The latest information on COVID-19, a novel coronavirus.
MASSACHUSETTS HOSPITALS STAND READY
All Massachusetts hospitals have
established policies for containing and treating contagious diseases and
for dealing with patient surges if the need arises. Hospitals are
dedicated to ensuring safe patient care and providing the men and women
who treat patients the safest possible environments to conduct their
work. MHA and its membership have been in regular contact with the
Massachusetts Department of Public Health and national health
organizations to ensure that the commonwealth is well-prepared to meet
the challenges presented by the COVID-19 novel coronavirus.
The Most Current Information
These state, federal, and global entities are continually updating their resources to provide the most current information on COVID-19.
The well-respected medical journal, The Lancet, has created a coronavirus research center that brings together content from across The Lancet’s many journals (for example, The Lancet Global Health, The Lancet Infectious Diseases, and The Lancet Respiratory Medicine) as it is published. The content on the website is free.
This 5-page list from the federal government details many links to federal agencies and their specific guidance related to COVID-19. It's a valuable resource.
Frequently Asked Questions About COVID-19
What is it? How does it spread? How do I protect myself? What about my pet and the novel coronavirus? Check here for answers to these and other common questions.
This section contains operational resources for hospitals that are
updating their airborne isolation plans, personal protective equipment
inventory, among other best practices to employ during widespread
contagion events. The resources are from around the U.S.
Click here for more resources
Ongoing Resources and Best Practices
Check back here frequently for regular updates from health agencies, as well as notable news alerts and stories of interest.
MARCH 23, 2020 – DOI URGES PREMIUM RELIEF. In an administrative bulletin today (Bulletin 2020-05) the Division of Insurance informed insurance companies that it expects them to “take all necessary steps to preserve individual and employer access to insurance coverage during this emergency period.” Specifically, DOI urged carriers to be “flexible in collecting premiums,” clearly explain grace periods, and work on a case-by-case basis to find “the best ways to address concerns with the timing of premium payments.” Specifically for health insurers, DOI said they should have personnel available to discuss COBRA or other coverage for the recently unemployed, and to work with employers to allow flexibility.
MARCH 23, 2020 – GOVERNOR’S ESSENTIAL SERVICES ORDER. Governor Baker today issued an emergency order, mandating that all “non-essential” business must close their doors to their workers and the public effective tomorrow, March 24, at noon. This is a step that MHA and many hospitals have been seeking. We had been in contact with the administration on this issue throughout the past week. Today’s order designates a list of COVID-19 Essential Services that will be allowed to continue operations. Medical professionals and caregivers, along with a whole host of hospital personnel, are included in the essential services list, along with those in law enforcement, energy, transportation, and more. Here is the full Exhibit A list of COVID-19 Essential Services that was attached to the governor’s order. And here is the order.
MARCH 22, 2020 – FDA VENTILATOR GUIDANCE. The Food and Drug Administration (FDA) published additional information focused on mitigating disruptions to or shortages in the ventilator supply chain. First, the agency released updated guidance to provide flexibility around and expand the availability of ventilators and other respiratory devices to treat patients during the public health emergency. The FDA also released a letter to healthcare providers in an effort to supplement the updated guidance and provide recommendations directed at providers. Due to the urgency of this issue, the guidance was issued without public comment and will remain in effect only for the duration of the public health emergency.
MARCH 22, 2020 – CMS REPORTING WAIVED. CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs. Specifically, CMS is implementing extensions for upcoming measure reporting and data submission deadlines for a host of programs, including: Quality Payment Program; Medicare Shared Savings Program Accountable Care Organizations; Hospital-Acquired Condition Reduction Program; Hospital Inpatient and Outpatient Quality Reporting Program; and the Hospital Readmissions Reduction Program—among many others. Read the media release here.
MARCH 22, 2020 -- DMH: ADMISSION OF YOUTH TO FACILITIES. Because there have been delays in admission of minors to DMH-licensed facilities due to the unavailability of the minor’s legal guardian to provide an in-person signature upon admission, DMH is issuing the following guidance: For the duration of this state of emergency, DMH is asking facilities to accept fax authorizations with follow up whenever the legal guardian can come to the facility. E-mail authorization should also be sufficient if the receiving facility has reasonable confidence that the sender is in fact the legal guardian. (A DCF e-mail, for instance, would be sufficient.) DMH says it recognizes that, under the circumstances, in person follow up may not be possible for the duration of the admission. The same principles for accepting fax authorizations for admission will apply if a facility is admitting someone with an authorized health care agent, when the admitting physician has invoked the person’s health care proxy (HCP). DMH Assistant Commissioner for Clinical and Professional Services/ Director of Licensing Janet Ross issued the guidance by e-mail to all licensed facilities.
