Turn Your Clocks Back One Hour

Daylight saving time in the U.S. will end on Sunday, November 5 at 2 a.m. local time, pushing clocks back an hour.

The modern idea of changing the clocks with the seasons can be traced back to at least the late 19th century when New Zealand entomologist George Hudson proposed it to conserve energy and extend summer daylight hours. The practice went through many variations before the U.S. standardized it in 1966 in the Uniform Time Act, which allows states to opt out of it but not to stay on daylight saving time permanently. A common myth is that the U.S. adopted daylight saving time to benefit farmers, but in reality many farmers are opposed to the practice for being disruptive to their schedules. The original motivation to conserve fuel is also under debate, as studies have found little, if any, energy savings from the shift, according to the Congressional Research Service.

Physicians support ending daylight savings time. Opponents of the semi-annual time change point to studies that have found adverse health effects linked to daylight saving time, such as a spike in fatal traffic accidents, heart attacks, strokes and sleep deprivation in the days after clocks are moved forward an hour every March. The U.S. is not ending daylight saving any time soon, though there is an effort in the federal government to pass the so-called Sunshine Protection Act, which would make daylight saving time permanent. The act, introduced in the Senate in 2022, was passed unanimously but stalled in the House because lawmakers could not agree on whether to keep standard time or permanent daylight saving time. The Senate reintroduced the bill again this year and it has been referred to the Committee on Commerce, Science and Transportation to review.

Saturday, November 18 - Christiana Hilton, Newark

Registration is open for the 234th MSD Annual Meeting to be held on Saturday, November 18th. This year's meeting will be held at the Christiana Hilton in Newark. All MSD members are encouraged to attend. Thank you to our Council members for their service to MSD and their constituents. Your fork is the most powerful tool to heal your body. Learn about the influence of nutrition on patients' wellbeing and how food can help manage chronic diseases and improve overall health during the planned education sessions. Register for the presentation (and cooking demo!) and discover the power of nutrition. It is vital for physicians to be able to educate their patients about nutrition to achieve optimal health.

Four resolutions have been submitted for the Council's consideration:

• Artificial Intelligence in Health Care
• MSD Response to the Obesity Epidemic - A Chronic Disease
• Support for Refugees in Delaware
• Gun Violence is a Public Health Crisis

Things to know:

• Registration deadline is Friday, November 10th!
• The Inaugural Gala is on hold for this year. View the Annual Meeting agenda.
• There will be two education sessions on the topic of "Food as Medicine." The Medical Society of Delaware designates this live activity for a maximum of 2 AMA PRA Category 1 Credit™. 
• Those members who graduated medical school fifty years ago (1973) will be recognized in a ceremony following the first education session.
• Delaware Medical Political Action Committee (DELPAC) members can enjoy gourmet coffee and conversation with Delaware lawmakers. Join DELPAC if you are not already a member.

Thank you to our Sponsors:

Enjoy Gourmet Coffee, Conversation with Legislators at the Annual Meeting

Why not grab a gourmet cup of coffee with some of Delaware's e-"steemed" legislators at the Delaware Medical Political Action Committee (DELPAC) Coffee and Conversation event at the MSD Annual Meeting on November 18th! Prepare to be treated to top tier, specifically tailored gourmet coffees, teas, espressos, lattes, and cappuccinos prepared by DELPAC's amazing barista, all while mixing and mingling with MSD's highly acclaimed political lobbying agency, the Byrd Group, and key Delaware legislators. This exclusive benefit is ONLY For DELPAC members and will be open from 7:30-11:00 a.m. Want to join the fun? Join DELPAC now! Now accepting donations for the 2024 cycle.

One Step At A time Foundation Requesting Help With Health Screenings

On Wednesday, November 22 – the day before Thanksgiving – the One Step At A Time Foundation is hosting an event for the community in Wilmington to enjoy a meal, educational opportunities on various health issues, and, hopefully, some basic health care assessments. That’s where you come in. The organization is looking for health care professionals willing to offer a few hours of their time to provide health screenings for these families. If you are available on November 22 between 11:00 am and 3:00 pm, please contact Frank Howard at Frank@ConvergencePubAffairs.com to get more details and make arrangements. This family health event will take place at the William "Hicks" Anderson Community Center, located at 501 N. Madison St., Wilmington. Help make a difference.

