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Coronavirus blood sample. Asian doctor holding test tube with blood for covid-19 analyzing. laboratory analyzing for testing and invent drug and vaccine during Coronavirus infection outbreak situation

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Harrisburg, PA- The Wolf Administration today announced a COVID-19 testing site at Mohegan Sun Arena at Casey Plaza in Wilkes-Barre, Luzerne County, to provide much-needed testing for symptomatic first responders, health care workers and residents 65 or older throughout Northeastern Pennsylvania.

“From 12:00 PM to 4:00 PM, Monday, the site will be open for 100 first responders and health care workers from Northeastern Pennsylvanian who are having COVID-19 symptoms to get tested,” Secretary of Health Dr. Rachel Levine said. “We are taking every precaution to safely provide this critical public health service and prevent the spread of COVID-19. People are required to stay in their cars to get tested and drive directly back onto the highway to return home.”

The drive-thru testing site will be held in the parking lot of the Mohegan Sun Pocono Arena and pre-registration is required. Beginning Tuesday, April 21, the site will be open from 10:00 AM to 4:00 PM daily to test up to 200 Northeastern Pa. residents over 65, first responders and health care workers each day. Registration is required one day in advance and can be found on the Department of Health’s website, health.pa.gov. No onsite registration is available.

Patients do not need a doctor’s prescription to be tested. Dr. Levine has signed a standing order for anyone who registers to be tested at the site.

For those who are registered, the site can be accessed by taking Exit 168 – Highland Park Boulevard from Interstate 81 (northbound or southbound) and following the signs and directions of local officials.

“After testing, you are required to return home and self-isolate,” Dr. Levine said. “If your symptoms worsen while you are waiting for your test results, talk to your doctor and if you experience a medical emergency please seek immediate care.”

The Department of Health State Laboratory will process the tests and provide residents with results in two to three business days. Patients will receive an email to log onto the registration site to access their test results.

“The planning and logistical efforts needed to pull together these testing sites in just a matter of days required a significant amount of coordination among state and county personnel,” said PEMA Director Randy Padfield. “It speaks to the professionalism and skills of the teams involved, and their dedication to the health and well-being of their communities.”

Symptoms of COVID-19 can include:

  • Fever
  • Cough
  • Shortness of breath
  • Diarrhea

Symptoms may appear in as few as two days or as long as 14 days after exposure. Reported illnesses have ranged from people with little to no symptoms to people being severely ill and dying.

As of 12:00 a.m., April 18, there were 31,069 positive cases of COVID-19 statewide in 67 counties and 836 deaths.  Most of the patients hospitalized are 65 or older, and most of the deaths have occurred in patients 65 and older. There have been no pediatric deaths to date. More data is available here.

All non-life-sustaining businesses are ordered to be closed and schools are closed statewide indefinitely. Currently the entire state is under a stay-at-home order.

For the latest information for individuals, families, businesses and schools, visit “Responding to COVID-19” on pa.gov.

The Wolf Administration stresses the role Pennsylvanians play in helping to reduce the spread of COVID-19:

  • Wash your hands with soap and water for at least 20 seconds or use hand sanitizer if soap and water are not available.
  • Cover any coughs or sneezes with your elbow, not your hands.
  • Clean surfaces frequently.
  • Stay home to avoid spreading COVID-19, especially if you are unwell.
  • If you must go out for a life-sustaining reason, please wear a mask.

Updated Coronavirus Links: Press Releases, State Lab Photos, Graphics

All Pennsylvania residents are encouraged to sign up for AlertPA, a text notification system for health, weather, and other important alerts like COVID-19 updates from commonwealth agencies. Residents can sign up online at www.ready.pa.gov/BeInformed/Signup-For-Alerts.

MEDIA CONTACT:  Nate Wardle, Health, 717-787-1783 or ra-dhpressoffice@pa.gov

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This week, we were fortunate enough to have two webinars for RCPA members with attorney Jeffrey Worley from Gibbel Kraybill & Hess LLP law firm in Lancaster, PA. Jason Asbell, also from GKH, joined us for one of the webinars.

You can reach Jeff via email here.

Jeffrey J. Worley, Esq. | Gibbel Kraybill & Hess LLP
2933 Lititz Pike | P.O. Box 5349 | Lancaster, PA 17606
P: 717.291.1700 | F: 717.291.5547 |

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In response to a civil rights complaint filed by Disability Rights Pennsylvania (DRP) and other advocacy groups, the U.S. Department of Health & Human Services’ Office for Civil Rights (OCR) announced on April 16, 2020, that Pennsylvania has made changes to its proposed guidelines on rationing of scarce medical care resources needed to treat COVID-19 patients that better protect people with disabilities from discrimination. Guidelines can be found here.

DOH removed criteria that automatically deprioritized persons needing critical care on the basis of particular disabilities and has included language to ensure that no one will be denied care based on stereotypes, assessments of quality of life, or judgments about a person’s “worth” based on disabilities. Importantly, OCR cautioned that “[t]his result does not, however, preclude future OCR enforcement in cases of potential discriminatory implementation of Pennsylvania’s policies by any covered health care provider.”

