Mental Health and Substance Use Disorders in EMS

From JEMS on October 9, 2020

Recognizing and Supporting EMS Providers with Mental Health and Substance Use Disorders

By Meredith M. O’Neal, MA; Simone Joannou, MA; and James Langabeer, PhD, EMT

About 30 percent of first responders develop mental health disorders, including depression, Acute Stress Disorder (ASD) and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population.3 Another common occupational risk factor includes acute and chronic exposure to both primary and secondary trauma, the latter referring to the phenomenon of emotional and moral attachment to the experience of the individuals they rescue.

These overwhelming demands from first responders can lead to compassion fatigue, a depleted capacity for empathy that results in various behavioral issues including depression and anxiety. Burnout is a similar phenomenon of exhaustion resulting from occupational strain such as overwork and lack of support from leadership. These conditions have been found to directly contribute to the more than doubled suicide rates among medics than other professionals.

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CMS: Revised Repayment Terms for Medicare Accelerated Payments

On October 8, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a Fact Sheet setting forth the repayment terms for advances made under the Medicare Accelerated and Advance Payments Program (AAPP).  These changes were mandated by the passage of the Continuing Appropriations Act, 2021 and Other Extensions Act, which was enacted on October 1, 2020.

Background

On March 28, 2020, CMS expanded the existing Accelerated and Advance Payments Program to provide relief to Medicare providers and suppliers that were experiencing cash flow disruptions as a result of the COVID-19 pandemic, and associated economic lockdowns.  Under the AAPP, Medicare providers and suppliers were eligible to receive an advance of up to three months of their historic Medicare payments.  These advances are structured as “loans,” and are required to be repaid through the offset of future Medicare payments.

CMS began accepting applications for Medicare advances in mid-March 2020, before ending the program in late April following the passage of the CARES Act.  CMS ultimately approved more than 45,000 applications for advances totaling approximately $100 billion, before it suspended the program in late April 2020.

Under the pre-existing terms of the AAPP, repayment through offset was required to commence on the 121st day following the provider or supplier’s receipt of the advance funds.  The program also called for a 100% offset until all advanced funds had been repaid.

Revised Payment Terms

Under the revised payment terms announced by CMS, providers and suppliers will not be subject to recoupment of their Medicare payments for a period of one year from the date they received their AAPP payment.  Starting on the date that is one year from their receipt of the AAPP payment, repayment will be made out of the provider’s or supplier’s future Medicare payments.  The schedule for such repayments will be as follows:

  • 25% of the provider’s or supplier’s Medicare payments will be offset against the outstanding AAPP balance for the next eleven (5) months; and
  • 50% of the provider’s or supplier’s Medicare payments will be offset against the outstanding AAPP balance for the next six (6) months

To the extent there remains an outstanding AAPP balance after that 17 month period (i.e., 29 months after the date the provider or supplier received its AAPP payment, the provider or supplier will receive a letter setting forth their remaining balance.  The provider or supplier will have 30 days from the date of that letter to repay the AAPP balance in full.  To the extent the AAPP balance is not repaid in full within that 30-day period, interest will begin to accrue on the unpaid balance at a rate of 4%, starting from the date of the letter.

Medicare providers and suppliers are also permitted to repay their accelerated or advance payments at any time by contacting their Medicare Administrative Contractor.

 

EMS.gov | Public Comment for EMS Controlled Substances Rule

From EMS.gov

Public Comment Period for Proposed Rule on EMS and Controlled Substances

As part of the Protecting Patient Access to Emergency Medications Act of 2017, which was passed 3 years ago, the DEA was required to establish regulations associated with the use of controlled substances by EMS agencies. The DEA has now published in the Federal Register proposed rules to implement the law. Comments on the proposed rules can be submitted electronically or by mail on or before December 4, 2020. Individuals, agencies and organizations may submit comments.

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JEMS | How Empress EMS (NY) Responded to COVID-19 in the Pandemic’s Epicenter

From JEMS on October 2, 2020 | By Hanan Cohen

The onset of the COVID-19 pandemic created extraordinary new challenges for the emergency medical services (EMS) industry. Frequently shifting state and federal guidance and emerging information about the novel virus has required EMS agencies to be even more nimble in delivering care.

