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    Global health leaders discussed the challenges of climate change and widening inequality during low cost viagra the closing keynote sssion, 'Climate Change, Social Determinants of Health. Leading Recovery and low cost viagra Preparing for the Future'.The speakers were Prof Jan Semenza, lead of the Health Determinants Programme, European Centre for Disease Prevention and Control (ECDC) in Sweden, Professor Prof Sam Shah, founder &. Director, Faculty of Future Health in the UK, Dr Hans Kluge, regional director for Europe, WHO in Denmark and Hal Wolf, president and CEO, HIMSS, US. WHY IT MATTERS HIMSS20 Digital Learn on-demand, earn credit, find products low cost viagra and solutions. Get Started >>.

    It is predicted that low cost viagra climate change will cause around 250,000 additional annual deaths between 2030 and 2050. The combined effect of climate change, and increasing inequality, could lead to a more divided world. This could exacerbate the impact of social and low cost viagra environmental determinants of health, for example, clean air. Safe drinking water. Sufficient quantity and quality of low cost viagra food.

    Secure shelter. And access to low cost viagra quality health and care services.ON THE RECORDProfessor Jan Semenza said climate change would impact health. €œExtreme weather events such as heat or rising sea levels are modulated by a number of vulnerabilities, or factors, such as the human capital in the human population, social capital, financial capital, fiscal capital and natural capital. Exposure can cause injuries, fatalities, drownings, heat- related mortality, morbidity, displacement low cost viagra. A whole slew of different kinds of risks”.

    Semenza said a Matched Case Control Study was carried out between 1992 and 2012 in Denmark, low cost viagra Finland, Norway and Sweden to determine whether excess precipitation could mobilise and transport pathogens, leading to water-borne outbreaks. This showed there was an association between heavy precipitation events and water-borne outbreaks.Dr Hans Kluge, WHO, said. €œThe relationship between health and economic development and low cost viagra social cohesion, is linked to climate change. An economy of wellbeing is a fair and environmentally friendly society where everyone has his social safety protector and where health does not put on an economic burden but is a job creator.What citizens legitimately, and reasonably, expect from the health authorities is to guarantee the fundamental right to universal health coverage. But for that you low cost viagra need solidarity.

    If solidarity does not come from the heart, it should come from the brain because no-one is safe until everyone is safe”.Hal Wolf, HIMSS, said. €œThe stark realisation from COVID-19 is that borders have nothing to with the spread of disease low cost viagra and no-one is safe until everyone is safe. We do not understand how to bring the most basic healthcare and the most basic service to each and every village, and every country, around the world. We are going to continue to create vulnerabilities that will start someplace else, spread across the borders and really put everyone in jeopardy, so this idea that strong economies will remain strong and invulnerable to the hardships of individuals, who don’t have the same capabilities, or low cost viagra luxuries, just isn’t true.”He said digital health might help. €œIt is one of the big equalisers.

    We will face shortages of primary care physicians and clinicians so we have to create, through digital health, some of those equalisers, which can spread all the way down to the most basic phone in the most basic low cost viagra village and that’s a positive step forward.“ Professor Sam Shah, faculty of Future Health in the UK also recognised the potential impact of digital to help citizens access services. However, he questioned whether the right technology was reaching the right people but concluded that the digital divide was “probably just a transitory state”. However, he warned that wider society low cost viagra was becoming increasingly divided. €œCOVID-19, if anything, has exacerbated, highlighted and exposed the widening of inequalities in society. The gap between those who low cost viagra have and those who have not.

    The results of this are very different, in everything from life expectancy, outcomes and access to services.”Shah said that climate change could cause a range of problems such as respiratory illness, cardiovascular disease, injuries, and premature death. He also believed it would have an impact on low cost viagra mental health and wellbeing. He said the wider social determinants of health, such as education, employment and housing, could significantly affect health, particularly mental health.Access sessions from the HIMSS &. Health 2.0 European Digital Conference 'On Demand' and find all the latest news and deveopments from the event here.Hyland, a Westlake, Ohio-based content services and enterprise imaging technology vendor, signed a definitive agreement to acquire content services platform Alfresco this week.The move follows Hyland's acquisition low cost viagra of German robotic process automation software developer Another Monday this past month."We continue to grow our business and advance our platform organically and via acquisitions," said Bill Priemer, president and CEO of Hyland, in a statement.WHY IT MATTERSHyland, which provides content services for a variety of industries – including financial services, government, higher education, insurance and healthcare – has products in use at more than half of Fortune 100 companies, says the vendor.Its cloud-based, SaaS platform includes security features such as version control, data classification and at-rest data encryption, according to the company's website.Expected to close in the fourth quarter of 2020, Alfresco's entire business of cloud-native content services solutions for enterprises with large volumes of unstructured content will likely be managed under Hyland."With this acquisition Alfresco brings significant geographic and industry experience to Hyland as well as an open source community as a new source of product innovation," said Jay Bhatt, president and CEO of Alfresco. Another Monday, meanwhile, houses four complementary software products for automation, including tools for automatic process documentation, development, conduction and monitoring."The RPA market is an exciting and challenging space with rapid growth and a vast number of possible applications that organizations can easily combine and integrate for better and more flexible business processes support," said Hans Martens, CEO of Another Monday, in a statement."We see Hyland as the best fit to embed our RPA technology into their powerful automation platform, to truly implement easy, end-to-end automation for everyone," Martens continued.Hyland also this past month announced new enhancements to its platform, including updated mobile capabilities and an improved upgrade process.THE LARGER TRENDSusan deCathelineau, senior vice president of healthcare sales and services at Hyland, told Healthcare IT News earlier this year that unstructured information – such as clinical documents, narratives, consents and images – has largely been overlooked when it comes to interoperability concerns.

    She also pointed to artificial intelligence as a needed complement to physicians overwhelmed by data and noted that moving to the cloud was an essential shift for the healthcare industry."The hesitancy that used to surround cloud adoption in healthcare now is being replaced low cost viagra by the realization of its ultimate inevitability. Once again, this shift in mindset largely has to do with data overload," she said.Hyland had at the time recently acquired the blockchain-credentialing vendor LearningMachine, another in a string of acquisitions dating back years.ON THE RECORD"This acquisition will expand our global reach, enabling us to help more organizations achieve their digital transformation goals and become more informed, empowered and connected," said Priemer in a statement. Kat Jercich is low cost viagra senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.With the increasing spread of COVID-19 infections, the governor of Arizona low cost viagra declared a moratorium on “elective surgeries” on March 19, 2020, in order to conserve hospital PPE supplies and build capacity for potential COVID-19 patients needing hospitalization.The moratorium lasted for six weeks and was finally lifted on May 1, 2020.

    The end of the suspension resulted in a backlog of more than 3,000 surgical procedures at Phoenix Children’s Hospital.THE PROBLEM HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >> low cost viagra. “While it is true that elective surgeries are typically nonurgent, many of these are medically necessary and important for a child’s health and well-being,” explained Dr. Vinay Vaidya, chief medical information officer at Phoenix Children’s Hospital.“Besides the delay in surgery for the patient, deferring all elective surgeries put a major financial low cost viagra strain on hospitals across the country. The challenge we had to address was how to resume the thousands of deferred surgeries, in addition to the new surgeries that were being added each day.”These operations needed to be conducted in a timely and efficient manner while ensuring utmost safety for patients and healthcare providers.

    The scheduling of surgeries is a complex process that involves many low cost viagra players and requires a series of sequential and interdependent actions. The COVID-19 pandemic added magnitudes of complexity to each step in this process.“This was an unprecedented situation that needed coordination across our entire system of care, from executive leadership to surgeons, anesthesiologists, nursing staff, operating room staff, schedulers, and ultimately patients and their families,” Vaidya said.“We needed to build a common communication highway, based on information technology, that would provide real-time visibility through the entire scheduling process, and to all stakeholders.”PROPOSALOnce the moratorium on elective surgeries was lifted, the process of rescheduling the backlog of more than 3,000 cases could begin.Clearly, what was needed was much more than simply throwing additional scheduling staff to work through the backlog one patient at a time, Vaidya said. Amidst a pandemic, staff had to rewrite the rules of how a surgical scheduling process would unfold.“Based on our previous experience of successfully using information technology in general, and data analytic dashboards in particular, it was evident at the very outset that we would need a similar approach to address the complex low cost viagra logistics,” he said. €œThe solution to resuming these surgeries was the development of a proprietary dashboard, which could facilitate the entire triage of operations.”MEETING THE CHALLENGEGiven the challenges posed by COVID-19, it was important to take into consideration a number of factors such as. The type of surgery, low cost viagra medical necessity and need for hospital/ICU stay, Vaidya explained.

    These elements needed to be balanced with the availability of PPE, adequate staffing, general and ICU bed availability, and ventilator availability, while ensuring the highest standards of safety for patients and hospital staff.“Using a careful and well-planned approach, a surgical prioritization was developed and uniformly communicated to all surgical teams,” Vaidya said. €œTo support the assignment of surgical priority for 3,000-plus cases, a new dashboard low cost viagra was created. This technology allowed each surgeon to review all their respective cases, and rapidly assign a priority of high, medium or low to all the backlogged cases, as well as new cases.”As this data was captured electronically, it was used to feed a separate dashboard created specifically for the schedulers, who found it easy to work through the list, based on surgical priority. This significantly improved the efficiency of the process, allowing staff to low cost viagra schedule a much higher number of patients each day than previously possible."The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations."Dr. Vinay Vaidya, Phoenix Children’s Hospital“For those patients who were successfully scheduled for surgery, it was mandatory to test them for COVID-19 in the 72 hours preceding the date of surgery,” Vaidya noted.“This process was also facilitated using the dashboard, which displayed the patients who were scheduled for COVID-19 testing, those who completed the test, and those who tested negative and were finally cleared for surgery.

    It also identified patients who tested positive for COVID-19 and needed to have their surgeries postponed.”The entire end-to-end electronic process provided a single enterprise-wide view that allowed streamlined tracking of the patient throughout the multiple steps, not unlike that of an Amazon package, right from ordering to final delivery, Vaidya described.“This also obviated the need for inefficient and time-consuming internal communication via emails, phone calls and spreadsheets between the surgeons, operating room staff and the low cost viagra schedulers,” Vaidya said. €œThe dashboard thus became the de facto central hub and the single source of truth, updated in real time, and extensively used across the entire organization, from the frontline staff right up to senior leadership.”Vaidya added that it is important to point out that the hospital was able to accomplish all of this very quickly.“We already had in place an existing robust data warehouse structure that was receiving feeds from almost every information system used in the hospital, including live feeds from our EHR,” he said. €œIn addition, much of the data needed for the dashboards had already been prepackaged into ready-to-use analysis cubes that had been previously built for other surgical projects preceding COVID-19.”Finally, a couple of data analysts who were already proficient in rapidly building visually informative, interactive, actionable dashboards using Microsoft’s Power BI software, were able to deliver the dashboards in record time.RESULTSThe one success metric of this project that stands out is that the hospital was not only able to catch up quickly on the backlog of surgeries, but actually ended up performing 166 more surgeries in June and July of this year, compared with the same period last year – 4,199 low cost viagra versus 4,033 – Vaidya reported. This volume speaks to the approach. An extensive use of data, analytics and dashboards to support every stage of the process, from surgeon prioritization to scheduling, testing and finally low cost viagra surgery, he added.“Among the numerous types of surgeries performed during this challenging period, it is worth highlighting the results of our surgical volumes for two very complex surgeries,” he said.“Phoenix Children’s Hospital is nationally recognized as a center of excellence, and draws patients from all across the country for Pectus surgery, done to correct chest wall deformities, and Scoliosis surgery, to correct abnormal spine curvature.

    Both are complex, long-duration surgeries that require a hospital stay, and are often planned months in advance to coincide with school summer break.”In the case of Scoliosis surgery, the hospital succeeded in performing more surgeries this year during May through August compared with the same period last year, 95 versus 91. The results low cost viagra for Pectus repair surgery were even more noteworthy. The surgical teams outperformed by 41% the number of surgeries performed this year from May to August compared with the same period last year, 72 versus 51.“The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations,” Vaidya said. €œThroughout this project, given that patient and provider safety was our highest priority, it is important to point out that no surgeon or anesthesiologist has tested positive for COVID-19 since surgery restarted – a testament to extensive safety protocols that were supported by dashboard usage at every stage.”ADVICE FOR OTHERSThe success of this project no doubt depended on the low cost viagra collaboration and cooperation of many different teams, Vaidya said. However, its foundation was built upon the optimum use of data analytics, and dashboard technology, to provide precise, real-time, actionable information to all the key players, he added.“Fortunately, most hospitals and health systems have developed their electronic capabilities over the last 10 years and are sitting on a trove of data,” he said.“Ensuring that the multiple, often disparate, information systems in a hospital setting all feed their data to a common data warehouse platform allows for optimum use of this data,” he explained.

