CMS Granting Key Flexibilities – Worth Including Twice: Yesterday, CMS released an array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The new rules allow hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility. CMS also posted a complete summary of the flexibilities provided to all physicians and clinicians to help clarify current allowable and billable practices. CMS also approved two additional Section 1135 waivers today, bringing the total of approved waivers to 40 states.
Granting Financial Relief for Medicare Providers – Worth Repeating: Over the weekend, CMS provided financial relief to Medicare providers by expanding their accelerated and advance payment program to help ensure that they have resources needed to combat COVID-19. Accelerated and advance Medicare payments provide emergency funding and addresses cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19. The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers.
Providing Guidance for Healthcare Professionals: CDC added to their FAQ document for healthcare professionals additional information on drugs and investigational therapies to address common questions and misperceptions on available and approved drugs to treat COVID-19. CDC also released guidelines and a decision algorithm for how to guide care advice and messages with evaluating and triaging potential patients.
Obtaining Funding from FEMA for Emergency Medical Care Activities: The FEMA COVID-19 Emergency Protective Measures Fact Sheet included a list of eligible emergency medical care activities. This fact sheet provides additional guidance related to the eligibility of emergency medical care activities as an emergency protective measure under the Emergency Declaration and any Major Disaster Declaration authorizing Public Assistance (PA) for COVID-19.
Ensuring Providers Can Practice at Health Centers and Free Clinics: HRSA has released information on updated Federal Tort Claims Act policies for providers in health centers and free clinics to enable them to treat patients in these settings in an effort to prevent, prepare or respond to COVID-19.
Make plans to join AAFP’s Virtual Town Hall Wednesday 4/1 from 7-8pm.
AAFP President Dr. Gary LeRoy and AAFP SVP Advocacy Shawn Martin will join me to provide an overview of recently announced CMS accelerated payments, the CARES Act and what you can be doing now to position yourself to receive relief funding, followed by an open Q&A session.
Remember, Live CME credit is available for participating on Wednesday.
You can join the Town Hall via the links below:
IMPORTANT NEWS FROM CMS: Regulatory Changes by Trump Administration Help U.S. Healthcare
The Centers for Medicare & Medicaid Services (CMS) is issuing an unprecedented set of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic.
Highlights of the temporary actions announced by CMS today:
More information:
Medicare Payment for Telephone (only) Visits
Earlier today, the Centers for Medicare and Medicaid Services (CMS) announced a series of changes to Medicare benefit and payment policies. Included in the announcement was a change in payment policy whereby CMS will begin paying for telephone-only visits conducted by physicians.
Achieving this change in payment policy has been a priority for the AAFP and we specifically requested this policy change in a letter to CMS.
You can read about the new CMS policies here.
The AAFP will have more information and guidance on this change in payment policy today. This will be important, for example, because CMS is not permitting 99211-215 services via telehealth audio only, they are paying for previously non-billable telephone visit codes 99441-43.
You may want to add your home address to your Medicare Enrollment if you are providing telehealth services from your home.
There are no payment restrictions on distant site practitioners furnishing Medicare telehealth services from their home. The practitioner is required to update their Medicare enrollment with the home location. The practitioner can add their home address to their Medicare enrollment file by reaching out to the Medicare Administrative Contractor in their jurisdiction through the provider enrollment hotline. It would be effective immediately so practitioners could continue providing care without a disruption. More details about this enrollment requirement can be found at 42 CFR 424.516. If the physician or non-physician practitioner reassigns their benefits to a clinic/group practice, the clinic/group practice is required to update their Medicare enrollment with the individuals’ home location. The clinic/group practice can add the individual’s home address to their Medicare enrollment file by reaching out to the Medicare Administrative Contractor in their jurisdiction through the provider enrollment hotline.
Mental Health in a public health crisis
Mental Health Technology Transfer Center (MHTTC) Network Resources
Public health emergencies such as COVID-19 have a significant impact on people with mental illness, their families, and caregivers; the mental health workforce; and the mental health treatment system. They also cause stress and anxiety across the population. Visit the MHTTC website for webinars, products, and resources that can be useful when coping with the effects of widespread public health crises.
CMS Financial Relief Program for Medicare Providers
Gov. Evers Issues Order to Expedite Expansion, Enhance Efficiency of Healthcare Workforce
Governor Evers issued a new order designed to make it easier for certain providers to gain licensure and credentialing during the public health emergency. A press release is below with the order linked in the release. However, for the sake of brevity, the order essentially does the following:
Accelerated/Advance Payments for Medicare Providers
On March 28 the Centers for Medicare and Medicaid Services (CMS) announced that they would immediately implement a new Accelerate and Advance Medicare Payment policy to assist family physicians and other Medicare Part A and Part B providers and suppliers. Again, family physicians who meet the qualifying criteria are eligible for these accelerated and advanced Medicare payments. This is the policy that the AAFP asked CMS to implement earlier this week.
Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. CMS anticipates that the payments will be issued within seven days of the provider’s request. Here is information on how to apply – you must go through your regional contractor
You can find a copy of the fact sheet here.
You can find a copy of the press release here.
Quality Payment Program and Quality Reporting Program/Value Based Purchasing Program COVID-19 Relief
On March 22, 2020, CMS announced relief for clinicians, providers, hospitals and facilities participating in quality reporting programs in response to the 2019 Novel Coronavirus (COVID-19). This memorandum and factsheet supplements and provides additional guidance to health care providers with regard to the announcement. CMS has extended the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline from March 31 by 30 days to April 30, 2020. This and other efforts are to provide relief to clinicians responding to the COVID-19 pandemic. In addition, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30, 2020 deadline.
You can find a copy of the memo here: Memo
You can find a copy of the fact sheet here: Fact Sheet
Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit
On March 27, CMS issued an electronic toolkit regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities. Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS over the last week in response to the National Health Emergency. Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.
CARES Act signed
On Friday March 27 Congress passed and the President signed the CARES Act, a $2 trillion relief package that provides much needed economic relief for American families and businesses who are hurting through no fault of their own. This legislation will provide assistance to America’s heroic healthcare workers who are on the frontlines of this outbreak, including $100 billion which will go to healthcare providers, including hospitals on the front lines of the COVID-19 pandemic, $27 billion which will go to bolstering life-saving capabilities, including developing vaccines and the development, purchase, and distribution of critical supplies and $45 billion which will go to the Federal Emergency Management Agency Disaster Relief Fund, more than doubling the amount available to support the President’s Emergency and Disaster Declarations to empower State, local, and tribal leaders to effectively respond.
More information will be coming from AAFP. Of interest, Sec. 3704 – Enhancing Medicare telehealth services for Federally qualified health centers and rural health clinics during emergency period. Also adds FQHCs and RHCs as “distant site” providers for purposes of the COVID-19 telehealth waiver, allowing them to bill for telehealth services under the waiver.
New COVID-19 Digest Available
Dear Colleagues,
We have an opportunity in front of us. As the acceleration phase of the COVID-19 pandemic brings it inland,the AAFP has partnered with other national healthcare organizations to gain governmental buy-in to suppression and containment strategies. With elements of these strategies now in place across numerous states, there is hope that we can begin to“attack the virus”locally, slow its spread, prevent its resurgence, and ultimately save more lives. The work for family physicians on the front lines is far from over, instead promising to become increasingly difficult in the upcoming weeks. Rest assured that we here at WAFP are standing by your side and advocating for your needs during thisCOVID-19 pandemic.
Click here to read the full March 30th Digest
Updates from CMS re: Enrollment Relief, Open Payments, Beneficiary Notices:
2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs)
CMS released Frequently Asked Questions on Medicare Provider Enrollment Relief related to COVID-19 including the toll-free hotlines available to Medicare Administrative Contractors (MACs). CMS has established toll-free hotlines at each MAC to allow physicians and non-physician practitioners to initiate temporary Medicare billing privileges. These hotlines provide expedited enrollment and answer questions related to COVID-19 enrollment requirements. FAQ
Frequently Asked Questions (FAQs) on Enforcing Open Payments Deadlines
CMS released an updated comprehensive list of Frequently Asked Questions (FAQs) about the Open Payments program. Tuesday, March 31, 2020 is the Open Payments Program Year 2019 data submission deadline for applicable manufacturers and group purchasing organizations (GPOs) to submit and attest to data for the June 2020 publication of Program Year 2019 data. The deadline cannot be extended past March 31, 2020, therefore, CMS will exercise enforcement discretion for submissions completed after the statutory deadline due to circumstances beyond the reporting entity’s control related to the pandemic. FAQ
Beneficiary Notice Delivery Guidance in light of COVID-19
If you are treating a patient with suspected or confirmed COVID-19, CMS encourages the provider community to be diligent and safe while issuing the following beneficiary notices to beneficiaries receiving institutional care:
In light of concerns related to COVID-19, current notice delivery instructions provide flexibilities for delivering notices to beneficiaries in isolation. These procedures include:
We encourage the provider community to review all of the specifics of notice delivery, as set forth in Chapter 30 of the Medicare Claims Processing Manual. https://www.cms.gov/media/137111
CMS has taken several recent actions in response to the Coronavirus Disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts. A summary of recent CMS activities can be found here: https://www.cms.gov/newsroom/press-releases/cms-news-alert-march-26-2020
To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website.
