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Tamar Hodges RN, JD

Tamar is a healthcare attorney and registered nurse bringing clients a 360-degree view of healthcare regulation. In addition to counseling clients on complex healthcare regulatory matters, her experience includes nursing on medical-surgical and intensive care units at Level 1 trauma centers, coordinating risk management for a pediatric academic medical center, and serving on hospital ethics committees. Tamar understand regulation from all perspectives: drafting, implementation and enforcement.

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Dentist

On July 10, 2020, the U.S. Department of Health and Human Services (HHS) announced dentists and other dental providers are eligible to apply for relief from the Provider Relief Fund. The Provider Relief Fund General Distribution FAQs outlined the eligibility requirements and payment methodology for calculating distribution amounts. The deadline for applying is July 24, 2020.

Due to expanded COVID-19 diagnostic testing availability, the Missouri Department of Health and Senior Services (MDHSS) is encouraging providers to test both symptomatic and asymptomatic individuals, if the clinician’s medical judgment determines it is necessary. At the same time, MDHSS also posted words of caution regarding the use of serological testing, which is not considered diagnostic for COVID-19 but rather detects antibodies which could reveal exposure to SARS-CoV- 2 (the virus which causes COVID-19) or a different  infection, including other strains of coronavirus, altogether. The recent MDHSS COVID-19 Serological Testing Quick Facts (Quick Facts) cautions that:

Since February 6, 2020, the Centers for Medicare and Medicaid  (CMS) issued official Coronavirus (COVID-19) guidance for health care providers in all care settings to implement in an effort to control the rate of COVID-19 transmission. However, a special focus is on nursing facilities because these facilities house the country’s population most susceptible to COVID-19. In the CDC’s March 18, 2020 Morbidity and Mortality Weekly Report (MMWR), the agency highlights the COVID-19 outbreak at a nursing home in King County, Seattle, Washington, in which 81 of the 130 residents (62%) contracted COVID-19, and 49 of those residents were hospitalized. The median age of the infected residents was 81 years old. To date, 80% of deaths related to COVID-19 are of persons 65 years old or greater.  Therefore, it is imperative nursing homes take drastic measures to reduce the risk of severe illness or death associated with COVID-19. Husch Blackwell’s answers to the Frequently Asked Questions below follow the current CDC and CMS guidance which outlines these drastic measures.

physicians

COVID-19 Update: CMS Waiver Information for Private Practice Physicians and Non-Physician Practitioners

By Hal Katz and Tamar E. Hodges

President Donald Trump declared the coronavirus pandemic a National Emergency on March 13, 2020. This declaration granted the Department of Health and Human Services (HHS) Secretary Alex Azar authority to relax certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements set forth in Section 1135 of the Social Security Act. The primary purpose of this waiver is to give providers greater flexibility to meet the needs of Medicare, Medicaid, and CHIP beneficiaries during an emergency.  CMS may issue “blanket waivers” after a declaration of a public health emergency when it determines many “similarly situated providers” would require certain waivers. CMS requires providers to put the state licensing agency and CMS Regional Office on notice if it intends to modify their operations in light of such waivers, although the blanket waivers are essentially automatic and, therefore, do not require the provider to submit a request. The waiver is in effect through the duration of the emergency or until CMS terminates the waiver.

In the wake of the COVID-19 global pandemic declaration, hospice providers are faced with the difficult conundrum of ensuring the continuity of care for their vulnerable patients while attempting to comply with the recent CDC and CMS guidelines regarding post-acute care facilities’ lock-down procedures. There is no question the intentions of long-term care facilities are well-meaning in an effort to protect its residents who are most susceptible to COVID-19 complications.[1] However, these precautionary measures put residents receiving hospice services at risk of missing supportive treatment and important care planning.  The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) derived its skilled nursing facility visitor restriction recommendations from the CMS revised guidance issued March 9, 2020, and hospice providers should take note of these recommendations to ensure they are not prohibited from caring for their patients.

As the novel coronavirus outbreak continues, the federal government and commercial health insurers have taken significant steps to increase Americans’ access to treatment and testing. In the past week, the federal government and private insurers have issued a number of guidance documents expanding coverage and payment requirements in an effort to minimize the spread of the virus. As with any changes in coverage and reimbursement, healthcare providers offering telehealth services should carefully review these changes and take steps to ensure that all regulatory and coverage requirements are met prior to submitting claims for reimbursement.

I. Medicare

On March 6, 2020, the bipartisan Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (“Coronavirus Appropriations Act”) was signed into law authorizing federal spending to combat the ongoing coronavirus outbreak in the United States. This Act, among other things, gives the United States Department of Health and Human Services’ (“HHS”) secretary the authority to temporarily waive certain Medicare requirements for telehealth services.

The Centers for Medicare and Medicaid Services (“CMS”) currently reimburses a limited set of telehealth services provided to Medicare beneficiaries subject to certain criteria under section 1834(m) of the Social Security Act. Generally, the patient receiving telehealth services must be located at one of eight “originating sites”, which include hospitals, physicians’ offices, and rural health clinics. In addition, the originating site must meet certain geographic requirements which have essentially limited the availability of telehealth to patients in rural areas. These requirements have long posed a hurdle to the expansion of telehealth despite the industry’s demand for lessened restrictions. However, with the rapid spread of the coronavirus and the possibility of facing large scale isolations and quarantines, lawmakers have signaled their willingness to expand access to telehealth to fight against this public health crisis.

Within the Coronavirus Appropriations Act is the Telehealth Services During Certain Emergency Periods Act of 2020, which sets forth the waiver authority for the secretary of HHS regarding the certain telehealth requirements. Under the Telehealth Services During Emergency Periods Act, the secretary is authorized to temporarily waive the originating site and geographic requirements for telehealth services provided to Medicare beneficiaries located in an identified “emergency area” during an “emergency period” when provided by a qualified provider. To qualify for the waiver, the provider must have treated the patient within the previous three years or be in the same practice (i.e., as determined by tax identification number) of a practitioner who has treated the patient in the past three years. The bill also lessens the telecommunications requirements by allowing Medicare beneficiaries to receive telehealth services via their smartphones (i.e., telephones that allow for real time, audio-video interaction between the provider and the beneficiary). Because the federal government has declared a nationwide public health emergency as a result of the coronavirus, the waiver will apply across the country until there is no longer a nationwide public health emergency.

Players in the healthcare industry continue to identify ways to use technological innovations to decrease overhead expenditures and increase bottom lines.  AI software to automatize EHR documentation in place of human input, mobile apps and portals to grant patients immediate access to their medical records, and blockchain technology to accelerate claims adjudication are some examples. In particular, commercial health insurers have employed various cost containment measures to minimize non-claim expenses. One measure involves the use of virtual credit cards, or VCCs, in lieu of traditional payment methods to reimburse providers for services rendered to plan enrollees. A VCC is linked to the payer source’s credit card account but generates a new 16-digit single-use number each time the physical card’s 16-digit number is used. Payers send providers the number with instructions to access and process these payments electronically.