    €œMining the data, and providing it to frontline users via intuitive interfaces, turns it into actionable intelligence that produces results.“As IT professionals, we have been promising our health providers that data can be used to produce higher quality outcomes,” low cost viagra he added. €œUsing technology in the resumption of surgeries is a perfect example of delivering on this promise.”Twitter. @SiwickiHealthITEmail the writer low cost viagra. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication..

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    Speaking at an in-person meeting in the Assembly hall, Tijjani Muhammad-Bande go recounted some of the important initiatives the 74th session had conducted throughout the coronavirus pandemic.“The General Assembly successfully organized socially distanced elections for the General Assembly Presidency, the Security Council, different types of viagra and the Economic and Social Council (ECOSOC). Furthermore, we employed virtual methods to gather stakeholders from around the world on Charter Day, and once again at the multi-stakeholder hearing on the occasion of the 25th anniversary of the Fourth World Conference on Women”, he detailed. The virusMr different types of viagra. Muhammad-Bande also applauded the World Health Organization (WHO) for “leading the response from the outset”.“Today’s meeting takes place as many people suffer and bear great losses due to the COVID-19 pandemic”, he said. €œThe entire UN system has rallied to address the different types of viagra needs of the people we serve”.

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    Muhammad-Bande also applauded the World Health Organization (WHO) for “leading the response from the outset”.“Today’s meeting takes place as many people suffer and bear great losses due to the COVID-19 pandemic”, he said. €œThe entire UN system has rallied to address the needs of the low cost viagra people we serve”. The UN official gave “particular thanks” to humanitarian workers in the field as well as UN Peacekeepers, “who continue to protect communities in the most complex environments around the world”.

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    Muhammad-Bande told the journalists that it low cost viagra had been a privilege to serve as the President of the 74th session of the Assembly, expressing his confidence that the targets set out in the 2030 Agenda for Sustainable Development would be realized if everyone continues to strive together, and deliver for all. UN Photo/Eskinder DebebeTijjani Muhammad-Bande, President of the the 74th session of the UN General Assembly..

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    Scott Gottlieb, i loved this former Commissioner of the FDAAdam can i get viagra over the counter at walmart Jeffery | CNBCDr. Scott Gottlieb, former FDA chief under President Donald Trump, said on Sunday that the new guidance from the Centers for Disease Control and Prevention to not test asymptomatic people for Covid-19 was "unfortunate" because those people could be at high risk of contracting the infection. "We should be testing those people to make sure they haven't become infected and aren't asymptomatic carriers because we know that they can spread the infection," Gottlieb said in an interview on CBS' "Face the Nation." "They're less can i get viagra over the counter at walmart likely to spread the infection, but they can still spread the infection."Earlier this month, the CDC quietly revised its guidance on coronavirus testing and dropped its previous recommendation to test everyone who has come into close contact with an infected person, even those who don't have symptoms.The move drew immediate criticism from medical groups and allegations of political motivation. Two federal health officials reportedly said the CDC was pressured into changing the guidance by top officials at the White House and Department of Health and Human Services.Medical experts and lawmakers say that early and widespread testing of people without symptoms can help mitigate the spread of the virus.

    Gottlieb said that one reason can i get viagra over the counter at walmart for the CDC's decision could is viagra safe be that businesses were requiring people to test negative for the virus before they can return to work. He said he doesn't think the new guidance will likely be followed by states. "If that's the case and that was a concern, there were more targeted ways to address that and can i get viagra over the counter at walmart speak to that problem, as opposed to making this very broad, sweeping change in the recommendations, which I think could be misinterpreted by the general public and certainly by public health agencies within states," Gottlieb said. "And so I don't think this changed guidance is likely to be followed by many states." "I think it's prudent that we test people who might be at high risk of contracting the infection," Gottlieb added.

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    Scott Gottlieb, former Commissioner of the FDAAdam Jeffery | CNBCDr low cost viagra http://www.amisdepasteur.fr/viagra-price-per-pill/. Scott Gottlieb, former FDA chief under President Donald Trump, said on Sunday that the new guidance from the Centers for Disease Control and Prevention to not test asymptomatic people for Covid-19 was "unfortunate" because those people could be at high risk of contracting the infection. "We should be testing those people to make sure they haven't become infected and aren't asymptomatic carriers because we know that they can spread the infection," Gottlieb said in an interview on CBS' "Face the Nation." "They're less likely to spread the infection, but they can still spread the infection."Earlier this month, the CDC quietly revised its guidance on coronavirus testing and dropped its previous recommendation to test everyone who has come into close contact with an infected person, even those who don't have symptoms.The move drew immediate criticism from medical groups and allegations of political low cost viagra motivation.

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    Today, under the leadership of President Trump, the U.S how to get viagra. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to nursing homes. This distribution is the latest update in the previously announced $5 billion in planned support to how to get viagra nursing homes grappling with the impact of COVID-19. Last week, HHS announced it had delivered an additional $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs. Other resources are also being dedicated to support training, mentorship and safety improvements in nursing homes."The Trump Administration has focused resources throughout our response on protecting the most vulnerable, including older Americans in nursing homes," said HHS Secretary Alex Azar how to get viagra.

    "By tying these new funds for nursing homes to outcomes, while providing the support they need to improve quality and infection control, we will help support quality care, slow the spread of the virus, and save lives."Nursing homes have been particularly hard hit by this pandemic. By tying continued relief payments to patient outcomes, the Trump Administration is demonstrating its commitment to preserving the lives and safety of America's seniors, who are especially vulnerable to COVID-19. Nursing homes will not have to how to get viagra apply to receive a share of this $2 billion incentive payment allocation. HHS will be measuring nursing home performance through required nursing home data submissions and distributing payments based on these data.QualificationsIn order to qualify for payments under the incentive program, a facility must have an active state certification as a nursing home or skilled nursing facility (SNF) and receive reimbursement from the Centers for Medicare &. Medicaid Services (CMS) how to get viagra.

    HHS will administer quality checks on nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS) to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities must also report to at least one of three data sources that will be used to establish eligibility and collect necessary provider data to how to get viagra inform payment. Certification and Survey Provider Enhanced Reports (CASPER), Nursing Home Compare (NHC), and Provider of Services (POS).Performance and Payment CycleThe incentive payment program is scheduled to be divided into four performance periods (September, October, November, December), lasting a month each with $500 million available to nursing homes in each period. All nursing homes or skilled nursing facilities meeting the previously noted qualifications will be eligible for each of the four performance periods. Nursing homes will be assessed based on a full month's worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the prior month's performance period.MethodologyUsing data from the Centers for Disease Control and Prevention (CDC), HHS will measure nursing how to get viagra homes against a baseline level of infection in the community where a given facility is located.

    CDC's Community Profile Reports (CPRs) include county-level information on total confirmed and/or suspected COVID-19 infections per capita, as well as information on COVID-19 test positivity. Against this baseline, facilities will have their performance measured on two outcomes how to get viagra. Ability to keep new COVID infection rates low among residents. Ability to keep COVID mortality low among residents.To measure facility COVID-19 infection and mortality rates, the incentive program will utilize data from the National Healthcare Safety Network (NHSN) LTCF COVID-19 module. CMS issued guidance in early May requiring that certified nursing facilities submit data to the NHSN COVID-19 how to get viagra Module.

    Data from this module will be used to assess nursing home performance and determine incentive payments.HHS will continue to provide more updates as it works to assist providers in slowing the spread of infection while simultaneously offering financial support to these frontline heroes combating the pandemic. Funding for this nursing home incentive effort was made possible from the $175 billion Provider Relief program funded through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act how to get viagra. Incentive payments will be subject to the same Terms and Conditions applicable to the initial infection control payments announced last week (available here).For updates and to learn more about the Provider Relief Program, visit. Hhs.gov/providerrelief.Start Preamble Start Printed Page 55292 Centers for Disease Control and Prevention (CDC), Department of Health how to get viagra and Human Services (HHS). Agency Order.

    The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) announces the issuance of an Order under Section 361 of the Public Health Service Act to temporarily halt residential evictions to prevent the further spread of COVID-19. This Order is how to get viagra effective September 4, 2020 through December 31, 2020. Start Further Info Nina Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H21-10, Atlanta, GA 30329. Telephone. 404-639-7000.

    Email. Cdcregulations@cdc.gov. End Further Info End Preamble Start Supplemental Information Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S. Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths.

    Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease. The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal.

    People of any age with certain underlying medical conditions, such as cancer, an immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health. According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these best efforts, COVID-19 continues to spread and further action is needed. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease.

    Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition. They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19. The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19.

    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 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. Renter's or Homeowner's Declaration Attachment A is a Declaration form that tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions to prevent the further spread of COVID-19 may use. To invoke the CDC's order these persons must provide an executed copy of the Declaration form (or a similar declaration under penalty of perjury) to their landlord, owner of the residential property where they live, or other person who has a right to have them evicted or removed from where they live.

    Each adult listed on the lease, rental agreement, or housing contract should likewise complete and provide a declaration. Unless the CDC order is extended, changed, or ended, the order prevents these persons from being evicted or removed from where they are living through December 31, 2020. These persons are still required to pay rent and follow all the other terms of their lease and rules of the place where they live. These persons may also still be evicted for reasons other than not paying rent or making a housing Start Printed Page 55293payment. Executed declarations should not be returned to the Federal Government.

    Centers for Disease Control and Prevention, Department of Health and Human Services Order Under Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2 Temporary Halt in Residential Evictions To Prevent the Further Spread of COVID-19 Summary Notice and Order. And subject to the limitations under “Applicability”. Under 42 CFR 70.2, 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 from any residential property in any jurisdiction to which this Order applies during the effective period of the Order. Definitions “Available government assistance” means any governmental rental or housing payment benefits available to the individual or any household member.

    €œAvailable housing” means any available, unoccupied residential property, or other space for occupancy in any seasonal or temporary housing, that would not violate Federal, State, or local occupancy standards and that would not result in an overall increase of housing cost to such individual. €œCovered 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),[] (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 extraordinary [] 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. €œEvict” and “Eviction” means any action by a landlord, owner of a residential property, or other person with a legal right to pursue eviction or a possessory action, to remove or cause the removal of a covered person from a residential property. This does not include foreclosure on a home mortgage.

    €œResidential property” means any property leased for residential purposes, including any house, building, mobile home or land in a mobile home park, or similar dwelling leased for residential purposes, but shall not include any hotel, motel, or other guest house rented to a temporary guest or seasonal tenant as defined under the laws of the State, territorial, tribal, or local jurisdiction. €œState” shall have the same definition as under 42 CFR 70.1, meaning “any of the 50 states, plus the District of Columbia.” “U.S. Territory” shall have the same definition as under 42 CFR 70.1, meaning “any territory (also known as possessions) of the United States, including American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands.” Statement of Intent This Order shall be interpreted and implemented in a manner as to achieve the following objectives. Mitigating the spread of COVID-19 within congregate or shared living settings, or through unsheltered homelessness.

    Mitigating the further spread of COVID-19 from one U.S. State or U.S. Territory into any other U.S. State or U.S. Territory.

    And supporting response efforts to COVID-19 at the Federal, State, local, territorial, and tribal levels. Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S. Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths. Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease.

    The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal. People of any age with certain underlying medical conditions, such as cancer, an Start Printed Page 55294immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health.

    According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these significant efforts, COVID-19 continues to spread and further action is needed. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease. Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition.

    They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into close quarters in congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19. Applicability 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. 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.

    Additionally, this Order shall not apply to American Samoa, which has reported no cases of COVID-19, until such time as cases are reported. 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. Nothing in this Order precludes evictions based on a tenant, lessee, or resident.

    (1) Engaging in criminal activity while on the premises. (2) threatening the health or safety of other residents; [] (3) damaging or posing an immediate and significant risk of damage to property. (4) violating any applicable building code, health ordinance, or similar regulation relating to health and safety. Or (5) violating any other contractual obligation, other than the timely payment of rent or similar housing-related payment (including non-payment or late payment of fees, penalties, or interest). Eviction and Risk of COVID-19 Transmission Evicted renters must move, which leads to multiple outcomes that increase the risk of COVID-19 spread.

