In The News

Child Care for Essential Health Care Employees Extended and Expanded

March 31, 2020

Child care for essential health care employees has been extended and expanded until Sunday, May 17. There is an expanded list of critical workers in the latest CDPHE guidance who can participate, allowing as many available as 5,000 more families to enroll. The parent and provider matching transitioned to an app that matches parents with providers – details here.

 

Governor Polis Updates March 30, 2020 COVID-19 Including PPE Supplies Tracker

Quick Links to Stay Up to Date

Topline Update

As of today we have 2,627 cases, 51 deaths, and 414 hospitalizations out of 15,364 completed tests. Colorado has seen its first death of someone in their 40s, underscoring that no one, no matter how young or how healthy, is invincible or immune from this virus. We are thinking of these families and communities during these trying times.

Encouraging News

The Governor shared some encouraging news today that shows that the social distancing steps that we are taking are helping to slow the spread of the virus, which will protect our health care capacity, our frontline workers, and ourselves.

This first chart shows that the rate of positive cases is slowing down. On March 12th, the number of positive cases in Colorado were doubling every 1.5 days. Today, the number of positive cases are doubling every 5 days. 

While we are encouraged by this slowdown in the rate of positive cases, the volume of cases still threatens to overwhelm our health care system, which is why we need to continue to do all we can to maintain social distancing and stay at home.

This second chart shows the decline in vehicular traffic in Colorado; car traffic is down 60% in the past four weeks. 

This isn’t a perfect metric, but it can be used as a proxy for social interactions. Fewer people on the roads means fewer person-to-person contacts, fewer chances for Colorado residents to spread the virus to others.

Personal Protective Equipment (PPE) Update

This chart shows our severe need for personal protective equipment (PPE) for our medical personnel. What the Governor has requested to date will get us through a couple of weeks. It doesn’t begin to reflect what we know the need will be in the weeks and months ahead as this situation evolves. 

The administration is doing everything we can to pursue additional PPE through alternative channels, including: PPE drive(s), through the Innovation Response Team marshalling the private sector and identifying additional supply chains, and of course we are relying on whatever help we can get from the federal government. 

You can view these charts and the rest of the presentation here. 

 

Major Disaster Declaration

On Saturday night, the Governor received the news that he secured a Major Disaster Declaration from the federal government for the state of Colorado, which unlocks access to more federal resources during this trying time.

 

In a practical sense, this declaration means that we will have access to greater emergency assistance. It ensures that Colorado can be on a level playing field with other states that already have this status like New York and Washington when it comes to federal disaster funding and Federal Emergency Management Agency assistance.

 

The Governor spoke with the President and the Vice President today to discuss additional programs and aid for Colorado under the disaster declaration.

 

 

CMS Announces Blanket Waivers 

March 30, 2020

“Every day, heroic nurses, doctors, and other healthcare workers are dedicating long hours to their patients. This means sacrificing time with their families and risking their very lives to care for coronavirus patients,” said CMS Administrator Seema Verma. “Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible. This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly.”

Other temporary CMS waivers and rule changes dramatically lessen administrative burdens, knowing that front line providers will be operating with high volumes and under extraordinary system stresses. 

CMS recently approved hundreds of waiver requests from healthcare providers, state governments, and state hospital associations in the following states: Ohio; Tennessee; Virginia; Missouri; Michigan; New Hampshire; Oregon; California; Washington; Illinois; Iowa; South Dakota; Texas; New Jersey; and North Carolina. With today’s announcement of blanket waivers, other states and providers do not need to apply for these waivers and can begin using the flexibilities immediately.

Administrator Verma added that she applauds the March 23, 2020, pledge by America’s Health Insurance Plans (AHIP) to match CMS’s waivers for Medicare beneficiaries in areas where in-patient capacity is under strain. “It’s a terrific example of public-private partnership and will expand the impact of Medicare’s changes,” Verma said.

CMS’s temporary actions announced today empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls:

CMS will allow communities to take advantage of local ambulatory surgery centers that have canceled elective surgeries, per federal recommendations. Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent 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 will now temporarily permit 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. This will expand the capacity of communities to develop a system of care that safely treats patients without COVID-19, and isolate and treat patients with COVID-19.

CMS will also allow 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 will both increase access to testing and reduce risks of exposure. The new guidance allows healthcare systems, hospitals, and communities to set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment.

