The Drug Enforcement Administration (DEA) issued new guidance to allow DEA-registered telehealth practitioners to issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, for the duration of the public health emergency.  All of the following conditions must be met: (1) The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice (2) The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system and (3) The practitioner is acting in accordance with applicable Federal and State law.

FierceHealthCare, Robert King, March 15, 2020 8:15pm

Accountable care organizations (ACOs) are seeking flexibility from the Trump administration on mitigating any financial losses that could arise from treating the burgeoning coronavirus outbreak.

The concerns come as the coronavirus has spread to more than 1,200 people across the country and has healthcare facilities worried about being overwhelmed. ACOs are in a particularly difficult situation as they are on the hook for paying back Medicare if healthcare costs skyrocket.

ACOs participating in either the Medicare Shared Savings Program (MSSP) or the Next-Gen ACO program agree to take on some form of financial risk. If they meet spending targets, they get a share of the savings, but if that spending accelerates they must pay back the Centers for Medicare & Medicaid Services (CMS) for a share of the losses.

Read more.

On March 18, 2020, the Health Resources and Services Administration (HRSA) launched an information collection effort to support the Trump Administration’s response to the COVID-19 pandemic, surveying HRSA-funded health centers on their involvement in the COVID-19 response, including whether they are offering diagnostic tests. This effort was made possible by a Paperwork Reduction Act waiver issued pursuant to statutory authorities that became available as a result of the public health emergency declared by HHS Secretary Alex Azar in late January.

Read the news release.

March 17, 2020

Harrisburg, PA – The Department of Human Services’ (DHS) Office of Mental Health and Substance Abuse Services (OMHSAS) today released operational recommendations and telehealth guidelines for providers of behavioral health services.

“The Wolf administration is committed to serving vulnerable populations every day, and that commitment will not waiver in the face of an emergency,” said DHS Secretary Teresa Miller. “We are working with county mental health programs and behavioral health service providers to be sure that behavioral health services for Pennsylvanians continue uninterrupted.”

OMHSAS has developed the following operational recommendations, which will be updated and re-released on a recurring basis as new information becomes available. Recommendations include:

• Exercise and promote hygienic practices;
• Review agency emergency preparedness plan and infection control procedures;
• Report all suspected cases of COVID-19 to OMHSAS;
• Contact OMHSAS before making any changes to your business practice whenever possible. Examples of changes in business practices include, but are not limited to;
  • Suspending services at a service location or temporarily closing programs.
  • Closing county offices.
• Document what actions were taken and maintain evidence for why actions were taken.
• Stay Informed via the Pennsylvania Department of Health and the Centers for Disease Control and Prevention.

OMHSAS has also temporarily suspended certain requirements for providing behavioral health services via telehealth. Changes to existing telehealth regulations include:

• Staff may deliver telehealth services via telephonic and video communication applications such as FaceTime or Skype available on smart phones, and through telephonic only devices when video technology is not available;
• Telehealth services may be provided in the home and without provider staff being physically present with the individual receiving services;
• Practitioner types who can provide telehealth services is expanded beyond what is typically permitted;
• Both Behavioral HealthChoices and fee-for-service providers may bill for telehealth;
• Typical face-to-face contact percentages may be met with use of telehealth;
• Programmatic limits for the amount of service that may be provided through telehealth are temporarily suspended.

For more information on existing telehealth behavioral health guidance in Pennsylvania, refer to this bulletin.

DHS has already released operational recommendations for providers of child welfare services, intellectual disability and autism services, and long-term services and supports in Pennsylvania in response to COVID-19. DHS program offices are continuing to formulate recommendations for other provider communities and will publish guidance as it becomes available.

Visit the PA Department of Health’s dedicated Coronavirus webpage for the most up-to-date information regarding COVID-19.

If you are experiencing anxiety or stress related to COVID-19, advice on how to manage this is available from the Centers for Disease Control and Prevention here.

Guidance to DHS providers related to COVID-19 is available here.

CONTACT: Erin James, 717-425-7606

March 17, 2020

From Dylan Ferguson, Director, Bureau of Emergency Medical Services, PA Department of Health and Dr. Douglas Kupas, Commonwealth EMS Medical Director, Bureau of Emergency Medical Services, PA Department of Health

In response to the COVID-19 pandemic, the Bureau of EMS (Bureau) is issuing an update to BLS Protocol # 931 Suspected Influenza-Like Illness (ILI). Primary additions to the protocol include additional emphasis on deferring aerosol generating procedures unless absolutely necessary. Furthermore, the protocol authorizes EMS providers to carry albuterol meter dosed inhalers (MDI) and spacers to be used in place of nebulizers when required. Please note that these MDI’s should only be utilized one per patient and not reused for subsequent patients. EMS providers of all levels are encouraged to review this updated protocol in its entirety. This updated protocol is effective immediately.

The Bureau is also issuing the following guidance as it relates to the potential need for EMS to transport to alternate destinations.

Section 8128 of the EMS Act sets forth requirements for a facility to be considered a receiving facility for EMS emergency patients. Those requirements include but are not limited to:

(b) Requirements. –A receiving facility shall include, but need not be limited to, a fixed location having an organized emergency department, including a physician trained to manage cardiac, trauma, pediatric, medical, behavioral and all-hazards emergencies, who is present in the facility and available to the emergency department 24 hours per day and seven days per week.

By regulation, the department may authorize other types of facilities to serve as receiving facilities for purposes of serving patients who have special medical needs.

(c) Patient transports. –Unless directed otherwise by a medical command physician, the initial transport of a patient following an ambulance response to a reported emergency shall be to a receiving facility pursuant to a protocol under section 8105(c).

