COVID 19: New and Updated Information and Resources
NJAASC has curated authoritative information and a list of resources for our Membership’s reference. We will continue to update this as more information becomes available.


NEW YORK TO RELAX ELECTIVE PROCEDURES BAN IN SOME COUNTIES- 4/23/20
Be aware that NY, NJ, CT, PA Governors are part of a regional task force that regularly meet and communicate. There is talk of NJ opening up as well, but nothing definitive yet.


CARES FUND PORTAL NOW LIVE – 4/23/30
The CARES Act Provider Relief Fund Portal is now live. It can be accessed here:
 
For additional details about the program from the
U.S. Department of Health & Human Services:

Brach Eichler Coronavirus Mini-Update - 4/23/20
Governor Murphy held a press conference this afternoon providing an update on positive COVID-19 cases and announced an additional 3,551 cases which brings the statewide total to 95,865. He also announced an additional 314 deaths which brings the statewide total to 5,063.
 
The Governor mentioned a significant flattening of the curve thus far, with statistics showing that the growth rate is steadily decreasing. Despite the positive data, Governor Murphy emphasized that New Jersey is still not close to claiming victory over COVID-19. He said that the curve must continue to flatten before reopening the State. The Governor mentioned that the social distancing policies must stay in place for the next several weeks.
 
This morning, Governor Murphy spoke with New York Governor Cuomo in regards to tri-state cooperation on contact tracing with Connecticut. The discussion is in early stages and it is vital to the reopening of New Jersey. The broader 7-state regional coalition met this morning for the first time and will continue to meet twice a week. New Jersey, New York, Delaware, Connecticut, Pennsylvania, Rhode Island, and Massachusetts are all a part of the regional coalition to coordinate plans to reopen their economies.
 
Yesterday, the NJ Office of Emergency Management received a shipment of 500 additional ventilators that the State purchased. Governor Murphy explained that this will put our State in a position to be better prepared as we reopen and expect a spike in positive cases.
 
The Governor is signing legislation today that requires all NJ hospitals to report demographic and racial data for all individuals who have tested positive for COVID-19 to the NJ Department of Health. Governor Murphy said that this is a critical step in fully understanding how COVID-19 has impacted our diverse NJ communities.
 
NJ Department of Health Commissioner Judith Persichilli reported that 6 hospitals were on divert last night. The Commissioner reported that there has been a flattening of cases in the northern region of the State, but an increase in the central region. The counties in the central region are Somerset, Middlesex, Mercer, Monmouth, and Ocean.


Healthcare News

AMBULATORY ASSESSMENT REPORTING DEADLINE FOR 2019 POSTPONED - 4/21/20
NJDOH has agreed to postpone the filing date for calendar year 2019 until July 15 th .
This brings the assessment in line with State and Federal tax filings.

Facility Administrator,

In accordance with the state and federal income tax filing extensions granted by State of New Jersey, and the U.S. Department of the Treasury, Internal Revenue Service related to COVID-19  https://covid19.nj.gov , the New Jersey Department of Health (Department) has extended the due date of your Calendar Year 2019, State Fiscal Year SFY 2021 HFEL-5 Annual Financial Report to  July 15, 2020  .

Click here to download a copy of the Calendar Year (CY) 2019 Annual Financial Report (HFEL-5), the form required for each licensed facility offering certain types of ambulatory care services to submit an annual financial report for (SFY) State Fiscal Year 2021.

Registered users may complete Form HFEL-5 using the Department’s web-based portal at  https://dohlicensing.nj.gov   . Detailed instructions for registered users on how to submit the HFEL-5 can be found at  https://dohlicensing.nj.gov/helpHFEL5 . If you are unregistered, you may request registration at  aap@doh.nj.gov .

If you have any questions about ambulatory assessment reporting requirements, or the completion of the HFEL-5 Financial Form, please contact the Department at  (609) 913-5970  or email us at  aap@doh.nj.gov .

Thank you,

David Preston, Director
Ambulatory Assessment Program
NJ Department of Health


CARES Grant Attestation Portal Now Live – 4/21/20
Healthcare providers can now attest that they wish to keep the grants the US Department of Health & Human Services (HHS) began distributing last Friday. This grant fund is part of the $100 billion in relief included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 that was signed by President Trump on March 27, 2020.

ADDITIONAL DIRECTION FROM ASCA ON RE-OPENING ASCS -4/21/20
CMS Releases Recommendations for Reopening Healthcare Facilities
The Centers for Medicare & Medicaid Services (CMS)  released guidance  yesterday on restarting non-emergent non-COVID-19 healthcare. If states or regions have passed the  Gating Criteria  (symptoms, cases and hospitals) the White House announced on April 16, 2020, then they may proceed to Phase I. These recommendations can guide healthcare systems and facilities as they consider resuming in-person care of non-COVID-19 patients in regions with a low incidence of COVID-19 disease.

