Chapter Advocacy Roundtable (CAR) Monthly Call Pam Varhol CAR Chair New England Chapter April 17, 2020 1 1
Agenda • U.S. Federal & State Actions: COVID -19 • Announcements • Open Discussion on COVID -19 2
Coronavirus Aid, Relief, and Economic Security (CARES) Act Key Health IT Provisions David Gray Se nio r Ma na g e r, G o v e rnme nt Re la tio ns & Co nne c te d He a lth Po lic y 3 3
Congressional Action to COVID-19 COVID #1 - Coronavirus Preparedness and Response Supplemental Appropriations Act • Sig ne d into la w Ma rc h 6, 2020 • Pro vide d $8.3 billio n in e me rg ency funding fo r fe de ra l a g e ncie s to re spo nd to COVID- 19 pa nde mic • Gra nte d HHS Se c re ta ry wa ive r a utho rity o ve r 1834(m) o rig ina ting site re stric tio ns o n te le he a lth • Allo we d rura l AND urba n site s, a nd be ne fic ia ry’s ho me , to se rve a s e lig ible o rig ina ting site s • R e quire d pro viders to ha ve a Me dic a re -esta blished re la tio nship with be ne fic ia r y in pre vio us 3 ye a rs COVID #2 - Families First Coronavirus Response Act • Sig ne d into la w Ma rc h 18, 2020 • Fo c used o n pa id le a ve , fre e c o ro na virus te sting , pro te ctio n fo r public he a lth wo rke rs, a nd e xpa nde d be ne fits fo r c hildre n a nd fa milie s • Mo difie d “Qua lifie d Pro vider” la ng ua g e fo r Me dic a re te le hea lth se rvic es to a llo w re quire d pre existing re la tio nship to be e sta blishe d o utside the Me dic a re pro g ram COVID #3 - Coronavirus Aid, Relief and Economic Security (CARES) Act • Sig ne d into la w Ma rc h 27, 2020 • Ove r $2 trillio n re lie f pa c ka g e fo c used o n he a lthc a re de live ry, sta te & lo c a l funding , busine ss a nd no n-profi t re lie f, a nd o ve ra ll e c o nomic stimulus. • Pro vide s fina nc ia l re lie f, a dva nced re imbursement pa yme nts, a nd e xpa nded te le hea lth fle xibility COVID #4, 5, 6 - ??? 4
Medicare Telehealth Takeaways (*limited to COVID-19 PHE) • a nts (Se c . 3212): - Re a utho rize s HRSA’ s g ra nt pro g ra ms tha t pro mo te the use o f te le he a lth. T he b ill HRSA Gr a utho rize s $29 millio n a nnua lly thro ug h F Y 2025, with a t le a st 50% o f the funds a wa rde d fo r pro je c ts in rura l a re a s vic e s (Se c . 3701) - Allo ws fo r Hig h De duc tib le He a lth Pla ns (HDHP) with a He a lth Sa v ing • *HSAs for T e le he a lth Se r Ac c o unt (HSA) to c o v e r te le he a lth se rv ic e s prio r to a pa tie nt re a c hing the de duc tib le . • le xibilitie s (Se c . 3703) - Re mo v e s the re q uire me nt tha t a pro v ide r must ha v e tre a te d the *Me dic a r e T e le he a lth F pa tie nt in the pa st thre e ye a rs. F urthe r, the se c tio n e xpa nds the Se c re ta ry’ s wa iv e r a utho rity o v e r a ll 1834(m) sta tuto ry re stric tio ns. • e le he a lth Dista nc e Site s (Se c . 3704) - Allo ws F e de ra lly Q ua lifie d He a lth Ce nte rs a nd Rura l He a lth Clinic s to se rv e *T a s a dista nt site fo r te le he a lth se rv ic e s during the CO VID-19 e me rg e nc y. (Se c . 3705) - E limina te s the re q uire me nt tha t a ne phro lo g ist c o nduc t so me o f the • *Home Dia lysis Pa tie nts Wa ive r pe rio dic e v a lua tio ns o f a pa tie nt o n ho me dia lysis fa c e -to -fa c e during the CO VID-19 e me rg e nc y pe rio d. • e le he a lth Wa ive r(Se c . 3706) - Allo ws q ua lifie d pro v ide rs to use te le he a lth to fulfill the ho spic e *Hospic e Ca r e T fa c e -to -fa c e re c e rtific a tio n re q uire me nt during the CO VID-19 e me rg e nc y pe rio d. s (Se c . 3707) - Dire c ts HHS to issue • *T e le c ommunic a tions, Re mote Pa tie nt Monitor ing a nd T e le he a lth Wa ive r g uida nc e e nc o ura g ing the use o f te le c o m syste ms, inc luding RPM, to furnish ho me he a lth se rv ic e s during the CO VID-19 e me rg e nc y. a l Communic a tions Commission - Pro v ide s $200 millio n fo r the F CC to suppo rt the e ffo rts o f pro v ide rs b y • F e de r pro v iding te le c o mmunic a tio ns se rv ic e s, info rma tio n se rv ic e s, a nd de v ic e s ne c e ssa ry to e na b le the pro v isio n o f te le he a lth se rv ic e s. 5
