June 25, 2020
GOVERNOR ABBOT ISSUES EXECUTIVE ORDER EXPANDING HOSPITAL CAPACITY
Governor Greg Abbott today issued an Executive Order to ensure hospital bed availability for COVID-19 patients as Texas faces an increase in COVID-19 cases and hospitalizations. The Governor’s order suspends elective surgeries at hospitals in Bexar, Dallas, Harris, and Travis counties. Under this order, the Governor directs all hospitals in these counties to postpone all surgeries and procedures that are not immediately, medically necessary to correct a serious medical condition or to preserve the life of a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician.
Through proclamation, the Governor can add or subtract from the list of counties included in the Executive Order to address surges in hospitalizations that may arise in other parts of the state.
“As Texas faces a rise in COVID-19 cases, we are focused on both slowing the spread of this virus and maintaining sufficient hospital capacity for COVID-19 patients,” said Governor Abbott. “These four counties have experienced significant increases in people being hospitalized due to COVID-19 and today’s action is a precautionary step to help ensure that the hospitals in these counties continue to have ample supply of available beds to treat COVID-19 patients. As we work to contain this virus, I urge all Texans to do their part to help contain the spread by washing their hands regularly, wearing a mask, and practicing social distancing.”
April 23, 2020
Governor Abbott’s third Executive Order (GA-15) relates to hospital capacity and personal protective equipment (PPE) needed for the COVID-19 response. The order loosens restrictions on surgeries put in place by Governor Abbott in March. Beginning at 11:59pm on April 21 through 11:59pm on May 8, all licensed health care professionals and all licensed health care facilities must continue to postpone all surgeries and procedures that are not medically necessary to diagnose or correct a serious medical condition of, or to preserve the life of, a patient who without timely performance of the surgery or procedure would be at risk for serious adverse medical consequences or death as determined by a patient’s physician. Exceptions now include:
April 14, 2020
INITIAL $30 BILLION OF CARES ACT PROVIDER RELIEF FUNDING—NOW BEING DELIVERED
As a result of the concerns raised by APMA, AMA, and other medical societies, HHS has updated the terms and conditions of the provider relief fund as well as the guidance provided on its website.
The relevant language in the terms and conditions now states that “[t]he Recipient certifies that it…provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19…” (Emphasis added). According to HHS guidance, offices that closed are eligible to receive the funds, and HHS takes a broad view that every patient could be a possible COVID-19 patient for purposes of providers being eligible for these funds.
Specifically, HHS states,
“If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”
APMA believes that this clarification should satisfy many of the questions and concerns raised by members. We encourage members to read the terms and conditions closely before attesting, and seek guidance from their legal counsel if necessary. The attestation portal should be made available this week at www.hhs.gov/providerrelief.
Updated HHS guidance: https://www.hhs.gov/provider-relief/index.html
Updated Terms and Conditions: https://www.hhs.gov/sites/default/files/relief-fund-payment-terms-and-conditions-04132020.pdf
April 7, 2020
DEA RELEASES GUIDELINES REGARDING PRESCRIBING CONTROLLED SUBSTANCES:
CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT (CARES ACT): KEY PROVISIONS FOR HEALTH CARE PROVIDERS
While the business and personal relief provisions of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) are understandably receiving the greatest coverage in the immediate aftermath of the bill’s signing, the CARES Act also contains substantial support for the expansion of the health care delivery system to meet the enormous stress that is now beginning to overwhelm the system. The CARES Act provisions range from expansive financial relief for health care providers to a waiver of copays and deductibles for Medicare and Medicaid beneficiaries. The vast majority of the statutory provisions are temporary, effective only during the COVID-19 emergency, and many of them will require the issuance of regulations and/or administrative guidance in order to implement them.
CMS OFFERING ADVANCED PAYMENT PROGRAM (WITH FACT SHEET)
CMS RAPIDLY EXPANDS HEALTH CARE WORKFORCE
Local private practice clinicians and their trained staff may be available for temporary employment since nonessential medical and surgical services are postponed during the public health emergency. CMS’s temporary requirements allow hospitals and health care systems to increase their workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community, as well as those licensed from other states without violating Medicare rules.
