March 23rd Newsletter

State Updates 

Governor Cuomo Announces Expanded Hospital, Staff, and Lab Capacity

In press releases today and over the weekend, Governor Cuomo made several announcements and updates regarding the COVID-19 emergency, including:

• Hospital Capacity

• • The Army Corps of Engineers will develop four temporary hospital sites at the Jacob K. Javits Convention Center, SUNY Stony Brook, SUNY Old Westbury and the Westchester Convention Center.
  • The Federal Emergency Management Agency (FEMA) will deploy four emergency hospitals at the Jacob K. Javits Convention Center with 250 beds each.
  • The federal government declared a major disaster in New York and will waive the 25% state share of FEMA funding.
  • The State will repurpose existing residential facilities, hotels, nursing homes and repurposing them as temporary hospitals, such as the Brooklyn Health Center for Rehabilitation and Healthcare, which will provide 600 beds.
  • Effective March 25^th, all non-critical elective surgeries in New York hospitals will be suspended.
  • Governor Cuomo is issuing an emergency order requiring all hospitals to develop plans to expand capacity by a minimum of 50 percent, with a goal of expanding capacity by 100 percent.

• Staff Capacity

• • The Department of Financial Services (DFS) will issue a request to health care personnel employed at insurance companies (e.g., for utilization review) to temporarily provide direct patient services.
  • Over 30,000 ex-medical practitioners have registered as part of the State’s request for volunteers to temporarily rejoin the health care workforce.

• Other

• • New York is now testing up to 16,000 people per day.
  • The FDA has approved certain experimental drug trials to start this week for New Yorkers seriously ill with COVID-19.

Yesterday (March 23^rd) the Governor also ordered New York City to come up with a plan in the next 24 hours to address the lack of adherence to social distancing protocols in the area, including at parks and other public spaces. The Governor expects to implement the provisions of the plan elsewhere in the State.

The Governor’s latest press briefing is available here.

DFS Guidance to Insurance Entities on Utilization Review and Emergency Admission Notification Requirements

On March 20^th, DFS announced new guidance for insurance entities that suspends prior-authorization and administrative requirements, including certain utilization review and notification requirements, for 90 days. Requirements being temporarily suspended or modified include:

• Preauthorization review for scheduled surgeries or admissions at hospitals;
• Concurrent review for inpatient hospital services;
• Retrospective review for inpatient hospital services and emergency services provided at in-network hospitals;
• Preauthorization requirements for home health care services following an inpatient hospital admission;
• Preauthorization requirements for inpatient rehabilitation services following a hospital admission;
• Preauthorization for inpatient rehabilitation services for mental health or substance use disorder treatment following a hospital admission if required;
• Submission of medical records as part of an emergency admission notification or penalties for a failure to provide notification of an emergency admission due to staffing shortages;
• Deadlines for a hospital to submit an internal or external appeal; and
• Non-essential audits of hospital payments and the timeframe for the insurer to recover overpayments.

DFS is strongly encouraging third party administrators to apply the provisions of this guidance letter to their administrative services arrangements with self-funded plans.

The guidance letter is available here.

New York State Agency Guidance Documents

The New York State Department of Health (DOH), Office of Mental Health (OMH) and Office for People with Developmental Disabilities (OPWDD) have released the below guidance documents for providers related to COVID-19. Some significant new developments include:

• DOH released a new Medicaid Update that expands the scope of reimbursable telephonic services to any service that is appropriate to deliver by telephone, including rate codes for licensed programs. Also, there are “no limits on originating sites” and “all sites are eligible to be distant sites for delivery and payment purposes,” including clinic providers working from their own homes and FQHCs treating dual eligibles. Any Medicaid service delivered via telehealth will be reimbursed at parity with existing off-site visit payments (clinics) or face-to-face visits (i.e., 100% of Medicaid payment rates).
• OPWDD released revised telehealth guidance that now specifies that providers may be reimbursed for services delivered by telephone, and that medical practitioners may be licensed in any state, not just New York.

