This corrects a prior message that appeared in our March 31, 2020 Special Edition.

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:

• Place of Service (POS) equal to what it would have been had the service been furnished in-person
• Modifier 95, indicating that the service rendered was actually performed via telehealth

As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:

• Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier
• Furnished for diagnosis and treatment of an acute stroke, use G0 modifier

There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.

Here is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions taken in response to the COVID-19 virus, 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 April 3, 2020 at 10:00 AM.

Trump Administration Issues Key Recommendations to Nursing Homes, State and Local Governments

Recently, CMS, in consultation with the Centers for Disease Control and Prevention (CDC), issued critical recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes. The recommendations build on and strengthen recent guidance from CMS and CDC related to effective implementation of longstanding infection control procedures.

Press Release

Guidance

CMS Approves Additional State Medicaid Waivers and Amendments to Give States Flexibility to Address Coronavirus Pandemic

CMS approved its 44th state Medicaid waiver delivering urgent regulatory relief to ensure States can quickly and effectively care for their most vulnerable citizens. In light of the urgent and evolving needs of states during the COVID-19 crisis, CMS developed a toolkit to facilitate expedited application and approval of State waivers requests in record time. The waivers support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported. Recently approved states include Alaska, Arkansas, and Nebraska.

CMS also approved one more state waiver amendment requests for California to give emergency flexibilities in their programs that care for the elderly and people with disabilities, bringing the total to 17 approvals across 15 states.

Section 1135 Waivers

1915(c) Appendix K Waivers

Medicare and Telehealth Services Blog

The Social Security Administration (SSA) featured a guest blog by CMS Administrator, Seema Verma with important information on Medicare coverage and recently expanded coverage of telehealth services. CMS actions protect beneficiaries while maintaining trusted access to care in the face of the coronavirus pandemic.

Social Security Matters Blog

Medicaid Telehealth Flexibilities for Rural Health Care Substance Use Disorder

CMS released an Informational Bulletin to states that explains how states can use telehealth delivery methods to expand access to Medicaid services, including substance use disorder (SUD) treatment and services. The guidance outlines how telehealth may be used to service rural communities, high-risk individuals, school-based health centers and SUD programs. It provides information about Medicaid coverage and reimbursement of SUD treatment services and supports CMS actions in response to the COVID-19 virus as well as the opioid epidemic.

Informational Bulletin

Updates Available to Medicaid and CHIP Frequently Asked Questions

CMS issued additional Frequently Asked Questions for State Medicaid and Children’s Health Insurance Program (CHIP) agencies to aid states in their response to the COVID-19 outbreak.  Topics include: emergency preparedness and response; flexibilities around eligibility and enrollment; benefits, premiums and cost sharing; financing; managed care; fair hearings; health information exchanges; and COVID-19 T-MSIS coding guidance.

 Frequently Asked Questions

April 1–Today, nonprofits DirectEmployers Association and the National Association of State Workforce Agencies (NASWA), announce the launch of NeedAJobNow.USNLx.com, a job site dedicated to providing a centralized location for displaced workers to access employment opportunities from U.S. corporations with immediate hiring needs due to the novel coronavirus (COVID-19). Powered by the National Labor Exchange (NLx), the site houses jobs from vetted employers in all industries and provides an opportunity for Americans to return to work and gain meaningful employment.

“The National Labor Exchange’s mission is to provide a cost-effective national employment system that improves labor market efficiency. We are working together to align and leverage the assets and power of major U.S. corporations and all workforce partners to minimize the economic impact on displaced workers due to COVID-19,” says Candee Chambers, DirectEmployers Association’s Executive Director.

NeedAJobNow.USNLx.com contains over 400,000 job openings and continues to grow daily. While many employers are downsizing their staff, others are significantly increasing their hiring efforts due to current demands. Through this initiative, DirectEmployers and NASWA will assist in bridging the gap between job supply and demand by offering an easy way for job seekers to gain access to current open positions and for employers to fill positions quickly and efficiently during these difficult times.

“This new tool will help states quickly connect workers to employers with urgent job openings,” said Scott B. Sanders, NASWA Executive Director. “The Need A Job Now site will provide new opportunities for our workforce during these unprecedented times and we are proud to be a partner in this NLx initiative.”

As part of the NLx, this resource is offered at no cost to job seekers or employers. All jobs found on NeedAJobNow.USNLx.com will be refreshed daily with current job content from employers across the country. Employers wishing to have their jobs included within the site can visit https://needajobnow.usnlx.com/post for more information.

On April 3, at the direction of President Trump, the Centers for Medicare & Medicaid Services (CMS), in consultation with the Centers for Disease Control and Prevention (CDC), issued critical recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes. The recommendations build on and strengthen recent guidance from CMS and CDC related to effective implementation of longstanding infection control procedures.

Press Release

Guidance

The U.S. Department of Treasury (Treasury) and Small Business Administration (SBA) released an interim final rule on the Paycheck Protection Program (PPP). While SBA still needs to confirm some administrative details, loans will be provided on a first-come, first-served basis and producers can get started on the application now.

