June 18th Newsletter

State Updates

Governor Cuomo Expects NYC to Enter Phase 2 of Reopening on Monday

Today (June 18^th), Governor Cuomo held a press conference during which he announced continued progress in combatting the COVID-19 pandemic in New York State, with 0.90 percent of the approximately 70,000 individuals tested yesterday receiving a positive result. New York City also continues to make progress, with only 1 percent of tests yesterday being positive. As a result, the City will likely progress to Phase 2 of reopening, allowing office workers, outdoor dining, and other activities to resume, on Monday, June 22^nd. The percent of individuals who received positive tests yesterday by borough is as follows:

• Bronx: 0.9 percent
• Brooklyn: 1.2 percent 
• Manhattan: 0.8 percent
• Queens: 1.1 percent 
• Staten Island: 0.4 percent

Following complaints of social distancing violations this past weekend, the Governor reiterated the importance of following Phase 2 guidelines, stating that successful reopening will require compliance from individuals and enforcement from local governments, and that violations of reopening rules and guidelines could result in an immediate loss of a liquor license or a shutdown order.

The State will be issuing guidance to colleges and universities that will allow some residential and face-to-face programming this fall. Campuses must develop a plan that attests to meeting this guidance and file the plan with the State.

Governor Cuomo Signs Several Bills in COVID-19 Legislative Package

On June 17^th, Governor Cuomo signed several bills that were passed by the New York State Assembly and Senate in late May as part of a COVID-19 legislative package. The following bills have now been signed by the Governor:

• S.8416/A.10404A: Ensure audio-only and video-only telehealth and telemedicine services will be eligible for reimbursement.
• S.8189/A.10270: Update New York’s anti-price gouging law to include medical supplies and services as well as goods and services used to promote public health.
• S.8397A/A.10326A: Prohibit health care employers from retaliating against health care workers speaking out about workplace safety or health violations including to the news media or on social media.
• S.8181A/A.10294A: Authorize Industrial Development Agencies (IDAs) to create a COVID-19 State of Emergency loan program to provide capital funding for small businesses and not-for-profits, and to provide grants for the acquisition of personal protective equipment (PPE) to prevent the spread of COVID-19.
• S.8182A/A.10508A: Allow licensed pharmacists to administer a vaccine for COVID-19 no sooner than 90 days once a vaccine has been approved by the Food and Drug Administration (FDA) and after DOH and the State Education Department certify that having pharmacists administer the vaccine is in the best interest of public health.
• S.8289B/A.10394A: Require residential health care facilities to prepare and comply with an annual pandemic emergency plan.
• S.8412/A.10498: Enable businesses, nonprofits and religious institutions to conduct board meetings and actions through electronic and/or audio-visual technologies.
• S.8427/A.10528: Establish a COVID-19 pension benefit for families of public employees who die due to their workplace exposure to the disease.

The Governor vetoed one bill:

• S.8119C/A.10303B: Would have extended paratransit certifications until August 31, 2020, and established infection control requirements for paratransit providers.

DOH Hospital Visitation Guidance

On June 17^th, the Department of Health (DOH) released guidance for hospitals with updated visitation guidance in accordance with the Governor’s announcement earlier this week that visitation would be permitted at all hospitals statewide at their discretion beginning on June 19^th. However, hospitals that choose to initiate expanded visitation must notify DOH no later than 48 hours prior to the start of the expanded visitation policy and include in the notification a plan to communicate parameters of the new visitation policy to patients. Notifications can be emailed tohospinfo@health.ny.info.gov. 

Hospitals must adhere to the requirements outlined in the guidance, including ensuring time-limited visits and that visitors wear the appropriate personal protective equipment (PPE) and undergo symptom and temperature checks. Hospitals are still required to comply with the policies on allowing support persons for pediatrics, childbirth, and patients with intellectual/developmental/cognitive disabilities as listed in DOH’s previous visitation guidance here. 

CMS Approves New York State’s Emergency Appendix K Amendment to Children’s Waiver

Today, the Centers for Medicare and Medicaid Services (CMS) approved New York State’s emergency Appendix K Amendment to the Children’s Waiver services. The Amendment includes provisions allowing services to be provided via electronic modalities (telehealth/telephonic), a modification of service limits and incident reporting protocols, and the allowance of retainer payments for community and day habilitation providers, among other provisions. The Amendment is effective retroactively to March 1, 2020 and in effect until February 28, 2021.

The Appendix K approval is available here.  

OPWDD Interim Visitation Guidance for Residential Facilities

Today, the Office for People with Developmental Disabilities (OPWDD) released interim visitation guidance (available here) for residential facilities. As per the Governor’s announcement earlier this week, visitation may resume at OPWDD certified group homes and residential facilities starting on June 19^th.

