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State and Federal Overview: the Novel Coronavirus (COVID-19), October 23, 2020
International
Key Items from the WHO’s Weekly Coronavirus Disease (COVID-19) Epidemiological Update:
 
Therapeutics: The Solidarity Therapeutics Trial have produced conclusive evidence on whether selected repurposed drugs are effective for COVID-19. Interim results from the Solidarity Therapeutics Trial, coordinated by WHO, indicate that remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon regimens appear to have little or no effect on 28-day mortality or the in-hospital course of COVID-19 among hospitalised patients.
 
A call of Solidarity: Kim Sledge and the World We Want have partnered with WHO Foundation to re-record the unity anthem, “We Are Family”, in response to COVID-19 and to bring focus on global public health needs. A special edition cover of Sister Sledge’s hit “We Are Family” will be released in a new and inspiring call for global solidarity to respond to the COVID-19 pandemic and to generate proceeds to address the most pressing global health challenges of our time. In support of the song’s release, people worldwide are invited to submit videos of themselves singing We Are Family for inclusion in a compilation video for release on 7 December 2020.
 
Briefings: WHO Director-General Dr Tedros, in his regular media briefing on 12 October, expressed concern around the concept of reaching so-called “herd immunity” by the letting the virus spread – “never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic. It is scientifically and ethically problematic”. Furthermore, in a media briefing on 16 October, Dr Tedros highlighted the rising number of cases of COVID-19 globally, especially in Europe where, although the number of deaths reported is much lower than in March, hospitalisations are increasing.
 
Health System Strengthening: WHO published a Handbook for public health capacity-building at ground crossings and cross-border collaboration. The objectives of the handbook are to introduce principles of strategic risk assessment for prioritizing preparedness and response capacity building; highlight issues to consider when selecting ground crossings for designation under the International Health Regulations (2005, IHR); and, support the establishment and maintenance of cross-border collaboration to improve coordination and communication.
 
Food security, public health and livelihoods: On 13 October, WHO with the International Labour Organization (ILO), Food and Agriculture Organization (FAO), and the International Fund for Agriculture Development (IFAD) released a joint statement on the Impact of COVID-19 on people's livelihoods, their health and our food systems. The pandemic has been affecting the entire food system and has laid bare its fragility. Border closures, trade restrictions and confinement measures have been preventing farmers from accessing markets, including for buying inputs and selling their produce, and agricultural workers from harvesting crops, thus disrupting domestic and international food supply chains and reducing access to healthy, safe and diverse diets. According to the policy brief published by the United Nations, in the long run, we face possible disruptions to the functioning of food systems, with severe consequences for health and nutrition.
 
Access the full update here.
 
View the WHO’s Situation Dashboard for COVID-19 here.

 
Federal Government
U.S. Cases - Provided by the New York Times
As of October 22, 2020, 9:43 A.M. E.T.
 
  Total Reported On Oct. 21 14-Day Change
Cases 8.3 million 62,751 +32%
Deaths 222,157 1,170 +9%
 
Includes confirmed and probable cases where available. 14-day change trends use 7-day averages.
 
Centers for Medicare & Medicaid Services
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) — Revised. CMS updated MLN Matters Special Edition Article SE20011 Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) (PDF) with Critical Access Hospital (CAH) HCPCS codes for COVID-19 testing-related services. The skilled nursing facility benefit period waiver applies to rural hospitals and CAHs.
CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management Call — October 22
Thursday, October 22 from 4 to 5 pm ET

CMS, CDC, and the Quality Improvement Organization (QIO) Program present this live Q&A series:
Target Audience: Clinical and administrative nursing home staff members.
Nursing Home COVID-19 Preparedness for Fall & Winter Web-Based Training. Nursing homes: Learn how to prepare for COVID-19, provide resident-centered care, and prevent and control infection. Visit the Quality, Safety & Education Portal to access free scenario-based trainings for managers and frontline staff. See the flyer for more information.
U.S. Department of Health and Human Services
Trump Administration Takes Action to Further Expand Access to Vaccines, COVID-19 Tests. The U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Health (ASH), issued guidance - PDF* under the Public Readiness and Emergency Preparedness Act (PREP Act) authorizing qualified pharmacy technicians and State-authorized pharmacy interns to administer childhood vaccines, COVID-19 vaccines when made available, and COVID-19 tests, all subject to several requirements. This  guidance clarifies that the pharmacy intern must be authorized by the State or board of pharmacy in the State in which the practical pharmacy internship occurs, but this authorization need not take the form of a license from, or registration with, the State board of pharmacy.
 
