NDMA is collaborating closely with the ND Dept. of Health, ND Hospital Association and other partners to ensure that the physician community of North Dakota is well informed and has the resources to provide quality care to patients during the developing COVID-19 outbreak.
NDMA will continue to keep the physician community informed on efforts to prevent the spread of the virus.
HEALTH ALERT NETWORK
April 21, 2021
Update on SARS-CoV-2 Variants of Concern, Testing and Treatment for COVID-19
Ongoing surveillance for SARS-CoV-2 variants (variants) has resulted in the detection of 116 variants of concern as of April 19.
The North Dakota Department of Health (NDDoH) is providing this update on variant surveillance in North Dakota and other updates regarding testing for SARS-CoV-2.
Eighty-six reported variants are the B.1.1.7 variant, 29 of the California variants (B.1.427 and B.1.429) and one B.1.151 variant have been reported. Variants have been reported from 15 counties that are widely distributed throughout North Dakota
Variants are being reported out of Burleigh, Barnes, Cass, Grand Forks, Logan, McLean, Morton, Nelson, Richland, Sheridan, Stark, Traill, Walsh, Ward and Williams counties.
The United States Centers for Disease Control and Prevention (CDC) has classified SARS-CoV-2 variants into three broad categories.
1. Variants of Interest
a. Have genetic markers that are predicted to affect transmission, diagnostics, therapeutics or immune escape
b. Includes B.1.526, B.1.525 and P.2
2. Variants of Concern
a. Evidence of impact on diagnostics, therapeutics or vaccines along with disease severity and increased transmissibility
b. Includes B.1.1.7, B.1.351, B.1.427, B.1.429 and P.1
3. Variants of High Consequence
a. A variant of high consequence has clear evidence that prevention measures or medical countermeasures have significantly reduced effectiveness relative to previously circulating variants
b. There are currently no variants in this category in the United States
Data is emerging that some of these variants of concern can impact the effectiveness of monoclonal antibody therapy. COVID-19 cases at increased risk for severe disease and severe outcomes are recommended to receive monoclonal antibody therapy. On April 16, 2021 the Food and Drug Administration revoked the emergency use authorization for Bamlanivimab, when administered alone. More information can be found here.
The NDDoH Laboratory Services Section asks that positive COVID-19 samples are submitted for surveillance whole genome sequencing (WGS). Please submit for all hospitalized patients in addition to any outpatient specimens. This testing is for epidemiologic information only so no reports will be reported back to providers or patients.
Providers are encouraged to vaccinate their patients as soon as possible with any of the available vaccines. All the vaccines are showing high levels of efficacy against the B.1.1.7 variant. Although some studies have shown a reduction in neutralization of some variants by vaccine induced antibodies, all the vaccines are likely to be highly effective in preventing serious illness, hospitalizations and deaths. The Pfizer® vaccine is showing high efficacy against disease caused by the B.1.351 variant.
Testing continues to be play an important role in our response to COVID-19. Providers are encouraged to test patients who present with symptoms of COVID-19, including GI symptoms, that may be overlooked but have been identified as symptoms associated with SARS-CoV-2 infections.
As a reminder, providers need to consider GI symptoms in the differential of a COVID-19 diagnosis before clearing children and adults to go back to child-care, school or work.
The CDC guidance for treatment is available here. Providers who have questions, comments or suggestions may contact the NDDoH by calling 1-800-472-2180 or 701-328-2378.
April 16, 2021
FDA Revokes Emergency Use Authorization for Monoclonal Antibody Bamlanivimab
Alternative monoclonal antibody therapies authorized to treat patients with COVID-19 remain available.
Today, the U.S. Food and Drug Administration revoked the emergency use authorization (EUA) that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients.
Based on its ongoing analysis of emerging scientific data, specifically the sustained increase of SARS-CoV-2 viral variants that are resistant to bamlanivimab alone resulting in the increased risk for treatment failure, the FDA has determined that the known and potential benefits of bamlanivimab, WHEN ADMINISTERED ALONE, no longer outweigh the known and potential risks for its authorized use. Therefore, the agency determined that the criteria for issuance of an authorization are no longer met and has revoked the EUA.
Alternative monoclonal antibody therapies that continue to remain available under EUA, including REGEN-COV (casirivimab and imdevimab, administered together), and bamlanivimab and etesevimab, administered together, for the same uses as previously authorized for bamlanivimab alone. The FDA believes that these alternative monoclonal antibody therapies remain appropriate to treat patients with COVID-19 when used in accordance with the authorized labeling based on information available at this time.
Recent data from the U.S. Centers for Disease Control and Prevention’s (CDC) national genomic surveillance program show an increased frequency of SARS-CoV-2 variants that are expected to be resistant to bamlanivimab administered alone.
As of mid-March 2021, approximately 20% of viruses sequenced in the U.S. were reported as variants expected to be resistant to bamlanivimab alone, increasing from approximately 5% in mid-January 2021.
Additionally, there are currently no testing technologies available that enable health care providers to test individual patients for SARS-CoV-2 viral variants prior to start of treatment with monoclonal antibodies. Therefore, empiric treatment with monoclonal antibody therapies that are expected to work broadly against variants across the nation should be used to reduce the likelihood of treatment failure.
Wednesday, April 21, 2021 - 11:40 am
Burgum to lift COVID-19 emergency declaration on April 30; vaccination efforts remain top priority
BISMARCK, N.D. – Gov. Doug Burgum announced today he will lift North Dakota’s COVID-19 emergency declaration on April 30 as the state continues to shift the focus of its pandemic response efforts to increasing vaccination rates.
Burgum declared a state of emergency in response to COVID-19 on March 13, 2020, the same day then-President Donald Trump declared a national emergency and two days after North Dakota had confirmed its first case of COVID-19.
“Lifting this emergency declaration on April 30 recognizes the tremendous progress our state has made in protecting the most vulnerable, preserving hospital capacity and making safe, effective vaccines available to every eligible North Dakotan,” Burgum said. “Nearly 70% of North Dakotans ages 65 years and older have received at least one dose of the vaccine and 64% are fully vaccinated, including over 90% of long-term care residents. Our vaccination efforts remain a top priority as another wave of COVID-19 continues to spread across the country and world.”
The State of North Dakota currently has no enforced business or event protocols related to COVID-19, though local measures or orders may still be in place. A statewide mask requirement, implemented by the state health officer with Burgum’s support on Nov. 18 as hospitals and health care workers were overwhelmed with patients and COVID-related deaths were peaking, was lifted Jan. 18, making its 65-day duration the shortest among states that implemented such requirements.
“North Dakota has relied heavily on individual responsibility and local control throughout our pandemic fight. Mitigation measures were deployed strategically and kept in place long enough for vaccines to be made available to every eligible citizen,” Burgum said. “Our vaccination efforts will continue stronger than ever, and we encourage those who haven’t received the vaccine to consider getting it to protect themselves and their communities.”
Over 510,000 doses of COVID-19 vaccine have been administered in North Dakota, which has an estimated population of 762,000. More than 62% of North Dakotans ages 50 years or older have received at least one dose, and over 54% are fully vaccinated.
“While the emergency declaration is ending, the virus is still present in our communities,” Interim State Health Officer Dirk Wilke said. “We encourage North Dakotans to keep using the tools that got us here: physical distancing, wearing a mask when you can’t distance, getting tested and vaccinated.”
Lifting the emergency declaration on April 30 will eliminate the remaining pandemic-related executive orders. The Unified Command will be decommissioned effective April 30, however National Guard resources will continue to be available to support the Department of Health and local public health vaccination and testing efforts.
Waiting until April 30 to lift the declaration will allow the Legislature to pass pending legislation tied to pandemic-related executive orders that cut red tape and ensured assistance reached citizens, and will allow an orderly decommission of the Unified Command.