Ensure the Correct Volume is Withdrawn From the Vial

The Food and Drug Administration (FDA) is advising health care professionals who administer the Moderna COVID-19 Vaccine (2023-2024 Formula) to individuals 6 months through 11 years of age to ensure that the correct volume of the vaccine (0.25 mL) is withdrawn from the vial, so that the correct dose is administered to the vaccine recipient. The Moderna COVID-19 Vaccine (2023-2024 Formula) is authorized for use in individuals 6 months through 11 years of age. FDA has become aware that some health care professionals may not recognize that the single dose vial of Moderna COVID-19 Vaccine (2023-2024 Formula) for use in individuals 6 months through 11 years of age contains notably more than 0.25 mL of the vaccine. Some health care professionals may be withdrawing the entire contents of the vial to administer to an individual. However, the volume of a single dose of Moderna COVID-19 Vaccine (2023-2024 Formula) is only 0.25 mL.

Enrollment Began November 1st and Runs Through January 15, 2024

Delawareans seeking coverage for 2024 will find more choice in insurers and plans than ever before on the Health Insurance Marketplace in the 11th year of open enrollment. The marketplace’s open enrollment period started on Wednesday, November 1, and ends January 15, 2024. Consumers can renew existing coverage or sign up for a new plan at www.HealthCare.gov. Coverage for enrollees who sign up by December 15 and pay their first month’s premium will be effective January 1. Individuals who don’t act by January 15, 2024, cannot get coverage for 2024 unless they qualify for a Special Enrollment Period based on circumstances such as a loss of qualifying health coverage, change of income, becoming a parent, or other qualifying factors.

For Adolescents and the Health Care Workforce

On Tuesday this week, the Department of Health and Human Services (HHS) issued Take Action for Adolescents: A Call to Action for Adolescent Health and Well-Being a new effort to promote collaboration and spur action to improve the health and well-being of adolescents across the U.S. Take Action for Adolescents outlines a vision, key principles, eight goals, and a set of initial action steps. It is research-based and was developed with extensive input from adult and youth allies and partners, including nationally recognized adolescent health experts. It is accompanied by a Take Action Toolkit with tips and resources to spur collaboration in states and communities.

The Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) also announced on Tuesday the launch of Impact Wellbeing. This new campaign provides hospital leaders with evidence-informed resources to improve workplace policies and practices that reduce burnout, normalize help-seeking, and strengthen professional wellbeing. Impact Wellbeing supports hospital leaders, and in turn their health care workforce, by providing actionable steps to fine-tune quality improvements, establish new workflows, and help staff feel safe seeking help. 

New Guidelines Indicate Millions More Should be Screened

According to updated guidelines by the American Cancer Society (ACS), more Americans who smoke or used to smoke should undergo annual screenings for lung cancer. The ACS had previously recommended annual screenings for adults aged 55 to 74 with at least a ≥30 pack-year smoking history who either currently smoke or quit smoking less than 15 years ago. The updated guidelines adjust for how long ago someone quit smoking and is no longer a factor in whether someone is screened for lung cancer. The ACS recommends annual lung cancer screening for current or past smokers, ages 50 to 80, with at least a ≥20 pack-year smoking history. Many former smokers are still at a high risk for lung cancer regardless of when they quit smoking.

FDA Continues to Curb Youth Use with Fines Against Retailers

Today, the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), released data from the 2023 National Youth Tobacco Survey (NYTS) on tobacco product use among U.S. youth. The findings, which were collected between March and June 2023, show that 10% of U.S. middle and high school students (2.8 million youth) reported current use of any tobacco product. Among U.S. high school students, current overall tobacco product use declined during 2022-2023 (16.5% to 12.6%), primarily attributable to reduced e-cigarette use (14.1% to 10%), which translates to 580,000 fewer high school students who reported current use of e-cigarettes in 2023. Among high school students, declines in current use were also observed during 2022-2023 for cigars and overall combustible tobacco smoking, representing all-time lows. Although a decrease in e-cigarette use was observed among high school students, among middle school students there was an increase in current overall tobacco product use (4.5% to 6.6%) and multiple tobacco product use (1.5% to 2.5%). However, among middle school students overall, no significant change was observed during 2022-2023 for current use of any individual tobacco product type, including e-cigarettes. 

Policy Changes for Medicare Payment Under the Physician Fee Schedule

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announces finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2024. The calendar year (CY) 2024 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality, affordability, and innovation.

