Practice Guidance for COVID-19

Updated May 22, 2020

Below is guidance released by the Department of Health and Human Services, FDA and at the state level related to COVID-19 to assist psychiatrists with providing mental health and substance use services.

Click on a topic below to jump to the relevant practice guidance:

[Telehealth]   [Substance Use Disorders]   [Inpatient Psychiatric Settings]   [Commercial Payers]   [State-by-State Guide]

General

  • NEW Deadline – June 3, 2020 Response Required by all who received payments through the Provider Relief Fund

    • If you received a payment from CMS based on your previous Medicare claims filings as part of the CARES Act (Provider Relief Fund) and you do not respond that you do not wish to keep the money by June 3, 2020, CMS will assume that you have agreed to accepting the funds and are willing to comply with the financial accounting that will be requested in the future.
    • The Department of Health and Human Services (HHS) continues to further refine the provisions put in place for financial relief to hospitals, physicians and other health care providers allocated in the Public Health and Social Services Emergency Funds in the recently enacted CARES Act. CARES Act Provider Relief Fund payments are not loans (pending acceptance of the terms and conditions). Some providers have received a portion of the funds directly into their business accounts based on their share of total Medicare FFS reimbursements in 2019. Funds were sent by UnitedHealth Group to each organization’s TIN that normally receives Medicare payments. These funds are to be used for health care expenses or for lost revenues (see clarification from AMA below) attributed to COVID-19. Physicians who have received a payment from that initial distribution by April 24, 2020 at 5:00 pm now have 45 days to attest to the receipt of funds, accept the terms and conditions and provide supporting financial information. The terms and conditions have raised concerns which APA, AMA and others are seeking clarification on. APA is also in the process of clarifying if the supporting financial information is required by all or just those seeing additional funds.
    • AMA has shared the following: Questions have arisen regarding what HHS views as the appropriate use of the CARES Act funds. We have not seen additional guidance beyond that provided on the website and we think it would be difficult for HHS to craft language in a way that would be relevant to each practice’s individual needs. We believe that the key thing is that each practice is able to clearly document the revenue losses and expenses it is incurring that are directly due to COVID-19, which could include losses related to social distancing (such as cancellation of visits and procedures, Part B drugs that have passed their expiration date), costs of new infection control practices, PPE, digital health equipment, etc., and that are not reimbursable from other sources (excluding loans that have to be repaid).
    • From the CMS FAQ on the provider relief fund - General Distribution FAQs