January 15, 2021
Burgum urges vigilance to keep COVID-19 numbers trending downward as statewide mask requirement expires Monday
December 2, 2020
Molly Howell, ND Dept. of Health Immunization Manager, shared the priority strategy on vaccine distribution. North Dakota has 68,864 health care works and 22,300 are employed with referral hospitals. The referral category will be on the top priority list to receive the vaccine. If everything goes according to plan, the ND Dept. of Health is expecting the Pfizer vaccine to reach North Dakota by December 14 with Moderna not far behind with an expected date of December 21st. Some sensitive issues for the vaccines are cold storage requirements and shelf life, once the vaccines are prepared for dispensing. Molly is expecting Pfizer's first week distribution dose to be 6,825; Moderna is estimated at 13,000 doses, noting that both companies will ship doses each week.
For a more detailed prioritization chart, you can learn more about the PHASE 1A for COVID-19 Vaccine here.
Molly also shared that the COVID-19 vaccination goal for North Dakota is to have 70% of eligible residents vaccinated to acquire herd immunity. The ND Dept. of Health shares this link to learn more about the vaccines.
November 6, 2020
COVIC Vaccine Planning Update
The following information regarding COVID Vaccine Implementation Planning for the week of November 2nd was released by the ND Dept. of Health.
401 healthcare provider sites enrolled to receive COVID-19 vaccine in North Dakota. If your facility is interested in giving COVID-19 vaccine in the future, please be sure to complete enrollment as soon as possible at https://www.health.nd.gov/immunization-guidance-health-care-providers.
The Advisory Committee on Immunization Practices (ACIP) discussed COVID-19 vaccine on Friday, October 30th. Below is some important information from that meeting.
COVID-19 Vaccine Update from Phase III Clinical Trials:
AstraZeneca : AZD1222 vaccine announced removal of FDA hold 10/23, resuming Phase III trials
Janssen: Ad26.COV2.S vaccine announced lifting of safety pause 10/23, resuming Phase III trials
Pfizer/BioNtech: BNT162b2 vaccine
42,133 participants enrolled as of 10/26/2020
35,771 participants have received their second vaccination
30% of U.S. participants enrolled have “diverse backgrounds”
Moderna: mRNA-1273 vaccine:
30,000 participants enrolled as of 10/22/2020
25,654 participants have received their second vaccination
Modeling strategies for the initial allocation of COVID-19 vaccine (phase 1B):
This group analyzed what the potential impact of prioritizing the COVID-19 vaccine to adults over 65, people at high risk for COVID-19, and/or essential workers would look like.
Initially vaccinating high-risk adults or essential workers in phase 1B averts approximately 1-5% more infections compared to targeting age 65+.
Initially vaccinating age 65+ in Phase 1B averts approximately 1-4% more deaths compared to targeting high risk adults or essential workers.
COVID-19 Vaccine Update from the ND COVID-19 Vaccination Planning Committee. See presentation here.
CDC COVID-19 Vaccine Website Updates:
The North Dakota Advisory Committee on COVID-19 Vaccine Ethics met Monday, November 2 and will meet again on Monday, November 9th at 11 am. This is an open meeting if you are interested in listening. Prioritization of healthcare worker vaccination will continue to be discussed at the upcoming meeting. See minutes here.
PrepMod, North Dakota’s mass vaccination software, goes live on Monday, November 9th. Additional information will be sent in the near future.
Do you have questions about COVID-19 vaccine or need help planning? Join the NDDoH immunization division for office hours every Monday at noon.
+1 701-328-0950 United States, Fargo (Toll)
Conference ID: 531 662 856#
HOSPITALS: Here is a tabletop exercise for your use. You are HIGHLY encouraged to walk through it with applicable staff in the next couple of weeks. If you would like a member of the NDDoH Division of Immunization to participate on your tabletop, please email your request to email@example.com.
Have you calculated your capacity for COVID-19 vaccination or your throughput? If not, please do so immediately.
How many staff do you have available for vaccination?
How many COVID-19 doses can each staff member give in an hour?
How many hours per week will they vaccinate?
Is this enough capacity to vaccinate the various priority groups (i.e., healthcare workers, patients)?
