The capital city is focused right now on reaching an agreement on the next bill to address the health and economic consequences of the coronavirus pandemic. Should legislation get enacted, it is expected to be the last COVID bill before the election. Congressional Democrats and the White House have been negotiating since last weekend, but still seem to be far apart in the overall amount to spend, as well as some major substantive issues. In other news, a court has stopped the “public charge” rule from being implemented during the public health emergency. Find COVID- and non-COVID-related news, information, and resources in this week’s Update.

August is National Immunization Awareness Month (CDC).

Note on the organization of this Update: Non-coronavirus updates are first, followed by items related to the coronavirus pandemic.

CDC Expects 2020 Outbreak of Life-Threatening Acute Flaccid Myelitis--Doctors urged to quickly recognize symptoms and to hospitalize patients immediately

(CDC Newsroom Release, 8/4/20) (In Spanish). Parents and doctors should suspect Acute Flaccid Myelitis (AFM) in patients with sudden limb weakness, especially during August through November. Recent respiratory illness or fever and the presence of neck or back pain or any neurological symptom should heighten their concern.

On July 29, federal district court in New York issued an injunction against implementation of the Department of Homeland Security’s final “public charge rule” during the public health emergency (PHE) in effect because of the coronavirus pandemic. (The Secretary of Health & Human Services recently renewed the PHE declaration, so it will now be in effect through October 22.) The Center for Public Representation provides a detailed timeline of the various regulatory and judicial actions related to the rule. 

The RAISE Family Caregiving Advisory Council is meeting for the fifth time on August 12, 2020, from 12:30-4:30 ET. The webinar link (coming soon) will be live for access at 12:15 on the day of the meeting. No registration is required to join the webinar. The agenda is forthcoming.

HHS Secretary’s Report Calls for Congressional Action to Combat Surprise Billing and Promote Price Transparency (HHS News Release, 7/29/20)

Spotlight: Giving kids their best shot at wellness – For Indian Country and Beyond (Center for Medicare and Medicaid Services (8/5/20):

“Children and adolescents who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) are eligible to receive routine vaccinations (checklist, PDF, 2 pp), behavioral assessments, and other essential health benefits (brochure, PDF, 2 pp). And enrollment in CMS programs helps support Indian health facilities (resources in multiple American Indian languages.)

“The Connecting Kids to Coverage National Campaign works closely with partners and community-based organizations who conduct outreach. That’s why Connecting Kids to Coverage recently created new resources on free or low-cost health care coverage options available through Medicaid and CHIP to children and adolescents up to age 19. (Palm cards, posters, PSAs in multiple languages, web button, mail inserts, and social media messages images.)

“Notably, the new resources encourage all parents and caregivers to apply for benefits, even if they applied previously and were deemed ineligible. This message is especially important now, given pandemic-related layoffs and the resulting drop in employer-sponsored health care coverage.”

On August 3, the Centers for Medicare & Medicaid Services (CMS) published the 2020 version of the Coordination of Benefits/Third Party Liability in Medicaid Handbook (COB/TPL).

Coalition Calls on Secretary Azar to Use Medicaid Waiver Authority to Promote Health Equity (Blog of the Georgetown University Center for Children and Families, 7/23/20): Numerous (279) national and state groups representing patients, providers, racial justice organizations and others sent a letter to Secretary Azar urging him to: (1) deny the pending Sec. 1115 waiver requests from Alabama, Mississippi, Oklahoma, Tennessee, and South Dakota that would establish work requirements as a condition of Medicaid eligibility for very low-income parents, which would disproportionately impact Black women; and (2) approve pending Sec. 1115 waiver requests from Illinois and NJ, and future requests from other states, that would allow them to extend Medicaid eligibility for one year post-partum. The Georgetown University Center for Children and Families, Family Voices, March of Dimes, and the American Academy of Pediatrics, were among the many national groups that signed onto the letter. 

Referral and Care Coordination Forms (National Academy for State Health Policy, August 2020)

On this page, you can find examples of referral forms that are compliant with federal Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) privacy and confidentiality requirements, feedback forms to inform primary care providers of the results of evaluations, and referral guidelines. This map shows states that have standardized referral forms: States with Standardized Referral Forms.