Childhood and COVID-19 Vaccines
On September 3, 2020, the Assistant Secretary for Health issued guidance authorizing state-licensed pharmacists to order and administer, and state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist to administer, to persons ages three or older, COVID-19 vaccinations that have been authorized or licensed by the Food and Drug Administration (FDA), provided that certain conditions are met—thereby making them “covered persons” under the PREP Act with respect to this activity. 
 
This guidance authorizes both qualified pharmacy technicians and State-authorized pharmacy interns acting under the supervision of a qualified pharmacist to administer to FDA-authorized or FDA-licensed COVID-19 vaccines to persons ages three or older and to administer FDA-authorized or FDA-licensed ACIP-recommended vaccines to persons ages three through 18 according to ACIP’s standard immunization schedule, if the requirements listed below are satisfied: 
  • The vaccination must be ordered by the supervising qualified pharmacist.
  • The supervising qualified pharmacist must be readily and immediately available to the immunizing qualified pharmacy technicians.
  • The vaccine must be FDA-authorized or FDA-licensed.
  • In the case of a COVID-19 vaccine, the vaccination must be ordered and administered according to ACIP’s COVID-19 vaccine recommendation(s).
  • In the case of a childhood vaccine, the vaccination must be ordered and administered according to ACIP’s standard immunization schedule.
  • The qualified pharmacy technician or State-authorized pharmacy intern must complete a practical training program that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include a hands-on injection technique and the recognition and treatment of emergency reactions to vaccines.
  • The qualified pharmacy technician or State-authorized pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.
  • The qualified pharmacy technician must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during the relevant State licensing period(s).
  • The supervising qualified pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers vaccines, including informing the patient’s primary care provider when available and submitting the required immunization information to the State or local immunization information system (vaccine registry).
  • The supervising pharmacist is responsible for complying with requirements related to reporting adverse events.
  • The supervising qualified pharmacist must review the vaccine registry or other vaccination records prior to ordering the vaccination to be administered by the qualified pharmacy technician or State-authorized pharmacy intern. 
  • The qualified pharmacy technician and State-authorized pharmacy intern must, if the patient is 18 years of age or younger, inform the patient and the adult caregiver accompanying the patient of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate.
  • The supervising qualified pharmacist must comply with any applicable requirements (or conditions of use) as set forth in the CDC’s COVID-19 vaccination provider agreement and any other federal requirements that apply to the administration of COVID-19 vaccine(s).
COVID-19 Testing. This guidance also authorizes qualified pharmacy technicians and State-authorized pharmacy interns to administer COVID-19 tests, including serology tests, that the FDA has approved, cleared, or authorized.
 
Information on the Third Amendment to the PREP Act declaration.
 
Information on Operation Warp Speed
 
Clinical resources on vaccines, including continuing education training on best practices
 
* Persons using assistive technology may not be able to fully access information in this file. For assistance, please contact the Office of the Assistant Secretary for Health at ashmedia@hhs.gov.
HHS Expands Relief Fund Eligibility and Updates Reporting Requirements. The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the latest Provider Relief Fund (PRF) application period has been expanded to include provider applicants such as residential treatment facilities, chiropractors, and eye and vision providers that have not yet received Provider Relief Fund distributions. On October 1, 2020, HHS announced it would be making up to $20 billion in new Phase 3 General Distribution funding available for providers on the frontlines of the coronavirus pandemic. HHS is also focused on ensuring the safe continuity of all types of health care delivery despite this pandemic. As such, the Administration is committed to providing relief resources in an equitable manner to assist the diverse health care provider community regardless of whether they accept Medicare or Medicaid payments. HHS is also announcing it will be updating its most recent PRF reporting instructions to broaden use of provider relief funds.
 
