DOH Submits Amendment to Revise State Plan Based on COVID-19 Pandemic
Today (August 27th), the New York State Department of Health (DOH) publicly posted a State Plan Amendment (SPA) which would, if approved by the Centers for Medicare and Medicaid Services (CMS), codify existing and make new adjustments to Medicaid operating and reimbursement policies in response to COVID-19. Programs and services affected include:
- DOH: Intermediate Care Facilities (ICFs), Health Homes, and telehealth services, including telephonic, Remote Patient Monitoring (RPM), and store-and-forward;
- OMH: Clinic treatment, partial hospitalization, continuing day treatment, day treatment for children, residential rehabilitative services, Personalized Recovery Oriented Services (PROS), and Assertive Community Treatment (ACT);
- OASAS: Opioid treatment services and rehabilitative services; and
- Children: Children and Family Treatment and Support Services (CFTSS) and children’s Home and Community Based Services (HCBS).
The amendment would make various revisions to required treatment plan timeframes and reviews, the clinical assessment process, payment/billing methodology, provider training requirements, and telehealth permissions. Some changes have already been announced in previous guidance. Notable items include:
- The amendment proposes that effective March 17, 2020, Intermediate Care Facilities serving Individuals with Intellectual Disabilities (ICFs/IID) receive a supplemental payment for day services when active treatment outside the residence is not possible because the external treatment facility is closed or not accepting patients due to COVID-19. The supplemental payment to ICFs will be available until the end of the public health emergency or when outside treatment facilities are permitted to safely resume operations. Government-operated ICFs are not eligible for the supplemental payment. The supplemental weekday daily fee would be $111.02 (Region 1), $124.89 (Region 2), or $103.39 (Region 3).
- The amendment would allow clinic/outpatient evaluation and management visits to occur outside of the clinic site, such as non-hospital buildings, parking lots, community sites, and patient homes.
- The amendment would increase reimbursement for all Medicaid providers for store-and-forward services from 75 percent to 100 percent of a face-to-face visit.
- During the emergency, the amendment would allow providers billing for remote patient monitoring (RPM) to additionally bill CPT code Q3014 for administrative expenses.
The SPA was submitted on August 25th to the Division of the Budget (DOB) for approval and would next go to CMS. The text of the SPA is available here. If approved, the changes would be effective retroactive to March 1, 2020.
CMS Releases Testing Guidelines for Nursing Homes
On August 26th, CMS released guidance for long-term care facilities (LTC) in response to the COVID-19 public health emergency (PHE). This guidance elaborates on the third COVID-19 interim final rule with comment period (IFC) published on August 25th, which established a requirement for nursing homes to test both residents and staff for COVID-19 on a regular basis and report on results.
The new guidance sets out parameters for this requirement, including the required testing frequency in the case of a symptomatic individual, an outbreak in the facility, or for routine infection control purposes. For routine testing, the required frequency depends on local COVID-19 prevalence:
- LTCs in a county with a COVID-19 positivity rate of less than 5% should test staff at least once per month;
- LTCs in a county with a COVID-19 positivity rate of between 5% and 10% should test staff weekly; and
- LTCs in a county with a COVID-19 positivity rate of greater than 10% should test staff two times per week.
When a new case of COVID-19 is detected, all staff and residents should be tested every three to seven days until there are no new cases for two weeks. CMS does not recommend routine testing for asymptomatic residents unless a resident regularly leaves an LTC facility (e.g., for dialysis or chemotherapy).
The guidance is available here.
CMS Approves New York’s Supplemental Nursing Home Transition and Diversion and Traumatic Brain Injury Appendix K Waiver Request
On August 25th, CMS approved New York’s supplemental Appendix K waiver request to amend the following 1915(c) HCBS waivers:
- Nursing Home Transition and Diversion (NHTD)
- Traumatic Brain Injury (TBI)
The request amends previously approved language to limit retainer payments to up to three 30-day episodes, not to exceed a total of 90 days. Providers may not seek retainer payments if they would exceed the number of hours in the approved service plan. Retainer payment requests authorized after June 30, 2020 must include the following supplementary attestations in addition to the prior attestation:
- All current billing requirements remain in place, including that retainer payments will be subject to recoupment if inappropriate billing or duplicate payments for services occurred.
- While receiving retainer payments, the provider has not received relief from any other source (including, but not limited to, unemployment benefits and Small Business Administration (SBA) loans) that would exceed revenue for the last full quarter prior to the PHE.
- The provider will not lay off staff and will maintain wages at existing levels.
- If the provider received revenue from other sources that exceeds pre-PHE level income, retainer payments will not be available.
- Funding is subject to a final reconciliation to include an evaluation of other sources of emergency funding, including unemployment benefits and SBA loans, and may require the recoupment of retainer payments if revenue exceeds the quarter prior to the PHE.
The amendment also extends the timeframes for submission of evidentiary/372 reports. The changes are effective from March 1, 2020 through February 28, 2021.
The CMS approval letter is available here. The waiver request is available here.
DOH Announces Emergency Rule Developing a Surge and Flex Health Coordination System
On August 26th, DOH posted an emergency rule in the State Register (available here, p. 4) that grants the Commissioner of Health authority to direct certain actions and waive certain regulations during the COVID-19 emergency. In particular, given the possibility of a “second wave” of COVID-19 in New York State, the emergency regulations provide the Commissioner and DOH with flexibility to impose additional requirements to ensure an effective response to a COVID-19 resurgence and, accordingly, to “Surge and Flex” the health care system statewide as needed. The Commissioner would have the authority to issue directives to authorize and require clinical laboratories or hospitals to take certain actions consistent with the Governor’s Executive Orders, and to temporarily suspend or modify certain regulatory provisions during the emergency. The emergency regulations would also require hospitals to:
- Develop disaster emergency response plans;
- Maintain a 90-day supple of personal protective equipment (PPE);
- Ensure that staff capable of working remotely are equipped and trained to do so; and
- Report data as requested by the Commissioner.
The rule will expire on November 3rd unless otherwise extended.
NYC Emergency Management COVID-19 Surge Staffing Group Purchasing Organization
New York City (NYC) Emergency Management has developed a medical surge staffing group purchasing organization (GPO) to assist NYC health care facilities that are facing staffing shortages as a result of COVID-19 or that are preparing surge staffing plans for future waves of COVID-19. Each health care facility is responsible for creating their own contract with appropriate staffing vendors. NYC Emergency Management serves as the vendor manager for the GPO and retains records for the master agreement.
The following types of facilities within the five boroughs of NYC are eligible:
- General hospitals
- Residential health care facilities or nursing homes
- Adult care facilities
- Home care providers
- Residential treatment programs
- Outpatient mental health clinics
- Diagnostic and treatment centers and clinics, including Chronic Renal Dialysis Services
Facilities must be licensed by DOH or the OMH. The brochure is available here and an FAQ is available here. The clinical staff group purchasing agreement is available here. The GPO will be available until June 2021. Questions should be sent to HealthMedicalESFList@oem.nyc.gov.