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State and Federal Overview: the Novel Coronavirus (COVID-19), September 4, 2020

Federal Government
U.S. Cases - Provided by the New York Times
As of September 3rd at 6:00 PM:

Total Cases:
 6.1 million+
Deaths: 186,330
Includes confirmed and probable cases where available.
Congressional Budget Office
An Update to the Budget Outlook: 2020 to 2030. CBO projects a federal budget deficit of $3.3 trillion in 2020, more than triple the shortfall recorded in 2019, mostly because of the economic disruption caused by the 2020 coronavirus pandemic and the enactment of legislation in response.

Read the full release.
The Outlook for Major Federal Trust Funds: 2020 to 2030. CBO projects that the balances held by federal trust funds will fall by $43 billion in fiscal year 2020. Spending from the trust funds is projected to exceed income by $18 billion in 2021, a deficit that grows to $502 billion by 2030.
Read the full release.
Centers for Medicare & Medicaid Services
CMS Updates Medicare COVID-19 Snapshot. The Centers for Medicare & Medicaid Services (CMS) released our monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 773,000 COVID-19 cases among the Medicare population and nearly 215,000 COVID-19 hospitalizations. 
Other key findings:
  • The rate of COVID-19 cases among Medicare beneficiaries grew 40% since the July release to 1,208 cases per 100,000 beneficiaries.
  • Similarly, the rate of COVID-19 hospitalizations among Medicare beneficiaries grew 33% since the July release to 338 hospitalizations per 100,000 beneficiaries.
  • Weekly counts of COVID-19 cases and hospitalizations reached the lowest point to date in late June and began to increase in July.
  • The rate of COVID-19 cases and hospitalizations grew the most among disabled beneficiaries, Hispanic beneficiaries, and Medicare-only beneficiaries (those who are not dually eligible for Medicaid).
  • Medicare Fee-for-Service (Original Medicare) spending associated with COVID-19 hospitalizations grew to $3.5 billion or just over $25,000 per hospitalization.
  • Data on discharge status and length of stay for COVID-19 hospitalizations remained similar to previously reported figures in the July release. 29% of beneficiaries went home at the end of their hospital stay and 24% died. Nearly half of the hospitalizations lasted 7 days or less while 5% lasted more than 31 days.  
The updated data on COVID-19 cases and hospitalizations among Medicare beneficiaries covers the period from January 1 to July 18, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by August 14, 2020.
Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19) — Revised. CMS revised MLN Matters Article MM11623 on Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19) (PDF) to include 12 new procedure codes for therapeutics.
Department of Health and Human Services
Provider Relief Fund Application Deadline Extended Until 9/13/2020. This is a reminder that the deadline to apply for the Federal CARES Act Provider Relief Fund, Phase 2 General Distribution Funding, has been extended to Sunday, September 13th, 2020. Interested providers are encouraged to apply.  
More information on both programs is available here.
Food and Drug Administration
The U.S. Food and Drug Administration (FDA) continued to take action in the ongoing response to the COVID-19 pandemic:
  • Today, the FDA updated its guidance, “Investigational COVID-19 Convalescent Plasma,” to provide additional information related to the recently issued Emergency Use Authorization (EUA) for the use of COVID-19 convalescent plasma to treat hospitalized patients with COVID-19. This update includes a discussion regarding FDA’s intent to exercise temporary enforcement discretion regarding the IND requirements for the use of this product when blood establishments, hospitals, and health care providers collect plasma that does not meet the Conditions of Authorization of the EUA. The revised guidance continues to provide recommendations for health care providers who wish to administer and study convalescent plasma under an Investigational New Drug Application. In addition, the agency updated the web page, “Recommendations for Investigational COVID-19 Convalescent Plasma,” which also provides this information.
  • On September 1, 2020, the FDA approved an abbreviated new drug application for cisatracurium besylate USP 20 mg/10mL, which is indicated to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Side effects of cisatracurium besylate injection include bradycardia, hypotension, flushing, bronchospasm, and rash. This drug is listed in the FDA Drug Shortage Database. The FDA remains deeply committed to facilitating access to medical products that are experiencing increased demand.