How can you increase your capacity for vaccination (i.e., student nurses, pharmacists/pharmacy interns/techs, partnerships)?
It is likely that Pfizer vaccine will be available first. It requires ultra cold chain storage or if refrigerated, has to be used within 5 days. How many doses could your facility give in 5 days?
COVID-19 vaccine code sets (CVX, NDC) for electronic medical records and immunization information systems were made available this week. Please share with applicable information technology staff.
During the 1918 flu pandemic, masks were controversial for "many of the same reasons they are today"
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More than a century ago, during the 1918 flu pandemic, there were some similar feelings about masks.
As Americans were celebrating victory in World War I in the fall of 1918, the masks on returning troops showed that the U.S. was losing another war against the so-called Spanish Flu.
Masks were controversial back then "for many of the same reasons they are today," said Nancy Tomes, a history professor at the State University of New York at Stony Brook.
They argued the ordinance was unconstitutional and that masks had not been proven effective. Some 2,000 people turned out for a rally at the Dreamland skate rink.
Other cities would mandate masks, including Denver, Seattle, Oakland, Sacramento and Phoenix. They were met with resistance too, but one major difference then was it wasn't political.
"There was disagreement between the various politicians about which businesses should get closed down, but the decision to mask or not to mask never became identified with a specific political party," Tomes said.
Although the materials used for masks in 1918 were less effective than those used today, according to Tomes, masks did lower the number of deaths when coupled with other measures like social distancing.
Health Alert Network
COVID-19 Reinfection Assessment and Investigation
On October 16, the North Dakota Department of Health (NDDoH) distributed a Health Alert Network Health Advisory sharing information on COVID-19 reinfection:
Immune response, including duration of immunity, to SARS-CoV-2 infection is not fully understood. There are limited data about reinfection with SARS-CoV-2 after recovery from COVID-19. At this time, it is unclear if susceptibility to reinfection may be high, as with other coronaviruses that cause the common cold, or if immunity may be longer lasting, as observed with MERS-CoV or SARS CoV-1.
It is not recommended to test asymptomatic individuals for SARS-CoV-2 during the first three months after their most recent illness or infection (onset date if symptomatic or specimen collection date if asymptomatic).
For persons who previously tested positive for SARS-CoV-2 by RT-PCR, have clinically recovered, and later tests positive again by RT-PCR, please consider the following when assessing for possible COVID-19 reinfection:
Individual Remains Asymptomatic
- Positive tests that occur less than 90 days after symptom onset could represent a new infection or a persistently positive test associated with the previous infection.
Individual With COVID-like Symptoms
- Positive tests that occur 45 days or more after a person’s symptom onset or specimen collection date, clinicians should consider the possibility of reinfection.
Until we have more information, the determination of whether a patient with a positive test in any of these situations represents a possible reinfection should be made on a case-by-case basis. Because reinfection investigation my take some time, public health actions such as isolation, contact tracing, work furlough, and long-term care outbreak testing initiation, may take place immediately.
Persons who have recovered from COVID-19 and later are identified as a close contact within 3 months of symptom onset or specimen collection date of their most recent infection, do not need to be quarantined or tested for SARS-CoV-2. However, if it has been 3 months or more, they should follow quarantine recommendations for close contacts.
NDMA and ND Long Term Care Association Appeal to Governor on Considering Mask Policy
On October 20th, the North Dakota Medical Association, along with the ND Long Term Care Association teamed up and appealed to Governor Doug Burgum to consider endorsing more stringent guidelines when it comes to protecting the safety and well-being of our patients and residents during the COVID-19 pandemic.
This comes at a crucial time as COVID-19 infections are escalating and voluntary efforts have proven to not be effective, even though mounting evidence continues to grow showing that masks work.
Thursday, October 15, 2020
North Dakota Physicians Offer Pandemic Health Advice
The Physician Advisory Group, which began meeting as part of the North Dakota Medical Association in August, is taking action to help get the word out on steps the public can take to prevent the spread of COVID-19. This letter was also a topic of discussion during NDMA's Annual Meeting Policy Forum.
The letter endorses care for the whole self to optimize health. In times of crisis, like this pandemic, this is more important now than ever. Part of the letter stresses avoiding the spread using this equation:
Infection = Exposure to Virus x Time
Based on this equation, the following strategies are effective in limiting the spread of Sars-CoV- 2:
- Minimize virus in the air we all breathe by:
- Limit crowd density- fewer people per square foot = fewer breaths/sq. foot and less likelihood of infected person in that space
- Limit time in public places- less time in one spot=less breaths of recirculated air that may contain Sars-CoV-2 virus.
- Mask use- this reduces (not eliminates) the amount of droplets (which carry the virus) released when you breathe, speak, sing etc. The fewer droplets in the air, the less virus in the air. The greater percentage of people wearing masks in a given setting, the less virus in the air.
- Increase air exchange/filtration of air- This air movement helps to disperse/dilute the amount of virus in a given air space.
- Stay home and isolate when infected with Sars-CoV-2- This confines your viral air to your small space that is inhabited by only you.
- Quarantining of those with exposure to an infected person that is significant enough to merit risk of infection has the potential to limit this person’s spread of virus through the air to others at a time when this person may be infected and contagious, but not feel symptoms.
- Minimize virus on surfaces– Note that this is NOT the primary route of transmission, but does contribute to transmission
- Wash your hands frequently
- Do not touch your face- If you have to touch your face, please wash your hands before and after.
- Frequently disinfect surfaces.
- Stay home and isolate when infected with Sars-CoV-2- This confines your virally contaminated surfaces to your small space that is inhabited by only you.
- Quarantining of those with exposure to an infected person that is significant enough to merit risk of infection has the potential to limit this person’s spread of virus via contaminated surfaces to others at a time when this person may be infected and contagious, but not feel symptoms.
The Physician Advisory Group (PAG) is asking physicians from across the state to participate by adding their signature to the document. The letter and list of supporting physicians can be viewed here. This listing will be continually updated to reflect the latest physician signatures.
If you, as a physician, choose to add your name, CLICK HERE.
Tuesday, October 20, 2020
NDDoH takes action to prioritize faster results on COVID-19 tests, adjust contact tracing process
September 24, 2020
September 23, 2020
State Health Officer Mariani Amends Close Contacts Order
Interim State Health Officer Dr. Paul Mariani today amended a state-wide order expanding the quarantine order to all close contacts. This follows the Centers for Disease Control and Prevention (CDC) guidance. The North Dakota Department of Health has always recommended close contacts quarantine to reduce the spread of COVID-19, but previously the order referred only to household contacts.
“Whenever possible, all close contacts of individuals infected with COVID-19 should stay home for 14 days past the last day they were in contact with the person who tested positive,” said Mariani. “Individuals who are named as close contacts and comply with their quarantine are actively protecting older adults in their community. These are our parents and grandparents. Quarantine is not convenient, but it is necessary.”
The order continues to allow essential workforce exemptions for individuals who are close contacts of people testing positive for COVID-19. Exempt individuals include essential critical infrastructure workers as defined by the United States Department of Homeland Security.
For the most updated and timely information and updates related to COVID-19, visit the NDDoH website at www.health.nd.gov/coronavirus.
September 23, 2020
Taking Further Action to Address COVID-19 Cases at Long-term Care Centers
The North Dakota Department of Health (NDDoH) is adjusting COVID-19 testing and contract tracing strategies to address a recent uptick in confirmed coronavirus cases among residents and staff at long-term care facilities.
The State Lab is using the state’s Vulnerable Population Protection Plan (VP3) team to assist in strategic adjustments, including:
- Testing of long-term care residents and staff has been prioritized over all other testing, and every effort will be made to return results from long-term care tests within 24 hours of testing to allow for immediate isolation and cohorting, or grouping together, of positive residents and staff and quarantine of close contacts.
- The NDDoH will begin to implement a plan to use emergency medical technicians (EMTs) and others to conduct test swabbing and is prioritizing approximately 200 nurses from the NDDoH’s Department Operations Center to provide staff coverage as needed in long-term care facilities and other congregate settings.
