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AzHHA Member Advisory - COVID-19: March 26

As of March 26, 2020, the Arizona Department of Health Services (ADHS) reports 508 individuals have tested positive for COVID-19 in Arizona, with eight deaths reported. Community spread is now considered widespread with all counties reporting cases. For daily case reporting, visit the ADHS COVID-19 home page.

WHAT’S NEW

New Executive Orders Issued

Governor Ducey today issued an Executive Order intended to increase hospital capacity to address an anticipated surge of COVID 19 patients. The order makes mandatory recommendations that ADHS Director, Dr. Cara Christ, sent to hospitals in a letter dated March 25, 2020. The new Hospital Capacity Executive Order requires hospitals to:

  • activate their facility emergency plan,
  • implement triage processes and develop triage criteria for decompressing Eds and
  • institute plans to optimize staffing levels.

In addition, all hospitals, except psychiatric hospitals, must develop a plan to increase their bed capacity by 50% by April 24, with the first 25% implemented by April 10, 2020. All hospitals, except psychiatric hospitals, must begin reporting bed data to ADHS within a week of the executive order.

The Hospital Capacity Executive Order comes on the heels of an Enhanced Surveillance Advisory Executive Order issued March 24 requiring hospitals to report staffing, supply and bed data to ADHS through EMResource. While the Enhanced Surveillance Executive Order technically applies to all licensed hospitals, only short-term acute care hospitals currently have access to EMResource. This is expected to change under the Hospital Capacity Executive Order. ADHS held a conference call with hospital staff on Wednesday to review the reporting data fields. The department has released this EMResource toolkit to assist hospitals in reporting data correctly.

On Wednesday the Governor released a separate Executive Order expanding telemedicine access. The order applies to commercial and Medicaid health plans, and addresses coverage and payment parity, service location and qualifying providers. AzHHA will provide an update as more information is made available.

All Executive Orders are now posted to Governor Ducey’s webpage here: https://azgovernor.gov/executive-orders.

SDMAC Recommends PPE and COVID-19 Testing protocols

ADHS convened the State Disaster Medical Advisory Committee (SDMAC) on March 24, 2020, and approved guidance for personal protective equipment (PPE) preservation and testing prioritization in accordance with the Arizona Crisis Standards of Care Plan. Under the recommendations, standards for PPE use should be shifted from conventional to contingency measures; organizations should prepare for crisis measures. Recommendations for contingency use of different elements of PPE include extended use strategies. Further details may be found online under CDC’s Strategies for Optimizing the Supply of PPE.

Given limited testing supplies, both reagents and swabs, and limited PPE, the SDMAC approved the following testing priorities. Public health and healthcare professionals should prioritize testing among three specific groups until sufficient and consistent PPE, testing supplies and capacity are widely available:

  • Healthcare workers, first responders and employer identified critical infrastructure personnel with COVID-19 symptoms
  • Individuals living in congregate settings with symptoms of COVID-19
  • Individuals hospitalized with respiratory symptoms

More information on the committee and the guidance reported here can be found on the ADHS website for SDMAC.

AzHHA Convenes Group to Discuss Emergency Regulatory Waivers

AzHHA yesterday held a conference call of over 30 hospital attorneys and compliance officers to identify emergency waivers of federal and state regulations that may be necessary to accommodate a surge of COVID-19 patients and to safeguard the financial resiliency of the healthcare delivery system. Drafts of the recommendations will be circulated among workgroup members next week before being sent to state and federal officials. Questions or requests to join the workgroup may be sent to Communications@azhha.org.

Hospitals Speak to Arizona’s Congressional Delegation

AzHHA convened a call with the Arizona congressional delegation Tuesday to share hospital concerns and needs with our federal representatives. Senator Kyrsten Sinema, Representative Ann Kirkpatrick, Representative Raul Grijalva, Representative Andy Biggs, Representative David Schweikert and Congresswoman Debbie Lesko joined the call to discuss their work in securing testing kits, protective equipment and supplemental funding required to keep hospitals open.