  • As part of the FDA’s effort to protect consumers, the agency issued a warning letter jointly with the Federal Trade Commission to 1 Party At A Time for selling an unapproved product with fraudulent COVID-19 claims. The company sells BetterFly, a niacin containing product, with false or misleading claims that the product can mitigate, prevent, treat, diagnose, or cure COVID-19 in people. There are currently no FDA-approved products to prevent or treat COVID-19. FDA requested that 1 Party At A Time immediately stop selling this unapproved and unauthorized product. Consumers concerned about COVID-19 should consult with their health care provider.
  • Testing updates:
    • To date, the FDA has currently authorized 238 tests under EUAs; these include 192 molecular tests, 42 antibody tests, and 4 antigen tests. 
Centers for Disease Control and Prevention
Seroprevalence of SARS-CoV-2 Among Frontline Health Care Personnel in a Multistate Hospital Network — 13 Academic Medical Centers, April–June 2020: Summary
What is already known about this topic? Little is known about the prevalence and features of SARS-CoV-2 infection among frontline U.S. health care personnel.
What is added by this report? Among 3,248 personnel observed, 6% had antibody evidence of previous SARS-CoV-2 infection; 29% of personnel with SARS-CoV-2 antibodies were asymptomatic in the preceding months, and 69% had not previously received a diagnosis of SARS-CoV-2 infection. Prevalence of SARS-CoV-2 antibodies was lower among personnel who reported always wearing a face covering while caring for patients (6%), compared with those who did not (9%).
What are the implications for public health practice? A high proportion of SARS-CoV-2 infections among health care personnel appear to go undetected. Universal use of face coverings and lowering clinical thresholds for testing could be important strategies for reducing hospital transmission.
Read the report.
Federal Register Notice: Temporary Halt in Residential Evictions to Prevent the Further Spread of COVID-19. CDC Director Dr. Robert Redfield signed a declaration determining that the evictions of tenants could be detrimental to public health control measures to slow the spread of SARS-Cov-2, the virus that causes COVID-19. For more information on the order, follow this link.
Declaration Form here.
Applicability. Under this Order, a landlord, owner of a residential property, or other person with a legal right to pursue eviction or possessory action, shall not evict any covered person (see definition below) from any residential property in any jurisdiction to which this Order applies during the effective period of the Order.
This Order does not apply in any State, local, territorial, or tribal area with a moratorium on residential evictions that provides the same or greater level of public-health protection than the requirements listed in this Order. Nor does this order apply to American Samoa, which has reported no cases of COVID-19, until such time as cases are reported.
In accordance with 42 U.S.C. 264(e), this Order does not preclude State, local, territorial, and tribal authorities from imposing additional requirements that provide greater public-health protection and are more restrictive than the requirements in this Order. This Order is a temporary eviction moratorium to prevent the further spread of COVID-19.
This Order does not relieve any individual of any obligation to pay rent, make a housing payment, or comply with any other obligation that the individual may have under a tenancy, lease, or similar contract. Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract.
“Covered person” means any tenant, lessee, or resident of a residential property who provides to their landlord, the owner of the residential property, or other person with a legal right to pursue eviction or a possessory action, a declaration under penalty of perjury indicating that:
1) The individual has used best efforts to obtain all available government assistance for rent or housing;

2) The individual either (i) expects to earn no more than $99,000 in annual income for Calendar Year 2020 (or no more than $198,000 if filing a joint tax return),6 (ii) was not required to report any income in 2019 to the U.S. Internal Revenue Service, or (iii) received an Economic Impact Payment (stimulus check) pursuant to Section 2201 of the CARES Act;

3) the individual is unable to pay the full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, a lay-off, or extraordinary7 out-of-pocket medical expenses;

4) the individual is using best efforts to make timely partial payments that are as close to the full payment as the individual’s circumstances may permit, taking into account other nondiscretionary expenses; and

5) eviction would likely render the individual homeless— or force the individual to move into and live in close quarters in a new congregate or shared living setting— because the individual has no other available housing options.
