IHA Daily Briefing: Nov. 11

Wednesday, November 11, 2020  
General Assembly Cancels Fall Veto Session
Behavioral Health Reimbursement and Advocacy Updates
FDA EUA & Medicare Coverage for Antibody Treatment
CDC Update on Masking to Prevent COVID-19 Spread
CDPH Modifies Emergency Travel Order
State, National, Global COVID-19 Updates
Illinois Joins Effort to Lower Suicide Rates Among Veterans

General Assembly Cancels Fall Veto Session
The Illinois General Assembly will not hold its fall Veto Session, which was scheduled for Nov. 17-19 and Dec. 1-3.

In a statement, Senate President Don Harmon and House Speaker Michael Madigan cited a renewed surge in COVID-19 infections.

“The front page in [Tuesday’s] Springfield paper warns of a COVID ‘tsunami’ sweeping the region and its health care system. This is not the time to physically bring together hundreds of people from all around the state. Given what’s happening, it was an obvious decision. It’s not safe or responsible to have a legislative session under these circumstances,” said Harmon.

“The health and safety of the people who work for and serve in the Illinois General Assembly, and their respective families, is paramount. We will continue to monitor the situation, consult medical experts and do intend to schedule additional session days so we can finish our important work,” said Madigan.

The current 101st General Assembly will wrap up business in a lame duck session in early January. The new 102nd General Assembly begins Jan. 13, 2021.

Behavioral Health Reimbursement and Advocacy Updates
Yesterday, IHA sent members a memo providing several updates concerning hospital and health system behavioral healthcare, including summaries of:

  • Illinois Dept. of Healthcare and Family Services Provider Notice announcing Medicaid coverage and provider enrollment instructions for applied behavioral analysis (ABA) services for children (0 through 20 years old);   
  • Cancellation of Medicaid Integrated Health Homes;   
  • Updated Medicaid fee schedule for community mental health providers; and   
  • Advocacy on behavioral health payment parity for services covered by Medicaid and commercial payers.

FDA EUA & Medicare Coverage for Antibody Treatment
On Tuesday, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for Eli Lily’s Bamlanivimab monoclonal antibody treatment, which may be administered only in outpatient settings via intravenous infusion to eligible patients with mild to moderate COVID-19 cases. According to a fact sheet from Eli Lily, eligible patients include those who are 12 years or older, do not require oxygen therapy due to the virus, and are at high risk for progressing to severe COVID-19 and/or hospitalization.

Also yesterday, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare will cover the treatment at no cost to beneficiaries during the public health emergency. The treatment will be available in a range of settings, including physician offices, freestanding and hospital-based infusion centers, and nursing homes.

In its announcement, CMS noted that the monoclonal antibody product will initially be given to providers at no charge; however, reimbursement will be provided for the infusion of the product. At such a time when providers begin to purchase the product, Medicare anticipates setting the payment rate in the same way it sets the rates for COVID-19 vaccines. CMS will issue billing and coding instructions in the coming days.

A CMS infusion program instruction document is available here. AHA members may access an AHA Special Bulletin here.

CDC Update on Masking to Prevent COVID-19 Spread
In a new scientific brief issued on Tuesday, the Centers for Disease Control and Prevention (CDC) recommends community use of masks to prevent the transmission of SARS-CoV-2.

The CDC says: “Masks are primarily intended to reduce the emission of virus-laden droplets, which is especially relevant for asymptomatic or presymptomatic infected wearers who feel well and may be unaware of their infectiousness to others, and who are estimated to account for more than 50% of transmissions. Masks also help reduce inhalation of these droplets by the wearer. The community benefit of masking for SARS-CoV-2 control is due to the combination of these effects; individual prevention benefit increases with increasing numbers of people using masks consistently and correctly…Adopting universal masking policies can help avert future lockdowns, especially if combined with other non-pharmaceutical interventions such as social distancing, hand hygiene, and adequate ventilation.”

The brief cites numerous studies that the CDC says confirm the benefit of universal masking.

Late last week, the CDC released a Morbidity and Mortality Weekly Report on the effectiveness of mitigation measures implemented in Delaware last spring. The report says state-mandated stay-at-home orders and public mask mandates, coupled with case investigations with contact tracing, contributed to an 82% reduction in COVID-19 incidence, 88% reduction in hospitalizations, and 100% reduction mortality during late April-June.

CDPH Modifies Emergency Travel Order
On Tuesday, the Chicago Department of Public Health (CDPH) announced that it is revamping its Emergency Travel Order to better reflect the changing nature of the pandemic and provide more specific guidance to travelers entering or returning to the city amid a surge in COVID-19 cases locally and nationally. Under the new system, states will be placed in three categories – red, orange and yellow – based on the status of the outbreak in the states and how the data compares to the situation in Chicago.