Under the Phase 3 General Distribution, which began accepting applicants on October 5, 2020, HHS invited providers that had already received PRF payments to apply for additional funding that considers changes in patient care operating revenue and expenses caused by the coronavirus. HHS also expanded the list of eligible applicants to providers who had not previously received PRF payments, including behavioral health providers known to the Substance Abuse and Mental Health Services Administration (SAMHSA) and certain providers who began practicing in 2020. Still, pandemic related needs across the entirety of the provider community remains high. HHS has designed the PRF program to be agile and responsive to the unique and dynamic challenges this virus presents to the health care ecosystem. Important to this approach is maintaining an open line of communication with providers and provider organizations, members of Congress, and state and local officials. As HHS receives input and feedback on needs caused by the coronavirus pandemic, it has tried to respond.
 
Newly Eligible Phase 3 General Distribution Providers
Today, HHS is expanding the pool of eligible Phase 3 applicants to include providers across a broad category of practices. Many providers who accept Medicare and Medicaid within these categories have already received a PRF payment, but others have not and HHS is working to ensure even more providers are able to receive Phase 3 funding. The list below includes eligible practices where providers may now apply for Phase 3 funding regardless of whether they accept Medicaid or Medicare.
  • Behavioral Health Providers
  • Allopathic & Osteopathic Physicians
  • Dental Providers
  • Assisted Living Facilities
  • Chiropractors
  • Nursing Service and Related Providers
  • Hospice Providers
  • Respiratory, Developmental, Rehabilitative and Restorative Service Providers
  • Emergency Medical Service Providers
  • Hospital Units
  • Residential Treatment Facilities
  • Laboratories
  • Ambulatory Health Care Facilities
  • Eye and Vision Services Providers
  • Physician Assistants & Advanced Practice Nursing Providers
  • Nursing & Custodial Care Facilities
  • Podiatric Medicine & Surgery Service Providers
(For a detailed description of all eligible Phase 3 General Distribution provider types, visit the PRF website.)
 
These providers and all Phase 3 applicants will have until 11:59PM EST on November 6, 2020 to submit their applications for payment consideration. Once validated, these providers will receive a baseline payment of approximately 2% of annual revenue from patient care plus an add-on payment that considers changes in operating revenues and expenses from patient care, including expenses incurred related to coronavirus. All payment recipients will be required to attest to receiving the Phase 3 General Distribution payment and accept the associated Terms and Conditions.
 
Reporting Requirements Update
HHS is committed to distributing PRF funds in a way that is fast, fair, simple and transparent. In September, HHS published final reporting guidance to set expectations for PRF payment recipients. In providing this guidance, HHS also updated its Frequently Asked Questions (FAQs) to clarify that for purposes of relief payments for lost revenues attributable to COVID-19, recipients must submit information showing a negative change in year-over-year net patient care operating income. This definition sought to balance fairness and establish guardrails to restrict some providers from receiving distributions that would make them more profitable than they were before the pandemic.

As providers, provider organizations, and members of Congress familiarized themselves with the reporting requirements, HHS received feedback from many voicing concerns regarding this approach to permissible uses of PRF money. In response to concerns raised, HHS is amending the reporting instructions to increase flexibility around how providers can apply PRF money toward lost revenues attributable to coronavirus. After reimbursing healthcare related expenses attributable to coronavirus that were unreimbursed by other sources, providers may use remaining PRF funds to cover any lost revenue, measured as a negative change in year-over-year actual revenue from patient care related sources.
 