Federal Emergency Management Agency
Coronavirus Pandemic Response: FEMA Releases New Policy for Declarations. FEMA released an interim policy to clarify eligible work under the Public Assistance program as part of the response to coronavirus (COVID-19) pandemic. The interim policy “COVID-19 Pandemic: Work Eligible for Public Assistance” is applicable to eligible applicants only and is exclusive to emergency and major disaster declarations for the COVID-19 pandemic. This policy applies to work performed on or after September 15, 2020.
FEMA releases this interim policy as part of the President’s March 13 nationwide emergency declaration and subsequent major disaster declarations for COVID-19. Because of these declarations, state, local, tribal, and territorial (SLTT) government entities and certain private non-profit (PNP) organizations are eligible to apply for assistance under the FEMA Public Assistance program. 
The interim policy defines the framework, details and requirements for eligibility of work and costs under the Public Assistance Program to ensure consistent and appropriate implementation across all COVID-19 emergency and major disaster declarations.  Only work associated with the performance of emergency protective measures specifically listed in this policy is eligible for Public Assistance in COVID-19-declared events.
Under the new policy, FEMA provides assistance for emergency protective measures in response to COVID-19 declared events, to include the following:
  • Purchase and distribution of Personal Protective Equipment (PPE) that is directly related to the performance of otherwise eligible emergency work, or is provided to healthcare workers, patients with confirmed or suspected COVID-19 infection, and first responders. 
    • Funding for stockpiling a supply of eligible PPE is limited to a 60-day supply from date of purchase.
    • Funding for storing eligible PPE is limited to what is necessary to store 60-day PPE supply.
  • Medical care, in accordance with COVID-19 specific policy – “COVID-19 Pandemic: Medical Care Costs Eligible for Public Assistance, Version 2 (Interim)” policy – being concurrently released or subsequent updates. 
  • Purchase and distribution of food, in accordance with COVID-19 specific policy or subsequent updates.
  • Non-congregate medical sheltering, in accordance with COVID-19 specific policy or subsequent updates.
  • Operation of Emergency Operations Centers to direct and coordinate resources and response activities for COVID-19 declarations.
  • Communications to disseminate public information regarding health and safety measures and provide warnings about risks and hazards.
  • Mass casualty management, including the storage of human remains and mass mortuary services needed to manage mass fatalities caused by COVID-19.
  • Assistance for other activities may be eligible when necessary to perform otherwise eligible emergency work listed in the policy; for example, the purchase and distribution of face masks, temperature screening, disinfecting in accordance with CDC guidance, and temporary physical barriers.
FEMA may provide Public Assistance funding to applicants for eligible work under the COVID-19 declarations that may also be eligible for funding under another federal agency’s authorities.  Potential Public Assistance applicants may have the flexibility to determine which source of funding to use for their costs, subject to the purpose and eligibility requirements of each of the federal programs and funding sources. 
The “COVID-19 Resource Summary Report” is a list of resources provided by the federal government since the start of the response to COVID and is designed to assist with recovery efforts. Partners should directly consult each agency’s program information to verify the applicability of a resource.
FEMA and Ad Council Urge Americans to “Make a Plan Today.” FEMA and the Ad Council have begun National Preparedness Month with new public service announcements informing Americans how they and their families can best prepare for disaster while accounting for the reality of COVID-19.
FEMA’s most recent National Household Survey finds nearly 60% of Americans perceive themselves to be prepared for a disaster emergency, and 10% still see no need to prepare. That’s why the theme of National Preparedness Month 2020 is “Disasters Don’t Wait. Make Your Plan Today.” It encourages people from all communities to prepare for the possibility of natural disasters, which could range from wildfires to hurricanes to tornadoes.
The 2020 campaign encourages parents and caregivers to visit to find tools and tips for making an emergency plan with their family. Ad agency Newfangled Studios created pro bono TV, radio spots, print, digital and out-of-home ads. The TV component of the campaign will feature a family preparing for disasters, to run on broadcast TV. 
This round of creative work for the Ready Campaign is the latest in 17 years of educating the American public about disaster and emergency preparedness
Each week of National Preparedness Month, the Ready campaign will emphasize a unique aspect of preparedness:
National Institutes of Health
NIH-supported study to track prevalence and impact of SARS-CoV-2 among pregnant women in low- and middle-income countries. The National Institutes of Health has launched a study to track the prevalence and impact of SARS-CoV-2 infection among approximately 16,000 pregnant women in seven low- and middle-income countries. The study will follow women through pregnancy and 12 months after childbirth to compare maternal, fetal and newborn outcomes of participants who have been infected with the virus to those of pregnant women who have not been infected.
