Emergency Management

Corona Virus (COVID-19) Pandemic
Overview
Getting Started
Current Disasters
Four Phases of Emergency Preparedness
Resources

Corona Virus (COVID-19) Pandemic

People with disabilities are at increased risk of serious or fatal complications from COVID-19.  The best advice is to isolate at home.  The Centers for Disease Control and Prevention (CDC) recommends that people at high risk stock up on necessities, ranging from hearing aid batteries to tissues and prescription medications (as well as over the counter cold/cough remedies) https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html#Have-supplies-on-hand.  Changes have been made in many states, as well as in some federal programs, to facilitate obtaining advance refills.  The CDC’s website has many resources regarding symptoms, what to do if you feel sick, and preparation for an outbreak in your area:  https://www.cdc.gov/coronavirus/2019-ncov/index.html

The Administration on Community Living (ACL) has a website that will be continually updated throughout the course of the COVID-19 outbreak.  https://acl.gov/COVID-19 includes useful information.

Several other federal agencies have dedicated webpages including the US Department of Education (https://www.ed.gov/coronavirus).  Note in particular interim guidance relating to services to young children and students with disabilities at https://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/qa-covid-19-03-12-2020.pdf

The US Department of Labor’s Occupational Safety and Health Administration (OSHA) published “Guidance on Preparing Workplaces for COVID-19” https://www.osha.gov/Publications/OSHA3990.pdf to help companies respond in the event of coronavirus in the workplace. The guidance was developed in collaboration with the U.S. Department of Health & Human Services (HHS).

Health Insurance Coverage

Because of the impact of this emergency on health insurance, it is important to review materials that relate to coverage for assistive technology devices and services.  In addition to information coming from the international sources (e.g. World Health Organization [WHO]), the federal government including the Center for Disease Control (CDC) check with your state regarding issues like authorization for and delivery of (and funding for) tele-rehabilitation services.

CMS’s fact sheet for state Medicaid and Children’s Health insurance Agencies responds to Frequently Asked Questions https://www.medicaid.gov/state-resource-center/downloads/covd-19-faqs-20200312.pdf. While aimed that those agencies, it may be helpful for state AT programs to understand the flexibilities that are (or are not) available to public programs in the context of the COVID-19 emergency.

The CMS Information Sheet for Providers https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf (March 13, 2020) addresses a variety of requirements that are waived in the emergency, including around access to DME:

Where Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) is lost, destroyed, irreparably damaged, or otherwise rendered unusable, contractors have the flexibility to waive replacements requirements such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.

This March 10, 2020 memorandum address Medicare Advantage, Part D, and Medicare-Medicaid plans: https://www.cms.gov/files/document/hpms-memo-covid-information-plans.pdf  

Updates from Federal Agencies: Education

The following are recent resources:

March 12, 2020:  QUESTIONS AND ANSWERS ON PROVIDING SERVICES TO CHILDREN WITH DISABILITIES DURING THE CORONAVIRUS DISEASE 2019 OUTBREAK (March 2020)
https://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/qa-covid-19-03-12-2020.pdf

March 16, 2020: Addressing the Risk of COVID-19 in Schools While Protecting the Civil Rights of Students
https://www2.ed.gov/about/offices/list/ocr/docs/ocr-coronavirus-fact-sheet.pdf

March 17, 2020:  Office of Civil Rights webinar regarding Online Education and Website Accessibility
https://www.youtube.com/watch?v=DCMLk4cES6A

March 21, 2020:  Correcting misunderstanding about distance education and students with disabilities
https://www2.ed.gov/about/offices/list/ocr/frontpage/faq/rr/policyguidance/Supple%20Fact%20Sheet%203.21.20%20FINAL.pdf?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=

At the outset, OCR and OSERS must address a serious misunderstanding that has recently circulated within the educational community. As school districts nationwide take necessary steps to protect the health and safety of their students, many are moving to virtual or online education (distance instruction). Some educators, however, have been reluctant to provide any distance instruction because they believe that federal disability law presents insurmountable barriers to remote education. This is simply not true. We remind schools they should not opt to close or decline to provide distance instruction, at the expense of students, to address matters pertaining to services for students with disabilities. Rather, school systems must make local decisions that take into consideration the health, safety, and well-being of all their students and staff. To be clear: ensuring compliance with the Individuals with Disabilities Education Act (IDEA), † Section 504 of the Rehabilitation Act (Section 504), and Title II of the Americans with Disabilities Act should not prevent any school from offering educational programs through distance instruction.

Updates from Federal Agencies: Health and Human Services (HHS)

Administration for Community Living Guidance

ACL has issued an FAQ guidance document: State AT Programs COVID-19 Frequently Asked Questions

Telehealth services

The HHS OCR Guidance on telehealth identifies technologies that could be used for telehealth and those that cannot be used for telehealth, here is an excerpt from the guidance on the HHS website https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html. Note that just because a telehealth service is permitted does not assure payment by public or private insurance payers. In addition, telehealth/telerehab providers representing licensed professions should check with their state’s respective licensing body.

“Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.

Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.

Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • Doxy.me
  • Google G Suite Hangouts Meet

Note: OCR has not reviewed the BAAs offered by these vendors, and this list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products. There may be other technology vendors that offer HIPAA-compliant video communication products that will enter into a HIPAA BAA with a covered entity. Further, OCR does not endorse any of the applications that allow for video chats listed above.

Under this Notice, however, OCR will not impose penalties against covered health care providers for the lack of a BAA with video communication vendors or any other noncompliance with the HIPAA Rules that relates to the good faith provision of telehealth services during the COVID-19 nationwide public health emergency.

OCR has published a bulletin advising covered entities of further flexibilities available to them as well as obligations that remain in effect under HIPAA as they respond to crises or emergencies at https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf - PDF

Sanitization/cleaning

While the CDC recommends you wash your hands frequently and avoid touching your face, it is harder to clean the other things that touch your face – especially your phone.  When reviewing advice and products, note whether there is a claim to kill bacteria or viruses.  Even if it is “only” going to take care of bacteria, it doesn’t hurt to clean your electronics!

Advice from the New York Times here: https://www.nytimes.com/2020/03/12/smarter-living/clean-your-phone.html?te=1&nl=morning-briefing&emc=edit_NN_p_20200316&section=topNews&campaign_id=9&instance_id=16781&segment_id=22269&user_id=8fa8cd33132f23241ab7ea4d3ef5de30&regi_id=97901944tion=topNews

Apple advice (although don’t try going to an Apple store for consultation at the “Genius Bar” – many Apple stores are closed).  https://support.apple.com/en-us/HT204172?mod=article_inline

PC magazine addresses “spring cleaning” for a variety of electronics, including headphones, phones, and tablets and laptops

https://www.pcmag.com/how-to/how-to-spring-clean-your-electronics?fbclid=IwAR2kiFsIyWrwO63Srv0fDChUcknYD_O2V_HZAAWWOHDK_J-8nTG9b0P_Gfg

This article from NPR (3/14/2020) responds to information that the virus can live several days on hard smooth surfaces

https://www.npr.org/sections/health-shots/2020/03/14/811609026/the-new-coronavirus-can-live-on-surfaces-for-2-3-days-heres-how-to-clean-them?utm_source=facebook.com&utm_term=nprnews&utm_campaign=npr&utm_medium=social&fbclid=IwAR253fHy3oG_OX3LOdTsGbjG7MwxzA7LBquHGwzyYeEqoGReg9_IR1PUbYk&fbclid=IwAR2djuCerTxEhxKBCkwdVznFqy0D6biX6e4bYxmBsm1uQUnV6F50A8qsaFY

The ”AT News and Tips” blog from March 9, 2020 (updated 3/16/2020) summarizes these and other resources for cleaning https://at3centerblog.com/category/emergency-preparedness/ 

General cleaning and disinfection advice from the CDC is at https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html

And of course, refer to the archived AT3 webinar (November 9, 2019) on “basic” sanitization and cleaning procedures at https://www.at3center.net/repository/ReuseCoP

Managing Anxiety in the time of COVID19

Even those without pre-pandemic anxiety may be able to find helpful information in AT3’s “AT News and Tips” blog https://at3centerblog.com/2018/05/23/at-for-managing-anxiety/

The CDC has useful information at https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fcoping.html

Other Materials

It is possible that the State AT program is the only entity that is available to assist consumers with information particular to assistive technology devices and services.  This may especially be true for families who rely on the schools for AT services for their children.  PrAACticalAAC has a comprehensive compilation of materials to explain the virus (e.g. social stories); visual supports for handwashing; visual schedules (especially good to have if parents are suddenly home schooling!) and communication (sample boards; symbols; vocabulary)  https://praacticalaac.org/praactical/praactical-resources-dealing-with-the-covid-19-pandemic/?fbclid=IwAR3RY5BFN8tMoi3Be-ekTKLaf7fneljxZs9Bd8bDyoAEyIa9hcGygkjd8Uk

Overview

Disasters – large scale events that have an extreme impact on life and property – disproportionately affect people with disabilities. They are more likely to have difficulty evacuating without assistance, are more likely to be segregated in shelters, and have more difficulty recovering in the disaster’s aftermath. Individuals with disabilities who are independent in their day-to-day lives may lose access to their caregivers (paid/volunteer staff or family members), transportation, accessible living or working environments and assistive technologies.   

People with disabilities are significantly less prepared than the general population (Smith & Notaro, 2015) and are more likely to be severely impacted by the disaster. Under “blue skies” conditions assistive technology (AT) is critical to the independence and well-being of people with disabilities; in an emergency or disaster, access to AT may mean survival and/or the difference in recovery from the event. Thus, involvement of state AT programs in emergency management efforts is a natural fit.

