COVID-19 Resources
COVID-19 Data from the MS Dept of Health. For "daily" updates from their official website relating to the coronavirus, CLICK HERE.
Local COVID-19 testing: MDH now has a list of local COVID-19 testing providers for you to contact if you have symptoms: View local testing providers »
COVID-19 Resources and Policy Changes
There have been significant changes in the practice of medicine in the state since last Friday’s E-Update. As the week has progressed, the Mississippi Psychiatric Association has been working to develop guidelines for providers in order to best protect themselves and meet the needs of their patients in a safe and effective manner.
Please find an update, below, of policy changes enacted by various state and national organizations related to COVID-19. Please contact those agencies directly for clarification that is not understood. MPA sees this as an ongoing effort to keep you abreast of state and federal changes effecting you and your patients. .
Mississippi Division of Medicaid (DOM) NEW
Department of Health & Human Services
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S2-26-12
Baltimore, Maryland 21244-1850
March 23, 2020
Mr. Drew L. Snyder
Executive Director
Mississippi Division of Medicaid
550 High Street, Suite 1000
Jackson, MS 39201-1399
Re: Section 1135 Flexibilities Requested in March 18, 2020 Communication
Dear Mr. Snyder:
On March 13, 2020, the President of the United States issued a proclamation that the COVID-19 outbreak in the United States constitutes a national emergency by the authorities vested in him by the Constitution and the laws of the United States, including sections 201 and 301 of the National Emergencies Act (50 U.S.C. 1601 et seq.), and consistent with section 1135 of the Social Security Act (Act). On March 13, 2020, pursuant to section 1135(b) of the Act, the Secretary of the United States Department of Health and Human Services invoked his authority to waive or modify certain requirements of titles XVIII, XIX, and XXI of the Act as a result of the consequences of the COVID-19 pandemic, to the extent necessary, as determined by the Centers for Medicare & Medicaid Services (CMS), to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the respective programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of such requirements as a result of the COVID-19 pandemic, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse. This authority took effect as of 6PM Eastern Standard Time on March 15, 2020, with a retroactive effective date of March 1, 2020. The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the public health emergency, including any extensions.
Your communication to CMS on March 18, 2020, detai1ed a number of federal Medicaid, the Children’s Health Insurance Program (CHIP), and Medicare requirements that pose issues or challenges for the health care delivery system in all counties in Mississippi and requested a waiver or modification of those requirements. Attached, please find a response to your requests for waivers or modifications, pursuant to section 1135 of the Social Security Act, to address the challenges posed by COVID-19. This approval addresses those requests related to Medicaid, Medicare, and CHIP.
To streamline the section 1135 waiver request and approval process, CMS has issued a number of blanket waivers for many Medicare provisions, which primarily affect requirements for individual facilities, such as hospitals, long term care facilities, home health agencies, and so on. Waiver or modification of these provisions does not require individualized approval, and, therefore, these authorities are not addressed in this letter. Please refer to the current blanket waiver issued by CMS.
CMS continues to work on the additional waiver or modification requests that are not currently reflected in the attached approval. For those waiver or modification requests that require approval under authority other than section 1135, such as under applicable regulations, through an amendment to the state plan, or through a section 1115 demonstration, my staff will continue to work with your team to review and make determinations regarding approval as quickly as possible.
Please contact Jackie Glaze, Acting Director, Medicaid and CHIP Operations Group, at (404) 387-0121 or by email at Jackie.Glaze@cms.hhs.gov if you have any questions or need additional information. We appreciate the efforts of you and your staff in responding to the needs of the residents of the State of Mississippi and the health care community.
Sincerely,
Calder Lynch
Deputy Administrator and Director
STATE OF MISSISSIPPI
FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: March 23, 2020
Temporarily suspend Medicaid fee-for-service prior authorization requirements. Section 1135(b)(1)(C) allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.
Prior authorization and medical necessity processes in fee-for-service delivery systems are established, defined and administered at state/territory discretion and may vary depending on the benefit. See 42 C.F.R. §440.230(d). Under section 1135(b)(1)(C) of the Act, CMS is approving the State of Mississippi’s request to waive or modify the following state plan prior authorization requirements and processes for benefits administered through the fee-for-service delivery system.
Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
If prior authorization processes are outlined in Mississippi’s state plan for particular benefits, CMS is using the flexibilities afforded under section 1135(b)(1)(C) of the Act that allow for waiver or modification of pre-approval requirements to permit services approved to be provided on or after March 1, 2020, to continue to be provided without a requirement for a new or renewed prior authorization, through the termination of the public health emergency, including any extensions (up to the last day of the emergency period under section 1135(e) of the Act), for beneficiaries with a permanent residence in the geographic area of the public health emergency declared by the Secretary.
Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
Section 1919(e)(7) of the Act allows Level I and Level II assessments to be waived for 30 days. All new admissions can be treated like exempted hospital discharges. After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) should receive a Resident Review as soon as resources become available.
Additionally, please note that per 42 C.F.R. §483.106(b)(4), new preadmission Level I and Level II screens are not required for residents who are being transferred between nursing facilities (NF). If the NF is not certain whether a Level I had been conducted at the resident's evacuating facility, a Level I can be conducted by the admitting facility during the first few days of admission as part of intake and transfers with positive Level II screens would require a Resident Review.
The 7-9-day timeframe for Level II completion is an annual average for all preadmission screens, not individual assessments, and only applies to the preadmission screens (42 C.F.R. §483.112(c)). There is not a set timeframe for when a Resident Review must be completed, but it should be conducted as resources become available.
State Fair Hearing Requests and Appeal Timelines
Mississippi requested flexibility to temporarily delay scheduling of Medicaid fair hearings and issuing fair hearings decisions during the emergency period. CMS approves a waiver under section 1135 that allows enrollees to have more than 90 days, up to an additional 120 days for an eligibility or fee for service appeal to request a fair hearing. The timeframes in 42 C.F.R. §431.221(d) provides that states can choose a reasonable timeframe for individuals to request a fair hearing not to exceed 90 days for eligibility or fee-for-service issues.
CMS cannot waive parts of the Medicaid managed care regulations at 42 C.F.R. Part 438 Subpart F related to appeals of adverse benefit determinations which occur before Fair Hearings for managed care enrollees or parts of 42 C.F.R. Part 431, Subpart E. However, CMS is able to modify the federal timeframes associated with appeals and fair hearings. Therefore, CMS approves the following through the end of the public health emergency:
Modification of the timeframe for managed care entities to resolve appeals under 42 C.F.R. §438.408(f)(1) before an enrollee may request a State fair hearing to no less than one day in accordance with the requirements specified below; this allows managed care enrollees to proceed almost immediately to a state fair hearing without having a managed care plan resolve the appeal first by permitting the state to modify the timeline for managed care plans to resolve appeals to one day so the impacted appeals satisfy the exhaustion requirements.
The requirements of 42 C.F.R. §438.408(f)(1) establish that an enrollee may request a State fair hearing only after receiving a notice that the Managed Care Organization (MCO), Prepaid Inpatient Health Plan (PIHP) or Prepaid Ambulatory Health Plan (PAHP) is upholding the adverse benefit determination but also permits, at 42 C.F.R. §438.408(c)(3) and (f)(l)(i) that an enrollee's appeal may be deemed denied and the appeal process of the managed care plan exhausted (such that the State fair hearing may be requested) if the managed care plan fails to meet the timing and notice requirements of 42 C.F.R. §438.408. Section 1135 of the Act allows CMS to authorize a modification to the timeframes for required activities under section 1135(b)(5) of the Act. CMS authorizes the state to modify the time line for managed care plans to resolve appeals to no less than one day. If the state uses this authority, it would mean that all appeals filed between March 1, 2020 and the end of the public health emergency are deemed to satisfy the exhaustion requirement in 42 C.F.R. §438.408(f)(1) after one day (or more if that is the timeline elected by the state) and allow enrollees to file an appeal to the state fair hearing level.
Modification of the timeframe under 42 C.F.R. §438.408(f)(2) for enrollees to exercise their appeal rights to allow an additional 120 days to request a fair hearing when the initial 120th day deadline for an enrollee occurred during the period of this section 1135 waiver.
In addition, CMS approves a modification of the timeframe, under 42 C.F.R. §438.408(f)(2), for managed care enrollees to exercise their appeal rights. Specifically, any managed care enrollees for whom the 120-day deadline described in 42 C.F.R. §438.408(f)(2) would have occurred between March 1, 2020 through the end of the public health emergency, are allowed up to an additional 120 days to request a State Fair Hearing.