At delivery, women enrolled in the study will receive an antibody test to determine if they have been exposed to SARS-CoV-2. Researchers hope to determine if infection increases the risk of complications such as preterm birth, fetal growth restriction, stillbirth, newborn death and birth defects. They also hope to assess participants’ knowledge and attitudes of COVID-19 during pregnancy, including safety, protective practices and prenatal care. Women in the study will also be invited to participate in a follow-up analysis to determine if maternal SARS-CoV-2 infection influences infant outcomes such as cerebral palsy, developmental delays and hearing and vision abnormalities. 
The study is being conducted by the Global Network for Women’s and Children’s Health Research, a group of clinical sites funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The participating countries are Guatemala, Bangladesh, India, Pakistan, Kenya, Democratic Republic of Congo and Zambia.
Learn more.
NIH continues to boost national COVID-19 testing capacity. The National Institutes of Health today announced $129.3 million in scale-up and manufacturing support for a new set of COVID-19 testing technologies as part of its Rapid Acceleration of Diagnostics (RADx) initiative. NIH is awarding contracts to nine companies for technologies that include portable point-of-care tests for immediate results and high-throughput laboratories that can return results within 24 hours. These tests add to initial awards made to seven companies on July 31, 2020.
In addition to NIH support, aspects of some of the testing technologies have been supported by the Biomedical Advanced Research and Development Authority (BARDA), also in the Department of Health and Human Services, and by the Defense Advanced Research Projects Agency (DARPA), in the Department of Defense.
Read the full release.
Department of Agriculture
Federal Communications Commission, U.S. Department of Health and Human Services, and U.S. Department of Agriculture Team Up for Rural Health Initiative. The Federal Communications Commission (FCC), U.S. Department of Health and Human Services (HHS), and U.S. Department of Agriculture (USDA) today announced that they have signed a Memorandum of Understanding to work together on the Rural Telehealth Initiative, a joint effort to collaborate and share information to address health disparities, resolve service provider challenges, and promote broadband services and technology to rural areas in America. This action delivers on President Trump’s recently signed Executive Order on Improving Rural Health and Telehealth Access. The ongoing coronavirus pandemic has highlighted the critical importance of telehealth in delivering quality healthcare to rural Americans.
Rural Americans are acutely affected by gaps in the healthcare system, from hospital closures to a lack of specialty care. According to the Centers for Disease Control and Prevention, rural Americans, who make up more than 15% of the U.S. population, face numerous health disparities compared with their urban counterparts. Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and strokes than their urban counterparts. Telemedicine plays an increasingly critical part in treating patients, improving health outcomes, lowering costs, and helping health care providers maximize their impact on their communities, especially in rural areas of the United States.
Read the full release.
Department of Labor
Unemployment Insurance Weekly Claims - Seasonally Adjusted Data. In the week ending August 29, the advance figure for seasonally adjusted initial claims was 881,000, a decrease of 130,000 from the previous week's revised level. The previous week's level was revised up by 5,000 from 1,006,000 to 1,011,000. The 4-week moving average was 991,750, a decrease of 77,500 from the previous week's revised average. The previous week's average was revised up by 1,250 from 1,068,000 to 1,069,250.
The advance seasonally adjusted insured unemployment rate was 9.1 percent for the week ending August 22, a decrease of 0.8 percentage point from the previous week's unrevised rate. The advance number for seasonally adjusted insured unemployment during the week ending August 22 was 13,254,000, a decrease of 1,238,000 from the previous week's revised level. The previous week's level was revised down by 43,000 from 14,535,000 to 14,492,000. The 4-week moving average was 14,496,250, a decrease of 709,000 from the previous week's revised average. The previous week's average was revised down by 10,500 from 15,215,750 to 15,205,250.

Read the release.
U.S. Department of Labor Awards $646 Million in Employment Service Grants to States. The U.S. Department of Labor announced the disbursement of $646 million in Employment Service Grants to improve the functioning of the nation’s labor markets by providing labor exchange services to all job seekers and helping businesses to meet their hiring needs by referring qualified workers.
