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IMPORTANT NOTE:
If facilities have run out of PPE, contact your local emergency management centers. Click
HERE
to view the most recent directory.
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COVID-19 Updates: March 29, 2020
This update includes:
- Gov. Evers Releases COVID-19 Funding Plan
- FMAP Update
- Medicare Accelerated and Advanced Payments Now Available
- Department of Labor Guidance on New Leave Benefits Excludes Health Facility Employees
- CMS Releases Telehealth Toolkit
- DCF Launches Childcare Map Website
- ACHA/NCAL Video Update: What to Do When COVID-19 Gets into Your LTC Facility
- Emotionally Supporting Staff
- Medicare Hearings and Appeals Move Forward
- UnitedHealthCare and Cigna Suspend Prior Authorizations for SNF Admissions
- SNF PEPPER Report Delayed
- DEA Permits Prescribing Across State Lines
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As of today, there are 1,112 confirmed cases of COVID-19 in the state of Wisconsin and 13 deaths caused by the virus. Click
HERE
to view the latest outbreak information from the Wisconsin Department of Health Services.
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Gov. Evers Releases
COVID-19 Funding Plan
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Gov. Tony Evers has released a funding proposal of $700 million for responding to the COVID-19 public health crisis. If approved by the Legislature, the proposal would also authorize the Department of Health Services to create an unlimited state funding stream for Wisconsin health officials to respond to the coronavirus pandemic and any future health emergencies.
According to the Legislative Fiscal Bureau (LFB), the Governor’s Proposal includes $100 million in grants to healthcare providers including SNF and ALF providers. The grants are designed to provide flexible resources to meet urgent provider needs and build general health system capacity.
Grants could be used for the following purposes:
- Establishment and operation of temporary sites to provide testing services, treatment beds, or to isolate or quarantine affected individuals;
- Temporary conversion of space for another purpose that after a COVID-19 outbreak reverts to its original purpose;
- Staff overtime and hiring additional staff;
- Staff training or orientation;
- Purchasing of consumable protective or treatment supplies and equipment;
- Development and implementation of COVID-19 screening and testing procedures;
- Patient outreach related to COVID-19;
- Emergency transportation;
- Information technology and systems to support telehealth activities, patient triage and COVID-19 screening;
- Purchasing replacement parts or filters necessary for medical equipment;
- Specialty cleaning supplies;
- Expenses related to isolation and quarantine of staff; and
- Expenses that assist with planning or preparing for, or responding to an outbreak of COVID-19.
The proposal also includes sum sufficient GPR funding for general resources and position authority for the Department of Health Services during public health emergency. Funds may be used to facilitate coordination, make grants, provide awards, enter into contracts, conduct investigations, facilitate research, purchase products, strengthen surveillance, support emergency operations, create and fund FTE positions and carry out other activities the state health officer determines appropriate.
Evers’ proposal also suspends the requirement that DHS submit waivers and SPAs to the Joint Committee on Finance for approval during a public health emergency. During a national emergency or disaster declaration, state Medicaid programs are permitted to submit 1135 and 1115 waivers, as well as SPAs and Appendix Ks in order to adjust the program to meet unique needs emerging from the emergency.
The proposal would not give DHS the ability to expand Medicaid.
Key Documents:
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On March 13, 2020, Congress enacted the federal Families First Cononavirus Response Act (FFCRA). It provides states with a temporary 6.2 percent increase to the applicable Federal Medical Assistance Percentage (FMAP) under the Medicaid program. States may apply the increased FMAP retroactively to January 1, 2020, and may continue to apply it through the end of any calendar-year quarter in which the emergency declaration is in effect. However, in order to qualify, states must adhere to certain conditions for the duration of the emergency.
Under FFCRA, states must do all of the following in order to apply the increased FMAP:
- Maintain eligibility standards and procedures for the Medicaid program that are no more restrictive than as of January 1, 2020.
- Not charge premiums that exceed those as of January 1, 2020.