On July 27, Senate Majority Leader Mitch McConnell (R-KY) released the Senate leadership’s proposal for the next COVID legislation. It is a set of separate bills, together called the HEALS Act, for Health; Economic Assistance; Liability protection; and Schools. See McConnell Press Release (7/27/20); Republican leaders release $1 trillion coronavirus stimulus proposal (Axios, 7/27/20). Costing about $1 trillion, this package is much more limited than the $3-trillion House-passed bill, the HEROES Act (H.R. 6800). (See the May 19 Washington Update for details of the House bill.)

The Senate package would not provide an additional increase in the federal Medicaid matching rate (Federal Medical Assistance Percentage, or FMAP). The House bill would increase the FMAP by 5.8 percentage points, on top of the 6.2 percentage points added in earlier law, until June 30, 2021. This additional FMAP increase is a very high priority for many state, provider, and patient, advocacy groups. (See the July 1 letter on that point from about 100 organizations.) Disability and aging advocates are pushing hard for an additional 10-percentage-point FMAP increase dedicated to home and community-based services, as was included in the House bill (HEROES Act). See Senate GOP's COVID-19 response sets up battle over Medicaid (The Hill, 7/28/20).

The Senate package would provide a single “rebate” payment of up to of $1200 per adult in families below certain income levels, plus up to $500 per dependent in the family, regardless of the dependent’s age. This is an improvement over the payment provided under the CARES Act, which was limited to dependents under age 17. If the Senate provision is enacted, it would help families with adult children who are dependents because they are disabled or have special health care needs.

The Senate package would provide a federal addition to unemployment insurance of $200 per week, rather than the $600 per week that was provided under the CARES Act and is in the House bill. The Senate package would also give some liability protections to schools, colleges, charities, churches, government agencies and businesses that are sued for harms resulting from coronavirus exposure.

For more information, see HEALS Act Provisions (National Conference of State Legislatures, 8/3/20); Senate HEALS Act vs. House HEROES Act (Center for Public Representation); and summary of the American Workers, Families, and Employers Assistance Act, the part of the HEALS Act that includes tax, Medicaid, and unemployment provisions.

OUTLOOK: As of this writing, representatives from the White House have been negotiating with House Speaker Nancy Pelosi (D-CA) and Senate Democratic Leader Chuck Schumer (D-NY) to try to reach a compromise deal on the next COVID package. Senate Republicans are divided on whether they even want a bill at all. See McConnell: 15-20 GOP senators will not vote for any coronavirus deal (The Hill, 7/31/20). While it will be difficult to reach an agreement, there is a decent chance that one will be worked out within the next two or three weeks, as there are some signs of flexibility on each side. See Second stimulus check updates: White House, GOP soften on opposition to $600 unemployment benefit as COVID-19 relief bill talks continue (Associated Press/Chicago Tribune, 7/31/20); White House: Friday or bust for virus aid deal -- McConnell to keep Senate in session next week; Pelosi softens on overall spending target (Roll Call, 8/5/20). On the other hand, Negotiators remain far apart on coronavirus deal as deadline looms (The Hill, 8/5/20). White House negotiators say, that they don’t see the point of continuing negotiations if a deal isn’t reached by Friday, August 7.

On July 23, Secretary of Health & Human Services Alex Azar renewed the current Public Health Emergency, which is effective July 25 for 90 days (through Oct. 22), unless the Secretary determines that it should end earlier. Many of the provisions in the coronavirus-relief laws are effective only during the Public Health Emergency, including the increase in the federal Medicaid match and some of the telehealth provisions.

FDA updates on hand sanitizers consumers should not use (Food & Drug Administration, 7/31/20): FDA test results show certain hand sanitizers have ineffectively low levels of ethyl alcohol or isopropyl alcohol, which are active ingredients in hand sanitizer products. The agency urges consumers not to use these sub-potent products and has expanded its list (scroll down on page) to include sub-potent hand sanitizers, in addition to hand sanitizers that are or may be contaminated with methanol. [Note: On 8/5/20 at 4:57 pm, your Update author saw only two out of 115 problem products listed that were not made in Mexico -- TriCleanz Tritanium Labs Hand Sanitizer, and Leiper’s Fork Distillery Disinfectants, although I could have missed some.] For more information, see:

For a complete and updated list of CMS actions, guidance, and other information in response to the COVID-19 virus, see the Current Emergencies Website. CMS has also launched a dedicated, Medicaid.gov, COVID-19 resource page that will be continually updated with relevant information. For information on all the activities of the White House Coronavirus Task Force, see www.coronavirus.gov. 

