NAHC COVID-19 Crisis Update for April 22, 2020
Washington Policy Updates
Leverage the Power of Home Care and Hospice to Fight COVID-19
Quality health care in the home is not only popular and affordable, it is also one of the best ways to stop the spread of COVID-19. CMS and Congress have taken some steps to unleash the vast potential of home care to fight the novel coronavirus, but additonal steps are needed.
Congress should:
Increase Medicare home health reimbursement by 15 percent;
Establish in-home care providers as a priority in PPE distribution;
Create waivers to allow telehealth visits to be reimbursed within the home health benefit;
Waive or suspend Medicare requirement that home health orders and eligibility certification be signed and dated by a physician during the public health emergency.
We are asking you to help by using our Advocacy Center. It takes only seconds and a few clicks of your mouse.
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HHS Announces Additional Allocations of CARES Act Provider Relief Fund
The CARES Act legislation provides relief to American families, workers, and the healthcare providers on the frontline of the COVID-19 outbreak. $100 billion is being distributed by the Administration to healthcare providers, including hospitals battling this disease.
The allocation of funds is intended to address both the economic harm across the entire healthcare system due to the stoppage of elective procedures, and addressing the economic impact on providers incurring additional expenses caring for COVID-19 patients, and to do so as quickly and transparently as possible.
GENERAL ALLOCATION
$50 billion of the Provider Relief Fund is allocated for general distribution to Medicare facilities and providers impacted by COVID-19, based on eligible providers’ 2018 net patient revenue.
To expedite providers getting money as quickly as possible, $30 billion was distributed immediately, proportionate to providers’ share of Medicare fee-for-service reimbursements in 2019. On Friday, April 10, $26 billion was delivered to bank accounts. The remaining $4 billion of the expedited $30 billion distribution was sent on April 17.
This simple formula, working with the data we had, was used to get the money out the door as quickly as possible. We were very clear that additional funds would be going out quickly to help providers with a relatively small share of their revenue coming from Medicare fee-for-service, such as children’s hospitals.
Those funds are beginning to be delivered this week. HHS will begin distribution of the remaining $20 billion of the general distribution to these providers to augment their allocation so that the whole $50 billion general distribution is allocated proportional to providers’ share of 2018 net patient revenue.
On April 24, a portion of providers will automatically be sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to a portal opening this week at https://www.hhs.gov/providerreliefforadditionalgeneraldistributionoffunds.
Providers who receive their money automatically will still need to submit their revenue information so that it can be verified.
Payments will go out weekly, on a rolling basis, as information is validated, with the first wave being delivered at the end of this week (April 24, 2020).
Providers who receive funds from the general distribution have to sign an attestation confirming receipt of funds and agree to the terms and conditions of payment and confirm the CMS cost report.
The terms and conditions also include other measures to help prevent fraud and misuse of the funds. All recipients will be required to submit documents sufficient to ensure that these funds were used for healthcare-related expenses or lost revenue attributable to coronavirus. There will be significant anti-fraud and auditing work done by HHS, including the work of the Office of the Inspector General.
President Trump is committed to ending surprise bills for patients. As part of this commitment, as a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
TARGETED ALLOCATIONS
ALLOCATION FOR COVID-19 HIGH IMPACT AREAS
$10 billion will be allocated for a targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 outbreak. As an example, hospitals serving COVID-19 patients in New York, which has a high percentage of total confirmed COVID-19 cases, are expected to receive a large share of the funds.
Hospitals should apply for a portion of the funds by providing four simple pieces of information via an authentication portal before midnight PT, Thursday April 23. This portal is live, and hospitals have already been contacted directly to provide this information.
Hospitals will need to provide:
Tax Identification Number
National Provider Identifier
Total number of Intensive Care Unit beds as of April 10, 2020
Total number of admissions with a positive diagnosis for COVID-19 from January 1, 2020 to April 10, 2020
The authentication and data-sharing process should take less than five minutes via a system that should be familiar to most hospitals.
This information is necessary for the government to determine what facilities will qualify for a targeted distribution. Supplying this information does not guarantee receipt of funds from this distribution.
The Administration will use the data it receives to distribute the targeted funds to where the impact from COVID-19 is greatest. The distribution will take into consideration the challenges faced by facilities serving a significantly disproportionate number of low-income patients, as reflected by their Medicare Disproportionate Share Hospital (DSH) Adjustment.
ALLOCATION FOR TREATMENT OF THE UNINSURED
The Trump Administration is committed to ensuring that Americans are protected against financial obstacles that might prevent them from getting the treatment they need for COVID-19.
As announced in early April, a portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured.
Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding.
