Federal Updates
CMS Issues New COVID-19 Regulatory Waivers
Today, CMS released a new set of waivers in response to the COVID-19 outbreak creating more regulatory flexibilities for Medicare providers, retroactive to March 1st. These waivers will:
- Add new services to the list of Medicare eligible telehealth services that may be provided with audio-only technology. This includes various behavioral health counseling and educational services, such as psychotherapy (CPT codes 90832 and 90834) and many others, as well as telephone-only evaluation and management (CPT codes 99441-99443).
- Make anyone who is eligible to bill Medicare for professional services also eligible to bill by telehealth from a distant site. This includes physical therapists (PT), occupational therapists (OT), and speech language pathologists (SLP).
- Modify the scope of the Quality Assurance and Performance Improvement (QAPI) program in long-term care facilities (LTCFs) and home health agencies (HHAs) to focus on adverse events and infection control.
- Waive the discharge planning requirement for LTCFs and HHAs and extend the clinical records timeframe requirement for both types of facilities to ten days.
- Delay the annual 12 hours of in-service training requirement for nurse aides and home health aides until the end of the first full quarter after the declaration of the PHE concludes.
- Waive the requirement that registered nurse or other appropriate skilled professional make an annual onsite supervisory visit at an HHA until 60 days after the expiration of the PHE.
- Postpone the deadline for hospices to conduct an annual skills and competence assessment and provide in-service training and education programs throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes.
- Waive certain physical environment requirements for hospitals, critical access hospitals, inpatient hospice, ICF/IIDs, and skilled nursing facilities/nursing facilities.
- Waive the requirement that medical staff privileges be periodically reappraised, and the scope of procedures performed be periodically reviewed in ambulatory surgical centers.
- Modify QAPI requirements specific to Community Mental Health Centers (CMHC), including waiving the requirement that prohibits CMHCs from providing partial hospitalization services and other CMHC services in an individual’s home, and waiving the requirement that a CMHC provides at least 40% of its items and services to individuals who are not eligible for Medicare benefits.
The complete list of regulatory waivers is available here.
CMS Issues Interim Final Rule with Further COVID-19 Flexibilities
Today, CMS announced additional regulatory waivers and an interim final rule with comment period (IFC) to provide further flexibility during the COVID-19 public health emergency (PHE). The IFC will address the following areas:
- Coverage for Testing: Amends several Medicare policies to cover FDA-authorized COVID-19 serology tests, allow any authorized provider to order COVID-19 diagnostic tests, and add COVID-19 testing to the Physician Fee Schedule and Outpatient Prospective Payment System.
- Site-Neutral Payments: Allows on-campus and excepted off-campus provider-based departments (PBDs) that relocate in response to the COVID-19 PHE to continue to bill using the outpatient prospective payment system during the COVID-19 PHE.
- Basic Health Program (BHP): Allows states operating a BHP (New York’s Essential Plan) to seek certification of a revised BHP Blueprint for temporary COVID-19 related changes, which may apply retroactively to the start of the PHE.
- Accountable Care Organizations (ACOs): Makes several changes to ACOs participating in the MSSP program, including:
- Discontinues the 2021 ACO application cycle;
- Allows existing ACOs whose periods expire in 2020 to extend their existing performance periods for an additional year;
- Allows BASIC track ACOs to stay in the BASIC track for an additional year; and
- Clarifies that ACOs will have shared losses reduced by a factor of the number of months of the COVID-19 PHE divided by twelve (i.e., if the PHE ends in June 2019, shared losses will be reduced by half);
- Excludes all Part A and B payment amounts related to COVID-19 episodes from shared savings calculations.
- Reporting: Grants various exceptions and delays related to quality reporting for hospitals participating in the Hospital Value-Based Purchasing (VBP) Program; providers in the Merit-based Incentive Payment System (MIPS); and the Home Health Value-Based Purchasing (HHVBP) Model.
The IFC is available here.
State Updates
Governor Cuomo Discusses Contact Tracing Program, Announces MTA Disinfection Efforts
Today (April 30th), Governor Cuomo held a press conference during which he announced that the State is now conducting approximately 30,000 diagnostic tests per day. The State, in partnership with former Mayor Michael Bloomberg, who is leading the contact tracing initiative, is recruiting a contact tracer “army” from the State, City, and County Health Departments as well as other government employees and applicants identified by CUNY and SUNY. Using a benchmark of 30 contact tracers per 100,000 individuals plus an additional number based on the projected number of cases in a region, the State estimates needing between 6,400 and 17,000 contact tracers statewide. The Johns Hopkins Bloomberg School of Public Health is developing a remote training and certification program that tracers will be required to pass. Mayor Bloomberg’s initiative is also working on developing three new smartphone apps to support contact tracing efforts, including helping contact tracers quickly find information and data, allowing individuals to submit data to health departments, and providing quick access to guidance and services for individuals in quarantine.