A policy memorandum on the reporting requirement decision can be found here - PDF*.
The amended reporting requirements guidance can be found here - PDF.*
 
For updates and to learn more about the Provider Relief Program, visit: hhs.gov/providerrelief.
*This content is in the process of Section 508 review. If you need immediate assistance accessing this content, please submit a request to digital@hhs.gov.
Food and Drug Administration
FDA Approves First Treatment for COVID-19. The U.S. Food and Drug Administration approved the antiviral drug Veklury (remdesivir) for use in adult and pediatric patients 12 years of age and older and weighing at least 40 kilograms (about 88 pounds) for the treatment of COVID-19 requiring hospitalization. Veklury should only be administered in a hospital or in a healthcare setting capable of providing acute care comparable to inpatient hospital care. Veklury is the first treatment for COVID-19 to receive FDA approval. 
 
This approval does not include the entire population that had been authorized to use Veklury under an Emergency Use Authorization (EUA) originally issued on May 1, 2020. In order to ensure continued access to the pediatric population previously covered under the EUA, the FDA revised the EUA for Veklury to authorize the drug’s use for treatment of suspected or laboratory confirmed COVID-19 in hospitalized pediatric patients weighing 3.5 kg to less than 40 kg or hospitalized pediatric patients less than 12 years of age weighing at least 3.5 kg. Clinical trials assessing the safety and efficacy of Veklury in this pediatric patient population are ongoing.
 
Read the full release.
The U.S. Food and Drug Administration announced the following actions taken in its ongoing response effort to the COVID-19 pandemic:
  • The FDA posted a new “FDA Insight” podcast featuring Deputy Commissioner Anand Shah, M.D., and Dr. Peter Marks, the Director of FDA's Center for Biologics Evaluation and Research, discussing the upcoming Vaccines and Related Biological Products Advisory Committee meeting on October 22, 2020.
  • In a new “FDA Voices”, entitled the FDA’s Vaccines and Related Biological Products Advisory Committee and its Role in Advising the Agency on COVID-19 Vaccines, Peter Marks, M.D., Ph.D., highlights the value of transparency. Dr. Marks states that facilitating the development of safe and effective COVID-19 vaccines is a high priority for the FDA, and that the FDA recognizes that being transparent about the data the agency will evaluate in support of the safety and effectiveness of these vaccines, and discussing this data with the members of the Vaccines and Related Biological Products Advisory Committee, in a public forum is critical to building trust and confidence in their use by the public.
  • The FDA issued a Consumer Update entitled, Advisory Committees Give FDA Critical Advice and the Public a Voice. It describes how the FDA relies on its many advisory committees to help it make sound decisions based on the best science available.
  • Testing updates:
    • As of today, 282 tests are authorized by FDA under EUAs; these include 220 molecular tests, 56 antibody tests, and 6 antigen tests.
Centers for Disease Control and Prevention
COVID-19 in a Correctional Facility Employee Following Multiple Brief Exposures to Persons with COVID-19 — Vermont, July–August 2020. On August 11, 2020, a confirmed case of coronavirus disease 2019 (COVID-19) in a male correctional facility employee (correctional officer) aged 20 years was reported to the Vermont Department of Health (VDH). On July 28, the correctional officer had multiple brief encounters with six incarcerated or detained persons (IDPs)* while their SARS-CoV-2 test results were pending… Data are limited to precisely define “close contact”; however, 15 minutes of close exposure is used as an operational definition for contact tracing investigations in many settings. Additional factors to consider when defining close contact include proximity, the duration of exposure, whether the infected person has symptoms, whether the infected person was likely to generate respiratory aerosols, and environmental factors such as adequacy of ventilation and crowding. A primary purpose of contact tracing is to identify persons with higher risk exposures and therefore higher probabilities of developing infection, which can guide decisions on quarantining and work restrictions. Although the initial assessment did not suggest that the officer had close contact exposures, detailed review of video footage identified that the cumulative duration of exposures exceeded 15 minutes. In correctional settings, frequent encounters of ≤6 feet between IDPs and facility staff members are necessary; public health officials should consider transmission-risk implications of cumulative exposure time within such settings.
 
Read the full release.
Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity — United States, January 26–October 3, 2020: Summary
 
What is already known about this topic? As of October 15, 216,025 deaths from COVID-19 have been reported in the United States; however, this might underestimate the total impact of the pandemic on mortality.
 