These health care workers can then perform the functions they are qualified and licensed for, while awaiting completion of federal paperwork requirements. CMS is issuing waivers so that hospitals can use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state’s emergency preparedness or pandemic plan. These clinicians can perform services such as order tests and medications that may have previously required a physician’s order where this is permitted under state law. CMS is waiving the requirements that a Certified Registered Nurse Anesthetist (CRNA) is under the supervision of a physician. This will allow CRNAs to function to the fullest extent allowed by the state and free up physicians from the supervisory requirement and expand the capacity of both CRNAs and physicians.
CMS also is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients. CMS will also allow health care providers (clinicians, hospitals and other institutional providers, and suppliers) to enroll in Medicare temporarily to provide care during the public health emergency.
Sometime in the afternoon on April 1st, CMS made a change to requirements for claims submission when billing for telehealth services (via an interim Final Rule). Previously DPMs were instructed to bill place of service 02 (Telehealth) with no modifier (along with the appropriate code depicting the type of service provided; real-time communication, telephone, check-in or e-visit). Now, DPMs have been instructed to use the place of service code depicting if this would have been a patient treated in the office, a hospital consult, skilled facility visit, etc. (example: 11 for office) along with modifier 95. Claims previously submitted with POS 02 and no modifier will be rejected and should be re-submitted.
(This will be retroactive to March 1st – so denied claims will have to be refiled once Novitas is on-board allowing DPMs to file these telehealth claims.)
Can also be found on the APMA COVID-19 resource page
APMA WEBINAR: SBA LOANS, PAYCHECK PROTECTION PROGRAM, AND OTHER RESOURCES FOR YOUR PRACTICE
Tuesday, April 7, 5 pm ET
Register now, space is limited!
The impact of COVID-19 on our economy and individual businesses has prompted a response from the government in the form of loans, federal stimulus, and information about tax filings and payments. APMA anticipates many podiatry practices will wish to take advantage of these options.
Join Mike Trabert, CPA, CVA, CMAP, CEPA, CM&AA, Dawn Minotas, CPA, MBA, Maryann Czarnota, CPA, MST, CFF, CVA, CFFA, CDFA, CEPA, MAFF, and Dave Mustin, MBA, partners with Marcum Accountants and Advisors’ Advisory Services group, for a critical presentation on preserving value in times of crisis. If you are unable to make the webinar this evening, a recording will be available to APMA members.
March 27, 2020
It is with deep regret we inform you of the cancellation of the 2020 TPMA Annual Conference & Business Meeting scheduled for June 25-28, 2020 at The Woodlands Resort in The Woodlands, TX. As a result of the COVID-19 pandemic, The Woodlands Resort made the difficult decision to temporarily suspend operations at their hotel and restaurants through at least July 1, 2020.
Please know that during these challenging times we appreciate you, we’re here for you and together we will all get through this. That said, we are looking forward to coming together again at the 2020 Southwest Foot & Ankle Conference (SWFAC) at the Irving Convention Center in Irving, TX on September 24-26. We hope you will join us!
March 24, 2020
As the effects of the COVID-19 pandemic continues, the TPMA will continue to share important information with you and guidance for your practice and patients during this challenging time. To help with disseminating information, both the TPMA and the APMA have created a dedicated COVID-19 resource page on their websites.
GOVERNOR ABBOTT SIGNS EXECUTIVE ORDER
Governor Greg Abbott signed an Executive Order on March 22, 2020. Under this order, the Governor directed all licensed health care professionals and facilities to postpone all surgeries and procedures that are not immediately, medically necessary to correct a serious medical condition or to preserve the life of a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician. This does not apply to any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the personal protective equipment needed to cope with the COVID-19 disaster. Read about the order here.
NON-URGENT ELECTIVE SURGERIES
The Texas Medical Board (TMB) gives guidance on the scheduling of non-urgent elective surgeries and procedures during the Texas Disaster Declaration for COVID-19 pandemic.
Also, available on the TMB website is a Frequently Asked Questions (FAQs) page regarding non-urgent, elective surgeries and procedures during the Texas Disaster Declaration for COVID-19 pandemic.