As a result, EMS providers may transport a patient to an alternate destination, other than a receiving facility as defined above, when ordered by a medical command physician. It is the Bureaus desire to give EMS agencies, medical facilities, and patients the flexibility needed to be able to respond to the current public health emergency.

Despite this ability, it must be reiterated that at this time patients must consent to the alternative destination. If the patient does not consent to the alternate destination, they must be transported to an appropriate receiving facility following the guidance outlined in BLS protocol 170 Patient Destination – Ground Transport.

It should be noted that the Bureau cannot guarantee that EMS agencies will be reimbursed by insurers for transports to alternate destinations as each insurer has different policies, coverages and criteria.

Furthermore, if based on a patient’s presentation of an influenza like illness and the approval of a medical command physician the EMS provider and/or medical command physician may recommend to the patient the option to not be transported and instead provide instructions for care or isolation at home. However, as above if the patient still desires transport then at this time, they must be transported to an appropriate receiving facility following the guidance outlined in BLS protocol 170 Patient Destination – Ground Transport.

The Department of Health’s Bureau of EMS website will always contain the most current version of the EMS protocols, the scope of practice for each level of provider, important EMS Information Bulletins, and many other helpful resources. This information can be accessed online at www.health.pa.gov.

Pennsylvania EMS Protocols can be found here.

Any questions regarding to this information should be directed to your Regional EMS Council.

On Wednesday, March 18, the President signed the “Families First Coronavirus Response Act” shortly after the Senate approved the legislation with a 90-8 vote. Last week, the House of Representatives approved a version of the bill which incorporated bipartisan technical changes, including paid sick leave and changes to the temporary increase of federal medical assistance percentages for Medicaid.  The bill text can be found here. A high-level analysis of key public health provisions in the legislation is provided below.

Public Health Provisions

• Requires private health plans to provide coverage for COVID-19 diagnostic testing at no cost to the consumer.
• Mandates that personal respiratory protective devices be treated as covered countermeasures under the PREP Act declaration.
• Provides a temporary increase to the federal medical assistance percentage (FMAP) of 6.2% to each state, including the District of Columbia, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, Puerto Rico, and the United States Virgin Islands. The increase will remain in effect until the close of the fiscal quarter during which the public health emergency ends.

Domestic Nutrition Assistance Programs

• Provides an additional $500 million for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
• Grants an additional $400 million to the Emergency Food Assistance Program (TEFAP).
• Permits the Department of Agriculture to approve new state SNAP plans in response to the COVID-19 outbreak.
• Provides $100 million in nutrition assistance grants for the U.S. territories of Puerto Rico, America Samoa, and the Commonwealth of the Northern Mariana Islands.
• Releases $250 million for the senior nutrition program in the Administration for Community Living. Funding will provide meals to low-income seniors who:
  • Are home-bound
  • Have disabilities
  • Have multiple chronic illnesses
• Permits the Secretary of Agriculture to issue new nationwide school meal waivers.

Paid Sick Leave

• Grants $5 million to the Department of Labor to administer emergency paid sick leave.
• Requires employers with fewer than 500 employees and government employers to provide employees with two weeks of paid sick leave.
• Amends the Family and Medical Leave Act to grant the aforementioned groups the right to take up to 12 weeks of job-protected leave.

Other Provisions

• Requires OSHA to issue an emergency temporary standard within 30 days requiring healthcare employers to develop and implement a comprehensive infectious disease exposure control plan to protect healthcare workers from COVID-19.
• Releases an additional $1 billion in FY2020 emergency grants to states to process and pay unemployment insurance benefits.

Mandates that state emergency operations centers receive real-time reporting on aggregated COVID-19 testing data as well as results from state and local public health departments. This data is also required to be shared with the CDC.

The Center for Connected Health Care Policy has developed a chart that compares current Medicare Telehealth policy with what was proposed in the Connect for Health Act.  The chart can be accessed here.

On March 18, 2020, the Centers for Medicare & Medicaid Services (CMS) is posting an update to its Frequently Asked Questions (FAQs) on the Medicaid.gov website to aid state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their response to the 2019 Novel Coronavirus (COVID-19) outbreak. CMS is taking this action to continue its efforts to protect the health and safety of providers and patients, including those who are covered by Medicaid and CHIP.

You can find the updated FAQs here:  https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf

These FAQs, and earlier CMS actions in response to the COVID-19 virus, are 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 Current Emergencies Website.

On March 18, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.   You can find a copy of the press release here: https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

You can find a copy of the guidance here: https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

The Centers for Medicare & Medicaid Services (CMS) is taking action to protect the health and safety of our nation’s patients and providers in the wake of the 2019 Coronavirus (COVID-19) outbreak.  In an effort to be transparent and share this information broadly, CMS will be posting several of our stakeholder calls.  CMS held a National Stakeholder Call on March 13, 2020, to update the healthcare community on the rapidly evolving COVID-19 situation which was declared a national emergency by President Trump on March 13.   This bold move empowered CMS to waive certain federal requirements in Medicare, Medicaid, and CHIP to rapidly expand the Administration’s aggressive efforts against COVID-19 led by the White House Coronavirus Taskforce.

The transcript and audio recording from that call are now available to download. CMS will hold future calls and post those transcripts and audio recordings as they become available. To access Coronavirus COVID-19 Stakeholder calls visit:  https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts   This call and earlier CMS actions in response to the COVID-19 virus, are 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 Coronavirus.gov.  For information specific to CMS, please visit the Current Emergencies Website

For more information on COVID-19 visit:

Coronavirus.gov

USA.gov