CMS and CDC announce provider reimbursement available for counseling patients to self-isolate at time of COVID-19 testing (CMS News Release, 7/30/20)

The Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention have announced that Medicare and Medicaid will reimburse health care providers for counseling patients, at the time of coronavirus disease 2019 (COVID-19) testing, about the importance of self-isolation after they are tested and prior to the onset of symptoms. See Provider Q&A – payments for COVID counseling (CMS, 07/27/2020).

OCR Issues Guidance on Civil Rights Protections Prohibiting Race, Color, and National Origin Discrimination During COVID-19 (HHS News Release, 7/20/20)

The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) has issued guidance (Title VI Bulletin) to ensure that recipients of federal financial assistance understand that they must comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19. This Bulletin focuses on recipients' compliance with Title VI of the Civil Rights Act of 1964 (Title VI).

To learn more about non-discrimination on the basis of sex, race, color, national origin, age, and disability; conscience and religious freedom; and health information privacy laws, and to file a complaint with OCR, please visit www.hhs.gov/ocr.

Trump Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and Advances Access to Care in Rural Areas (CMS News Release, 8/3/20) 

·      Back to School Planning: Checklists to Guide Parents, Guardians, and Caregivers

·      School Decision-Making Tool for Parents, Caregivers, and Guardians

Local governments go to war over schools (Axios, 8/5/20) – Municipal, county, and state governments may be at odds about how schools re-open.

There’s not much good news about kids and coronavirus (Axios, 8/5/20)

CDC: Children might play 'important role' in spreading COVID-19 (The Hill, 7/31/20)

This is the report referenced in the above articles about the Georgia camp study showing the quick spread of the virus among a large group of campers and counselors: SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020 Top of Form

Morbidity and Mortality Weekly Report (MMWR) Early Release / July 31, 2020 / 69

WORTH REPEATING: COVID-19 in Children and the Dynamics of Infection in Families (Pediatrics, 7/8/20)

Attorneys general ask feds to use march-in rights for remdesivir (Axios, 8/4/20)

On August 4, a bipartisan group of 34 state and territorial attorneys general sent a letter to the heads of the Department of Health & Human Services, NIH, and FDA asking the federal government to exercise “march-in drug rights” for remdesivir, a drug used for treating seriously ill COVID-19 patients. March-in rights allow the federal government to license a drug’s patent rights to third-parties if the drug was developed with federal funding and the patent holder fails to achieve a reasonable price or fails to reasonably “alleviate health or safety needs” of consumers. This would allow more companies to produce the drug, thereby increasing the supply and lowering the price. March-in rights have never been used before, and may not be available in all cases, due to contract terms between the government and a drug manufacturer. For more details, see Gilead's COVID med remdesivir is scarce and costly, AGs say, urging feds to sidestep its patents (Fierce Pharma, 8/5/20).

Amended and New State and Local Laws and Guidance on Paid Sick Days in Response to COVID-19 (Fact Sheet from the Center for Law & Social Policy, 7/1/20)

·      For the latest guidance and communication resources on COVID-19, visit CDC’s webpage for Guidance Documents. (See below for CDC resources on schools.)

·      COVID-19 One-Stop Shop Toolkits (CDC, Updated July 17, 2020) --

Videos, Social Media, PSAs, Print Resources, Checklists, FAQs, and Web Resources. For information in Spanish only, visit CDC en Español. See materials in other Languages.

·      Natural Disasters, Severe Weather, and COVID-19 is a new CDC website that provides information on preparedness and recovery during the COVID-19 pandemic and what the general public can do to keep themselves safe. 