    Specifically, many evicted renters move into close quarters in shared housing or other congregate settings. According to the Census Bureau American Housing Survey, 32% of renters reported that they would move in with friends or family members upon eviction, which would introduce new household members and potentially increase household crowding.[] Studies show that COVID-19 transmission occurs readily within households. Household contacts are estimated to be 6 times more likely to become infected by an index case of COVID-19 than other close contacts.[] Shared housing is not limited to friends and family. It includes a broad range of settings, including transitional housing, and domestic violence and abuse shelters. Special considerations exist for such housing because of the challenges of maintaining social distance.

    Residents often gather closely or use shared equipment, such as kitchen appliances, laundry facilities, stairwells, and elevators. Residents may have unique needs, such as disabilities, cognitive decline, or no access to technology, and thus may find it more difficult to take actions to protect themselves from COVID-19. CDC recommends that shelters provide new residents with a clean mask, keep them isolated from others, screen for symptoms at entry, or arrange for medical evaluations as needed depending on symptoms.[] Accordingly, an influx of new residents at facilities that offer support services could potentially overwhelm staff and, if recommendations are not followed, lead to exposures. Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L.

    116-136) to aid individuals and businesses adversely affected by COVID-19. Section 4024 of the CARES Act provided a 120-day moratorium on eviction filings as well as other protections for tenants in certain rental properties with Federal assistance or federally related financing. These protections helped alleviate the public health consequences of tenant displacement during the COVID-19 pandemic. The CARES Act eviction moratorium expired on July 24, 2020.[] The protections in the CARES Act supplemented temporary eviction moratoria and rent freezes implemented by governors and local officials using emergency powers. Researchers estimated that this temporary Federal moratorium provided relief to a material portion of the nation's roughly 43 million renters.[] Start Printed Page 55295Approximately 12.3 million rental units have federally backed financing, representing 28% of renters.

    Other data show more than 2 million housing vouchers along with approximately 2 million other federally assisted rental units.[] The Federal moratorium, however, did not reach all renters. Many renters who fell outside the scope of the Federal moratorium were protected under State and local moratoria. In the absence of State and local protections, as many as 30-40 million people in America could be at risk of eviction.[] A wave of evictions on that scale would be unprecedented in modern times.[] A large portion of those who are evicted may move into close quarters in shared housing or, as discussed below, become homeless, thus contributing to the spread of COVID-19. The statistics on interstate moves show that mass evictions would likely increase the interstate spread of COVID-19. Over 35 million Americans, representing approximately 10% of the U.S.

    Population, move each year.[] Approximately 15% of moves are interstate.[] Eviction, Homelessness, and Risk of Severe Disease From COVID-19 Evicted individuals without access to housing or assistance options may also contribute to the homeless population, including older adults or those with underlying medical conditions, who are more at risk for severe illness from COVID-19 than the general population.[] In Seattle-King County, 5-15% of people experiencing homelessness between 2018 and 2020 cited eviction as the primary reason for becoming homeless.[] Additionally, some individuals and families who are evicted may originally stay with family or friends, but subsequently seek homeless services. Among people who entered shelters throughout the United States in 2017, 27% were staying with family or friends beforehand.[] People experiencing homelessness are a high-risk population. It may be more difficult for these persons to consistently access the necessary resources in order to adhere to public health recommendations to prevent COVID-19. For instance, it may not be possible to avoid certain congregate settings such as homeless shelters, or easily access facilities to engage in handwashing with soap and water. Extensive outbreaks of COVID-19 have been identified in homeless shelters.[] In Seattle, Washington, a network of three related homeless shelters experienced an outbreak that led to 43 cases among residents and staff members.[] In Boston, Massachusetts, universal COVID-19 testing at a single shelter revealed 147 cases, representing 36% of shelter residents.[] COVID-19 testing in a single shelter in San Francisco led to the identification of 101 cases (67% of those tested).[] Throughout the United States, among 208 shelters reporting universal diagnostic testing data, 9% of shelter clients have tested positive.[] CDC guidance recommends increasing physical distance between beds in homeless shelters.[] To adhere to this guidance, shelters have limited the number of people served throughout the United States.

    In many places, considerably fewer beds are available to individuals who become homeless. Shelters that do not adhere to the guidance, and operate at ordinary or increased occupancy, are at greater risk for the types of outbreaks described above. The challenge of mitigating disease transmission in homeless shelters has been compounded because some organizations have chosen to stop or limit volunteer access and participation. In the context of the current pandemic, large increases in evictions could have at least two potential negative consequences. One is if homeless shelters increase occupancy in ways that increase the exposure risk to COVID-19.

    The other is if homeless shelters turn away the recently homeless, who could become unsheltered, and further contribute to the spread of COVID-19. Neither consequence is in the interest of the public health. The risk of COVID-19 spread associated with unsheltered homelessness (those who are sleeping outside or in places not meant for human habitation) is of great concern to CDC. Over 35% of homeless persons are typically unsheltered.[] The unsheltered homeless are at higher risk for infection when there is community spread of COVID-19. The risks associated with sleeping and living outdoors or in an encampment setting are different than from staying indoors in a congregate setting, such as an emergency shelter or other congregate living facility.

    While outdoor settings may allow people to increase physical distance between themselves and others, they may also involve exposure to the elements and inadequate access to hygiene, sanitation facilities, health care, and therapeutics. The latter factors contribute to the further spread of COVID-19. Additionally, research suggests that the population of persons who would be evicted and become homeless would include many who are predisposed to developing severe disease from COVID-19. Five studies have shown an association between eviction and hypertension, which has been associated with more severe outcomes from COVID-19.[] Also, the homeless Start Printed Page 55296often have underlying conditions that increase their risk of severe outcomes of COVID-19.[] Among patients with COVID-19, homelessness has been associated with increased likelihood of hospitalization.[] These public health risks may increase seasonally. Each year, as winter approaches and the temperature drops, many homeless move into shelters to escape the cold and the occupancy of shelters increases.[] At the same time, there is evidence to suggest that the homeless are more susceptible to respiratory tract infections,[] which may include seasonal influenza.

    While there are differences in the epidemiology of COVID-19 and seasonal influenza, the potential co-circulation of viruses during periods of increased occupancy in shelters could increase the risk to occupants in those shelters. In short, evictions threaten to increase the spread of COVID-19 as they force people to move, often into close quarters in new shared housing settings with friends or family, or congregate settings such as homeless shelters. The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19. Findings and Action Therefore, I have determined the temporary halt in evictions in this Order constitutes a reasonably necessary measure under 42 CFR 70.2 to prevent the further spread of COVID-19 throughout the United States.

    I have further determined that measures by states, localities, or U.S. Territories that do not meet or exceed these minimum protections are insufficient to prevent the interstate spread of COVID-19.[] Based on the convergence of COVID-19, seasonal influenza, and the increased risk of individuals sheltering in close quarters in congregate settings such as homeless shelters, which may be unable to provide adequate social distancing as populations increase, all of which may be exacerbated as fall and winter approach, I have determined that a temporary halt on evictions through December 31, 2020, subject to further extension, modification, or rescission, is appropriate. Therefore, under 42 CFR 70.2, subject to the limitations under the “Applicability” section, 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 from any residential property in any State or U.S. Territory in which there are documented cases of COVID-19 that provides a level of public-health protections below the requirements listed in this Order. This Order is not a rule within the meaning of the Administrative Procedure Act (“APA”) but rather an emergency action taken under the existing authority of 42 CFR 70.2.

    In the event that this Order qualifies as a rule under the APA, notice and comment and a delay in effective date are not required because there is good cause to dispense with prior public notice and comment and the opportunity to comment on this Order and the delay in effective date. See 5 U.S.C. 553(b)(3)(B). Considering the public-health emergency caused by COVID-19, it would be impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of this Order. A delay in the effective date of the Order would permit the occurrence of evictions—potentially on a mass scale—that could have potentially significant consequences.

    As discussed above, one potential consequence would be that evicted individuals would move into close quarters in congregate or shared living settings, including homeless shelters, which would put the individuals at higher risk to COVID-19. Another potential consequence would be if evicted individuals become homeless and unsheltered, and further contribute to the spread of COVID-19. A delay in the effective date of the Order that leads to such consequences would defeat the purpose of the Order and endanger the public health. Immediate action is necessary. Similarly, if this Order qualifies as a rule under the APA, the Office of Information and Regulatory Affairs has determined that it would be a major rule under the Congressional Review Act (CRA).

    But there would not be a delay in its effective date. The agency has determined that for the same reasons, there would be good cause under the CRA to make the requirements herein effective immediately. If any provision of this Order, or the application of any provision to any persons, entities, or circumstances, shall be held invalid, the remainder of the provisions, or the application of such provisions to any persons, entities, or circumstances other than those to which it is held invalid, shall remain valid and in effect. This Order shall be enforced by Federal authorities and cooperating State and local authorities through the provisions of 18 U.S.C. 3559, 3571.

    42 U.S.C. 243, 268, 271. And 42 CFR 70.18. However, this Order has no effect on the contractual obligations of renters to pay rent and shall not preclude charging or collecting 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. Criminal Penalties Under 18 U.S.C.

    3559, 3571. 42 U.S.C. 271. And 42 CFR 70.18, a person violating this Order may be subject to a fine of no more than $100,000 if the violation does not result in a death or one year in jail, or both, or a fine of no more than $250,000 if the violation results in a death or one year in jail, or both, or as otherwise provided by law. An organization violating this Order may be subject to a fine of no more than $200,000 per event if the violation does not result in a death or $500,000 per event if the violation results in a death or as otherwise provided by law.

    The U.S. Department of Justice may initiate court proceedings as appropriate seeking imposition of these criminal penalties. Notice to Cooperating State and Local Officials Under 42 U.S.C. 243, the U.S. Department of Health and Human Services is authorized to cooperate with and aid State and local authorities in the enforcement of their quarantine and Start Printed Page 55297other health regulations and to accept State and local assistance in the enforcement of Federal quarantine rules and regulations, including in the enforcement of this Order.

    Notice of Available Federal Resources While this order to prevent eviction is effectuated to protect the public health, the States and units of local government are reminded that the Federal Government has deployed unprecedented resources to address the pandemic, including housing assistance. The Department of Housing and Urban Development (HUD) has informed CDC that all HUD grantees—states, cities, communities, and nonprofits—who received Emergency Solutions Grants (ESG) or Community Development Block Grant (CDBG) funds under the CARES Act may use these funds to provide temporary rental assistance, homelessness prevention, or other aid to individuals who are experiencing financial hardship because of the pandemic and are at risk of being evicted, consistent with applicable laws, regulations, and guidance. HUD has further informed CDC that. HUD's grantees and partners play a critical role in prioritizing efforts to support this goal. As grantees decide how to deploy CDBG-CV and ESG-CV funds provided by the CARES Act, all communities should assess what resources have already been allocated to prevent evictions and homelessness through temporary rental assistance and homelessness prevention, particularly to the most vulnerable households.

    HUD stands at the ready to support American communities take these steps to reduce the spread of COVID-19 and maintain economic prosperity. Where gaps are identified, grantees should coordinate across available Federal, non-Federal, and philanthropic funds to ensure these critical needs are sufficiently addressed, and utilize HUD's technical assistance to design and implement programs to support a coordinated response to eviction prevention needs. For program support, including technical assistance, please visit www.hudexchange.info/​program-support. For further information on HUD resources, tools, and guidance available to respond to the COVID-19 pandemic, State and local officials are directed to visit https://www.hud.gov/​coronavirus. These tools include toolkits for Public Housing Authorities and Housing Choice Voucher landlords related to housing stability and eviction prevention, as well as similar guidance for owners and renters in HUD-assisted multifamily properties.

    Similarly, the Department of the Treasury has informed CDC that the funds allocated through the Coronavirus Relief Fund may be used to fund rental assistance programs to prevent eviction. Visit https://home.treasury.gov/​policy-issues/​cares/​state-and-local-governments for more information. Effective Date This Order is effective upon publication in the Federal Register and will remain in effect, unless extended, modified, or rescinded, through December 31, 2020. Attachment Declaration Under Penalty of Perjury for the Centers for Disease Control and Prevention's Temporary Halt in Evictions to Prevent Further Spread of COVID-19 This declaration is for tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions (not including foreclosures on home mortgages) to prevent the further spread of COVID-19. Under the CDC's order you must provide a copy of this declaration to your landlord, owner of the residential property where you live, or other person who has a right to have you evicted or removed from where you live.

    Each adult listed on the lease, rental agreement, or housing contract should complete this declaration. Unless the CDC order is extended, changed, or ended, the order prevents you from being evicted or removed from where you are living through December 31, 2020. You are still required to pay rent and follow all the other terms of your lease and rules of the place where you live. You may also still be evicted for reasons other than not paying rent or making a housing payment. This declaration is sworn testimony, meaning that you can be prosecuted, go to jail, or pay a fine if you lie, mislead, or omit important information.

    I certify under penalty of perjury, pursuant to 28 U.S.C. 1746, that the foregoing are true and correct. I have used best efforts to obtain all available government assistance for rent or housing; [] I either expect 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), was not required to report any income in 2019 to the U.S. Internal Revenue Service, or received an Economic Impact Payment (stimulus check) pursuant to Section 2201 of the CARES Act. I am unable to pay my full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, lay-offs, or extraordinary [] out-of-pocket medical expenses.

    I am 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. If evicted I would likely become homeless, need to move into a homeless shelter, or need to move into a new residence shared by other people who live in close quarters because I have no other available housing options.[] I understand that I must still pay rent or make a housing payment, and comply with other obligations that I may have under my tenancy, lease agreement, or similar contract. I further understand that fees, penalties, or interest for not paying rent or making a housing payment on time as required by my tenancy, lease agreement, or similar contract may still be charged or collected. I further understand that at the end of this temporary halt on evictions on December 31, 2020, my housing provider may require payment in full for all payments not made prior to and during the temporary halt and failure to pay may make me subject to eviction pursuant to State and local laws. I understand that any false or misleading statements or omissions may result in criminal and civil actions for fines, penalties, damages, or imprisonment.

    _____ Signature of Declarant Date _____ Authority The authority for this Order is Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2. Start Signature Dated. September 1, 2020. Nina B.

    Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention. End Signature End Supplemental Information [FR Doc. 2020-19654 Filed 9-1-20. 4:15 pm]BILLING CODE 4163-18-P.

    Today, under the leadership of President Trump, low cost viagra the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to nursing homes. This distribution is the latest low cost viagra update in the previously announced $5 billion in planned support to nursing homes grappling with the impact of COVID-19. Last week, HHS announced it had delivered an additional $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs. Other resources are also being dedicated to support training, mentorship and safety improvements in nursing homes."The Trump Administration has focused resources throughout our response on protecting the most vulnerable, including older Americans in nursing homes," said HHS Secretary low cost viagra Alex Azar.

    "By tying these new funds for nursing homes to outcomes, while providing the support they need to improve quality and infection control, we will help support quality care, slow the spread of the virus, and save lives."Nursing homes have been particularly hard hit by this pandemic. By tying continued relief payments to patient outcomes, the Trump Administration is demonstrating its commitment to preserving the lives and safety of America's seniors, who are especially vulnerable to COVID-19. Nursing homes will not have to apply to receive a share of this $2 billion incentive low cost viagra payment allocation. HHS will be measuring nursing home performance through required nursing home data submissions and distributing payments based on these data.QualificationsIn order to qualify for payments under the incentive program, a facility must have an active state certification as a nursing home or skilled nursing facility (SNF) and receive reimbursement from the Centers for Medicare &. Medicaid Services low cost viagra (CMS).

    HHS will administer quality checks on nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS) to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities must also report to at least one low cost viagra of three data sources that will be used to establish eligibility and collect necessary provider data to inform payment. Certification and Survey Provider Enhanced Reports (CASPER), Nursing Home Compare (NHC), and Provider of Services (POS).Performance and Payment CycleThe incentive payment program is scheduled to be divided into four performance periods (September, October, November, December), lasting a month each with $500 million available to nursing homes in each period. All nursing homes or skilled nursing facilities meeting the previously noted qualifications will be eligible for each of the four performance periods. Nursing homes will be assessed based on a full month's worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the low cost viagra prior month's performance period.MethodologyUsing data from the Centers for Disease Control and Prevention (CDC), HHS will measure nursing homes against a baseline level of infection in the community where a given facility is located.

    CDC's Community Profile Reports (CPRs) include county-level information on total confirmed and/or suspected COVID-19 infections per capita, as well as information on COVID-19 test positivity. Against this baseline, facilities will have their low cost viagra performance measured on two outcomes. Ability to keep new COVID infection rates low among residents. Ability to keep COVID mortality low among residents.To measure facility COVID-19 infection and mortality rates, the incentive program will utilize data from the National Healthcare Safety Network (NHSN) LTCF COVID-19 module. CMS issued guidance in early May requiring that certified low cost viagra nursing facilities submit data to the NHSN COVID-19 Module.

    Data from this module will be used to assess nursing home performance and determine incentive payments.HHS will continue to provide more updates as it works to assist providers in slowing the spread of infection while simultaneously offering financial support to these frontline heroes combating the pandemic. Funding for this nursing home incentive effort was made possible from the $175 billion Provider Relief program funded through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act low cost viagra. Incentive payments will be subject to the same Terms and Conditions applicable to the initial infection control payments announced last week (available here).For updates and to learn more about the Provider Relief Program, visit. Hhs.gov/providerrelief.Start Preamble Start Printed Page 55292 Centers for Disease Control and Prevention (CDC), Department of Health low cost viagra and Human Services (HHS). Agency Order.

    The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) announces the issuance of an Order under Section 361 of the Public Health Service Act to temporarily halt residential evictions to prevent the further spread of COVID-19. This Order is effective September 4, 2020 through December 31, low cost viagra 2020. Start Further Info Nina Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H21-10, Atlanta, GA 30329. Telephone. 404-639-7000.

    Email. Cdcregulations@cdc.gov. End Further Info End Preamble Start Supplemental Information Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S. Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths.

    Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease. The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal.

    People of any age with certain underlying medical conditions, such as cancer, an immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health. According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these best efforts, COVID-19 continues to spread and further action is needed. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease.

    Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition. They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19. The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19.

    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 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. Renter's or Homeowner's Declaration Attachment A is a Declaration form that tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions to prevent the further spread of COVID-19 may use. To invoke the CDC's order these persons must provide an executed copy of the Declaration form (or a similar declaration under penalty of perjury) to their landlord, owner of the residential property where they live, or other person who has a right to have them evicted or removed from where they live.

    Each adult listed on the lease, rental agreement, or housing contract should likewise complete and provide a declaration. Unless the CDC order is extended, changed, or ended, the order prevents these persons from being evicted or removed from where they are living through December 31, 2020. These persons are still required to pay rent and follow all the other terms of their lease and rules of the place where they live. These persons may also still be evicted for reasons other than not paying rent or making a housing Start Printed Page 55293payment. Executed declarations should not be returned to the Federal Government.

    Centers for Disease Control and Prevention, Department of Health and Human Services Order Under Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2 Temporary Halt in Residential Evictions To Prevent the Further Spread of COVID-19 Summary Notice and Order. And subject to the limitations under “Applicability”. Under 42 CFR 70.2, 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 from any residential property in any jurisdiction to which this Order applies during the effective period of the Order. Definitions “Available government assistance” means any governmental rental or housing payment benefits available to the individual or any household member.

    €œAvailable housing” means any available, unoccupied residential property, or other space for occupancy in any seasonal or temporary housing, that would not violate Federal, State, or local occupancy standards and that would not result in an overall increase of housing cost to such individual. €œCovered 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),[] (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 extraordinary [] 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. €œEvict” and “Eviction” means any action by a landlord, owner of a residential property, or other person with a legal right to pursue eviction or a possessory action, to remove or cause the removal of a covered person from a residential property. This does not include foreclosure on a home mortgage.

    €œResidential property” means any property leased for residential purposes, including any house, building, mobile home or land in a mobile home park, or similar dwelling leased for residential purposes, but shall not include any hotel, motel, or other guest house rented to a temporary guest or seasonal tenant as defined under the laws of the State, territorial, tribal, or local jurisdiction. €œState” shall have the same definition as under 42 CFR 70.1, meaning “any of the 50 states, plus the District of Columbia.” “U.S. Territory” shall have the same definition as under 42 CFR 70.1, meaning “any territory (also known as possessions) of the United States, including American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands.” Statement of Intent This Order shall be interpreted and implemented in a manner as to achieve the following objectives. Mitigating the spread of COVID-19 within congregate or shared living settings, or through unsheltered homelessness.

    Mitigating the further spread of COVID-19 from one U.S. State or U.S. Territory into any other U.S. State or U.S. Territory.

    And supporting response efforts to COVID-19 at the Federal, State, local, territorial, and tribal levels. Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S. Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths. Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease.

    The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal. People of any age with certain underlying medical conditions, such as cancer, an Start Printed Page 55294immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health.

    According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these significant efforts, COVID-19 continues to spread and further action is needed. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease. Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition.

    They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into close quarters in congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19. Applicability 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. 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.

    Additionally, this Order shall not apply to American Samoa, which has reported no cases of COVID-19, until such time as cases are reported. 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. Nothing in this Order precludes evictions based on a tenant, lessee, or resident.

    (1) Engaging in criminal activity while on the premises. (2) threatening the health or safety of other residents; [] (3) damaging or posing an immediate and significant risk of damage to property. (4) violating any applicable building code, health ordinance, or similar regulation relating to health and safety. Or (5) violating any other contractual obligation, other than the timely payment of rent or similar housing-related payment (including non-payment or late payment of fees, penalties, or interest). Eviction and Risk of COVID-19 Transmission Evicted renters must move, which leads to multiple outcomes that increase the risk of COVID-19 spread.

    Specifically, many evicted renters move into close quarters in shared housing or other congregate settings. According to the Census Bureau American Housing Survey, 32% of renters reported that they would move in with friends or family members upon eviction, which would introduce new household members and potentially increase household crowding.[] Studies show that COVID-19 transmission occurs readily within households. Household contacts are estimated to be 6 times more likely to become infected by an index case of COVID-19 than other close contacts.[] Shared housing is not limited to friends and family. It includes a broad range of settings, including transitional housing, and domestic violence and abuse shelters. Special considerations exist for such housing because of the challenges of maintaining social distance.

    Residents often gather closely or use shared equipment, such as kitchen appliances, laundry facilities, stairwells, and elevators. Residents may have unique needs, such as disabilities, cognitive decline, or no access to technology, and thus may find it more difficult to take actions to protect themselves from COVID-19. CDC recommends that shelters provide new residents with a clean mask, keep them isolated from others, screen for symptoms at entry, or arrange for medical evaluations as needed depending on symptoms.[] Accordingly, an influx of new residents at facilities that offer support services could potentially overwhelm staff and, if recommendations are not followed, lead to exposures. Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L.

    116-136) to aid individuals and businesses adversely affected by COVID-19. Section 4024 of the CARES Act provided a 120-day moratorium on eviction filings as well as other protections for tenants in certain rental properties with Federal assistance or federally related financing. These protections helped alleviate the public health consequences of tenant displacement during the COVID-19 pandemic. The CARES Act eviction moratorium expired on July 24, 2020.[] The protections in the CARES Act supplemented temporary eviction moratoria and rent freezes implemented by governors and local officials using emergency powers. Researchers estimated that this temporary Federal moratorium provided relief to a material portion of the nation's roughly 43 million renters.[] Start Printed Page 55295Approximately 12.3 million rental units have federally backed financing, representing 28% of renters.

    Other data show more than 2 million housing vouchers along with approximately 2 million other federally assisted rental units.[] The Federal moratorium, however, did not reach all renters. Many renters who fell outside the scope of the Federal moratorium were protected under State and local moratoria. In the absence of State and local protections, as many as 30-40 million people in America could be at risk of eviction.[] A wave of evictions on that scale would be unprecedented in modern times.[] A large portion of those who are evicted may move into close quarters in shared housing or, as discussed below, become homeless, thus contributing to the spread of COVID-19. The statistics on interstate moves show that mass evictions would likely increase the interstate spread of COVID-19. Over 35 million Americans, representing approximately 10% of the U.S.

    Population, move each year.[] Approximately 15% of moves are interstate.[] Eviction, Homelessness, and Risk of Severe Disease From COVID-19 Evicted individuals without access to housing or assistance options may also contribute to the homeless population, including older adults or those with underlying medical conditions, who are more at risk for severe illness from COVID-19 than the general population.[] In Seattle-King County, 5-15% of people experiencing homelessness between 2018 and 2020 cited eviction as the primary reason for becoming homeless.[] Additionally, some individuals and families who are evicted may originally stay with family or friends, but subsequently seek homeless services. Among people who entered shelters throughout the United States in 2017, 27% were staying with family or friends beforehand.[] People experiencing homelessness are a high-risk population. It may be more difficult for these persons to consistently access the necessary resources in order to adhere to public health recommendations to prevent COVID-19. For instance, it may not be possible to avoid certain congregate settings such as homeless shelters, or easily access facilities to engage in handwashing with soap and water. Extensive outbreaks of COVID-19 have been identified in homeless shelters.[] In Seattle, Washington, a network of three related homeless shelters experienced an outbreak that led to 43 cases among residents and staff members.[] In Boston, Massachusetts, universal COVID-19 testing at a single shelter revealed 147 cases, representing 36% of shelter residents.[] COVID-19 testing in a single shelter in San Francisco led to the identification of 101 cases (67% of those tested).[] Throughout the United States, among 208 shelters reporting universal diagnostic testing data, 9% of shelter clients have tested positive.[] CDC guidance recommends increasing physical distance between beds in homeless shelters.[] To adhere to this guidance, shelters have limited the number of people served throughout the United States.

    In many places, considerably fewer beds are available to individuals who become homeless. Shelters that do not adhere to the guidance, and operate at ordinary or increased occupancy, are at greater risk for the types of outbreaks described above. The challenge of mitigating disease transmission in homeless shelters has been compounded because some organizations have chosen to stop or limit volunteer access and participation. In the context of the current pandemic, large increases in evictions could have at least two potential negative consequences. One is if homeless shelters increase occupancy in ways that increase the exposure risk to COVID-19.

    The other is if homeless shelters turn away the recently homeless, who could become unsheltered, and further contribute to the spread of COVID-19. Neither consequence is in the interest of the public health. The risk of COVID-19 spread associated with unsheltered homelessness (those who are sleeping outside or in places not meant for human habitation) is of great concern to CDC. Over 35% of homeless persons are typically unsheltered.[] The unsheltered homeless are at higher risk for infection when there is community spread of COVID-19. The risks associated with sleeping and living outdoors or in an encampment setting are different than from staying indoors in a congregate setting, such as an emergency shelter or other congregate living facility.

    While outdoor settings may allow people to increase physical distance between themselves and others, they may also involve exposure to the elements and inadequate access to hygiene, sanitation facilities, health care, and therapeutics. The latter factors contribute to the further spread of COVID-19. Additionally, research suggests that the population of persons who would be evicted and become homeless would include many who are predisposed to developing severe disease from COVID-19. Five studies have shown an association between eviction and hypertension, which has been associated with more severe outcomes from COVID-19.[] Also, the homeless Start Printed Page 55296often have underlying conditions that increase their risk of severe outcomes of COVID-19.[] Among patients with COVID-19, homelessness has been associated with increased likelihood of hospitalization.[] These public health risks may increase seasonally. Each year, as winter approaches and the temperature drops, many homeless move into shelters to escape the cold and the occupancy of shelters increases.[] At the same time, there is evidence to suggest that the homeless are more susceptible to respiratory tract infections,[] which may include seasonal influenza.

    While there are differences in the epidemiology of COVID-19 and seasonal influenza, the potential co-circulation of viruses during periods of increased occupancy in shelters could increase the risk to occupants in those shelters. In short, evictions threaten to increase the spread of COVID-19 as they force people to move, often into close quarters in new shared housing settings with friends or family, or congregate settings such as homeless shelters. The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19. Findings and Action Therefore, I have determined the temporary halt in evictions in this Order constitutes a reasonably necessary measure under 42 CFR 70.2 to prevent the further spread of COVID-19 throughout the United States.

    I have further determined that measures by states, localities, or U.S. Territories that do not meet or exceed these minimum protections are insufficient to prevent the interstate spread of COVID-19.[] Based on the convergence of COVID-19, seasonal influenza, and the increased risk of individuals sheltering in close quarters in congregate settings such as homeless shelters, which may be unable to provide adequate social distancing as populations increase, all of which may be exacerbated as fall and winter approach, I have determined that a temporary halt on evictions through December 31, 2020, subject to further extension, modification, or rescission, is appropriate. Therefore, under 42 CFR 70.2, subject to the limitations under the “Applicability” section, 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 from any residential property in any State or U.S. Territory in which there are documented cases of COVID-19 that provides a level of public-health protections below the requirements listed in this Order. This Order is not a rule within the meaning of the Administrative Procedure Act (“APA”) but rather an emergency action taken under the existing authority of 42 CFR 70.2.

    In the event that this Order qualifies as a rule under the APA, notice and comment and a delay in effective date are not required because there is good cause to dispense with prior public notice and comment and the opportunity to comment on this Order and the delay in effective date. See 5 U.S.C. 553(b)(3)(B). Considering the public-health emergency caused by COVID-19, it would be impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of this Order. A delay in the effective date of the Order would permit the occurrence of evictions—potentially on a mass scale—that could have potentially significant consequences.

    As discussed above, one potential consequence would be that evicted individuals would move into close quarters in congregate or shared living settings, including homeless shelters, which would put the individuals at higher risk to COVID-19. Another potential consequence would be if evicted individuals become homeless and unsheltered, and further contribute to the spread of COVID-19. A delay in the effective date of the Order that leads to such consequences would defeat the purpose of the Order and endanger the public health. Immediate action is necessary. Similarly, if this Order qualifies as a rule under the APA, the Office of Information and Regulatory Affairs has determined that it would be a major rule under the Congressional Review Act (CRA).

    But there would not be a delay in its effective date. The agency has determined that for the same reasons, there would be good cause under the CRA to make the requirements herein effective immediately. If any provision of this Order, or the application of any provision to any persons, entities, or circumstances, shall be held invalid, the remainder of the provisions, or the application of such provisions to any persons, entities, or circumstances other than those to which it is held invalid, shall remain valid and in effect. This Order shall be enforced by Federal authorities and cooperating State and local authorities through the provisions of 18 U.S.C. 3559, 3571.

    42 U.S.C. 243, 268, 271. And 42 CFR 70.18. However, this Order has no effect on the contractual obligations of renters to pay rent and shall not preclude charging or collecting 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. Criminal Penalties Under 18 U.S.C.

    3559, 3571. 42 U.S.C. 271. And 42 CFR 70.18, a person violating this Order may be subject to a fine of no more than $100,000 if the violation does not result in a death or one year in jail, or both, or a fine of no more than $250,000 if the violation results in a death or one year in jail, or both, or as otherwise provided by law. An organization violating this Order may be subject to a fine of no more than $200,000 per event if the violation does not result in a death or $500,000 per event if the violation results in a death or as otherwise provided by law.

    The U.S. Department of Justice may initiate court proceedings as appropriate seeking imposition of these criminal penalties. Notice to Cooperating State and Local Officials Under 42 U.S.C. 243, the U.S. Department of Health and Human Services is authorized to cooperate with and aid State and local authorities in the enforcement of their quarantine and Start Printed Page 55297other health regulations and to accept State and local assistance in the enforcement of Federal quarantine rules and regulations, including in the enforcement of this Order.

    Notice of Available Federal Resources While this order to prevent eviction is effectuated to protect the public health, the States and units of local government are reminded that the Federal Government has deployed unprecedented resources to address the pandemic, including housing assistance. The Department of Housing and Urban Development (HUD) has informed CDC that all HUD grantees—states, cities, communities, and nonprofits—who received Emergency Solutions Grants (ESG) or Community Development Block Grant (CDBG) funds under the CARES Act may use these funds to provide temporary rental assistance, homelessness prevention, or other aid to individuals who are experiencing financial hardship because of the pandemic and are at risk of being evicted, consistent with applicable laws, regulations, and guidance. HUD has further informed CDC that. HUD's grantees and partners play a critical role in prioritizing efforts to support this goal. As grantees decide how to deploy CDBG-CV and ESG-CV funds provided by the CARES Act, all communities should assess what resources have already been allocated to prevent evictions and homelessness through temporary rental assistance and homelessness prevention, particularly to the most vulnerable households.

    HUD stands at the ready to support American communities take these steps to reduce the spread of COVID-19 and maintain economic prosperity. Where gaps are identified, grantees should coordinate across available Federal, non-Federal, and philanthropic funds to ensure these critical needs are sufficiently addressed, and utilize HUD's technical assistance to design and implement programs to support a coordinated response to eviction prevention needs. For program support, including technical assistance, please visit www.hudexchange.info/​program-support. For further information on HUD resources, tools, and guidance available to respond to the COVID-19 pandemic, State and local officials are directed to visit https://www.hud.gov/​coronavirus. These tools include toolkits for Public Housing Authorities and Housing Choice Voucher landlords related to housing stability and eviction prevention, as well as similar guidance for owners and renters in HUD-assisted multifamily properties.

    Similarly, the Department of the Treasury has informed CDC that the funds allocated through the Coronavirus Relief Fund may be used to fund rental assistance programs to prevent eviction. Visit https://home.treasury.gov/​policy-issues/​cares/​state-and-local-governments for more information. Effective Date This Order is effective upon publication in the Federal Register and will remain in effect, unless extended, modified, or rescinded, through December 31, 2020. Attachment Declaration Under Penalty of Perjury for the Centers for Disease Control and Prevention's Temporary Halt in Evictions to Prevent Further Spread of COVID-19 This declaration is for tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions (not including foreclosures on home mortgages) to prevent the further spread of COVID-19. Under the CDC's order you must provide a copy of this declaration to your landlord, owner of the residential property where you live, or other person who has a right to have you evicted or removed from where you live.

    Each adult listed on the lease, rental agreement, or housing contract should complete this declaration. Unless the CDC order is extended, changed, or ended, the order prevents you from being evicted or removed from where you are living through December 31, 2020. You are still required to pay rent and follow all the other terms of your lease and rules of the place where you live. You may also still be evicted for reasons other than not paying rent or making a housing payment. This declaration is sworn testimony, meaning that you can be prosecuted, go to jail, or pay a fine if you lie, mislead, or omit important information.

    I certify under penalty of perjury, pursuant to 28 U.S.C. 1746, that the foregoing are true and correct. I have used best efforts to obtain all available government assistance for rent or housing; [] I either expect 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), was not required to report any income in 2019 to the U.S. Internal Revenue Service, or received an Economic Impact Payment (stimulus check) pursuant to Section 2201 of the CARES Act. I am unable to pay my full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, lay-offs, or extraordinary [] out-of-pocket medical expenses.

    I am 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. If evicted I would likely become homeless, need to move into a homeless shelter, or need to move into a new residence shared by other people who live in close quarters because I have no other available housing options.[] I understand that I must still pay rent or make a housing payment, and comply with other obligations that I may have under my tenancy, lease agreement, or similar contract. I further understand that fees, penalties, or interest for not paying rent or making a housing payment on time as required by my tenancy, lease agreement, or similar contract may still be charged or collected. I further understand that at the end of this temporary halt on evictions on December 31, 2020, my housing provider may require payment in full for all payments not made prior to and during the temporary halt and failure to pay may make me subject to eviction pursuant to State and local laws. I understand that any false or misleading statements or omissions may result in criminal and civil actions for fines, penalties, damages, or imprisonment.

    _____ Signature of Declarant Date _____ Authority The authority for this Order is Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2. Start Signature Dated. September 1, 2020. Nina B.

    Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention. End Signature End Supplemental Information [FR Doc. 2020-19654 Filed 9-1-20. 4:15 pm]BILLING CODE 4163-18-P.

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    Credit. IStock Share Fast Facts In a small double-blind study, Johns Hopkins researchers report that a substantial majority of people suffering cancer-related anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin — the active compound in hallucinogenic “magic mushrooms.” The researchers cautioned that the drug was given in tightly controlled conditions in the presence of two clinically trained monitors and said they do not recommend use of the compound outside of such a research or patient care setting. The Johns Hopkins team released its study results, involving 51 adult patients, concurrently with researchers from New York University Langone Medical Center, who conducted a similarly designed study on 29 participants. Both studies are published in the Journal of Psychopharmacology on Dec. 1.

    The Johns Hopkins group reported that psilocybin decreased clinician- and patient-rated depressed mood, anxiety and death anxiety, and increased quality of life, life meaning and optimism. Six months after the final session of treatment, about 80 percent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 percent showing symptom remission into the normal range. Eighty-three percent reported increases in well-being or life satisfaction. Some 67 percent of participants reported the experience as one of the top five meaningful experiences in their lives, and about 70 percent reported the experience as one of the top five spiritually significant lifetime events. €œThe most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions,” says Roland Griffiths, Ph.D., professor of behavioral biology in the Departments of Psychiatry and Behavioral Sciences and of Neuroscience at the Johns Hopkins University School of Medicine.

    He notes that traditional psychotherapy offered to people with cancer, including behavioral therapy and antidepressants, can take weeks or even months, isn’t always effective, and in the case of some drugs, such as benzodiazepines, may have addictive and other troubling side effects. Griffiths says his team’s new study grew out of a decade of research at Johns Hopkins on the effects of psilocybin in healthy volunteers, which found that psilocybin can consistently produce positive changes in mood, behavior and spirituality when administered to carefully screened and prepared participants. The study was designed to see if psilocybin could produce similar results in psychologically distressed cancer patients. €œA life-threatening cancer diagnosis can be psychologically challenging, with anxiety and depression as very common symptoms,” says Griffiths. €œPeople with this kind of existential anxiety often feel hopeless and are worried about the meaning of life and what happens upon death.” For the study, the investigators recruited 51 participants diagnosed with life-threatening cancers, most of which were recurrent or metastatic.

    They were chosen from a total of 566 individuals reached through flyers, web advertisements and physician referrals. Most participants had breast, upper digestive, GI, genitourinary or blood cancer, and each had been given a formal psychiatric diagnosis, including an anxiety or depressive disorder. Half of the participants were female with an average age of 56. Ninety-two percent were white, 4 percent were African-American and 2 percent were Asian. Each participant had two treatment sessions scheduled five weeks apart, one with a very low psilocybin dose (1 or3 milligrams per 70 kilograms) taken in a capsule and meant to act as a “control” placebo because the dose was too low to produce effects.

    In the other session, participants received a capsule with what is considered a moderate or high dose (22 or 30 milligrams per 70 kilograms). To minimize expectancy effects, the participants and the staff members supervising the sessions were told that the participants would receive psilocybin on both sessions, but they did not know that all participants would receive one high and one low dose. Blood pressure and mood were monitored throughout the sessions. Two monitors aided participants during each session, encouraging them to lie down, wear an eye mask, listen to music through headphones and direct their attention on their inner experience. If anxiety or confusion arose, the monitors provided reassurance to the participants.

    In addition to experiencing changes in visual perception, emotions and thinking, most participants reported experiences of psychological insight and often profound, deeply meaningful experiences of the interconnectedness of all people. The researchers assessed each participant’s mood, attitude about life, behaviors and spirituality with questionnaires and structured interviews before the first session, seven hours after taking the psilocybin, five weeks after each session and six months after the second session. Immediately after the sessions, participants completed questionnaires assessing changes in visual, auditory and body perceptions. Feelings of transcendence. Changes in mood.

    And more. Structured clinical interviews, such as the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, and patient questionnaires, like the Beck Depression Inventory and the State-Trait Anxiety Inventory, assessed depression and anxiety. Other questionnaires assessed quality of life, death acceptance, meaningful existence, optimism and spirituality — generally defined as a search for the meaning of life and a connection to something bigger than one’s self. To measure the changes in attitudes, moods and behavior over time, the researchers administered a questionnaire that assessed negative or positive changes in attitudes about life, mood and behavior. With regard to adverse effects, Griffiths says 15 percent of participants were nauseated or vomited, and one-third of participants experienced some psychological discomfort, such as anxiety or paranoia, after taking the higher dose.

    One-third of the participants had transient increases in blood pressure. A few participants reported headaches following the session. €œBefore beginning the study, it wasn’t clear to me that this treatment would be helpful, since cancer patients may experience profound hopelessness in response to their diagnosis, which is often followed by multiple surgeries and prolonged chemotherapy,” says Griffiths. €œI could imagine that cancer patients would receive psilocybin, look into the existential void and come out even more fearful. However, the positive changes in attitudes, moods and behavior that we documented in healthy volunteers were replicated in cancer patients.” Up to 40 percent of people with cancer suffer from a mood disorder, according to the National Comprehensive Cancer Network.

    Anticipating wide interest in the psilocybin research from scientists, clinicians and the public, the journal solicited 11 commentaries to be co-published with the study results written by luminaries in psychiatry, palliative care and drug regulation, including two past presidents of the American Psychiatric Association, a past president of the European College of Neuropsychopharmacology, the former deputy director of the U.S. Office of National Drug Control Policy, and the former head of the U.K. Medicines and Healthcare Products Regulatory Authority. In general, the commentaries were supportive of the research and of using these drugs in a clinical setting as tools for psychiatry. Additional authors included Matthew Johnson, Michael Carducci of the Sidney Kimmel Comprehensive Cancer Center, Annie Umbricht, William Richards, Brian Richards, Mary Cosimano and Margaret Klinedinst, all of The Johns Hopkins University.The study was funded by grants from the Heffter Research Institute, the RiverStyx Foundation, William Linton, the Betsy Gordon Foundation, the McCormick family, the Fetzer Institute, George Goldsmith, Ekaterina Malievskaia and the National Institute on Drug Abuse (R01DA03889)..

    Credit. IStock Share Fast Facts In a small double-blind study, Johns Hopkins researchers report that a substantial majority of people suffering cancer-related anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin — the active compound in hallucinogenic “magic mushrooms.” The researchers cautioned that the drug was given in tightly controlled conditions in the presence of two clinically trained monitors and said they do not recommend use of the compound outside of such a research or patient care setting. The Johns Hopkins team released its study results, involving 51 adult patients, concurrently with researchers from New York University Langone Medical Center, who conducted a similarly designed study on 29 participants.

    Both studies are published in the Journal of Psychopharmacology on Dec. 1. The Johns Hopkins group reported that psilocybin decreased clinician- and patient-rated depressed mood, anxiety and death anxiety, and increased quality of life, life meaning and optimism.

    Six months after the final session of treatment, about 80 percent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 percent showing symptom remission into the normal range. Eighty-three percent reported increases in well-being or life satisfaction. Some 67 percent of participants reported the experience as one of the top five meaningful experiences in their lives, and about 70 percent reported the experience as one of the top five spiritually significant lifetime events.

    €œThe most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions,” says Roland Griffiths, Ph.D., professor of behavioral biology in the Departments of Psychiatry and Behavioral Sciences and of Neuroscience at the Johns Hopkins University School of Medicine. He notes that traditional psychotherapy offered to people with cancer, including behavioral therapy and antidepressants, can take weeks or even months, isn’t always effective, and in the case of some drugs, such as benzodiazepines, may have addictive and other troubling side effects. Griffiths says his team’s new study grew out of a decade of research at Johns Hopkins on the effects of psilocybin in healthy volunteers, which found that psilocybin can consistently produce positive changes in mood, behavior and spirituality when administered to carefully screened and prepared participants.

    The study was designed to see if psilocybin could produce similar results in psychologically distressed cancer patients. €œA life-threatening cancer diagnosis can be psychologically challenging, with anxiety and depression as very common symptoms,” says Griffiths. €œPeople with this kind of existential anxiety often feel hopeless and are worried about the meaning of life and what happens upon death.” For the study, the investigators recruited 51 participants diagnosed with life-threatening cancers, most of which were recurrent or metastatic.

    They were chosen from a total of 566 individuals reached through flyers, web advertisements and physician referrals. Most participants had breast, upper digestive, GI, genitourinary or blood cancer, and each had been given a formal psychiatric diagnosis, including an anxiety or depressive disorder. Half of the participants were female with an average age of 56.

    Ninety-two percent were white, 4 percent were African-American and 2 percent were Asian. Each participant had two treatment sessions scheduled five weeks apart, one with a very low psilocybin dose (1 or3 milligrams per 70 kilograms) taken in a capsule and meant to act as a “control” placebo because the dose was too low to produce effects. In the other session, participants received a capsule with what is considered a moderate or high dose (22 or 30 milligrams per 70 kilograms).

    To minimize expectancy effects, the participants and the staff members supervising the sessions were told that the participants would receive psilocybin on both sessions, but they did not know that all participants would receive one high and one low dose. Blood pressure and mood were monitored throughout the sessions. Two monitors aided participants during each session, encouraging them to lie down, wear an eye mask, listen to music through headphones and direct their attention on their inner experience.

    If anxiety or confusion arose, the monitors provided reassurance to the participants. In addition to experiencing changes in visual perception, emotions and thinking, most participants reported experiences of psychological insight and often profound, deeply meaningful experiences of the interconnectedness of all people. The researchers assessed each participant’s mood, attitude about life, behaviors and spirituality with questionnaires and structured interviews before the first session, seven hours after taking the psilocybin, five weeks after each session and six months after the second session.

    Immediately after the sessions, participants completed questionnaires assessing changes in visual, auditory and body perceptions. Feelings of transcendence. Changes in mood.

    And more. Structured clinical interviews, such as the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, and patient questionnaires, like the Beck Depression Inventory and the State-Trait Anxiety Inventory, assessed depression and anxiety. Other questionnaires assessed quality of life, death acceptance, meaningful existence, optimism and spirituality — generally defined as a search for the meaning of life and a connection to something bigger than one’s self.

    To measure the changes in attitudes, moods and behavior over time, the researchers administered a questionnaire that assessed negative or positive changes in attitudes about life, mood and behavior. With regard to adverse effects, Griffiths says 15 percent of participants were nauseated or vomited, and one-third of participants experienced some psychological discomfort, such as anxiety or paranoia, after taking the higher dose. One-third of the participants had transient increases in blood pressure.

    A few participants reported headaches following the session. €œBefore beginning the study, it wasn’t clear to me that this treatment would be helpful, since cancer patients may experience profound hopelessness in response to their diagnosis, which is often followed by multiple surgeries and prolonged chemotherapy,” says Griffiths. €œI could imagine that cancer patients would receive psilocybin, look into the existential void and come out even more fearful.

    However, the positive changes in attitudes, moods and behavior that we documented in healthy volunteers were replicated in cancer patients.” Up to 40 percent of people with cancer suffer from a mood disorder, according to the National Comprehensive Cancer Network. Anticipating wide interest in the psilocybin research from scientists, clinicians and the public, the journal solicited 11 commentaries to be co-published with the study results written by luminaries in psychiatry, palliative care and drug regulation, including two past presidents of the American Psychiatric Association, a past president of the European College of Neuropsychopharmacology, the former deputy director of the U.S. Office of National Drug Control Policy, and the former head of the U.K.

    Medicines and Healthcare Products Regulatory Authority. In general, the commentaries were supportive of the research and of using these drugs in a clinical setting as tools for psychiatry. Additional authors included Matthew Johnson, Michael Carducci of the Sidney Kimmel Comprehensive Cancer Center, Annie Umbricht, William Richards, Brian Richards, Mary Cosimano and Margaret Klinedinst, all of The Johns Hopkins University.The study was funded by grants from the Heffter Research Institute, the RiverStyx Foundation, William Linton, the Betsy Gordon Foundation, the McCormick family, the Fetzer Institute, George Goldsmith, Ekaterina Malievskaia and the National Institute on Drug Abuse (R01DA03889)..

    Rebecca viagran

    NONE

    You may be hearing about how virtual care, often described as telehealth or telemedicine, is beneficial during COVID-19 and how health systems rebecca viagran are offering virtual access like never before. There’s a reason for that, too. For the past few weeks I’ve seen Facebook posts daily from former nursing colleagues in metro Detroit, one of the hardest hit areas in the country, as they provide front-line care to patients with COVID-19.

    It makes me very proud to call these rebecca viagran nurses my friends. As a former emergency department nurse, I recall the feeling of satisfaction knowing that I’ve helped someone on the worst day of their life. One of the best parts of being a nurse is knowing you matter to the only person in health care that truly matters.

    The patient rebecca viagran. Several years ago I made the difficult decision to no longer perform bedside nursing and become a nurse administrator. The biggest loss from my transition is the feeling that what I do matters to the patient.

    COVID-19 has forced a lot of us to rethink the role we play rebecca viagran in health care and what the real priority should be. Things that were top priorities three months ago have been rightfully cast aside to either care for patients in a pandemic or prepare for the unknown future of, “When is our turn?. € For me, COVID-19 has reignited the feeling that what I do matters as virtual care has become a powerful tool on the forefront of care during this crisis.

    It has rebecca viagran also shown that many of the powerful rules and regulations that limit virtual care are not needed and should be discarded permanently. When I became the director of virtual care at our organization in 2015 I knew nothing about telehealth. Sure, I had seen a stroke robot in some Emergency Departments, and I had some friends that told me their insurance company lets them FaceTime a doctor for free (spoiler alert.

