State of Emergency: Coronavirus Waivers and Flexibilities Sam Ross, Project Manager 4/15/2020 THE CHICAGO HIT REGIONAL EXTENSION CENTER Bringing Chicago together through health IT
This webinar was developed with support from the Office of National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS), and the Illinois Department of Healthcare and Family Services (HFS). The contents do not necessarily reflect the opinions of the ONC, CMS or HFS.
Policy changes within the COVID-19 environment are rapidly developing. We are unable to cover complete details of waivers and flexibilities during the public health emergency, nor address all potential scenarios for each provider and practice type. This presentation is intended to provide a high-level overview of available information at time of publication. The contents of this presentation are not legal advice. Webinar registrants, attendees, viewers and readers are encouraged to work with individual counsel and insurance companies to ensure compliance with relevant regulations, policies and procedures.
Agenda • Federal Waivers and Flexibilities • State Waivers and Flexibilities • Telehealth Expansion – Medicare • Telehealth Expansion – Medicaid • Telehealth Coding and Reimbursement • COVID-19 Coding
Federal Waivers and Fle lexibilities
Section 1135 Waivers • Health and Human Services (HHS) can temporarily modify or waive certain Medicare, Medicaid, CHIP or HIPAA requirements using section 1135 of the Social Security Act (SSA) • When there's an emergency, sections 1135 or 1812(f) of the SSA allow blanket waivers and flexibilities to help beneficiaries access care • Blanket waivers are in effect with a retroactive date of March 1, 2020 through the end of the emergency declaration • Blanket waivers do not require CMS providers to apply for individual waivers or seek additional approvals https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current- emergencies/coronavirus-waivers
Fle lexibilities Overview • Equip the American healthcare system with maximum flexibility to respond to COVID-19 • Relax regulatory requirements to help system create and staff non-traditional care sites Make use of Telehealth/care Rapidly expand Test patients community by phone workforce where they are resources COVID-only Expand hospital Patients over care centers capacity paperwork https://www.cms.gov/files/document/covid-flexibilities-overview-graphic.pdf
Examples – Physicians and Other Clinicians • Allowing physician supervision to be provided virtually using real-time audio/video • Establishing hotlines to enroll and receive temporary Medicare billing privileges: • Waiving certain screening requirements • Postponing revalidation actions • Same-day screening and approval for physicians and non-physician practitioners • Waiving requirement that a physician or non-physician practitioner must be licensed in the state in which s/he is practicing (when meeting certain conditions and subject to state requirements) • Waiving “Stark Law” requirements in order to permit renting equipment or services, making loans, providing benefits to staff, or furnishing medically necessary services in the home https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf
Examples – Hospitals • Conducting screenings or providing services in non-hospital buildings/other facilities or setting up temporary expansion sites in places such as hotels or community facilities • Waiving requirements for Critical Access Hospitals to limit beds and length of stay • Allowing flexibilities for verbal orders, discharge planning, and utilization review • Waiving requirements for emergency preparedness policies and procedures • Waiving requirements for sterile compounding and respiratory services • Allowing physicians whose privileges will expire to continue practicing or new physicians to practice before full staff review https://www.cms.gov/files/document/covid-hospitals.pdf
Payment • Suspending most Fee-For-Service pre- and post-payment medical review • Expanding the current Accelerated and Advance Payment Program • Authorizes payments during period of emergency to providers that submit a request and meet requirements • Medicare Administrative Contractors will work to review requests and and issue payments within seven calendar days • Extending repayment to begin from 90 days to 120 days after issuance • Appeals in Fee for Service, Medicare Advantage (MA) and Part D • Allowing extensions to file an appeal • Allowing waiver of requirements for timeliness for requests for additional information to adjudicate appeals • Allowing process of appeal with incomplete information https://www.cms.gov/files/document/covid-hospitals.pdf https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf
HIP IPAA, Civil Rights, and COVID ID-19 19 • During the COVID-19 public health emergency, the HHS Office for Civil Rights (OCR) has provided guidance on enforcement discretion under the HIPAA Privacy Rule • OCR has identified key areas for enforcement discretion: • Not imposing penalties for noncompliance with good faith participation in the operation of Community-Based Testing Sites • Not imposing penalties for good faith rendering of telehealth services • Permitting covered entities to disclose protected health information of an individual who has been infected with, or exposed to, COVID-19 with law enforcement, paramedics/first responders, and public health authorities without the individual’s authorization https://www.hhs.gov/hipaa/for-professionals/special-topics/hipaa-covid19/index.html
Dis iscretion for Tele lehealth Communications • Some telehealth technologies, and the manner in which they are used, may not fully comply with the requirements of the HIPAA Rules • OCR will not impose penalties for noncompliance with HIPAA in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency • Providers are encouraged to notify patients of privacy risks, and should enable all available encryption and privacy modes when using such applications • May use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype • Facebook Live, Twitch, TikTok, and similar public facing communications should not be used https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement- discretion-telehealth/index.html
State Waivers and Fle lexibilities
Section 1135 Waivers • In additional to blanket federal waivers, Illinois has requested additional waivers to provide flexibility to state Medicare, Medicaid and CHIP programs during the COVID-19 pandemic • Partial approvals were received on March 23 rd , providing for: • Temporary suspension of (and extension of existing) prior authorization requirements • Provisionally, temporarily enroll providers who are enrolled with another state Medicaid agency or Medicare for the duration of the public health emergency • Waive screening requirements (application fee, background check, site visits, in-state licensure requirements) for providers not already enrolled with another state Medicaid agency or Medicare • Reimburse otherwise payable claims from out-of-state providers approved by another state Medicaid or Medicare with a valid out-of-state license • Additional requests were submitted and more may be made as needs are identified https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200320c.aspx https://www.illinois.gov/hfs/SiteCollectionDocuments/1135WaiverRequestFactSheetFINAL.pdf https://www.illinois.gov/hfs/SiteCollectionDocuments/PartialApprovalIllinoisSection1135Waiver.pdf
Additional Fle lexibilities • Pharmacy billing policies: • Allow a 90 day supply of insulin (reviewing other medications) • Adjusting preferred drug list • Temporary coverage of OTC coverage for acetaminophen and cough suppressants • Transportation providers • Physician Certification Statement (PCS) form not required for prior approvals • Transportation to/from alternative destinations (tent triage, convention center converted to medical center) is appropriate • FQHC/RHC advance payments to address revenue shortfall during transition to a per- member, per-month (PMPM) methodology • For a full list of updates, visit https://www.illinois.gov/hfs/Pages/coronavirus.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330a.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200408b.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200408d.aspx
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