This is true for Empress EMS, a PatientCare EMS Solutions company, which serves New Rochelle, New York – the first epicenter of America’s COVID-19 pandemic. Empress first began monitoring for COVID-19 on February 15, 2020, as it recognized the New York City area’s high risk for the virus.

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CMS: COVID Testing and Screening Guidance for SNF and Long-Term Care Facilities

On August 25, 2020, the Centers for Medicare and Medicaid Services (CMS) published an interim final rule with a comment period titled “Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments of 1988 (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency.”  The interim final rule sets forth a number of new requirements designed to limit the COVID-19 exposure and to prevent the spread of COVID-19 within nursing homes.

Specifically, the interim final rule requires skilled nursing and other long-term care facilities to test residents and staff for COVID-19.  The frequency of such testing is based on the positivity rate in which the facility is located, and can require COVID-19 testing as frequently as twice per week.  Regardless of the frequency of required COVID-19 tests, facilities must also screen all staff, residents, and persons entering the facility for the signs and symptoms of COVID-19.

These requirements extend to individuals that provide services to nursing homes under arrangements, including health care personnel rendering care to residents within the facility.  In subsequent guidance, CMS clarified that these testing and screening requirements apply to EMS personnel and other health care providers that render care to residents within the facility.  However, in that same guidance, CMS indicated that EMS personnel must be permitted to enter the facility provided that: (1) they are not subject to a work exclusion as a result of to an exposure to COVID-19 or (2) showing signs or symptoms of COVID-19 after being screened.”  CMS further indicated that “EMS personnel do not need to be screened so they can attend to an emergency without delay.”

In plain terms, CMS has created an affirmative obligation on nursing homes to ensure that any individual that provides services under a contractual arrangement with the nursing home comply with these testing and screening requirements.  CMS has expressly waived the screening requirements for EMS personnel responding to medical emergencies at a nursing home.  However, CMS has not specifically addressed the testing and screening requirements applicable to EMS personnel responding to nursing homes in non-emergency situations. 

The A.A.A. is aware that a handful of State Health Agencies have issued their own guidance on this issue.  The A.A.A. is also aware that individual nursing homes have started to require proof that EMS personnel have been tested for COVID-19 prior to allowing these individuals to enter the nursing home in a non-emergency situation.

EMS agencies may already be subject to state and local testing mandates.  EMS agencies may also have their own internal policies that require employees to be periodically tested for COVID-19.  As a result, there exists the potential for conflict where these existing testing policies conflict with the testing requirements of your local nursing homes.

The A.A.A. has been engaged in an ongoing conversation with CMS on these issues since the issuance of the interim final rule in August.  As part of that conversation, the A.A.A. pushed for the exclusion of EMS personnel from the screening requirement when responding to medical emergencies, which was included in the recent CMS guidance document.  The A.A.A. also continues to push for additional funding for COVID-19 testing for EMS agencies.  CMS has recognized that the frequent testing of health care workers is essential to reducing the spread of the novel coronavirus.  CMS has allocated funding for these purposes to other industries, including hospitals and nursing homes.  As front-line health care workers, EMS agencies should have similar access to testing funds.  The A.A.A. will continue to push for funding equity for the EMS industry.

In the interim, we strongly encourage our members to work with their state associations and other stakeholders to advocate for reasonable rules related to testing on the state and local levels.  To the extent the applicable state or local agency has determined the appropriate frequency for the testing of EMS personnel responding to medical emergencies, those rules should also apply to EMS personnel responding to scheduled transports and other non-emergencies that start or end at a nursing home.  Requiring more frequent testing in these situations would impose an undue burden on EMS agencies that provide these services.  More frequent testing may also prove counterproductive, as it may discourage EMS agencies that cannot meet these higher requirements from responding in these situations.  We also encourage our members to continue to push for state and local funding for the testing of their employees.