The new guidance documents can be found at the below links:

• DOH Medicaid Update – Updated Telehealth Guidance
• OPWDD Revised Interim Telehealth Guidance
• DOH Guidance for Transportation Managers and Brokers
• DOH Guidance for Facilitated Enrollment Agencies for the Aged, Blind and Disabled
• OMH Residential Treatment Facilities Visitation Guidance
• OMH Guidance on Clozapine and Blood Test Monitoring  
• OMH Telemental Health FAQ
• OMH Guidance Regarding the Use of State Aid Funding
• OMH Consolidated Fiscal Report Due Date Extension
• OMH Essential Business Letter
• OMH Admissions and Continuity of Care Advisory
• OMH COVID-19 Screening Form

New York City Guidance Documents

The New York City Department of Homeless Services (DHS) has released the following guidance documents and workflows for shelters during the COVID-19 emergency:

• DHS Guidance for Homeless Shelters
• DHS Street Homeless Outreach Workflow
• DHS Protocol for Isolation and Discharge to Shelter
• DHS Isolation Plan and Best Practices for Shelters

The New York City Mayor’s Office of Contract Services released guidance (available here) for not-for-profit human services providers. The guidance indicates that the City will reimburse providers for contract expenses even if usual service delivery is suspended or modified, as well as for additional personnel expenditures related to overtime and temporary staff to address any shortages during the emergency. The City will also be issuing increased cash advances to avoid unnecessary payment delays, postponing or extending deadlines for audits, and reimbursing for any additional supplies related to COVID-19.

Federal Updates

CMS Announces Medicare Quality Reporting Program Changes

On March 22^nd, CMS announced reporting requirement exceptions and extensions for participants in Medicare quality reporting programs in light of recent events regarding COVID-19. Specifically, CMS is making the following adjustments:

• Physicians and ACOs: Merit-based Incentive Payment System (MIPS) / Medicare Shared Savings Program Accountable Care Organizations

• • CMS is extending the deadline for 2019 data submission to April 30^th, and allowing MIPS eligible clinicians who miss that deadline to qualify for the automatic extreme and uncontrollable circumstances policy and receive a neutral payment adjustment for the 2021 MIPS payment year.

• Hospitals, Ambulatory Surgical Centers, and ESRD: Ambulatory Surgical Centers Quality Reporting Program / ESRD Quality Incentive Program / CROWNWeb National ESRD Patient Registry and Quality Measure Reporting System / Hospital-Acquired Condition Reduction Program / Hospital Inpatient Quality Reporting Program / Hospital Outpatient Quality Reporting Program / Hospital Readmissions Reduction Program / Hospital Value-Based Purchasing Program / Inpatient Psychiatric Facility Quality Reporting Program / PPS-Exempt Cancer Hospital Quality Reporting Program / Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals

• • CMS is making the deadlines for October 1, 2019 to December 31, 2019 optional. If that data is submitted, it will be used to calculate 2019 performance and payment. If not, the 2019 performance will be calculated based on January 1, 2019 to September 30, 2019. CMS will not count data from January 1, 2020 to June 30, 2020 for performance or payment programs.

• Long Term Care Services: Home Health Quality Reporting Program / Hospice Quality Reporting Program / Inpatient Rehabilitation Facility Quality Reporting Program / Long Term Care Hospital Quality Reporting Program / Skilled Nursing Facility Quality Reporting Program / Skilled Nursing Facility (SNF) Value-Based Purchasing Program

• • Similar to the previously mentioned programs, CMS is making the deadlines for October 1, 2019 to December 31, 2019 optional and, if submitted, will use that data to calculate the 2019 performance and payment. Data from January 1, 2020 to June 30, 2020 does not need to be submitted to CMS. Additionally, Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from January 1, 2020 to September 30, 2020 does not need to be submitted to CMS. For the SNF Value-Based Purchasing Program, qualifying claims will be excluded from the claims-based SNF 30-Day All-Cause Readmission Measure.