Medicare Shared Savings Program Fact Sheet

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) final rule that includes changes to the Medicare Shared Savings Program (Shared Savings Program) to further advance CMS’ overall value-based care strategy of growth, alignment, and equity. These changes include refinements to the broader changes finalized in the CY 2023 PFS final rule (87 FR 69404, 69777 through 69968 (Nov. 18, 2022) and also described in the CY 2023 Medicare Physician Fee Schedule Final Rule — Medicare Shared Savings Program Fact Sheet. 

Expands Behavioral Health Services, Advances Cancer Moonshot, Supports Family Caregivers, Accelerates Value-Based Care

Today, the Centers for Medicare & Medicaid Services (CMS) announced it is finalizing policies to support primary care, advance health equity, assist family caregivers and expand access to behavioral and certain oral health care. These policies are included in the calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) final rule, which also provides payment for principal illness navigation services to help patients and their families navigate cancer treatment and treatment for other serious illnesses, supporting the Biden-Harris Administration’s Cancer Moonshot mission to accelerate the fight against cancer.

CMS Extending the MDPP Expanded Model's PHE Flexibilities for 4 Years

The Centers for Medicare & Medicaid Services (CMS) announced on November 1, 2023, that it will extend the Medicare Diabetes Prevention Program (MDPP) Expanded Model’s Public Health Emergency Flexibilities for four years. Previously, MDPP suppliers were required to resume in-person delivery of the MDPP set of services after December 31, 2023. In CY 2024 Medicare Physician Fee Schedule (PFS) QPP Final Rule Resources, CMS will allow all MDPP suppliers to continue to use specific MDPP COVID-19 Public Health Emergency (PHE) flexibilities, through December 31, 2027. These flexibilities include the virtual delivery of the set of MDPP services through distance learning. This rule also simplifies MDPP’s current performance-based payment structure by allowing fee-for-service payments for beneficiary attendance. This new rule allows all MDPP suppliers to continue to offer the Set of MDPP services virtually through December 31, 2027 as long as they maintain an in-person Centers for Disease Control and Prevention Diabetes Prevention Recognition Program organizational code. This includes the ability to:

• Collect weight measurements for MDPP beneficiaries via virtual technology and/or self-reported weight measurements.
• Provide all MDPP services virtually, with no maximum of virtual sessions provided.
• Use a new distance learning G-code for MDPP services delivered virtually via distance learning.
• Bill for each session attended (up to 22 sessions over the 12-month MDPP services period).

Questions may be submitted through the MDPP Supplier Support Portal.

Additional information regarding this ruling may be found in the Federal Register.

For Calendar Years 2018-2022 Final Rule

On November 2, 2023, in light of the Supreme Court’s decision in American Hospital Association v. Becerra (142 S. Ct. 1896 (2022)) and the district court’s remand to the agency, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining the remedy for the invalidated Outpatient Prospective Payment System (OPPS) 340B-acquired drug payment policy for Calendar Years 2018-2022. CMS is publishing this final rule to remedy the payment rates the Court held were invalid. Aspects of this finalized policy will affect nearly all hospitals paid under the OPPS. This fact sheet discusses the provisions of the final rule (CMS- 1793-F), which can be downloaded at https://www.federalregister.gov/documents/current.

Final Rule Fills Gaps in Behavioral Health Services to Improve Outcomes

Today, the Centers for Medicare & Medicaid Services (CMS) announced it is expanding access to behavioral health services for people with Medicare through coverage of intensive outpatient services and that it is making it easier for the public to learn what a hospital charges for items and services through improved hospital price transparency requirements. These policies are included in the calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule with comment period released today, which also updates payment rates by 3.1% for hospital outpatient and ASC services for calendar year 2024.

2023 Report to Congress

The U.S. Preventive Services Task Force (USPSTF) has released its “13th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.” In this annual report, the USPSTF calls attention to high-priority research gaps related to promoting mental health and wellness for people of all ages. The report also reinforces the USPSTF’s commitment to improving health equity by highlighting research gaps that are reflective of populations that are most affected by these conditions. The topics featured in this report include screening for anxiety disorders, depression, and suicide risk in children, adolescents, and adults in the primary care setting. These important mental health conditions are common and affect many Americans and their families. Future research can help fill gaps in these areas and may result in new recommendations that will help to improve the mental health of people nationwide. By identifying evidence gaps and highlighting them as research priorities, the USPSTF aims to inspire collaboration among researchers to generate new knowledge in disease prevention, reduce disparities in healthcare, and close key evidence gaps. Read the complete report on the USPSTF website.