- The federal government is providing the state with Abbott BinaxNOW point-of-care testing that can be used at long-term care facilities that will assist facilities when residents and health care workers present with symptoms.
June 11, 2020
QUICK RESOURCE LINKS:
- Clinician and Patient Resources
- UND COVID-19 Response
- Guidance for Health Care Workers Who Recently Traveled or have Travel Plans
- Travel Quarantine Orders for the Public
You can easily navigate the latest information by using the bulleted links below:
PHYSICIAN RESOURCE: COVID-19 Update
UPDATE APRIL 2
UPDATE MARCH 26
UPDATE MARCH 20:
As a result of the ND Dept. of Health Coronavirus (COVID-19) Health Advisory Group, the ND Dept. of Health may modify guidance recommendations. This update covers the following:
- Guidance for the routine use of surgical masks and gloves
- Routine screening form for health care workers
- Guidance for health care workers exposure
- Travel guidance for health care workers
On Wed., April 1, President Donald Trump granted Gov. Burgum's request for a major presidential disaster declaration to make federal assistance available to support North Dakota’s response to the COVID-19 pandemic.
“We are deeply grateful to the President and his administration for making this assistance available to help us expand our response efforts and protect public health as the COVID-19 pandemic rapidly evolves,” Burgum said. “We also appreciate the support from our state’s congressional delegation and the many local, state, federal and tribal partners contributing to this unprecedented effort.”
The declaration makes federal funding available to state, tribal and eligible local governments and certain private nonprofit organizations for emergency protective measures, including direct federal assistance.
On Tuesday, March 24, the NDMA Council met and targeted high-priority issues that have the potential to impact how physicians provide care to patients. Some pressing issues being closely monitored are as follows:
- Elective or “non-essential” surgery: it is the official position of NDMA that determining whether or not to continue with a procedure or surgery is best left between the physician and patient, keeping in mind the guidance from the Centers for Medicare and Medicaid Services (CMS).
- Use of hydroxychloroquine, or other pharmaceuticals, as a Coronavirus (COVID-19) treatment or prophylactic measure: a committee was appointed to closely monitor progress.
- Telehealth payment parity: NDMA supports payment parity to ensure that physicians are reimbursed for telehealth services at the same rate as in-person services. Medicaid and Medicare both provide payment parity. NDMA will be monitoring progress of private payer health plans.
Board of Pharmacy Expresses Concerns on Dispensing Hydroxychloroquine as COVID-19 Prevention Treatment
UPDATE ON HYDDROXYCHLOROQUINE - APRIL 2, 2020:
The North Dakota Department of Health is advising health care providers to be aware of severe illness in people who have ingested non-pharmaceutical chloroquine phosphate. This is a product sold for aquarium use.
Health care providers should report illness or death in patients due to ingestion of these products to the North Dakota Department of Health at 701.328.2378.
The North Dakota Department of Health is recruiting medical personnel to staff facilities such as, long-term care centers, hospitals, and alternate care locations, as needs arise for surging during the COVID-19 pandemic.
Deployment dates and times will be determined at the time of need. HOWEVER, AT THE TIME OF THIS RELEASE, the ND Dept. of Health is not in a state of deployment.
Physicians available and willing to be deployed must be registered in the ESAR-VHP program. Please register at the following link: http://www.ndhealth.gov/EPR/HP/PHEVR/ as soon as possible.
MOBILE MEDICAL TEAM CONCEPT:
Hospital Mobile Medical Teams, which include physicians, nurses and support personnel will be mobilized from unaffected areas of the state.
HOSPITAL MOBILE MEDICAL TEAM LICENSE & CREDENTIALS:
- Team members will be registered in the ESAR-VHP system
- Team members will be appropriately licensed and credentialed
MOBILE MEDICAL TEAM FUNCTION:
Team members will provide treatment in an existing medical facility (hospital, long term care, or other alternate care) in ND.
- The team would provide levels of care based on mission, resources and setting.
- Team members would work up to 12 hours per shift, be sustainable for up to 72 hours, and deployable for up to 14 days.