Additional Key Health and Health IT Provisions • niza tion - Autho rize s $500 millio n fo r pub lic he a lth da ta surve illa nc e a nd infra struc ture CDC Public Hea lth Da ta Moder mo de rniza tio n e ffo rts a t the CDC, sta te , a nd lo c a l he a lth de pa rtme nts • g enc y Fund – Pro vide s $100 b illio n fo r o ur he a lth syste m to pre ve nt, pre pa re fo r, a nd Public Hea lth a nd Soc ia l Ser vic es E m er re spo nd to c o ro na virus, do me stic a lly o r inte rna tio na lly. • 42 CFR Pa r t 2 Cha ng es • Ame nds re g ula tio ns g o ve rning the c o nfide ntia lity a nd disc lo sure o f sub sta nc e use diso rde r re c o rds, inc luding a llo wing c e rta in re -disc lo sure s to c o ve re d e ntitie s, b usine ss a sso c ia te s, o r o the r pro g ra ms sub je c t to HIPAA a fte r o b ta ining the pa tie nt’ s prio r writte n c o nse nt. • HHS Se c re ta ry sha ll issue g uida nc e within 180 da ys o n the sha ring o f pa tie nts’ pro te c te d he a lth info rma tio n re la te d to COVID- 19, inc luding g uida nc e o n c o mplia nc e with HIPAA re g ula tio ns a nd a pplic a b le po lic ie s. • a tion – e xte nds funding fo r the se pro g ra ms (a nd Com m unity Hea lth Center s a nd Com m unity Menta l Hea lth Ser vic es Dem onstr o the rs) thro ug h No ve mb e r 30, 2020 • elief Fund - Pro vide s $150 b illio n to Sta te s, Te rrito rie s, a nd Trib a l g o ve rnme nts to use fo r e xpe nditure s inc urre d due to Cor ona vir us R the pub lic he a lth e me rg e nc y with re spe c t to COVID-19 in the fa c e o f re ve nue de c line s, • I nc r ea sed R eim bur sem ent a nd Additiona l Wa iver s a nd Flexibilities: • Te mpo ra rily suspe nds 2% Me dic a re se q ue stra tio n fo r the pe rio d Ma y 1, 2020 thro ug h De c e mb e r 31, 2020 • Me dic a re a dd-o n pa yme nts fo r inpa tie nt ho spita l COVID-19 pa tie nts, inc re a sing the pa yme nt tha t wo uld o the rwise b e ma de to a ho spita l fo r tre a ting the se c o mple x pa tie nts b y 20 pe rc e nt. • Give s a c ute c a re ho spita ls fle xib ility during the COVID-19 e me rg e nc y pe rio d to tra nsfe r pa tie nts o ut o f the ir fa c ilitie s a nd into a lte rna tive c a re se tting s (suc h a s po st-a c ute c a re ) in o rde r to prio ritize re so urc e s ne e de d to tre a t COVID-19 c a se s • Pr ovides a dditiona l funding to a ddr ess issues a r ound Sm a r t Com m unities, SDOH, Pr ec ision Medic ine 6
HIMSS CARES Act Summary of Key Provisions https:/ / www.himss.or g / ne ws/ c a r e s-a c t-pr ovisions-he a lthc a r e -a nd-he a lth-it
US Federal Policy Responses to COVID -19 Pandemic April 17, 2020 8 8
CMS Relaxes Telehealth Requirements • In- Sta te T e le he a lth L ic e nsure R e quire me nts • I n g e ne ra l, a pro vide r must b e lic e nse d in the sta te whe re the pa tie nt is lo c a te d a t the time o f tre a tme nt • CMS ha s wa ive d this re q uire me nt fo r Me dic a re pa tie nts • Sta te s c a n re q ue st a Me dic a id wa ive r fro m CMS • Ac c ording to the F e de ra tion of Sta te Me dic a l Boa rds, 44 sta te s ha ve wa ive rs in pla c e for the ir Me dic a id prog ra ms for this purpose • CMS Inte rim CMS F ina l R e g ula tion pe rmits 80 a dditiona l te le he a lth se rvic e s • Aud io -o nly visits • Inpatie nt re habilitatio n, ho spic e , and ho me he alth fac ilitie s • Re mo te patie nt mo nito ring • Prio r pro vid e r-patie nt re latio nship no lo ng e r ne e d e d 9
Other CMS Actions Granting More Flexibility • Physic ian Se lf- R e fer r al R ule s • On Marc h 30, CMS issue d b lanke t waivers o f sa nc tions und e r the p hysic ia n se lf-re ferral law fo r COVID-19 p urp o ses, p ro viding vital fle xibility fo r p hysic ians a nd p ro vid e r s • T he wa ive rs a re e ffe c tive Marc h 1, 2020, a nd ma y b e use d witho ut no tifying CMS • Quality Payme nt Pr ogr am and Quality R e por ting Pr ogr am/ Value -Based Pur c hasing • De a d line fo r 2019 sub missio n e xte nd e d until Ap ril 30, 2020 • COVID-19 ha s trigge re d implementatio n o f the MIPS Auto ma tic E xtre me a nd Unc o ntr o llable Circ umsta nc e s (E &UC) p o lic y • Clinic ians who d o n’ t sub mit d a ta will a uto ma tic ally re c e ive a ne utra l p a yment a d justment in 2021 • T he a uto ma tic p o lic y d o e s no t a p p ly to gro up s o r vir tual gro up s • Re q uired to c o mp lete a n a p p lic atio n if d a ta ha s a lre ad y b e e n sub mitted • Gra nting e xc e p tio ns fro m re p o rting re q uir e me nts a nd e xte nsio ns fo r c linic ians a nd p ro vide r s p a rtic ipating in Me dic are q ua lity re p o rting p ro gra ms fo r up c o ming me a sure re po rting a nd d a ta sub missio n 10
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