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Governor Polis Updates April 2, 2020 COVID-19 Including PPE Supplies Tracker

Quick Links to Stay Up to Date

Topline Update

We have 3,342 cases and 620 hospitalizations out of 18,645 completed tests. Tragically, we have had 80 deaths to date. We are thinking of these families and communities during these difficult times.

Yesterday, the Governor provided an overview of what the state must do to to return to economic and societal normalcy:

  • Reduce the rate of infections to a level where each Coloradan is infecting fewer than one other Coloradan. At this point, the virus begins to die out.

  • Build out capacity in our medical system so that we can treat everyone who gets sick and save lives.

  • Resolve supply chain issues so that we can establish a mass testing and containment program so that we can quarantine and isolate on a case-by-case basis instead of these onerous distancing measures that amount to quarantining our entire society

The Governor also provided a critical update on the state’s ability to obtain Personal Protective Equipment as well as an overview of how we are building out our medical capacity to meet the coming surge of cases. A link to the presentation that the Governor presented during yesterday’s press conference can be found here 

Personal Protective Equipment Update

Not only are we facing a health care crisis, we are also facing a supply chain crisis that has hampered our abilities to effectively respond to the health care needs. 

The Governor submitted an official request to Vice President Pence requesting what we need from the Strategic National Stockpile in terms of equipment.

Here is what we have gotten from the federal government so far

  • N95 Masks: We have gotten 220k out of 2M requested

  • Surgical masks: We have gotten 517k out of 4.6M requested

  • Face Shields: We have gotten 350k out of 880k requested

  • Surgical Gowns: 100k out of 720k requested

  • Gloves: 504k out of 4.3M requested

  • Ventilators: 0 out of 10k requested

One of the biggest challenges is that this precious personal protective equipment (PPE) and ventilators are in demand across the country and around the world, so everyone is competing against each other to get it, and what we received from the national stockpile won’t get us past a few days of need. 

We’ve asked every relevant sector of the economy to do an inventory, and offer up to the health care system any PPE or DME (Durable Medical Equipment) they have to spare. 

We are working to build entirely new supplier relationships with global companies to acquire PPE.

We’re also working with manufacturers within Colorado and all over the world who are repurposing their operations to make these needed supplies.To date, we have placed a series of orders with various suppliers, and will continue to place orders as we identify reputable manufacturers both in Colorado and across the globe.

 

Once we physically obtain this equipment, we need to test it to make sure that it is safe for doctors, nurses and patients alike -- we thank our partners at CU and CSU for helping us test this equipment so we can get it in the hands of our medical providers.

At this point of this crisis, PPE equals lives. Ventilators equals lives. It’s the difference between our healthcare workers being able to treat the sick, and falling ill themselves.

And we will continue to work with anyone and everyone who can provide this equipment until Colorado’s needs are met.

Medical Surge Capacity

Healthcare institutions across the state have been preparing for COVID-19 for many months and have taken steps to increase internal capacity to prepare for a surge of patients.

The role of the state is to:

  • Support healthcare systems with coordinated access to private sector resources to acquire PPE, ventilators, and other equipment

  • Coordinate the recruitment and utilization of volunteer medical professionals to provide surge capacity within the healthcare system

  • Provide information on the status of the healthcare system

  • Create systems that overlay the normal healthcare system to provide coordination and response when the healthcare system becomes overwhelmed

Based on epidemiological models, and depending on the effectiveness of social distancing measures like school closures and stay-at-home orders, Colorado can expect to see a surge of patients that will overwhelm hospitals between April and July 2020.  Remember -- we are trying to delay the peak so it is not as severe, and so it buys us time to build more capacity, get more PPE, and save lives.

And based on clinical evidence from areas previously hit with the COVID-19 outbreaks, patients who are severely ill will require intensive care and will be ventilator dependent for an average of 11 to 20 days.

Just like in normal life, some cases are more critical than others. So we have developed a four-tier system by which we will classify patients.

And we have matched the appropriate class of patient with the type of facility that will best meet their needs.

This chart details our four-tier plan, and when we expect to have the additional capacity built.



We want to thank our health care partners and other partners including the Army Corps of Engineers for helping to build out this capacity.

In addition to the bed construction, we are also working to establish a patient transport unit so that patients can be transported to the appropriate facility as their symptoms progress.

We believe that this plan -- along with the drastic physical distancing measures that we are all taking -- will allow us to deal with the surge of patients without overwhelming our public health capacity here in Colorado.

Stay in Primary Residence

We have gotten reports of an alarming increase in people who own a second home in the mountains traveling there. As a reminder, this is not a vacation. The mountain communities have a much higher rate of infection than the rest of the state and anyone traveling there now is putting themselves and others at additional risk.

Furthermore, from the beginning, we have been extremely concerned about overwhelming the public health systems in our isolated mountain communities that do not have the capacity to handle a surge in positive cases. We cannot afford to put extra pressure on our small mountain health care systems, as EMS, Law Enforcement, hospitals are already strained, and grocery stores are already struggling to keep up with demand just from local residents, much less an influx of second homeowners who think this is an opportunity for a vacation.

Please stay in your primary residence. It is much more likely that your primary residence has better access to necessities and health care resources than our mountain communities that are having a much more difficult time dealing with this crisis.

Evictions and Utility Bill Notices 

During this unprecedented time, Coloradans should not have stress over rent, mortgage payments, or utility bills adding to the other anxieties caused by COVID-19. That’s why on March 20, 2020, Governor Jared Polis issued Executive Order D 2020 012, ordering Colorado state agencies to work with property owners, mortgage companies, and utilities providers to limit evictions, foreclosures, and public utility disconnections while Colorado is in a state of emergency. 

Furthermore, the federal government has passed legislation that will give individuals making under $99,000 per year up to $1,200 in cash assistance, including $500 for each dependent.

Finally, Colorado is encouraging those who have lost wages or lost their job because of this crisis to apply for unemployment insurance at https://www.colorado.gov/pacific/cdle/unemployment

If you know you won’t be able to pay for these vital needs, or are concerned about your ability to pay in the coming months, please review the steps that have been taken by both government and private industries, to see how they may impact you. You can also find resources for assistance with payment of rent, mortgage, and utility bills by visiting www.211colorado.org or by dialing 211 on a phone.

Our teams at the Department of Local Affairs (DOLA) and at the Department of Regulatory Affairs (DORA) have pulled together a document that shares resources with consumers to help with these issues during this time of crisis.

Extension of School Closure E.O. to April 30

Yesterday, the Governor announced the extension of the closure of all schools through April 30. This is consistent with the President’s views that restrictions on in-person gatherings should go on for at least the month of April. The practice of announcing executive orders for 30 days is something that typically happens during times of crises. We expect that many districts will make the decision to stay closed for the remainder of the school year; for now the Governor believes that the best statewide policy is to remain closed until April 30th.

Across the state, superintendents, school leaders, and educators are stepping up to build remote learning plans so students don’t lose out on valuable instruction because of this crisis. Here in Colorado, our educators are innovative and strong. And we must continue to prioritize creativity and do the best we can in this virtual environment. 

We know that the extension of closures will be tough news for parents, including those who are juggling working from home and helping their children with schoolwork. But this is the best way to keep everyone safe, prevent the spread of coronavirus, and prevent unnecessary death. So we want to thank all the parents, educators, and students out there for adapting to this situation as best as we can.

UPDATE: Special Enrollment Period Extended to April 30th

Our special enrollment period for the state’s health care exchange has been extended to April 30th. If you are or someone you know is currently uninsured or if you have temporarily lost your job due to COVID-19, please take advantage of this special enrollment period to get affordable health coverage. Visit connectforhealthco.com and enroll today.

DACA

The Governor is calling on the federal government to extend protections for DREAMers through 2020. We need to be 100% focused on the crisis at hand, and many DACA recipients work in critical services including healthcare and law enforcement. We should not be expending resources to throw people out of the country who were brought here as children through no choice of their own, and many of whom know no other home than America.

Census Day

Finally, I want to salute everyone who is doing their civic duty -- their patriotic duty -- by staying at home and practicing physical distancing. But there is another civic duty that arrived in your mailbox in the last month: your Census form.

The Census is so much more than a population count. It is a critical process meant to ensure that the people of our state and their communities get access to the resources that they need to thrive, both now and for the future. An accurate count will mean billions of dollars over the next 10 years in federal funds for our communities to help with a variety of necessary projects, from building roads to providing healthcare.

This pandemic shows exactly how crucial it is that we have the representation and funding we need to care for Coloradans. Across the United States, there is approximately $880 billion in federal funding that is allocated based on Census counts. And for Coloradans, that equates to roughly $13 billion annually or an estimated $2,300 per person. The census ensures that Coloradans are fairly represented in Congress. Colorado’s population has grown steadily since the last Census and with an accurate count we might be up for an 8th Congressional seat. That means more folks advocating for our fair share from Washington.

The bottom line is that we want those dollars here in Colorado, improving the quality of life for all of our residents. Go to Census.gov for more information, and if you have lost your form, call 1-800-772-7851 to request a new one.

 

Colorado Health Emergency Leave with Pay Orders

April 1, 2020

Division of Labor Standards and Statistics in the Colorado Department of Labor and Employment is notifying you that on Thursday, March 26, 2020, the Division adopted amendments to the Colorado Health Emergency Leave with Pay ("Colorado HELP") rules, following Governor Polis’ announcement on March 10, declaring a state of emergency in response to the increases coronavirus COVID-19 cases in Colorado.

These changes to the temporary or emergency rules, originally adopted and effective March 11, 2020, as amended on March 26, 2020, modify Rule 3.1 to add coverage for:

(A) an additional industry category, “retail establishments that sell groceries”; and

(B) not just those “being tested” for COVID-19 (as in the original rules), but also those “under     instructions from a health care provider to quarantine or isolate due to a risk of having COVID-19.”

 These rules will remain in effect for the longer of (a) 30 days after adoption, or (b) the duration of the State of Disaster Emergency declared by the Governor, up to a maximum of 120 days after the adoption of these temporary rules.

For more information, visit our webpage dedicated to this rule (the content of which has already been updated to reflect the March 26th changes), which links the Colorado HELP Rules, and the Division’s Statement of Basis, Purpose, Authority, and Findings supporting and explaining the rules. The page also lists email and phone contact information for any further questions you may have.

Thank you, 

Michael Primo
Director of Operations
Division of Labor Standards and Statistics
 

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.

 
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