- Provide coverage with no cost-sharing requirements of testing, services, and treatments related to COVID-19, including vaccines, specialized equipment, and therapies.
- Provide continuous coverage to all individuals who were enrolled in Medicaid on March 18, 2020 or thereafter, regardless of any change in circumstances that otherwise would terminate eligibility, unless an individual requests voluntary termination or is no longer a resident of the state.
On March 24, 2020, the Wisconsin Department of Health Services (DHS) submitted proposed modifications to Medicaid policies and procedures to the state legislature's Joint Committee on Finance (JCF) in order to qualify for the increased FMAP included in the FFCRA. The proposal included a request to suspend two Medicaid requirements set forth in state statutes. One relates to suspending the collection of premiums for childless adults, as detailed above. The other relates to continuous coverage for current enrollees, as detailed above.
On March 27, 2020, the Joint Committee on Finance responded to the Department’s proposal, rejecting it on the grounds that the Committee lacks the authority to grant exceptions to state law. The Committee encouraged the Department to work with the full legislature and legislative leaders to specifically authorize the needed changes through the legislative process.
On March 28, 2020, Gov. Tony Evers released 65-page COVID-19 Public Health Emergency
(PHE) Bill #1
, a legislative proposal which, among $700 million in crisis response spending, authorizes DHS to suspend compliance with provisions of Medicaid statutes to satisfy criteria to qualify for an increased FMAP.
On March 28, 2020, GOP Legislative Leaders, Senator Scott Fitzgerald and Representative Robin Vos,
responded disfavorably
to the state spending in the bill, but did not address the FMAP issue directly.
WHCA/WiCAL leadership is actively working with health sector partners in advocating for resolution of this issue.
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Medicare Accelerated and Advanced Payments Now Available
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CMS announced on Saturday, March 28 that it is expanding its accelerated and advanced payment program for Medicare providers. These payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.
To qualify for accelerated or advance payments, the provider or supplier must:
- Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form;
- Not be in bankruptcy;
- Not be under active medical review or program integrity investigation; and
- Not have any outstanding delinquent Medicare over-payments.
Medicare will start accepting and processing the Accelerated and Advanced Payment Requests immediately. CMS anticipates that the payments will be issued within 7 days of the provider’s request.
CMS guidance on provider eligibility and submission processes from the announcement differ from those found in the
Medicare Financial Management Manual
, Overpayments, Chapter 8, Section 150.
Providers should contact their MACs, directly, to understand how the MAC will be operationalizing CMS’s guidance. CMS is delegating the payment request processing to the MACs.
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Department of Labor Guidance on New Leave Benefits Excludes Health Facility Employees
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In response to AHCA/NCAL’s advocacy to include nursing home, assisted living, and ID/DD staff in their definition of “health care provider,” the Department of Labor has published guidance to address exemptions and employer requirements to the expanded Family Medical Leave Act and sick leave benefits included in the recently passed Families First Coronavirus Response Act. Of note, the Department’s exemptions
FAQ
(see #56) states that the “health care provider” exemption to these new leave requirements applies to “anyone employed at any... nursing facility, retirement facility, nursing home, home health care provider... This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.” The exemption also applies to employees of contractors with the above institutions who “provide services or to maintain the operation of the facility." Employers with over 500 employees are also exempted. Please review this
FAQ
closely.
To minimize the spread of the virus associated with COVID-19, the Department encourages employers to be judicious when using this definition to exempt health care providers from the provisions of the FFCRA.
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CMS Releases Telehealth Toolkit
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CMS recently issued an
electronic toolkit
regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities.
CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.
This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS in response to the National Health Emergency.
Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well.
There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.
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DCF Launches Childcare Map Website
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The Wisconsin Department of Children and Families has compiled resources to help essential workers, providers, and families navigate the child care landscape during the COVID-19 crisis, including a searchable
online map
identifying available child care options:
In the resources provided, employees, contractors, and other staff in long term care and residential care are identified as Tier 2 workers, which take priority in accessing child care over the general public, but under Tier 1 workers. Tier 1 workers include employees, contractors, and other support staff working in health care.