Federal Legislation

The Senate last night passed by 96-0 H.R. 748, the Coronavirus Aid, Relief, and Economic Security (CARES) This bill is the third large-scale congressional measure in response to the COVID-19 outbreak. The House is expected to pass the legislation on Friday. Among other health care-related provisions, the package:

  • Increases funding to the Public Health Services and Social Emergency Fund by almost $127 billion to, among other things, reimburse hospitals for COVID-19 expenses.
  • Creates a Medicare add-on payment of 20% for both rural and urban inpatient hospital COVID-19 patients.
  • Removes the Medicare sequester from May through December 2020.
  • Expands the existing option for hospitals to receive “accelerated” Medicare payments, including by ensuring critical access hospitals can access this option.
  • Eliminates $8 billion in total Medicaid DSH cuts over FY 2020 (eliminates $4 billion cut) and FY 2021 (reduces cut to $4 billion from $8 billion).
  • Provides flexibility to post-acute care providers, including waiving long-term care hospital (LTCH) site-neutral policy.
  • Takes steps to improve the supply chain, including access to masks and drugs, among other items.
  • Takes steps to expand coverage for COVID-19 testing and testing-related services; and
  • Provides new telehealth flexibilities, including expanding access in rural areas.

A Warning About Insufficiently Tested Treatments

In light of a recent death in Arizona, ADHS issued a warning this week to providers to not prescribe theorized “anti-COVID” medications and to counsel patients against using inappropriate medications and household products to prevent or treat COVID-19. Stories have been circulating on social media about the effectiveness of antimalarial and antibiotic medications for treatment of COVID-19. However, the data do not support this currently. Moreover, there have been several detrimental downstream impacts associated with this practice:

  • Patients are inappropriately requesting prescriptions of antimalarial and certain antibiotic medications.
  • Pharmacies are running out of antimalarial and certain antibiotic medications.
  • Patients are self-administering antimalarial and certain antibiotic medications.
  • Patients are self-administering non-FDA and household products (e.g., fish tank cleaner).

Management of COVID-19 is currently supportive care for respiratory and pneumonia care. For further resources on treatment guidelines, see the CDC clinical guidance and clinical trials.

CDC Issues Interim Guidance on the Discontinuation of Transmission-Based Precautions and Discharge of Hospitalized Patients

On March 23, 2020 the CDC released interim guidance for healthcare personnel managing patients with COVID-19. The guidance:

  • clarified that patients with COVID-19 can be discharged from a healthcare facility whenever clinically indicated.
  • updated testing recommendations (a single swab, preferably nasopharynx),
  • details a test-based strategy and a non-test-based strategy for discontinuation of transmission-based precautions.
  • outlines when a testing-based strategy is preferred.
  • emphasizes that meeting criteria for discontinuation of transmission-based precautions is not a prerequisite for discharge.
  • addresses discontinuation of empiric transmission-based precautions for patients suspected of having COVID-19.
  • clarifies transmission-based precautions for patients discharged to home or to LTC or Assisted Living facility.

Additional information is available on the CDC website.

Additional State Announcements and Guidance

Temporary Waivers for EMS and Trauma Center Regulations

CMS Approval of AHCCCS 1135 Waiver Requests

ADHS Provider and Facilities COVID 19 Webpage

New Federal Agency Announcements and Guidance

CMS grants exceptions and extensions to Medicare quality reporting

Updated CMS COVID 19 Coverage and Coding FAQs

Updated CMS COVID 19 Coverage and Payment Fact Sheet

Medicare Provider Enrollment Relief FAQ

Updated CDC Guidance on Discharging COVID 19 Patients

Updated CDC Guidance for Collecting, Handling and Testing Specimens

CDC Hospital Resources for Preparing for COVID 19 Patients

CDC PPE Burn Rate Calculator

Updated Evaluating and Testing Persons for COVID 19

CDC Interim Infection Control Recommendations for COVID 19 Patients in a Healthcare Setting

Quick Guide: FEMA Reimbursement for acute Care Hospitals

COVID-19 Updates

Ensure your hospital response team is on AzHHA’s COVID-19 member advisory distribution list. Visit our website to read previous advisories and sign upto receive future member advisories and COVID-19 updates.

Questions? Contact us at Communications@AzHHA.org.