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State COVID-19 News – Tennessee
Tennessee COVID-19 statistics
Tennessee cases as of May 19: 18,532 total; 287 total in Appalachian Highlands
Cases in counties of the Appalachian Highlands region:
- Carter Co. – 19 total, 17 recovered
- Cocke Co. – 20 total, 17 recovered
- Greene Co. – 46 total, 44 recovered
- Hamblen Co. – 24 total, 18 recovered
- Hawkins Co. – 31 total, 29 recovered
- Johnson Co. – 15 total, 15 recovered
- Sullivan Co. – 58 total, 54 recovered
- Unicoi Co. – 3 total, 3 recovered
- Washington Co. – 71 total, 62 recovered
Stay-at-home order expiring April 30
Tennessee Gov. Bill Lee has announced the state’s safer-at-home order will expire on Thursday, April 30. Please stay alert and attentive to phased reopening guidelines, and continue to observe physical distancing guidelines.
Ballad Health officials are involved with the economic workgroup established in Tennessee to provide input on how to reincorporate nonessential procedures and services that have been suspended.
Apr. 23, 2020
Unified Command releases new data, special report on nursing homes
Yesterday, Tennessee’s COVID-19 Unified Command Group released new data on COVID-19 in the state’s long-term care facilities and outlined its action plan on how to prevent further cases and mitigate existing clusters within these facilities.
Beginning immediately, the Tennessee Department of Health (TDH) will report the number of confirmed cases and COVID-19-related fatalities in all long-term care facilities across the state. The department’s website will be updated every Friday at 2 p.m. CDT to provide this data.
“This data and report give a clear picture on the risks that the virus poses to long-term care facilities and the aggressive actions the state has taken and will continue to take to protect residents and staff,” said TDH Commissioner Lisa Piercey, M.D. “We take our duties to protect both public health and patient privacy very seriously. Based upon the current development of the COVID-19 situation in Tennessee, the department has determined that releasing this data is in the public health interest. Unified Command stands at the ready to assist long-term care facilities in mitigating outbreaks among residents and staff.”
Action Plan for Long-Term Care Facilities
TDH provided detailed plans in its report on how the department works with long-term care facilities to protect residents and staff from COVID-19 and mitigate outbreaks. The action plans include:
- Immediate notification of the public health department of a suspected or confirmed COVID-19 cases in residents or staff
- Immediate facility notification of residents and their representatives of suspected or confirmed COVID-19 cases inside the facility
- Robust and swift information gathering by department staff in concert with the facility to determine:
- Personal protective equipment (PPE) and environmental cleaning needs
- The need for targeted or widespread testing of residents and staff
- Whether positive residents can cohort within the facility or must be relocated to hospitals for greater medical care
- Ongoing investigation and contact tracing by department staff, facility cleaning and daily situation updates with the facility to ensure the facility is safe for residents and staff.
Apr. 20, 2020
New executive order expands opportunities for healthcare workforce
On April 17, Governor Bill Lee signed Executive Order 28, which includes the following provisions relevant to hospitals:
- Relieves nurse practitioners (NPs) who hold a certificate of fitness to write/issue drugs from their physician collaboration requirement.
- Relieves physician assistants (PAs) from their physician collaboration requirement.
- Allows nurse graduates who have completed all requirements for licensure but have not yet taken their NCLEX to practice nursing under the supervision of a licensed registered nurse.
- Authorizes NPs and PAs to order home health services.
- Permits medical lab personnel employed by a licensed lab and under the supervision of a laboratory director to remotely review electronic data and report results without having a license for each remote location.
- Extends price gouging prohibition through May 3. (This prohibition only can be extended in 15-day increments.)
Provisions included in this order remain in effect through May 18.
Earlier Tennessee updates
WEEK of Apr. 12–18, 2020
Economic Recovery Group established to guide reopening of state economy
On Thursday, Governor Bill Lee established the Economic Recovery Group, a joint effort between state departments, members of the legislature and leaders from the private sector to build guidance to safely reboot Tennessee’s economy.
“COVID-19 has not only created a public health crisis, it has hurt thousands of businesses and hundreds of thousands of hardworking Tennesseans,” said Governor Lee. “As we work to safely open Tennessee’s economy, this group will provide guidance to industries across the state on the best ways to get Tennesseans back to work.”
The group is led by Tennessee Department of Tourism Development Commissioner Mark Ezell.