Provider Enrollment
Mississippi currently has the authority to rely upon provider screening that is performed by other State Medicaid Agencies (SMAs) and/or Medicare. As a result, Mississippi is authorized to provisionally, temporarily enroll providers who are enrolled with another SMA or Medicare for the duration of the public health emergency.
Under current CMS policy, as explained in the Medicaid Provider Enrollment Compendium (PDF 586.81 KB) (7/24/18), at pg. 42, Mississippi may reimburse otherwise payable claims from out-of-state providers not enrolled in Mississippi Medicaid program if the following criteria are met:
The item or service is furnished by an institutional provider, individual practitioner, or pharmacy at an out-of-state/territory practice location– i.e., located outside the geographical boundaries of the reimbursing state/territory’s Medicaid plan,
The National Provider Identifier (NPI) of the furnishing provider is represented on the claim,
The furnishing provider is enrolled and in an “approved” status in Medicare or in another state/territory’s Medicaid plan,
The claim represents services furnished, and;
The claim represents either:
A single instance of care furnished over a 180-day period, or
Multiple instances of care furnished to a single participant, over a 180-day period
For claims for services provided to Medicaid participants enrolled with Mississippi Medicaid program, CMS will waive the fifth criterion listed above under section 1135(b)(1) of the Act. Therefore, for the duration of the public health emergency, Mississippi may reimburse out-of-state providers for multiple instances of care to multiple participants, so long as the other criteria listed above are met.
If a certified provider is enrolled in Medicare or with a state Medicaid program other than Mississippi, Mississippi may provisionally, temporarily enroll the out-of-state provider for the duration of the public health emergency in order to accommodate participants who were displaced by the emergency.
With respect to providers not already enrolled with another SMA or Medicare, CMS will waive the following screening requirements under 1135(b)(1) and (b)(2) of the Act, so the state may provisionally, temporarily enroll the providers for the duration of the public health emergency:
Payment of the application fee - 42 C.F.R. §455.460
Criminal background checks associated with Fingerprint-based Criminal Background Checks - 42 C.F.R. §455.434
Site visits - 42 C.F.R. §455.432
In-state/territory licensure requirements - 42 C.F.R. §455.412
CMS is granting this waiver authority to allow Mississippi to enroll providers who are not currently enrolled with another SMA or Medicare so long as the state meets the following minimum requirements:
Must collect minimum data requirements in order to file and process claims, including, but not limited to NPI.
Must collect Social Security Number, Employer Identification Number, and Taxpayer Identification Number (SSN/EIN/TIN), as applicable, in order to perform the following screening requirements:
OIG exclusion list
State licensure – provider must be licensed, and legally authorized to practice or deliver the services for which they file claims, in at least one state/territory
Mississippi must also:
Issue no new temporary provisional enrollments after the date that the emergency designation is lifted,
Cease payment to providers who are temporarily enrolled within six months from the termination of the public health emergency, including any extensions, unless a provider has submitted an application that meets all requirements for Medicaid participation and that application was subsequently reviewed and approved by Mississippi before the end of the six month period after the termination of the public health emergency, including any extensions, and
Allow a retroactive effective date for provisional temporary enrollments that is no earlier than March 1, 2020.
Under section 1135(b)(1)(B), CMS is also approving Mississippi’s request to temporarily cease revalidation of providers who are located in Mississippi or are otherwise directly impacted by the emergency.
These provider enrollment emergency relief efforts also apply to the Children’s Health Insurance Program (CHIP) to the extent applicable.
Provision of Services in Alternative Settings
CMS approves a waiver under section 1135(b)(1) of the Act to allow facilities, including NFs, intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDDs), psychiatric residential treatment facilities (PRTFs), and hospital NFs, to be fully reimbursed for services rendered to an unlicensed facility (during an emergency evacuation or due to other need to relocate residents where the placing facility continues to render services) provided that the State makes a reasonable assessment that the facility meets minimum standards, consistent with reasonable expectations in the context of the current public health emergency, to ensure the health, safety and comfort of beneficiaries and staff. The placing facility would be responsible for determining how to reimburse the unlicensed facility. This arrangement would only be effective for the duration of the section 1135 waiver.
Duration of Approved Waivers
Unless otherwise specified above, the section 1135 waivers described herein are effective March 1, 2020 and will terminate upon termination of the public health emergency, including any extensions. In no case will any of these waivers extend past the last day of the public health emergency (or any extension thereof).
