Trump Administration Launches New Toolkit to Help States Navigate COVID-19 Health Workforce Challenges
The Centers for Medicare & Medicaid Services and the Assistant Secretary of Preparedness and Response released a new toolkit to help state and local healthcare decision makers maximize workforce flexibilities when confronting 2019 Novel Coronavirus in their communities. This toolkit includes a full suite of available resources to maximize responsiveness based on state and local needs, building on President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.
“The Administration has taken swift and unprecedented emergency action to lift regulatory constraints, ease federal rules and approve waivers that help local hospitals, clinics and other healthcare facilities boost their frontline medical staffs and increase their ability to care for patients in the face of crisis. This new resource will help states apply all of these important changes on the ground to maximize their workforce to ensure care for patients,” said CMS Administrator Seema Verma.
In response to this pandemic, the Trump Administration has provided sweeping flexibility to the US health care system. To bolster the health care workforce, barriers have been removed for hiring and retaining of physicians, nurses, and other health care professionals to keep staffing levels high. Medical practitioners are able to practice at the top of their licenses and across state lines, offering more flexibility for rural providers and expanding the available workforce. CMS has allowed additional healthcare providers to temporarily enroll in Medicare to provide care during the public health emergency. An unprecedented expansion of telehealth services covered by Medicare, allows patients to have doctors’ visits at home, no matter where they live, to reduce potential viral exposure.
The COVID-19 Healthcare Workforce Toolkit builds on the steps CMS has taken to ensure healthcare facilities across the nation are fully staffed and equipped to treat COVID-19 patients as efficiently as possible. This comprehensive toolkit for individuals managing workforces during the COVID-19 pandemic provides helpful information on funding flexibilities, liability protections, and workforce training in one place.
The COVID-19 Healthcare Workforce Toolkit provides up-to-date best practices so state and local healthcare decision makers have a go-to resource to know what’s been implemented in the field and to find out how it’s working. The toolkit is available online and includes an assistance center, information exchange of case studies and additional peer-to-peer communications that can be used to help local communities determine the best way to battle the COVID-19 based on their unique needs.
To view the COVID-19 Healthcare Workforce Toolkit, visit: https://asprtracie.hhs.gov/Workforce-Virtual-Toolkit
The COVID-19 Healthcare Workforce Toolkit are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.
Term Care Hospitals, Rural Health Clinics, Federally Qualified Health Centers and Intermediate Care Facilities
CMS continues to release additional blanket waivers to the healthcare community to provide the flexibilities needed to care for patients during this public health emergency. CMS is providing blanket waivers relating to care for patients in Long-Term Care Hospitals, temporary expansion locations of Rural Health Clinics and Federally Qualified Health Centers, staffing and training modifications in Intermediate Care Facilities for individuals with Intellectual disabilities, and the limit for substitute billing arrangements (locum tenens).
AMA letter to NGA urging Governors to adopt civil immunity protections for physicians
A couple quick updates on state efforts to adopt civil immunity for physicians in response to COVID-19.
- AMA sent a letter to the Executive Director of the National Governor’s Association urging Governors adopt health care emergency response protections for physicians providing COVID-19 related care and those following federal, state and local directives relating to COVID-19. We encouraged Governors adopt civil immunity protections similar to those adopted by Executive Order in Connecticut and New York, as well as subsequent legislation enacted in New York.
- A copy of AMA’s press release can be found here
- A copy of AMA’s letter to NGA can be found here
- Recently, the Massachusetts legislature enacted 2630, The legislation provides civil immunity for health care professionals and facilities providing care during the COVID-19 emergency. It provides a great model for states requiring a legislative solution.
In addition to the updated joint statement pasted below (online here), the AMA has updated its state chart regarding Board of Pharmacy restrictions and other policies relating to prescribing and dispensing certain medications. The chart is available here. The updated joint statement provides further detail and clarification about key areas that have evolved in recent weeks, including in-patient use of certain medications compared to prophylaxis, the distribution/supply chain, safety considerations and the need for adverse-event reporting, and further supports the need for evidence/science to guide discussions and decisions.