As outlined in the guidance, providers of residential services will be required to follow specific protocols and guidelines for visitation that take into account staffing, disinfection and infection controls, and staggered visits to ensure social distancing and documentation of who is visiting the home. In addition, all visitors will be required to take part in symptom and temperature checks, wear a mask and sanitize their hands upon arrival, and maintain hand hygiene throughout the visit. Visitation is encouraged to occur outside the facility if weather permits, with masks worn by all parties and with social distancing in place.

Facilities that would like to permit visitation in accordance with this guidance must notify OPWDD and attest to their ability to meet the criteria by emailing the attestation (available here) to quality@opwdd.ny.gov. All facilities will have the option to impose additional visitation restrictions upon notice to and approval by OPWDD. 

OMH Infection Control Guidance 

On June 17^th, the Office of Mental Health (OMH) released COVID-19 infection control guidance (available here) for residential and site-based programs. The guidance includes the most current information and guidance on symptoms and physical distancing and provides general infection control guidance for residential and site-based programs and staff. The guidance also includes information on accepting new clients, responding when a client develops symptoms, handling clients returning from the hospital, taking precautions for non-emergent transportation, implementing home-time leaves, and dealing with a shortage of PPE. The guidance additionally provides specific considerations and information for scattered-site housing programs.

On June 15^th, OMH released COVID-19 infection control guidance (available here) for a broad range of public mental health programs. The guidance encourages programs to continue using telemental health services as much as possible. However, programs are required to maintain capacity for in-person services for individuals who are unable to connect via telehealth or who require long-acting injectable medications or laboratory testing. Additionally, in areas of the State that have progressed in reopening, in-person meetings outside or off-site may be considered. The guidance contains the appropriate steps that programs and staff should take prior to and during such in-person visits. The guidance also provides information on infection control protocols for programs and staff.

OASAS Reopening Guidance for Certified Programs

On June 18^th, the Office of Addiction Services and Supports (OASAS) released reopening guidance (available here) for all certified programs. The guidance relaxes some previously released emergency regulations, including allowing residential and inpatient addiction treatment programs to return to admitting and discharging patients per previous LOCADTR 3.0 criteria once they notify and receive approval from OASAS and as long as they do not have any confirmed COVID-19 cases among staff or patients. The guidance also allows residential and inpatient addiction treatment programs in regions that have entered Phase Three of reopening to allow visitation to and from programs with appropriate precautions in place, including social distancing and the use of face coverings.

For outpatient addiction treatment programs, telepractice is still the preferred method of providing treatment if possible; however, in-person individual sessions may occur with masks/face coverings and the use of social distancing. Toxicology may also resume in the context of an in-person program visit for another reason. In-person counseling/treatment and recovery groups can meet outdoors while using masks/face coverings and maintaining social distancing and may resume indoors with appropriate precautions for regions that have entered Phase Three. Programs offering prevention or recovery services in regions that have entered Phase Two may allow but not require staff to resume operating in their office spaces, but must adhere to all business guidance for reopening in Phase Two. Phase Three regions may resume such in-person services with the appropriate precautions.

Questions should be submitted to OASAS Regional Offices, PICM@oasas.ny.gov, Legal@oasas.ny.gov, or Prevention@oasas.ny.gov. 

DOH Weekly Provider COVID-19 Webinar

Today, DOH held its weekly provider webinar (available for viewing here). The webinar provided treatment and testing updates, discussed New York State’s progress on reopening, and reviewed recently released guidance on the resumption of elective surgeries and hospital visitation.  

DOH’s weekly provider webinars will now be held every other Thursday at 1pm and can be viewed here. The next webinar will be held on July 2^nd. 

Workers’ Compensation Board Publishes COVID-19 Q&A

The New York State Workers’ Compensation Board has published a COVID-19 Q&A document (available here) that provides details on how individuals can receive workers’ compensation benefits in New York State due to COVID-19 exposure. The document describes the claims filing process for workers and what benefits workers may be entitled to. Workers who contract COVID-19 will not be presumed to have been exposed at work and will need to file a medical report stating that the illness was caused by work, but the Board will consider workers who work in locations where COVID-19 exposure is documented or workers who directly interact with the public to be more likely to have compensable claims.

