A message from KMS Executive Director Rachelle Colombo:
We heard from many of you about financial strain, lack of PPE, testing concerns, and questions around telehealth. Thank you for taking the time to share your experiences with us. It helps us focus our advocacy on those things that are most important to you. We hope this update provides quick access to some of the answers and resources you need. We are talking to policymakers at every level, every day. Sharing your stories is powerful and timely. In addition to the resources from government at the state and federal level, your local communities are looking for ways to support you. As an example, the Kansas Farm Bureau—which has local chapters throughout rural Kansas—has reached out and encouraged physicians to call upon their members for help with childcare and homemade protective equipment, and has pledged to partner with us in conversations with our congressional delegation to ensure these needs are met.
Federal economic stimulus bill
Just before midnight Wednesday, the U.S. Senate voted unanimously to approve a $2 trillion relief package to shore up the economy as it weathers the coronavirus pandemic. The House is expected to take up the bill on Friday and approve it, sending it to President Trump for his signature. In addition to payments to individual Americans, it provides $350 billion in federally guaranteed loans to small businesses and establishes a $500 billion government lending program for distressed companies. According to early reports on the stimulus package, small businesses that pledged to keep their workers would also receive cash-flow assistance structured as federally guaranteed loans. If the employer continued to pay workers for the duration of the crisis, those loans would be forgiven.
Provisions of particular interest to physicians and their practices include:
- Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
- $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
- Suspension of the 2% Medicare sequester in May through December 2020.
- Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
- A temporary waiver of the face-to-face visit requirement with home dialysis patients.
- Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
- Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.
As more details of the stimulus package emerge, we will update you on those elements aimed at supporting physician practices. KMS recently joined a letter from dozens of organizations urging Congress to include such support.
Personal Protective Equipment (PPE) update
Although the situation is gradually improving countrywide, problems with obtaining adequate supplies of PPE persist. The coronavirus “hotspots” in the U.S. are receiving the most supplies, with low incidence states like Kansas still experiencing severe shortages in clinics, hospitals, and other facilities. KDHE officials are pleading with federal agencies to quickly improve both the supply and distribution of PPE to Kansas health care providers.
The latest guidance on PPE from federal partners sent to KMS: Providers in need of PPE—such as N95 respirators, surgical masks, face shields, surgical gowns, gloves, etc.—are advised to first contact their regular distributors for additional supplies. If distributors cannot fulfill the order, providers should then contact county public health officials to request supplies from any local stockpiles. A directory of all Kansas county health departments is available here. Here's a flowchart of the recommended PPE request process.
Providers are also advised to contact KDHE officials (request form available here) to request supplies from available state stockpiles (the state can then send requests to the Strategic National Stockpile). If a provider receives supplies, they are advised to circle back with any other avenues in which requests were made to avoid double-filling the same request.
Additional PPE equipment has been received and Kansas Division of Emergency Management (KDEM) is working on distributing those. KDEM regional contact information is available here. CDC's guidance on Strategies for Optimizing the Supply of PPE during COVID-19 Response.
Recently issued KDHE guidance documents are available for Kansas hospitals for optimizing PPE:
- Strategies for Optimizing Eye Protection - Updated 3/23/2020
- Strategies for Optimizing Isolation Gowns - Updated 3/23/2020
- Strategies for Optimizing Facemasks - Updated 3/23/2020
FEMA has begun coordinating PPE requests and delivery. Contact information at FEMA for PPE is expected to be available soon, and KMS will disseminate to members immediately.
→ Previous KMS updates on PPE are available here: www.KMSonline.org/PPE.
Questions related to U.S. Small Business Administration resources
KMS has received numerous inquiries from members regarding potential financial resources available via the U.S. Small Business Administration (SBA). The SBA has designated COVID-19 as a qualifying event for the provision of Economic Injury Disaster Loans (EIDL) for businesses in affected communities, which includes Kansas. Small businesses suffering substantial economic injury due to COVID-19 may be eligible to receive EIDL funds. While there may be additional SBA loan resources available in the stimulus bill, for now practices can learn more about existing loan resources at: https://disasterloan.sba.gov/ela.
AMA releases special coding advice related to COVID-19
New guidance from the AMA provides special coding advice related to COVID-19. One resource outlines coding scenarios designed to help health care professionals apply best coding practices. The scenarios include telehealth services for all patients. There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19.
Telehealth and related payor updates
The Kansas Legislative Coordinating Council approved several coronavirus-related executive orders by Gov. Laura Kelly. Among them was the order temporarily expanding telehealth/telemedicine and loosening some related regulations in response to COVID-19. The executive order encourages physicians to utilize telehealth where possible. It also allows out-of-state physicians to treat patients in Kansas via telehealth without a license from the state. View details of Executive Order 20-08. KMS has posted current telehealth information—including payor updates—here and will continue to update members as guidance becomes available.
For physicians who wish to reduce or waive cost-sharing obligations for telehealth, the U.S. Office of the Inspector General (OIG) has released a statement and FAQ:
- OIG policy statement regarding physicians and other practitioners that reduce or waive amounts owed by Federal health Care Program beneficiaries for Telehealth
- OIG FAQ on policy regarding physicians and other practitioners reducing or waiving beneficiary cost sharing for telehealth services during COVID-19
OIG has also created a portal for information and announcements related to COVID-19. The portal can be accessed at http://oig.hhs.gov/coronavirus.
KDHE now providing email-based updates
While Kansas COVID-19 updates have been posted regularly since January at www.kdheks.gov/coronavirus, email alerts are now available letting you know when updates to the page have been made.
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