The Wagner-Peyser Act of 1933, amended by the Workforce Innovation and Opportunity Act (WIOA), established the Employment Service, a nationwide system of public employment offices. The Employment Service serves job seekers in nearly 2,400 American Job Centers nationwide, providing services to all interested job seekers and businesses, and delivers reemployment services to unemployed individuals to help them return to work.
In January 2020, the Department made additional regulatory changes to the 2016 WIOA Final Rules to modernize the regulations implementing the Wagner-Peyser Act to align the regulations with the flexibility under WIOA, which allow states to tailor their staffing approach better when providing services in the Employment Service program.
Read the full release.
U.S. Department of Labor Provides $100 Million to States to Combat Unemployment Insurance Fraud. The U.S. Department of Labor announced $100 million in funding to support state efforts to combat fraud and recover improper payments in the Unemployment Insurance (UI) program, including those programs created under the Coronavirus Aid, Relief and Economic Security (CARES) Act.
At the same time, the Department’s Employment and Training Administration (ETA) issued UI Program Letter (UIPL) 28-20, which highlights tools and strategies to assist states in strengthening their anti-fraud operations, including the availability of a new identity verification solution to confirm the identity of individuals filing for unemployment benefits.
States are permitted to use this targeted funding for staff or contract services to conduct fraud investigations and other fraud detection-related activities, and to implement tools to increase prevention, detection and recovery of fraudulent improper payments in the PUA and PEUC programs.
The Department encourages state agencies to adopt new fraud prevention and detection strategies, and utilize Unemployment Insurance Integrity Center resources to enhance current fraud prevention operations. The Center’s Integrity Data Hub is a secure data cross-matching system, containing an array of effective fraud prevention and detection tools. The Hub’s new identity verification solution is now fully operational and available to all states. 
The Department encourages states to use these funds to enhance their PUA and PEUC fraud prevention efforts and to work with the Employment and Training Administration and the Unemployment Insurance Integrity Center to use these resources to address fraud aggressively in these programs.
Texas $2,041,200 $388,800
Read the full release.
The State of Texas
Health Care
Department of State Health Services
COVID-19 Case Count. The Texas Department of State Health Services (DSHS) is working closely with the Centers for Disease Control and Prevention (CDC) in responding to the new coronavirus disease 2019 (COVID‑19) that is causing an outbreak of respiratory illness worldwide. State case counts can be found by accessing the DSHS COVID-19 Dashboard.
Health and Human Services Commission
Stakeholder Update: COVID 19 & Hurricane Laura
Medicaid and CHIP Services September 3, 2020
Provider Relief Fund: Medicaid CHIP Distribution
  • The U.S. Department of Health and Human Services (HHS) expects to distribute $15 billion to eligible Medicaid and CHIP providers that have not yet received a payment from the Provider Relief Fund General Distribution allocation.
  • HHS has indicated the payment to each eligible provider will be at least 2 percent of reported gross revenue from patient care.
  • Instructions for the enhanced portal form and attestation can be found here.
  • For additional information, please call the Provider Support Line at (866) 569-3522. For TTY, dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday.
The deadline to apply has been extended to September 13, 2020.
Medicaid – Hurricane Laura: Texas Providers Serving Louisiana Medicaid Clients  
Updated Frequently Asked Questions for ALF Providers. HHSC LTCR has updated the Frequently Asked Questions about COVID-19 document for assisted living facilities.
The Texas Education Agency published the following:
Strong Start 2020-2021
FAQ and Guidance Tools, Templates and Resources  
Texas Home Learning Phase 3: 20-21 School Year Asynchronous and Synchronous Instruction
Attendance and Enrollment
Strong Start 2020-2021
FAQ and Guidance  
Strong Start 2020-2021
FAQ and Guidance Tools Templates and Resources
Energy and Water
The Electric Reliability Council of Texas published the COVID-19 Load Impact Analysis
Observations for Week Beginning 8/23
  • No COVID-19 impacts on daily peak demand
  • Weekly energy use decreased by 1%
  • Load reduction primarily during the early morning hours between 6 and 10 a.m.
Access the full analysis.
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