IHA Daily Briefing: March 23

Monday, March 23, 2020
Gov. Pritzker Purchases Millions of PPE
Manufacturers to Help on COVID-19 Medical Supplies
IHA, Hospitals Plea for PPE Donations
Illinois COVID-19 Update
HFS Extends March Hospital Assessment Due Date
IDFPR Loosens Regs for Needed Healthcare Workers
IHA Launches COVID-19 ‘Help Us Help You’ Campaign
IHA Submits Federal 1135 Waiver for IL Hospitals
COVID-19 Update
Senate Fails Again on COVID-19 Package

Gov. Pritzker Purchases Millions of PPE
In another effort to build supply to protect those on the frontlines, battling this pandemic, Gov. Pritzker announced today at his daily press briefing that the state has executed contracts to purchase 2.5 million N95 masks, 1 million disposable surgical masks, 11,000 gloves and 10,000 personal protection kits.

While medical facilities across the state do have their own stocks of personal protective equipment (PPE) and use their own vendors to source additional PPE, the administration's procurement effort aims to supplement their existing supply during this period of heightened need.

In a press release, the Governor outlined his request of PPE from the federal government and what the state has received to date. Continuing his calls for more support from the federal government, Gov. Pritzker called for the federal activation of the Defense Production Act to vastly increase the production of essential medical supplies and their distribution to states in need.

As the state receives personal protective equipment from across its multi-pronged procurement operation, Gov. Pritzker announced today that the state has in turn distributed these vital supplies to county emergency management agencies, health departments and hospitals across the state. The Illinois Emergency Management Agency has distributed more than 28,400 N95 masks, more than 15,500 pairs of gloves and nearly 6,200 gowns to over a dozen county health departments with the most need.

The Illinois Department of Public Health has also distributed supplies to 150 hospitals and 62 local health departments across Illinois, and the second shipment of supplies from the National Strategic Stockpile will soon be distributed to every public health jurisdiction and hospital in the state.

Manufacturers to Help on COVID-19 Medical Supplies
Gov. J.B Pritzker this afternoon announced that the state is partnering with two business groups on the production and purchase of personal protective equipment (PPE) and ventilators to protect healthcare workers on the frontlines of fighting the COVID-19 epidemic.

The Illinois Manufacturers Association (IMA) is connecting companies that shift their production to items such as masks, sanitizer, test kits, and ventilators with buyers and help them in dealing with federal rules. The Illinois Biotechnology Innovation Organization (iBIO) will connect producers and medical providers as well as launch a fund to raise money to purchase products that are not donated.

“America is facing extraordinary times that rival some of the greatest challenges in our nation’s history. While the task is daunting, manufacturers stand ready to once again answer our nation’s call, conquering obstacles and leading the way forward,” said Mark Denzler, president & CEO of the Illinois Manufacturers’ Association. “The Illinois Manufacturers’ Association and the 592,000 women and men working on factory floors across our state are proud to support Governor J.B. Pritzker’s efforts to combat and contain this virus, producing life-saving products in desperate need across Illinois.”

IMA asks that manufacturers, which can provide or donate essential medical supplies such as N95 masks, gloves, gowns, ventilators, and sanitize, to take a brief survey, and IMA will be in touch with them.

iBIO is providing technical assistance to factories that want to switch their product mix and establishing a fund for those who want to donate money to help healthcare workers and first responders.

“The Illinois Biotechnology Innovation Organization – iBIO – is the association that represents the 85,000 life science employees in Illinois. Our life sciences community is leading the charge in the fight In Illinois against COVID-19,” said John Conrad, president & CEO of iBIO. “Illinois’ innovative companies are ramping up efforts to study the virus and develop solutions to prevent, diagnose and treat this deadly infectious disease. As a community we are proud to support Governor J.B. Pritzker’s efforts to provide immediate support to healthcare workers and first responders. These unsung heroes are directly working with patients in these unprecedented times, and will continue to do so at great risk to their health and their ability to care for others until they have all of the protective equipment they need.”

IHA, Hospitals Plea for PPE Donations
Last Thursday (March 19), IHA issued a public plea to the leaders of associations for the construction industry, dentists, veterinarians, colleges and universities, and other groups that may be able to help by donating unused N95 masks and related personal protective equipment (PPE) to Illinois hospitals.  In addition to businesses, community members across the state have responded to IHA’s plea, asking how they can help their local hospitals by donating masks, hand sanitizers or wipes, or even sewing masks at home. Since hospital needs for supplies and materials vary, we are directing interested donors to visit the website of their local hospitals to check on their specific needs.

Carle Foundation Hospital embraced their community support and created a website that includes specific instructions on how to make and package home-sewn masks. IHA will continue to encourage volunteers who contact us expressing interest in donating homemade masks to contact their local hospital.

The Illinois Dept. of Public Health (IDPH) released a bulletin over the weekend encouraging donations from Outpatient Surgical and Procedural Centers, Ambulatory Surgery Centers and Veterinarians, requesting surgical gloves, gowns, goggles, face shields, surgical masks, and N95 respirator masks.  IHA will direct all interested donors of PPE to contact IDPH at PPE.donations@illinois.gov or to visit a special PPE donation webpage.

The Centers for Disease Control and Prevention (CDC) has issued guidance on “Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings."

Aligning with its mission to give back to the communities it serves, big and small across the U.S., Harbor Freight Tools has decided to donate its entire supply of selected personal protective equipment to front line hospitals with 24-hour emergency rooms in communities served by its stores. Specifically, Harbor Freight is donating N95 masks, face shields and 5 mil and 7 mil nitrile gloves.

Hospital procurement staff are asked to submit their PPE request form so that Harbor Freight can determine if it is able to fulfill the request. Those who would like to submit a name of a hospital in need can send an email to hospitalhelp@harborfreight.com with the hospital’s city and state in the subject line. Hospitals selected for assistance will be emailed a voucher when the supplies are available for pick up at their local Harbor Freight Tools store.

The company asks that all requests follow this process. Please do not contact local stores or its call center.

Illinois COVID-19 Update
At today’s press briefing, the Illinois Dept. of Public Health (IDPH) announced 236 new COVID-19 cases, for a total of 1,285 cases in 31 counties statewide. Three new deaths were reported for a total of 12 deaths.

The Governor, his staff, the Office of Early Childhood Development (OECD), the Illinois Dept. of Human Services (IDHS) and the Illinois Dept. of Children and Family Services (IDCFS) have established an emergency licensing process for hospitals to set up their own childcare centers.  Completed applications should be submitted to IDCFS at Emergency.Daycare@illinois.gov.

In addition, IHA is working closely with the Governor and IDPH as they coordinate the state’s preparations for and response to the COVID-19 crisis. They are seeking information about the potential demand for and use of childcare services for healthcare workers. Please complete a brief survey by 5 p.m. on Wed., March 25.

In its latest health alert, the Chicago Dept. of Public Health provides guidance to city hospitals about disposition of COVID-19 persons under investigation and confirmed cases who are unstably housed or returning to homeless shelters and other high-risk settings. The alert also provides resources available to discharge planners.

Chicago Mayor Lori E. Lightfoot and Sittercity, an online resource for in-home care, announced a new initiative to help Chicago’s most essential workforce – healthcare workers, first responders and the teams who support them – continue to work on behalf of the City amid COVID-19.  A new, dedicated website – sittercity.com/chicagoresponds – will make it easier for workers deemed an essential part of the infrastructure to find reliable childcare that will allow them to continue their crucial work. The Chicago Mayor’s Office asks that all Chicago hospitals make their employees and contractual employees aware of this service.

See IHA’s COVID-19 webpage for a variety of resources in a central location.

HFS Extends March Hospital Assessment Due Date
The Illinois Department of Healthcare and Family Services (HFS) has notified IHA that it will be extending the due date for the March Hospital assessment for one week, to March 30.  All are encouraged to make sure that payment is received by March 30 to aid in facilitating the April Hospital Assessment payments. IHA is working with the MCOs to aid in finalizing all of the March Directed and Pass through payments during the current week. IHA will update member as further developments occur.