TEXAS DEPARTMENT OF INSURANCE EMERGENCY RULES
The Commissioner of Insurance adopts new rule 28 TAC §35.1, concerning Telemedicine and Telehealth Services, on an emergency basis, effective immediately. The emergency adoption is necessary to ensure adequate access to telemedicine and telehealth service in response to the COVID-19 pandemic. The new rule is intended to reduce these barriers and expand telemedicine by implementing parity with payment and documentation requirements applicable to in person services. Under the rule, services that are the same must be reimbursed at the same rate whether provided in-person or through telemedicine or telehealth. Similarly, the new rule does not permit health benefit plans to require documentation for telemedicine or telehealth services beyond what the plan already requires for in-person services. https://www.tdi.texas.gov/rules/2020/documents/20206287.pdf
NOTIFICATION FROM U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES FOR TELEHEALTH REMOTE COMMUNICATIONS AND HIPAA COMPLIANCE
During the COVID-19 national emergency, covered health care providers subject to HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies. The Office for Civil Rights (OCR) will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. Read full article
SEVERAL TEXAS COUNTIES ISSUE SHELTER-IN-PLACE
Gov. Greg Abbott has left it to local officials to impose stay-at-home orders, and Dallas County was among the first to do so. All elective medical, surgical, and dental procedures are prohibited. Individuals may leave their residence only to perform essential activities, which include visiting a health care professional when care is essential to their health and safety. Check your local listings for up-to-date information and guidelines.
SUGGESTED STATEMENT TO YOUR PATIENTS AND BEST PRACTICES FOR YOUR MEDICAL CLINIC
As all of you, we continue to monitor the COVID-19 pandemic. We want to bring everyone up to speed on our plan over the next several weeks to months as this is an ever-changing situation. As a trusted and leading health care provider, our goal is to ensure you can continue receiving care with the confidence that we have taken every precaution necessary regarding your safety while in our offices.
Prometric, the provider of the APMLE for the podiatric medicine program has closed testing centers in the United States and Canada. To learn more, visit the Prometric webpage.
ADDITIONAL INFORMATION ON COVID-19
March 20, 2020
As the effects of the COVID-19 pandemic continues, the Texas Podiatric Medical Association wants to share some important information with you and guidance for your practice during this challenging time. Below are some links that we hope will help you deal with the current situation.
Many podiatrists are searching for answers about how to address COVID-19 in their practices and personal lives. TPMA/APMA is here to help by directing you to the most authoritative and timely news and tools. These resources are available on APMA’s COVID-19 resource page at www.apma.org/covid19 as well as an FAQ page.
PODIATRISTS CAN PROVIDE E/M SERVICES REMOTELY
A resource that may be of interest to you are APMA-developed resources on providing telehealth services. You may need to provide Telephone Services and Online Digital Evaluation and Management Services during this time. CMS has announced major changes to services that podiatrists can furnish remotely under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. This waiver allows Medicare to pay for office, hospital, and other visits furnished via telehealth. This change means podiatrists can submit CPT 99201–99215 when these services are provided remotely. Watch APMA’s webinar for guidance on coding, compliance, and documentation for these service types. As of today, telehealth can be provided for Medicare Part B (Fee for Service) and Medicare Advantage plans only. Rules and Regulations change from day to day so stay tuned for updates.
Additionally, there may be upcoming issues with patients requiring “covered routine foot care” (RFC) and/or diabetic therapeutic shoes (DTS). With regard to the RFC and DTS it is APMA’s understanding that, “DME CMD’s suggest that CMS is having discussions with all the CMD’s on many of the policy issues given that it is not possible for most folks to get into their PCP offices right now. Priority for ill patients not for those who need to be certified for shoes or routine foot care must be given.
Some coders have also suggested that if possible (based on the patient’s history, physical finding, diagnoses and the Novitas Solution’s LCD on RFG) to use non-asterisk (*) diagnoses as these do not require the patient to be seen by their attending within the past six months. This is just a suggestion and may not be appropriate for every patient’s situation. There is also the possibility that these patients can be scheduled farther out after the virus situation and the social distancing is no longer a problem.
THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT WAS SIGNED INTO LAW ON MARCH 18, 2020
In the coming days and weeks, federal regulatory agencies, including the Department of Labor (DOL) and Health and Human Services (HHS), will provide guidance on how to execute or implement the new requirements. In the meantime, employers and advisors must rely on a good faith interpretation of the act’s text. View the Families First Act
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
TEXAS DEPARTMENT OF LICENSING AND REGULATION
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
WORLD HEALTH ORGANIZATION (WHO)
JOHNS HOPKINS UNIVERSITY & MEDICINE
CENTERS FOR MEDICARE & MEDICAID SERVICES
TEXAS WORKFORCE COMMISSION
Stay well and safe,
Steven P. Brancheau
Chief Medical Officer