      • Which types of providers are eligible to receive a General Distribution Provider Relief Payment?
        (Added 5/6/2020) To be eligible for a General Distribution payment, providers must have billed Medicare on a fee- for- service basis (Parts A or B) in Calendar Year 2019. Additionally, under the Terms and Conditions associated with payment, these providers are eligible only if they provide or provided after January 31, 2020, diagnoses, testing or care for individuals with possible or actual cases of COVID-19. HHS broadly views every patient as a possible case of COVID-19. All providers retaining funds must sign an attestation and accept the terms and conditions associated with payment. Providers must also submit tax documents and financial loss estimates if they wish to be eligible for additional funds.
      • How can I return a payment I received under the Provider Relief Fund?
        (Modified 5/20/2020) Providers may return a payment by going into the attestation portal within 45 days of receiving payment via ACH or within 60 days of check payment issuance and indicating they are rejecting the funds. The CARES Act Provider Relief Fund Payment Attestation Portal will guide providers through the attestation process to reject the funds. To return the money, the provider needs to contact their financial institution and ask the institution to refuse the received Automated Clearinghouse (ACH) credit by initiating an ACH return using the ACH return code of “R23 - Credit Entry Refused by Receiver." If a provider received the money via ACH they must return the money via ACH. If a provider was paid via paper check, after rejecting the payment in the attestation portal, the provider should destroy the check if not deposited or mail a paper check to UnitedHealth Group with notification of their request to return the funds.
      • How should a provider return a payment it received via check?
        (Added 5/12/2020) If the provider received a payment via check and has not yet deposited it, destroy, shred, or securely dispose of it. If the provider has already deposited the check, mail a refund check for the full amount, payable to “UnitedHealth Group” to the address below. Please list the check number from the original Provider Relief Fund ACH payment or check in the memo. UnitedHealth Group Attention: CARES Act Provider Relief Fund PO Box 31376 Salt Lake City, UT 84131-0376
      • Why does the General Distribution website say I have to attest before requesting additional funds?
        The CARES Act requires that providers meet certain terms and conditions to receive Provider Relief Funds. In order to keep the initial General Distribution payment, and in order to be eligible to receive additional General Distribution funds, you must attest that you meet these terms and conditions and you must submit your financial and tax information.
      • Why do I need to upload my tax forms?
        The $50 billion general allocation is apportioned based on provider revenue. Tax forms are needed to ascertain and confirm provider revenue
    • Note that HHS is making a list publicly available of the providers who have received and accepted money from the Provider Relief Fund here: https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6
    • Guidance on this program continues to be developed and refined. We will continue to update this site as information becomes available. Additionally, CMS is routinely updating their website on Provider Relief Fund including fact sheets and FAQs.
  • Updated Guidance on Prior Authorization to Increase Flexibilities: CMS issued guidance to issuers of individual, small patients do not experience care delays. Updated guidance for Medicare Advantage and Part D plans group, Medicare Advantage, and Part D plans, addressing the flexibilities available related to utilization management and prior authorization during the COVID-19 public health emergency. New guidance for individual and small group health plans encourages issuers to utilize flexibilities related to utilization management processes, as permitted by state law, to ensure that staff at hospitals, clinics, and pharmacies can focus on care delivery and ensure that allows them to implement a number of additional flexibilities to support efforts that can help curb the spread of the virus and to help ensure MA and Part D enrollees do not experience disruptions in care or disruptions in pharmacy and prescription drug access.
  • Information on Impact of COVID-19 in Racial and Ethnic Minority Groups: CDC released information on COVID-19 in Racial and Ethnic Minority Groups. To date, the effects of COVID-19 on the health of racial and ethnic minority groups is still emerging; however, current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups. APA submitted a letter to HHS urging them to collect, analyze, and make available to the public, explicit, comprehensive, standardized data on race, ethnicity related to the testing status, hospitalization, and mortality associated with COVID-19.
  • REMS: On March 23, the Food and Drug Administration released guidance to sponsors and healthcare providers regarding certain Risk Evaluation and Mitigation Strategy (REMS). For drugs subject to REMS with laboratory testing (or imaging) requirements (includes Clozapine), healthcare providers prescribing and/or dispensing these drugs should consider whether there are compelling reasons not to complete lab tests, or delay them, during this public health emergency and use best medical judgement in weighing the benefits and risks of continuing treatment in the absence of laboratory testing. The judgement regarding the risk/benefits should be communicated to patients. The FDA does not intend to take action against sponsors and other health care providers for the duration of the public health emergency for failing to adhere to REMS requirements for certain laboratory testing.
  • Medicare Quality Reporting: CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility's choice to report. In addition, no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS's calculations for the Medicare quality reporting and value-based purchasing programs.

Telehealth

APA has a page dedicated to Telepsychiatry and COVID-19. Key guidance for the duration of the emergency declaration includes:

  • CMS Changes for Audio Only

    • Audio Only services: On April 30, 2020, CMS issued a new ruling permitting audio only telephone care for the following psychiatry codes: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90853. The psychotherapy add-on codes are to be used with the E/M telephone codes, 99441,99442, and 99443. CMS also announced they will increase payments for these E/M codes to match payments for similarly timed office and outpatient visits. Payments for these services have increased from the current range of about $14-$41 to the higher range of about $46-$110, and these payments are retroactive to March 1, 2020.
    • When billing these services in addition to a psychotherapy service (90833, 90836, 90838), divide the time spent between the two codes according to the work performed, taking care not to count the same minute twice. And be sure to document the time spent on each service accordingly.
    • Anyone providing care via audio AND video will continue to bill as they have been using the traditional E/M codes (see below – clarification on billing Medicare telehealth) with the 95 modifier.
  • Clarification on billing Medicare for telehealth: When conducting a telemedicine encounter:

