March 30, 2020
Workforce Expanded; New Federal Reporting; and more …
|State Authorizes Process for New Rates, Supplemental Payments
By this executive order today, Governor Baker, citing the excessive demands COVID-19 has placed on healthcare providers has authorized the creation of “classes of health and human service providers” that will be issued “temporary rates and supplemental payments.” EOHHS will establish “new rate and payment methodologies and arrangements to reflect the new modalities through which providers are delivering their services.” The new payments and methodologies go into effect with the publication of Administrative Bulletins.
State Order Expands Healthcare Workforce
If you are a licensed out-of-state provider in good standing, or if you were licensed in Massachusetts within the past 10 years and your license expired or wasn’t renewed, the state wants you to be able to practice again. A new order issued yesterday by DPH Commissioner Monica Bharel, M.D., seeks to expand the workforce in Massachusetts able to combat the COVCID-19 epidemic. Those Massachusetts providers who had their licenses revoked, suspended, or surrendered aren’t eligible. But commonwealth providers who have retired or who let their licenses lapse, and providers from other states who can present evidence they’re in good standing, will be able to practice in Massachusetts.
Federal Government Adds New Reporting Layer
Vice President Mike Pence sent a letter to all hospitals this weekend asking that hospital laboratories that are conducting their own in-house COVID-19 tests report the data each day to FEMA/CDC. Hospitals are also being asked to report on daily capacity, deaths, and more.
The laboratory reporting is due each day by 5 p.m. using this 9-data-element spreadsheet. Pence wrote that “if all of your COVID-19 testing is sent out to private labs and performed by one of the commercial laboratories on the list below, you do not need to report using the spreadsheet.” Those commercial labs are: LabCorp, BioReference Laboratories, Quest Diagnostics, Mayo Clinic Laboratories, and ARUP Laboratories.
In addition, Pence asked hospitals to report each day on a 13-data-field COVID-19 Patient Impact and Hospital Capacity Module. That data tracks such items as hospitalized and ventilated patients, ED overflow, deaths, number of beds, etc., and is being collected by the National Healthcare Safety Network (NHSN). The data form for the module and instructions for it are here. Hospitals are already reporting much of this data to the state.
CMS OKs MHA-Association Waiver Request
As has been reported, the EOHHS-drafted request for an 1135 waiver from certain aspects of the Medicaid program was granted – in part – by CMS last week. The Massachusetts request was one of dozens that CMS has rapidly approved. On Saturday CMS approved a new waiver request from MHA and a group of 16 other state hospital associations. The associations compiled waivers that CMS has approved for individual states and, noting that hospitals in many states could benefit from the same relief, asked CMS to extend those individual waivers across state lines. The approved waivers, which have a retroactive effective date of March 1, 2020, concern such things as EMTALA, verbal orders, reporting, sterile compounding, and more. See the new waivers that MHA and the associations were able to get for the state. And see this list of blanket waivers from CMS.
CMS to Offer Accelerated and Advance Payment Program
As noted in an MHA Advisory yesterday, CMS announced the expansion of its accelerated and advance payment program for Medicare participating healthcare providers, including hospitals and physicians. Accelerated and advance Medicare payments address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. Medicare will start immediately accepting and processing Accelerated/Advance Payment Requests that are submitted to the appropriate Medicare Administrative Contractor (MAC). CMS anticipates that the payments will be issued within seven days of the provider’s request. Qualified providers/suppliers must request a specific amount to be paid using an “Accelerated or Advance Payment Request” form provided on each MAC’s website. Inpatient acute care hospitals, children’s hospitals, and cancer hospitals can request up to 100%, and CAHs can request up to 125% of their historical Medicare payment amount for a six-month period. Most other providers and suppliers will be able to request up to 100% of their historical Medicare payment amount for a three-month period. Repayment of the accelerated/advance payment begins 120 days after the date of issuance of the payment. An informational fact sheet on the accelerated/advance payment process and how to submit a request is here.
Beaumont Rehab is the First Dedicated COVID-19 Facility
The first dedicated skilled nursing facility to care for patients who have been diagnosed with COVID-19, are stable, but still need nursing facility level of care has been established at Beaumont Rehabilitation and Skilled Nursing Center in Worcester. Patients without COVID-19 that already were in Beaumont are being moved to other facilities in the area where they can continue to receive nursing care. The reasoning is as follows: elderly, stable COVID-19 patients need to be moved from acute care hospitals to make room for the surge of patients expected in the next few weeks. If those COVID-19 nursing care patients were introduced into a nursing facility with other elderly patients the possibility of spreading the infection to a very at-risk population would be great. So the state is dedicating one facility for COVID-19 nursing care patients and moving the other patients to nearby facilities. Other such dedicated facilities are expected to follow.
