National emergency declared, with hospital provisions included, in response to the coronavirus

• The executive order asked hospitals to implement their emergency preparedness plans.
• It may allow suspension of the 25-bed limit for a facility to be designated as a critical access hospital, and of the requirement that CAHs limit care to 96 hours.
• Medicare plans to issue a ban on visitors to nursing homes.

President Donald Trump declared a national emergency on March 13 due to the new coronavirus, aiming to provide additional federal assistance to states, hospitals and other entities.

The declaration allows the administration to tap up to $50 billion to mitigate effects of the coronavirus. Other provisions of the order include:

• Asking hospitals to implement emergency preparedness plans
• Ordering states to each open their own emergency operations center focused on the coronavirus

The executive order also will provide “broad new authority” to Alex Azar, secretary of the U.S. Department of Health and Human Services (HHS), giving him the ability to waive:

• Laws and regulations to give providers more flexibility to respond
• Laws limiting the use of telehealth
• State licensing requirements so out-of-state physicians can help hard-hit areas
• Requirements that capacity at designated critical access hospitals (CAHs) be limited to 25 beds
• Requirements that CAHs limit stays to 96 hours
• The requirement that hospital stays last at least three days before Medicare will pay for nursing home care
• Restrictions on hospitals’ ability to bring in more physicians or get needed office space
• Restrictions on where hospitals can provide patient care within the facility

“They know what they have to do; now they [won’t] have any problem getting it done,” Trump said. “We’ll remove or eliminate every obstacle necessary to deliver our people the care that they need and that they are entitled to.”

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said the order would help with containment and mitigation of the virus.

“We still have a long way to go; there will be many more cases, but we will take care of that and ultimately, as the president said, this will end,” Fauci said at a White House news conference.

Seema Verma, administrator of the Centers for Medicare & Medicaid (CMS), said the waivers authorized by the executive order “are reserved for the rarest of circumstances, and they represent a massive mobilization of our country’s resources to combat this terrible virus.”

“The flexibilities we are offering will be a godsend to the providers, clinicians and facilities on the front lines of this fight,” Verma said.

Nursing home restrictions will be implemented

Verma said coming guidance will instruct nursing homes to temporarily restrict “all visitors and nonessential personnel, with a few exceptions for end-of-life situations.”

The coming policy would disrupt nursing home patients’ lives but are necessary to protect the vulnerable populations in those facilities, she said.

Chip Kahn, president and CEO of the Federation of American Hospitals, hailed the national emergency declaration for providing more resources, administrative flexibility and regulatory waivers “to help hospitals meet the possible surge of patients.”

“The threat of COVID-19 is rapidly evolving and will test our nation’s health system over the coming weeks and months,” Kahn said, referring to the disease caused by the new coronavirus. “The president’s action gives HHS Secretary Alex Azar the authority to make crucial decisions in a timely fashion that will enable caregivers to meet this challenge.”

Testing efforts are set to expand

A partnership with the private sector was announced to increase coronavirus testing capabilities. The Food and Drug Administration (FDA) approved a new test for the virus by drugmaker Roche, which expected to provide up to 500,000 tests early next week.

Another privately developed test may receive FDA approval within the next 24 hours, which would add capacity for a total of 1.4 million tests by next week, Trump said, and up to 5 million within a month.

In another testing-related development, several national retailers, including Walmart and CVS, have agreed to provide parking-lot space for coming mobile testing centers.

“The goal is for individuals to be able to drive up and be swabbed without having to leave your car,” Trump said.

That testing will be driven by a website that will screen users and then direct them to a mobile testing site.

Such capacity is in addition to that of state labs, academic medical centers and major health systems that are starting to perform testing, said Deborah Birx, MD, a coordinator for coronavirus response in the White House.

Birx said testing by LabCorp and Quest Diagnostics has found the virus in only 1% to 2% of those tested.

The executive order will authorize distribution of more supplies from the Strategic National Stockpile and allow hospitals to defer elective procedures if needed to treat surges of coronavirus patients, Birx said.

Trump praised sports leagues for ending seasons, employers for canceling work travel, colleges that have canceled in-person classes and local decisions to limit large gatherings.

“Over the coming weeks we’ll all have to make changes and sacrifices, but these short-term sacrifices will produce long-term gain,” Trump said.