The Mississippi Division of Medicaid has added new procedure codes that can be used by providers and laboratories to bill for certain Coronavirus Disease 2019 (COVID-19) diagnostic to increase the testing and tracking of new cases.
The Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002 were developed by the Centers for Medicare and Medicaid Services (CMS), and DOM is in the process of entering them into its claims processing system. They should be available for billing later this week, and they will apply to dates of service on or after Feb. 4, 2020. Providers will be notified once the codes are available in the system.
The HCPCS code U0001 is specifically used for CDC testing laboratories to test patients for SARS-CoV-2. HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). The published fees for the two codes will be:
U0001 = $32.33
U0002 = $46.20
These fees do not include cutbacks, assessment fees, etc. Payment is not guaranteed.
For more information on the coverage or the evaluation and testing of COVID-19, find the following resources online:
Medicaid and CHIP Coverage and Payment Related to COVID 19
CDC Guidance on Evaluating and Testing Persons for COVID-19
Medicaid Updated Telehealth Regulations
In response to the coronavirus outbreak, the Mississippi Division of Medicaid (DOM) will expand its coverage of telehealth services throughout the state in alignment with Governor Tate Reeves’ recommendations on leveraging telemedicine to care for patients while limiting unnecessary travel, clinic visits and possible exposure.
Effective immediately through April 30, 2020, DOM’s Emergency Telehealth Policy will allow additional use of telehealth services to combat the spread of Coronavirus Disease 2019 (COVID-19). Details of enhanced services include the following:
A beneficiary may access telehealth services from his or her home.
A beneficiary may use his or her personal cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care with a qualified distant-site provider.
The requirement for a telepresenter to be present with the beneficiary is waived when the beneficiary receives telehealth services in the home.
Any provider that is eligible to bill DOM for services is now allowed to serve as a distant site provider, including Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Any limitation on the use of audio-only telephonic consultations is waived.
These enhanced telehealth options will be available in fee-for-service Medicaid, Medicaid managed care, and the Children’s Health Insurance Program.
The agency also is seeking federal approval for an 1135 Medicaid waiver to give the program a wider range of flexibilities during the emergency. If approved, the 1135 waiver would give DOM the discretion, when necessary and proper, to relax prior authorization requirements, eliminate Preadmission Screening and Annual Resident Review (PASRR) reviews at nursing homes, suspend revalidations for current providers, and expedite new provider enrollment.
Other requested Section 1135 flexibilities include allowing care to be provided in alternative settings, revising rules for critical access hospitals, and relaxing telehealth security requirements so that providers can use readily available platforms like Facetime and Skype to facilitate telehealth visits with patients.
Additional information on policies, coding, and reimbursement related to the COVID-19 outbreak will continue to be added to a resource page on the agency’s website at https://medicaid.ms.gov/coronavirus-updates/.
Providers are asked to direct their questions to 800-884-3222.
Note: To confirm, this now allows RHCs and FQHCs to be a distance site provider for Medicaid-reimbursed telehealth in Mississippi.
MSDH's New Reporting Requirements for Hospitals and LTC
Mississippi Hospitals "As cases of COVID-19 continue to increase, it is critical that the Mississippi State Department of Health have an accurate count of available hospital beds. The Office of Emergency Response and Planning has directed that all hospitals log in to the Mississippi State Department of Health Knowledge Center at knowledge-center.com and update their bed count each day by 9:00 AM and 5:00 PM."
Click here for official PDF.
Mississippi Nursing Homes"As cases of COVID-19 continue to increase, it is critical that the Mississippi State Department of Health have an accurate count of available beds. The Office of Emergency Response and Planning has directed that all Long Term Care facilities log in to the Mississippi State Department of Health Knowledge Center at knowledge-center.com and update their bed count each day by 9:00 AM and 5:00 PM."
Click here for official PDF.
Commercial Payers (Note that coverage varies by individual policy) NEW
Anthem, National: View guidance here.
Anthem Georgia: View guidance here.
BlueCross BlueShield, National: View guidance here.
BlueCross Arkansas: View guidance here.
BCBS Louisiana: View guidance here.
BlueCross of Tennessee: View guidance here.
Capitol Blue: View guidance here.
CareFirst: View guidance here.
Cigna: View guidance here.
Highmark: View guidance here.
Horizon: View guidance here.