MADISON — Gov. Tony Evers today launched an initiative designed to get more personal protective equipment (PPE), such as gowns, gloves and masks, to those working on the frontlines of the response to the COVID-19 pandemic.
AAFP is working to build out resources to help you to address the stress (for our family physicians, their practice teams, and their families). There are just a few resources here at the moment, but we will be adding more.
You can find those here: https://www.aafp.org/patient-care/emergency/2019-coronavirus/Covid-19-practice-management.html#well-being
ACOG have shared the following FAQ's with the latest guidance on COVID-19 care for maternity care.
You can find that here: https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics
The March 2020 ForwardHealth Update (2020-09), titled "Changes to ForwardHealth Telehealth Policies for Covered Services, Originating Sites, and Federally Qualified Health Centers," has been revised since its original publication. The CPT code 99423 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes) been corrected. Revisions appear in red text on page seven.
Materials for Homemade Surgical Masks
People who want to sew masks buy surgical drape from veterinary supply stores and use the patterns from several hospitals.
Alternatively, vacuum bags have a similar filtration for droplets as surgical masks and could be sown as disposable masks. Not n95 quality but it might be helpful for office or for family members caring for sick persons in the home.
Thirdly, a cloth mask that can be washed and dried with a place for a disposable vacuum bag or coffee filter insert might be a reasonable option. See links on patterns below:
CDC Interim US Guidance on Risk and Exposures:
Interim US Guidelines on Risk and Exposures
COCA Call about Underlying Medical Conditions and People at Higher Risk for Coronavirus Disease 2019 (COVID-19) is postponed to March 27, 2020, still Noon-1:00pm.
The archived version will be available later here.
If you use Facebook, please watch the webinar live or archived on Facebook Live here.
To call in by phone use one of the following numbers plus the webinar ID.
Telephone: +1 646 876 9923 or +1 312 626 6799 or +1 301 715 8592 or +1 346 248 7799 or +1 669 900 6833 or +1 253 215 8782
Webinar ID: 963 649 423
Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19
On March 22, CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19).
CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report.
CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions, and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.
You can find a copy of the press release here.
CMS will continue monitoring the developing COVID-19 situation and assess options to provide additional relief to clinicians, facilities, and their staff so they can focus on caring for patients.
This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit the coronavirus.gov webpage. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Webpage on CMS.Gov.
COVID-19 Provider Enrollment Relief FAQs
On March 22, CMS released Frequently Asked Questions on Medicare Provider Enrollment Relief related to COVID-19, including the toll-free hotlines available to provide expedited enrollment and answer questions related to COVID-19 enrollment requirements.
A copy of the FAQs can be found here.
Surgical Innovation Fellowship - COVID-19: Our response to the N95 shortage
CMS Relaxes Quality Payment Program (QPP) (MIPS)
The Centers for Medicare & Medicaid Services (CMS) has extended(www.cms.gov) the deadline to report data for the Merit-based Incentive Payment System (MIPS) 2019 performance year, as requested in a recent letter from the American Academy of Family Physicians. Practices now have until April 30, 2020, to submit data. The original deadline was March 31. This new deadline, part of the agency's response to COVID-19, also applies to participants in the Medicare Shared Savings Program (MSSP)
Administration for Community Living (a division of HHS): older adult related COVID-19 resources https://acl.gov/COVID-19
The SAMHSA-funded Technology Transfer Centers (TTC) link:
https://www.samhsa.gov/technology-transfer-centers-ttc
Region 3 TTCs: https://attcnetwork.org/centers/central-east-attc/home
Each region has a SAMHSA-funded TTC center for Addiction, Mental Health, and Prevention with a listserv, newsletter, archived and upcoming webinars and other free resources.
Today, Compassion Fatigue and the Behavioral Health Workforce, was posted
http://uclaisap.org/html2/compassion-fatigue-behavioral-workforce-cip.html
This 5-part Curriculum Infusion Package (CIP) on Compassion Fatigue and the Behavioral Health Workforce was developed in 2020 by the Pacific Southwest Addiction Technology Transfer Center (PSATTC). The main developers included Nancy Roget, MS, Joyce Hartje, PhD, and Terra Hamblin, MA, with additional guidance and editing support provided by Beth Rutkowski, MPH, Thomas E. Freese, PhD, and Michael Shafer, PhD.
Compassion Fatigue Curriculum Infusion Package Slides
Part 1: The Behavioral Health Workforce
Part 2: Defining Compassion Fatigue and Related Conditions
Part 3: Burnout and Organizational Response
Part 4: Compassion Satisfaction and Self-Care
Part 5: Self-Care and Ethical Issues
The Compassion Fatigue CIP was created to help college and university faculty infuse brief, science-based content into existing substance use disorder-related course syllabi (e.g., foundation of addiction courses, ethics, counseling courses, etc.). Instructors can select the specific content to infuse throughout the duration of the course depending on specific needs of the learners. Each slide contains notes for the instructor to provide guidance as necessary. References are included for each slide and handouts when possible.
