May 4th Newsletter

May 4, 2020

Governor Cuomo Provides Details on Phased Reopening Plan

Today (May 4th), Governor Cuomo held a press conference during which he announced that total hospitalizations, new hospitalizations, and deaths related to COVID-19 are continuing to decline. Addressing the State’s reopening plan, the Governor reaffirmed that certain regions will be permitted to begin reopening on May 15th based on their own analysis and their compliance with the requirements put forth by the State and federal government. Such requirements for a region include:

  • At least 14 days of decline in total hospitalizations and deaths (3-day rolling average);
  • No more than 15 new total cases or 5 new deaths (3-day rolling average) in regions with few COVID-19 cases;
  • Less than two new COVID-19 patients admitted per 100,000 residents per day;
  • At least 30 percent of total hospital and ICU beds available;
  • At least 90 days of personal protective equipment (PPE) stockpiled at each hospital;
  • At least 30 tests for every 1,000 residents per month; and
  • At least 30 contact tracers for every 100,000 residents plus additional tracers based on the projected number of cases in the region.

These requirements will be monitored on a daily basis by regional “control rooms” comprised of hospital, state, and local leaders. Once requirements are met in a region, businesses will be permitted to reopen based on a risk/reward analysis (infection risk vs. economic benefit). The State plans to allow businesses to reopen in the following order:

  • Phase 1: Construction, manufacturing and wholesale supply chain, select retail (curbside pickup).
  • Phase 2: Professional services, finance, insurance, retail, administrative support, real estate/rental leasing.
  • Phase 3: Restaurants/food services, hotels/accommodations.
  • Phase 4: Arts/entertainment/recreation, education.

However, the Governor reiterated that all businesses must take safety precautions and “reimagine” their operations to ensure safety and compliance with new protocols, including adjusting workplace hours, social distancing, restricting non-essential travel, requiring masks for frequent contact with others, conducting strict cleaning and sanitation, and completing continuous screening and tracing.

Governor Cuomo Announces Multi-State Supply Chain for PPE and Medical Equipment

Over the weekend, the Governor announced that he is partnering with governors from several other northeastern states to develop a regional supply chain for PPE and medical equipment. States participating in the collaboration will continue to work with the federal government during the COVID-19 emergency to procure supplies. However, the regional partnership will identify needs for products, aggregate demand, and reduce costs by combining the purchasing of multiple states. The states will coordinate policies regarding PPE inventory to prepare for a potential second wave of COVID-19 in the fall and will identify suppliers with capacity to scale for the entire region over the next three months.

The press release on the multi-state supply chain is available here. The Governor also issued Executive Order 202.26 (available here) over the weekend, which contains directives related to elections and education requirements.

DFS Releases Emergency Regulation Regarding Cost-Sharing for Mental Health Services

On May 2nd, the Department of Financial Services (DFS) announced in a press release (available here) that, as per Governor Cuomo’s announcement last week, it issued an emergency regulation requiring regulated health insurance plans to waive out-of-pocket costs (i.e. cost-sharing, deductibles, copayments, and coinsurance) for in-network mental health services for frontline essential workers during the COVID-19 emergency. Frontline essential workers include:

  • Health care workers;
  • First responders;
  • Transit workers;
  • Food service workers;
  • Retail workers at essential businesses; and
  • Other frontline essential employees who directly interact with the public.

DFS-regulated health insurance plans are prohibited from imposing cost-sharing for both telehealth and in-person mental health services rendered by in-network providers to these essential workers. However, if the individual is covered by a high-deductible plan, the service may be subject to the plan’s annual deductible if required by federal law. Plans must issue letters to all in-network mental health providers to inform them not to accept patient payment for covered members and provide the definition for frontline essential workers.

Additional details and a full list of essential workers eligible for waived out-of-pocket costs are available in the DFS circular letter to insurance plans here. Questions may be submitted to health@dfs.ny.gov. 

Updated DOH Telehealth Guidance and FAQ

On May 1st, the New York State Department of Health (DOH) updated its comprehensive guidance (available here) and their FAQ (available here) regarding the use of telehealth/telephonic services during the COVID-19 emergency. The guidance includes the following policies, among others:

Billing Rules

  • Provides detailed instructions on when providers should use different telehealth modifiers and Place of Service (POS) codes when billing for services, including which codes should be used when the provider is delivering services from their home.
  • Modifies billing rules for Federally Qualified Health Centers (FQHCs) to make wraparound payments available for licensed practitioners providing services via telehealth (including telephonic) under qualifying PPS and offsite rate codes.
  • Indicates that all new telephonic rate codes were loaded to eMedNY on April 10th and advises providers with rejected claims for dates of service on or after March 1st to resubmit claims.
  • Clarifies that when the distant-site practitioner is physically located at the Article 28 distant site or is providing service from their home during the State of Emergency, the distant site may bill Medicaid under APGs for the telehealth encounter using the appropriate CPT code for the service provided. 
  • Specifies that Medicaid will reimburse for telephonic services provided by Medicaid-enrolled doulas.

Clarifications on Provider and Patient Locations

  • Reaffirms that the originating site may be anywhere the patient is located, including their home.
  • Reaffirms that the distant site may be anywhere the provider is located, including FQHCs and the provider’s home.

Medicaid Managed Care Plans

  • Clarifies that Medicaid Managed Care plans are required to provide telehealth coverage as described in the guidance, but may establish claiming requirements (e.g., specialized coding) that vary from the fee-for-service billing instructions. 
  • Regarding payment parity for telehealth and telephonic services, explains that absent existing State-mandated rates or negotiated rates for such services, Medicaid Managed Care plans must reimburse network providers at the same rate that would be reimbursed for providing the same service in-person.
  • Allows Medicaid Managed Care plans and providers to negotiate payment rates/methodology for services delivered via telehealth/telephonic means for services that do not have State-mandated or benchmark rates.
  • Prohibits Medicaid Managed Care plans from limiting member access to telehealth/telephonic services to only their telehealth vendors.
  • Requires plans to cover the appropriate telehealth/telephonic services provided by other network providers.

Tomorrow, May 5th from 10:30am to 12pm, DOH will host a webinar to review this updated guidance and FAQ. DOH will address participant questions if time permits. Interested parties may register here.