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ACHA/NCAL Video Update: What to Do When COVID-19 Gets into Your LTC Facility
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AHCA/NCAL President & CEO Mark Parkinson gives a national
update
on the COVID-19 pandemic. Mark talks with Chief Medical Officer Dr. David Gifford about what to do if your staff or residents are potentially COVID-19 positive (
view more detailed guidance
), and if you’re running low on PPE.
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Emotionally Supporting Staff
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The COVID-19 pandemic has taken a mental and emotional toll on Americans across the country. Health care workers especially feel the burden of this crisis. Providers must take steps to ensure the health and well-being of their staff as they navigate this challenging time. AHCA/NCAL has compiled
resources
to help providers prevent burnout and ensure staff feel supported at work.
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Medicare Hearings and Appeals Move Forward
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Although the Office of Medicare Hearings and Appeals (OMHA) office space is closed to the general public, OMHA hearings and appeals processing measures are proceeding as scheduled. Unless an appellant is notified directly that a hearing has been postponed or canceled, appellants should continue to appear for hearings by telephone as scheduled. The office will demonstrate flexibility with regard to reasonable requests to reschedule hearings. Additional information and updates will be provided as the situation evolves.
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UnitedHealthCare and Cigna Suspend Prior Authorizations for SNF Admissions
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UnitedHealthcare (UHC) has issued a
press release
that they have suspended requiring Prior Authorizations (PAs) for all SNF admissions through May 31, 2020.
According to UHC, the admitting provider must notify us within 48 hours of transfer and penalties still apply. Further, length of stay reviews still apply, including denials for days that exceed approved length. This is a national release and appears to cover all UHC plans. Providers who are in network with UHC should check their provider manual or with their local UHC representative to confirm this policy change applies, and any other specific requirements related to PAs. If a provider is not in network with UHC, providers should continue to get and document PAs to protect their ability to bill claims.
Cigna has also
announced
it is waiving PAs for the transfer of its patients to in-network subacute facilities, including skilled nursing facilities. Providers who are in network with Cigna should check their provider manual or with their local Cigna representative to confirm this policy applies, and any other specific requirements related to PAs.
See the AHCA/NCAL
template letter
requesting similar administrative relief from other Managed Care Organizations (MCOs).
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SNF PEPPER Report Delayed
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The Centers for Medicare and Medicaid Services (CMS) has announced another measure to free up the attention of providers as they respond to the COVID-19 pandemic. To this end, the release of the Q4FY19 PEPPER schedule for an April release has been delayed for SNFs and other providers. Providers will be notified about the rescheduled release date for the Q4FY19 PEPPERs when determined.
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DEA Permits Prescribing Across State Lines
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The Drug Enforcement Administration has granted an
exception
to allow practitioners in states that have granted reciprocity with other states for medical licensing to prescribe controlled substances in another state. Under the exception, DEA-registered practitioners are not required to obtain additional registration(s) with DEA in the additional state(s) where the dispensing (including prescribing and administering) occurs, if authorized to dispense controlled substances by both the state in which a practitioner is registered with DEA and the state in which the dispensing occurs.
Practitioners, in other words, must be registered with DEA in at least one state and have permission under state law to practice using controlled substances in the state where the dispensing occurs. This applies to prescription of controlled substances via telemedicine in states where they are not registered with DEA. This is effective March 23, 2020 through the during of the public health emergency.
Please note that some states may also require state-specific registration for narcotic prescribing. Practitioners should be certain to comply with any additional steps required for state compliance.
Additional COVID-19 related information from the DEA is available
here
.
For additional questions, please email
COVID19@ahca.org
and
www.ahcancal.org/coronavirus
for more information and resources.
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As a reminder, WHCA/WiCAL's staff team is ready to serve your facility. We are committed to providing members with the services you need to succeed in your mission to provide high-quality care to Wisconsin's most vulnerable residents.
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Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
pat@whcawical.org
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