What is added by this report? Overall, an estimated 299,028 excess deaths occurred from late January through October 3, 2020, with 198,081 (66%) excess deaths attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino persons.
 
What are the implications for public health practice? These results inform efforts to prevent mortality directly or indirectly associated with the COVID-19 pandemic, such as efforts to minimize disruptions to health care.
 
Read the full release.
Risk for In-Hospital Complications Associated with COVID-19 and Influenza — Veterans Health Administration, United States, October 1, 2018–May 31, 2020: Summary
 
What is already known about this topic? Patients hospitalized with COVID-19 are reported to be at risk for respiratory and nonrespiratory complications.
 
What is added by this report? Hospitalized patients with COVID-19 in the Veterans Health Administration had a more than five times higher risk for in-hospital death and increased risk for 17 respiratory and nonrespiratory complications than did hospitalized patients with influenza. The risks for sepsis and respiratory, neurologic, and renal complications of COVID-19 were higher among non-Hispanic Black or African American and Hispanic patients than among non-Hispanic White patients.
 
What are the implications for public health practice? Compared with influenza, COVID-19 is associated with increased risk for most respiratory and nonrespiratory complications. Certain racial and ethnic minority groups are disproportionally affected by COVID-19.
 
Read the full release.
 
Department of Labor
Unemployment Insurance Weekly Claims Report Update. In the week ending October 17, the advance figure for seasonally adjusted initial claims was 787,000, a decrease of 55,000 from the previous week's revised level. The previous week's level was revised down by 56,000 from 898,000 to 842,000. The 4-week moving average was 811,250, a decrease of 21,500 from the previous week's revised average. The previous week's average was revised down by 33,500 from 866,250 to 832,750. The advance seasonally adjusted insured unemployment rate was 5.7 percent for the week ending October 10, a decrease of 0.7 percentage point from the previous week's revised rate. The previous week's rate was revised down by 0.4 from 6.8 to 6.4 percent.
 
The advance number for seasonally adjusted insured unemployment during the week ending October 10 was 8,373,000, a decrease of 1,024,000 from the previous week's revised level. The previous week's level was revised down by 621,000 from 10,018,000 to 9,397,000. The 4-week moving average was 10,085,750, a decrease of 1,093,500 from the previous week's revised average. The previous week's average was revised down by 302,500 from 11,481,750 to 11,179,250.
 
Read the full release here.
The State of Texas
From the Office of the Governor, Greg Abbott
Governor Abbott Surges Additional COVID-19 Resources To El Paso. Governor Greg Abbott today announced that the Texas Department of State Health Services (DSHS) and the Texas Division of Emergency Management (TDEM) are surging additional medical personnel and equipment to the El Paso region to assist with the community's COVID-19 response. DSHS is deploying over 460 medical personnel to the region this week, and the agencies are sending a Texas Emergency Medical Task Force ambulance bus, medical incident support team, five ambulances, and mobile medical unit to assist first responders. DSHS is also deploying 48 patient monitors, 25 medical beds, and 30 oxygen concentrators to support area hospitals. 
 
These resources build upon the medical personnel and personal protective equipment (PPE) previously deployed by TDEM and DSHS last week, more than doubling the number of personnel on the ground in El Paso to help care for COVID-19 patients. 
 
TDEM has provided millions of pieces of PPE to support El Paso’s COVID-19 response. Currently, El Paso’s emergency response warehouses are stocked with over 4.8 million masks, over 629,000 gowns and coveralls, over 400,000 gloves, over 38,000 face shields, and additional PPE that has been provided by TDEM.
Health Care
Department of State Health Services
COVID-19 Case Count. The Texas Department of State Health Services (DSHS) is working closely with the Centers for Disease Control and Prevention (CDC) in responding to the new coronavirus disease 2019 (COVID‑19) that is causing an outbreak of respiratory illness worldwide. State case counts can be found by accessing the DSHS COVID-19 Dashboard.
 

1 older cases recently reported by labs were included in the statewide total but excluded from statewide and Dallas County new confirmed cases (522).