For more information, contact Kelly Nagel, ND Dept. of Health Director, Systems and Performance at 701.328.4596; or email firstname.lastname@example.org
On Thursday, March 19, North Dakota Gov. Doug Burgum signed an executive order suspending state requirements related to licensure of health care professionals. Health care providers receiving a licensure waiver include physicians and surgeons, nurses, pharmacists behavioral specialists and a number of other workers - who are licensed and in good standing in another state - will be able to practice as needed in North Dakota.
The temporary licensure waiver allows health care professionals in good standing in another state to practice in North Dakota, as needed, without going through the North Dakota licensure process.
Gov. Burgum stressed that during the state of public health emergency, health care professionals in good standing in states other than North Dakota, may be needed to provide treatment to citizens and residents of long term care facilities impacted by COVID-19.
The executive order includes provisions for telehealth services and states (d) insurance carriers shall not subject telehealth coverage, including virtual check-ins and e-visits for established patients, to deductible, coninsurance, copayment or other cost sharing provisions. (e) no insurance carriers shall impose any specific requirements on the technologies used to deliver telehealth, cirtual check-in and e-visit services (including any limitations on audio-only or live video technologies) that are inconsistent with these requirements.
Learn more about reported North Dakota Coronavirus (COVID-19) cases here.
MARCH 26, 2020 - UPDATE:
The group is chaired by 6th district President Joan Connell, MD. This week’s discussion focused on:
- Modification of personal protective equipment (PPE) used in routine patient care
- Modification of current recommendations for exposed healthcare workers
- Question whether fatigue and myalgia should be eliminated in symptom list for Covid-19 health care workers (HCW)
- Current testing strategy clarification: consensus was that health care providers should perform COVID-19 testing in patients who are suspicious of being infected, particularly if they meet the criteria.
MARCH 19, 2020 - UPDATE:
The Physicians Advisory Group discussed the following:
- Drive up testing is being set up in various health care systems across the state
- Emergency preparedness of incident commands and staff
- Personal Protective Equipment (PPE) Institutions seem to be unaware of medical cache
- Updated testing guidance- recommendations:
- assure testing sites know they can use ONE swab for influenza and coronavirus-19
- Only ONE nasopharyngeal swab is required
- Criteria for testing will be expanded to include ambulatory patients with fever, cough OR fatigue/malaise
- Recommending that those with ONLY sore throat and stuffy nose DO NOT get tested
- Shortage of testing supplies- especially swabs
- Removal from isolation
- CDC guidance: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
- Agreed with non-testing recommendation made by CDC for people who are NOT healthcare workers
- Healthcare workers still need to follow CDC criteria, which includes TWO sequential negative tests
- Healthcare personnel travel restrictions and quarantine after travel
- Strongly discouraged domestic and international air travel.
- Those returning from level 3 countries still need to follow CDC guidelines of home quarantine for 14 days
- Airborne vs. droplet precautions
- Continue airborne precautions for now, but reconsider if PPE supply is getting low
- Discontinuation of elective surgeries, non-urgent procedures, etc.
- This decision be left to the individual health care organization
- Moving forward with plans for telehealth visits with mobile immunization strategy
ND Dept. of Health COVID-19 Testing Criteria can be viewed here.
The ND Dept. of Health held many news conferences keeping North Dakotans informed of the latest coronavirus (COVID-19) updates. Shown left to right: NDMA member Joan Connell, MD (at the podium); Governor Doug Burgum; and Dept. of Health, Health Officer Mylynn Tufte.
Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.
Health care providers no longer need to call the NDDoH Division of Disease Control prior to testing. Providers must complete a COVID-19 Evaluation and Test Report Form and the Test Request Form (page 2). Both forms must be included with the specimen.
If the COVID-19 Evaluation and Test Report Form is not included with the specimen, that specimen may move to the bottom of the queue if specimens need to be prioritized. Health care providers should NOT refer patients to the ND Dept. of Health for medical consultation or screening to determine the need for testing.
Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.
These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings.
While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.