Humana: View guidance here.
Independence Blue Cross: View guidance here.
Magellan: View guidance here.
Optum Behavioral Health: Optum has released their telehealth guidance to allow a range of remote services including telephone and telehealth using an expanded number of platforms.
Premera BlueCross: View guidance here.
Regence: View guidance here.
Wellmark Blue Cross: View guidance here.
Blue Cross Blue Shield of Mississippi NEW
In response to the COVID-19 pandemic, Blue Cross & Blue Shield of Mississippi is ensuring expanded access to care, to include enhanced telemedicine coverage. This is important given the nature of the COVID-19 outbreak and the Centers for Disease Control and MS State Department of Health direction to self-isolate, not use the emergency room and call your primary care provider. Effective March 16, 2020, the BCBSMS COVID-19 Pandemic Telemedicine Policy allows Healthcare Providers to provide medically necessary services that can be appropriately delivered via audio and/or visual consultation. The BCBSMS COVID-19 Pandemic policy is effective March 16, 2020 through April 30, 2020, and will be reassessed as needed.
Specific guidelines are noted below:
Telemedicine, in this Policy, is appropriate for visits for either low complexity, routine or ongoing evaluation and management for established patients, as well as addressing new and established patient needs related to COVID-19 symptoms.
Member cost-sharing (co-pays, deductibles, etc) and benefit levels will apply according to the Blue Cross and Blue Shield Member's Health and Wellness Benefit Plan. BCBSMS will waive the co-pay for all Network Provider covered telemedicine visits for fully-insured Members.
For routine evaluation and management of established patients, Healthcare Providers (MDs, DOs and professional Allied Providers, such as Nurse Practitioners) may bill for established patient evaluation and management codes up to a Level 3 (CPT codes 99211, 99212 and 99213) with a place of service 02 (Telehealth), regardless if provided telephonically or using visual equipment. Please note, however, providers should only bill for telephonic visits when the provider speaks directly to the patient. Providers should not bill BBSMS for services when only office staff and/or a nurse speaks with the patient, regardless if a provider was consulted.
To address new patient needs relative to COVID-19 symptoms, Healthcare Providers (MDs, DOs and professional Allied Providers, such as Nurse Practitioners) may bill for new patient evaluation and management codes up to a Level 2 (CPT codes 99201 and 99202) with a place of service 02 (Telehealth), regardless if provided telephonically or using visual equipment. Please note, however, providers should only bill for telephonic visits when the provider speaks directly to the patient. Providers should not bill BCBSMS for services when only office staff and/or a nurse speaks with the patient, regardless if a provider was consulted.
Behavioral Health Providers (Psychiatrists, Psychologists, Licensed Professional Counselors, and Licensed Certified Social Workers) may bill for established patient visits and evaluation and management codes as follows with a place of service 02 (Telehealth): -CPT codes 99211, 99212 and 99213 - CPT code 90832
All services must be medically necessary and documented as part of the Member's permanent health record, to include the amount of time spent with the patient. Patient must give consent to be treated virtually and/or telephonically and appropriately documented in the medical record prior to initiation of telemedicine.
This policy only applies to medically necessary visits that are patient-initiated or are replacing a previously scheduled visit.
Mississippi Board of Medical Licensure (MSBML)
The Mississippi Board of Medical Licensure created recent policy changes that are in effect during the Governor’s State of Emergency:
1. Providers are highly encouraged to utilize telemedicine whenever possible for treating patients to avoid unnecessary clinic visits and possible exposure
2. The Mississippi Board of Medical Licensure shall allow non-Mississippi licensed physicians to provide telemedicine within Mississippi
3. Urine drug screens are not required for controlled substances, but use of the MPMP is still enforced.
Mississippi Board of Nursing (MSBN)
The Mississippi State Board of Nursing created recent policy changes that are in effect during the Governor’s State of Emergency:
1. APRNs are highly encouraged to utilize telemedicine whenever possible for treating patients to avoid unnecessary clinic visits and possible exposure
2. Non-Mississippi licensed APRNs with an unrestricted out of state licensure are allowed to provide telemedicine within Mississippi
3. Point of service drug testing is not required for controlled substances, but use of the MPMP is still enforced.
Mississippi State Department of Health (MSDH)
Prior approval from MSDH for submission of samples to the Mississippi Public Health Laboratory is no longer required.