Updated April 17, 2020
Joint statement of the American Medical Association, American Pharmacists Association and American Society of Health-System Pharmacists
Physicians’ and pharmacists’ first and foremost ethical obligation in situations of epidemic, disaster or terrorism is to provide urgent medical care and ensure availability and appropriate use of necessary medications. This requires close coordination with the entire health care team to help ensure patients receive the testing, treatments, follow-up care and medications they need. We applaud the innumerable selfless acts by health care professionals across the nation who are putting themselves in harm’s way to provide care to America’s patients.
We are issuing this joint statement to highlight the important role that physicians, pharmacists and health systems play in being just stewards of health care resources during times of emergency and national disaster. We are aware that some physicians and others are prescribing or dispensing medications currently identified as potential treatments or prophylaxis for COVID-19 (e.g., chloroquine or hydroxychloroquine, azithromycin) for themselves, their families, or their colleagues. In addition, some entities have been purchasing excessive amounts of these medications through commercial distribution channels in anticipation of potentially using them for COVID-19 prevention and treatment. We strongly oppose these actions that can lead to supply disruptions for patients who need these medicines for chronic conditions.
We collectively support state and federal requirements that direct a prescription must be written only for a legitimate medical purpose. Novel off-label use of FDA-approved medications is a matter for the physician’s or other prescriber’s professional judgment. We also strongly support a pharmacist’s professional responsibility to make reasonable inquiries to a prescriber to resolve any questions about a prescription. If a prescription is not for a legitimate medical purpose, it should not be written, and it should not be dispensed. We encourage patient-centered care decisions, made on an individualized basis with patients’ informed consent about the risks and benefits associated with any treatment regimen. However, evidence-based science and practice must guide these determinations. Physicians, pharmacists and other members of the healthcare team are more than capable of working together and resolving questions.
At the same time, we caution hospitals, health systems, other entities, and individual practitioners that no medication has been FDA-approved for use in COVID-19 patients. Definitive evidence for the role of these drugs in treating COVID-19 patients has not been determined through robust clinical trials; decisions to use these medications off-label must be made with extreme caution and careful monitoring. Physicians, pharmacists, patients and policymakers must understand that these medications have dangerous side effects, that may lead to patient harm, including fatal cardiac arrhythmias. In the event that an adverse drug event is suspected or observed from any medication used to prevent or treat COVID-19, we urge healthcare providers to submit a report to FDA MedWatch. Stockpiling these medications—or depleting supplies with excessive, anticipatory orders— and price gouging in the midst of a pandemic, have grave consequences for patients with conditions such as lupus or rheumatoid arthritis if the drugs are not available in the community. The health care community must collectively balance the needs of patients taking medications on a regular basis for an existing condition with new prescriptions that may be needed for patients diagnosed with COVID-19. Being just stewards of limited resources is essential.
We are further concerned by the confusion that may result from various state government agencies and boards issuing emergency rules limiting or restricting access to chloroquine, hydroxychloroquine or other emerging therapies or requiring new procedures for physicians and other healthcare professionals and patients If these bodies promulgate new rules, we urge that they emphasize professional responsibility and leave room for professional judgment. We further urge that patients already on these medications for chronic conditions should not be negatively impacted by new laws, rules or other guidance. In a time of national pandemic, now is not the time for states to issue conflicting guidance, however well-intentioned, that could lead to unintended consequences.
We applaud the ongoing efforts to conduct clinical trials and generate evidence related to these and other medications during a time of pandemic. We are also encouraged that some pharmaceutical manufacturers are increasing production of high-demand medications as well as supplying them for use in clinical trials.
The nation’s physicians and pharmacists continue to demonstrate remarkable leadership on a daily basis. We are confident in physicians’ and pharmacists’ judgment to make the right decisions for their patients, communities and the health care system overall.