Issue: May 1, 2020

Published on May 1, 2020

Articles in this issue:

DOH: Updated Medicaid Guidance Regarding Telehealth, Including Telephonic, Services During the COVID-19 Emergency/Webinar May 5

Author: Jackie Pappalardi and Nancy Leveille* Published in Clinical & Quality

The Department of Health has released updated guidance for Medicaid providers regarding the use of Telehealth, including Telephonic, services during the COVID-19 State of Emergency. The accompanying Frequently Asked Questions document has also been updated. These documents are available on the Department of Health website at https://www.health.ny.gov/health_care/medicaid/covid19/index.htm, or via the links below.

Medicaid Update: https://www.health.ny.gov/health_care/medicaid/program/update/2020/no05_2020-03_covid-19_telehealth.htm

Frequently Asked Questions: https://www.health.ny.gov/health_care/medicaid/covid19/faqs.htm

A summary of the changes is provided below.

The intent of this guidance is to provide broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely during the COVID-19 State of Emergency, to the extent it is appropriate for the care of the member.

Telehealth services will be reimbursed at parity with existing off-site visit payments (clinics) or face-to-face visits (i.e., 100% of Medicaid payment rates). This guidance relaxes rules on the types of clinicians, facilities, and services eligible for billing under telehealth rules.

Webinar Regarding Medicaid Telehealth Guidance During the COVID-19 Emergency

On Tuesday, May 5, 2020 from 10:30 AM to 12:00 PM, the Department of Health Office of Health Insurance Programs will host a webinar to review Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency

To register for the Webinar please visit https://meetny.webex.com/meetny/onstage/g.php?MTID=e5f212ed128ffe5f173d478348226385e.

This webinar will provide an overview of the guidance and cover frequently asked questions. Additional questions will be addressed by webinar participants, as time permits. A recording of the webinar will be also made available on the Department’s website.

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Nancy Leveille, RN, MS
Director, Special Projects and Educational Development
518-462-4800 x20

AHCA: Update #56 | CMS Issues Interim Final Rule with New Reporting Requirements for COVID-19

Author: Jackie Pappalardi and Nancy Leveille* Published in Clinical & Quality

CMS Issues Interim Final Rule with New Requirements for COVID-19 Reporting for Nursing Homes

Last night, CMS issued an interim final rule with comment period which revises § 483.80 establishing explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this interim final rule which is the date of the publication at the Office of the Federal Register. AHCA will notify members when it is published. 

Under this new requirement nursing facilities must: 

Electronically Report to CDC’s National Healthcare Safety Network (NHSN)

In addition, providers must continue to comply with state and local reporting requirements for COVID-19. AHCA will continue to advocate to align State and CDC reporting to avoid duplication of effort that is taking staff away from resident care. 

Inform Residents, their Representatives, and Families 

AHCA will continue to advocate for CMS to issue clarifying language that makes this feasible and as least burdensome as possible.

Please email COVID19@ahca.org for additional questions, or visit ahcancal.org/coronavirus for more information.

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Nancy Leveille, RN, MS
Director, Special Projects and Educational Development
518-462-4800 x20

DOH Advisory: COVID-19 Serology Testing

Author: Lisa Volk and Jackie Pappalardi* Published in Clinical & Quality

Serological tests for determining the presence of antibodies against SARS-CoV-2 are now available from commercial manufacturers. Serology tests are used to determine if antibodies against SARS-CoV-2 are present. Certain serology tests can look for the general presence of SARS-CoV-2 antibodies, while others can determine if specific types of SARS-CoV-2 antibodies, such as IgM and/or IgG, are present. See full advisory.

NYSHFA/NYSCAL CONTACTS:

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

CMS: Medicare Promoting Interoperability Program Eligible Hospital and Critical Access Hospital Hardship Exception Application for the 2019

Author: Jackie Pappalardi and Nancy Leveille* Published in Clinical & Quality

The Centers for Medicare & Medicaid Services (CMS) requires that all eligible hospitals and critical access hospitals (CAHs) use 2015 Edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Programs. As required by law, downward payment adjustments must be applied to eligible hospitals and CAHs that are not meaningful users of CEHRT.

Eligible hospitals and CAHs may be exempt from Medicare penalties if they can show that compliance with the requirement for being a meaningful EHR user would result in a significant hardship. To be considered for an exemption, eligible hospitals and CAHs must complete a hardship exception application and provide proof of hardship. If approved, the hardship exception is valid for only one payment adjustment year. Eligible Hospitals and CAHs would need to submit a new application for subsequent years and in no case may an eligible hospital or CAH be granted an exception for more than five years. 

The application for eligible hospitals and CAHs is available online via the QualityNet Secure Portal as a web-based application and can be found here. Previously registered users should already have account access, and new users can create an account by visiting QualityNet and selecting “Register”.

