COVID-19 Legislative, Regulatory, and Advocacy Update
American Nurses Association - Department of Policy & Government Affairs
The American Nurses Association’s (ANA) Department of Policy and Government Affairs is committed to providing nurses and nurse advocates with the most comprehensive and up-to-date information regarding the current legislative, regulatory, and advocacy developments related to addressing the Coronavirus Disease 2019 (COVID-19) global pandemic. Given the rapidly changing landscape associated with the COVID-19 pandemic, ANA will update this page regularly based on new developments. This information is current as of 4 PM EST on Monday, June 8, 2020.
Relevant COVID-19 Links:
- ANA's Call to Action for Congress to Provide Mental Health Services and Hazard Pay to Essential Health Care Providers on the Frontlines of the COVID-19 Pandemic
- ANA COVID-19 Pandemic Website
- Centers for Medicare & Medicaid Services (CMS) Coronavirus Resources Page
- Department of Labor Whistleblower Protection Program
- ANA President Ernest Grant's Letter to HHS Secretary Azar Regarding APRN Full Practice Authority and Emergency Waivers
Monday, June 8, 2020 Update
The U.S. Food and Drug Administration (FDA) is kicking off a webinar series starting tomorrow, June 9, on Respirators for Health Care Personnel Use during COVID-19 Pandemic. This series will occur every other Tuesday at Noon ET. For more information go to the FDA website here.
FDA is requesting that nurses report any problems they have come across with medical devices, including PPE. Medical Device Reporting (MDR) is one of the post-market surveillance tools the FDA uses to monitor device performance, detect potential device-related safety issues, and contribute to benefit-risk assessments of these products. Nurses can call (301) 796-6670 or visit the FDA website here.
The FDA reissued an Emergency Use Authorization revising which types of respirators can be decontaminated for reuse. This was in response to public health and safety concerns about decontaminating certain respirators. The FDA has determined that respirators manufactured in China may vary in design and performance; respirators that have exhalation valves should no longer be decontaminated or reused.
The U.S. Department of Health and Human Services (HHS) outlined steps the Administration is taking to address racial and ethnic disparities, and to improve prevention, testing, and treatment of COVID-19 in minority populations, recognizing that both short- and long-term strategies are required. In a fact sheet, HHS focuses on immediate steps, including data collection and reporting on the impact of COVID-19 by race and ethnicity; expanded testing by safety net providers in underserved areas; making treatment more affordable; and targeted outreach and communications in minority and non-English-speaking communities. The fact sheet also notes expanded telehealth options as a means to reach more people with barriers to access, such as lack of transportation. The full fact sheet can be accessed here.
Today, HHS also announced new guidance that specifies what additional data must be reported to HHS by laboratories along with COVID-19 test results. The guidance standardizes reporting to ensure that public health officials have access to comprehensive and nearly real-time data to inform decision making in their responses to COVID-19. Access the full press statement here.
On June 5, the World Health Organization (WHO) issued interim guidance on the use of masks in the context of COVID-19. This interim guidance is an updated version of the WHO’s guidance issued on April 6, 2020 and includes updated scientific evidence relevant to the use of masks for preventing the transmission of COVID-19, including new guidance on the targeted continuous use of medical masks by health workers and updated guidance on the use of medical and non-medical masks by the general public. This updated guidance can be accessed here.
Please join ANA for a Virtual Day of Advocacy on June 25! The Virtual Day of Advocacy is part of ANA’s nationwide campaign to reinvest in the public health infrastructure and workforce as our country begins to recover from the COVID-19 pandemic.
Tell your members of Congress to focus on rebuilding the public health workforce and infrastructure by funding community-based care and the CDC so that the U.S. can better manage and recover from the COVID-19 pandemic and respond to any future national health crises to ensure a stronger and brighter future. Join here and add your voice today: https://bit.ly/3cNqH4m. Be sure to share your advocacy efforts on social media and promote the Virtual Day of Advocacy on June 25 using the hashtag #RNAction.
Friday, May 29, 2020 Update
On May 26, 2020 CMS released a fact sheet for State and Local Governments & hospitals who are developing alternate care sites (ACS) to expand capacity and provide needed care to patients. The fact sheet details how ACS’s may access payments through CMS programs – Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) – for acute inpatient care and outpatient care furnished at these sites. CMS notes that the easiest way to obtain payments for covered health care services is for the ACS to hand over operation and billing of care to an already-enrolled hospital or health system, treating the ACS as a temporary expansion of their existing brick-and-mortar location.
Wednesday, May 13, 2020 Update
On Friday, May 8, ANA sent a letter to House and Senate leadership urging consideration of the following priorities as future legislation to address Coronavirus is negotiated. To read the full letter, please go here.
• Establish mental health resources for nurses and other health care workers serving across all health care settings on the frontlines of the pandemic.
• Provide hazard pay to nurses, and other frontline health care workers, to maintain a ready workforce in the face of the demands and hardships of the crisis.
• Prioritize testing and treatment of nurses, and other frontline health care providers, who become exposed to COVID-19, so those individuals can go back to work as soon as possible. Nurses who are exposed are being sent home for 14-days without ever being tested.
• Pass the Medical Supply Chain Emergency Act of 2020, legislation that would require the federal government to immediately ramp up manufacturing of medical supplies and create a coordinated procurement and distribution process to states and health care facilities.
• Prevent nurses and other frontline providers from being forced to use paid time off because of suspected exposure or contraction of COVID-19.
• Require the Centers for Disease Control and Prevention to provide science-based information on the transmission of the virus so that nurses can make the best decision on the appropriate level of protection.
• Require the Department of Health and Human Services to develop reporting requirements to better track quantities of PPE at health care facilities.
• Ensure network adequacy by implementing provider nondiscrimination protections.
• Rebuild the public health infrastructure that was decimated after the 2008 financial crisis through budget cuts.
• Pass the Improving Access to Cardiac and Pulmonary Rehabilitation Act, to allow advanced practice providers to begin supervising patients’ day-to-day cardiac and pulmonary rehabilitation care.
On May 12, House Democrats released the fourth legislative package aimed at combating the Coronavirus and to prop up the economy, the Helping Emergency Responders Overcome Emergency Situations (HEROES) Act of 2020 (H.R. 6800). Republicans have said they would prefer to wait until the $2.2 trillion in spending from the last Coronavirus legislation has been distributed before looking at more legislation. The Trump administration has signaled they would like to evaluate the economic impact of reopening the economy before passing another package. ANA staff are reviewing the legislation.
“Phase Four” proposes spending $3 trillion on:
• $200 billion "heroes fund" that would provide "hazard pay" for essential workers such as health care workers.
• $500 billion for state governments.
• $375 billion for local governments.
• $175 billion for testing and other health-related expenses.
• $75 billion in housing assistance.
• $25 billion for the U.S. Postal Service.
• $20 billion for tribal relief.
• $20 billion for relief for territories.
• $10 billion for small businesses.
• $3.6 billion for election security and preparation.
• $1.5 billion to address broadband issues.
• Directs the NIH’s National Institute of Mental Health to support research on the mental health consequences of COVID-19, including the impact on health care providers.
The House is scheduled to vote on this legislation Friday.
On Friday, May 8, ANA President Ernest Grant, PhD, RN, FAAN, sent a letter to HHS Secretary Alex Azar urging the Secretary to use his full authority to make permanent the APRN full practice authority regulatory changes implemented in response to COVID-19. President Grant’s letter also urges the Secretary to explicitly extend emergency waivers related to COVID-19 that offer flexibility to providers during the public health emergency; these waivers are still in effect. President Grant’s letter can be found here.
CMS expanded the ability for hospitals to offer long-term care services (“swing-beds”) for patients who do not require acute care services but do meet the skilled nursing facility (SNF) level of care criteria as set forth at 42 CFR 409.31. In order to qualify for this waiver, hospitals must: (1) not use SNF swing beds for acute level care, (2) comply with all other hospital conditions of participation and those SNF provisions set out in 42 CFR 482.58(b) to the extent not waived, (3) be consistent with the state’s emergency preparedness or pandemic plan. The hospital must call the CMS Medicare Administrative Contractor (MAC) enrollment hotline to add swing bed services and the hospital must attest to CMS that: (a) they have made a good faith effort to exhaust all other options; (b) there are no SNFs within the hospital’s catchment area that under normal circumstances would have accepted SNF transfers, but are currently not willing to accept or able to take patients because of the COVID-19 public health emergency (PHE); (c) the hospital meets all waiver eligibility requirements; (d) they have a plan to discharge patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.
Grassroots and Advocacy
As the latest proposed aid package has been introduced in the House, it remains important that the final legislation provides mental health services and hazard pay to essential health care providers who remain on the frontlines of the COVID-19 pandemic. Take action now!
This call to action launched Thursday, May 7 and as of Wednesday, May 13, the call to action has already seen 6,662 advocates send 20,613 letters to Congress.
Friday, May 8, 2020 Update
Grassroots and Advocacy
Tell your member of Congress to provide mental health services and hazard pay to essential health care providers who remain on the frontlines of the COVID-19 pandemic – risking exposure and stress to themselves and their loved ones! https://p2a.co/XO4y4sK
This call to action launched Thursday, May 7 and as of Friday, May 8, the call to action has already seen 5,660 advocates send 17,400 letters to Congress.
On May 8th CMS published an interim final rule with comment period requiring nursing homes to report COVID-19 facility data to the CDC and to residents, their representatives, and families of residents in facilities. CMS will begin posting data from the CDC national Healthcare Safety Network for viewing by facilities, stakeholders, or the general public. The COVID-19 public use file will be available on https://data.cms.gov/
HHS has extended the deadline for health care providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. Providers will now have 45 days, increased from 30 days, from the date they receive a payment to attest and accept the Terms and Conditions or return the funds. For example, the initial 30-day deadline for providers who received payment on April 10, 2020, is extended to May 24 from May 9, 2020. With the extension, not returning the payment within 45 days of receipt of payment will be viewed as acceptance of the Terms and Conditions.
Friday, May 1, 2020 Update
On April 30, the Centers for Medicare & Medicaid Services (CMS) announced that they are including behavioral health and patient education services to the list of services that may be conducted by audio-only telephone between the beneficiary and their clinician. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
CMS announced that Medicare will no longer require an order from the treating qualified health care professional for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. Previously, during the Public Health Emergency, COVID-19 tests could only be covered when ordered by any health care professional authorized to do so under state law.
CMS announced that pharmacists can work with a qualified health care professional to provide assessment and specimen collection services, and the qualified health care professional can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law. With these changes, beneficiaries can get tested at “parking lot” test sites operated by pharmacies and other entities consistent with state requirements.
CMS will also now pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing and make separate payment when that is the only service the patient receives. This builds on previous action to pay laboratories for technicians to collect samples for COVID-19 testing from homebound beneficiaries and those in certain non-hospital settings and encourages broader testing by hospitals and practices.
CMS announced that Medicare and Medicaid will cover certain serology (antibody) tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.
Wednesday, April 29, 2020 Update
On April 24, the Occupational Safety and Health Administration (OSHA) released interim guidance on the reuse of filtering facepiece respirators (FFRs). The guidance applies in health care and other settings where there is risk of exposure to COVID-19. OSHA notes that employers may find it necessary to decontaminate FFRs for reuse; however, there are no National Institute for Occupational Safety and Health (NIOSH)-approved methods for such processes. The guidance describes a number of methods that may be used during the COVID-19 emergency.
On April 27, the U.S. Department of Health and Human Services (HHS) launched a COVID-19 Uninsured Program Portal, allowing health care providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020 to submit claims for reimbursement. Providers can access the portal at COVIDUninsuredClaim.HRSA.gov.
The Centers for Medicare & Medicaid Services (CMS) published a General Distribution Portal FAQ document related to the Provider Relief Fund Program authorized under the CARES Act (see the Friday, April 24 update for more details). This FAQ document can be accessed here: https://www.hhs.gov/sites/default/files/20200425-general-distribution-portal-faqs.pdf
The Food and Drug Administration (FDA) published an Emergency Use Authorization for Facemasks (Non-Surgical) FAQ document related to the use of cloth facemasks. The FAQ notes that these face masks are not authorized to be personal protective equipment, meaning they are not a substitute for filtering FFRs or for surgical face masks. The FAQ document can be accessed here: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-emergency-use-authorization-face-masks-non-surgical
Friday, April 24, 2020 Update
On Friday, April 24, President Trump signed the Paycheck Protection Program and Health Care Enhancement Act (H.R. 266). In the legislation, the Paycheck Protection Program (PPP) for small businesses will be replenished. The highlights of the legislation include:
- $310 billion in additional lending authority for the PPP;
- $60 billion for separate disaster loans to small businesses;
- $75 billion for hospitals through the Public Health and Social Services Emergency fund (funds can be used to reimburse providers for coronavirus related expenses);
- $25 billion for COVID-19 testing, including for active infections and previous exposure, through the Public Health and Social Services Emergency Fund (funds can be used for manufacturing and distributing tests, personal protective equipment, and conducting surveillance and contact tracing).
The House is already discussing the next COVID-19 related legislative package, which is rumored to also address redeveloping the nation’s infrastructure.
On Thursday, April 23, the Centers for Medicare & Medicaid Services (CMS) released a toolkit to help accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs. The toolkit includes special considerations for pediatric populations, technology requirements, patient populations eligible for telehealth services, providers and practitioners eligible to provide services via telehealth, and coverage and reimbursement policies.
CMS is delaying the launch of the Medicaid MOM Model program, which is designed to test new care coordination models for pregnant and postpartum beneficiaries with opioid use disorders. States selected for the demonstration will now have until July 1, 2021 to screen and enroll participants, instead of January 2021. Those states are Colorado, Indiana, Louisiana, Maine, Maryland, Missouri, New Hampshire, Tennessee, Texas, and West Virginia.
CMS announced further details of the allocation of the $100 billion Provider Relief Fund authorized through the CARES Act. CMS on Friday, April 24, will begin to distribute the remaining $20 billion of the $50 billion allocation for Medicare facilities impacted by COVID-19. Allocations are based on eligible providers' 2018 net patient revenue. More information can be found here: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html.
The Joint Commission supports the CDC’s recommendations that all health care facilities implement source control for everyone entering a health care facility regardless of symptoms. The Joint Commission suggests that all patients and visitors should be instructed to wear a cloth face covering when entering any health care building, excluding those under the age of 2, anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. Health care personnel should wear at least a cloth mask when leaving their home but when providing direct patient care they should don a “medical grade” facemask or respirator, depending on the care provided.
Wednesday, April 22, 2020 Update
On Tuesday, April 21, the U.S. Senate passed H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act. In the legislation, the Paycheck Protection Program (PPP) for small businesses would be replenished. The highlights of the legislation include:
- $310 billion in additional lending authority for the PPP;
- $60 billion for separate disaster loans to small businesses;
- $75 billion for hospitals through the Public Health and Social Services Emergency fund (funds could be used to reimburse providers for coronavirus related expenses);
- $25 billion for COVID-19 testing, including for active infections and previous exposure, through the Public Health and Social Services Emergency Fund (funds can be used for manufacturing and distributing tests, getting personal protective equipment, and conducting surveillance and contact tracing).
The House of Representatives is expected to consider this legislation on Thursday, April 23. The President has indicated he will sign the legislation.
The Centers for Medicare & Medicaid Services (CMS) has posted recordings and transcripts from its recurring stakeholder engagement sessions related to the COVID-19 responses. Sessions are open to the health care community, including nurses.
- Information about these CMS calls is available by subscribing to Open Door Forums: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums.
- Recordings and transcripts of past CMS calls are available at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.
The Surgeon General Jerome Adams announced a new U.S. Department of Health and Human Services telehealth website intended to be a resource for health care providers and patients to access high quality health care across the United States. The new website can be found at: https://telehealth.hhs.gov/
The Food and Drug Administration (FDA) approved LabCorp’s home testing kit for COVID-19. These kits will initially be available to health care workers and first responders who may have been exposed to the virus or have symptoms. With a doctor’s order, patients can collect samples through a nasal swab and mail the sample for testing. FDA said LabCorp intends to have the kit available in most states in the coming weeks.
Grassroots and Advocacy
ANA calls on you to tell your members of Congress to support the Medical Supply Chain Emergency Act in order to fully exercise the Defense Production Act (DPA) to get needed PPE to frontline providers to keep nurses safe! Visit ANA’s Call to Action page on RNAction to ensure that your Member of Congress hears from you. We have so far had over 10,500 nurse advocates send over 32,000 messages to Congress to urge them to support the Medical Supply Chain Emergency Act. ANA will continue to make sure that your voices are heard in the fight to get crucial PPE to the frontlines!
Monday, April 20, 2020 Update:
On April 19, CMS released guidelines for reopening the health care system, focusing on a return to providing non-COVID, non-emergency care in areas with low COVID incidence. CMS said that clinically appropriate care can be offered within a facility or community with low-COVID incidences, provided there is the ability to quickly respond to a COVID surge, if necessary. Decisions should be consistent with public health information and in collaboration with state public health authorities. Factors to consider include availability of PPE, workforce considerations, sanitation protocols, and testing capacity.
The National Institutes of Health (NIH) said it is partnering with the Foundation for the NIH to work with public and private stakeholders on an international response to COVID-19. The planned Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) partnership will coordinate processes in vaccine and treatment development. Participating agencies include the HHS Office of Preparedness and Response, CDC, FDA, and the European Medicines Agency.
The Department of Health and Human Services Office for Civil Rights will not impose penalties for noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules against covered health care providers in connection with the good faith provision of telehealth during COVID-19 nationwide public emergency.
Grassroots and Advocacy
ANA calls on you to tell your member of Congress to support the Medical Supply Chain Emergency Act in order to fully exercise the Defense Production Act (DPA) to get needed PPE to frontline providers to keep nurses safe! Visit ANA’s Call to Action page on RNAction to ensure that your Member of Congress hears from you. We have so far had over 10,000 nurse advocates send over 32,000 messages to Congress to urge them to support the Medical Supply Chain Emergency Act. ANA will continue to make sure that your voices are heard in the fight to get crucial PPE to the frontlines!
Wednesday, April 15, 2020 Update:
In interim guidance for the COVID-19 pandemic, OSHA instructed field personnel to prioritize inspections related to COVID-19-related hazards, with particular attention to health care organizations and first responders. In deciding whether to make an on-site inspection versus a less formal approach, OSHA will consider whether complaints about inadequate PPE are due to supply issues. Guidance also highlights needs for OSHA staff to protect themselves when conducting on-site inspection work, and further cautions staff to take care to avoid interference with the provision of ongoing medical services.
CMS announced that effective April 14, 2020 through the public health emergency, Medicare will now pay the higher payment of $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more effective means of combating the spread of the virus. High-throughput lab tests can process more than two hundred specimens a day using highly sophisticated equipment that requires specially trained technicians and more time-intensive processes to assure quality.
CMS implemented the requirement under the CARES Act for group health plans and group and individual health insurance to cover both diagnostic testing and certain related items and services for COVID-19 provided during a medical visit with no cost sharing. This includes urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test. Covered COVID-19 tests include all FDA-authorized COVID-19 diagnostic tests, COVID-19 diagnostic tests that developers request authorization for on an emergency basis, and COVID-19 diagnostic tests developed in and authorized by states. It also ensures that COVID-19 antibody testing will also be covered.
CMS now waives cost-sharing (coinsurance and deductible amounts) under Medicare Part B for Medicare patients for certain COVID-19 testing-related services. CMS recently repurposed the CS modifier for COVID-19 purposes. Now, for services furnished on March 18, 2020, and through the end of the Public Health Emergency, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under specific payment systems outlined in the April 7 message should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and to get 100% of the Medicare-approved amount. Additionally, they should not charge Medicare patients any co-insurance and/or deductible amounts for those services.
ANA President Ernest Grant, PhD, RN, FAAN, strongly encouraged the administration to reconsider the decision to discontinue U.S. funding for the World Health Organization (WHO) as the U.S. and the rest of the world continues to fight the COVID-19 pandemic, noting that international cooperation among governments and the scientific and health care communities is essential to halt the spread of the disease. Read Dr. Grant’s full statement here.
The Department of Veterans Affairs (VA) announced “Fourth Mission” actions to help respond to COVID-19. The VA’s first mission is helping Veterans, but they are also helping to make 1,500 beds available to the Federal Emergency Management Agency (FEMA) at VA facilities across the country. The VA is also caring for those in nursing homes and donating resources to communities in need to set up field hospitals and remote care locations.
Grassroots and Advocacy
Nurses are experiencing severe shortages in personal protective equipment (PPE) as they work on the frontlines to provide vital care to COVID-19 patients. ANA calls on you to tell your member of Congress to support the Medical Supply Chain Emergency Act in order to fully exercise the Defense Production Act (DPA) to get needed PPE to frontline providers to keep nurses safe! Visit ANA’s Call to Action page on RNAction to ensure that your Member of Congress hears from you. We have so far had over 10,000 nurse advocates send over 30,000 messages to Congress to urge them to support the Medical Supply Chain Emergency Act. ANA will continue to make sure that your voices are heard in the fight to get crucial PPE to the frontlines!
Friday, April 10, 2020 Update:
Grassroots and Advocacy
Nurses are experiencing severe shortages in personal protective equipment (PPE) as they work on the frontlines to provide vital care to COVID-19 patients. ANA calls on you to tell your member of Congress to support the Medical Supply Chain Emergency Act in order to fully exercise the Defense Production Act (DPA) to get needed PPE to frontline providers to keep nurses safe! Visit ANA’s Call to Action page on RNAction to ensure that your Member of Congress hears from you. We have so far had over 7,000 nurse advocates send over 23,000 messages to Congress to urge them to support the Medical Supply Chain Emergency Act. ANA will continue to make sure that your voices are heard in the fight to get crucial PPE to the frontlines!
CMS clarified that Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill for visiting nursing services in areas in which there exists a shortage of home health agencies (HHAs). A visiting nursing service can be furnished to a homebound individual by an RN or an LPN under a written plan of treatment.
CMS has expanded virtual communication services for RHCs and FQHCs to include online digital evaluation and management services using patient portals. Online digital evaluation and management services are non-face-to-face, patient-initiated, digital communications using a patient portal, that require a clinical decision that otherwise typically would have been provided in the office.
CMS allows clinical staff to provide Remote Physiologic Monitoring (RPM) services under general supervision. Beneficiary consent to receive these services may also be obtained by auxiliary personnel under general supervision of the billing practitioner. In cases that the direct supervision requirement applies for services that are furnished incident to a practitioner’s services, that requirement may be met virtually through audio/video real-time communications technology.
There has been some confusion related to the CDC’s new guidelines issued this week for essential workers exposed to Covid-19 (found here). The new guidelines advise that workers who have had close contact individual infected with COVID-19 may continue to work, rather than be removed from the job, if they remain asymptomatic under certain conditions. Nurses and other health care workers are covered under the March 7 Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with COVID-19 (found here).
HHS announced the immediate disbursement of the first $30 billion out of the $100 billion that Congress allocated to hospitals, physicians and other health care providers in the Public Health and Social Services Emergency Fund in the CARES Act. This initial $30 billion is being directed to hospitals and practices in direct proportion to their share of Medicare fee-for-service spending. All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds. These are grants, not loans, and do not have to be repaid. More information can be found here: https://www.hhs.gov/provider-relief/index.html
Each state’s Board of Nursing is operating in conjunction with their respective Governors’ Executive Orders, and there is variation between states, with some state decisions changing daily. To keep abreast of states’ emergency responses, such as licensing waivers and applicable statutory and administrative provisions, including relaxation of practice barriers, exemptions for inactive or retired licensees wishing to work or volunteer etc., please visit the NCSBN site here.
Wednesday, April 8, 2020 Update:
ANA and the American Association of Nurse Practitioners (AANP) met with the Department of Health and Human Services, Deputy Secretary Eric Hargan, to discuss the needs of nurses as the government continues to respond to the pandemic. ANA and AANP both stressed the need for more PPE as well as the need to provide nurses in non-COVID-19 facilities who are being displaced, losing hours or employment. ANA further discussed staffing and retaliation against nurses who speak out about the conditions at their facilities.
CMS announced that it has approved approximately $34 billion in the past week to health care providers on the frontlines battling the COVID-19. The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic. The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.
CMS has approved numerous blanket waivers at the national level through the HHS Secretary’s authority under Section 1135 and Section 1812(f) of the Social Security Act in order to rapidly expand the federal government’s response to COVID-19. These blanket waivers apply to hospitals, home health agencies, skilled nursing facilities, and hospice, among others. The full list of blanket waivers can be found here: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.
CMS released a tiered framework for state and local officials, clinicians, and delivery systems to consider for prioritizing services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition. Examples of key considerations for the framework include current and projected COVID-19 cases in the community or region; ability to implement telehealth modalities; supply of PPE; staffing availability; testing capability in community; and urgency of the treatment or service.
OSHA cautioned employers that it is illegal to retaliate against workers who report unsafe conditions on the job, specifically referring to such actions during the coronavirus pandemic. OSHA further noted that workers have specific rights to file whistleblower complaints if they believe they are experiencing retaliation for reporting unsafe working conditions. Whistleblowers can call 1-800-321-OSHA.
OSHA announced that health care and other employers may consider alternatives to standard uses of PPE when confronted with shortages of adequate N95 respirators. Specifically, OSHA said employers will not be cited for violating respiratory protection rules if they reuse N95s or take other measures as long as they adhere to CDC guidance. OSHA urged non-health-care employers, such as construction companies, to consider alternative building methods that reduce the need for N95s in order to preserve the supply for health care purposes.
The FDA posted relaxed requirements for distribution and use of clinical electronic thermometers for the duration of the COVID-19 emergency in order to ease the availability of such devices. The agency signaled it would not enforce certain regulations pertaining to clinical electronic thermometer approvals and recommended appropriate labeling to indicate if devices are not in full compliance with FDA approval standards.
As the U.S. House of Representatives and Senate start to compile the next stimulus package to address COVID-19, ANA’s government affairs team has compiled a list of priorities to be included.
- Prioritize testing and treatment of nurses, and other frontline health care providers, who become exposed to COVID-19, so those individuals can quarantine or can go back to work as soon as possible. Nurses who are exposed are being sent home for 14-days without ever being tested.
- Pass the Medical Supply Chain Emergency Act of 2020, legislation that would require the federal government to immediately ramp up manufacturing of medical supplies and create a coordinated procurement and distribution process to states and health care facilities.
- Instruct all manufacturers of respirators providing equal or higher protection as N95s, such as N99 or N100 filtering facepieces, reusable elastomeric respirators with appropriate filters or cartridges, or powered air purifying respirators, to sell their supply to health care facilities at fair market value.
- Ensure hazard pay is available for frontline health workers.
- Prevent nurses and other frontline providers from being forced to use their paid time off when they are furloughed from being exposed to COVID-19.
- Retrofit or repurpose closed or currently running manufacturing plants and put individuals back to work by manufacturing more PPE in the United States.
- Require the Centers for Disease Control and Prevention to provide science-based information on the transmission of the virus so that nurses can make the best decision on the appropriate level of protection.
- Require the Department of Health and Human Services to develop reporting requirements to better track shortages of PPE.
- Implement protections against provider nondiscrimination.
- Rebuild the public health infrastructure that was decimated after the 2008 financial crisis through budget cuts.
- Pass the Improving Access to Cardiac and Pulmonary Rehabilitation Act, to allow advanced practice providers, to begin supervising patients’ day-to-day cardiac and pulmonary rehabilitation care.
In addition, ANA’s Acting Chief Executive Officer and Chief Nursing Officer, Debbie Hatmaker, sent a letter to President Trump asking the Administration to ensure that personal protective equipment is available for nurses and other frontline health care providers and the Strategic National Stockpile is maintained with medical supplies. The letter also urges the Administration to put employee protections in place for nurses facing retaliation from employers during COVID-19 and to explore policy options around hazard pay. To read the full letter, please go here: https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/letter-wh/.
Friday, April 3, 2020 Update:
This week, ANA supported the Medical Supply Chain Emergency Act. This legislation is introduced by Senators Chris Murphy (D-CT) and Brian Schatz (D-HI) in the U.S. Senate and Representatives Elissa Slotkin (D-MI) and Tim Ryan (D-OH) in the U.S. House of Representatives. This bill would force President Trump to implement the Defense Production Act (DPA).
If enacted, the President would be required to identify private sector capacity to produce no fewer than:
- 500,000,000 N95 respirators;
- 200,000 medical ventilators;
- 20,000,000 face shields;
- 500,000,000 pairs of gloves; and
- 20,000,000 surgical gowns.
This legislation would also require the Administration to control the distribution of the supplies to avoid unnecessary competition between states and health care institutions.
Additionally, ANA staff is currently in communication with House and Senate staff and the Administration regarding legislative priorities in the fourth COVID-19 aid and relief package. While the House released a framework that would address the nation’s infrastructure, including money to rebuild roads, mass transit, rail systems, wireless communications networks and water projects, some Senate Republicans say it’s too soon for another package and want to see the implementation process start on the third package. President Trump has expressed support for a fourth package that would tackle infrastructure.
ANA CEO Loressa Cole and CNO Debbie Hatmaker had an opportunity to virtually share nurses’ concerns with Department of Labor Secretary Eugene Scalia. Among the topics discussed on the call was the need to ensure guidelines for whistleblower protections if a nurse needs to speak out. As a result of the call, OSHA included a box on its whistleblowers.gov landing page that highlights that whistleblower protections apply to the COVID-19 pandemic. We thank Secretary Scalia for the expediency in addressing this issue.
The Drug Enforcement Administration (DEA), in coordination with the Substance Abuse and Mental Health Services Administration (SAMHSA), issued guidance that for the duration of the public health emergency, DATA-waived practitioners can prescribe buprenorphine to new and existing patients with Opioid Use Disorder for maintenance treatment or detoxification treatment following an evaluation via telephone voice calls, without first performing an in-person or telemedicine evaluation. This may only be done if the evaluating practitioner determines that an adequate evaluation of the patient can be accomplished via the use of a phone.
Grassroots and Advocacy
As Congress begins to negotiate a fourth COVID-19 legislative aid package, please continue to visit RNAction or monitor Twitter and Facebook for our next call to action (to follow soon) as we engage with Congress and the Administration for our continued asks to support nurses and other frontline providers.