The Governor also addressed ensuring safe transportation for essential workers. The Metropolitan Transit Authority (MTA) will now be disinfecting trains and buses every 24 hours. As a result, service will be suspended from 1am to 5am every night; however, the MTA will be providing buses, for-hire vehicles, and compliant “dollar vans” at no cost to essential workers. The MTA will also be disinfecting Metro North and Long Island Railroad (LIRR) trains without an interruption in service.
Governor Cuomo Issues Executive Order on Resuming Elective Surgeries
On April 29th, Governor Cuomo signed Executive Order 202.25 (available here) that contains several directives to address the COVID-19 emergency. The order implements the Governor’s recent announcement permitting elective procedures to resume in some areas of the State, including a new provision that allows hospitals who do not meet the below criteria to submit a request for the criteria to be waived.
In general, hospitals may resume performing elective surgeries and procedures as long as the following conditions are met:
- Within the hospital’s county, the total available hospital inpatient capacity is over 30 percent and the total available hospital ICU capacity is over 30 percent;
- Within the hospital’s county, the total change in the number of hospitalized patients who are positive for COVID-19 was fewer than 10 during the period from April 17th to April 27th; and
- The hospital’s available inpatient capacity is over 30 percent and the available hospital ICU capacity is over 30 percent, and the change in the number of hospitalized patients who are positive for COVID-19 was fewer than 10 during the period from April 17th to April 27th.
The list of the 35 qualifying counties is available here. Hospitals that resume elective procedures must report, at a minimum, the number and types of surgeries and procedures performed to the New York State Department of Health (DOH). Before performing any elective surgery or procedure, the patient receiving the surgery or procedure must test negative for COVID-19 through an approved diagnostic test.
Hospitals that do not meet the above criteria may seek a waiver. Hospitals seeking a waiver must submit a plan that includes, at a minimum, their facility capacity, physical configuration, infection disease protocols, and staffing capacity, including any information on employment hardship resulting from the inability to perform elective surgeries or procedures, such as furloughs or workforce reductions.
The Executive Order also modifies previous directives related to pregnant patients by:
- Allowing the Commissioner of Health to approve and certify temporary dedicated birthing sites operated by birthing hospitals and birthing centers that are currently licensed;
- Modifying previous directives to allow a pregnant person’s support person to stay for the full duration of the patient’s stay in the facility; and
- Allowing a doula who does not have symptoms of COVID-19 to be present for the labor, delivery, and remaining duration of the patient’s stay.
COVID-19 Maternity Task Force Provides Initial Recommendations
On April 29th, Secretary to the Governor Melissa DeRosa issued a report to Governor Cuomo outlining the COVID-19 Maternity Task Force’s initial recommendations. The Task Force was established to address the impact of COVID-19 on maternity care and is comprised of a multi-disciplinary group of maternal and infant health professionals from across New York State. The Governor accepted the recommendations in full, which include:
- Undertaking measures to diversify birthing site options and support patient choice.
- Extending the period of time during which a healthy support person can accompany a mother after delivery and permitting doulas as additional support persons.
- Mandating testing of all pregnant New Yorkers, including issuing guidance identifying pregnant individuals as a priority population for testing.
- Ensuring equity in birth options by establishing work groups charged with developing standards, policies, and/or regulations related to birthing options with participation from community members.
- Creating an educational campaign with support from experts, community members, and representatives from community-based organizations.
- Reviewing the impact of COVID-19 on pregnancy and newborns with a special emphasis on reducing racial disparities in maternal mortality.
Several of these recommendations have already been addressed in Executive Order 202.25 (see above). The Task Force’s report is availablehere. The press release is available here.
DOH Weekly Provider Webinar
Today, DOH held its weekly provider webinar (available for viewing here) which discussed updates related to diagnostic and serological testing protocols and guidelines, including priority populations for testing and new provisions allowing for pharmacy-based testing. The webinar also discussed the current status of clinical trials for COVID-19 therapeutic agents. The webinar announced a new online survey being administered by DOH that will be sent to all health care workers regarding provider wellness. DOH hopes to gain insight from the survey on how to best address the needs of all health care personnel during this time, regardless of whether the individual provider is deployed on the front lines of the COVID-19 response.
DOH’s weekly provider webinars are held every Thursday at 1pm and can be viewed here.