    • By audio and video: use the same CPT codes as if the encounter were in-person, and on the 1500 Claim Form you should add the modifier 95 after each CPT code to indicate that the care was provided as telemedicine. These same directions should be applicable for most commercial payers as well. Please let APA know if your experience is different.
    • By audio only: use any of the psychiatric services identified in the following list: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90853. E/M services should be reported using the telephone E/M codes (99441-99443). As noted above, on the 1500 Claim Form you should add the modifier 95 after each CPT code to indicate that the care was provided as telemedicine, including next to the 99441-99443 codes.
    • For all telehealth services use the Place of Service (POS) that aligns with where your encounter would have occurred
    • For new telepsychiatry encounters (both audio and video as well as audio only) provided to patients under the waiver that would have been office visits, psychiatrists should consider their office as the place of service (POS) and use the place of service code 11, just as you did when you were seeing your patients in person. If you are providing inpatient care, you should use the place of service you would ordinarily use for that place even though you are not actually there.
    • Those psychiatrists who were previously providing telepsychiatry under Medicare's pre-waiver rules should continue to report this care as they always have with POS 02.
    • For more information on telepsychiatry during COVID, see our Telepsychiatry blog.
  • CMS released guidance on March 17, 2020, that allows patients to be seen via live videoconferencing in their homes, without having to travel to a qualifying "originating site" for Medicare telehealth encounters, regardless of geographic location.
  • The Office of Civil Rights (OCR) has indicated they will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through FaceTime or Skype.
  • The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
  • The Ryan Haight Act requires that a provider conduct an initial, in-person examination of a patient—thus establishing a doctor-patient relationship—before electronically prescribing a controlled substance. As of March 17, 2020, the DEA has indicated that this requirement has been suspended.
  • The American Professional Agency, Inc, which provides professional liability malpractice insurance, developed resources to help members, specifically issued an FAQ about Coronavirus and Telehealth and Coronavirus and Telehealth Resources.

Substance Use Disorders

  • On March 31, SAMHSA and the Drug Enforcement Agency (DEA) released guidance providing flexibility to prescribe buprenorphine to new and existing patients with opioid use disorder via telephone by otherwise authorized practitioners without requiring such practitioners to first conduct an examination of the patient in person or via telemedicine. SAMHSA has separate guidance for patients treated with methadone in an Opioid Treatment Program.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) is providing guidance and resources for treating patients with mental health and substance use disorders on its COVID-19 webpage.
  • On March 19, the Substance Abuse and Mental Health Services Administration (SAMHSA) released guidance on 42 CFR Part 2 to ensure that substance use disorder treatment services are uninterrupted during this public health emergency.
  • On March 16, SAMHSA posted COVID-19 guidance providing potential flexibility for Opioid Treatment Programs (OTPs). The COVID19 guidance includes approaches for providing pharmacotherapy for opioids use disorder patients exposed to infections and COVID-19, disaster planning, potential flexibility for take-home medication, OTP guidance for patients quarantined at home with the coronavirus, and Frequently Asked Questions. Learn more about SAMHSA's COVID-19 Guidance for Opioid Treatment Programs here.
  • On March 16, the Drug Enforcement Administration’s released guidelines on Use of Telemedicine While Providing Medication Assisted Treatment (MAT).
  • On March 12, National Institute on Drug Abuse alerted the research community that populations with Substance Use Disorders (SUDs) may be impacted particularly hard.

Inpatient Psychiatric Settings

  • March 18, Centers for Medicare & Medicaid Services (CMS) released recommendations on the delay of adult elective surgeries, and non-essential medical, surgical, and dental procedures during the COVID-19 outbreak. CMS indicates that "as more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators." APA considers ECT an essential procedure.

Commercial Payers (Note that coverage varies by individual policy)

APA developed this sample letter to send to the private insurers and Medicaid Directors that provide coverage to your patients. Please let APA know if you receive a response.

APA has also joined others to request the implementation of consistent telehealth policies across all payers that remove unnecessary barriers to care during the emergency. This includes outreach to America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association.

State-by-State Guidance

Additional resources are available on the National Governors Association website, What Steps Have States Taken To Address Coronavirus?

Click on your state below to jump to the state-issued guidance:

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Alabama

Insurance coverage of telehealth: March 13 Department of Insurance bulletin asks asking health carriers to review telehealth services and make sure they're "robust."