MARCH 22, 2020 – REIMBURSEMENT FOR COSTS INCURRED (MEMA). The Massachusetts Emergency Management Agency (MEMA) has issued guidance on how costs incurred from the COVID-19 response may be eligible for reimbursement through FEMA or other federal agencies. It is important that applicants track their costs for the duration of the response to be ready to submit for reimbursement once the crisis has passed. Costs will be evaluated at that time and routed to the appropriate federal agency for reimbursement. See the original March 20 notice from FEMA below and review this MEMA document that discusses eligible costs and contains a link to a question-and-answer forum.
MARCH 22, 2020 – ALTERNATIVE HOSPITAL SPACES. In addition to CMS waiving requirements to allow acute care hospitals to house patients in excluded distinct part units, DPH is allowing acute care hospitals to care for admitted patients in alternate acute inpatient space. All hospitals operated by the DPH, or licensed pursuant to 105 CMR 130 may implement procedures as necessary to accommodate the surge of patients requiring care for COVID-19, to use alternate acute inpatient space that would be appropriate for inpatient care, including but not limited to: post-anesthesia care unit beds, beds out of service, and inpatient rehabilitation units. Beds considered appropriate for acute inpatient care use must be equipped with medical gases (one oxygen outlet and one vacuum outlet for each bed), be spaced at least six feet apart from another bed, and have access to hand washing sinks and privacy partitions. The complete guidance is here.
MARCH 20, 2020 – WAIVER REQUEST TO CMS. The Massachusetts Executive Office of Health and Human Services, acting on behalf of “its partners in the healthcare community” including MHA and its membership, has filed with CMS a request for a Section 1135 waiver. CMS can grant such waivers under the national emergency declaration the president made on March 13. EOHHS’ request ask for waivers from current rules relating to revalidation of providers; enforcement of MassHealth ordering, referring, prescribing provider requirements; claims filing deadlines; patient transfers; bed limits and staffing in nursing homes; physician oversight of physician assistants; certain laboratory guidelines; upper payment limits; and much, much more. The entire waiver request is here. EOHHS notes that it may be asking for additional waivers as the situation develops.
MARCH 20, 2020 — TELEHEALTH. Today CMS released two toolkits on telehealth that are specific to general practitioners as well as providers treating patients with end-stage renal disease. Each toolkit contains electronic links to sources of information on telehealth and telemedicine, which will reduce the amount of time providers spend searching for answers and increase their time with patients. On MARCH 22, the toolkits were updated. You can find the updated telehealth toolkit for general practitioners here, and the updated end-stage renal disease providers toolkit here.
MARCH 20, 2020 – RESOURCE DATA. The Society of Critical Care Medicine has updated its statistics on critical care resources available in the United States. Its goal is to provide information regarding the resources both available and needed to care for a potentially overwhelming number of critically ill patients, many of whom may require mechanical ventilation. In the report here, the Society addresses the most current data and estimates on the number of acute care, ICU, and step-down (eg, observation, progressive) beds; ICU occupancy rates; mechanical ventilators; and staffing. It also provides context to the data.
MARCH 20, 2020 – PRICE GOUGING. Attorney General Maura Healey announced today that her office has filed an emergency regulation to prohibit price gouging of essential products and services during the COVID-19 public health emergency. The amendment to regulation 940 CMR 3:18, filed today with the Secretary of State’s Office and effective immediately, prohibits price gouging of goods and services necessary for public health and safety during a declared statewide or national emergency. Previously under the state’s consumer protection law, the only existing regulation related to price gouging addressed the sale of gasoline and other petroleum products.
MARCH 20, 2020 -- FEMA FUNDING. Under the national emergency declaration, eligible emergency protective measures taken to respond to the COVID-19 emergency at the direction or guidance of public health officials may be reimbursed by FEMA. FEMA will not duplicate assistance provided by U.S. HHS (including CDC), or other federal agencies. States and local governments – as well as certain private non-profit organizations – are eligible to apply for public assistance. Information is available here, including a link to FEMA’s Public Assistance (PA) Program and Policy.