The Guidelines include the following protections for people with disabilities:

  • No categorical exclusions. No person will be disqualified from receiving critical care solely on the basis of their disability. Health care providers cannot use a list of disabilities to de-prioritize those patients for critical care if rationing is implemented. As the Guidelines explain, such exclusions “will make many feel like their lives are ‘not worth saving,’ leading to justified perceptions of discrimination.”
  • A prohibition on reallocation of the personal ventilators that adults with disabilities ordinarily use and bring with them when they seek care.
  • No reference to specific disabilities as a basis to reduce the likelihood that those individuals would receive critical care.
  • No consideration of life expectancy in the longer term, including 10-year life expectancy after critical care treatment.
  • No one can “be denied care based on stereotypes, assessments of quality of life or judgments about a person’s ‘worth’ based on the presence or absence of disabilities or other factors.”
  • All rationing decisions must be based on individualized patient assessments by clinicians using the best available objective medical evidence. This means that rationing decisions cannot be based on discriminatory assumptions about a person’s disability or medical condition.
  • “Triage officers” – the health care professionals who will be responsible to make any rationing decisions – should receive training on implicit bias and cultural competency.
  • Patients and their family members or caregivers who have concerns about rationing decisions should be notified of their right to express their concerns or file a complaint with the hospital. Unresolved or unsatisfactorily resolved complaints can be brought to the Pennsylvania Department of Health.

While the above changes go a long way in ensuring that people with disabilities do not suffer from discrimination, DRP remains concerned about a number of the Guidelines’ principles:

First, in rationing care, the Guidelines allow health care providers to consider predictions about how long a person will live in the short term, including up to five years after treatment, due to a disability or medical condition unrelated to COVID-19. This rule could unfairly limit access to health care resources for people with disabilities. To avoid discrimination, health care providers should only consider a person’s immediate term survivability, that is, the likelihood of surviving COVID-19 if provided treatment.

Second, the Guidelines do not explicitly instruct health care providers that they are required under the law to make reasonable modifications to accommodate people with disabilities, including by:

  • Making modifications to the assessment tools used under the Guidelines if a person cannot be accurately and fairly assessed due to a disability.
  • Making modifications for people whose disabilities might require a longer period of treatment – for example, on a ventilator – in order to ensure an equal opportunity to benefit from the treatment.
  • Providing effective communication to people with sensory disabilities and making modifications to restrictive visitor policies to allow individuals with disabilities who need family members or staff to accompany them in the hospital to ensure that they are properly assessed and can participate in their treatment.

To continue to advocate for the rights of people with disabilities on this issue, DRP is opening a Health Care Rationing Hotline during the pandemic. Individuals with disabilities or family members or caregivers of individuals with disabilities who experience discrimination in health care rationing, who are denied effective communication at the hospital, or who are prohibited from bringing a needed family member or staff with them in the hospital should contact DRP at 1.800.692.7334 ext 402.

DRP has also created a fact sheet to assist people with disabilities with questions or concerns about medical rationing. It can be found here.

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On Wednesday, April 15, ADvancing States and the National Association of State Directors of Developmental Disabilities Services (NASDDDS) sent a letter to Congress outlining additional legislative requests to assist state aging, disability, and LTSS agencies as they respond to the COVID pandemic. Specifically, the letter requests:

  • Further increase the Medicaid Federal Medical Assistance Percentage (FMAP) to a total of 12%;
  • Allow states to provide Medicaid retainer payments to additional provider categories and for extended periods of time as warranted by the emergency;
  • Provide additional supports to ensure that older adults and people with disabilities have access to food;
  • Delay the CURES Act Electronic Visit Verification penalties;
  • Delay the proposed Medicaid Financial Accountability Regulation (MFAR); and
  • Provide additional resources for Adult Protective Services to respond to abuse, neglect, and exploitation.

Click here to read the full letter.

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The Centers for Medicare and Medicaid Services released the inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule for fiscal year (FY) 2021. Due to the COVID-19 public health emergency and the demands that have been placed on the healthcare industry, CMS limited the rulemaking to essential policies and proposals to reduce provider burden and assist IRF’s, especially in the COVID-19 response. Some of the proposals include:

  • Payment: CMS proposes to implement its annual updates to the weights and average lengths of stays for the IRF PPS Case Mix Groups (CMGs), update the standard payment conversion factor due to growth in the IRF market basket, and increase the labor-related share. Overall, CMS estimates payments to IRFs will increase by 2.9 percent.
  • IRF Coverage Requirements: CMS proposes to amend the IRF coverage requirements to remove the post-admission physician evaluation (PAPE) requirement.
  • Non-Physician Practitioners: CMS proposes to modify the IRF coverage requirements to allow non-physician practitioners (NPP) to perform certain services that are currently required to be performed by a rehabilitation physician. Some of these services include the pre-admission screening, developing the individual plan of care, performing three face-to-face visits per week, and leading interdisciplinary team meetings
  • Documentation: CMS proposes to codify existing documentation instructions and guidance to ensure uniformity between the Medicare Benefit Policy Manual and regulations that are applicable.
  • Definition of a Week: CMS clarifies that, for the purposes of the intensity of therapy requirement, a “week” would be defined as a period of seven consecutive calendar days beginning with the date of admission to the IRF.
  • Quality Reporting Program (QRP): The only provision impacting the QRP in the proposed rule is a two percent reduction to the applicable FY 2021 market basket increase factor for IRFs that fail to comply with quality data submission requirements.
  • Outlier Threshold: CMS proposes to update the outlier threshold amount from $9,300 for FY 2020 to $8,102 for FY 2021 ensure outlier payments account for 3 percent of total payments. CMS estimates there will be a $40 million increase in aggregate payments to IRFs due to this proposed change. The outlier threshold is used to determine when an IRF is entitled to an outlier payment. CMS attempts to set the outlier threshold each year so that 3 percent of total payments are outliers.

The proposed rule will be published in the April 21, 2020 edition of the Federal Register. A more in-depth analysis will be forthcoming following the publication. A fact sheet is also available for members to obtain additional information.

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