In addition, CMS will allow hospital emergency departments to test and screen patients for COVID-19 at drive-through and off-campus test sites.

During the public health emergency, ambulances can transport patients to a wider range of locations when other transportation is not medically appropriate. These destinations include community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers, and any locations furnishing dialysis services when an ESRD facility is not available.

Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surge during the public health emergency.

In addition, hospitals can bill for services provided outside their four walls. Emergency departments of hospitals can use telehealth services to quickly assess patients to determine the most appropriate site of care, freeing emergency space for those that need it most. New rules ensure that patients can be screened at alternate treatment and testing sites which are not subject to the Emergency Medical Labor and Treatment Act (EMTALA) as long as the national emergency remains in force. This will allow hospitals, psychiatric hospitals, and critical access hospitals (CAHs) to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19.

  • Rapidly Expand the Healthcare Workforce:

Local private practice clinicians and their trained staff may be available for temporary employment since nonessential medical and surgical services are postponed during the public health emergency. CMS’s temporary requirements allow hospitals and healthcare systems to increase their workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community as well as those licensed from other states without violating Medicare rules.

These healthcare workers can then perform the functions they are qualified and licensed for, while awaiting completion of federal paperwork requirements.

CMS is issuing waivers so that hospitals can use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state’s emergency preparedness or pandemic plan. These clinicians can perform services such as order tests and medications that may have previously required a physician’s order where this is permitted under state law.

CMS is waiving the requirements that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician. This will allow CRNAs to function 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 also is issuing 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 will also allow healthcare providers (clinicians, hospitals and other institutional providers, and suppliers) to enroll in Medicare temporarily to provide care during the public health emergency.

  • Put Patients over Paperwork:

CMS is temporarily eliminating paperwork requirements and allowing clinicians to spend more time with patients. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously Medicare only covered them under certain circumstances.  

During the public health emergency, hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation. Hospitals will also have more time to provide patients a copy of their medical record.

CMS is providing temporary relief from many audit and reporting requirements so that providers, healthcare facilities, Medicare Advantage health plans, Medicare Part D prescription drug plans, and states can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.

This is being done by extending reporting deadlines and suspending documentation requests which would take time away from patient care.

  • Further Promote Telehealth in Medicare:

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.

These temporary changes will ensure that patients have access to physicians and other providers while remaining safely at home.

Providers can bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth. New as well as established patients now may stay at home and have a telehealth visit with their provider.

CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.

CMS is making it clear that clinicians can provide remote patient monitoring services to patients with acute and chronic conditions, and can be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.

In addition, CMS is allowing physicians to supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.

For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient

For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

 

Congress Passes and the President Signs into Law Third COVID-19 Package

March 27, 2020

Today, the U.S. Congress passed and the President signed into law, the Coronavirus Aid, Relief, and Economic Security (CARES) Act. 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 do something about the lack of personal protective equipment (PPE). Thankfully, the legislation provides $1.5 billion to States for the equipment, 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 providers 
  • $1,200 checks for middle class 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. 

Congressional leaders have indicated there will be additional supplemental packages to come in the following weeks. ANA will continue to be engaged with Congress and the Administration about priorities for nurses in the upcoming packages. Some areas that need to be addressed are: 

  • Prioritize treatment of nurses, and other frontline health care providers who contract COVID-19, so those individuals can go back to work as soon as possible. 
  • 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. 
  • 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. 

As we continue to move forward, ANA will continue to provide updates on what Congress is doing to address COVID-1

 

Governor Polis Updates March 28, 2020 COVID-19

Quick Links to Stay Up to Date

Topline Update

As of today we have 1,734 cases, 31 deaths, and 239 hospitalizations out of 11,676 completed tests. 

The most up-to-date public health order can be found here.

While the state is not requiring it, our Department of Public Safety has added a Critical Business Self-Certification form to their website in response to requests from employees and private sector members for a document to carry that certifies that they are traveling for work for a critical business. The form is voluntary. It is not required. Link to the document can be found  here.

Today, the Governor announced that he is removing restrictions on auto insurance for drivers for Restaurant Delivery. In an effort to protect these workers and their vehicles, the Colorado Department of Insurance released emergency regulations to allow for restaurant workers  to deliver food with less red tape and insurance delays. Restaurant owners are encouraged to contact their insurance agents, brokers or companies to discuss additional coverage riders and other options that could offer more protection for their workers and their businesses. Such options could prove useful even after the COVID-19 emergency. 