MARCH 19, 2020 -- HEALTHCARE WORKFORCE. DPH has issued new guidance, based on CDC guidance, which outlines how providers may consider allowing asymptomatic healthcare personnel, who have had an exposure to COVID-19, to continue working after a series of conditions have been met. If a facility has fulfilled guidelines relating to its emergency staffing plan and curtailing elective surgeries, among other mandates, then it can allow the employment of asymptomatic workers who have been exposed to COVID-19 as long as the worker meets conditions relating to daily assessment of temperature, continually wearing a mask, and ceasing work at the first sign of symptoms – among other guidelines. Read the full guidance here.
MARCH 19, 2020 – SUBSTANCE USE DISORDER/SAMHSA. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has provided this guidance relating to the use and disclosure of patient identifying information (such as substance use disorder records) during a medical emergency. SAMSHA emphasize that under the medical emergency exception providers make their own determinations whether a bona fide medical emergency exists for purposes of providing needed treatment to patients.
MARCH 19, 2020 – PHARMACY FAQs. The State’s Board of Registration in Pharmacy has issued this Frequently Asked Questions document the covers such topics as signature requirements for prescriptions, filling clozapine without lab results, compounding, and more.
MARCH 17, 2020 – EMERGENCY CREDENTIALING. DPH issued this order allowing for Expedited Credentialing Procedures for Licensed independent Practitioners and Expedited Transfers of Licensed Clinical Staff Among Facilities. All DPH regulated hospitals and facilities must immediately implement expedited credentialing procedures pursuant to the hospital’s or facility’s emergency management plan in order to process applications from licensed practitioners seeking to practice at the hospital during the public health emergency. During the emergency, all licensed clinical staff, including but not limited to nurses, respiratory technicians, and licensed independent practitioners who are employed by or work at any DPH regulated facility are hereby authorized to work at any other DPH regulated facility.
MARCH 18, 2020 – EMS DIRECTIVES. The state’s Office of Emergency Medical Services (OEMS) has issued directives extending its recertification deadlines for CPR and Advanced Cardiac Life Support; designating the type of continuing education that will be allowed for EMS personnel with certificates expiring; and issuing a waiver to reduce required staffing of each ambulance to one EMT and/or one paramedic, depending on level of ambulance, with a driver who is a first responder.
Also, DPH issued an order requiring local board of health to disclose to those administering emergency calls within a jurisdiction the address of persons within that jurisdiction who the board knows have tested positive for COVID-19. The disclosure is of the address only , not the name of the person. Further details are in this March 18 order.
MARCH 18, 2020 -- CHILDCARE GUIDANCE. Governor Baker issued this executive order today closing all child care programs by the end of day, Sunday, March 22, but empowering the Department of Early Education and Care with the flexibility to issue new policies and procedures for the creation, approval, operation, staffing, and oversight of emergency child care programs, and to provide funding for them. The order states that vulnerable children and children of families, who work to maintain the health, safety, and welfare of all commonwealth residents addressing the COVID-19 pandemic, including hospital employees, shall receive priority access to these emergency programs. If your facility is interested in setting up a childcare facility, you must begin the process by completing an Exempt Emergency Child Care Inquiry Form.
MARCH 17, 2020 -- Governor Baker issued two orders today relating to healthcare staffing. The first expands access to physician services by allowing the Board of Registration in Medicine to reactivate the licenses of retired physicians; fast-tracks license renewals; permits Massachusetts to extend emergency licenses to practice to physicians from other states; and allows “limited licensees” to operate beyond their specialty training program as long as they have the proper oversight. Retired physicians may visit here to access the necessary application.
The second order extends the registrations of certain licensed healthcare professionals -- RNs, LPNs, pharmacists, and physician assistants. The relevant board of registration can waive requirements for training and continuing education for those with extended licenses. And during the state of emergency, licensed nurses, social workers, psychologists, or MDs in good standing cannot be prohibited from providing services using telemedicine to patients across state lines who during the current school year were enrolled in a Massachusetts college or university.
MARCH 17, 2020 – As a reminder, pharmacists may process patient-specific prescriptions remotely in accordance with standing Massachusetts Board of Registration in Pharmacy policy. Although the policy only addresses pharmacists, the Board announced it is actively working on remote processing guidance for pharmacy technicians and interns, and hopes to have new guidance soon.