    It’s not rebecca viagran FaceTime). I was tech-savvy from a consumer perspective and a tech novice from an IT perspective. Nevertheless, my team and I spent the next few years learning as we built one of the higher volume virtual care networks in the state of Michigan.

    We discovered a lot of barriers that rebecca viagran keep virtual care from actually making the lives of patients and providers better and we also became experts in working around those barriers. But, there were two obstacles that we could not overcome. Government regulation and insurance provider willingness to cover virtual visits.

    These two barriers effectively cripple most legitimate attempts to provide value-added direct-to-consumer virtual care, rebecca viagran which I define as using virtual care technologies to provide care outside of our brick-and-mortar facilities, most commonly in the patient home. The need to social distance, cancel appointments, close provider offices, keep from overloading emergency departments and urgent cares and shelter in place created instant demand for direct-to-consumer virtual care. In all honesty, I’ve always considered direct-to-consumer virtual care to be the flashy, must-have holiday gift of the year that organizations are convinced will be the way of the future.

    If a health system wants to provide on-demand access to patients for low-complexity acute conditions, rebecca viagran they will easily find plenty of vendors that will sell them their app and their doctors and put the health system’s logo on it. What a health system will struggle with is to find is enough patient demand to cover the high cost. Remember my friends from earlier that told me about the app their insurance gave them?.

    Nearly all of them followed that up by telling me they’ve never actually used it rebecca viagran. I am fortunate that I work for an organization that understands this and instead focuses on how can we provide care that our patients actually want and need from the doctors they want to see. Ironically, this fiscal year we had a corporate top priority around direct-to-consumer virtual care.

    We wanted to expand what we thought were some successful pilots and perform rebecca viagran 500 direct-to-consumer visits. This year has been one of the hardest of my leadership career because, frankly, up until a month ago I was about to fail on this top priority. With only four months left, we were only about halfway there.

    The biggest problem we ran into was that every great idea a physician brought rebecca viagran to me was instantly dead in the water because practically no insurance company would pay for it. There are (prior to COVID-19) a plethora of rules around virtual care billing but the simplest way to summarize it is that most virtual care will only be paid if it happens in a rural location and inside of a health care facility. It is extremely limited what will be paid for in the patient home and most of it is so specific that the average patient isn’t eligible to get any in-home virtual care.

    Therefore, most good rebecca viagran medical uses for direct-to-consumer care would be asking the patient to pay cash or the physician to forgo reimbursement for a visit that would be covered if it happened in office. Add to that the massive capital and operating expenses it takes to build a virtual care network and you can see why these programs don’t exist. A month ago I was skeptical we’d have a robust direct-to-consumer program any time soon and then COVID-19 hit.

    When COVID-19 started to spread rapidly in rebecca viagran the United States, regulations and reimbursement rules were being stripped daily. The first change that had major impact is when the Centers for Medicare and Medicaid Services (CMS) announced that they would temporarily begin reimbursing for virtual visits conducted in the patient’s home for COVID-19 and non-COVID related visits. We were already frantically designing a virtual program to handle the wave of COVID-19 screening visits that were overloading our emergency departments and urgent cares.

    We were having plenty of discussions around reimbursement for this rebecca viagran clinic. Do we attempt to bill insurances knowing they will likely deny, do we do a cash clinic model or do we do this as a community benefit and eat the cost?. The CMS waiver gave us hope that we would be compensated for diverting patients away from reimbursed visits to a virtual visit that is more convenient for the patient and aligns with the concept of social distancing.

    Realistically we don’t know if we will be paid for any of this rebecca viagran. We are holding all of the bills for at least 90 days while the industry sorts out the rules. I was excited by the reimbursement announcement because I knew we had eliminated one of the biggest direct-to-consumer virtual care barriers.

    However, I was quickly brought back to reality when I was reminded that HIPAA (Health Insurance Portability and Accountability rebecca viagran Act) still existed. I had this crazy idea that during a pandemic we should make it as easy as possible for people to receive virtual care and that the best way to do that was to meet the patient on the device they are most comfortable with and the application (FaceTime, Facebook, Skype, etc.) that they use every day. The problem is nearly every app the consumer uses on a daily basis is banned by HIPAA because “it’s not secure.” I’m not quite sure what a hacker stands to gain by listening into to my doctor and me talk about how my kids yet again gave me strep throat but apparently the concern is great enough to stifle the entire industry.

    Sure, not every health care discussion is as low-key as strep throat and a patient may want to protect certain topics from being discussed over a “non-secure” app but why not let the patient decide through informed rebecca viagran consent?. Regulators could also abandon this all-or-nothing approach and lighten regulations surrounding specific health conditions. The idea that regulations change based on medical situation is not new.

    For example, in my home state of Michigan, adolescents are essentially considered emancipated if it involves sexual health, mental rebecca viagran health or substance abuse. Never mind that this same information is freely given over the phone by every office around the country daily without issue, but I digress. While my job is to innovate new pathways for care, our lawyer’s job is to protect the organization and he, along with IT security, rightfully shot down my consumer applications idea.

    A few days later I legitimately screamed out loud in joy when the Department of Health and Human Services announced that it would use rebecca viagran discretion on enforcing HIPAA compliance rules and specifically allowed for use of consumer applications. The elimination of billing restrictions and HIPAA regulations changed what is possible for health care organizations to offer virtually. Unfortunately both changes are listed as temporary and will likely be removed when the pandemic ends.

    Six days after the HIPAA changes were announced, we launched a centralized virtual clinic for any patient that wanted rebecca viagran a direct-to-consumer video visit to be screened by a provider for COVID-19. It allows patients to call in without a referral and most patients are on-screen within five minutes of clicking the link we text them. They don’t have to download an app, create an account or even be an established patient of our health system.

    It saw over 900 patients in the first 12 days it rebecca viagran was open. That is 900 real patients that received care from a physician or advanced practice provider without risking personal exposure and without going to an already overwhelmed ED or urgent care. To date, 70 percent of the patients seen by the virtual clinic did not meet CDC testing criteria for COVID-19.

    I don’t believe we rebecca viagran could have reached even half of these patients had the consumer application restrictions been kept. A program like this almost certainly wouldn’t exist if not for the regulations being lifted and even if it did, it would have taken six to 12 months to navigate barriers and implement in normal times. Sure, the urgency of a pandemic helps but the impact of provider, patients, regulators and payors being on the same page is what fueled this fire.

    During the virtual clinic’s rebecca viagran first two weeks, my team turned its attention to getting over 300 providers across 60+ offices virtual so they could see their patients at home. Imagine being an immunocompromised cancer patient right now and being asked to leave your home and be exposed to other people in order to see your oncologist. Direct-to-consumer virtual care is the best way to safely care for these patients and without these temporary waivers it wouldn’t be covered by insurance even if you did navigate the clunky apps that are HIPAA compliant.

    Do we really think the immunocompromised cancer rebecca viagran patient feels any more comfortable every normal flu season?. Is it any more appropriate to ask them to risk exposure to the flu than it is to COVID-19?. And yet we deny them this access in normal times and it quite possibly will be stripped away from them when this crisis is over.

    Now 300 to 400 patients per rebecca viagran day in our health system are seen virtually by their own primary care doctor or specialist for non-COVID related visits. Not a single one of these would have been reimbursed one month ago and I am highly skeptical I would have gotten approval to use the software that connects us to the patient. Lastly, recall that prior to COVID-19, our system had only found 250 total patients that direct-to-consumer care was value-added and wasn’t restricted by regulation or reimbursement.

    COVID-19 has been a wake-up call to the whole country and health care is no exception rebecca viagran. It has put priorities in perspective and shined a light on what is truly value-added. For direct-to-consumer virtual care it has shown us what is possible when we get out of our own way.

    If a regulation has to be removed to allow for care rebecca viagran during a crisis then we must question why it exists in the first place. HIPAA regulation cannot go back to its antiquated practices if we are truly going to shift the focus to patient wellness. CMS and private payors must embrace value-added direct-to-consumer virtual care and allow patients the access they deserve.

    COVID-19 has forced this industry forward, we cannot rebecca viagran allow it to regress and be forgotten when this is over. Tom Wood is the director of trauma and virtual care for MidMichigan Health, a non-profit health system headquartered in Midland, Michigan, affiliated with Michigan Medicine, the health care division of the University of Michigan. The views and opinions expressed in this commentary are his own.When dealing with all of the aspects of diabetes, it’s easy to let your feel fall to the bottom of the list.

    But daily care and evaluation is rebecca viagran one of the best ways to prevent foot complications. It’s important to identify your risk factors and take the proper steps in limiting your complications. Two of the biggest complications with diabetes are peripheral neuropathy and ulcer/amputation.

    Symptoms of peripheral neuropathy include numbness, tingling and/or burning in your feet and legs rebecca viagran. You can slow the progression of developing neuropathy by making it a point to manage your blood sugars and keep them in the normal range. If you are experiencing these symptoms, it is important to establish and maintain a relationship with a podiatrist.

    Your podiatrist can make sure things are looking healthy and bring things to your attention rebecca viagran to monitor and keep a close eye on. Open wounds or ulcers can develop secondary to trauma, pressure, diabetes, neuropathy or poor circulation. If ulcerations do develop, it’s extremely important to identify the cause and address it.

    Ulcers can get worse quickly, so it’s necessary to seek immediate medical treatment if you find yourself or a rebecca viagran loved one dealing with this complication. Untreated ulcerations often lead to amputation and can be avoided if proper medical attention is sought right away. There are important things to remember when dealing with diabetic foot care.

    It’s very important to inspect rebecca viagran your feet daily, especially if you have peripheral neuropathy. You may have a cut or a sore on your feet that you can’t feel, so your body doesn’t alarm you to check your feet. Be gentle when bathing your feet.

    Moisturize your feet, but not between your rebecca viagran toes. Do not treat calluses or corns on your own. Wear clean, dry socks.

    Never walk barefoot, and consider socks and shoes made specifically for patients with diabetes.

    You may be hearing about how virtual care, often described as telehealth or telemedicine, is beneficial during COVID-19 and how health systems low cost viagra are offering virtual access like never before. There’s a reason for that, too. For the past few weeks I’ve seen Facebook posts daily from former nursing colleagues in metro Detroit, one of the hardest hit areas in the country, as they provide front-line care to patients with COVID-19.

    It makes me very proud to call these nurses my friends low cost viagra. As a former emergency department nurse, I recall the feeling of satisfaction knowing that I’ve helped someone on the worst day of their life. One of the best parts of being a nurse is knowing you matter to the only person in health care that truly matters.

    The patient low cost viagra. Several years ago I made the difficult decision to no longer perform bedside nursing and become a nurse administrator. The biggest loss from my transition is the feeling that what I do matters to the patient.

    COVID-19 has forced low cost viagra a lot of us to rethink the role we play in health care and what the real priority should be. Things that were top priorities three months ago have been rightfully cast aside to either care for patients in a pandemic or prepare for the unknown future of, “When is our turn?. € For me, COVID-19 has reignited the feeling that what I do matters as virtual care has become a powerful tool on the forefront of care during this crisis.

    It has also shown that many of the powerful rules and regulations that low cost viagra limit virtual care are not needed and should be discarded permanently. When I became the director of virtual care at our organization in 2015 I knew nothing about telehealth. Sure, I had seen a stroke robot in some Emergency Departments, and I had some friends that told me their insurance company lets them FaceTime a doctor for free (spoiler alert.

    It’s not low cost viagra FaceTime). I was tech-savvy from a consumer perspective and a tech novice from an IT perspective. Nevertheless, my team and I spent the next few years learning as we built one of the higher volume virtual care networks in the state of Michigan.

    We discovered a low cost viagra lot of barriers that keep virtual care from actually making the lives of patients and providers better and we also became experts in working around those barriers. But, there were two obstacles that we could not overcome. Government regulation and insurance provider willingness to cover virtual visits.

    These two barriers effectively cripple most legitimate attempts to provide value-added direct-to-consumer virtual care, which I define as using virtual care technologies to provide care outside of our brick-and-mortar facilities, most commonly in low cost viagra the patient home. The need to social distance, cancel appointments, close provider offices, keep from overloading emergency departments and urgent cares and shelter in place created instant demand for direct-to-consumer virtual care. In all honesty, I’ve always considered direct-to-consumer virtual care to be the flashy, must-have holiday gift of the year that organizations are convinced will be the way of the future.

    If a health system wants to provide on-demand access to patients for low-complexity acute conditions, they will easily find plenty of low cost viagra vendors that will sell them their app and their doctors and put the health system’s logo on it. What a health system will struggle with is to find is enough patient demand to cover the high cost. Remember my friends from earlier that told me about the app their insurance gave them?.