The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.
Yes, ND Medicaid covers telemedicine services, including those that originate from a member or provider’s home. More information about telemedicine coverage is available in the telemedicine section of the General Information for Providers Manual.
If the member’s home is used as the originating site, no originating site fee may be billed to ND Medicaid. If the visit originates from a clinic, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility, the originating site fee may be billed to ND Medicaid.
Services not covered via telemedicine: therapies provided in a group setting, store and forward, targeted case management for high risk pregnant women and infants and targeted case management for individuals in need of long-term care services. Providers should use codes as noted in LEARN MORE.
US Department of Health and Human Services
Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency.
OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification is effective immediately.
A Congressional Update:
AMA, AHA and ANA Appeal to Congress for $1 Billion in Coronavirus Emergency Funding Response
In a letter to House and Senate leaders, the American Hospital Association, American Medical Association and American Nurses Association requested the next economic stimulus package include funding "to ensure that hospitals, health systems, physicians and nurses are viable and directly supported for preparedness and response."
The healthcare provider groups said they're committed to working with all stakeholders to respond to COVID-19, the illness caused by the novel coronavirus.
House Passes Law
On March 14, by a vote of 363-40, the U.S. House of Representatives approved a second, bipartisan Coronavirus aid package, the Families First Coronavirus Response Act (H.R. 6201). The U.S. Senate is expected to consider the House-passed package, with potential amendments, the week of March 16.
Changes to Temporary Increase in Federal Medical Assistance Percentages (FMAP) for Medicaid; Increased Allotments for Territories. The amendment would temporarily increase federal Medicaid funds to states and territories by increasing the FMAP percentage for each state and territory by 6.2%, with some changes to the state maintenance of effort requirements to ensure greater coverage. As in the previous language, the period for the increase would begin in the calendar quarter of the emergency period and end in the quarter when the emergency period ends. States would be required to meet certain conditions to receive the FMAP increase, including:
- Maintaining eligibility requirements no more restrictive than the eligibility standards and methodologies in place as of Jan. 1, 2020;
- Maintaining premium amounts that do not exceed those in place as of Jan. 1, 2020; and
- Providing coverage without cost-sharing for COVID-19 testing and testing-related services during the emergency period.
The amendment would modify more restrictive language in the previous version to provide coverage for individuals (both those currently enrolled as of the date of enactment, and those who enroll during the emergency) until the emergency period is lifted. Coverage during this period would end only if the individual terminates coverage or is no longer a resident of the state. Eligibility reviews for income and other criteria would not apply during this emergency period.
Medicaid Coverage for the Uninsured
The amendment would create a new, optional Medicaid eligibility category for uninsured individuals. Uninsured individuals — defined as not eligible for Medicaid and not enrolled in group, individual or public coverage — could be enrolled in Medicaid and receive COVID-19 testing services. This is limited to diagnostic services, and does not include treatment or preventive care. This coverage is eligible for a 100% FMAP, including administrative expenses provided the state can demonstrate administrative expenses were attributable to this population. The amendment removes language from the previous version regarding Section 1135 waiver authority and Medicaid coverage.
Given the nature of the COVID-19 outbreak, seeking in-person medical care may lead to further spreading of the virus. BCBSND has encouraged the use of telehealth. As part of BCBSND’s commitment, BCBSND has further expanded telehealth services to all products effective March 16, 2020. A significant majority of products have already instituted this expanded set of telehealth services, but to reduce confusion and create consistency all products will have the expanded telehealth benefit during the COVID-19 pandemic.
Blue Cross Blue Shield Association President and CEO, Scott Serota issued the following statement announcing full coverage of telehealth services for members.
“The safety and security of our members – and of all Americans – remains our paramount priority during these unprecedented times. On Thursday, March 19, Blue Cross and Blue Shield (BCBS) companies announced a new policy regarding telehealth services that ensures members have swift access to the care needed to get and stay healthy – at no cost to them.
All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services.
The BCBS Association encourages you to contact your in-state BCBS plan for a full understanding of breadth of services since coverage may vary.