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COVID-19 Federal Responses: Tuesday, April 7, 2020

COVID-19 Federal Responses: Tuesday, April 7, 2020

Congress appears ready to pass legislation that provides upwards of $250 billion in additional funding for the paycheck protection program that provides Small Business Administration (SBA) loans to eligible small businesses and nonprofit organizations. Some of the loans can convert to grants that do not need to be repaid – if certain conditions are met. The Senate could vote as soon as this week.

  • Legislators from both parties and both Chambers of Congress agree that the SBA will need more funding for this program. President Trump told Congress that he supports providing more funding to this program as soon as possible.
  • The President’s support for quick action prompted an announcement from Senate Majority Leader Mitch McConnell (R-KY) that the Senate could pass legislation providing additional funding as early as Thursday. It appears that Democrats in both Chambers will support this bill.
  • It is not known how this impacts Congress’ efforts to pass a “Phase IV” economic relief bill. Congress began talking about a fourth major bill to address the public health emergency before it completed work on the “Phase III” CARES Act. Statements from Congressional Leadership such as House Speaker Nancy Pelosi (D-CA) indicate the Phase IV bill could reach $1 trillion.
  • Extra funding for the Paycheck Protection Program was one of the top priorities for Phase IV legislation. Congress is still expected to advance a fourth bill, but it is not clear how priorities for that bill will change if Congress passes a stand-alone measure to provide more funding for the Paycheck Protection Program.
  • More funding for the healthcare system could be a major component of that bill.

The Bureau of Labor Statistics (BLS) issued a report through an FAQ format on the effect that COVID-19 is having on job losses in specific sectors, including healthcare. The report is dated April 3 and describes the employment changes, both overall and by specific sector, for the month of March.

  • In March, the unemployment rate increased by 0.9 percentage point to 4.4 percent. This is the largest over-the-month increase in the rate since January 1975, when the increase was also 0.9 percentage point. The number of unemployed persons rose by 1.4 million to 7.1 million in March. The sharp increases in these measures reflect the effects of COVID-19 and efforts to contain it.
  • Employment in health care and social assistance fell by 61,000 in March. Health care employment declined by 43,000, with job losses in offices of dentists (-17,000), offices of physicians (-12,000), and offices of other health care practitioners (-7,000). Over the prior 12 months, health care employment had grown by 374,000. In March, social assistance saw an employment decline of 19,000, reflecting a job loss in child day care services (-19,000). Over the prior 12 months, social assistance added 193,000 jobs.

President Trump spoke by phone for about 15 minutes with former Vice President Joe Biden, who is also the frontrunner for the Democratic nomination for President in this year’s election. Former Vice President Biden shared ideas about how the federal government can respond to the public health emergency. Both President Trump and Former Vice President Biden described the conversation as constructive and cordial.

The Centers for Medicare and Medicaid Services (CMS) released new recommendations for how healthcare providers should handle non-emergent and elective medical services. CMS previously asked hospitals to postpone elective procedures to preserve hospital bed capacity and personal protective equipment. The document describes a tiered framework for prioritizing care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition.

CMS also published a summary of the actions it has taken to help clinicians respond to the public health emergency (PHE). Highlights of interest to allergists include:

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Accelerated and Advance Payments

CMS will provide accelerated payments to providers and suppliers who submit a request to their Medicare Administrative Contractor (MAC). More details are available in this fact sheet.

Medicare Telehealth Visits

Effective for the duration of the COVID-19 Public Health Emergency, Medicare has broadened the requirements for telehealth visits to include:

  • Patients may be either a new or established patient. 
  • These visits are the same services as would be provided during an in-person visit and are paid at the same rate as in-person visits. 
  • The patient may be located in any geographic location (not just those designated as rural), in any healthcare facility, or in their home.
  • The Medicare coinsurance and deductible would generally apply to these services; however, the HHS Office of the Inspector General is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. 
    • Common telehealth CPT and HCPCS codes include: 
    • 99201-99215: Office or other outpatient visits
    • G0406-G0408: Follow up inpatient telehealth consultations furnished to beneficiaries in hospitals or skilled nursing facility (SNF)

NOTE: For the duration of the PHE for the COVID-19 pandemic, Medicare will make separate payment for audio-only visits described by CPT codes 98966-98968 and CPT codes 99441-99443 as outlined on page 125 in the Interim Final Rule with Comment.