Steps will involve: enrolling as a provider participant, checking patient eligibility and benefits, submitting patient information, submitting claims, and receiving payment via direct deposit.
Providers can register for the program on April 27, 2020, and begin submitting claims in early May 2020. For more information, visit coviduninsuredclaim.hrsa.gov.
ALLOCATION FOR RURAL PROVIDERS
$10 billion will be allocated for rural health clinics and hospitals, most of which operate on especially thin margins and are far less likely to be profitable than their urban counterparts.
This money will be distributed as early as next week on the basis of operating expenses, using a methodology that distributes payments proportionately to each facility and clinic.
This method recognizes the precarious financial position of many rural hospitals, a significant number of which are unprofitable.
Rural hospitals are more financially exposed to significant declines in revenue or increases in expenses related to COVID-19 than their urban counterparts.
ALLOCATION FOR INDIAN HEALTH SERVICE
Recognizing the strain experiences by the Indian Health Service, $400 million will be allocated for Indian Health Service facilities, distributed on the basis of operating expenses. Indian Country is also being impacted by COVID-19.
This money will be distributed as early as next week on the basis of operating expenses for facilities.
This complements other funding provided to IHS and work we’ve done to expand IHS capacity for telehealth.
ADDITIONAL ALLOCATIONS
There are some providers who will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid.
HELPING ENSURE ALL AMERICANS HAVE ACCESS TO CARE
The Families First Coronavirus Response Act,as amended by the CARES Act,requires private insurers to waive an insurance plan member’s cost-sharing payments for COVID-19 testing. The President also secured funding to cover COVID-19 testing for uninsured Americans.
President Trump has also secured commitments from private insurers, including Humana, Cigna, UnitedHealth Group, and the Blue Cross Blue Shield system, to waive cost-sharing payments for treatment related to COVID-19 for plan members.
Additionally, President Trump is committed to ending surprise bills for patients. As part of this commitment, as a condition to receiving general funds, providers must agree not to seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
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NAHC Asks CMS to Waive Home Infusion Restrictions
NAHC suggests legislative remedy for crisis
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EXPERT U.S. PANEL DEVELOPS NIH TREATMENT GUIDELINES FOR COVID-19
"Living document" expected to be updated often as new clinical data accrue
A panel of U.S. physicians, statisticians, and other experts has developed treatment guidelines for coronavirus disease 2019 (COVID-19). These guidelines, intended for healthcare providers, are based on published and preliminary data and the clinical expertise of the panelists, many of whom are frontline clinicians caring for patients during the rapidly evolving pandemic. The guidelines are posted online <covid19treatmentguidelines.nih.gov> and will be updated often as new data are published in peer-reviewed scientific literature and other authoritative information emerges.
The guidelines consider two broad categories of therapies currently in use by healthcare providers for COVID-19: antivirals, which may target the coronavirus directly, and host modifiers and immune-based therapies, which may influence the immune response to the virus or target the virus.
The panel's conclusions about treating COVID-19 with various agents that fall into these two classes of therapies are distilled in summary recommendations. Subsequently, the document provides background information about each agent -- such as clinical data about its use, ongoing clinical trials, and known interactions with other drugs -- that forms the basis for the Recommendation. Tables briefly outline the same information.
The guidelines also describe the evaluation and stratification of patients based on their risk of infection and severity of illness. Recommendations in this section address best practices for managing patients at different stages of infection, for example:
--Outpatients who are either asymptomatic or who have mild to moderate symptoms and are self-isolating
--Inpatients with severe illness or critical disease
Special considerations for pregnant women and for children who are infected are also included.
A comprehensive section of the guidelines addresses a range of considerations for clinicians caring for the most critically ill hospitalized patients. This section includes multiple recommendations for patients needing critical care, including infection control procedures, hemodynamic and ventilatory support, and drug therapy.
Finally, the guidelines include recommendations concerning the use of concomitant medications. These include statins; corticosteroids; non-steroidal anti-inflammatory drugs; and certain drugs used to control hypertension, known as ACE inhibitors and ARBs.
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Regulation Roundup
New Guidance and Waivers for Home Health, Rural Heath and More
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HHS Webinar for IT Stakeholders on HIPPAA Privacy & Security
The HHS Office for Civil Rights (OCR) is hosting a webinar for health IT stakeholders on HIPAA privacy and security issues related to COVID-19 and recent OCR actions related to the pandemic.
