IHA Daily Briefing: July 28

Tuesday, July 28, 2020
U.S. Senate GOP Releases COVID-19 Relief Bill
HHS Finalizes ACA Section 1557 Rule
IHA Leadership Webinar Aug. 6: Strategize on Health Equity
CDC COVID-19 Health Equity Webinar Wednesday
FDA Issues New Warning on Tainted Hand Sanitizer
Chicago Expands Travel Order to Four More States
State, National, Global COVID-19 Updates
Technical Assistance Available for Rural Hospitals

U.S. Senate GOP Releases COVID-19 Relief Bill
Late Monday, U.S. Senate Republicans announced the release of their proposal for the next COVID-19 relief legislation. The roughly $1 trillion Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act focuses on reopening schools, improving the economy and “winning the healthcare fight against the virus.”

IHA’s Take: The HEALS Act represents a critical next step in responding to and recovering from the COVID-19 pandemic. IHA applauds the strong liability protections included in the package; however, we will be working with the Illinois Congressional delegation over the coming days to improve key provisions of the bill, including increasing funding for hospitals and making significant improvements to the Medicare Accelerated and Advance Payment Program.

Among numerous other provisions, the HEALS Act:

  • Provides an additional $25 billion for the Provider Relief Fund (the American Hospital Association recently asked Congress for an additional $100 billion);   
  • Directs $16 billion for testing and contract tracing in states;   
  • Establishes specific healthcare liability protections, including:   
    • Creating an exclusive federal cause of action for medical liability claims against providers (facilities, administrators, doctors, nurses and volunteers);   
    • Requiring plaintiffs to demonstrate gross negligence or willful misconduct by a defendant; and
  • Pre-emption of state laws, while allowing states to impose further liability protections.   
  • Adjusts repayment terms for the Medicare Accelerated and Advance Payment Programs by extending the start of the loan repayment to 270 days (currently 120 days), and extending the period of repayment before interest begins to 18 months (currently 12 months);
  • Extends telehealth flexibilities, including:   
    • Providing the Secretary of Health and Human Services (HHS) with authority to extend Medicare telehealth waivers through the duration of the public health emergency or December 2021, whichever is later; and     
    • Extending for five years beyond the end of the public health emergency the allowance for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as distant sites.           
  • Improves medical supply chain stability by supporting on-shore manufacturing of medical supplies, improving identification of specific supply needs, and strengthening the Strategic National Stockpile and establishing state stockpiles;   
  • Modernizes infectious disease data collection and authorizes a network of ten regional Centers for Public Health Preparedness to support state and local health departments, healthcare coalitions and the public; and  
  • Provides additional assistance to small businesses, including   
    • $190 billion of new funds to support the Paycheck Protection Program (PPP) and allowing for “Second Draw Loans” (in order to qualify for a second PPP loan, borrowers must have no more than 300 employees and demonstrate at least a 50 percent loss in gross revenues.); and   
    • Improvements to original PPP loans such as expansion of the list of forgivable expenses and expanding eligibility to include certain 501(c)(6) organizations.

Bipartisan negotiations on the next relief package began yesterday, and final legislation must garner enough Democratic support to meet the 60-vote threshold necessary to advance in the Senate and be approved by the U.S. House. A list of IHA priorities for the next legislative package is here; an Advocacy Alert here; and IHA President & CEO A.J. Wilhelmi’s recent letter to the Congressional delegation urging action on critical hospital priorities here.

HHS Finalizes ACA Section 1557 Rule
On June 19, 2020, the U.S. Dept. of Health and Human Services (HHS) published a final rule (Final Rule) making changes to the 2016 HHS regulations implementing Section 1557 of the Affordable Care Act (ACA). The Final Rule adjusts or eliminates various requirements, but does not add new obligations.

Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age and disability by healthcare entities – in concert with long-standing and familiar principles established by federal civil rights laws such as Title IV of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975.

Among other things the Final Rule:

  • Retains the requirement that healthcare entities provide written notice of nondiscrimination practices, but eliminates the requirement for healthcare entities to send notices and taglines in the top 15 non-English languages most commonly spoken in the state with all “significant communications”;   
  • Enumerates a “four-factor analysis” for use by HHS in evaluating provider compliance of Limited English Proficient (LEP) matters;   
  • Reaffirms expectations for effective communication with LEP and disabled populations (or persons with impaired sensory, manual, or speaking skills);   
  • Permits remote English-language interpreting services to be audio-based rather than requiring them to be video-based if meaningful access is maintained;   
  • Drastically reduces federal law rights for various groups relating to sex, gender identity and sexual orientation. (Note: There is a pending Federal lawsuit relative to the Final Rule’s rollback of gender identity protections);
  • Eliminates the definitions of terms and list of examples of discriminatory practices provided in the 2016 version, instead deferring to the terms as defined by the underlying federal civil rights statutes;   
  • Adds a provision that Section 1557 must be enforced in a manner consistent with other statutes including the Religious Freedom Restoration Act and federal conscience protection laws; and   
  • Repeals the requirement that entities designate a 1557 compliance coordinator, instead indicating that healthcare providers should handle Section 1557 complaints through existing grievance procedures (for hospitals, as required by the Medicare Conditions of Participation for Hospitals at 42 CFR 482.13(a)(2)).

