Summary List Update of COVID19-related Federal Actions Relevant to Healthcare

Coronavirus Preparedness and Response Supplemental Appropriations Act signed into law.  Waives Medicare telehealth payment requirements. During the Public Health Emergency to allow beneficiaries in all areas of the country to receive telehealth services, including at their home.  Starting March 6th, all Medicare patients are eligible for telehealth services.  The rural-only patient requirement is suspended.

• CMS List of Services that are normally furnished in-person that may be furnished via Medicare telehealth. See list: www.cms.gov/Medicare/Medicare-GeneralInformation/ Telehealth/Telehealth-Codes. Services are described by HCPCS codes and paid under the Physician Fee Schedule.
• CMS FAQ on Medicare Telehealth can be found here: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

CMS Issues Section 1135 Blanket Waivers for COVID-19.  Covers:

• Skilled Nursing Facilities
• Critical Access Hospitals
• Housing Acute Care Patients in Excluded Distinct Part Units
• Durable Medical Equipment
• Care for Excluded Inpatient Psychiatric Unit Patient in Acute Care Unit of Hospital
• Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital
• Supporting Care for Patients in Long-Term Care Acute Care Hospital (LTCH)s
• Home Health Agencies
• Provider Locations
• Provider Enrollment Medicare Appeals for Fee-for-Services, MA and Part D

CMS Issues Additional Section 1135 Blanket Waivers for COVID-19:  

CMS Hospitals without Walls

• Allow use ACFs and ASCs to treat patients
• Allow use of non-hospital buildings/space for patients
• Allow COVID-19 drive-through testing off-site
• Ambulances allowed to transport to wider range even if not “medically necessary”
• Hospitals can temporarily increase use of non-licensed beds
• Allow hospitals to bill for services outside 4-walls

Rapidly Expand Healthcare Workforce

• Allow for temporary employment of staff w/o training
• Allow for broad use of PAs and NPs to fullest extent possible
• CRNA need to be under the supervision of a physician
• Allow hospitals to offer meals, laundry, clothes to staff
• Allow temporary enrollment of providers to allow them to provide care during pandemic

Patients Over Paperwork

• Eliminate paperwork requirements
• Suspend need for P&Ps on COVID-19 patients in isolation
• Increase time that hospital has to provide patient with copy of their medical record
• Temp relief from any audit and reporting requirements

Further Promote Telehealth in Medicare

• CMS will no allow for more than 80 additional services to be furnished via telehealth
• Wide range of App use allowed, including audio-only phones
• Providers can bill for their TeleHealth visits and the same rate as in –person visits

CMS issues Blanket Waivers for Stark Law, retroactive to March 1, 2020.   Allowing transactions that would otherwise fail to meet the applicable Stark Law exceptions. Only applies to transactions related to COVID-19 Purposes. “COVID-19 Purposes” means:

• Diagnosis or medically necessary treatment of COVID-19 for any patient or individual, whether or not the patient or individual is diagnosed with a confirmed case of COVID-19;
• Securing the services of physicians and other health care practitioners and professionals to furnish medically necessary patient care services, including services not related to the diagnosis and treatment of COVID-19, in response to the COVID-19 outbreak in the United States;
• Ensuring the ability of health care providers to address patient and community needs due to the COVID-19 outbreak in the United States;
• Expanding the capacity of health care providers to address patient and community needs due to the COVID-19 outbreak in the United States;
• Shifting the diagnosis and care of patients to appropriate alternative settings due to the COVID-19 outbreak in the United States; or
• Addressing medical practice or business interruption due to the COVID-19 outbreak in the United States in order to maintain the availability of medical care and related services for patients and the community.

HHS Notice of Enforcement Discretion re: HIPAA Business Associates may disclose COVID-19 PHI to Public Health Authorities for public health purposes or health oversight purposes.  

Will not enforce against CE or BA where BA releases PHI related to COVID-19 for Public Health purposes or Health Oversight activities during the nationwide public health emergency. Requires following satisfied:

• the business associate makes a good faith use or disclosure of the covered entity’s PHI for public health activities consistent with 45 CFR 164.512(b), or health oversight activities consistent with 45 CFR 164.512(d); and
• the business associate informs the covered entity within ten (10) calendar days after the use or disclosure occurs (or commences, with respect to uses or disclosures that will repeat over time).

Examples of such good faith uses or disclosures covered by this Notification include uses and  disclosures for or to:

• the Centers for Disease Control and Prevention (CDC), or a similar public health authority at the state level, for the purpose of preventing or controlling the spread of COVID-19, consistent with 45 CFR 164.512(b).
• the Centers for Medicare and Medicaid Services (CMS), or a similar health oversight agency at the state level, for the purpose of overseeing and providing assistance for the health care system as it relates to the COVID-19 response, consistent with 45 CFR 164.512(d).