Two new orders bolster health care workforce and telehealth

The Administration of Governor Janet Mills has taken two actions to promote Maine people’s access to health care in response to COVID-19, which bolster the health care work force and facilitate the expansion of telehealth.

“I am committed to ensuring that Maine people have access to quality, affordable health care as we respond to COVID-19,” said Governor Mills. “As a result of these actions, I am hopeful that more Maine people will be able to get counseling, prescriptions, and treatment from their trusted health care providers from the safety of their homes whenever possible and without sacrificing other basic necessities.”

“These changes advance Maine’s role as a national leader in supporting telehealth and make it possible for more of our patients and health care providers to connect online and over the phone rather than in person,” said Department of Health and Human Services Commissioner Jeanne Lambrew. “We stand ready to work with providers to ensure patients can get the health care they need, especially with so many Maine people staying home to help prevent the spread of COVID-19.”

First, Governor Mills has signed an Executive Order (PDF) allowing licensed physicians, physician assistants, and nurses greater flexibility to contribute to Maine’s response during the civil state of emergency. Those who are licensed and in good standing in other states can now:

• Receive an emergency license to provide health care in person or through telehealth to Maine people, with no application fee
• See Maine patients through telehealth without obtaining a Maine license, if already serving those patients at out-of-state locations
• Have their licenses automatically renewed if up for renewal during the state of emergency
• Suspend conforming to physician oversight requirements (for physician assistants and advanced practice registered nurses)
• Reactivate their license immediately with no application fee, if retired.

Additionally, all physicians, physician assistants and nurses licensed in Maine and those authorized under the order may provide services through all methods of telehealth, including video, audio and other electronic technologies to treat Maine people for all medical needs. The order expands acceptable technologies beyond only those that are compliant with patient privacy laws, to align Maine with major changes made by the federal government that provide broad coverage for telehealth services for Medicare members.

In addition to this Executive Order, the Administration’s second action also aligns Maine with federal guidance and improves the affordability of needed health care services delivered through telehealth. To implement the Governor’s initiative, Superintendent of Insurance Eric Cioppa on Friday signed an order that requires insurance companies to provide coverage for clinically-appropriate services delivered by telephone, as well as via more commonly used apps, such as FaceTime, WhatsApp and Skype, as long as they are private. This provides flexibility to patients who may not have access to web-based applications traditionally used for telehealth.

“The telehealth order allows health care providers greater options in delivering care to Mainers,” said Cioppa. “The change will allow people to have virtual house calls, providing them with the health care they need, while at the same time maintaining social distancing.”

The Superintendent’s order also requires insurance carriers to pay providers for telehealth services at the same rate they would pay for an in-person visit for the same service. This supports health care providers who are following national and state recommendations to postpone in-person appointments for non-urgent care and makes it more likely that patients will be able to get the care they need through telehealth visits.

MaineCare, or Medicaid, already pays the same rate for most covered services whether delivered in person or through telehealth. Last week, the Maine Department of Health and Human Services (DHHS) announced an expansion of this already robust policy through an emergency rule change that allows for prescribing through telehealth. Maine DHHS has long supported the promotion of telehealth services, as described in a new fact sheet.

The Insurance Superintendent’s authority extends only to fully-insured health plans -- not to Medicare Advantage or self-insured plans. The Governor urges all self-insured large employers in Maine to adopt the same policies to ensure their employees continue to get the care they need.

DHHS Commissioner Jeanne Lambrew and the Northeast Telehealth Resource Center will host a statewide virtual statewide Telehealth Town Hall meeting on Thursday, March 26 for health providers to explain these changes and announce a range of resources (PDF) available to support them in using telehealth services.

Additionally, DHHS reconstituted a statewide Telehealth Advisory Committee in 2019 to promote consistent practices across health care payers, use of tele-psychiatry in emergency departments, and use of telehealth for new workforce models.

Letter to Leader McConnell, Speaker Pelosi, Leader Schumer,and Leader McCarthy

Emergency Order #16: Temporary prohibition on scheduled gatherings of 10 or more attendees

Governor Sununu's letter to McConnell and Pelosi

Concord, NH – Today, Governor Chris Sununu issued Emergency Orders 11, 12, 13, 14, and 15, as part of the state's efforts to respond to COVID-19.

Emergency Order #11: Temporary authority to perform secure remote online notarization.

Emergency Order #12: Temporary modification of public access to meetings under RSA 91-A.

Emergency Order #13: Temporary allowance for New Hampshire pharmacists and pharmacies to compound and sell hand sanitizer over the counter ("OTC") and to allow pharmacy technicians to perform non-dispensing tasks remotely.