    Nearly all low cost viagra of them followed that up by telling me they’ve never actually used it. I am fortunate that I work for an organization that understands this and instead focuses on how can we provide care that our patients actually want and need from the doctors they want to see. Ironically, this fiscal year we had a corporate top priority around direct-to-consumer virtual care.

    We wanted to expand what we thought were some successful low cost viagra pilots and perform 500 direct-to-consumer visits. This year has been one of the hardest of my leadership career because, frankly, up until a month ago I was about to fail on this top priority. With only four months left, we were only about halfway there.

    The biggest problem we ran into was that every great idea a physician brought to me was instantly dead in low cost viagra the water because practically no insurance company would pay for it. There are (prior to COVID-19) a plethora of rules around virtual care billing but the simplest way to summarize it is that most virtual care will only be paid if it happens in a rural location and inside of a health care facility. It is extremely limited what will be paid for in the patient home and most of it is so specific that the average patient isn’t eligible to get any in-home virtual care.

    Therefore, most good medical uses for direct-to-consumer care would be asking low cost viagra the patient to pay cash or the physician to forgo reimbursement for a visit that would be covered if it happened in office. Add to that the massive capital and operating expenses it takes to build a virtual care network and you can see why these programs don’t exist. A month ago I was skeptical we’d have a robust direct-to-consumer program any time soon and then COVID-19 hit.

    When COVID-19 started to spread rapidly in the United States, regulations and reimbursement rules were being low cost viagra stripped daily. The first change that had major impact is when the Centers for Medicare and Medicaid Services (CMS) announced that they would temporarily begin reimbursing for virtual visits conducted in the patient’s home for COVID-19 and non-COVID related visits. We were already frantically designing a virtual program to handle the wave of COVID-19 screening visits that were overloading our emergency departments and urgent cares.

    We were having plenty of discussions around reimbursement low cost viagra for this clinic. Do we attempt to bill insurances knowing they will likely deny, do we do a cash clinic model or do we do this as a community benefit and eat the cost?. The CMS waiver gave us hope that we would be compensated for diverting patients away from reimbursed visits to a virtual visit that is more convenient for the patient and aligns with the concept of social distancing.

    Realistically we don’t know if we will be paid for any low cost viagra of this. We are holding all of the bills for at least 90 days while the industry sorts out the rules. I was excited by the reimbursement announcement because I knew we had eliminated one of the biggest direct-to-consumer virtual care barriers.

    However, I was quickly brought back to reality when I was reminded that HIPAA (Health Insurance Portability and low cost viagra Accountability Act) still existed. I had this crazy idea that during a pandemic we should make it as easy as possible for people to receive virtual care and that the best way to do that was to meet the patient on the device they are most comfortable with and the application (FaceTime, Facebook, Skype, etc.) that they use every day. The problem is nearly every app the consumer uses on a daily basis is banned by HIPAA because “it’s not secure.” I’m not quite sure what a hacker stands to gain by listening into to my doctor and me talk about how my kids yet again gave me strep throat but apparently the concern is great enough to stifle the entire industry.

    Sure, not every health care discussion is as low-key as strep throat and a patient may want to protect certain topics from being discussed over a “non-secure” app but why not let the patient decide through low cost viagra informed consent?. Regulators could also abandon this all-or-nothing approach and lighten regulations surrounding specific health conditions. The idea that regulations change based on medical situation is not new.

    For example, in my home state of Michigan, adolescents are essentially considered emancipated low cost viagra if it involves sexual health, mental health or substance abuse. Never mind that this same information is freely given over the phone by every office around the country daily without issue, but I digress. While my job is to innovate new pathways for care, our lawyer’s job is to protect the organization and he, along with IT security, rightfully shot down my consumer applications idea.

    A few days later I legitimately screamed out loud in joy when the Department of Health and Human Services announced that it low cost viagra would use discretion on enforcing HIPAA compliance rules and specifically allowed for use of consumer applications. The elimination of billing restrictions and HIPAA regulations changed what is possible for health care organizations to offer virtually. Unfortunately both changes are listed as temporary and will likely be removed when the pandemic ends.

    Six days after the HIPAA changes were announced, we launched a centralized virtual clinic for any patient that wanted a direct-to-consumer video visit to be screened by a provider low cost viagra for COVID-19. It allows patients to call in without a referral and most patients are on-screen within five minutes of clicking the link we text them. They don’t have to download an app, create an account or even be an established patient of our health system.

    It saw over 900 patients in the first low cost viagra 12 days it was open. That is 900 real patients that received care from a physician or advanced practice provider without risking personal exposure and without going to an already overwhelmed ED or urgent care. To date, 70 percent of the patients seen by the virtual clinic did not meet CDC testing criteria for COVID-19.

    I don’t believe we could have reached even half of these low cost viagra patients had the consumer application restrictions been kept. A program like this almost certainly wouldn’t exist if not for the regulations being lifted and even if it did, it would have taken six to 12 months to navigate barriers and implement in normal times. Sure, the urgency of a pandemic helps but the impact of provider, patients, regulators and payors being on the same page is what fueled this fire.

    During the virtual clinic’s first two weeks, my team turned its attention to getting over low cost viagra 300 providers across 60+ offices virtual so they could see their patients at home. Imagine being an immunocompromised cancer patient right now and being asked to leave your home and be exposed to other people in order to see your oncologist. Direct-to-consumer virtual care is the best way to safely care for these patients and without these temporary waivers it wouldn’t be covered by insurance even if you did navigate the clunky apps that are HIPAA compliant.

    Do we really think the immunocompromised cancer patient feels any more comfortable low cost viagra every normal flu season?. Is it any more appropriate to ask them to risk exposure to the flu than it is to COVID-19?. And yet we deny them this access in normal times and it quite possibly will be stripped away from them when this crisis is over.

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    For more information, please contact:Jennifer de Vallancejdevallance@mathematica-mpr.com202-484-4692Mathematica is committed to advancing public health by applying our expertise across disciplines that constitute some of the most critical areas of public health today. The following focus areas highlight how we’re working to progress together to improve public well-being.APHA Public Health Film Festival. Helping Families Affected by Substance UseThe APHA selected a short film that Mathematica produced with support from the Administration for Children and Families to show at the APHA Public Health Film Festival.

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    Social Determinants of HealthPolicymakers and practitioners are increasingly interested in social determinants of health—the conditions in which people are born, grow, live, work, and age—to address upstream social risks, such as food insecurity and lack of affordable housing, that, in turn, improve health care outcomes. Mathematica data and policy experts recently produced a series of blog posts and research on how different stakeholders can improve and leverage data on social determinants of health to maximize the health and well-being of children and adults in the United States.COVID-19 ServicesResponding to the current public health crisis and illuminating the path forward to safely re-open businesses, schools, workplaces, and community services requires a seasoned partner with trusted solutions. Built on our foundation of rigorous data and evidence, Mathematica’s scalable services provide state and local agencies, as well as private-sector employers, with the confidence and clarity they need to take on the complex challenges of COVID-19.

    Some of our services include contact tracing, workforce planning, modeling and forecasting, and wastewater testing and analysis.Data Analytics and Survey ExpertiseAt Mathematica, we apply our expertise at the intersection of data science and social science to produce efficient, high quality, and action-oriented analysis that advances your mission.Using advanced technologies, reusable and scalable platforms, and high-performance secure cloud infrastructure, we enable our partners to target areas of opportunity and make the most of their data. We collect the data you need, manage data as a secure asset, analyze to surface insights, and place this knowledge in the hands of those who need it most.Mental Health and Substance UseMathematica understands the pressing challenges faced by our partners working to improve the delivery system, innovative value-based service models, and financing strategies that states and payers are testing—strategies that could improve the prevention and treatment of behavioral health conditions. We’re leading efforts to address the opioid crisis, increase access to care while controlling costs, and support the integration of behavioral health services with other health care and social services.Our staff have in-depth knowledge of the complex array of intersecting public and private programs and eligibility requirements that create challenges for consumers to get the help they need.

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    As part of our ongoing commitment to prioritizing healing and humanity as we stand against social injustice, Mathematica is pleased to announce that President and CEO Paul Decker is joining more than 1,300 CEOs and business leaders as a member of CEO Action for Diversity and low cost viagra Inclusion™. This coalition represents the largest CEO-driven business commitment to advancing workplace diversity, equity, and inclusion, while working to ensure opportunity at the highest levels of corporate leadership.“During a time when the nation continues to be tested by unresolved issues of social justice, Mathematica has taken significant strides toward centering diversity, equity, and inclusion in our interactions with each other and in our approach to our work,” said Decker. €œToday, we’re taking another important step forward by joining CEO Action for Diversity and Inclusion, an organization that unites business leaders from around the low cost viagra world to advance DEI initiatives in our own workplaces and beyond. I’m honored to represent Mathematica in this coalition fighting for meaningful change.”CEO Action represents approximately 13 million employees across more than 85 industries.

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    For more information, please contact:Jennifer de Vallancejdevallance@mathematica-mpr.com202-484-4692Mathematica is committed to advancing public health by applying our expertise across disciplines that constitute some of the most critical areas of public health today. The following focus areas highlight how we’re working to progress together to improve public well-being.APHA Public Health Film Festival. Helping Families Affected by Substance UseThe APHA selected a short film that Mathematica produced with support from the Administration for Children and Families to show at the APHA Public Health Film Festival. The film focuses on how the Regional Partnership Grant program improves the safety, permanency, and well-being of children affected by parent’s substance use disorders.

    Starting October 19, registered APHA Annual Meeting attendees can watch the film on demand. Registered attendees can also submit questions to Debra Strong a senior researcher for the Regional Partnership Grant National Cross-Site Evaluation, using a discussion board that will be available with the film. Please visit APHA’s page about public health films focusing on substance use and addiction treatment for more information. Diversity, Equity, and InclusionWhat does it take for organizations to progress together?.

    It takes a common purpose, shared values, a complementary array of resources and capabilities, and a mutual desire to learn from and with each other. Our ongoing diversity, equity, and inclusion journey is driving necessary changes in who we are. How we relate to each other, our partners, and our communities. And how we approach our work.

    Social Determinants of HealthPolicymakers and practitioners are increasingly interested in social determinants of health—the conditions in which people are born, grow, live, work, and age—to address upstream social risks, such as food insecurity and lack of affordable housing, that, in turn, improve health care outcomes. Mathematica data and policy experts recently produced a series of blog posts and research on how different stakeholders can improve and leverage data on social determinants of health to maximize the health and well-being of children and adults in the United States.COVID-19 ServicesResponding to the current public health crisis and illuminating the path forward to safely re-open businesses, schools, workplaces, and community services requires a seasoned partner with trusted solutions. Built on our foundation of rigorous data and evidence, Mathematica’s scalable services provide state and local agencies, as well as private-sector employers, with the confidence and clarity they need to take on the complex challenges of COVID-19. Some of our services include contact tracing, workforce planning, modeling and forecasting, and wastewater testing and analysis.Data Analytics and Survey ExpertiseAt Mathematica, we apply our expertise at the intersection of data science and social science to produce efficient, high quality, and action-oriented analysis that advances your mission.Using advanced technologies, reusable and scalable platforms, and high-performance secure cloud infrastructure, we enable our partners to target areas of opportunity and make the most of their data.

    We collect the data you need, manage data as a secure asset, analyze to surface insights, and place this knowledge in the hands of those who need it most.Mental Health and Substance UseMathematica understands the pressing challenges faced by our partners working to improve the delivery system, innovative value-based service models, and financing strategies that states and payers are testing—strategies that could improve the prevention and treatment of behavioral health conditions. We’re leading efforts to address the opioid crisis, increase access to care while controlling costs, and support the integration of behavioral health services with other health care and social services.Our staff have in-depth knowledge of the complex array of intersecting public and private programs and eligibility requirements that create challenges for consumers to get the help they need. Our work involves evaluating a wide range of behavioral health service delivery and payment models, helping partners establish programs that implement new services and policies and fill data gaps, fielding large-scale behavioral health surveys, developing and implementing behavioral health quality measures, and analyzing policy to guide decision making. For more than two decades, we’ve conducted national surveys of every known mental health and substance use disorder treatment facility in the country.

    Our analyses of T-MSIS data for the Centers for Medicare &. Medicaid Services provide critical information on patterns of substance use disorders and treatment across states as evidenced by the T-MSIS Substance Use Disorder (SUD) Data Book and a series of supporting data quality briefs..

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