April 13th Newsletter

April 13, 2020

Federal Updates 

CMS, DOL, and Treasury Announce Expanded Coverage for Diagnostic Services

On April 11th, the Centers for Medicare & Medicaid Services (CMS), Department of Labor, and Department of the Treasury jointly issued a set of frequently asked questions (FAQs) implementing new requirements to offer coverage with no cost-sharing for COVID-19 testing and associated services provided during a medical visit. The guidance applies both to group health plans and group and individual health insurance coverage. The guidance accompanies the implementation of related requirements of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The FAQs clarify that eligible visits may include urgent care and emergency room settings as well as visits delivered by telehealth. It also provides details on what types of COVID-19 diagnostic tests are included.

The guidance is available here.

 

CMS to Allow Diagnoses from Telehealth Services for Risk Adjustment

On April 10th, CMS released guidance on the use of diagnoses from telehealth services for risk adjusted payment purposes. In the guidance, CMS stated that Medicare Advantage (MA) organizations and other organizations that submit diagnoses for risk adjusted payment will be able to submit diagnoses for risk adjustment that are from telehealth visits when those visits meet all other criteria for risk adjustment eligibility. As such, the visits must be for an allowable inpatient, outpatient, or professional service and stem from a “face-to-face” encounter. In this context, telehealth services provided using an interactive audio and video telecommunications system that permits real-time interactive communication, e.g., a smart phone, will satisfy the face-to-face requirement. This guidance applies to submissions to both the Risk Adjustment Processing System (RAPS) and the Encounter Data System (EDS).

The guidance is available here.

 

CMS Releases Initial $30 Billion in CARES Act Provider Relief

On April 10th, the Department of Health and Human Services (HHS) announced the immediate distribution of $30 billion of the $100 billion allocated for provider relief by the CARES Act. HHS partnered with UnitedHealth Group to offer a direct deposit Automated Clearing House (ACH) payment to the bank account on file of all facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019, with the amount proportional to their share of total FFS reimbursement.

HHS has stated that the remaining $70 billion will be disbursed to rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. As a condition of retaining these funds, providers must refrain from “balance billing” patients for COVID-19 related treatment (the scope of this requirement appears to apply to the uninsured and all those going out of network for COVID-19 related testing and treatment). Providers must sign an attestation confirming receipt of the funds and agree to terms and conditions of payment within 30 days.

The attestation signing portal will be made available here sometime this week. The Terms and Conditions document for the payments is available here.

 

FCC Releases Telehealth Program Application Guidance

On April 8th, the Federal Communications Commission (FCC) released guidance for applicants to the COVID-19 Telehealth Program, which will provide $200 million in funding for providers’ telecommunications services, information services, and devices. Eligible providers include not-for-profit hospitals, medical schools and colleges, Federally Qualified Health Centers (FQHCs), community mental health centers, local health departments, rural health clinics, skilled nursing facilities (SNFs), or collaborations of the above types of agencies. Such providers, if they purchased eligible telecommunications services, information services, and/or devices in response to the COVID-19 pandemic after March 13th, 2020, may apply for funding. Examples of eligible services include the following:

  • Telecommunications Services and Broadband Connectivity Services: Voice services, and Internet connectivity services for health care providers or their patients. The program will pay for services that require monthly recurring charges through September 30th, 2020.
  • Information Services: Remote patient monitoring platforms and services, patient reported outcome platforms, store and forward services, and other platforms and services to provide synchronous video consultation.
  • Internet Connected Devices/Equipment: Tablets, smart phones, or connected devices to receive connected care services at home.

The FCC began accepting applications today (April 13th) and will make awards on a rolling basis. The fillable application form is available on the FCC website here. Other information can be found in the public notice here.

 

CMS Offering COVID-19 “Office Hours”

Tomorrow (April 14th), from 5pm to 6pm, the Centers for Medicare and Medicaid Services (CMS) will hold “Office Hours” to answer questions from hospitals, health systems, and providers regarding CMS’ temporary actions regarding the following waivers and rule changes:

  • Increase Hospital Capacity – CMS Hospitals Without Walls;
  • Rapidly Expand the Healthcare Workforce;
  • Put Patients Over Paperwork; and
  • Further Promote Telehealth in Medicare

To access the event, attendees can call 833-614-0820 and use the Event Plus Passcode 2395745. Alternatively, attendees can access the audio webcast link here.

 

State Updates

Governor Cuomo Reports Continued Improvements in Outlook and Efforts to Increase Testing Capacity

Today (April 13th), Governor Cuomo held a press conference during which he announced that the curve of the COVID-19 emergency continues to flatten in New York State, and it appears that New York has reached a plateau, with the hospital census holding steady at slightly under 19,000 COVID-19 patients on each day. As such, the State is beginning to plan the process of how New York will start to “reopen.” As the Governor stated last week, reopening will be a gradual, phased-in process and will depend upon the State’s ability to perform rapid diagnostic and antibody testing at scale. In line with this, the State will be focusing on widely deploying the Department of Health’s (DOH) antibody test, including developing the capacity to conduct 1,000 tests by this week and 2,000 tests by next week. The Governor has also called on the federal government to use the Defense Production Act to help develop testing capacity, and said that New York State would offer full partnership with the federal government on these efforts and would be developing a testing coalition with Connecticut and New Jersey. Today, the Governor noted that reopening will be a coordinated effort advised by experts that will closely monitor if the infection rate begins to increase during the process. Objectives for reopening include:

  • Easing isolation;
  • Increasing economic activity;
  • Recalibrating “essential worker” economy;
  • Applying more testing and precaution; and
  • Avoiding an increase in the infection rate.