·      Chart: Each State’s COVID-19 Reopening and Reclosing Plans and Mask Requirements (National Academy for State Health Policy, 7/13/20)

·      Update on Federal Mandates to Cover COVID-19 Testing Services: New Guidance for States, Plans, and Insurers (Georgetown University Center on Health Insurance Reforms, 7/2/20)

·      Providing and Receiving Respite Care Safely During the COVID-19 Pandemic: Voluntary National Guidelines (ARCH National Respite Network and Resource Center, 7/9/20)

·      Supporting Family Caregivers in the Time of COVID-19: State Strategies (Center for Health Care Strategies blog, 6/2/20) 

Download the latest TRICARE East Region or TRICARE West Region newsletter at www.tricare.mil/publications.

Sign up for email alerts, and keep up with TRICARE and COVID-19 updates.

The Administration for Community Living (ACL) is seeking input from stakeholders on the new The Strategic Framework aims to support states efforts to:

Feedback can be submitted via email to ACLFramework@acl.hhs.gov.

The Asian & Pacific Islander American Health Forum (APIAHF) has launched a crowd-sourcing project to collect Asian American and Native Hawaiian & Pacific Islander in-language COVID-19 resources. APIAHF will gather all of the responses and organize them by language here, so that people can see the variety of available resources. Please fill out the form here to submit a resource.

NEW How Can States Leverage Telehealth Policies and Implement Eligibility and Enrollment Strategies to Protect Children’s Access to Medicaid During COVID-19?

Note: If you can’t attend the live session on August 10, click here to register now and receive a link to view the program on demand.

NEW Systemic Racism & Health: Solutions, Making Change Happen

NEW Vaccine Confidence (how to reduce hesitancy during the COVID-19 pandemic)

Tuesday, August 11, 3:00-4:00 ET

NEW Meeting of RAISE Family Caregiving Advisory Council

NEW Resilience & Strength: African-American Family Caregivers Discussion

NEW Increasing Flu Vaccine Confidence Within African American Communities

NEW Exploring the Intersectionality of Peer Support and Person-Centered Planning across Disability

The National Center on Advancing Person-Centered Practices and Systems (NCAPPS)

NEW Dr. Laura Blaisdell Provides Medical Guidance on COVID 19

NEW SAVE THE DATE: HHS Office of Minority Health (OMH) Announces Upcoming Virtual Symposium to Advance the Response to COVID-19

On Thursday, September 17, 2020, the U.S Department of Health and Human Services (HHS) Office of Minority Health (OMH) is hosting a virtual symposium to highlight state, Tribal, territorial and community-based efforts to address COVID-19 among racial and ethnic minority populations. The Advancing the Response to COVID-19: Sharing Promising Programs and Practices for Racial and Ethnic Minority Communities virtual symposium will feature presentations and strategies developed for public health leaders and community organizations confronting the pandemic. Help advance the response to COVID-19 by spreading the word. Registration information is forthcoming.

NEW SERIES: 9-part OE8 [Open Enrollment] webinar series.

Health Reform: Beyond the Basics (Center for Budget and Policy Priorities) 

All webinars will be recorded and available for viewing on our website.

The Arc’s Summer Leadership Institute -- Various dates throughout August. This Leadership Institute is an educational event for executives, senior leaders, and staff across the disability and public service sectors. Presented in a virtual format, it will provide a series of FREE live streaming events and on-demand webinars spread across July and August. This year’s sessions cover everything from the financial challenges of COVID-19, providing direct services, and navigating policy to advocate for people with intellectual and developmental disabilities (I/DD).

‘Family CNA Model’ for Pediatric Home Health Patients Gaining Momentum Amid COVID-19 (Home Health Care News, 7/30/20)

The unequal impacts of COVID-19 on children (diversitydatakids.org, Institute for Child, Youth and Family Policy, Heller School for Social Policy and Management, Brandeis University, 5/26/20).

How the Navajo Nation slowed one of the worst COVID-19 outbreaks in the US

Black children are more likely to die after surgery than white counterparts, new study finds (STAT News, 7/20/20)           

Park: Politicians Claim Cutting Medicaid Spending Will Ensure Funding for Schools. Our Analysis Shows the Opposite Will Happen (The 74, 7/21/20)

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Family Voices is a national organization and grassroots network of families and friends of children and youth with special health care needs and disabilities that promotes partnership with families--including those of cultural, linguistic and geographic diversity--in order to improve healthcare services and policies for children.