Decisions must be consistent with public health information and in collaboration with state public health authorities. All facilities should continually evaluate whether their region remains at a low risk of incidence and should be prepared to cease non-essential procedures if a surge occurs. Adhering to the following recommendations can allow for safely extending in-person, non-emergent care in select communities and facilities.

General Considerations
  • In coordination with state and local public health officials, evaluate the incidence and trends for COVID-19 in the area where restarting in-person care is being considered.
  • Evaluate the necessity of the care based on clinical needs.
  • Consider establishing Non-COVID Care (NCC) zones that would screen all patients for symptoms of COVID-19, including temperature checks. Staff would be screened routinely as would others who work in the facility (physicians, nurses, housekeeping, delivery and all people who would enter the area).
  • Sufficient resources should be available to the facility across phases of care, including personal protective equipment (PPE), healthy workforce, facilities, supplies, testing capacity and post-acute care, without jeopardizing surge capacity.

In addition to the general considerations, CMS outlines the following recommendations:
  • PPE for staff and patients;
  • workforce availability and staff screening;
  • facility considerations, including social distancing in waiting areas and maintaining low patient volumes;
  • sanitation protocols, including an established plan for thorough cleaning and disinfection prior to using spaces;
  • adequate equipment, medication and supplies must be ensured and must not detract from the community’s ability to respond to a potential surge;
  • all patients must be screened for potential symptoms of COVID-19 prior to entering the NCC facility, and staff must be routinely screened for potential symptoms; and
  • when adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory testing as well.

In addition to CMS, ASCA and other healthcare organizations have each identified potential pathways for healthcare providers, including ASCs, to provide care to more patients as the COVID-19 pandemic recedes.

The  ASCA Statement on Resuming Elective Surgery as the Pandemic Recedes , the Society for Ambulatory Anesthesia (SAMBA)  Statement on Resuming Ambulatory Anesthesia Care as Our Nation Recovers from COVID-19 , supported by the American Society of Anesthesiologists (ASA) and ASCA, and the  Roadmap for Resuming Elective Surgery after COVID-19 Pandemic , prepared by the American College of Surgeons, ASA, the Association of periOperative Registered Nurses and the American Hospital Association, can all be found in ASCA’s  COVID-19 Resource Center .

As always, we recommend visiting ASCA's  COVID-19 Resource Center  for valuable resources for ASCs and to find the latest information on the pandemic.

CMS ANNOUNCES NEW GUIDELINES FOR NON-EMERGENT CARE – 4/20/20
While this is good news and a beginning, remember that Governor Murphy’s Executive Order 109 still takes precedent over this.

ELECTIVE PROCEDURES ARE COMING BACK
CMS Administrator Seema Verma on Sunday announced  new guidelines   on how hospitals can move to "Phase I" of providing non-emergent, non-Covid-19 care in states and regions where  coronavirus outbreaks  are deemed under control.

Among the Phase I criteria : Hospitals must have plans to conserve supplies, maintain capacity for surges and ensure appropriate cleaning and protections for patients.

"This isn't going to be like a light switch," Verma said. "It's more like a sunrise where it's going to be a gradual process."

Some GOP-led states, like Oklahoma and Texas, late last week announced plans to pursue elective procedures, saying that their hospitals had  capacity  to handle a surge.

The freeze on elective procedures had major ripple effects on patients and providers . Many Americans put off  essential procedures , like cancer care, stent repair and other surgeries. Meanwhile, hospitals struggled to adjust to the massive drop in revenue, with workers furloughed and many wards left empty.

"It is important to recognize that so-called elective care or scheduled care often involves providing lifesaving treatments and procedures that are necessary to save lives and keep people healthy," said Rick Pollack of the American Hospital Association, praising CMS' move.

VERMA: NURSING HOMES   MUST REPORT COVID-19 CASES DIRECTLY  — The CMS administrator also announced that the facilities must now tell patients, families and the CDC when there are cases. That data will then be made public by CMS.

"As we reopen the United States, our surveillance effort around the virus will begin in nursing homes," Verma said.  See CMS' announcement .

—  The move comes after thousands of deaths in nursing homes , and with advocates having spent weeks pushing federal officials to adopt more transparency.
Verma has consistently called nursing homes "ground zero" in the spread of Covid-19.

FIRST IN PULSE : HOUSE OVERSIGHT WANTS NURSING HOME ANSWERS FROM VERMA — Democrats want Verma to explain whether CMS is continuing with a proposed rule to roll back nursing home protections, according to a  letter shared first with PULSE  . Under its proposal, CMS would roll back a required annual facility-wide assessment and a requirement that every nursing home maintain at least one qualified infection preventionist on staff, at least part-time.

"Now is the time to shore up protections for nursing home residents — not eliminate them," Chair  Carolyn Maloney  and Economic and Consumer Policy Subcommittee Chair  Raja Krishnamoorthi   write to Verma, asking for a briefing by Friday.

What's at stake : "There has never been such a clear illustration of how devastating infections can be in nursing homes — coronavirus is killing scores of nursing home residents," Krishnamoorthi told PULSE, adding that Americans are closely watching the federal response. "If the administration rolls back infection control measures in nursing homes now, Americans who lose loved ones will never forgive them."