“This public-private partnership will prioritize connection, collaboration and communication across industries, the medical community and state government,” said Ezell. “We’re grateful to these leaders for serving at a critical time in our state’s history.”
Sammie Arnold will serve as the chief of staff for the Economic Recovery Group. Arnold currently serves as assistant commissioner of rural development at the Tennessee Department of Economic and Community Development.
Members of the Economic Recovery Group include:
Lee administration representatives
- Mark Ezell, Director
- Sammie Arnold, Chief of Staff
- House Majority Leader William Lamberth (R – Portland)
- Senate Majority Leader Jack Johnson (R – Franklin)
- Brandon Gibson, Governor’s Office
- Bob Rolfe, Tennessee Department of Economic and Community Development
- Greg Gonzales, Tennessee Department of Financial Institutions
- David Gerregano, Tennessee Department of Revenue
- Dr. Charles Hatcher, Tennessee Department of Agriculture
- Dr. Jeff McCord, Tennessee Department of Labor and Workforce Development
- Hodgen Mainda, Tennessee Department of Commerce and Insurance
- Tony Niknejad, Governor’s Office
- Brigadier General Scott Brower, COVID-19 Unified Command Group
- Dr. Morgan McDonald, Tennessee Department of Health
- Butch Eley, Tennessee Department of Finance & Administration
- Jim Brown, National Federation of Independent Business
- Bradley Jackson, Tennessee Chamber of Commerce and Industry
- Beverly Robertson, Memphis Chamber of Commerce
- Rob Ikard, Tennessee Grocers & Convenience Store Association
- Rob Mortensen, Tennessee Hospitality & Tourism Association
- Colin Barrett, Tennessee Bankers Association
- Fred Robinson, Tennessee Credit Union League
- Dave Huneryager, Tennessee Trucking Association
- Will Cromer, Tennessee Hospital Association
- Mayor Kevin Davis, Tennessee County Services Association
- Mayor Jill Holland, Tennessee Municipal League
- Jeff Aiken, Tennessee Farm Bureau
- Tari Hughes, Center for Non-Profit Management
- Roland Myers, Tennessee Retail Association
- Clay Crownover, Associated Builders & Contractors of Tennessee
Financial Accountability Group appointed
Governor Bill Lee announced on Thursday the creation of the Stimulus Financial Accountability Group to ensure proper fiscal management of stimulus funds received by the state through the Coronavirus Relief Fund created by the federal Coronavirus Aid, Relief and Economic Security (CARES) Act. The state of Tennessee projects a distribution of approximately $2.3 billion from the fund.
“The CARES Act has given our state critical relief to help mitigate the spread of COVID-19 and begin to reopen Tennessee’s economy,” said Gov. Lee. “We must ensure that these funds are spent wisely and effectively, and I’m grateful to the members of this group for their valuable input as we steward these resources and serve Tennesseans.”
Members of the group include:
- Governor Bill Lee
- Lieutenant Governor Randy McNally (R – Oak Ridge)
- House Speaker Cameron Sexton (R – Crossville)
- Sen. Bo Watson (R – Hixson)
- Sen. Raumesh Akbari (D – Memphis)
- Rep. Pat Marsh (R – Tullahoma)
- Rep. Harold Love, Jr. (D – Nashville)
- Comptroller Justin Wilson
- Tennessee Department of Finance & Administration Commissioner Butch Eley
- COVID-19 Unified Command Director Stuart McWhorter
The first meeting of the Stimulus Financial Accountability Group will be held remotely on April 22.
Governor announces creation of economic recovery group
Following yesterday’s extension of a statewide mandatory stay at home order through April 30, Governor Bill Lee announced the development of his Economic Recovery Group to focus on a phased-in restart of the state’s economy. The group will be led by Tennessee Department of Tourism Commissioner Mark Ezell and will work in coordination with legislative leadership, local mayors, healthcare professionals and representatives from impacted industries. The Economic Recovery Group will issue industry-specific guidance so businesses can be prepared to operate safely and protect their employees and customers.
By formalizing an economic recovery-specific group, the state’s COVID-19 Unified Command Group can continue its focused efforts on disease management and improving hospital and testing capacity, as well as increasing the personal protective equipment (PPE) supply chain. The Unified Command Group also will be making recommendations to Governor Lee about when and how to begin the phased-in reopening of the economy.
