Governor Cuomo’s Update
Today, March 16th, Governor Andrew Cuomo provided another update on New York’s efforts to address the coronavirus pandemic (COVID-19) (available here). The Governor announced a unified set of public health measures being taken by New York, New Jersey, and Connecticut, including banning gatherings of more than 50 people, closing various public-facing businesses by 8pm tonight, and closing schools by the end of the day Wednesday.
The State will aim to add surge capacity of 9,000 new hospital beds downstate by retrofitting existing facilities, including 5,000 in New York City, 2,000 beds in Westchester, and 1,000 beds each in Nassau and Suffolk Counties. Pursuant to the Governor’s Executive Order, DOH will be suspending regulations to allow for these and other increases of hospital capacity as needed. The Governor now expects the state to reach testing capacity of 7,000 per day by the end of the week.
Governor Cuomo also reiterated the calls he made yesterday in an open letter to President Trump (available here) for the federal government to take certain measures to combat COVID-19. These letter’s requests include:
- The mobilization of the Army Corps of Engineers in high-need areas to retrofit facilities to serve as temporary medical centers;
- Further Food and Drug Administration (FDA) approvals of COVID-19 testing laboratories and methods; and
- The development of uniform standards for shutdowns of public gatherings, facilities, and events.
The Governor stated that the budget might be delayed because of provisions in the federal Families First Coronavirus Response Act, which passed the House of Representatives on Saturday. The Act would offer an extra 6.2 percent federal matching funds during the COVID-19 public health emergency, subject to a prohibition on (a) any new restrictions on “eligibility standards, methodologies, or procedures” in the Medicaid program and (b) States may not require a greater percentage of Medicaid expenditures to be paid by local governments. The Governor’s second Medicaid Redesign Team (MRT II) has been considering both types of actions.
Mayor de Blasio’s Press Conference
Yesterday (March 15th), Mayor Bill de Blasio delivered an update on New York City’s efforts to address COVID-19. Mayor de Blasio announced that he will sign an executive order today requiring all hospitals in New York City to cancel future elective surgeries, with some flexibility for surgeries scheduled in the short-term.
The Mayor also announced a closure of New York City’s public school systems until Monday, April 20th at the earliest. Additionally, the City will be closing all senior centers and associated programming with the exception of those related to food, and will be using the space for food delivery preparation and as locations for meal pickups.
The video can be viewed here.
Department of Financial Services Circular Letter
Yesterday (March 15th), the Department of Financial Services issued a new circular letter on telehealth services during the COVID-19 emergency (available here). The letter clarifies that, for the duration of the emergency, the definition of “telehealth” includes electronic information and communication technologies such as telephonic or video modalities (including technology commonly available on smart phones and other devices) when medically appropriate, and when other requirements are met. However, such services still must be secure and compliant with privacy laws.
The letter emphasizes that this is applicable to both commercial and Medicaid insurers. Commercial insurers must reimburse for services that would otherwise be covered if they were provided in-person. Moreover, DFS will promulgate an emergency regulation to require that no cost sharing can apply to such services for commercial insurers. For Medicaid, DOH and other State agencies will be releasing further guidance on telehealth shortly.
Department of Health Updates and Guidance Documents
Medicaid Update on E&M Services by Telephone
Yesterday (March 15th), DOH released a special Medicaid Update (available here) with guidance on telephonic communication during the COVID-19 outbreak. During the COVID-19 emergency, NYS Medicaid will reimburse evaluation and management (E&M) services delivered by telephone (in addition to telehealth) in cases where face-to-face visits may not be recommended and it is medically appropriate for the member to be evaluated and managed by telephone. Telephonic E&M services must be provided by a physician, nurse practitioner, physician assistant, or licensed midwife actively enrolled in fee-for-service Medicaid or Medicaid Managed Care Plans. If the telephone call follows a clinic/office visit that took place within the past seven days for the same diagnosis, then the telephone services are considered part of the previous clinic/office visit and should not be billed separately. The relevant CPT codes for billing are available in the update.
The update also indicates that, effective immediately, all services delivered through telehealth are exempt from Medicaid copayments, regardless of whether they are related to COVID-19.
Health Home Care Management and Children’s Home and Community Based Services (HCBS)
On March 14th, DOH released guidance documents for providers regarding Health Home Care Management (available here) and children’s HCBS (available here). For both Health Home Care Management (adults and children) and children’s HCBS, face-to-face requirements will be temporarily waived unless medically necessary. In lieu of face-to-face contact, providers and care managers may utilize telephonic or telehealth capabilities following the recently released guidelines in the Medicaid update above and OMH supplemental guidance below.
Health Advisory for Nursing Homes and Adult Care Facilities
On March 13th, DOH released a health advisory (available here) for nursing homes and adult care facilities which, in accordance with the Governor’s Executive Order 202, immediately requires facilities to:
- Suspend all visitation unless it is a hospice provider, a family member of a resident in an imminent end-of-life situation, or an individual who is otherwise medically necessary;
- Implement health checks for all health care providers and other staff at the beginning of each shift; and
- Ensure that all staff wear a facemask while within six feet of residents.
The health advisory also provides guidance for nursing home and adult care facilities on the required procedures if there is a confirmed case of COVID-19.
DOH Epidemiological Webinar
On March 13th, the New York State Department of Health (DOH) hosted a webinar (available here) providing an epidemiological update on COVID-19 for health care providers. The webinar also provides guidance for providers on when and how to test for COVID-19, protocols for infection prevention and control, and requirements for isolation and quarantine. Future calls will be held on Thursday, March 19th and Thursday, March 26th. Recordings will be posted here.
Additional Guidance Documents
DOH has also released the following guidance documents related to COVID-19:
- Medicaid Pharmacy Guidance (available here)
- Home Health Care Agencies and Hospice Providers (available here)
- Nursing Homes (available here)
- Home Care Services (available here)
- Facilities Providing Housing to Individuals who are Homeless and Supportive Housing Facilities (available here)
Office of Mental Health Supplemental Telehealth Guidance
On March 13th, the New York State Office of Mental Health (OMH) released additional supplemental guidance (available here) on Telemental Health Services. During the COVID-19 emergency, telemental health will be expanded to include both telephonic and video communications, including technology commonly available on smart phones and other devices. Also, paraprofessionals and unlicensed behavioral health staff may deliver qualified services via telemental health, such as the new Children and Family Treatment and Support Services (CFTSS) or adult Home and Community Based Services (HCBS) through a Health and Recovery Plan (HARP). There is no change in Medicaid reimbursement rates or methodology.
Providers must complete the updated self-attestation form (available here) indicating that they will meet operating standards, use a secure telehealth system, maintain confidentiality, and use appropriate telehealth modifiers in billing.
Office for People with Developmental Disabilities Updates
On March 14th, the Office for People with Developmental Disabilities (OPWDD) released interim guidance on the delivery of services via telehealth (available here). According to the guidance, all residential and nonresidential facilities and programs certified or operated by OPWDD are permitted and encouraged to be delivered via telehealth to individuals with intellectual and/or developmental disabilities (I/DD), whenever possible. Health and habilitation services may be delivered via telehealth unless the service requires the physical presence of a staff member for the health and safety of the individual (e.g., residential habilitation). Article 16 clinic providers should bill for the encounter using the appropriate billing rules for the services rendered and should include the telehealth modifier for the location code. Providers of HCBS waiver services should bill for the service as they normally do.
OPWDD also released interim guidance regarding on-site visits by State and voluntary staff (available here). All essential agency functions should continue during the State of Emergency. However, OPWDD will not perform unscheduled site visits during this period.