On March 20, HFS issued a Provider Notice to Long-Term Care (LTC) providers on temporary revisions to Medicaid processes for conducting required pre-admission screenings.  The Pre-admission Screening and Resident Review (PASRR) assessment, the Specialized SLP Mental Health assessment, and the Determination of Need (DON) assessment will incorporate the following:

  • Screenings can be conducted telephonically instead of in-person;  
  • Post admission screenings will be allowed if conducted within 10 days of admission; and   
  • State screening agents should coordinate with hospital discharge planners and LTC settings to schedule a time for the screenings and assure a staff person is available to assist the individual being screened.

IDFPR Loosens Regs for Needed Healthcare Workers
The Illinois Dept. of Financial and Professional Regulation (IDFPR) today has announced several actions to increase the number of healthcare professionals to assist during the COVID-19 pandemic. IDFPR has issued a proclamation to allow out-of-state physicians, nurses, physician assistants, and respiratory care therapists to provide care to Illinois residents affected by COVID-19. Additionally, the department has prepared a series of variances allowing Illinois physicians, nurses, physician assistants, and respiratory care therapists whose license status is inactive, non-renewed, or expired that also satisfy an additional set of specific criteria, to restore their licenses temporarily during this crisis. Out-of-state licensed physicians, nurses, physician assistants, and respiratory care therapists may practice in the state of Illinois in a limited set of circumstances as provided for by the IDFPR proclamation.

Complete details including applications for reinstatement can be found in an IDFPR press release. To view the proclamation and variances issued, click here.

With these new measures in place, IDFPR encourages medical professionals to volunteer their expertise and services at all levels during this critical time.

IHA Launches COVID-19 'Help Us Help You' Campaign
To reduce the spread of COVID-19, IHA’s “Help Us Help You” campaign urges all Illinois residents to take preventive measures to protect themselves, their families and their neighbors. Doing so will also help prevent a surge of COVID-19 patients that could inundate the state’s 200 hospitals and nearly 40 health systems.

Michael Wahl, MD, emphasized the urgency of slowing the spread of the virus. Dr. Wahl is medical director of the Illinois Poison Center (IPC) at IHA. IPC is assisting the Illinois Department of Public Health (IDPH) in running the State’s COVID-19 hotline (800-889-3931).

“If this does not happen, a large number of people will get sick in a very short time frame, which will overwhelm our healthcare system as all seek care at the same time,” Dr. Wahl said.

IHA President and CEO A.J. Wilhelmi said IHA strongly supports Gov. J.B. Pritzker’s stay-at-home order effective through April 7.

“Over the past two months, Illinois hospitals have taken extraordinary and swift action in response to the coronavirus outbreak,” Wilhelmi said. “They are prepared thanks to staunch emergency preparedness and infection control training.”

Hospitals’ preventive measures include:

  • Screening all patients and staff before entrance;   
  • Enhancing sanitation protocols; and   
  • Offering increased telehealth services.

Read IHA’s press release on our “Help Us Help You” campaign.

IHA Submits Federal 1135 Waiver for IL Hospitals
Shortly after the President’s national emergency declaration, CMS issued blanket waivers and U.S. Dept. of Health and Human Services (HHS) Secretary Azar issued blanket waivers and modifications, both under Section 1135, and more have been issued since then, including ones for EMTALA, HIPAA and telehealth, among others.  These waivers are essentially “blanket” waivers which means that a hospital does not need to do anything further to utilize these waivers – they are self-executing.

Late Friday (March 20), IHA filed a statewide Section 1135 waiver on behalf of all Illinois hospitals with the Dept. of Health and Human Services and the Centers for Medicare & Medicaid Services, and we are awaiting a response.  If, however, a hospital desires a waiver that is not included in the existing blanket waivers or IHA’s requested waivers, it will need to file its own waiver request or submit it to IHA to be included in a future supplemental request.