MARCH 17, 2020 – The FDA has updated its policy relating to laboratory diagnostic testing for COVID-19. First, the new policy FDA allows states to take responsibility for tests developed and used by laboratories in their states. States can set up a system in which they take responsibility for authorizing such tests and the laboratories will not engage with the FDA. Second, the FDA will not object to commercial manufacturers distributing, and labs using, new commercially developed tests prior to the FDA granting an Emergency Use Authorization (EUA). As noted in the guidance, the FDA believes that 15 business days is a reasonable period of time to prepare an EUA submission for a test whose performance characteristics have already been validated by the manufacturer. Finally, the updated policy provides recommendations for test developers who may wish to develop serological tests for use during the coronavirus outbreak. Serology tests are less complex than molecular tests and are solely used to identify antibodies, which limits their effectiveness for diagnosis; however, as stated in the updated guidance, the FDA does not intend to object to the distribution and use of serology tests to identify antibodies to SARS-CoV-2 where the test has been validated, notification is provided to the FDA, and warning statements are included with the tests.
MARCH 17, 2020 – The Massachusetts Division of Insurance (DOI) has updated its guidance (Bulletin 2020-04) for commercial insurers as follows: “When delivered via telehealth by in-network providers, [insurers are to] forego any prior authorization requirements and any cost-sharing (deductibles, coinsurance or copayments) for medically necessary Coronavirus treatment in accordance with DPH and CDC guidelines.” The order stresses the need to allow providers to conduct treatments – not just for COVID-19 – by telehealth and for insurers to reimburse them as they would for face-to-face care. Read the entire order here. And here is Bulletin 2020-02 which the new Bulletin supersedes.
MARCH 16, 2020 – Effective March 18, all hospitals licensed by DPH and all ambulatory surgical centers must postpone or cancel any non-essential, elective invasive procedures until May 31, 2020. This guidance explains the details of the order.
MARCH 16, 2020 – This Memorandum from DPH explains the hospital visitation guidance the state has instituted effective immediately. Among the series of restrictions hospitals must impose, hospitals must urge potential visitors to defer visitation until further notice, and they must require all visitors to perform hand hygiene before visiting a patient.
MARCH 16, 2020 – This Order from DPH’s Board of Registration in Pharmacy authorizes Massachusetts pharmacies and pharmacists to compound and sell hand sanitizer over the counter, as long as a series of conditions are met. The Board said it “expects pharmacies and pharmacists to price products fairly, to use judgment to avoid bulk sales that may result in hoarding or resale, and to uphold the integrity of the profession during this emergency.”
MARCH 16, 2020 – On March 10, Governor Charlie Baker declared a state of emergency, giving the Administration more flexibility to respond to the Coronavirus outbreak. On March 15, he issued a series of executive orders, including the ones detailed above dealing with elective surgeries, hand sanitizers, and hospital visits. This page on the state’s COVID-19 website lists all of the March 15 orders and guidance documents.
MARCH 16, 2020– The Joint Commission has suspended all regular surveying beginning today. Read the brief notice here.
MARCH 15, 2020 – DPH announced today that clinicians no longer must receive authorization to conduct COVID-19 testing on patients. DPH has implemented the CDC’s updated guidance on clinical testing protocols, which means clinicians are required to only submit one nasal swab, rather than the previous requirement to submit both nasal and throat swabs. In addition, in Massachusetts, clinicians now have more flexibility to determine which patients should be tested without having to call DPH’s Epi Line. Clinicians can submit specimens for testing directly to FDA-approved labs; they no longer must only use the DPH state lab, which is now processing up to 400 tests daily.
MARCH 13, 2020 – MassHealth/ EOHHS have released provider bulletins and additional guidance in response to COVID-19. These policies expand telehealth coverage, including telephonic coverage, expand coverage through Hospital-Determined Presumptive Eligibility (HPE), provide information for providers to bill for COVID-19 lab testing, cover 90-day refills of prescriptions and early refills, and remind providers that there are no copays for lab tests and pharmacists cannot deny medications if a member cannot pay.