Medicare Promoting Interoperability Program Hardship Exception Application Details

For More Information

For more information about payment adjustments and hardship information, click here. For more information on the Promoting Interoperability Programs, visit the Promoting Interoperability Programs website.

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Nancy Leveille, RN, MS
Director, Special Projects and Educational Development
518-462-4800 x20

COVID-19 CMS News Alert - May 1

Author: Jackie Pappalardi and Nancy Leveille* Published in Clinical & Quality

Here is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions taken in response to coronavirus disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, click here www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website. CMS updates these resources on an ongoing basis throughout the day; the information below is current as of  May 1, 2020 at 12:00 p.m. ET

Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic

Building on its recent historic efforts to help the U.S. healthcare system manage the COVID-19 pandemic, CMS issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services. The temporary changes will apply immediately for the duration of the Public Health Emergency declaration.

Press Release

Additional Information

CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes 

CMS announced a new independent Commission that will conduct a comprehensive assessment of the nursing home response to the COVID-19 pandemic. The Commission will help inform efforts to safeguard the health and quality of life of vulnerable Americans as CMS continues to battle COVID-19 as well as prepare for future threats to resident safety and public health. This unprecedented effort builds on the agency’s five-part plan unveiled last April to ensure safety and quality in America’s nursing homes, as well as recent CMS efforts to combat the spread of COVID-19 within these facilities.

Press Release

Fact Sheet

New Frequently Asked Questions on EMTALA

CMS issued Frequently Asked Questions (FAQs) clarifying requirements and considerations for hospitals and other providers related to the Emergency Medical Treatment and Labor Act (EMTALA) during the COVID-19 pandemic. The FAQs address questions around patient presentation to the emergency department, EMTALA applicability across facility types, qualified medical professionals, medical screening exams, patient transfer and stabilization, telehealth, and other topics.

Frequently Asked Questions

Guidance Available on Telehealth and HHS-Operated Risk Adjustment for Individual and Small Group Health Insurance Health Plans

In response to the increased need for providing telehealth due to COVID-19, CMS has given additional consideration to telehealth services in HHS-operated risk adjustment for issuers in the individual and small group health insurance markets inside and outside the Marketplaces. CMS’ new guidance clarifies which telehealth services are valid for HHS-operated risk adjustment data submission in light of the COVID-19 pandemic.

Frequently Asked Questions 

Dear Clinician: CMS Adds New COVID-19 Clinical Trials Improvement Activity to the Quality Payment Program

CMS issued a letter thanking clinicians for their ongoing efforts to treat patients and combat COVID-19 and shared additional details on the new Merit-Based Incentive Payment System (MIPS) improvement activity. As announced earlier this month, clinicians who participate in a COVID-19 clinical trial and report their findings to a clinical data repository or registry many now earn credit in MIPS under the Improvement Activities performance category for the 2020 performance period by attesting to this new activity.

Dear Clinician Letter

CMS Gives States Additional Flexibility to Address Coronavirus Pandemic

CMS has approved 140 requests for state relief in response to the COVID-19 pandemic, including recent approvals for Arkansas, Hawaii, Kentucky, Massachusetts, Minnesota, Montana, Oklahoma, Oregon, South Dakota, Tennessee, Virginia, and Wyoming. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of waivers, amendments, and Medicaid state plan flexibilities, including for programs that care for the elderly and people with disabilities. CMS developed a toolkit to expedite the application and review of each request and has approved these requests in record time. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

Section 1135 Waivers

Section 1115(a) Waivers 

1915(c) Waiver Appendix K Amendments

Medicaid State Plan Amendments

CHIP State Plan Amendments

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Nancy Leveille, RN, MS
Director, Special Projects and Educational Development
518-462-4800 x20

DOH: Laboratory Reporting Requirements for SARS-CoV-2 and Ensuring Complete Reporting of Patient Demographics

Author: Lisa Volk and Jackie Pappalardi* Published in Clinical & Quality

As the landscape of available tests for the COVID-19 infection continues to evolve, it is essential that the reporting of results for SARS-CoV-2 testing is complete, accurate, and timely. Efforts to successfully reopen businesses, schools, and other entities affected by current social distancing requirements will rely upon State and local public health officials having greatly expanded access to testing and accurate testing data. These efforts will also rely upon promptly interviewing positive cases, performing contact investigations, and issuing isolation and quarantine orders. See attached for full details.

For questions, please send an e-mail to bcdc@health.ny.gov.

NYSHFA/NYSCAL CONTACTS:

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

CMS: COVID-19 Lessons from the Front Lines

Author: Lisa Volk and Jackie Pappalardi* Published in Clinical & Quality

Below are some important links provided by CMS regarding COVID-19:

News

Claims, Pricers & Codes

Events

MLN Matters® Articles

Publications

Multimedia


NYSHFA/NYSCAL CONTACTS:

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16