May 1st Newsletter - Sachs Policy Group

State Updates

Governor Cuomo Extends School Closures, Seeks Targeted Info on New COVID-19 Hospitalizations

Today (May 1^st), Governor Cuomo held a press conference during which he announced that the slow but steady decline in new COVID-19 hospitalizations and deaths continues. In order to develop a targeted strategy for reducing the number of new hospitalizations, the Governor is meeting with hospitals to develop a plan for obtaining more specific information on the new cases, including where they live, if they are essential workers, how they commute, and their demographic information.

The Governor announced K-12 schools and college facilities will remain closed for the rest of the academic year and will continue to educate students via distance learning programs. A decision on summer school programming will be made by the end of this month. The Governor also announced that New York State will be directing insurers to waive all cost-sharing, copayments, and deductibles for mental health services provided to essential workers for the remainder of the COVID-19 emergency. The State has also implemented a new 24/7 emotional support hotline for frontline workers, which can be accessed by texting “NYFRONTLINE” to 741-741. Further information is available here.

DOH Guidance on Resuming Elective Surgeries and Procedures

On April 29^th, the New York State Department of Health (DOH) released guidance (available here) on the resumption of elective outpatient procedures, as per Governor Cuomo’s Executive Order 202.25 (available here). The guidance affirms that currently, only general hospitals may resume procedures if they meet the established criteria (or apply for a waiver if they do not). Resumption of elective surgeries for ambulatory surgery centers (ASCs), office-based surgery practices, and diagnostic and treatment centers (DTCs) will be re-evaluated in the future. However, all covered practices should note that various surgeries related to cancer, intractable pain, and highly symptomatic patients are considered “essential” and can and should be performed, regardless of setting.

General hospitals that meet the criteria must follow the below steps:

Developing a prioritization strategy appropriate to immediate patient needs;
Administering COVID-19 diagnostic tests on patients prior to the procedure;
Ensuring sufficient staffing and adequate personal protective equipment (PPE) and supplies;
Submitting an attestation form prior to resuming any elective surgeries or procedures to DOH; and
Sending required data to DOH on a monthly basis.

The guidance also provides specific details on the waiver process for hospitals that plan to submit a request to DOH for approval to resume elective surgeries if they are not otherwise permitted.

Federal Updates

CMS Rule and Waivers Remove Longstanding Obstacles

Yesterday, CMS issued an interim final rule and set of waivers offering significant new Medicare flexibilities during the COVID-19 emergency. SPG summarized some major provisions in yesterday’s update (available here). Additional notable details of the CMS announcement include:

Telephone E/M services (CPT codes 99441-99443) have had reimbursement increased to match in-person E/M services (CPT codes 99212-99214).
CMS intends to make ongoing updates to the permissible Medicare telehealth services list, based on provider requests, on a sub-regulatory basis.
The flexibility for COVID-19 diagnostic tests extends to tests for diagnoses that could clinically overlap, including all influenza and respiratory syncytial virus (RSV) codes. Any practitioner (including a pharmacist) may order such a test if it is clinically necessary.
CMS is recognizing the use of CPT code 99211 for all patients (not just established patients) “in the context of large-scale dedicated testing operations” to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident to their services.

$12 Billion Allocated for Hospitals in Areas Highly Impacted by COVID-19

Today, the White House announced that it has determined the distribution of about $12 billion of the $100 billion appropriated in the CARES Act’s Provider Relief Fund. The funding will be sent to hospitals in COVID-19 “hot spots,” including New York. Approximately $10 billion will be disbursed to hospitals with 100 or more COVID-19 patients, while $2 billion will be given across 395 hospitals based on the number of low-income and uninsured patients treated. Manhattan and the Bronx were mentioned among the hardest-hit areas that will receive funding, but the White House did not announce specific funding amounts by hospital.

Federal Reserve Expands Access to PPPLF

Yesterday (April 30^th), the Federal Reserve expanded access to the Paycheck Protection Program Liquidity Facility (PPPLF) to all PPP lenders approved by the SBA, including non-depository institution lenders. Additionally, eligible borrowers will be able to pledge whole PPP loans that they have purchased as collateral to the PPPLF.

More information on the PPLF is available here.

CMS Announces Nursing Home Independent Commission

On April 30^th, the Centers for Medicare and Medicaid Services (CMS) announced a new independent Commission that will conduct an assessment of the nursing home response to COVID-19. The Commission is expected to convene in late May and develop recommendations on three key tasks:

Ensuring that nursing home residents are protected from COVID-19 and improving the responsiveness of care delivery;
Strengthening efforts to enable rapid and effective identification and mitigation of COVID-19 transmission (and other infectious disease) in nursing homes; and,
Improving compliance with infection control policies in response to COVID-19.

The Commission will focus on identifying approaches to using data for better coordination between federal surveyors, state and local entities, and nursing homes to address the current spread of COVID-19 in nursing homes. It will also assess efforts across the country to stop or contain the virus within these facilities.

More information on the Commission is available here.

ERISA Industry Committee Seeking to Add Member States to Medical Licensure Compact

On April 27^th, the Employee Retirement Income Security Act (ERISA) Industry Committee announced in a press release (available here) that it sent letters to 21 state governors asking them to join the Interstate Medical Licensure Commission Compact. The Compact, which allows practitioners in each state to undergo an expedited application process for other states’ medical licenses, is currently in effect among the other 29 states and the District of Columbia. States that have not yet joined the compact include Connecticut, New Jersey, and New York.