Getting Started
Current Disasters
Four Phases of Emergency Preparedness

Getting Started

One of the first steps to engaging in statewide emergency management (EM) efforts is to become familiar with the structures, terminology, and acronyms/abbreviations used in these efforts on the national, regional and local levels. For example, the term “access and functional needs” is the current terminology used by emergency managers to refer to people with disabilities (although this term also includes people with special needs due to permanent or temporary medical conditions as well as individuals who do not speak English). Conversely, state AT programs seeking engagement with emergency management personnel may need to share the language and acronyms relating to disability. For a good example on this topic, visit the Special Education and Disability Acronyms website page.

Current Disasters

Many people with disabilities in North Carolina and South Carolina have been affected by Hurricane Florence (2018), losing their AT/DME or having new AT/DME needs as a result of the storm and subsequent flooding.  State AT programs can sign up in the Portlight/Pass It On Center Disaster Relief Portal https://documents.portlight.org/disaster-relief/index.php to list and respond to requests for DME.  For needs related specifically to augmentative and alternative communication (AAC, low tech or speech-generating devices and services), sign up at the portal maintained by the US Society to AAC (USSAAC) at https://aacdisasterrelief.recovers.org/

Four Phases of Emergency Preparedness

Emergency preparedness is typically conceptualized as having four phases: Preparedness; Response; Recovery; and Mitigation.

Personal preparedness

Emergency preparedness is based on the notion that there are certain predictable factors that will occur in an emergency or disaster, and the effects of these factors can be reduced or eliminated by taking steps in advance of the occurrence. The Federal Emergency Management Agency (FEMA) and the respective state emergency management agency, the Centers for Disease Control (CDC) as well as state public health agencies have online resources to promote personal preparedness for people with disabilities.

  • People who use AT should develop a plan, a “go kit” in the case of evacuation as well as supplies that will facilitate their ability to “shelter in place”.  Several state AT programs have developed preparedness resources with a focus on people who use AT. These resources are in the process of being added to this webpage. For immediate assistance, you can contact Amy.Goldman@ataporg.org

Emergency response

First responders include personnel such as police, fire, and other emergency workers who may be involved in assisting people with disabilities in safely evacuating their premises (whether at work or home) and in some cases transporting them to emergency shelters. It is helpful for first responders to understand the nature of various disabilities (including issues related to communication) and the importance of AT, and to have training on these topics. Agencies responsible for operating shelters may need assistance in developing, acquiring and deploying assistive technology resources that will enable people with disabilities to be safely housed in an accessible “general population” shelter when appropriate, rather than segregated in a restrictive medical needs shelter. State AT programs have developed resources to help train first responders as well as shelter personnel; suggested lists of AT for shelters (including not limited to AT for mobility and communication); and strategies to identify AT needs of survivors in the shelter.

Recovery

Recovery from emergencies and disasters may take a long time, depending upon the extent of the event and the robustness of the infrastructure prior to the event. For example, months after Puerto Rico was devastated by the 2017 hurricanes, the island was still without reliable power or telephone service. Many individuals with disabilities has lost their AT; others had new and unmet needs for AT devices and services as a result. While federally-declared disasters may provide some support for the replacement of AT, available funds may not cover the loss or it may take a long time. Reused AT may be a valuable resource to provide individuals with device loans to bridge the time between loss and replacement. The Pass It On Center has additional resources on deploying AT when helping survivors of emergencies and disasters.

Mitigation

The mitigation phase of emergency management refers to efforts related to reduce the (future) impact of emergencies. This may include additional steps in planning, training, and community preparation.  For example, state AT programs may be develop Memoranda of Understanding with community partners and EM officials that outline the ways in which the state program may be called upon in the event of a disaster declaration.

Resources

State AT Programs in the time of Corona Virus (COVID-19) Webinar Recording

Emergency Management and AT Programs Webinar

Recommendations for Emergency Managers For Improving the Delivery of Disaster Assistance to Disaster Survivors with Disabilities (pdf) (March 2019).

This document, produced by US Department of Homeland Security (DHS) Office for Civil Rights and Civil Liberties, is a synthesis of information gleaned from listening sessions held in communities affected by the 2017 and 2018 natural disasters. Recommendations support the engagement of state AT Act programs in all phases of emergency and the promotion of personal preparedness of people with disabilities, especially those who use power-dependent assistive technology and durable medical equipment.

Preserving Our Freedom: Ending Institutionalization of People with Disabilities During and After Disasters (pdf). Specific recommendations that involve assistive technology are included.

NCD recommends the FCC reestablish their Emergency Access Advisory Committee to establish effective communication access requirements for alerts, warnings and notification, including provision of American Sign Language and other existing and new assistive technology. These guidelines should be developed in consultation and collaboration with DOJ, applying the requirements for equal effective communication access. Implementation should include monitoring and enforcement by the FCC and the Department of Justice.

NCD recommends that HHS establish a process for states and territories for loaning and replacing durable medical equipment, consumable medical supplies, assistive technology, disability services and supports, as well as disaster case management to disaster survivors with disabilities in order to provide equal access and non-discrimination throughout emergency response to meet immediate health, safety, and independence needs.