President Signs Executive Order Establishing Standards for AI

President Biden on Monday, signed a sweeping executive order, invoking the Defense Production Act, establishing new safety, security and equity standards for artificial intelligence (AI), including its use within the health care industry. The President has instructed the Department of Health and Human Services (HHS) to establish a safety program to receive reports of, and act to remedy, harms or unsafe health care practices involving AI. There will also be an expansion of grants for AI research in health care. HHS will have a year to develop a broad strategic plan on responsible use of AI. HHS is tasked with exploring the intersection of nondiscrimination laws and AI, building an AI safety program for detecting harm-related incidents and be given 180 days to determine whether current AI is accurate enough for use in health care. The executive order includes a government-developed standard for AI safety testing to be used prior to public release, safeguards to protect individuals whose data is used in large-scale model training, standards protecting against AI synthesis of dangerous biological materials, best practices for detecting fake media created by AI ("deep fakes"), and principles mitigating the harms of automation on the health care and broader workforce.

How the HIPAA Security Rule Can Help Defend Against Cyber Attacks

In recognition of National Cybersecurity Awareness Month, the Office for Civil Rights (OCR) has produced a new video this October for organizations covered under the HIPAA Rules on how the HIPAA Security Rule can help regulated entities defend against cyber-attacks. The video is available in English and Spanish. This presentation is intended to educate the health care industry on real world cyber-attack trends from OCR breach reports and investigations and explore how implementation of appropriate HIPAA Security Rule safeguards can help detect and mitigate common cyber-attacks. Topics include:

• OCR breach and investigation trend analysis
• Common attack vectors
• OCR investigations of weaknesses that led to or contributed to breaches
• How Security Rule compliance can help regulated entities defend against cyber-attacks

The video presentation may be found on OCR’s YouTube channel at: http://youtube.com/watch?v=VnbBxxyZLc8. The video presentation in Spanish may be found on OCR’s YouTube channel at: http://youtube.com/watch?v=3oVarCxLcB8.

First Over-the-Counter Test for Preliminary Detection of Fentanyl in Urine

On Thursday last week, the US Food and Drug Administration (FDA) cleared Alltest Fentanyl Urine Test Cassette, the first over the counter test for the preliminary detection of fentanyl in urine. The test works by placing three drops of fresh urine onto a cassette containing a fentanyl test strip. After 5 minutes the test result will appear as colored lines. The agency expedited review of this test, making a decision on the submission in only 16 days from the date it was received. The test provides only preliminary results. A more specific alternative chemical method (confirmation testing) must be used in order to obtain a confirmed test result. The test includes a pre-addressed mailing box for shipping samples to the manufacturer’s laboratory for confirmation testing. The test may provide incorrect results if the urine sample is contaminated, for example by adding bleach. The test does not distinguish between drugs of abuse and certain medications. Certain foods or food supplements may give a false positive test result.

Investment in Scientific and Technological Innovation

The U.S. Economic Development Administration announced that the greater Philadelphia area has been designated a Regional Technology and Innovation Hub. With the support of the National Institute for Innovation in Manufacturing Biopharmaceuticals (NIIMBL) biopharmaceutical manufacturing institute at the University of Delaware, Delaware will invest in biotechnology and chemistry and improve health outcomes for all Delawareans. The Greater Philadelphia Region Precision Medicine Tech Hub (PA, DE, MD, NJ), led by the Ben Franklin Technology Partners of Southeastern PA, aims to become a global leader in end-to-end precision medicine.

30 Minutes of Quality Time is Easy - There's an App for That!

The Delaware Division of Public Health (DPH) and the Delaware Healthy Mother and Infant Consortium (DHMIC) have launched the QT30 app. QT30 stands for 30 minutes of quality time, a program aimed at making sure young children get a healthy start in life. It was created by the Delaware Help Me Grow Advisory Committee, with support from DPH. The app was developed to provide parents and caregivers of children ages 0 to 8 with activities that they can do every day and is available for free download in the Apple Store and Google Play, featuring more than 150 different activities. Activities are arranged by type of activity – outdoor, indoor, arts and crafts, words/numbers/ sounds, and kitchen and in-home. It also features a timer, to keep track of how much time you are spending, and video instructions for the activities too. More information, including a full list of activities, can be found at DEThrives.com/QT-30. Dedicating just 30 minutes of quality time a day to a child can lead to better health and increased chance of being ready for school and life overall. DPH and DHMIC have made this toolkit available with QT30 materials that can be easily displayed, posted, and shared with your patients.