Stay at Home Order

We have been getting a lot of questions from the press and from the public about our Stay-At-Home Order. As you all know, the Governor announced a stay-at-home order that took effect yesterday at 6 a.m. and will last until April 11. We want to stress to everyone that this is not a competition to see what you can get away with. This is not a time to try to figure out how close you can get to the line. This is a time to stay as far away from the line as you possibly can.

 Just stay at home unless it’s absolutely necessary. And if it is absolutely necessary, keep your distance from others, wash your hands frequently, wipe down surfaces, and practice common sense. Use your best judgment and err on the side of safety for yourself and others. And the age old wisdom applies here -- if you have to ask yourself if something is smart or safe -- it’s probably not. Treat this as seriously as you would treat a tornado, or a flood, or a wildfire, or a hurricane. Because the threat is just as real. And the more noncompliance there is, the longer and more severe this crisis will be, and the longer these extraordinary measures may be in place.

Some of the most frequent questions we are getting are

  1. Enforcement: This is an executive order, that means it is the law. The rule of law is the foundation of our society; it must be followed. Residents who suspect that a person or an establishment is violating the order should first contact their local public health agency to report any concerns. Residents may also file a report with the Attorney General’s Office at [email protected] if local law enforcement or a local public health agency is unresponsive.

  2. Parks and Outdoor Recreation: If you absolutely need to recreate, please do it in your own communities close to your home. This should not be treated as a “vacation.” This is not the time to drive two or three or four hours from Denver to a mountain community -- many of which are already reeling from this crisis -- and potentially contribute to the spread in our mountain communities. We’ve all seen the videos on social media of people packed onto trails at state parks -- that can be just as dangerous as being packed into a bar or at a crowded theater.

The trails are often quite narrow, so when you pass someone else, you’re most likely within six feet, and folks shouldn’t be going off-trail anyway -- we should all be practicing the ‘leave no trace’ guidelines. The mountains and canyons have been there for thousands of years. They will be there after this all blows over.  Just have patience and stop putting yourself and others at risk.

  1. Houses of Worship: We know faith is important to so many Coloradans, and more than that, houses of worship often function as community centers -- a place to come together. We know how difficult this is on so many Coloradans.  The order states that houses of worship may remain open for essential activities, but must practice social distancing, which means that at least six feet apart for each party and limit to 10 or less. We want to stress the importance of using electronic platforms to broadcast worship. Essential church staff including religious leaders can conduct services from the house of worship and broadcast it to members as long as all of the support staff are practicing proper social distancing. As with everything -- please don’t go out unless you have to, and please take steps to have church or synagogue or mosque or temple services by electronic means.

  1. Additional Allowances: A few more additional allowances for going out include:

  • Parents transporting children to comply with parenting plans.

  • Fulfilling online orders.

  • Administering elections and participating in elections are critical government functions.

  • We want to stress that even if your business qualifies as a critical business, we urge you to comply with social distancing requirements and allow employees to work from home as much as you can.

 If you still need additional clarification on what is considered essential. You are able to reach out to [email protected]with your questions. 

The data behind the decisions

Today, the Governor gave a slide presentation during his press conference to discuss some of the predictive modeling that is guiding the public health decisions that he is making.

Thank you to Dr. Jon Samet, Dean of the Colorado School of Public Health and his team who have been working hard to put together the modeling data in partnership with the University of Colorado School of Medicine and the Colorado Department of Public Health and Environment.

A copy of the presentation is here. This data explains why the Governor  issued the Stay-At-Home order. It is a blunt force instrument to knock down this curve as quickly and as hard as we can to spread it out. The more we can do to increase social distancing,  the more time we have to build additional capacity, secure medical equipment, build ventilators etc. The goal is to do a Stay-At-Home order once, make it as quick as possible so we can save our healthcare system and save lives. IF we are successful, we will be able to resume normal economic activity.

 Grant application for our COVID Relief Fund is open!

Community based organizations can start applying for relief funds. The link can be found onwww.helpcoloradonow.org or gohere. Community-based organizations that meet the following three criteria areas are eligible to apply: Organization type, populations served, and alignment with one of the Fund’s three funding priority areas of Prevention, Impact and Recovery. For more information on requirements, visit the website to review eligibility and to apply! 

 
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