Emergency Order #14: Temporary authorization for out-of-state pharmacies to act as a licensed mail-order facility within the State of New Hampshire.

Emergency Order #15: Temporary authorization for out of state medical providers to provide medically necessary services and provide services through telehealth.

Governor also urges large essential businesses to limit in-store customers, enhance curbside pick-up and delivery services, and implement physical distancing measures to protect customer and employee health

Under the authority granted to her during a State of Civil Emergency, Governor Janet Mills today issued an Executive Order (PDF) mandating that all non-essential businesses and operations in Maine close their physical locations that are public facing, meaning those that allow customer, vendor or other in-person contact. The Order also closes non-essential business sites that require more than ten workers to convene in a space where physical distancing is not possible. Non-essential businesses and operations may continue activities that do not involve these types of in-person contact and convenings, and should facilitate the maximum number of employees working remotely.

The Order is effective tomorrow, March 25, 2020 at 12:01 a.m. and extends for a period of 14 days through April 8, 2020 at 12:00 a.m.

It solidifies as a mandate her previous recommendation to close non-essential business sites.

Governor Mills also strongly urged all large, essential, public-facing businesses to immediately employ strategies to reduce congestion in their stores, including limiting the number of customers in the store at any one time and enhancing curbside pick-up and delivery services. These measures, aimed specifically at high-traffic retail stores in Maine that provide essential goods and services, seek to better protect both customers and employees from the threat of COVID-19.

“Today, I am taking further action to mitigate the spread of the virus, to protect the health of our loved ones and fellow citizens, and to safeguard the capacity of our health care system,” said Governor Mills. “I recognize these decisions will create significant difficulties for people and businesses across our state, but we are confronting an unprecedented challenge that is threatening the health and safety of our people.”

“Maine people should live their lives as if COVID-19 is in their community,” said Nirav D. Shah, Director of the Maine Center for Disease Control and Prevention. “Physical distancing in every part of Maine is crucial to limit potential spread of the virus. You can be there for loved ones without being in the same place.”

Governor Mills continues to strongly urge all Maine people to practice physical distancing. She particularly urged Maine residents who are considered at higher risk from COVID-19, such as older Mainers and those with underlying health conditions, to limit physical interactions with other people as much as possible.

Non-essential businesses and operations subject to the Governor’s Executive Order include, but are not limited to, shopping malls, fitness and exercise gyms, spas, barber shops, hair salons, tattoo and piercing parlors, massage facilities, nail technicians, cosmetologists and estheticians, electrolysis services, laser hair removal services, and similar personal care and treatment facilities and services.

The Executive Order excludes businesses that provide essential services including, but not limited to: food processing, agriculture, industrial manufacturing, construction, trash collection, grocery and household goods (including convenience stores), home repair and hardware and auto repair, pharmacy and other medical facilities, biomedical, behavioral health and health care providers, child care, post offices and shipping outlets, insurance, banks, gas stations, laundromats, veterinary clinics and animal feed and supply stores, shipping stores, public transportation, and hotel and commercial lodging.

State government remains open, but offices have significantly moved to telework and dispatch from home, limited client engagement, and have required physical distancing within office buildings. The Department of Administrative and Financial Services estimates that 70 percent of state government employees, not including 24/7, emergency, and public safety personnel, are working remotely. The Governor urges Maine people to avail themselves of the state’s online services and resources.

For those essential businesses that remain open, Governor Mills strongly urged them to implement physical distancing measures. She specifically urged high-traffic retail stores in Maine that provide essential goods and services to immediately employ strategies to reduce congestion in their stores, including:

• For stores with a physical retail space of more than 5,000 feet, limiting customers to no more than 100 at any one time;
• Enhancing their curbside pick-up and delivery services;
• Staggering their hours for shoppers of a certain age;
• Closing fitting rooms;
• Cautioning customers against handling merchandise they are not purchasing;
• Marking six-foot measurements by the cashier stations and reminding customers to remain six feet apart while in store;
• Staggering break times for employees and require frequent hand-washing;
• Frequently sanitizing high-touch areas, such as shopping carts.

These measures come as Governor Mills seeks to strengthen physical distancing measures in Maine to better protect both customers and employees from the threat of COVID-19. Physical distancing is considered one of the most effective methods to help mitigate the spread of COVID-19.

If the function of your business is not listed, but you believe that it is essential, you may request designation as an essential business at https://www.maine.gov/essentialservice

Questions may also be directed to business.answers@maine.gov.