104 older cases recently reported by labs were included in the statewide total but excluded from statewide and El Paso County new confirmed cases (1,161).

10 older cases recently reported by labs were included in the statewide total but excluded from statewide and Franklin County new confirmed cases (7).

9 older cases recently reported by labs were included in the statewide total but excluded from statewide and Galveston County new confirmed cases (41).

206 older cases recently reported by labs were included in the statewide total but excluded from statewide and Harris County new confirmed cases (637).

2 older cases recently reported by labs were included in the statewide total but excluded from statewide and Hopkins County new confirmed cases (1).

1 older cases recently reported by labs were included in the statewide total but excluded from statewide and Nacogdoches County new confirmed cases (9).

41 older cases recently reported by labs were included in the statewide total but excluded from statewide and Walker County new confirmed cases (11).

Multisystem Inflammatory Syndrome in Children (MIS-C) – Oct. 19, 2020. DSHS has confirmed 51 cases of Multisystem Inflammatory Syndrome in Children. MIS-C is a rare but serious complication associated with COVID-19. The condition causes different body parts to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs. Children with MIS-C may have fever and various symptoms, including abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired. The cause of MIS-C has not been determined. However, many children with MIS-C had the virus that causes COVID-19 or had been around someone with COVID-19.
 
Parents and caregivers should contact their child's health care provider if a child shows symptoms of MIS-C. Providers should report suspected cases to their public health department.

While the cause of MIS-C has not been identified, the best way to protect your children against the condition is to take precautions to prevent anyone in your household from getting COVID-19.
 
MIS-C at a glance:
  • Age range: 9 months-18 years old (median: 9 years old)
  • Sex: 30 Male (59%), 21 Female (41%)
  • Race/Ethnicity: 27 Hispanic (53%), 17 Black (33%), 4 White (8%), 1 Asian (2%), 2 Unknown (4%)
  • Onset date range (fever): 4/22/20 – 10/06/20
  • Hospital and ICU admission: 51 Hospitalized (100%), 40 ICU admission (78%)
  • Outcome: 48 Discharged (94%), 1 Died (2%), 2 Still hospitalized (4%)
Public Health Region Number of Cases
1 (Panhandle) 1
2/3 (North Texas) 22
4/5N (East Texas) 2
6/5S (Southeast Texas) 8
7 (Central Texas) 12
8 (South Texas) 6
Total 51 
Multisystem Inflammatory Syndrome in Children (MIS-C)
Health and Human Services Commission
HHSC Publishes Reporting Guidance for Long-Term Care Providers – Point-of-Care Antigen Testing (PL 20-46). HHSC has published Provider Letter 20-46 Reporting Guidance for Long-Term Care Providers – Point-of-Care Antigen Testing (PDF) for nursing facilities and assisted living facilities.

The provider letter outlines responsibilities related to reporting COVID-19 test results for providers conducting point-of-care antigen tests within their facilities. This letter is not intended for use by providers who do not conduct COVID-19 POC tests within their facility. Providers who do not conduct COVID-19 POC tests within their facility may refer to PL 20-37.
Managing the COVID-19 Crisis in Surging Areas - Webinars for ALF Providers. This webinar will emphasize the importance of identifying the root cause of COVID-19 spread in a facility. Useful examples and tips that can be used in response to the pandemic will also be shared.