Virtual Check-ins

A brief communication service between new or established patients and a practitioner – from wherever they are located.

  • During the PHE, it is not limited to rural settings or certain locations.
  • Services need to be initiated by the patient, but practitioners may provide education on the availability of the service prior to patient initiation.​
    • HCPCS code G2012: Brief communication via a technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to a new or established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
    • HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by a new or established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

E-Visits

These are visits made through an online patient portal; all locations and areas (not just rural). It can be used by new and/or established patients for non-face-to-face patient-initiated communications with physicians or other practitioners.

  • Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation. 
  • Common telehealth CPT and HCPCS codes include:
    • CPT codes 99421-99423
    • HCPCS codes G2061-G2063

Expanded Options for Telehealth Services During the PHE

CMS added many new services to be provided as telehealth services in efforts to lower exposure risks for clinicians and patients, including:

  • Emergency Department Visits, Levels 1-5
  • Domiciliary, Rest Home, or Custodial Care services, New and Established patients, All levels
  • Home Visits, New and Established Patient, All levels
  • Care Planning for Patients with Cognitive Impairment
  • Psychological and Neuropsychological Testing
  • Therapy Services, Physical and Occupational Therapy, All levels

Several other important changes to telehealth services were made including:

  • Clarifying the types of technology that can be used for Medicare telehealth services to allow telephones and other devices that offer interactive audio-video telecommunications.
  • Allowing home health agencies to provide more services to beneficiaries using telecommunications technology, so long as it is part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care.
  • Allowing hospices to provide services via a telecommunications system and permitting face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit to be conducted via telehealth.

A full list and more details are available at the Medicare Telehealth page.

Workforce Flexibilities

Several updates to overall workforce requirements were made to allow non-physician practitioners to expand their scope of practice, including:

  • Temporarily waiving Medicare and Medicaid’s requirements that physicians and non-physician practitioners be licensed in the state where they are providing services in order to contribute relief efforts.

More details are available in the Physician and Other Practitioner COVID-19 Worksheet.

CMS Quality Payment Program

The 2019 Merit-based Incentive Payment System (MIPS) data submission deadline will be extended by 30 days to April 30, 2020. Generally, if you have already submitted MIPS data or if you submit MIPS data by April 30, 2020, you will be scored and receive a MIPS payment adjustment based on the data you submit. If you need to revise any data that has already been submitted, you can still make changes by logging into qpp.cms.gov by the new deadline.

2019 MIPS Extreme and Uncontrollable Circumstances Policy Update:

If you are a MIPS eligible clinician, but have not submitted any MIPS data by April 30, 2020, you do not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. Additionally, CMS has modified the application-based extreme and uncontrollable circumstances policy to allow MIPS eligible clinicians who have been adversely affected by the COVID-19 public health emergency to submit an application and request reweighting of the MIPS performance categories for the 2019 performance year. This is an important change that allows clinicians who have been impacted by the COVID-19 outbreak and may be unable to complete their submission of MIPS data during the current submission period, to request reweighting and potentially receive a neutral MIPS payment adjustment for the 2021 MIPS payment year.

If no MIPS eligible clinicians in an APM Entity submit data for the Promoting Interoperability (PI) or Quality Performance categories due to extreme and uncontrollable circumstances, this would result in a neutral MIPS payment adjustment for MIPS eligible clinicians in the APM Entity. 

Emergency Waivers

CMS is extending many flexibilities authorized by the Secretary under Section 1135 of the Social Security Act or other waiver authority making it easier for clinicians and facilities to provide care. You are able to view all waivers and provisions on the CMS Coronavirus Waivers & Flexibilities page.

Many CMS resources are available in the summary including:

These and previous actions are part of the ongoing White House Coronavirus Task Force efforts. Keep up with the important work the Task Force is doing in response to COVID-19.

For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

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