To align with today’s Executive Order, Governor Mills today also renewed her previous Executive Order prohibiting gatherings of more than ten people and the closure of dine-in service at restaurants and bars in Maine to extend its timeframe to April 8, 2020 at 12:00 a.m. Today’s Executive Order does not modify the previous Executive Order in any other manner.

Governor Mills is taking into consideration all COVID-19 response options, including a stay-at-home restriction. She is consulting with the Maine CDC, other clinicians and health system leaders, other states that have invoked this option, and other members of her Coronavirus Response Team. Those discussions are ongoing, and include, but are not limited to the public health efficacy of such orders compared to existing measures, Maine-specific factors, and their potential secondary health and economic implications. The Governor will make recommendations based upon their advice and what she deems is in the best interest of the health and safety of Maine people.

The Governor has taken steps to protect Maine workers and small businesses impacted by COVID-19. Upon Governor Mills’ request, the Small Business Administration (SBA) declared that Maine businesses are now eligible to apply for economic support loans to help them overcome any temporary loss of revenue due to COVID-19. Additionally, the emergency omnibus package she signed temporarily revises eligibility for unemployment insurance to extend it to individuals whose employment has been impacted by COVID-19. It also temporarily waives the one week waiting period for benefits so that workers may obtain benefits faster and ensures that claims for UI will not affect an employer’s experience rating. It also establishes a consumer loan guarantee program through FAME, in partnership with financial institutions, to provide low- or no- interest loans for eligible people in Maine.

These new steps from the Governor build on the work done by the Mills Administration to respond to COVID-19, including:

• Convening a Coronavirus Response Team, led by Maine CDC Director Dr. Nirav Shah and comprised of key individuals in the Mills Administration, to coordinate State government’s response across departments and local agencies and health authorities;
• Signing a proclamation of civil emergency to bring the State of Maine to highest alert and allowing her to deploy all available state resources to protect the health and safety of Maine people and to take every action she reasonably deems necessary to help respond to and protect against the spread of COVID-19 in Maine. The proclamation also eased Maine’s access to critical federal aid to boost response efforts.
• Signing into law a $73 million supplemental budget proposal that protects the health and well-being of Maine people as the State responds to COVID-19;
• Signing into law a package of emergency measures granting her access to at least $11 million in State funding to respond to COVID-19, expanding authorities of State and local officials to allow them greater flexibility to respond to the virus, and provide support to Maine workers impacted by the virus.
• Mandating that all restaurants and bars statewide close to dine-in customers until midnight, March 31, 2020 and prohibiting all gatherings of more than 10 people until further notice.
• Distributing personal protective equipment (PPE) to first responders and health care professionals across Maine as it becomes available andpressing the Federal government to provide more PPE and testing supplies to the State of Maine.
• Issuing a Declaration of Abnormal Market Disruption, drafted in close consultation with Attorney General Aaron M. Frey, to prohibit price gouging of certain necessities;
• Declaring a health insurance emergency to require health insurance carriers providing health care coverage in Maine’s commercial market to cover costs related to coronavirus testing and increase access to care.
• Directing the Maine Department of Health and Human Services to issue emergency rules to ensure MaineCare does not charge copays for office visits and prescription drugs that may be needed for COVID-19 diagnosis and treatment, and to allow for a prescription refill of up to 90 days so people have to make fewer visits to pharmacies.
• Recommending ending classroom instruction in all public schools as soon as reasonably practical
• Applying for and receiving a waiver from the U.S. Department of Agriculture to allow schools the ability to provide meals offsite to students, if the school or community currently has, or qualifies for, a USDA Summer Food Service Program.
• Recommending hospital systems and health care providers across Maine postpone non-urgent medical procedures, elective surgeries, and appointments until further notice.
• Recommending all long-term care providers prohibit all visitors and non-essential health care personnel; except for certain compassionate care situations such as an end of life situation, until further notice.
• Pressing President Trump to marshal the resources of the federal government to support Maine’s vital fishing and seafood industries.
• Convening a call with Maine’s Congressional delegation to discuss the State’s response to COVID-19 and the Congressional delegation’s ongoing work to support those efforts.
• Temporarily suspending non-essential, out-of-state travel for all State employees and reviewing leave policies and telecommuting options.
• Launching a 211 option for Mainers to get answers to questions about COVID-19 at any time. This service is available by dialing 211 (or 1-866-811-5695), texting your ZIP code to 898-211, or emailing info@211maine.org.

For more information on Maine’s response to COVID-19 and updated testing results, visit the Maine CDC website.