 

COVID-19 fatalities among EMS clinicians

From EMS1
by
By Brian J. Maguire, Dr.PH, MSA, EMT-P
Barbara J. O’Neill, PhD, RN
Scot Phelps, JD, MPH, Paramedic
Paul M. Maniscalco, PhD(c), MPA, MS, EMT/P, LP
Daniel R. Gerard, MS, RN, NRP
Kathleen A. Handal, MD

The devastating effects of the COVID-19 pandemic resonate around the world. Escalating infection and death rates are reported daily. While emergency medical services clinicians have been operating at the far forward front lines of the COVID-19 pandemic from the start, their infections, lost work time, long-term clinical manifestations and deaths have not been adequately reported or recorded [1]. In this article, we examine currently available EMS COVID-19 mortality data in order to describe the extent of EMS losses and to compare the risks for EMS clinicians to the risks for other related professions.

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CARES Act Reporting Requirements Released

All recipients of payments from the Department of Health and Human Services’ Provider Relief Fund (PRF) are required to comply with the reporting requirements described in the Terms and Conditions and specified in future directions issued by the Secretary.

Providers that received more than $10,000 in grants will have to report on how they spent funds on coronavirus-related expenses and lost revenue in 2020 by Feb. 15, 2021. If providers do not spend all their grant funds by the end of 2020, they will be required to submit a final report on the remaining funds by July 31, 2021.

Any recipient of PRF payments may be subject to auditing to ensure the accuracy of the data submitted to HHS for payment.  Any recipients identified as having provided inaccurate information to HHS will be subject to payment recoupment and other legal action.

For more details, please refer to the Terms and Conditions associated with each payment distribution and the Reporting Requirements and Auditing FAQs.

Read more from HHS

Share Your Innovative Solutions

The American Ambulance Association Workforce Committee is seeking examples of creative solutions to EMS challenges, related and unrelated to the pandemic. If your service has solved a problem or overcome an obstacle in an innovative manner, please share it in our short form below. Entries will be reviewed by the Workforce Committee for potential adaptation into member education.

Thank you for your continued support and participation.

Update – SNF COVID-19 Testing Does Not Apply to EMS

CMS Clarify in Guidance that EMS Personnel Are Not Required To Be Tested under Skilled Nursing Facility Testing Interim Final Rule

The Centers for Medicare & Medicaid Services (CMS) have issued guidance clarifying the types of personnel who are subject to the testing requirements when entering a Skilled Nursing Facility (SNF) in the Interim Final Rule with Comment (IFC) on Additional Policy and Regulatory Revisions in Response to the COVID– 19 Public Health Emergency.  The new guidance memo states:

 

Entry of Health Care Workers and Other Providers of Services

Health care workers who are not employees of the facility but provide direct care to the facility’s residents, such as hospice workers, Emergency Medical Services (EMS) personnel, dialysis technicians, laboratory technicians, radiology technicians, social workers, clergy etc., must be permitted to come into the facility as long as they are not subject to a work exclusion due to an exposure to COVID-19 or show signs or symptoms of COVID-19 after being screened. We note that EMS personnel do not need to be screened so they can attend to an emergency without delay. We remind facilities that all staff, including individuals providing services under arrangement as well as volunteers, should adhere to the core principles of COVID-19 infection prevention and must comply with COVID-19 testing requirements.

 

CMS issued this guidance at the request of the American Ambulance Association (AAA) to address concerns our members had raised about some SNFs misinterpreting the requirements.  The guidance is also consistent with AAA’s interpretation of the IFC.   As we indicated in an earlier Member Advisory, the IFC requires SNFs to test certain individuals for COVID-19 before they enter the facility.  Specifically, it applies to employees, consultants, and contractors of a skilled nursing facility (SNF).  It does not apply to vendors, suppliers, attending physicians, family, or visitors. Providers, such as medical directors and hospice, that are under a contract or consultants to a SNF are subject to the rule.  EMS personnel do not come within the scope of the IFC.

 

Even though the testing requirements of the IFC do not extend to ground ambulance services that do not have a contractual relationship with a SNF, the AAA supports the efforts of all of our members to follow the World Health Organization and Centers for Disease Control and Prevention Guidelines to have EMT and paramedics use full Personal Protective Equipment (PPE) when they are engaging with any patient, not only those in SNFs.  We also want to recognize the best practices of many members who have worked with SNFs to establish outdoor locations where the SNF personnel, when possible, can bring a patient out of the building to transfer the patient to the ambulance.  These and other examples of safe practices can help control the spread of COVID-19, which is the paramount concern.

Expanded Support for EMS Responding to Natural Disasters, COVID-19

Frontline Impact Project Expands Support for Frontline Heroes, Offers Companies a New Way to Give Amidst Historic Natural Disasters

COVID-19 response platform will now direct resources to first responders facing wildfires, hurricanes and other catastrophes   

September 15, 2020 – Frontline Impact Project is expanding its mission and will now also support heroes on the frontlines of major natural disasters including the Western wildfires and Hurricane Laura. The platform, which The KIND Foundation launched in partnership with dozens of companies in response to COVID-19, will activate its existing infrastructure to shepherd resources like meals, snacks, beverages and personal care items to first responders in need. The announcement comes after extraordinary displays of courage and sacrifice from the nation’s firefighters, paramedics and emergency volunteers.

“We started Frontline Impact Project to meet the needs of those on the frontlines of the COVID-19 pandemic. While this work will continue, we are cognizant of the many others risking their lives to keep us safe, particularly as peak wildfire and hurricane seasons approach,” says Michael Johnston, President of The KIND Foundation. “Thanks to the generosity of more than 60 companies, we’re set up to respond in real time and help take care of America’s heroes as they take care of us.”

As part of this expansion, Frontline Impact Project has initiated partnerships with two leading disaster response nonprofits, National Voluntary Organizations Active in Disaster (NVOAD) and Good360, to get donated items to workers across the Gulf Coast and Western United States.

“Non-profit staff and volunteers work tirelessly to serve survivors impacted by disaster. Frontline Impact Project’s commitment and efforts to supporting those serving on the frontlines of disasters across the country is a welcome addition to the disaster response community,” says Katherine Boatwright, Director of Operations, NVOAD.

Since April, Frontline Impact Project has matched more than 650 frontline institutions with companies that have products or services to donate. Available resources include food, beverages, personal care items, mental health services and virtual fitness classes. Together with its inaugural partner KIND, the project has donated nearly four million products to date.

“We were looking for a flexible and streamlined way to donate our products. Frontline Impact Project gives us the opportunity to scale our giving as the situation demands and reach a deserving audience whose needs are paramount but not always top of mind,” says Aaron Croutch, Executive Vice President, Lenny & Larry’s.

Kara Goldin, Founder and CEO of Hint, adds, “Now, more than ever, it’s critical that we support first responders and help keep them healthy and hydrated. Hint has donated water to hundreds of healthcare organizations and first responders across the country, and the Frontline Impact Project has made coordination with a number of those groups much easier.”

In addition to Lenny and Larry’s and Hint, a number of companies have signed on to support this effort, including Adrenaline Shoc Smart Energy; Belgian Boys; CLEAN Cause; Just the Cheese; Kabaki Tea; Kodiak Cakes; KIND; La Colombe; Neuro; Paunchy Elephant; RISE Brewing Co; ROWDY; Purely Elizabeth; and ZICO Coconut Water.

To submit a donation or make a request, visit www.frontlineimpact.org.

ET3 Model Moves Forward Starting January 1, 2021

The Centers for Medicare & Medicaid Services (CMS) has announced that the first performance period for the Emergency Triage, Treat, and Transport (ET3) Model will begin on January 1, 2021. As we reported previously, CMS delayed the start of ET3 Model, consistent with its delaying or pausing other payment models, because of the COVID-19 public health emergency (PHE).

To start this effort, CMS has indicated that it will post a revised Participation Agreement (PA) to the ET3 Model Portal by mid-October 2020. Participants must upload signed PAs to the ET3 Model Portal by December 15, 2020. CMS will also post an Implementation Plan Template (IPT). Participants must submit their IPT CMS by November 15, 2020 to allow CMS to review and accept the IPT prior to beginning their participation in the Model.