Centers for Disease Control and Prevention (CDC)
CDC Infection Control Guidance: This updated guidance from the CDC provides updated PPE recommendations for the care of patients with known or suspected COVID-19. (Detailed information available on the CDC site.)
Facemasks are an acceptable alternative to N95 respirators when respirators are unavailable in healthcare settings. Respirators should be prioritized for procedures that are likely to generate respiratory aerosols.
When an adequate supply of respirators is available in a healthcare facility, facilities should return to use of respirators per their respiratory protection program.
Continue to use eye protection, gown, and gloves.
If there is a shortage of gowns, they should be prioritized for aerosol-generating procedures, high contact patient care activities, and activities where splashes and sprays may occur.
Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients undergoing aerosol-generating procedures.
LabCorp
• LabCorp is accepting COVID-19 test orders and samples from physicians and other healthcare providers, clinics, and hospitals anywhere in the U.S. We are processing tests in the order received.
• COVID-19 tests can be ordered directly from LabCorp. We are not aware of any requirements that state or local health authorities must provide approval for LabCorp to perform testing. However, healthcare providers who are evaluating or treating patients under suspicion for COVID-19 may be required to coordinate with or provide information to their local or state health authorities. As noted above, testing should be conducted on appropriate patients in accordance with the latest
clinical guidance from the CDC and other expert organizations. Please check with those authorities for more information.
• LabCorp is reporting COVID-19 test information to public health authorities as may be required, but the ordering provider may also be required to report results and other information as well.
• CMS has established reimbursement in the amount of $51.31 for COVID-19 testing, and an HCPCS code for billing. LabCorp will use that rate for all customers, payers, and patients.
Please visit LabCorp’s COVID-19 website for the most current
Centers for Medicare and Medicaid Services (CMS)
Medicare will pay doctors and hospitals for a broad range of telehealth services on a temporary basis, effective March 6. The program will pay for office and hospital telehealth visits and include a wide range of providers including nurse practitioners, clinical psychologists and social workers. Telehealth visits will be reimbursed for the same amount as in-person visits.
New Guidance
CMS issued a Section 1135 waiver to allow CAHs and rural (non-CAH) swing-bed hospitals to move patients from their acute care beds to swing beds for extended care services without a 72-hour prior hospitalization. This clarification will help utilization review processes in rural hospitals to better maximize use of patient care beds.
Note: The expanded waiver does not apply to Rural Health Clinics (RHC) or Federally Qualified Health Centers (FQHC) to bill for Medicare telehealth visits or e-visits. CMS does not have statutory authority to issue a waiver for these purposes. See the Congressional Action section below for more information.
Department of Health and Human Services (HHS)
During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies. Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.
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. This notification is effective immediately.
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. OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.
Private Practice/General Business Resources
During this pandemic, we know that anxieties will heighten, mental illnesses will develop, risk for relapse will increase. There is also great concern that asymptomatic patients, driven by mental health issues, will flood emergency departments. The need for mental health care will be great. What can you do to keep your psychiatric practice open and minimize exposure risk?
Coronavirus Information and FAQs (Society for Human Resource Management)
Pandemic Preparedness in the Workplace and the Americans with Disabilities Act (U.S. Equal Employment Opportunity Commission)
When May Employers Require Workers to Self-Quarantine? (Society for Human Resource Management)
Health, Wellness and Leave Benefits Help Employees with Coronavirus (Society for Human Resource Management)
Coronavirus (COVID-19) in the Workplace: Legal and Regulatory Considerations (HUB International)
Considerations for a Remote Work Policy (Society for Human Resource Management)
Coronavirus Impact: Google Hangouts Meet, Microsoft Teams, Cisco Webex Made Free to Encourage Work From Home (Gadgets 36)
Special Populations
Individuals with Substance Use Disorders
Practitioners CAN prescribe buprenorphine for OUD via telemedicine communication. Click here to review guidelines from the US Department of Justice DEA Diversion Control Division: COVID-19 info page.
CSAM Medicare Reimbursement & OTP Guidance - https://www.asam.org/advocacy/practice-resources/coronavirus-resources
CSAM Medicare/Telemedicine Provider Fact Sheet - https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
SAMHSA Opioid Treatment Program Guidance and FAQs - https://www.samhsa.gov/medication-assisted-treatment
SAMHSA Opioid Treatment Program (OTP) Guidance re: COVID-19 (3/16/2020) This guidance provides potential flexibility for Opioid Treatment Programs (OTPs).
