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AzHHA Member Advisory - COVID-19: May 29

Executive order issued on use of AZ Surge Line

Governor Ducey yesterday issued Executive Order 2020-38 requiring hospitals to use the Arizona Surge Line for interfacility transfer of COVID-19 patients and to accept transfers when “clinically appropriate and resources allow.” Under the executive order, insurers are also required to cover the transfer and treatment of COVID-19 patients “at in-network rates” without regard to whether the facility is in-network when the transfer is facilitated by the Arizona Surge Line. AzHHA is reviewing the executive order and will provide additional information as it becomes available.

Second tranche of COVID-19 hospital association awards to be released

The Department of Health and Human Services Assistant Secretary for Preparedness and Response has started issuing the second tranche of COVID-19 state hospital association awards. The total amount of the awards to be distributed through the 53 designated hospital association recipients in this round is $125 million. AzHHA has been notified that its share of the funding is $2.9 million. This amount is in addition to the first $850,000, which AzHHA has used to procure PPE for member hospitals. We expect the PPE to be distributed next week.

HHS announces additional remdesivir data submission

The Department of Health and Human Services will be issuing another data request Monday, June 1, 2020, to hospitals in support of the next allocation of Remdesivir to state health departments. The deadline for input of the requested data will be midnight Eastern time, Monday, June 8, 2020. ADHS urges all Arizona hospitals to report data. Given the limited availability of the drug, prioritization will be based upon the states’ total number of hospitalized patients with COVID-19, confirmed or suspected, and the total number of ICU patients with COVID-19 confirmed or suspected.

The emails will be sent on the morning of June 1 and will originate from the TeleTracking HHS email (teletracking@hhs.gov) account. All hospitals will receive an email from TeleTracking, regardless of the method by which they submit their routine hospital information (e.g. through NHSN or state reporting).

Consumers delaying care

Yesterday, Kaiser issued a new report showing that 48% of Americans or a family member has delayed medical care because of the pandemic and 11% said the condition worsened because of it. The American Hospital Association is currently running this ad to reinforce, even as the nation continues to fight COVID-19, hospitals and health systems are here to care for their community in every way, every day. As policymakers work on the next congressional relief package for COVID-19, the ad highlights the importance of making sure that hospitals and health systems have the resources they need to protect their teams and their communities.
 
Watch the ad here.

Arizona express pay program

Governor Ducey this week announced the creation of the AZCares Fund and specifically the Arizona Express Pay Program to expedite the delivery of reimbursement funding for the COVID-19 response efforts that non-profit hospitals have undertaken to support patients and local communities. The Arizona Department of Emergency and Military Affairs is holding a meeting/teleconference on Wednesday, June 3, 2020, to explain the program and inform hospitals on how to apply. Eligible hospitals will receive an invitation to attend the meeting from DEMA.

New Paycheck Flexibility Act

The U.S. House yesterday passed the Paycheck Flexibility Act to give more leeway for small business loans during the COVID-19 crisis. The bill extends the loan period to up to 24 weeks through Dec. 31 and extends the timeframe for repayment (if required). It also changes the parameters for potential loan forgiveness. Borrowers can use up to 40% of the loan on non-payroll expenses. It also gives forgiveness flexibility even if borrowers can’t retain or reinstate the same number of FTEs. PPP loan borrowers who seek loan forgiveness can qualify for deferred payment of the employer's portion of certain payroll taxes. 

PPP loan forgiveness requirements

The Small Business Administration Thursday released an interim final rule to clarify Paycheck Protection Program loan forgiveness requirements and the agency's process for reviewing PPP loan applications and loan forgiveness applications. Effective immediately, the rule will be published in the June 1 Federal Register with comments accepted for 30 days. SBA published another interim final rule with information on its process for reviewing PPP loan applications and loan forgiveness applications. The CARES Act created the program to provide forgivable loans to help eligible small businesses keep workers on payroll during the pandemic.

Hearing, letter on protecting workers from COVID-19

In response to the U.S. House Education and Labor Committee’s Workforce Protections Subcommittee hearing Thursday on protecting health care workers from COVID-19, AHA submitted a letter that outlines hospital infection control practices, emphasizes the ongoing need for PPE and describes the hurdles hospitals would face in implementing emergency temporary standards to protect workers from occupational exposure to COVID-19. It also outlines several important initiatives to support those on the front lines of health care delivery, including expanded liability protections.

Alternate care site payment resource

The Centers for Medicare & Medicaid Services this week released a fact sheet for state and local governments seeking Medicare, Medicaid or CHIP payment for inpatient and outpatient care provided at hospital alternative care sites during the COVID-19 emergency. The fact sheet covers hospital requirements, 1135 waivers, Medicare hospital enrollment and provider flexibilities.

Gowns and other apparel

This week, the Food and Drug Administration authorized emergency use of certain PPE to help address insufficient supply due to the COVID-19 pandemic. The authorization is related to the following otherwise-unapproved items, provided there is “no adequate, approved, and available alternative” during the COVID-19 public health emergency: conductive shoes and shoe covers, operating-room shoes, surgical apparel accessories, non-surgical isolation gowns, operating-room shoe covers, surgical helmets and surgical caps. Additional FDA guidance related to PPE can be found here

Report on universal, serial testing at skilled nursing facility 

The CDC this week released a report on the prevalence of asymptomatic transmission of COVID-19 in a skilled nursing facility. The report found that 19% of residents and 6% of staff at a skilled nursing facility for veterans in Los Angeles tested positive for COVID-19 two weeks after two residents initially tested positive. A total of 14 of the 19 positive residents were asymptomatic at the time of testing and developed symptoms the following week. The report makes the case for universal testing and rapid isolation of symptomatic and asymptomatic individuals.