The new guidance is as follows:

  • Yellow: States with a rolling 7-day average less than 15 cases/day/100,000 residents.   
    • No quarantine or pre-arrival test required. Maintain strict masking, social distancing and avoidance of in-person gatherings   
  • Orange: States have a rolling 7-day average between 15 cases/day/100,000 residents and the Chicago rolling 7-day average (currently 60)   
    • 14-day quarantine OR pre-arrival negative test no more than 72 hours before arrival in Chicago with strict masking, social distancing and avoidance of in-person gatherings   
  • Red: States have a higher 7-day rolling average of positive cases/day/100,000 Chicago residents.   
    • 14-day quarantine

Based on current data, this is where states fall:

  • 6 yellow states (no requirements): New York, California, New Hampshire, Maine, Hawaii, Vermont;   
  • 31 orange states and Puerto Rico (must quarantine or receive a pre-arrival negative test result) – Michigan is among 12 states being added in this category as of this Friday; and   
  • 12 red states (must quarantine): North Dakota, South Dakota, Iowa, Wisconsin, Nebraska, Wyoming, Montana, Minnesota, Utah, Idaho, Kansas, Indiana.

The new guidance will go into effect on Friday, Nov. 13; it will be updated every two weeks, although the initial version will be updated after one week to get on a two-week cycle to avoid conflict with the Thanksgiving weekend.

State, National, Global COVID-19 Updates
The Illinois Dept. of Public Health (IDPH) announced today 12,657 new confirmed and probable COVID-19 cases – another record high and the sixth straight day of more than 10,000 new cases – and 145 deaths (the highest daily number since May 27).

The total number of cases in the state is 523,840 in 102 counties, with a total of 10,434 deaths. IDPH says that in the past 24 hours, 93,464 test specimens have been processed, with a positivity rate of 13.5%. The preliminary seven-day statewide positivity rate for cases as a percent of total tests from Nov. 4 – Nov. 10 is 12.4%, and the seven-day test positivity rate is 13.6%.

Statewide COVID-19 hospitalizations in the past 24 hours increased from 4,742 patients to 5,042 patients – a new record high (eclipsing the previous mark of 5,037 on April 28). Of that figure, 951 patients were in the ICU, with 404 patients on ventilators.

To help decrease the positivity rate, IDPH today issued several recommendations:

  • Work from Home if Possible. For the next three weeks, work with your employer to plan to work from home unless it is necessary for you to be in the workplace. We ask employers to make accommodation for this. Our goal is to reduce transmission as we head into the holidays so businesses and schools can remain open.
  • Participate in Essential Activities Only. For the next three weeks, stay home as much as possible, leaving only for necessary and essential activities, such as work that must be performed outside the home, COVID-19 testing, visiting the pharmacy, and buying groceries.   
  • Limit Travel and Gatherings. The Centers for Disease Control and Prevention (CDC) and other health experts tell us that gatherings and travel in and out of communities present a high risk of spreading the infection. In our current situation, with a rising prevalence of the virus, attending even small gatherings that mix households, or traveling to areas that are experiencing high rates of positivity, is not advised and is potentially dangerous. Please, travel only if necessary.

Today’s CDC figures show more than 10.1 million confirmed and presumptive positive cases of COVID-19 in the U.S. (an increase of more than 134,000 cases), with 239,590 deaths.

Today’s WHO Coronavirus Disease Dashboard shows more than 51.2 million COVID-19 cases globally (an increase of more than 490,000 cases), with more than 1.27 million deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 22 million cases and more than 662,000 deaths.

Illinois Joins Effort to Lower Suicide Rates Among Veterans
Earlier this week, Governor J.B. Pritzker and the Illinois Dept. of Human Services announced that the state will join the Governor's Challenge to Prevent Suicide, a national effort that champions mental health support and preventative services for Veterans. The state is dedicating $2 million to the initiative, in partnership with the federal Substance Abuse and Mental Health Services Administration and the Illinois Dept. of Veterans Affairs. In 2019, suicide was the 12th leading cause of death among Illinois residents of all ages, but the 3rd leading cause of death among those aged 1-24 years.

“Our Veterans are heroes who served us bravely and deserve quality care here at home, including robust mental health services,” said Governor Pritzker. “I am pleased to announce that Illinois is putting $2 million towards suicide prevention, funding that will allow the State to provide critical care and preventative services to our heroes in their darkest hour.”

Illinois is the latest of 27 states to join the challenge.