Wednesday, April 1, 2020 Update:
The administration has released numerous guidelines and waivers this week in response to the COVID-19 emergency, including around telehealth, provider supervision, reimbursement, and site of service requirements, among many other policy issues. These items are listed in more detail below:
- The Centers for Medicare & Medicaid Services (CMS) built on previous actions to expand reimbursement for telehealth services to Medicare beneficiaries, including via audio phones only. Eligible providers can bill for telehealth visits at the same rate as in-person visits for emergency department visits, initial nursing facility and discharge visits, home health visits and therapy sessions, all of which must be provided by a clinician who is allowed to allowed telehealth. CMS is also allowing physician supervision of clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.
- CMS is waiving the requirements for a nurse to conduct an onsite visit every two weeks for home health and hospice. This includes waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not currently be physically possible.
- CMS is waiving the requirements that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician. This will allow CRNAs to practice to the fullest extent allowed by the state, and free up physicians from the supervisory requirement and expand the capacity of both CRNAs and physicians.
- CMS is allowing communities to take advantage of local ambulatory surgery centers that have canceled elective surgeries, per federal recommendations. Surgery centers can contract with local health care systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration, consistent with their state’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.
- CMS is temporarily permitting non-hospital buildings and spaces to be used for patient care and quarantine sites, provided that the location is approved by the state and ensures the safety and comfort of patients and staff. CMS is also allowing hospitals, laboratories, and other entities to perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital. This new guidance allows health care systems, hospitals, and communities to set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment.
- CMS issued a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients.
- CMS is expanding its accelerated and advanced payment program to provide needed cash flow to facilities impacted by the COVID-19 emergency. This program will now allow facilities to receive payment for services not yet rendered, based on historic spending; CMS considers these advanced payments to be loans to be reconciled at a later date and separate from the $100 billion subsidy funding provided under the CARES Act.
- CMS has approved 40 emergency Medicaid waivers under Section 1135 of the Social Security Act; the latest states to receive approval are Tennessee and South Carolina. These waivers offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to their Medicaid beneficiaries.
- The administration has decided against reopening the Healthcare.gov marketplace for a blanket special open enrollment period for private individual health insurance through the Affordable Care Act. Individuals who are newly unemployed and have lost their employer-sponsored health insurance may still enroll through a special open enrollment window.
- The administration has directed hospitals to begin daily reporting of COVID-19 information to CMS and the Centers for Disease Control and Prevention (CDC), including testing data from in-house labs, bed capacity, and supply levels. This information, which will not include personal identifying information, will be used to support federal response efforts and help direct resources according to data.
- The Food and Drug Administration (FDA) announced the creation of the Coronavirus Treatment Acceleration Program (CTAP), to speed the development of safe and effective COVID-19 treatments. CTAP is a public-private approach, with streamlined processes and operations bringing together FDA staff, developers and scientists, and health care providers and researchers to test products on an emergency basis.
- FDA issued guidance clarifying approvals for the expanded availability of surgical gowns and gloves, and has relaxed enforcement of certain existing regulations, for the duration of the COVID-19 emergency. FDA also announced emergency guidance on medical equipment cleaners and air purifiers.
- FDA is encouraging labs to take advantage of streamlined review pathways to approval for COVID-19 tests and has empowered states to engage more directly in test development and use. Despite expedited federal review, the agency noted that few labs have taken advantage of the flexibility because they did not have a test or lacked viral samples to check accuracy.
- The Federal Emergency Management Administration (FEMA) is adopting a new process to manage federal ventilator resources to ensure ventilators are shipped to the states in the amount needed to manage the immediate COVID-19 crisis. In the case of ventilators, immediate is defined as requirements necessary to sustain life within a 72-hour window. To submit a request, states and tribes will work through their FEMA/ HHS regional leadership. For a request to be processed, the state/tribe must provide detailed responses to the following five questions:
- How many usable ventilators, ICU beds, and convertible ventilators are currently available within the state or tribe?
- What is the current hospital bed and ICU bed occupancy rate in the state/tribe?
- How many new ICU beds does the state/tribe estimate it can stand-up and the number of ventilators, or FDA-approved ventilator alternatives, it can or is standing up?
- What is the decompression ability of hospitals in the state/tribe (i.e.: are there currently field hospitals or alternate care facilities established)?
- How many anesthesia machines are in the state/tribe and have they been converted?
Grassroots and Advocacy
Congress included billions of dollars in the CARES Act toward additional personal protective equipment (PPE) that will prove critical in protecting nurses on the frontlines of this pandemic; over 112,000 nurse advocates sent over 345,000 messages with the #GetMePPE call to action! Our advocates truly helped pave the way for this vital funding package. As Congress begins to negotiate a fourth COVID-19 legislative aid package, please continue to visit RNAction or monitor Twitter and Facebook for our next call to action (to follow soon) as we engage with Congress and the administration for our continued asks.
ANA continues to monitor discussions around a fourth COVID-19 legislative aid package and to engage with Congress with respect to ANA’s continued legislative asks.
Monday, March 30, 2020 Update:
On Friday, March 27, the President signed the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act into law. This legislation provides significant additional funding for hospitals and health care providers and state and local governments for the fight against COVID-19, as well as economic relief for individuals and businesses (see the Legislative section from Friday, March 27, below for more details).