The following bulletins and guidance have been posted:
• All Provider Bulletin 289: MassHealth Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19)
• Managed Care Entity Bulletin 20: Coverage and Reimbursement for Services Related to Coronavirus Disease 2019 (COVID-19)
• All Provider Bulletin 288: Coverage Provided via Hospital-Determined Presumptive Eligibility
• Pharmacy Facts: Updates Related to Coronavirus Disease 2019 (COVID-19) Effective March 14, 2020
• Community Day Program Settings (e.g. Adult Day Health, Day Habilitation, Councils on Aging, etc.) 2019 Novel Coronavirus (COVID-19) Guidance
• Non-Agency Based In-Home Caregivers (e.g. PCAs, Independent Nurses, etc.) 2019 Novel Coronavirus (COVID-19) Guidance
• Agency-Based In-Home Caregivers & Workers (e.g. Home Health Agencies, Personal Care Management Agencies, Home Care Agencies, Adult Foster Care, etc.) 2019 Novel Coronavirus (COVID-19) Guidance
MARCH 13, 2020 – Starting in April, laboratories performing the COVID-19 test can bill Medicare and other health insurers for services that occurred after February 4, 2020, using the newly created HCPCS code (U0001). This code is only to be used for the tests developed by the CDC. Laboratories performing non-CDC laboratory tests for COVID-19 can bill for them using a different HCPCS code (U0002). Full guidance is here. And here are Frequently Asked Questions relating to the Massachusetts State Public Health Laboratory
MARCH 12, 2020 – Today CMS posted these Frequently Asked Questions to the Medicaid.gov website to aid state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their response to the COVID-19 outbreak.
MARCH 11, 2020 – The World Health Organization (WHO) this morning declared the COVID-19 a “pandemic,” meaning it will likely spread across the globe. "WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “We have therefore made the assessment that COVID-19 can be characterized as a pandemic … Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.” Tedros said the virus can be suppressed and controlled with concerted action. “If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of COVID-19 cases can prevent those cases becoming clusters, and those clusters becoming community transmission,” he said.
MARCH 11, 2020 – The University of Washington’s UW Medicine system has developed a model for “drive through” testing of coronavirus for staff that minimizes the chances of spreading the virus. Rather than having staff who present with common symptoms of coronavirus enter into the medical facility, thereby increasing the odds of spreading the virus to others, the UW Medicine system directs staff, who have been pre-screened, to a parking garage where a nurse, wearing appropriate PPE including a face shield, will swab the noses of employees while they remain inside of their vehicles. The samples are then sent for testing and employees are sent home while they await notification of test results. MHA strongly urges healthcare facilities to explore replicating this model, which could be expanded to patients in addition to employees. This two-minute video from UW Medicine shows how the drive-through testing works.
MARCH 11, 2020 – CDC updated its personal protective equipment (PPE) recommendations for healthcare workers caring for patients with known or suspected COVID-19. Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable temporary alternative when the supply chain of respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to healthcare providers. (Facemasks protect the wearer from splashes and sprays; respirators, which filter inspired air, offer respiratory protection.) The recommendations cover use of eye protection, medical gown, airborne infection isolation rooms, and more. Read the full CDC guidance here.
MARCH 10, 2020 – The Centers for Medicare & Medicaid Services (CMS) has published this memorandum to State Survey Agency directors providing guidance to hospitals with emergency departments (EDs) on patient screening, treatment, and transfer requirements for infectious diseases, including COVID-19. CMS said Medicare-participating hospitals should continue to follow both CDC guidance for infection control and Emergency Medical Treatment and Labor Act (EMTALA) requirements. That is, Medicare-certified hospitals with EDs are to provide a federally required, appropriate medical screening examination to every patient that comes to the ED, including those suspected of having COVID-19. If the examination indicates a possible COVID-19 case, hospitals should isolate the patient following the guidance the CDC established to minimize the risk of cross-contamination. Hospitals should also immediately contact state or local public health officials for direction on next steps, including cases where a patient may need to be transferred. Here are FAQs on EMTALA.
MARCH 10, 2020 – The well-respected medical journal, The Lancet, has created a coronavirus research center that brings together content from across The Lancet’s many journals (for example, The Lancet Global Health, The Lancet Infectious Diseases, and The Lancet Respiratory Medicine) as it is published. The content on the website is free.
MARCH 9, 2020 – DPH has issued a circular letter about reducing or eliminating the need for boarding of patients in the hospital emergency department, and authorization and guidelines for use of alternate space for treatment of ambulatory patients presenting with possible COVID-19. To address the potential influx of patients with possible COVID-19 exposure or symptomology to hospital ED, DPH issued the guidance to acute care hospitals.
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as well as guidance documents that have been superseded by more recent directives.