Timothy Noonan, Deputy Director for Health Information Privacy, OCR
Marissa Gordon-Nguyen, Senior Advisor for Health Information Privacy Policy, OCR
Topics include:
COVID-19 and Permissible Disclosures under the HIPAA Privacy Rule
Enforcement Discretion and Guidance for Telehealth Remote Communications
Guidance for Disclosures to First Responders and Public Health Authorities
Enforcement Discretion for Business Associates to Use and Disclose PHI for
Public Health and Health Oversight Activities
Enforcement Discretion for Community-Based Testing Sites
When: Friday, April 24, 2020, from 12:00pm – 1:00pm Eastern
Please note, this webinar is limited to 3,000 participants. It will be recorded and made available on HealthIT.gov and the OCR website within the week.
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Education
New Webinar Series on COVID-19 Legal Changes
The National Association for Home Care & Hospice and the Private Duty Home Care Association (PDHCA) are co-hosting a weekly webinar series with Littler Mendelson and the Home Care Association of America, focusing on employment law issues during the COVID-19 pandemic.
A new webinar in the series airs live every Thursday at Noon Eastern (11:00 CT/10:00 MT/9:00 PT) and will last about two hours.
During this installment of our weekly webinar series, we will conduct a deep dive analysis of the most recent legislative trends impacting the home care industry, relevant updates on the stimulus package, and providing attendees with a complimentary recommended operating protocol document in response to this pandemic. We will also highlight how technology vendors across the industry are engaging to help install these Recommended Operating Protocols into the day-to-day operation of agencies and caregivers across the country.
With the barrage of changes in legislation, the introduction of the Families First Coronavirus Response Act (FFCRA) the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and the confusion that has ensued, the home care industry is a fertile breeding ground for class action lawsuits to commence. As such, Angelo Spinola will cover the Anatomy of a Class Action Lawsuit, providing you with an in-depth understanding of the mechanics of a class action, as well as share practical tips for the best method to preventing these class action lawsuits and the pros and cons of arbitration programs. Receive a holistic overview of the evolution in litigation in the home care industry, and a detailed analysis on COVID-19 related allegations.
The goal of this series is to bring the industry together for real time advocacy and legal updates, practical guidance in light of the same, and provide a forum to get the answers to your most pressing questions. Our industry is needed now more than ever, and we ask you to tune in for this series and continue to do your part to keep our patients and clients safe.
Faculty
Angelo Spinola, Shareholder, Littler Mendelson
Bill Dombi, President, NAHC
Vicki Hoak, Executive Director, HCAOA
Registration Fees:
Member: FREE
Non-Member: FREE
(Includes both the live and recorded event)
REGISTER NOW!
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COVID-19 Waiver Allowing HHAs Flexibility for OT to Open Cases – Part 1
Thursday, April 23, 2020, 2:00-3:00 pm Eastern
On April 9th, CMS announced a new blanket waiver for HHAs allowing OTs to perform initial and comprehensive assessment for all patients. This webinar provides the background and facts of the waiver, includes clarifications from CMS, dispels myths, and provides an outline of what’s next for HHAs and OTs to, in CMS’ words, “allow HH services to start sooner and free HH nurses to do more direct patient care.”
This webinar will be facilitated by Karen Vance, a leading national home care and hospice consultant with over 35 years of experience as both an occupational therapy provider, regulatory manager and a consultant. She routinely provides clinical and operations consulting services to home care and hospice agencies and helps providers establish and maintain quality management practices by providing assessment, training and consulting. Karen is widely known for her industry expertise and is sought as a speaker at national, regional, and state industry events.
Faculty: Karen Vance, BSOT, Senior Managing Consultant, BKD, LLP
Free to attend!
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Did You Miss the COVID-19 Town Hall Today?
NAHC's (totally free!) COVID-19 Town Hall series continued Wednesday, April 22, the fifth in this six-part series. The guests were Rachel Manchester, Director of Nursing, Providence Home Health (WA) and Christine Opiela, Executive Director, Home Care Association of Washington. These two women were on the front lines in the state of Washington when COVID-19 first hit U.S. shores and were among the first to deal with its impact on home health. Their unique and valuable insights are useful to anyone in the industry and if you missed it, we urge you to look for the recording.
The town halls take place on Wednesdays from 1:00 PM to 2:30 PM Eastern.
We will publish a link to this fifth webinar in this series ASAP. Look for it in this newsletter.
Watch the fourth webinar in this series HERE.
Here is a link to the second Town Hall, if you missed it.
If you missed the third webinar, on April 8, you can watch it here.
REGISTER NOW!
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Webinar on the The FY2021 Proposed Hospice Payment Rule and Update on Hospice COVID-19 Flexibilities
Did you miss the April 16 NAHC webinar on the FY2021 Proposed Hospice Rule? It also included lots of new information on new developments in hospice related to the COVID-19 pandemic. If you missed it, fear not, for you can still watch it for free RIGHT HERE.
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