On Saturday, March 28, the administration issued an Executive Order (EO) which would delegate authority under the Defense Production Act (DPA) with respect to health and medical resources to respond to COVID-19. This EO will delegate additional authorities to cabinet departments available under DPA beyond those that were delegated to Health and Human Services in the March 18, 2020 EO. To read the full EO, please visit the www.whitehouse.gov link here.
On Sunday, March 29, the President announced that the U.S. Centers for Disease Control and Prevention’s (CDC) social distancing guidelines will remain in effect across the country through Thursday, April 30.
Grassroots and Advocacy
Congress included billions of dollars in the CARES Act toward additional personal protective equipment (PPE) that will prove critical in protecting nurses on the frontlines of this pandemic; over 111,000 nurse advocates sent over 342,000 messages with this call to action! Please continue to check with RNAction as we continue to engage with Congress and the administration on the availability of PPE and other pressing issues related to COVID-19.
The U.S. Food and Drug Administration (FDA) issued non-binding guidance to provide policy to help expand the availability of surgical apparel for health care professionals, including gowns, hoods, and gloves, during the pandemic. This policy guidance is to remain in effect only during the duration of the public health emergency related to COVID-19.
Friday, March 27, 2020 Update:
Grassroots and Advocacy
ANA encourages you to mark your calendar and join us for our upcoming Twitter chat this Monday, March 30 from 2-3 PM ET, hosted by @Phone2Action with @ANANursingWorld, @RNAction & @ANAPresident, to learn how you can support our nurses nationwide during the COVID-19 pandemic.
Thank you to all who participated in ANA’s Call to Action for Congress to increase personal protective equipment (PPE) distribution for nurses and other frontline health care providers, which generated 330,983 messages to Congress from 107,868 nurse advocates. Congress included billions of dollars in the CARES Act toward additional PPE (see Legislative section below for more details) that will prove critical in protecting nurses on the frontlines of this pandemic – your voices were truly heard! Please check back with RNAction as we continue to engage with Congress and the administration on PPE and other pressing issues related to COVID-19.
Trending Social Media Hashtags: #GetMePPE | #COVID19 | #SupportNurses | #ThankANurse | #RNAction
Yesterday, the United States Senate passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which is phase three of the aid and relief legislative package in response to the COVID-19 pandemic; the United States House of Representatives is widely expected to pass the CARES Act today (March 27) or tomorrow (March 28). It includes more than $2 trillion in spending and tax breaks to help the economy and health care providers respond to the pandemic.
ANA has been aggressively pushing Congress and the administration to act in response to the nation’s lack of PPE. The CARES Act provides $1.5 billion to states to obtain PPE, contact tracing to identify additional cases, and other public health preparedness and response activities. Additionally, it provides $16 billion for the Strategic National Stockpile (SNS) for critical medical supplies, including more PPE, and life-saving medicine.
Additional details of the agreement include:
- $150 billion for hospitals and health care providers
- $1,200 checks for low- and middle-income Americans
- $150 billion for states and local governments
- $500 billion for loan guarantees for businesses
- $350 billion for small businesses to maintain payroll
- Reauthorizes Title VIII Nursing Workforce Development Programs
- Authorizes NPs and CNS’ to certify home health care for their patients
- Includes United States Public Health Service Modernization – Ready Reserve Corps to respond to public health and national emergencies.
The Centers for Medicare & Medicaid Services (CMS) announced new telehealth guidance that broadens access to telehealth services for Medicare beneficiaries regardless of patient residence. Within that guidance, CMS relaxes HIPAA rules and waives telehealth related penalties.
The U.S. Centers for Disease Control and Prevention (CDC) released a two-strategy guidance (test-based and non-test-based) to determine when Health Care Providers may return to work in health care settings. The test-based strategy required resolution of fever, improved respiratory symptoms and two negative COVID molecular assay test collected at least 24 hours apart. The second strategy, non-test-based, requires at least 72 hours since recovery (resolution of fever without the use of fever reducing medications and improved respiratory symptoms) and at least 7 days having passed since symptoms first appeared.
CMS extended deadlines for reporting 2019 quality data, and further explained how the agency will determine payment adjustments in cases of reporting hardships. CMS also shared lessons learned in Washington state from one nursing facility’s experience with COVID-19 fatalities. CMS is using this information to identify potential future COVID-19 hot spots and will target inspections accordingly. Routine nursing home inspections are being suspended.
New guidance from the American Medical Association (AMA) provides special coding advice with respect to COVID-19. One resource outlines coding scenarios designed to help qualified health care professionals (QHPs) apply best coding practices. These scenarios include telehealth services for all patients. Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for an E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit regarding COVID-19, and is directed to come to the QHP’s office or QHP’s group practice site for testing; receives a virtual check-in/online visit regarding COVID-19 (not related to E/M visit), and is directed to come to the QHP’s office for testing; and more.
There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center to stay up to date and for additional resources.
The U.S. Department of Health and Human Services released interim guidance on COVID-19 and caring for people with HIV. The guidance recommends “additional caution for all persons with HIV, especially those with advanced HIV or poorly controlled HIV”, acknowledging that current data is limited on the implications of COVID-19 for this population.