Administrative Position, Good Pay, State Benefits

The Delaware Department of Correction (DDOC) seeks a physician to fill the role of Medical Director within the Bureau of Healthcare, Substance Abuse and Mental Health Services. This is a fully administrative role with no direct patient care involvement. Please go to 

https://www.jobapscloud.com/DE/sup/bulpreview.asp?b=&R1=091923&R2=MDEB03&R3=380200 for further details and to apply. For questions, please contact Awele Maduka-Ezeh, MD, MPH, PhD, CCHP, Medical Director & Healthcare Epidemiologist, at the Delaware Department of Correction or Michael Records, Chief of Health Services.

"Kind to Kids" - Children, Teens in Foster Care Affected by Trauma

The Medical Society of Delaware (MSD) has selected Kind to Kids as our winter season charity fundraising beneficiary. Our goal is to raise $1,200 to help children and teens in foster care who are victims of child abuse and neglect. Your donation will provide direct support for a child in foster care. Kind to Kids is a foundation that helps meet the needs of children and teens in foster care who are deeply affected by the trauma in their lives. 100% of every dollar donated online will go directly to help a foster child during these difficult times. Please donate now and help us make a difference in the lives of these deserving kids. You can donate online at https://www.classy.org/fundraiser/5051939. Thank you for your support! 

Due to Risk of Eye Infection

The US Food and Drug Administration (FDA) is warning consumers not to purchase and to immediately stop using 26 over-the-counter eye drop products due to the potential risk of eye infections that could result in partial vision loss or blindness. Patients who have signs or symptoms of an eye infection after using these products should talk to their health care professional or seek medical care immediately. These products are marketed under the following brands: CVS Health, Leader (Cardinal Health), Rugby (Cardinal Health), Rite Aid, Target Up & Up, and Velocity Pharma. CVS, Rite Aid, and Target are removing the products from their store shelves and websites. Products branded as Leader, Rugby, and Velocity may still be available to purchase in stores and online and should not be purchased. Cardinal Health, Inc. has initiated a voluntarily recall for all lots of ophthalmic products supplied by Velocity Pharma, LLC to the consumer level. The Harvard Drug Group, LLC d/b/a Major® Pharmaceutical and Rugby® Laboratories has also initiated a voluntarily recall for all lots of Polyvinyl Alcohol, 1.4% Lubricating Eye Drops and Lubricating Tears Eye Drops (Dextran/Hypromellose, 0.1%/0.3%) supplied by Velocity Pharma, LLC to the consumer level. FDA recommended the manufacturer of these products recall all lots on October 25, 2023, after agency investigators found insanitary conditions in the manufacturing facility and positive bacterial test results from environmental sampling of critical drug production areas in the facility. FDA has not received any adverse event reports of eye infection associated with these products at this time. FDA encourages health care professionals and patients to report adverse events or quality problems with any medicine to FDA’s MedWatch Adverse Event Reporting program.

Due to Over-Inflation

Olympus is recalling its Olympus High Flow Insufflation Unit because the unit may over-insufflate (inflate) air into the body with no warning or alarm. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

Deadline Extended to November 30th

The Physicians Foundation recently launched the new Physicians Foundation’s Leadership Award Program to honor the next generation of physician leaders. Award winners will receive a $10,000 scholarship to elevate their efforts to address drivers of health (DOH) or to advance innovative solutions to make their communities or practices a healthier place for patients and physicians. New or early-career physicians are encouraged to apply by November 30th. 

January 2, 2024 Deadline

As a reminder, physicians may now apply for an Extreme and Uncontrollable Circumstances hardship exception to avoid an up to 9% penalty in the Merit-based Incentive Payment System (MIPS) due to the impact of the COVID-19 public health emergency (PHE). Applications can be submitted through Jan. 2, 2024. Read more.

Saving Time Reduces Turnover

It’s essential to be able to make the business case for timesaving measures—after all, saving time saves money. If supported by an organization’s leadership, some simple strategies can reduce burnout, improve culture, and reduce physician turnover. Replacing a physician who leaves can cost two to three times their salary.