Guidance on HRTS data requests
The state, local governments and individual facilities are receiving requests for local data from the Hospital Resources Tracking System (HRTS), which is administered by the Tennessee Department of Health (TDH).
Currently, TDH releases HRTS data in aggregate for the entire state. However, due to these requests, some regions are considering releasing their own local data. TDH requests that if local data is released, it is restricted to reporting aggregate data only at the level of the healthcare coalitions (HCCs). These coalitions include both metro and regional county data, which should provide helpful regional information without the risk of identifying any specific institution.
WEEK of Apr. 5–11, 2020
Governor extends prohibition on elective procedures
Governor Bill Lee signed Executive Order 25 [PDF], which extends the prohibition on elective medical procedures through April 30. The initial order blocking these procedures was set to expire on April 13.
Actions included in the order seek to:
- Ensure that personal protective equipment (PPE) is preserved, and community spread through close medical interaction is limited during the coming weeks when cases and hospitalizations are expected to increase.
- Expand the actions of Executive Order 18, which first suspended elective procedures, to more specifically cover all procedures that are elective and non-urgent and can be delayed until after the order without risking serious adverse consequences to a patient.
- Limit attendance at necessary surgeries and invasive procedures to essential personnel in order to preserve PPE to the greatest extent possible.
- Urge non-hospital providers impacted by the order to donate available PPE to the Tennessee Emergency Management Agency (TEMA).
Governor launches small and rural hospital readiness grant program
Governor Bill Lee announced the $10 million small and rural hospital readiness grant program to support hospitals that are facing financial strain due to the ongoing response to COVID-19. The grants will be allocated from the state’s FY20 COVID-19 response appropriation and distributed by the Tennessee Department of Finance & Administration.
For qualifying hospitals, grants are available up to $500,000 per hospital and will serve as a bridge over the coming weeks as patient volumes decline and new federal funds become available. THA hosted a webinar [PDF] to discuss how to support the required grant application. Additional information is available here.
THA requests MCOs suspend administrative requirements during COVID emergency
THA sent a letter to TennCare Director Stephen Smith, requesting that managed care organizations (MCOs) suspend some administrative requirements as hospitals focus staff efforts on direct patient care during this crisis. Requested suspensions include:
- Suspending notification, certification and concurrent review requirements related to utilization management
- Timely filing extensions
- No medical record requests and audits during the emergency
- Request that MCOs expedite processing of any outstanding claims to providers
Mental health department offers teleconnections between EDs and RMHIs
The four Tennessee regional mental health institutes (RMHI) have been granted greater flexibility during the pandemic to allow direct teleconnections with high-volume hospital emergency departments (ED) to perform RMHI admission evaluations prior to patient transport. Through this process, RMHI physicians can determine in advance whether a person meets the legal criteria for an emergency involuntary admission.
Typical onsite presentations to the RMHIs often can lead to a non-admit decision, so this type of connection has proven to be very effective in speeding up access to services, reducing the burden on law enforcement and decreasing trauma to the client. High-volume EDs interested in pursuing a RMHI teleconnection are encouraged to reach out to their local RMHI or crisis service provider.
East Tennessee nurses traveling to New Orleans to help in COVID-19 pandemic
“I’ve always loved going and helping out in other countries. We just feel like that we’re called to go help because this is at home. Our own people and our own nurses, they need us to help here. So we just feel like we’re called to go,” said Nikki Manis.
State works to support unemployed Tennesseans
COVID-19 has caused record spikes in unemployment, with the number of initial claims spiking to more than 250,000 in the last three weeks.
In March, at the onset of the pandemic, Governor Bill Lee directed the Tennessee Department of Labor and Workforce Development to conduct the following actions to support Tennesseans facing unemployment due to COVID-19:
- Extend unemployment benefits to those who are quarantined by a physician for COVID-19
- Suspend certain regulations to speed up payment time
Tennesseans who are out of work can apply for unemployment benefits at Jobs4TN.gov.
Health facilities licensure board acts on several COVID-19-related issues
The Tennessee Department of Health’s (TDH) Board for Licensing Health Care Facilities held an emergency conference call this week to address several COVID-19 response issues through adoption of board policies, as well as interpretive guidance and waiver of specific rules.
Each of these actions, which pertain to hospitals, home health, hospice, nursing homes and assisted living facilities, are available in the links below.
- Board Policy #82 – includes action related to temporary hospital structures
- Board Policy #83 – relative to trauma center designation for facilities due for re-designation
- Hospital Rule 1200-08-01-.01(19) – relative to critical access hospitals
- Hospital Rule 1200-08-01-.05(23) – relative to exceeding licensed bed capacity
- Home Health Rule 1200-08-26-.05(2)(4) and 1200-08-26-.05(8)8 – relative to use of nurse practitioners and physician assistants
- Home Health Rule 1200-08-26-.06(3)(b) – relative to physician signature
- Home Health Rule 1200-08-26-.06(7)(c) – relative to supervisory visits
- Hospice Rule 1200-08-27-.05(3), (5) and (9) – relative to review of plans of care
- Hospice Rule 1200-08-27-.06(11)(b) – relative to supervisory visits
- Nursing Home Rule 1200-08-06-.15(3) – relative to inclusion of nurse aides in Nurse Aide Registry
- Assisted Living Facility Rule 1200-08-25-.10(3)(a) and (b) – relative to fire drills
- Assisted Living Facility Rule 1200-08-25-.08(1)(c) – relative to admission and retention of COVID-19 patients
Governor issues mandatory stay-at-home order
Governor Bill Lee signed Executive Order 23 on Thursday, requiring that Tennesseans stay home unless they are carrying out essential activities as data shows an increase in citizen movement across the state.
Data from the Tennessee Department of Transportation analyzed traffic patterns for March 2020. While safer at home measures and further restrictions on businesses showed a steep drop-off in vehicle movement from March 13 through 29, data beginning on March 30 indicates travel is trending upwards again.
The executive order remains in effect until April 14 at 11:59 p.m. THA issued a statement to media in support of the governor’s action.
THA provides COVID-19 update to senate and house speakers
As the state continues to fight the COVID-19 pandemic, THA sent a letter to Lieutenant Governor Randy McNally and House Speaker Cameron Sexton to update them on the work of THA and its member hospitals. The letter highlights hospital priorities during this critical time and outlines the extensive work underway to respond to the crisis, including THA’s work with state officials and agencies.
Department of health develops PPE request portal
The Tennessee Department of Health (TDH) and Tennessee Emergency Management Agency (TEMA) have created an online PPE request form for hospitals and other providers to use to formally request needed personal protective equipment (PPE) from the state’s cache. Hospitals should use the online form AND communicate the request directly to their regional healthcare coordinators at the same time.
Hospitals need to continue all efforts to keep supplies coming in directly from vendors while focusing on conservation and reuse strategies.
Hospitals also need to report system their PPE status (and bed and ventilator capacity) daily in the healthcare resource tracking system (HRTS) so state officials effectively can plan and respond if the pandemic reaches predicted levels.
PASRR update from TennCare
TennCare sent all hospitals and nursing homes an update [PDF] on Monday’s Centers for Medicare & Medicaid Services (CMS) federal waiver related to the pre-admission screening and resident review (PASRR) process. The CMS waiver allows states to enact a 30-day suspension of PASRR requirements. The agency advises the PASRR suspension is a one-time only waiver, making it important that Tennessee invoke it at the point where hospital patient loads are at their highest/critical levels.
TDH/THA weekly calls archived on the THA website
Based on requests from the membership, the recordings of the weekly THA/Tennessee Department of Health (TDH) COVID 19 calls (every Friday from 11 to noon ET) have been archived on the THA website. Each new recording will be added by Monday following the Friday call.
WEEK of Mar. 29–Apr. 4, 2020
TennCare receives 1135 waiver approval
On March 31, CMS approved TennCare’s request for some 1135 waivers related to pre-admission screening and annual resident review (PASRR), provider enrollment and services provided in alternative settings during the COVID emergency.
Governor orders non-essential businesses closed, issues statewide “Safer at Home” order
Tennessee Governor Bill Lee issued Executive Order 21 [PDF] and Executive Order 22 [PDF], which ordered the closure of all non-essential businesses in the state and urged Tennesseans to comply with a Safer at Home policy to limit travel and public interactions. Read more
Unified command engaging entrepreneurs to address PPE shortage
Tennessee’s COVID-19 Unified Command announced a partnership with LaunchTN to work directly with Tennessee businesses and entrepreneurs who are willing to switch production to make lifesaving personal protective equipment (PPE) and medical supplies, as well as other important health care functions during the COVID-19 pandemic.