DMH Reduces Regulatory Requirements
Today, DMH released guidance indicating reduced regulatory requirement for entities licensed by DMH. These provisions include the ability to reduce strict adherence to the DMH licensing minimum required nursing care hours per patient day requirements if necessary due to workforce challenges, as long as certain requirements are met. Additionally, programs and facilities whose licenses are in good standing that would otherwise expire during the state of emergency will remain in effect for a period of 90 days after the termination of the state of emergency. If a license expired prior to the issuance of this order, but a request for license renewal was previously submitted, action on the renewal application will be suspended for this period of time, as will corrective action plans that are not directly related to life/safety issues. DMH will be issuing letters to each facility affected by this order clarifying its status. Any hospital or unit with an outstanding corrective action plan or order of correction that is not related to a health and safety deficiency may individually request an extension of the due date for responses.
DMH Hospitals: Make Requests to DMH, Not DPH
All DMH-licensed freestanding hospitals should submit their personal protective equipment (PPE) requests directly to DMH, as opposed to DPH. Use this Resource Request Form and send it to Liam.Seward@massmail.state.
UMass Memorial Uses UV Light to Decontaminate N95s
UMass Memorial Medical Center has begun a pilot project to decontaminate N95 masks with ultraviolet light. A hospital in Nebraska had earlier received national attention for using the UV decontamination method on masks. The approach has been under investigation for a number of years at the University of Nebraska linked to the university’s status as one of the US Bioterrorism-Emerging Pathogen sites. Here is the protocol from Nebraska Medicine. UMass said that the UV disinfection component of the protocol it has developed isn’t changing, but the logistics of how the masks are labelled and transported back and forth continues to be revised by the staff that has operationalized the system.
Loan Details of $2.2T Relief Bill
The $2.2 trillion Coronavirus Aid, Relief and Economic Security (CARES) Act contains money for grants to hospitals, the details of which are still not entirely worked out. However there are other relief components hospitals can take advantage of as noted in this AHA Bulletin:
Small Business Administration (SBA) Loans via the “Paycheck Protection Program” target both for-profit and non-profit organizations with fewer than 500 total employees. Under certain circumstances, these loans (or a portion of them) may be forgiven. The AHA estimates that approximately 700 hospitals may be eligible for a total of $7 billion.
Payroll Tax Delay. Employers may delay payment of the employer share of the Social Security portion of the Federal Insurance Contributions Act (FICA) between the date of enactment and Dec. 31, 2020. This payroll tax delay essentially functions as an interest free loan for nine months, which would need to be repaid over the next two years. Nearly all hospitals and health systems would be eligible for these delayed payments.
Other Business Loans through the Federal Reserve. The legislation authorizes $500 billion in business loans using the Federal Reserve’s emergency lending authority. While these loans may be available to a wide range of businesses, the legislation directs the Treasury “to endeavor to implement” loan programs specifically targeted for nonprofit organizations and businesses between 500 and 10,000 employees.
Potential FCC Funding for Telecommunications
FCC Chairman Ajit Pai has announced plans for $200 million appropriated through the CARES Act to support telehealth services. If approved, the COVID-19 Telehealth Program would support eligible healthcare providers in purchasing telecommunications services, information services, and devices necessary to enable the provision of telehealth services during the emergency period. It would provide selected applicants with full funding for eligible telehealth services and devices. In order to receive funding, providers would submit a streamlined application to the FCC. The announcement is available here. In addition, the FCC issued final rules regarding a broader, longer-term Connected Care Pilot Program. It targets funding to pilot projects that would primarily benefit low-income or veteran patients. The Pilot Program would make available up to $100 million, which would be separate from the budgets of the existing Universal Service Fund programs and the COVID-19 Telehealth Program.
Donation Site for PPE
The Baker Administration announced an online portal where individuals and companies can easily donate or sell personal protective equipment (PPE) and volunteer to support the COVID-19 outbreak in Massachusetts. The Commonwealth’s COVID-19 PPE Procurement and Donation Program creates an easy portal allowing companies and organizations to sell or donate protective equipment that is in short supply given the global demands for such items.
EMS Doesn’t Have to Transport Patients Who Can Self-Care at Home
Then state has issued a directive to EMS personnel allowing then to deny transport to patients who have mild COVID-19 symptoms, no other complaints, and who do not appear to require hospital-level treatment and resources. The State EMS Medical Director issued an algorithm for assessing which patients who, in consultation with online medical control, qualify for continued self-care at home. EMS will not need to obtain a patient refusal of transport for patients falling under this protocol. EMS crews using the protocol have to write up a report on their patient interaction and record the name of the online medical control physician who participates in the evaluation. EMS stresses that personnel have to be well trained in the protocol before putting it into practice. Here is the temporary waiver for non-transport. And here is the protocol.
COVID-19 Mortuary Concerns
DPH and the Massachusetts Office of the Chief Medical Examiner are working c with hospital morgue directors and private sector mortuary partners to ensure continuity of services in the commonwealth during the COVID-19 pandemic. DPH announced that within the coming week Massachusetts will open a facility to address any COVID-19-related mortuary needs, in particular the handling of remains. Instructions on accessing the facility will be sent to morgue directors from DPH. The Massachusetts Funeral Directors Association is asking hospitals to consider that funeral directors may also need PPE equipment. Shortages of such equipment may cause delays in the transfer of deceased persons, and if a hospital morgue is facing a severe surge situation, the availability of PPE for the funeral establishment could help expedite the transfer, the association says.