CMS plans to provide additional guidance, including:  an Orientation Overview fact sheet, Billing and Payment fact sheets, Model Participation During the PHE fact sheet, a Who’s Who fact sheet, and an ET3 Model Portal User Guide. These documents will be available to participants through the ET3 Model Portal during the next several weeks.

The re-engagement on the ET3 Model prior to the end of the PHE is something that the American Ambulance Association (AAA) has supported in discussions with CMS. While it does not address some of the gaps in reimbursement and treatment that our members are seeing nationwide, for those who are participating in the model, it will be an enormous benefit.

The AAA also continues to work with CMS to identify new models that will allow other ground ambulance providers and suppliers to participate in innovative models, even though there were not able to meet the ET3 participation requirements.

Trump Administration Releases COVID-19 Vaccine Distribution Strategy

FOR IMMEDIATE RELEASE
September 16, 2020

Contact: HHS Press Office
202-690-6343
media@hhs.gov

Trump Administration Releases COVID-19 Vaccine Distribution Strategy

The U.S. Department of Health and Human Services (HHS) and Department of Defense (DoD) today released two documents outlining the Trump Administration’s detailed strategy to deliver safe and effective COVID-19 vaccine doses to the American people as quickly and reliably as possible.

The documents, developed by HHS in coordination with DoD and the Centers for Disease Control and Prevention (CDC), provide a strategic distribution overview along with an interim playbook for state, tribal, territorial, and local public health programs and their partners on how to plan and operationalize a vaccination response to COVID-19 within their respective jurisdictions.

“As part of Operation Warp Speed, we have been laying the groundwork for months to distribute and administer a safe and effective COVID-19 vaccine as soon as it meets FDA’s gold standard,” said HHS Secretary Alex Azar. “This in-depth, round-the-clock planning work with our state and local partners and trusted community organizations, especially through CDC, will ensure that Americans can receive a safe and effective vaccine in record time.”

The strategic overview lays out four tasks necessary for the COVID-19 vaccine program:

  • Engage with state, tribal, territorial, and local partners, other stakeholders, and the public to communicate public health information around the vaccine and promote vaccine confidence and uptake.
  • Distribute vaccines immediately upon granting of Emergency Use Authorization/ Biologics License Application, using a transparently developed, phased allocation methodology and CDC has made vaccine recommendations.
  • Ensure safe administration of the vaccine and availability of administration supplies.
  • Monitor necessary data from the vaccination program through an information technology (IT) system capable of supporting and tracking distribution, administration, and other necessary data.

On August 14, CDC executed an existing contract option with McKesson Corporation to support vaccine distribution. The company also distributed the H1N1 vaccine during the H1N1 pandemic in 2009-2010. The current contract with McKesson, awarded as part of a competitive bidding process in 2016, includes an option for the distribution of vaccines in the event of a pandemic.

“CDC is drawing on its years of planning and cooperation with state and local public health partners to ensure a safe, effective, and life-saving COVID-19 vaccine is ready to be distributed following FDA approval,” said CDC Director Robert Redfield. “Through the Advisory Committee on Immunization Practices, CDC will play a vital role in deciding, based on input from experts and stakeholders, how initial, limited vaccine doses will be allocated and distributed while reliably producing more than 100 million doses by January 2021.”

Detailed planning is ongoing to ensure rapid distribution as soon as the FDA authorizes or approves a COVID-19 vaccine and CDC makes recommendations for who should receive initial doses. Once these decisions are made, McKesson will work under CDC’s guidance, with logistical support from DoD, to ship COVID-19 vaccines to administration sites.

“The Department of Defense is using its world-class logistical expertise to plan for distributing a safe and effective vaccine at warp speed,” said General Gustave Perna. “Americans can trust that our country’s best public health and logistics experts are working together to get them vaccines safely as soon as possible.”

Download the Strategy for Distributing a COVID-19 Vaccine – PDF*

Download the COVID-19 Vaccination Program Interim Playbook – PDF

About Operation Warp Speed:

OWS is a partnership among components of the Department of Health and Human Services and the Department of Defense, engaging with private firms and other federal agencies, and coordinating among existing HHS-wide efforts to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics.