Over the weekend, the Governor announced that he has joined Maryland Governor Larry Hogan in a bipartisan effort calling for $500 billion in federal aid to states to offset revenue shortfalls as a result of COVID-19. The Governor also reiterated his call for the federal government to repeal the cap on deductions for state and local taxes (SALT). The Governor’s press release is available here.

 

Governor Cuomo Issues Two New Executive Orders

On April 9th, Governor Cuomo signed Executive Order 202.15 (available here), which further expands permissions for health care personnel located and licensed in another state to practice or provide services within New York State and relaxes requirements for the Public Health and Health Planning Council (PHHPC) to approve operator/owner transfers. Additionally, the Order allows students who have graduated from registered or accredited medical programs in New York State in 2020 to practice medicine in New York State, without the need to obtain a license and without risk of civil or criminal penalty, provided they are supervised by a licensed physician.

Other provisions in this order will:

  • Permit a manufacturer, repacker, or wholesaler of prescription drugs or devices, physically located and licensed/registered in another state, to deliver prescription drugs or devices in New York.
  • Allow a New York-licensed pharmacy to receive drugs and medical supplies or devices from a pharmacy, wholesaler, or third-party logistics provider located and licensed in another state to alleviate a temporary shortage of a drug or device.
  • Waive certain approval requirements and delay any statutory time limits for transfer notices pertaining to operators of Article 28 and Article 36 licensed entities to limit DOH’s review functions to essential matters during the emergency.
  • Allow respiratory therapy technicians licensed in any state to practice in New York State without civil or criminal penalty.
  • Allow mental health counselors, marriage and family therapists, creative arts therapists, and psychoanalysts licensed in any state to practice in New York State without civil or criminal penalty.

Today, Governor Cuomo issued Executive Order 202.16 (available here) that modifies the qualification requirements of medical or clinical laboratory technologists to allow additional individuals to perform testing for the COVID-19 virus or its antibodies. Individuals performing testing must meet the federal requirements for testing personnel appropriate to the assay or device authorized by the Federal Drug Administration (FDA) or New York State DOH. The Order also:

  • Suspends or modifies any regulations that create a landlord tenant relationship between an individual assisting with the COVID-19 response or who has been displaced due to COVID-19 and a housing provider offering temporary housing during the emergency, such as a hotel owner, hospital, or not-for-profit housing provider.
  • Directs the New York City Department of Law to issue no-action or no-filing letters received during the duration of this Order within 45 days from submission of the application for essential projects involving affordable housing and homeless shelters.
  • Requires essential businesses and entities to provide, at their expense, employees with face coverings that must be worn when in direct contact with customers or members of the public, effective April 15th at 8pm.

 

DFS Health Insurance Guidance on Coverage Requirements for COVID-19

On April 11th, the Department of Financial Services released guidance (available here) for health insurers on coverage requirements during the COVID-19 emergency. The guidance provides information on cost-sharing waivers, telehealth requirements, notifications to in-network providers, and regulatory filings and examinations. The guidance clarifies that for services in which cost-sharing is waived during the emergency, including services delivered via telehealth and testing for COVID-19, the insurance company is required to pay the provider the entire allowed amount for the services, including the patient’s copayment, coinsurance, and annual deductible.

 

OPWDD New Day Services Retainer Program Webinar

The Office for People with Developmental Disabilities (OPWDD) has rescheduled the second webinar on the Day Services Retainer Program that will be effective April 16th. This webinar will provide more information on the timeline, billing procedures, and service documentation for the program. The webinar will take place on Thursday, April 16th at 2pm. Registration is available here.

 

DOH Weekly Health Care Provider Update Webinar

On April 9th, DOH held its weekly webinar providing an update to health care providers on COVID-19. The webinar provided an epidemiological update on COVID-19 globally, nationally, and within New York State. The webinar also discussed testing and specimen collection protocols, goals for community mitigation measures, telehealth, and the health care surge response.

 

The webinar presentation is available here. Webinars are held on Thursdays from 1pm to 2pm.

 

New York State and City Updated Guidance Documents

On April 11th, the Office of Mental Health (OMH) released interim guidance (available here) on the implementation of Executive Order 202.13 provisions regarding background checks. Applicable to all OMH licensed, funded, or approved programs, the document provides guidance on temporary modifications to the background check process for 1) Staff members currently employed by an OMH provider; 2) staff members currently employed by a provider of another state oversight agency; and 3) new staff members not otherwise employed by an approved provider. For new employees, if they have not gone through a background check they are eligible to work unsupervised as long as they do not appear on the Staff Exclusion List and have completed the OMH Executive Order 202.13 Criminal History Information Attestation form (available here). However, the program should limit the unsupervised contact of such employee to the extent possible. New employees will still be required to complete all other pre-employment checks. A fingerprinting appointment should be completed no later than 5 business days after the prospective employee’s first scheduled day of work.

The following additional guidance documents/health advisories related to COVID-19 have been recently posted by New York State and City agencies: