populations. HHS said the payments will go to hospitals with a Medicare Disproportionate Payment Percentage of 20.2% or more, an average amount of uncompensated care per bed of $25,000 or more, and profitability of 3% or less, as reported to CMS in their most-recently filed cost reports. HHS said eligible hospitals will receive between $5 million and $50 million.

    Separately, HHS said it will distribute another $10 billion to hospitals located in Covid-19 hot spots. The department said hospitals by June 15 must submit data on their Covid-19 positive-inpatient admissions for the period of Jan. 1 through June 10 to be eligible for the funds (Grady, New York Times, 6/9; Oprysko, Politico, 6/9; Lovelace, CNBC, 6/9; Japsen, Forbes, 6/9; Kacik, Modern Healthcare, 6/9; CMS release, 6/9; CMS patient guidance, 6/9; Hellmann, The Hill, 6/9; Goldstein, Washington Post, 6/9; Sibi Joseph, Reuters, 6/9; HHS release, 6/9; New York Times, 6/10).

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