The purpose of this webinar is to:
  • Inform and prepare assisted living facilities in a specific area of Texas where COVID-19 is surging
  • Review area specific data, and community and area resources
  • Highlight specifics of the Assisted Living Facility COVID-19 Response Plan
Managing the COVID-19 Crisis in El Paso Co. and Surrounding Areas
Nov. 3, 9:30 a.m.
Register for the webinar.
Managing the COVID-19 Crisis in Lubbock Co. and Surrounding Areas
Nov. 5, 10 a.m.
Register for the webinar.
Managing the COVID-19 Crisis in Travis/Williamson Co. and Surrounding Areas
Nov. 9, 2 p.m.
Register for the webinar.
Managing the COVID-19 Crisis in Hays Co. and Surrounding Areas
Nov. 10, 10 a.m.
Register for the webinar.
Managing the COVID-19 Crisis in Amarillo and Surrounding Areas
Nov. 12, 9:30 a.m.
Register for the webinar.
Managing the COVID-19 Crisis in Midland/Odessa and Surrounding Areas
Nov. 16, 10 a.m.
Register for the webinar.
HHSC 2020 COVID-19 Impact Survey - Your Participation Matters. As a contracted provider of services for the Texas Health and Human Services Commission, the duties and responsibilities of your organization are vital to the health and safety of the Texans we serve, especially during the ongoing global pandemic. HHSC understands the global pandemic is affecting providers in many ways, including impacts to revenues received, costs incurred and provider utilization. To fully assess all the impacts of the pandemic on HHSC providers, we request you complete an upcoming survey that will inform our agency of the financial, utilization and process impacts to your organization due to COVID-19. All survey responses will remain anonymous.
 
By taking this survey, you will help HHSC develop policies and secure funding that aims to mitigate the short-term and long-term impact of COVID-19 on providers.
 
On Oct. 26 your organization will receive an email that will include a link to the online survey.

We encourage you to forward these communications to the appropriate person or persons in your organization familiar with the financial and utilization information for your billing provider (as defined by NPI/TPI), so they can respond to this survey.
 
Your participation is voluntary and valued. We look forward to your feedback. Please contact HHSC Rate Analysis for questions about the survey.
COVID-19 Update to Temporary Change in HCS and TxHmL Policy for Service Providers of Respite and CFC PAS/HAB. HHSC is lifting the prohibition on service providers of respite and CFC PAS/HAB from living in the same home as the person receiving Home and Community-based Services and Texas Home Living program services. This will provide access to needed services for people living in their own or family’s home. A person’s spouse or a minor child’s parent is still prohibited from being a paid service provider of these services due to prohibition guidelines found in the following:
This is a temporary policy change. It is effective March 27, 2020 through Nov. 30, 2020.
Program providers must complete the required background checks for all service providers. They must follow:
Email the HCS program policy or the TxHmL program policy with questions.
COVID-19 Update to Telehealth Guidance on CLASS Professional and Specialized Therapies. The following CLASS professional and specialized therapy services are available by telehealth.
This is effective Mar. 15 through Nov. 30, 2020.
  • Physical therapy
  • Occupational therapy
  • Speech and language pathology
  • Recreational therapy
  • Music therapy
  • Behavior support
  • Dietary services
  • Cognitive rehabilitation therapy
Acceptable telehealth formats are synchronous audiovisual interaction or asynchronous store and forward technology. Use these with synchronous audio interaction between the client and the distant site provider.

The Office of Civil Rights has relaxed HIPAA requirements to allow use of video for telehealth services. Texas Medicaid recognizes OCR’s HIPAA enforcement discretion as it relates to telehealth platform requirements.

Therapies must have a treatment plan. The goals and outcomes must support being provided through telehealth. Revision of therapy hours may be added to an IPC and authorized by HHSC per the process outlined in
IL 20-12 (PDF).

Therapies not eligible for delivery by telehealth are:
  • Massage therapy
  • Hippotherapy
  • Therapeutic horseback riding
  • Aquatic therapy
Update to COVID-19 Guidance for FFS Service Coordinators and Case Managers. Fee-for-service Medicaid 1915(c) waiver case managers and service coordinators may suspend face-to-face service coordination visits.
 
This is a temporary policy change.
It extends through Nov. 30, 2020.
This temporary policy applies to:
  • Community Living Assistance and Support Services
  • Texas Home Living
  • Deaf-Blind with Multiple Disabilities
  • Home and Community-based Services
  • General Revenue Service Coordinators
  • Community First Choice Service Coordinators
  • Pre-admission Screening and Resident Review Habilitation Coordinators
Case managers, service coordinators, and habilitation coordinators are encouraged to complete visits due through Nov. 30, 2020. These can be done by phone, telehealth or telemedicine.