Part 1 provides a brief overview of the behavioral health workforce and associated shortages, and introduces the demands on the workforce. Part 2 focuses on compassion fatigue and secondary traumatic stress. Part 3 provides a brief overview of how organizations can help individuals avoid experiencing burnout. Part 4 focuses on actions that behavioral health professionals can take to prevent compassion fatigue. And Part 5 focuses on self-care as an ethical duty in order to manage compassion fatigue.
The slide decks are designed to be used by academic faculty in behavioral health programs, trainers, behavioral health providers, and state/county agency staff members for a variety of audiences. If you require further information on this topic, please do not hesitate to contact the Pacific Southwest ATTC (http://www.psattc.org). You are free to use these slides and the pictures, but please give credit to the Pacific Southwest ATTC when using them by keeping the logo on each slide and referencing the Pacific Southwest ATTC at the beginning of your presentation.
Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19
CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19)
CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report.
CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.
You can find a copy of the press release here.
CMS will continue monitoring the developing COVID-19 situation and assess options to additional relief to clinicians, facilities, and their staff so they can focus on caring for pat
This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing i response to COVID-19, please visit www.coronavirus.gov. For a complete and updated l CMS actions, and other information specific to CMS, please visit the Current Emergencies Webpage on CMS.Gov
New Tools To Help Speed States' Access to Emergency Flexibilities and Resources
The Trump Administration released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of tools available to maximize responsiveness to state needs. The agency has created four checklists that together will make up a comprehensive Medicaid COVID-19 federal authority checklist to make it easier for states to receive federal waivers and implement flexibilities in their program.
The tools include:
1115 Waiver Opportunity and Application Checklist
1135 Waiver Opportunity and Application Checklist
1915(c) Appendix K Template
Medicaid Disaster State Plan Amendment Template
Medicare Virtual Check-ins:
Virtual Check-ins (G2012) enable a quick visit with a patient to determine if an in-person appointment should be scheduled. This Medicare service is never restricted by geographic location/originating site or other Medicare telehealth restrictions. Virtual Check-In's are a brief (5-10 minutes of medical decision-making) technology-based communication (via phone or other digital device) for an established patient, not originating from a related E/M within prior 7 days and not leading to an E/M service within next 24 hours or soonest available appointment.
Medicare E-Visits:
E-Visits (99421-99423 for physicians or G2061-G2063 for non-physician qualified professionals) are a non face-to-face (virtual) asynchronous encounter, initiated by an established patient, utilizing digital means to achieve the visit. It can include lab orders, prescriptions, diagnosis and treatment plan with cumulative time reported once in a 7-day period. This Medicare service is never restricted by geographic location/originating site or other Medicare telehealth restrictions. Communication exchanged must be permanently stored.
CMS Releases Telehealth Toolkits for General Practitioners and End-Stage Renal Disease (ESRD) Providers
The Centers for Medicare & Medicaid Services (CMS) released two comprehensive toolkits on telehealth that are specific to general practitioners as well as providers treating patients with End-Stage Renal Disease (ESRD).
Under President Trump’s leadership to respond to the need to limit the spread of COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. These benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.
Each toolkit contains electronic links to reliable sources of information on telehealth and telemedicine, which will reduce the amount of time providers spend searching for answers and increase their time with patients. Many of these links will help providers learn about the general concept of telehealth, choose telemedicine vendors, initiate a telemedicine program, monitor patients remotely, and develop documentation tools. Additionally, the information contained within each toolkit will also outline temporary virtual services that could be used to treat patients during this specific period of time.
You can find the Telehealth Toolkit for General Practitioners here.
You can find the End-Stage Renal Disease Providers Toolkit here.
CMS continues to monitor the developing COVID-19 situation and assess options to bring relief to clinicians. To keep up with the important work the Task Force is doing in response to COVID-19 visit the coronavirus.gov webpage. For complete and updated information specific to CMS, please visit the Current Emergencies Website.
COVID-19 Elective Surgeries and Non-Essential Procedures Recommendations
The Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.
You can find a copy of the press release here.
You can find a copy of the guidance here.
ADDITIONAL RESOURCE LINKS
Effective, 3/18, UnitedHealthcare has added flexibility to their telehealth policies to make it easier for patients to connect with their family physicians. For the next 90 days, all eligible in-network medical providers who have the ability and want to connect with their patients through synchronous virtual care (live video-conferencing) can do so. UHC will waive member cost-sharing for COVID-19 related visits. This coverage applies to patients with UHC Medicare Advantage, Medicaid and commercial coverage.
