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From APTA.org

HHS Portal for Reporting How Relief Money Was Spent Opens Jan. 15 — With a Change
The U.S. Department of Health and Human Services is continuing to provide details on how providers who received relief funds need to account for how the money was spent, with the latest details including a change in how lost revenue should be calculated.

Stopgap Spending Bill Pushes Back Medicare Loan Repayment Dates
A recently enacted emergency spending bill to keep the federal government open includes some good news for providers, including PTs, who received loans from Medicare: Payback deadlines have been postponed. The bipartisan bill signed into law on Oct. 1 by President Trump will allow the government to remain open for business until Dec. 11, and includes provisions that push back repayments on Medicare Accelerated and Advance Payment Program loans to one year after the loan was issued. The previous repayment deadline was expected to begin 120 days after issuance.

From HHS

HHS Extends Public Health Emergency
On Friday, October 2, HHS Secretary Alex Azar announced via Twitter that he is extending the public health emergency declaration. This is the third time Azar has extended the public health emergency declaration, which must be renewed every 90 days. This renewal, in conjunction with the national health emergency declaration issued by the President on March 13, 2020, means that PTs and PTAs in private practice and facility-based physical therapy providers will continue to have access to the temporary Medicare regulatory waivers and new rules that afford providers flexibility to respond to COVID-19 pandemic, including telehealth coverage.

From CDC

U.S. COVID-19 Cases Top 7 Million, More than 200,00 Deaths
Total COVID-19 cases have reached 7.4 million as of Oct. 5, with just over 300,000 new cases in the previous week, according the CDC COVID-19 Data Tracker. More than 209,000 people have died from the disease so far.

Post-Acute and Long-term Care Crisis Standards of Care
The document “COVID-19: Considerations, Strategies, and Resources for Crisis Standards of Care in Post-Acute and Long-term Care (PALTC) Facilities” gives an overview of general considerations, potential strategies, and resources that those facilities may use to inform changes to their operations and care processes. Facilities should note that the information doesn’t replace state and local guidance for implementing crisis standards of care and sample tools and resources should be modified to locally adopted protocols as appropriate.

From CMS

CMS Reports Drop in Medicaid and CHIP Services Among Children During Pandemic
A report from the U.S. Centers for Medicare & Medicaid Services found that vaccines delivered through Medicaid and CHIP dropped by 22% in 2020 compared with the same point in 2019. Other changes include a 44% drop in child screenings, a 44% decrease in outpatient mental health services, and a 69% reduction in dental services.

CMS Releases Guidance on Safe Nursing Home Visits
CMS is encouraging outdoor visits with nursing home residents, and would allow for indoor visits if there have been no new COVID-19 cases in the past 14 days.

CMS Updates COVID-19 Testing Methodology for Nursing Homes
CMS updated its methodology used to determine the rate of COVID-19 positivity in counties across the United States. CMS states that the new methodology is intended to address state concerns over nursing home testing in rural areas, adding that the methodology “reduces burdens while still requiring [nursing] facilities to conduct testing at a frequency that can detect COVID-19 early to keep nursing home residents safe.” CMS guidance requires nursing homes to test staff for COVID-19 “at a frequency based on the positivity rate of their respective counties.”  

From OSHA

OSHA: Employees Have Eight Hours to Report Employee COVID-19 Deaths
The U.S. Occupational Safety and Health Administration issued a clarification that requires employers to report employee deaths due to COVID-19 within eight hours of learning of the fatality, if the fatality was due to the employee contracting the virus at the workplace. The requirement is listed under the "reporting" section of the OSHA COVID FAQ page.

From National Academies of Science, Engineering, and Medicine

National Academies Recommends Health Care Workers Be Among First Vaccinated
According to a consensus study conducted by the National Academies, Phase 1a of the distribution of a viable COVID-19 vaccine should include "front-line health workers (in hospitals, nursing homes, or providing home care); workers who provide health care facility services such as transportation and environmental services who also risk exposure to bodily fluids or aerosols; and first responders." Putting these workers first in line for vaccines is important, according to the report, because "this group has a critical role in maintaining health care system functionality, high risk of exposure to patients exhibiting symptoms of COVID-19, and higher risk of then transmitting the virus to others, including family members.

In the Media

Federal Government Steps Up Enforcement of COVID-19 Reporting Requirements
From NPR: "The federal government is preparing to crack down aggressively on hospitals for not reporting complete COVID-19 data daily into a federal data system, according to internal documents obtained by NPR. The draft guidance, expected to be sent to hospitals this week, also adds new reporting requirements, asking hospitals to provide daily information on influenza cases, along with COVID-19."

Special Panel on Nursing Homes Calls for More Aid
From The Washington Post: "The Trump administration convened a panel of nursing home operators and administrators, academics and state health officials to recommend ways to step up protections for nursing home residents amid the covid-19 pandemic, and this week it received the advice: More money for testing, for personal protective equipment, for registered nurses, for infection control training and staff salary increases."

New in Research

Organized Rehab Teams Key to Handling the COVID-19 "Rehabilitation Wave"
Clinicians with experience in treatment and rehabilitation of individuals with COVID-19 were asked to share their insights on care for this population. The report, published in the Archives of Physical Medicine and Rehabilitation, stresses high levels of interprofessional collaboration, but also acknowledges how local factors can influence treatment paths.

For Patients With COVID-19 in Acute Care, Treatment by PTs Makes a Difference in Outcomes
In a study published in PTJ, researchers tracked data from patients with COVID-19 admitted to 11 hospitals and found that increased physical therapy visits in the acute setting was associated with increased mobility at discharge as well as increased probability of being discharged to home.  

Disrupted Rehab Services Have Impacted Quality of Life for Breast Cancer Survivors
Researchers assessed 15 women who were survivors of breast cancer and experienced interruptions in their rehabilitation programs due to closures related to the COVID-19 pandemic. Even though some received telehealth services, nearly all reported higher levels of distress that resulted in reduced physical activity and quality of life. Authors of the article, published in Rehabilitation Oncology, call for further research "to validate optimal interventions including telehealth best practice to manage distress and QO: in a COVID-19 context."

Study of Function After SARS-CoV Infection May Have Implications for COVID-19
A systematic review of studies focused on physical function and fitness outcomes in individuals infected with Severe Acute Respiratory Syndrome-related Coronavirus found reduced levels of physical function, including a pattern of incomplete recovery of physical function and residual impairments that lasted up to two years after infection. Authors of the review believe the findings may be relevant to rehabilitation considerations for individuals recovering from COVID-19. The study was published in PTJ.

Novel Coronavirus Could Remain Active on Skin for Up to Nine Hours
A study published in Clinical Infectious Diseases found that the SARS-CoV-2 virus remained active for an average of 9.04 hours on skin surfaces, and 11.09 hours in "mucous conditions." The virus was inactivated on skin within 15 seconds by ethanol. Authors say the findings underscore the importance of proper hand hygiene.

Prone Positioning for COVID-19 Could Lead to Lasting Nerve Damage
Researchers studying patients with COVID-19 who underwent mechanical ventilation say they've found a link between extended prone positioning and peripheral nerve damage. In their study, published in the British Journal of Anaesthesiology, they write that among 12 patients admitted to a hospital for COVID-19 and prone-positioned, 11 developed peripheral nerve damage. The patients spent an average of 81.2 hours prone. While authors admit prone positioning may not be the sole cause of the damage, they believe it may play a significant role.


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