Federal Updates

CMS Updates COVID-19 Medicare FFS Billing FAQs

On June 16^th, the Centers for Medicare and Medicaid Services (CMS) updated the COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing document. Much of the new information regards guidance for Federally Qualified Health Centers (FQHCs), telehealth, ambulance services, and the Medicare Shared Savings Program (MSSP). Some major points include:

Telehealth

• When hospitals provide telehealth services to patients who are registered outpatients of the same hospital, and the patient’s home is being treated as a temporary expansion site, they should not bill using telehealth modifiers. Instead, they should bill as they ordinarily would and include the DR condition code or CR condition code on the claim.
• A mental health visit can be furnished as a distant site telehealth service, and a medical visit and a mental health visit can be furnished on the same day as a distant site telehealth service for the duration of the COVID-19 PHE. For FQHCs, Distant site Telehealth services should be billed with HCPCS code G2025 and the appropriate revenue code, 052X for a medical visit or 0900 for mental health. If a mental health visit code is not currently on the FQHC qualifying visit list, then those claims should be held until July 1, 2020.
• Health care providers that are currently authorized to provide primary care services in RHCs and FQHCs can provide distant site telehealth services under the waiver authority during the COVID-19 PHE. Other practitioners may also provide telehealth services within their scope of practice and consistent with Medicare benefit rules that apply to all services. In general, the requirements for direct supervision have been modified to include the use interactive audio and video telecommunications technology. Specimen collection services are included in the all-inclusive rate for RHCs and the prospective payment system for FQHCs and are not paid separately.

Ambulance Services

• MedPAC data collection and reporting requirements for the Medicare Ground Ambulance Data Collection System are delayed due to COVID-19, however, the 10% payment reduction will still apply if a ground ambulance organization does not sufficiently submit the required data after being selected to collect and report data under the modified data collection and reporting timeframe.
• Ground ambulance organizations that were selected by CMS to collect data beginning between January 1^st, 2020, and December 31^st, 2020 (year 1) do not have an option to continue with their current data collection period and must select a new data collection period that begins in 2021.
• Because there will be no data reporting in 2021, year 1 and year 2 selected ground ambulance organizations will collect and report data during the same time periods.

The updated FAQs are available here.

HHS Funding Opportunity for COVID-19 Community Interventions

On June 17^th, the Department of Health and Human Services (HHS) released a Funding Opportunity Announcement (FOA) for community interventions to address the adverse psychological, behavioral, and socioeconomic consequences of the COVID-19 pandemic among vulnerable populations. Applications are sought to test:

1. The impacts of mitigation strategies to prevent COVID-19 transmission and acquisition; and
2. Already implemented, new, or adapted interventions to address the adverse consequences of the pandemic on the health of vulnerable groups.

Eligible applicants include both not-for-profit and for-profit organizations. It is expected that projects will involve partnerships with community-based organizations, local government agencies, and other stakeholders as relevant to the project aim(s), setting(s), and population(s). HHS will award up to $500,000 per organization annually.

The FOA is available here. Applications may be submitted starting July 28^th until December 1^st.

SBA and Treasury Announce Revised and EZ Loan Forgiveness Processes

On June 16^th, the Small Business Administration (SBA), jointly with the Department of Treasury, announced a revised Paycheck Protection Program (PPP) loan forgiveness application that implements aspects of the PPP Flexibility Act of 2020 as well as a new EZ version of the forgiveness application process. Both applications give borrowers the option of using the original 8-week covered period or an extended 24-week covered period. The EZ Forgiveness Application applies to borrowers that:

• Are self-employed and have no employees; or,
• Did not reduce the salaries or wages of their employees by more than 25%, and did not reduce the number or hours of their employees; or,
• Experienced reductions in business activity as a result of health directives related to COVID-19, and did not reduce the salaries or wages of their employees by more than 25%.

The EZ Forgiveness Application is available here, and the revised Full Forgiveness Application is available here. Additionally, the SBA has revised its Loan Forgiveness Application Instructions (available here), and PPP Loan Forgiveness Calculation Form (available here).

SBA Announces Reopening of EIDL and EIDL Advance Program

On June 15^th, the SBA announced the reopening of the Economic Injury Disaster Loan (EIDL) and EIDL Advance program portal to all eligible applicants experiencing economic impacts due to COVID-19. The EIDL program offers long-term, low interest loans for small businesses and non-profits that can be used to cover payroll and inventory, pay debt or fund other expenses. The EIDL Advance program provides up to $10,000 that does not have to be repaid to businesses that are currently experiencing temporary difficulties.

The announcement is available here, and additional information is available here.

FCC Awards 62 Additional Funding Applications for COVID-19 Telehealth Program

On June 17^th, the Federal Communications Commission (FCC) announced that it had approved an additional 62 funding applications for the COVID-19 Telehealth Program, totaling $23.25 million. To date, the program has approved 367 funding applications in 45 states plus Washington, D.C. for a total of over $128 million in funding out of the $200 million available. The following funding was awarded to five telehealth providers in New York State:

• Maimonides Medical Center (Brooklyn, New York) – $1,000,000
• Silvercrest Center for Nursing and Rehabilitation (Briarwood, New York) – $631,795
• Hospital for Special Surgery (New York, New York) – $596,045
• Flushing Clinic (Flushing, New York) – $94,972
• Northern NY Rural Behavioral Health Institute (Saranac Lake, New York) – $55,180

More information is available here.