As of March 16, 2020, the Arizona Department of Health Services (ADHS) reports 18 individuals have tested positive for COVID-19 in Arizona. Commercial lab testing only accounted for one of these cases. As commercial lab testing expands, we expect to see a substantial increase in positive cases. For daily case reporting, visit the ADHS COVID-19 website – azhealth.gov/covid-19.

NEW THIS WEEK

Governor Convening Hospital Chief Medical Officers

Gov. Doug Ducey is convening a roundtable of Chief Medical Officers on March 17 to discuss COVID-19 and health system readiness. AzHHA is forwarding details to members. It is critical that hospitals and public health departments work together in the coming weeks to assess system capacity and resource needs. While there is still a lot to learn about the clinical characteristics of this disease, a study published in the New England Journal of Medicine found that of 1099 patients admitted to hospitals in China, 5% were admitted to the ICU, and 2.3% required intubation.

AzHHA has been in communication with ADHS regarding options for assessing system capacity and resource needs, and we will continue to advocate on your behalf.

Ensure your hospital response team is on AzHHA’s COVID-19 member advisory distribution list. Email [email protected]with your team’s email addresses and ask us to add you to the list to receive future member advisories and COVID-19 updates.

President Declares a National Emergency

The President declared a national emergency on March 13 under the National Emergencies Act due to the COVID-19 pandemic. The declaration paves the way for the Department of Health and Human Services Secretary (HHS) to provide Section 1135 waivers to grant regulatory flexibilities to help healthcare providers respond to the COVID-19 outbreak.

HHS released a list of blanket waivers on Friday. Hospitals and other providers do not need to request an individual waiver to be relieved of compliance with these laws to the extent described in this list.

Among other actions, the national declaration would allow for Medicare Conditions of Participation waivers of:

• AzHHA and AzCHER hospital member alert –COVID-19 The skilled nursing facility 3-day qualifying hospital stay requirement for beneficiaries, which would allow skilled nursing facility coverage in the absence of a hospital stay, making inpatient beds available for more seriously ill patients.
• Critical access hospitals' limitation of 25 in patient beds and the 96-hour length of stay limitation. This is crucial for rural areas that may not have other options for inpatient beds.

HHS held a conference call and announced it will be issuing further blanket waivers, including an EMTALA waiver and telehealth waivers. HHS will also announce restrictions on visitors to skilled-nursing facilities, which are expected to align with those authorized in Arizona’s emergency declaration and executive order. Click here for more information about waiver authority from CMS, and here for what additional emergency and disaster-related policies and procedures may be implemented with an 1135 waiver.

If the blanket waiver is insufficient to meet your organization’s need, you can request to operate under an individual Section 1135 waiver. ADHS previously developed a form for submission of individual waiver requests. AzHHA is confirming if this form and submission directions are current, and we will inform members as soon as possible. In any event, the request should be as clear as possible about the impact of the patient surge or supply/staffing shortage on the hospital.

Alternative Testing Options

Hospitals around the country have begun opening “drive-through” or mobile testing clinics. HHS has taken note of this approach and is partnering with states to support this effort. AzHHA is coordinating a member call this Tuesday from 3:00 pm -4:00 p.m.with representatives from Mayo Clinic (which has opened such clinics in Scottsdale and Rochester) and ADHS to discuss strategies for opening and operating these testing clinics. In addition, ADHS will be available to discuss the evolving testing landscape and respond to licensing questions. Information on these calls will be sent out shortly.

Public Call Center

The Arizona Poison and Drug Information Center is now available to take COVID-19 calls from Arizona providers and the general public:1-844-542-8201

School Closures & Childcare

Governor Ducey and Superintendent Kathy Hoffman on Sunday announced the statewide closure of Arizona schools from Monday, March 16 through Friday, March 27, 2020. AzHHA understands the impact this will have on your healthcare workforce, and we shared concerns with government officials. In an effort to mitigate the closure impact on Arizona’s workforce, Gov. Ducey announced a partnership with the Girls and Boys Club to expand services funded by the state and private donations. At this point, there is discussion of expanded services in the following Boys and Girls Club locations: Metro Phoenix, East Valley, West Valley, Scottsdale, Tucson, Bisbee, Casa Grande, Prescott, Flagstaff, Sierra Vista, White Mountain, Colorado River and Gila Valley, Arizona. Funders are meeting tomorrow to discuss opportunities to open to pool resources to assist Arizona Communities.

In addition, if your organization wishes to provide childcare for children of employees whose schools have been closed, ADHS has provided the following licensing guidance:

“IF the childcare site is ONSITE, there is an exemption from licensure, as the parents are onsite. If the childcare site is OFFSITE, but FREE, there is an exemption from licensure for that activity as well.So the bottom line is, onsite, (free or for compensation), no problem. If it is offsite it must be free, then no licensure is required.”

State and Federal COVID 19 Funding; Congressional Action

As a result of the emergency declaration, Arizona will receive approximately $12 million from the CDC. In addition, the Legislature in S.B. 1051 appropriated $5 million from the “rainy day” fund, with up to an additional $50 million for the state’s response efforts. Hospitals should be evaluating supply needs that could be met with these additional resources. AzHHA is working with ADHS on a process for a needs assessment, which is typically coordinated through local public health.

In related news, the U.S. House of Representatives has passed the Families First Coronavirus Response Act (H.R. 6201). The Senate is expected to take it up soon. The legislation would eliminate patient cost-sharing for COVID-19 testing and related services, establish an emergency paid leave program, and expand unemployment and nutrition assistance. Moreover, the bill would provide a temporary increase in the Medicaid Federal Medical Assistance Percentage (FMAP), enable states to apply for temporary waivers to cover COVID-19 testing for the uninsured through the Medicaid program, and provide $1 billion in testing for the uninsured. The bill does not make any changes to the Occupational Safety and Health Administration standards for hospitals, which AzHHA has opposed based on clinical science and how COVID-19 is transmitted.

COVID-19 Updates

Ensure your hospital response team is on AzHHA’s COVID-19 member advisory distribution list. Email [email protected]with your team’s email addresses and ask us to add you to the list to receive future member advisories and COVID-19 updates.