• For a top-line overview of the PPP program CLICK HERE
• Information for prospective borrowers can be found HERE
• The application for borrowers can be found HERE

Below please find additional details about the PPP program. We will answer outstanding issues once SBA provides further guidance.

1. Program Eligibility
   1. All businesses (including farm and ranch businesses) are eligible for a PPP loan if they (1) have fewer than 500 employees; (2) meet the definition of a “small business concern”; and (3) are subject to SBA’s affiliation rules (unless those rules were specifically waived in the CARES Act).
2. Waiting on SBA to clarify the definition of “small business concern” – do not anticipate any undue restrictions.
3. Waiting on SBA to confirm whether H2A workers are counted as “employees” for the purposes of determining size.

1. 1. Financial institutions, including the Farm Credit system, will be responsible for processing loan applications and administering the loan.
2. Loan Terms
   1. Loan amounts are calculated based on the payroll costs for all employees whose “principal place of residence” is in the U.S. Please note that this definition excludes H-2A workers, which will likely reduce the loan amount available to some agricultural producers.
   2. This loan has a maturity of 2 years and an interest rate of 1%. Loan payments will be deferred for the first six months.
   3. The loan will be fully forgiven if at least 75% of the funds are used for payroll costs, and the remainder is used for interest on mortgages, rent, and utilities.

1. Forgiveness is based on the employer maintaining or quickly rehiring employees and maintaining salary levels.  Forgiveness will be reduced if full-time headcount declines, or if salaries and wages decrease.

1. The best POC for questions on the Paycheck Protection Program is the Lender Relations Specialist in your local SBA Field Office.  The local SBA Field Office may be found at https://www.sba.gov/tools/local-assistance/districtoffices.

With the U.S. experiencing a record number of initial unemployment claims, WalletHub today released its report on the States with the Biggest Increases in Unemployment Due to Coronavirus, along with accompanying videos.

To identify which states have experienced the largest unemployment increases, WalletHub compared the 50 states and the District of Columbia across two key metrics. These metrics compare initial unemployment claim increases for the week of March 23, 2020 to both the same week in 2019 and the first week of 2020. Below, you can see highlights from the report, along with a WalletHub Q&A.

The Centers for Disease Control and Prevention (CDC) has released interim guidance for responding to COVID-19 among people experiencing unsheltered homelessness. The guidance provides information and actions for health departments, homeless service organizations, housing authorities and others serving people without homes during the COVID-19 pandemic. You can also access resources on the National Health Care for the Homeless website.

The U.S. Department of Education announced on March 20 that the Office of Federal Student Aid is providing student loan relief to tens of millions of borrowers during the COVID-19 national emergency. All borrowers with federally held student loans will automatically have their interest rates set to 0% for a period of at least 60 days. In addition, each of these borrowers will have the option to suspend their payments for at least two months to allow them greater flexibility during the national emergency. This will allow borrowers to temporarily stop their payments without worrying about accruing interest. Sec. DeVos has directed all federal student loan servicers to grant an administrative forbearance to any borrower with a federally held loan who requests one. The forbearance will be in effect for a period of at least 60 days, beginning on March 13, 2020. To request this forbearance, borrowers should contact their loan servicer online or by phone. The Secretary has also authorized an automatic suspension of payments for any borrower more than 31 days delinquent as of March 13, 2020, or who becomes more than 31 days delinquent, essentially giving borrowers a safety net during the national emergency. See the Department of Education website for more information.

The Pennsylvania Department of State issued a directive indicating that due to COVID-19, additional healthcare practitioners will be needed to treat ill Pennsylvanians. This need may extend beyond the capacity of the professionals currently licensed by Pennsylvania’s health-licensing boards. To increase the available number of practitioners, the Department of State requested from Gov. Wolf a suspension to several provisions that create barriers to temporary licensure. Click on the links below for detail on the suspensions granted by the Governor and additional information for healthcare professionals on how to obtain temporary licenses:

• Pennsylvania to Allow Retired Health Care Professionals to Bolster COVID-19 Response
• Pennsylvania Expands Access to Pharmacy Services
• Some License Requirements for Qualified Physicians Assistants Are Suspended During Coronavirus Emergency
• Pennsylvania Suspends Certain Licensure Requirements for State Board of Psychology, and State Board of Social Work, Marriage and Family Therapy and Professional Counselors
• Some Continuing-Education Restrictions Suspended for Licensed Professionals
• Pennsylvania Waives Some Nurse Licensing Requirements to Aid Coronavirus Response
• Medical Doctors’ Two-Facility Institutional License Limit Suspended During Coronavirus Emergency
• Certain Regulations Suspended for Nurse-Midwives
• Issuance of Temporary Licenses to HealthCare Practitioners Not Licensed In Pennsylvania to be Expedited During Coronavirus Emergency
• Application for a Temporary License for Physicians Not Licensed in Pennsylvania
• Licensed HealthCare Practitioners Can Provide Telemedicine Services to Pennsylvanians During Coronavirus Emergency