About HHS & CDC:

HHS works to enhance and protect the health and well-being of all Americans, providing for effective health and human services and fostering advances in medicine, public health, and social services. To learn more about federal support for the nationwide COVID-19 response, visit coronavirus.gov.

CDC works 24/7 protecting America’s health, safety and security. Whether disease start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

About DoD:

The Department of Defense’s enduring mission is to provide combat-credible military forces needed to deter war and protect the security of our nation. The Department provides a lethal and effective Joint Force that, combined with our network of allies and partners, sustains American influence and advances shared security and prosperity.

* People using assistive technology may not be able to fully access information in this file. For assistance, please contact digital@hhs.gov.

Study | Vitamin D reduces risk of ICU admission

From The Journal of Steroid Biochemistry and Molecular Biology

“Of 50 patients treated with calcifediol [bloodstream-form Vitamin D], one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%)… Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged.”

Read the full study> Castillo, Marta Entrenas, et al. “Effect of Calcifediol Treatment and best Available Therapy versus best Available Therapy on Intensive Care Unit Admission and Mortality Among Patients Hospitalized for COVID-19: A Pilot Randomized Clinical study.” The Journal of Steroid Biochemistry and Molecular Biology (2020): 105751.

CMS Updates Medicare COVID-19 Snapshot

From CMS on September 3, 2020

Today, the Centers for Medicare & Medicaid Services (CMS) released our monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 773,000 COVID-19 cases among the Medicare population and nearly 215,000 COVID-19 hospitalizations.

Other key findings:

  • The rate of COVID-19 cases among Medicare beneficiaries grew 40% since the July release to 1,208 cases per 100,000 beneficiaries.
  • Similarly, the rate of COVID-19 hospitalizations among Medicare beneficiaries grew 33% since the July release to 338 hospitalizations per 100,000 beneficiaries.
  • Weekly counts of COVID-19 cases and hospitalizations reached the lowest point to date in late June and began to increase in July.
  • The rate of COVID-19 cases and hospitalizations grew the most among disabled beneficiaries, Hispanic beneficiaries, and Medicare-only beneficiaries (those who are not dually eligible for Medicaid).
  • Medicare Fee-for-Service (Original Medicare) spending associated with COVID-19 hospitalizations grew to $3.5 billion or just over $25,000 per hospitalization.
  • Data on discharge status and length of stay for COVID-19 hospitalizations remained similar to previously reported figures in the July release. 29% of beneficiaries went home at the end of their hospital stay and 24% died. Nearly half of the hospitalizations lasted 7 days or less while 5% lasted more than 31 days.

The updated data on COVID-19 cases and hospitalizations among Medicare beneficiaries covers the period from January 1 to July 18, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by August 14, 2020.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf

Public Comment Requested for COVID-19 Vaccine Allocation

On September 1, 2020, the National Academies of Sciences, Engineering, and Medicine invited public comment on the Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine, commissioned by the Centers for Disease Control and the National Institutes of Health. Input from the public, especially communities disproportionately affected by the COVID-19 pandemic, is essential to produce a final report that is objective, balanced, and inclusive. The public comment period will be open for 4 days, from 12:00 p.m. ET on Tuesday, September 1, until 11:59 p.m. ET on Friday, September 4.

Learn More or Comment

State-Level COVID Funding and Distribution

From Dept. Of Treasury: 

The Department of the Treasury Office of Inspector General (OIG) is responsible for monitoring and oversight of the receipt, disbursement, and use of Coronavirus Relief Fund payments. On July 2, 2020, OIG notified each prime recipient of an Interim Report requirement for reporting costs incurred during the period March 1 through June 30, 2020.

State and local governments have spent a minimal amount of funds allocated as part of Congressional relief packages, according to the Treasury Inspector General.

The Inspector General published data showing how much each state was given from the federal government and how much each state has spent as of June 30th. While the report doesn’t reflect data for the month of July yet, members may work within their states to try to obtain funding there as well.

To learn more about this Treasury Report, CLICK HERE.

You will find a list of statements and disbursements to local entities.