Data submission for programs with data deadlines in April and May 2020 will be optional, and CMS will not use data reflecting services provided from January 1^st to June 30^th in calculations for the Medicare quality reporting and value-based purchasing programs.

A press release detailing the changes is available here.

CMS Releases COVID-19 Checklists and Tools for State Medicaid and CHIP Programs

On March 22^nd, CMS announced four tools intended support state Medicaid and Children’s Health Insurance Programs (CHIP) during the COVID-19 emergency. Specifically, CMS unveiled the following initiatives:

• 1115 Waiver Opportunity and Application Checklist – CMS is releasing a State Medicaid Director Letter #20-002, which includes a section 1115 demonstration opportunity to aid states with addressing the public health emergency.
• 1135 Waiver Checklist – The Center for Medicaid and CHIP Services created a checklist template based on commonly requested 1135 authorities.
• 1915(c) Appendix K Template – CMS created an Appendix K template addendum with pre-populated commonly requested program changes.
• Medicaid Disaster State Plan Amendment (SPA) Template – CMS developed a Disaster SPA template that will allow a state to submit one combined request for temporary program changes.

SAMHSA Guidance Documents

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released the following guidance documents related to the COVID-19 emergency:

• Public Health Emergency Response and 42 CFR Part 2 Guidance
• Disaster Planning Handbook for Behavioral Health Treatment Programs
• Considerations for the Care and Treatment of Mental and Substance Use Disorders
• Considerations for Crisis Centers and Clinicians in Managing the Treatment of Alcohol or Benzodiazepine Withdrawal
• Considerations for Outpatient Mental and Substance Use Disorder Treatment Settings 
• Interim Considerations for State Psychiatric Hospitals
• Virtual Recovery Resources
• Opioid Treatment Program Guidance
• Provision of Methadone and Buprenorphine FAQ

CMS Releases General Practitioner and ESRD Telehealth Toolkits

On March 23^rd, CMS released two telehealth toolkits specific to End-Stage Renal Disease (ESRD) practitioners and general practitioners. Each toolkit contains hyperlinks to sources of information on telehealth and telemedicine, and are intended to help providers learn about the general concept of telehealth, choose telemedicine vendors, initiate a telemedicine program, monitor patients remotely, and develop documentation tools.

The ESRD practitioner toolkit is available here, and the general practitioner toolkit is available here.

Innovative Solutions to Urgent Problems

SPG continually explores innovative telehealth and digital health solutions to the problems facing the health care industry. In light of the ongoing COVID-19 pandemic, we thought it would be helpful to start a series in which we present startups and tech companies that seek to provide solutions to the urgent needs many of our clients are facing (some of which are free of charge):

• Ro is a direct to consumer, online pharmacy and telehealth provider that launched a free telehealth assessment for COVID-19 for individuals experiencing signs or symptoms. If appropriate, Ro will connect individuals with a doctor for a free video visit.
• ZocDoc is a marketplace for providers to list appointments and streamline the patient booking and onboarding process. In response to COVID-19, ZocDoc is offering free access to chat with a licensed nurse (8am-10pm) or video visit a doctor (8am-midnight).
• Genoa Healthcare offers pharmacy and telepsychiatry services for community mental health centers and others. Genoa is offering telemedicine tech set up & training, video platform, clinical workflow development, ongoing program support for behavioral and non-behavioral care; free of charge until June 15^th at minimum.
• Memora Health digitizes protocols and automates communication through its SMS-based virtual assistant to relieve care teams of administrative tasks (e.g., CDC guidelines, condition-specific FAQs, pre and post procedure instructions, etc.). Memora is providing free COVID-19 access via text for consumers as well as free virtual assistants for payers and providers.
• Ride Health is a transportation coordination platform that improves access to care by enabling care managers to manage a spectrum of transportation options, including ride-hailing, NEMT providers operating wheelchair-accessible vehicles, stretcher vans and ambulettes. Ride Health is organizing COVID-equipped and -prepared NEMT providers to safely transport individuals at-risk for COVID-19 to appropriate care settings.