The best thing that Maine people can do to protect their health is to practice physical distancing and take the same preventive measures that avoid catching a cold: Wash your hands often for 20 seconds. Cover coughs and sneezes. Stay home if you are sick. Symptoms of COVID-19 include fever, shortness of breath, and lower respiratory distress. Call ahead to a health care professional if you develop a fever and symptoms of respiratory illness.Health care providers will make the initial determination on whether COVID-19 testing is necessary.

An update to our community.    As we continue to see new cases of COVID-19 in New Hampshire, today we'd like to share some ways you can help prevent the spread of infection in your home and community.     If You Have Symptoms    If you are experiencing common symptoms of COVID-19, such as fever or cough, please CALL your primary health care provider. For your safety and the safety of others, please do not come to an urgent care clinic or emergency room unless you have been instructed to do so.     For patients experiencing moderate to severe symptoms of COVID-19 or other respiratory illnesses, your provider may direct you to visit the Respiratory Clinic at Wentworth-Douglass Hospital, located outside our Emergency Department, for further evaluation, testing, and treatment.    The availability of timely and accessible testing for COVID-19 continues to be a concern. To preserve supplies so we can best serve those most in need, the hospital will ONLY test individuals who meet specific testing criteria. We will update the community if that changes.  Social Distancing  It is important to remember, since most people who get this virus have only mild to moderate symptoms—and don't realize they are infected—they can transmit the virus to more vulnerable people, like the elderly. To stop widespread transmission and to avoid overwhelming the health system, we are all encouraged to practice social distancing —or staying away from groups of people.  Here's how:  DON'T go to any group events or locations with 10 or more people.  DO get out in nature. Taking a walk in the fresh air is also a healthy habit.  DON'T go to work if your employer permits you to work from home.  DO wash your hands frequently with soap and water (at least 20 seconds).  Preventing the Spread of COVID-19 at Home  Most cases of COVID-19 are mild and patients are able to treat their symptoms at home. If you have confirmed or suspected COVID-19 and have been cleared to return home, here are tips to prevent spreading it to other household members while you are self-isolating.  Restrict activities outside your home, except for getting medical care.  Remain under home isolation until instructed by your doctor.  Separate yourself from other people and animals in your home.  Wear a facemask.  Cover your coughs and sneezes.  Clean your hands often.  Avoid sharing personal household items.  Clean all “high touch” surfaces such as counters, railings, doorknobs, and phones, every day.  Read more about Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities on the CDC's website.   We can all do our part to help slow the spread of transmission by practicing good public health habits, including maintaining social distancing, washing hands frequently, and staying home if you are sick.   Please visit our Coronavirus Updates page for more detailed information.

Dear Chamber Members,

This past week has certainly changed our lives and our businesses, but we have been impressed by those who are finding creative ways to support one another through this challenging time. As your local home health and hospice care provider, we are here for you and we are taking significant steps to ensure the health and well-being of our staff, patients, community members, and health care partners. Additionally, we recently added a new page on our website to provide important information and resources. Please visit https://cornerstonevna.org/covid-19/ to see how we are responding to COVID-19, and contact us at 4info@cornerstonevna.org if you have a business that we can include as a helpful resource for our patients and families.

 

Thank you,

Cornerstone VNA

ATTN: ALL BREWERY, RESTAURANT, BAR, & TAPROOM EMPLOYEES

Impacted by the COVID-19 Crisis

Stripe Nine Brewing Co. Will Be Offering a Free Artisan Wood-fired Pizza to Anyone Whose Job was Affected In the Local Service Industry. Pick Up/To Go Only. No Congregating Please. One Pizza Per Individual.

An Assorment of Cheese, Buffalo Chicken, Veggie and Meat Lovers Pizzas Will Be Offered While Topping Supplies Last. All Ticketed Guests Will Receive a Pizza.

PLEASE RESPECT THAT THIS EVENT IS FOR THOSE IN THE LOCAL BREWERY, RESTAURANT AND BAR INDUSTRY WHO HAVE LOST THEIR JOB BECAUSE OF THE COVID-19 CRISIS.

YOU MUST HAVE AN EVENT TICKET, A RECENT PAY STUB AND POSITIVE ID TO BE SERVED.

8 SOMERSWORTH PLAZA, SOMERSWORTH, NH

Friday, March 20, 2020 AT 6PM

Stripe Nine Brewing Co.

PLEASE RSVP HERE:

https://www.eventbrite.com/e/stripe-nine-pizza-for-service-industry-event-tickets-100435685840