The Final Rule’s effective date is August 18, 2020. See here for a detailed HHS fact sheet of the rule changes.

IHA Leadership Webinar Aug. 6: Strategize on Health Equity
To reduce health disparities, Dayna Bowen Matthew, JD, PhD, believes in a multidisciplinary approach where healthcare workers, lawyers and policymakers work together.

During an Aug. 6 IHA webinar, “How Hospitals and Health Systems Can Lead a 'Quiet Revolution' for Healing During a Pandemic," Matthew will boldly explore the unique role healthcare providers can play in improving health equity.

Matthew's career as a legal scholar and public health expert—spanning three decades—has focused on racial disparities in healthcare. She is currently dean of George Washington University Law School, as well as director of the University of Virginia's Equity Center. Matthew is also co-founder of the Colorado Health Equity Project, which unites medical and legal professionals to improve health for low-income patients.

In next week's IHA webinar, from noon to 1 p.m., Matthew will empower C-suite and department leaders to make progress on the pervasive problem of health disparities.

For more information on IHA's complimentary summer series and continuing education credits, see our registration page.

CDC COVID-19 Health Equity Webinar Wednesday
The Centers for Disease Control and Prevention webinar, “Promising Practices in the Health Equity,” will be held live on Zoom on Wednesday, July 29 at 2 p.m. CDT. Presenters include: Aletha Maybank, M.D., M.P.H., Chief Health Equity Officer, Vice President, American Medical Association; David Saunder, Office Health Equity Director, Pennsylvania Department of Health; and James E. Bloyd, M.P.H., Regional Health Office, Cook County Department of Public Health. Register here.

FDA Issues New Warning on Tainted Hand Sanitizer
The U.S. Food and Drug Administration (FDA) on Monday issued a new warning about hand sanitizers tainted with methanol. The FDA says consumers and healthcare professionals should not use certain alcohol-based hand sanitizers due to the dangerous presence of methanol, or wood alcohol. Methanol is often used to create fuel and antifreeze and can be toxic when absorbed through the skin as well as life-threatening when ingested. The agency has also taken additional action to help prevent certain hand sanitizers from entering the United States by placing them on an import alert. The FDA is proactively working with manufacturers to recall products and is encouraging retailers to remove products from store shelves and online marketplaces.

The FDA has posted a do-not-use list of dangerous hand sanitizer products, which is being updated regularly. In most cases, methanol does not appear on the product label. However, methanol is not an acceptable ingredient in any drug, including hand sanitizer, even if methanol is listed as an ingredient on the product label. The FDA’s ongoing testing has found methanol contamination in hand sanitizer products ranging from 1% to 80%.

Chicago Expands Travel Order to Four More States
The city of Chicago is adding four states – Missouri, Nebraska, North Dakota and Wisconsin – to the list of states under its emergency travel order, effective this Friday. Under the order, travelers from 22 states are asked to self-quarantine for 14 days.

State, National, Global COVID-19 Updates
The Illinois Department of Public Health (IDPH) announced today 1,076 new COVID-19 cases and 30 deaths. The total number of cases in the state is 173,731 in 102 counties, with a total of 7,446 deaths. IDPH says that in the past 24 hours, 28,331 test specimens have been processed, with a positivity rate of 3.8%. The preliminary seven-day statewide positivity rate from July 21 to July 27 is 3.8%. Statewide COVID-19 hospitalizations in the past 24 hours decreased from 1,417 patients to 1,383 patients. Of that figure, 329 patients were in the ICU, with 128 patients on ventilators.

Today’s Centers for Disease Control and Prevention (CDC) figures show more than 4.28 million confirmed and presumptive positive cases of COVID-19 in the U.S., with 147,672 deaths.

Today’s WHO Coronavirus Disease Dashboard shows more than 16.3 million COVID-19 cases globally, with more than 650,000 deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 8.7 million cases and more than 339,000 deaths.

Technical Assistance Available for Rural Hospitals
Applications are being accepted for free targeted technical assistance to rural hospitals and communities through the Federal Office of Rural Health Policy (FORHP)-funded Vulnerable Rural Hospital Assistance Program. The technical assistance is provided through the Center Optimizing Rural Health (CORH), which works with a cohort of 30 hospitals each year. 

To apply for the cohort, click here. An FAQ document is available here. The deadline to apply is Friday, July 31, however, CORH says it will be flexible on the deadline if hospitals email them expressing their interest. Emails may be sent to info@optimizingruralhealth.org and should include the hospital name, state, CAH or PPS designation and the number of beds.