Children, Parents & Families NEW
The Latest COVID-19 Information for Your Practice
The American Academy of Addiction Psychiatry will be providing regular updates on the COVID-19 health crisis on a weekly basis. Below is a list
of information and resources that may help you in your practice as we navigate through this uncertain landscape together. AAAP is here to help in any way so that you can continue to treat your patients and stay healthy and safe.
AATOD Issues Guidance to OTPs in Response to Coronavirus
The American Association for the Treatment of Opioid Dependence (AATOD) has issued a guidance for Opioid Treatment Programs (OTPs) to protect you and your patients during the COVID-19 healthcare crisis. The guidance includes practical information on maintaining adequate supplies of medications and other materials; facility infectious disease control standards; how to protect your workforce; how to protect your patients; how to conduct oral and urine drug screening; and more. The guidance also includes a section on considerations for take-home medication and how to weigh the risks and benefits of this. [Read Guidance]
SURVEY: OTP Questions in Response to Turbulent Times
AATOD, ATTCs, and AAAP are collecting questions from OTPs related to sustaining care, providing support and maintaining a safe work environment for staff during these turbulent and uncertain times. We will compile all questions, work with field experts to determine responses, and develop and disseminate a "FAQ" document. [Take Survey]
Practitioners May Prescribe Buprenorphine
to Treat OUD via Telemedicine
For as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:
The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice
The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
The practitioner is acting in accordance with applicable Federal and State law.
Provided the practitioner satisfies the above requirements, the practitioner may issue the prescription using any of the methods of prescribing currently available and in the manner set forth in the DEA regulations. Thus, the practitioner may issue a prescription either electronically (for schedules II-V) or by calling in an emergency schedule II prescription to the pharmacy, or by calling in a schedule III-V prescription to the pharmacy. [Learn more]
Enforcement Discretion for Telehealth Remote Communications
During the COVID-19 Nationwide Public Health Emergency
The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency. [Learn more]
SAMHSA and CDC Resources:
2) SAMHSA’s Guidance for OTPs;
3) SAMHSA’s TAP 34, Disaster Planning Handbook for Behavioral Health Treatment Programs.
4) Tips For Social Distancing, Quarantine, And Isolation During An Infectious Disease Outbreak
5) Guidance on OTPs - MA is a state issuing take-home extensions
6) Guidance on managing emotionally
7) COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance
8) FAQs for Opioid Use Disorder Prescribing and Dispensing in the COVID-19 Emergency
APA Child & Adolescent Telepsychiatry Toolkit: Developed in partnership with the American Academy of Child & Adolescent Psychiatry (AACAP).
AACAP Coronavirus Resources:
AACAP Member Podcast Discussion: Coronavirus and Mental Health (You do not need to be an AACAP member to listen. The podcast page also has several other helpful links.)
The New York Times: How to Talk to Your Kids about Coronavirus
More Resources:
Individuals with Disabilities
COVID-19 Information By and For People with Disabilities: This resource is an 8-page booklet about the Coronavirus written in plain language. It was created by and for people with developmental disabilities.
Elderly Individuals
Older adults and people who have severe chronic medical conditions like heart, lung or kidney disease and those with weakened immune systems seem to be at higher risk for more serious COVID-19 illness. Early data suggest older people are twice as likely to have serious COVID-19 illness. Learn more from the CDC. People at high risk include anyone:
Over 65 years of age, or
with underlying health conditions including heart disease, lung disease, or diabetes, or
with weakened immune systems.
What Should High-Risk People Do: MDH recommends that people at high risk of severe illness from COVID-19 stay at home to the extent possible to decrease the chance of infection.
Adult Congregate Living Facilities: MDH recommends that all facilities that serve as residential establishments for high-risk persons described above should restrict visitors. These establishments include nursing homes, independent and assisted living facilities, correctional facilities, and facilities that care for medically vulnerable children.
Individuals Experiencing Homelessness
These people may be at risk for infection during an outbreak of COVID-19. The CDC has resources to support response planning by homeless service providers, including overnight emergency shelters, day shelters, and meal service providers. This includes cleaning and disinfection recommendations.
The U.S. Department of Housing and Urban Development also has information for housing providers, including organizations that provide housing for homeless individuals and shelters. This includes guidance for how to plan and respond to COVID-19 and following the CDC's guidance for cleaning and disinfecting community facilities.