CONGRESSIONAL PACKAGE COMING TOGETHER  — Congress and the Trump administration are quickly nearing a deal on more than $400 billion in emergency funding for small businesses hit hard by the coronavirus pandemic, with passage expected in the coming days, POLITICO's Nolan McCaskill, Burgess Everett and Rishika Dugyala reports.

A deal could be announced as early as Monday, according to congressional aides. On a conference call with President Donald Trump and Republican senators on Sunday afternoon, Senate Majority Leader  Mitch McConnell  told Republicans that the only portion of the package not agreed upon focused on coronavirus testing, according to a person briefed on the call.

McConnell and Treasury Secretary Steven Mnuchin also said the money for state and local government funding, as well as food stamp aid requested by Democrats, would not be included in the deal.

CARES WEBINAR TODAY- 4/20/19
Below is the link to our next webinar on Monday, April 20 – “COVID-19 Crisis: CARES Act Provider Relief Fund Grants & the Medicare Accelerated & Advance Payments Program - Rules of the Road.”


ASCA STATEMENT ON RESUMING CASES - 04/20/20
Again, it is important to remember that this nor the Federal guidelines are binding here in New Jersey. The Governor’s Executive Order remains in effect.

ASCA Statement on Resuming Elective Surgery as the COVID-19 Pandemic Recedes
Ambulatory surgery centers (ASCs) have played a vital role in delivering safe, cost-effective care to millions of patients. As the nation struggles with the novel COVID-19 virus, ASCs have maintained their commitment to serve the needs of communities by partnering with hospitals to assist them with surge capacity, providing excess resources and releasing staff and equipment to aid in the crisis. 

Adhering to regulatory and clinical guidance for the protection of the public to minimize the spread of COVID-19 and to preserve the supply of personal protective equipment (PPE) for higher acuity needs, all elective non-urgent surgical procedures have been postponed. While this decision was the correct one at the time, it has resulted in a pent-up demand of patients who deferred needed care and are at increased risk of experiencing a negative clinical outcome. As examples, a deferred cataract surgery increases the possibility of a fall and a delayed colonoscopy allows cancer to grow undetected. 

The good news is that the country’s commitment to social distancing and shelter-in-place actions is reducing the spread of COVID-19. As that happens, it is prudent for health care providers to seek ways to cautiously resume activities and serve the growing healthcare demands in communities around the country. 

We support lifting the prohibition of elective, non-urgent surgeries as outlined in the  White House Guidelines for Opening Up America Again  and its reliance on gating criteria that focus on a sustained reduction in COVID-19 cases. The reality is that regions across the nation are impacted by COVID-19 to varying degrees. There are some communities that are ready for a strategic restart of deferred healthcare at this time, while continuing to focus on limiting COVID-19 spread.

ASCs should resume elective surgeries if two conditions are guaranteed. First, the community must be ready. The prevalence of COVID-19 in the community must be low or declining and the community must have sufficient bed capacity and PPE supplies to accommodate the potential needs of COVID-19 infected patients.

Second, ASCs should open only if the safety of patients and the broader community can be guaranteed. Every ASC must ensure patient health and the prevention of virus spread by applying the following principles:
  • Screening patients before visits and monitoring their health prior to starting surgery as part of the pre-operative procedure
  • Requiring staff to self-monitor and screen for viral symptoms daily
  • Continuing to use PPE per the latest Centers for Disease Control and Prevention (CDC) recommendations for all procedures
  • Following waiting room spacing guidelines, social distancing, face masking and other recommended procedures for patients and visitors prior to entering the facility
  • Ensuring heightened disinfection to prevent and mitigate risk of spread
  • Ensuring patients have been medically cleared by their primary care physician where applicable

In addition to these cautions, there are other factors to consider that will permit ASCs to reopen in a prudent and safe manner, balancing the needs of patient care with the risk of providing that care:
  • Geographic considerations: starting in states where the COVID-19 trendline follows gating criteria and expanding to other states as the situation improves
  • Patient prioritization: starting with patients who have lower co-morbidities and surgical risks
  • Procedure types: starting with procedures that are lower risk with regard to airborne transmission and those with minimal risk of unintended hospital admissions
  • COVID-19 testing considerations: consider testing where feasible and if it would change the clinical decision to proceed with the procedure

Because COVID-19 has evolved differently across the nation, state governments have taken a variety of actions to manage the crisis that now hinder ASCs’ capacity to resume care. As the pandemic recedes, states should lift restrictions on elective surgery and return decisions about care to treating physicians, patients and their families, letting clinical judgment prioritize time-sensitive surgical or procedural cases. 

In conclusion, ASCs are an integral part of our nation’s healthcare delivery system, providing cost-effective, high-quality surgical and procedural care. As always, we remain committed to working with federal and state policymakers to provide our communities with the help they need during the COVID-19 pandemic and beyond.
Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com