In the meantime, the Illinois Dept. of Healthcare and Family Services has also filed a Section 1135 waiver for Illinois’ Medicaid program.  Additionally, IHA is working on waivers of state law.

COVID-19 Update
The Centers for Disease Control and Prevention (CDC) Clinician Outreach and Communication Activity (COCA) will hold a call Wed., March 25 from 1-2 p.m. (CT) on strategies healthcare facilities can use to optimize personal protective equipment (PPE) supplies such as eye protection, isolation gowns, facemasks, and N95 respirators. For more information on the call, including ways to join in, click here.

Current CDC figures show a total of 33,404 confirmed and presumptive positive cases of COVID-19 in the U.S. in 54 states and U.S. territories, with 400 deaths. New York State leads the nation with more than 15,000 cases.

The Health Resources and Services Administration (HRSA) posted FAQs regarding questions raised about the administration of the 340B program in light of the COVID-19 public health emergency. The FAQs address the 340B patient definition, telehealth services, new 340B registrations for child-sites and contract pharmacies, the group purchasing organization prohibition for disproportionate share hospitals, and 340B audits. Regarding 340B audits, HRSA is planning to conduct 340B Program audits remotely. IHA is working with the American Hospital Association and Illinois’ Medicare Administrative Contractors (MACs) to pursue delays of 340B audits.

On March 22, the Centers for Medicare & Medicaid Services (CMS) released frequently asked questions on Medicare provider enrollment relief during the COVID-19 public health emergency. Under Section 1135 of the Social Security Act, CMS added a number of flexibilities to Medicare provider enrollment, including the establishment of a toll-free hotline with each of the Medicare Administrative Contractors (MACs) to allow physicians and non-physician practitioners to initiate temporary Medicare billing privileges. The toll-free hotline number for National Government Services is 888-802-3898 (8 a.m.-4 p.m. CT). The toll-free hotline number for Wisconsin Physician Services is 844-209-2567 (7 a.m.-4 p.m. CT).

Also on March 22, CMS issued two new notices:

On March 23, CMS released two telehealth toolkits with information for general practitioners and end-stage renal disease (ESRD) providers. The toolkits are meant for providers that are implementing telehealth services as a result of the COVID-19 public health emergency. Information includes 1135 waiver information, general telehealth policy guidance, an implementation guide, state statute guidance, basics on telehealth setup, technical assistance, vendor selection, and patient and community resources. The general practitioner toolkit can be found here, and the ESRD provider toolkit can be found here.

The latest WHO situation report shows more than 292,000 COVID-19 cases globally, with over 12,700 deaths. The European Region now leads the world in cases and deaths, with more than 151,000 confirmed cases with over 7,400 deaths, surpassing the Western Pacific Region over the weekend. The Western Pacific Region has nearly 95,000 confirmed cases and more than 3,400 deaths.

Senate Fails Again on COVID-19 Package
For a second time in less than 24-hours, a procedural vote in the U.S. Senate failed.

The U.S. Senate continues negotiations on a third legislative package to respond to the COVID-19 pandemic. The approximately $1.5 trillion CARES Act (the Coronavirus Aid, Relief, and Economic Security Act) is expected to include several critical provisions for hospitals and health systems, as well as support for families, workers and businesses.

Earlier today, Senate Democrats blocked the procedural vote required to consider the legislation, with many saying more transparency is needed on which businesses would be eligible to receive hundreds of billions in emergency loans. Negotiations are ongoing.

House Speaker Nancy Pelosi is expected to introduce legislation today which, according to a summary, includes $100 billion for hospitals to reimburse healthcare related expenses or lost revenue; $1.6 billion for the Strategic National Stockpile to procure personal protective equipment (PPE) and other medical supplies; a delay in Medicaid disproportionate share hospital (DSH) cuts; temporary suspension of Medicare sequester cuts, and numerous other provisions.

IHA has called on federal lawmakers to make funds immediately and directly available to hospitals to care for COVID-19 patients, protect and support the healthcare workers, access critical supplies and equipment, and scale up to meet surge capacity. See IHA's recent Advocacy Alert.