Persons experiencing homelessness and outreach workers should follow the same steps to prevent COVID-19 infection as all other MS residents. However, many persons experiencing homelessness do not have reliable access to running water. Outreach workers should prioritize distributing hand sanitizer containing at least 60% alcohol to persons experiencing homelessness so they can protect themselves from COVID-19.
Community-Wide Resources
Immediate Assistance:
Disaster Distress Helpline: Call 1-800-985-5990 or text TalkWithUs to 66746
National Suicide Prevention Lifeline: Call 800-273-8255 or Chat with Lifeline
Crisis Text line: Text TALK to 741741
Behavioral Health Issues: Addressing Anxiety, Fear, Trauma, Stigma
MDH is asking all MH/SUD providers to reach out to patients proactively to calm and reassure them. Please strongly discourage asymptomatic people from going to the EDs. Use the resources below for tips on how to communicate with patients about anxiety and stress during times of crisis.
The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence (Lancet 2020; 395: 912–20)
How to Prevent Loneliness in a Time of Social Distancing: Advice for preserving your mental health while avoiding physical proximity
VA Fact Sheet for Health Care Staff: Meeting the Ethical Challenges of a Severe Pandemic Influenza: Although prepared by VA staff during a past pandemic, this is a thoughtful and engaging resource on the topic of ethics principles.
“FACE COVID” How to Respond Effectively to the Corona Crisis (by Dr. Russ Harris, author of The Happiness Trap)
F = Focus on what’s in your control
A = Acknowledge your thoughts & feelings
C = Come back into your body
E = Engage in what you’re doing
C = Committed action
O = Opening up
V = Values
I = Identify resources
D = Disinfect & distance
Blurb you can use on your website/patient communications:
As we learn more about the virus and its impacts, it is critical that we all stay calm, thoughtful and diligent in our response. There are some practical things we can all do to prevent the spread of any respiratory illness:
Wash your hands often with soap and water for at least 20 seconds
Avoid close contact with people who are sick
Avoid touching your eyes, nose, and mouth
Stay home when you are sick
Cover your cough or sneeze with a tissue, then throw it away
Clean and disinfect frequently touched objects and surfaces using regular household cleaning spray
Taking Care of Yourself
Keep yourself safe and healthy! Take care of yourself, but also take prudent precautions. Your expertise and the care you can deliver is critical, even if you cannot be physically present in the office! Talk to colleagues, share information and resources, and let the MPA office know about needs and situations you are confronting via email or phone at 601-898-9662.
General COVID-19 Resources
National Updates: Centers for Disease Control & Prevention (CDC)
International Updates: World Health Organization (WHO)
APA Foundation COVID-19 Resource
The APA Foundation has published a resource for employers/employees on Covid-19 and mental health, developed by our Center for Workplace Mental Health and available online: www.workplacementalhealth.org/covid19tips
APA Approach to Coronavirus
COVID-19 Mental Health Impacts: Resources for Psychiatrists (This link contains a comprehensive list of resources for providers, families, and community leaders.)
Other COVID-19 announcements/resources from APA:
COVID-19 and Telepsychiatry: What you Need to Know (email sent 3/13/20)
APA Praises Passage of Emergency COVID-19 Funding; Authority to Government to Lift Restrictions on Telehealth Services (posted 3/5/20)
A Message from the APA on COVID-19 (email sent 2/28/20)
Coronavirus and Mental Health: Taking Care of Ourselves During Infectious Disease Outbreaks (posted online 2/19/20)
Keep an eye on the APA homepage for ongoing COVID-19 updates. With the community-spread of COVID-19, many patients may be unable or unwilling to travel to their psychiatrist’s office to keep their appointments. Additionally, psychiatrists situated in hospital or other critical care settings may wish to transfer their in-person patient caseload to something virtual in order to protect patients. With recent legislation at both the federal and state levels, this is becoming more feasible with respect to laws, regulations, and reimbursement policies around telemedicine.
I ask that you share this information with your colleagues. If you have additional questions, please contact the Practice Management Help Line
Saul Levin, MD, MPA, FRCP-E, FRCPsych
CEO & Medical Director
American Psychiatric Association Twitter and Instagram: @SaulLevinMD
APA Twitter and Instagram: @APAPsychiatric