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Elective procedures are coming back - Politico

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Quick Fix

— CMS announced a plan for hospitals to resume elective procedures, if the region and facility are able to meet key criteria on Covid-19 outbreaks.

— The Trump administration also will require nursing homes to directly report coronavirus cases to regulators, a move that advocates say is overdue.

— Congress and the White House are closing in on a $400 billion-plus package of emergency funding, focused on small businesses hit hard by the coronavirus pandemic.

WELCOME BACK TO MONDAY PULSE — Where we want to know: How popular are masks in your neck of the woods? What percentage of people are wearing them?

PULSE detects a big drop-off between DC and Baltimore's mask-wearing habits. If only there was some data that could unmask the problem. Tips to [email protected] and [email protected].

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Driving the Day

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.

THE NEXT HOT SPOTS? CORONA CASES SPIKE IN FARM BELT — The very places that top health officials from the Trump administration last week touted as areas that had done a good job of containing the coronavirus are now contending with their own outbreaks, POLITICO’s Dan Goldberg tells PULSE.

Over the last four days, Iowa has reported more than 900 new cases, an increase of 45 percent. During that same period, North Dakota saw a 60 percent increase in new cases, mostly spurred by an outbreak at the LM Wind Power manufacturing plant.

White House

TRUMP USES DPA 'HAMMER' TO SPIN UP SWABS — The president will use the Defense Production Act to compel an unnamed company to produce 20 million more coronavirus testing swabs every month — weeks after labs and public health officials started warning that shortages of these swabs were hurting efforts to ramp up testing nationwide, POLITICO's Alice Miranda Ollstein reports.

Asked why his administration waited for weeks to use the Defense Production Act on swabs, President Donald Trump alternately claimed that states have "millions coming in” already, that states can procure them on their own, and that governors “don't know quite where they are” and need the federal government’s help.

TRUMP’s PLAN TO ‘REOPEN AMERICA’ HAS MAJOR HOLES, PUBLIC HEALTH EXPERTS WARN Every metric that the president laid out last week has significant flaws, POLITICO’s Joanne Kenen reports. Diagnostic testing continues to run behind; antibody testing has flaws; and there aren’t enough public health workers to do the work of contact tracing.

The stakes are enormous: Without all the foundational pieces of a strong public health response, the virus could rebound in the fall, not only infecting and killing more people, but also snuffing out any economic recovery in the weeks or months leading up to the presidential election, Joanne writes.

WHITE HOUSE STILL SCRAMBLING TO COVER TREATMENT FOR UNINSURED — The White House pledged over two weeks ago to cover coronavirus treatment for uninsured Americans, but the administration still lacks a plan for how to do it, POLITICO’s Rachel Roubein and Susannah Luthi report.

Trump officials continue to grapple with key questions about how exactly to implement the treatment fund, including how to determine if a patient qualifies for the new federal dollars, an administration source said.

Adding to the challenge: They’re still figuring out how to divvy up funding that hospitals and physicians say is desperately needed. The delay indicates the difficulty of building a massive entitlement on the fly, as Congress gave HHS wide latitude on how to divide $100 billion in bailout money to providers. An HHS spokesperson said the administration is “finalizing” plans for covering the uninsured but didn’t specify a timeline.

But Trump’s decision to use part of that fund to cover treatment for the uninsured came days after he ruled out reopening Obamacare’s marketplaces during the pandemic.

Nervous patients are increasingly questioning whether they’ll be on the hook for potentially massive costs, according to the legions of advocates who help patients navigate America’s byzantine health care system. They say they don’t yet have answers.

Names in the News

NORTHEAST GOVERNORS NAME APPOINTEES TO ECONOMIC COUNCIL A 21-person council will help determine when seven Northeast states reopen for business. Each state’s appointees, announced Sunday, include a health expert, an economic development expert and the governor's chief of staff, with some familiar names for PULSE readers.

For instance, Pennsylvania tapped health secretary Rachel Levine as one of its appointees. New Jersey chose Richard Besser, RWJF’s CEO and the former acting director of the CDC, as one of its advisers.

FIRST IN PULSE: DAVE KING, former LabCorp CEO, to advise American Clinical Laboratory Association. King will work with ACLA on its response to the Covid-19 pandemic, including its efforts to share information about supply needs and communicate with the White House coronavirus task force. King stepped down as LabCorp CEO in October and will continue to serve as executive chairman of the board until next month.

JANICE NOLEN, 1954-2020. Nolen, who spent more than two decades with the American Lung Association and its affiliates, was honored this month with the Haagen-Smit Clean Air award, which the association said is like the “‘Nobel Prize’ of air pollution and climate science achievements.”

Nolen was the lead author of the association’s State of the Air report, which is due out this week. PULSE also was struck by the stories shared on her memorial page — including Nolen’s use of straws to convey what it was like for an asthmatic to breathe.

What We're Reading

The Trump administration's Covid-19 testing continues to be beset by disarray and backlogs, WSJ's Christopher Weaver and Rebecca Ballhaus report.

Alyson McClaran took striking photos of health workers appearing to block a Denver protest calling for an end to the stay-at-home order.

In fine print, HHS appeared to ban all surprise billing during the pandemic, KHN's Emmarie Huetteman reports.

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