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Pritzker Makes Emergency Healthcare Moves
I
n an
announcement
yesterday via executive order and emergency rulemaking, Gov. Pritzker took several steps regarding the state's response to COVID-19, predominately around telehealth.
The executive order covers non-ERISA commercial insurers and requires the following:
- In-network coverage requirement for telehealth services
- Prohibits unnecessary utilization control for telehealth
- No cost-sharing for in-network telehealth (high-deductible plan exception)
- Telehealth may be provided by any in-network provider regardless if they were previously designated as a telehealth provider
The emergency rules require Medicaid providers to be reimbursed at the same rate at which they are reimbursed for in-person visits.
Highllights from the waiver:
- Provider Participation & Conditions for Payment: Waive ordering, referring, and prescribing regulations; waive site visits to temporarily enroll a provider; suspend revalidation of Medicaid providers; extend the 180 day timely filing limit; provide payments to facilities for providing services in alternate settings, including unlicensed facilities or a patient's vehicle (in the case of the drive-thru screenings); allow staffing levels that exceed established limits, allow the state to broaden physician extenders, waive physical signature requirements for services via any method of delivery, and more.
- Service Authorization and Utilization Controls: Suspend prior authorization requirements for most services; extend existing prior authorizations; allow post-screenings for long term care admissions; allow flexibility of documentation; and more.
- Pharmacy: Cover over-the-counter products used for symptomatic relief of fever and body aches; allow prescribers not enrolled with Medicaid to write prescriptions for Medicaid patients; cover nonrebate-able products if drug shortages occur; and more.
- HIPAA: Allow non-HIPAA compliant telehealth modes for telehealth visits or check-ins at the location of the patient, including the patient's home; waive HIPAA sanctions and penalties from noncompliance with certain HIPAA privacy regulations; and more.
- Appeal and State Fair Hearing Request Deadlines: Provide an extension to file appeals; allow enrollees to have more time to request State Fair Hearings; and more.
- Administrative Activities: Provide expedited authorization for all State Plan Amendments that impact Medicaid reimbursement to providers; temporarily delay, modify, or suspend CMS-certified facility survey activities; and more.
Chamber Coronavirus Webinar
The Coronavirus: How Employers Can Manage the Outbreak - March 25, 1:30 - 3 pm.
Please join Greensfelder Hemker & Gale PC Labor And Employment Attorney, Scott Cruz, for this insightful webinar to better manage the risks and liabilities associated with your business when addressing COVID-19. Register here - it is free for all current Chamber members if you send an email request to
kconstant@ilchamber.org.
DCEO Working on Economic Relief
This week, the Chamber provided our first set of ideas to the Illinois Department of Commerce and Economic Opportunity (DCEO) for economic relief for small businesses. We will continue to be in communication but our first tranche included:
- Recommending state banking regulators communicate flexibility in forbearance related to banks' management of small business loans;
- Expanding opportunities to help the hospitality industry weather the crisis;
- The possibility of a state fiscal stimulus to assist the infrastructure community; and
- Specific needs of the transportation and energy sectors.
We will continue advocating for these options, and are requesting your ideas for actions the state government can take to alleviate the crisis. Please send your suggestions to aaron@wintersLLC.com.
JCAR Update
HFS proposed amendments to Medical Payment (89 IAC 140; 44 Ill Reg 4288) implementing Public Act 101-62, which establishes a Pharmaceutical and Therapeutics Advisory Board to determine which drug products will be included on HFS' Preferred Drug List (PDL) and which non-PDL drug products will require prior approval in order to be covered under medical assistance. The board will meet at least once per calendar quarter and will include voting members appointed by the Governor for 3-year terms, with non-voting clinicians serving as advisors. Board recommendations are nonbinding. When a new drug product is approved by the federal Food and Drug Administration, it will require prior approval until HFS determines otherwise. Drug manufacturers shall provide, in writing, all relevant drug product information to HFS and the board it its entirety.
DFPR proposed amendments to the Part titled Nurse Practice Act (68 IAC 1300; 44 Ill Reg 4158) implementing Public Act 100-513. The rulemaking clarifies various aspects of licensure, scope of practice, and other criteria for advanced practice registered nurses (APRNs), registered professional nurses (RNs) and licensed practical nurses (LPNs). RNs may delegate certain nursing interventions (e.g., administering oral or topical medication) to other RNs, LPNs or unlicensed personnel depending on the condition of the patient, the potential for harm, the complexity of the procedure/intervention being delegated, and the competency of the individual to whom the action is being delegated. An RN may not delegate medication administration to unlicensed personnel (e.g., aides) in any hospital, institution or long-term care facility unless specifically authorized by law. Other provisions expand the definition of unprofessional conduct, remove obsolete language, and clarify continuing education requirements, licensure requirements for foreign graduates, and procedures for seeking restoration of an expired or inactive license. Licensed nurses and their employers are affected by this rulemaking.
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