HHSC will release more guidance as information becomes available.
Updated: In-Home Day Habilitation Information for Program Providers for COVID-19 (IL 2020-19). The Texas Health and Human Services Commission is temporarily waiving requirements in Sections 4320 and 3710 of the Home and Community-based Services Billing Guidelines and the Texas Home Living Billing Guidelines.
 
This is in response to COVID-19 and to provide access to needed day habilitation services.

HHS published a revision to this in IL 2020-19 In-Home Day Habilitation Information for Program Providers (PDF).
 
This information letter was previously issued on July 30, 2020.
 
It extends the temporary guidance through Nov. 30, 2020.
HHSC: Assisted Living Facilities CLIA Waiver Information. As COVID-19 testing becomes more available, it will be important for assisted living facilities to apply for a Clinical Laboratory Improvement Amendment waiver as part of their overall preparedness efforts.
 
Facilities will need to apply for a CLIA waiver to offer and perform certain COVID-19 testing for staff and residents directly.
 
To obtain a CLIA Waiver for COVID-19 point of contact testing using a rapid POC diagnostic testing device, complete Form CMS-116 (PDF) available on the CMS CLIA website or on the HHSC Health Care Facilities Regulation - Laboratories  webpage found under the Application header. Email the form to the regional CLIA licensing group via the HHSC HCF Regulation – Laboratories webpage.
Education

The Texas Education Agency published the following:

INSTRUCTIONAL CONTINUITY PLANNING

Asynchronous and Synchronous Instruction

WAIVERS, FINANCE & GRANTS

State Funding

Taxes
From the Office of the Comptroller: OCTOBER Fiscal Notes Release

Fiscal Notes: Uninsured Texans. In the recently released October edition of Fiscal Notes, the Comptroller’s office examines the issue of uninsured Texans, the economic consequences for the state, options available to those who have recently lost their insurance — and various policies that could extend health coverage to more of our most vulnerable citizens.

According to recently released U.S. Census data, the share of Texans without health insurance was 18.4 percent in 2019. And the job losses and economic turmoil brought on by the COVID-19 pandemic has only exacerbated the issue.

“One of the most painful effects of losing a job is the loss of employer-sponsored insurance, which offers health coverage for the majority of full-time U.S. workers,” said Texas Comptroller Glenn Hegar. “In Texas, COVID-related losses have worsened a perennial problem in our state — a problem that is costing the state’s economy. The Texas Alliance for Health Care reports that Texas’ high rates of ‘uninsurance’ cost our state economy hundreds of billions of dollars.”

This edition of Fiscal Notes also takes a look at state funds held outside the state Treasury, called “local” funds. These funds are controlled directly by state agencies and institutions of higher education outside the Texas Legislature’s regular budgeting and appropriations process, a characteristic that sometimes has made them controversial during budget negotiations.

“Local Funds”: State Money Outside the Treasury - New Report Addresses Little-Known State Funds. In August 2017, Fiscal Notes reported on state funds held outside the state Treasury, also called “local” funds. These funds are controlled directly by state agencies and institutions of higher education outside the Texas Legislature’s regular budgeting and appropriations process, a characteristic that sometimes has made them controversial during budget negotiations.

Local funds give agencies greater operating flexibility. But because they are largely exempt from the state’s usual budgeting and reporting mechanisms, they can pose various challenges concerning transparency, efficiency and oversight.

Regarding transparency, Associate Deputy Comptroller Phillip Ashley explains, “Local funds are typically not part of state budget deliberations, not part of the financial information we report to the Legislature and generally not part of our accounting system. In comparison to normal state funds, the Comptroller’s office has little information on funds held outside the Treasury.”
 
Local funds give agencies greater operating flexibility, but pose various challenges concerning transparency, efficiency and oversight.
 
Until recently, Texas had no single, readily available source for basic information on these local funds — even for how many exist or how much money they hold. A new biennial report, however, first issued by the Legislative Budget Board (LBB) in 2019, sheds some light on these funds and will provide vital information next year as the Legislature convenes

Read the full publication here.
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