LEARN MORE:

• Playbook: Saving Time
• Toolkit: Getting Rid of Stupid Stuff
• Resource: Organizational Cost of Physician Burnout
• Other: De-implementation Checklist (PDF)

AMA STEPS Forward^® offers a collection of engaging and interactive educational content designed to help put the joy back into medicine.

Beebe Healthcare

ChristianaCare

Alfonso J. Arevalo, DO - Delaware Orthopaedic Specialists, PA

Zachary Bopp - Medical Student, Sidney Kimmel Medical College (2024)

Thomas C. Mueller, MD - ChristianaCare Neurology Specialists

Akul S. Patel, MD - Delaware Orthopaedic Specialists, PA 

Please join MSD in welcoming the newest members of the Medical Society of Delaware. As the third oldest medical society in the country, MSD has an amazing history. Thank you for taking part in our continued success!

Jigar C. Chauhan, MD - Pediatric Critical Care, Nemours Children's Hospital

Maria P. Childers, MD - Pediatrics, Atracare

Jane William Moore, MD - Family Medicine, Saint Francis Family Medicine

Kwabena Osei-Bonsu, MD - Internal Medicine, Seaford Internal Medicine 

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending members(s) listed above or if you know of someone interested in joining MSD. You could be eligible for a membership referral dues discount!

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.

The CDC adopted the 2023-2024 Advisory Committee on Immunization Practices’ (ACIP) recommendations on annual influenza (flu) vaccination for everyone 6 months and older in the United States on June 27, 2023. There were small changes to the annual recommendations around flu vaccination, including an acknowledgement of the updated flu vaccine composition for the 2023-2024 flu season and a change in the recommendations for vaccination of people with egg allergies. The adoption of the ACIP recommendations makes them official CDC policy, which have been published in the Morbidity and Mortality Weekly Recommendation Report August 23, 2023. Health care professionals should begin vaccinating patients according to CDC’s recommended timing, which remains the same as last season. Read the CDC Vaccine Recommendations for the 2023-2024 flu season.

Flu Vaccination Guidance for Children

Flu can be a serious threat to children. During a COCA call on August 31, 2023, presenters discussed flu prevention and treatment recommendations from the American Academy of Pediatrics and CDC. If you’ve missed it, this recording is a great update on vaccination, coadministration of flu vaccines, coverage, and health disparities.

The FDA has outlined the following brief guidelines for the updated COVID-19 vaccines to simplify the questions regarding whom should receive the vaccine and when: 

• Individuals 5 years of age and older regardless of previous vaccination are eligible to receive a single dose of an updated mRNA COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.  
• Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of an updated mRNA COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine received).  
• Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated authorized Moderna COVID-19 Vaccine. 
• On October 3, 2023, the FDA amended the emergency use authorization (EUA) of the Novavax COVID-19 Vaccine, Adjuvanted for use in individuals 12 years of age and older to include the 2023-2024 formula. Individuals 12 years of age and older previously vaccinated with a COVID-19 vaccine (and who have not already been vaccinated with a recently updated mRNA COVID-19 vaccine) are eligible to receive one dose and unvaccinated individuals receive two doses. As part of this action, the Novavax COVID-19 Vaccine, Adjuvanted (Original monovalent) is no longer authorized for use in the United States.

Vaccination will be available free for everyone through one of three methods.

• Most Private and government insurance plans - cost fully covered by insurance (receive through pharmacies, health care professionals)
• Uninsured, underinsured - cost covered through FQHCs; public health clinics; pharmacies; health care professionals via Delaware Immunization Program; and Walgreens, CVS, and pharmacies affiliated with ETrue North pharmacy network through Bridge Access Program.
• Children participating in CDC's Vaccines for Children Program - free from where they receive routine vaccinations.

 A full listing of vaccine locations is posted on www.vaccines.gov.

The national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic ended on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available, some of which have been updated based on recent action by Congress.

• Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (Updated 5/12/2023).
• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• Acute Hospital Care At Home
• Loss of Medicaid or CHIP coverage
• FAQs on CMS Waivers, Flexibilities, end of COVID-19 PHE (May 4, 2023)

Updates will continue to be provided as we approach the end of the PHE. You are encouraged to regularly visit the CMS Emergencies Page for the most up to date information

• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)