Alabama Board of Medical Licensure Guidance on Telehealth:

  • Continually updated with the latest information from the Board, including information on audio only

Alabama Medicaid Covering Telemedicine for Mental Health Services:

  • Can be telephone only
  • Must bill 02 with modifier CR for catastrophic/disaster. The following codes are turned on for telemedicine:
    • 90832
    • 90834
    • 90837*
    • 90846*
    • 90847*
    • H2011 (psychologist only)
    • * preferred method audio/visual

Telemedicine originating site fee for Medicaid: Effective April 1, 2020, the Alabama Medicaid Agency (Agency) will begin paying an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient.

  • Providers must bill the procedure code Q3014 – telemedicine origination site facility fee on a CMS-1500 or UB-04 claim.
  • Federally Qualified Health Centers and Rural Health Clinics should bill Q3014 independent of the encounter rate on a CMS-1500 claim form.

Waived Licensure: On March 13, Governor Ivey declared all health care professionals executing "alternative standard of care plans in good faith" to be "Emergency Management Workers." Under AL Code § 31-9-16 (2016), the term "emergency management worker" shall include any full-or part-time paid, volunteer, or auxiliary employee of this state, or other states, territories, possessions, or the District of Columbia, of the federal government, of any neighboring county or of any political subdivision thereof, or of any agency or organization performing emergency management services at any place in this state subject to the order or control of, or pursuant to, a request of, the state government or any political subdivision thereof. Additionally, any requirement for a license to practice any professional, mechanical, or other skill shall not apply to any authorized emergency management worker who shall, in the course of performing his duties as such, practice such professional, mechanical, or other skill during an emergency management emergency.

Prescribing controlled substances via telemedicine during health emergency (DEA/ALBME/ALBOP) (From the Alabama Board of Medical Examiners):

  • Can utilize telemedicine
  • Will authorize prescribers to call the Schedule II prescription in to a pharmacist

BCBS AL general guidance on telemedicine and New Directions Expanded Telemedicine Behavioral Health Coverage for BCBSAL

Viva Health Telemedicine Commercial (as of 3/13):

  • Telehealth: Members can have telehealth visits from any location with any network provider who offers them though their local office. Members will not have a copayment for telehealth visits with their local provider for the next 30 days. Some employer plans also include telehealth visits through Teladoc or other vendors. Members with this Teladoc coverage through ViVa HealtH can also access this benefit with no copayment for the next 30 days.
  • Prescription refills: On plans that include prescription drug coverage through ViVa HealtH, members can get early refills of their maintenance medications if needed. Members are encouraged to secure a 90- day supply of non-specialty maintenance medications. Home delivery from our mail-order pharmacy is available on all plans for most medications.

Alabama Department of Insurance provided an outline of health insurers’ response to COVID-19. This summarizes all actions insurers are taking in Alabama.

CMS has approved an 1135 Waiver for Alabama: Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days

CMS approved Alabama's second request for an 1135 Waiver:

  • Extends pre-existing authorizations
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.

The Governor granted expanded scope of practice to NPs, NMs, NAs, and PAs. The collaborative agreements for NPs and NMs will be with the medical director and/or facility instead of just one physician. NAs' supervision requirements will be with the facility and medical director. They are authorized to practice "to the full scope of their practice."" Out of state APRNs, PAs, and pharmacists can get emergency licensure in Alabama without a collaborative agreement.

Alabama Governor's Office of Volunteer Services:

  • Health professionals can volunteer through this website
  • Non-medical volunteers are also encouraged for other volunteer positions

Governor Ivey unveiled the website altogetheralabama.org:

  • The website seeks to connect people and businesses with needed resources

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Alaska

Governor Dunleavy signed HB 29 into law on March 16 requiring health care insurers to provide coverage for telehealth benefits. (Please note that even though the law seems to delete "mental health," the law means that all telehealth must be covered, including mental health).

Alaska Psychiatric Institute: March 13, Governor Dunleavy issued a mandate suspending and limiting general public visitation until otherwise rescinded by DHSS and the Office of the Governor.

Guidance on Telehealth & Licensing During COVID-19: This guidance outlines the currently waived restrictions on practicing telehealth and e-prescribing during the public health crisis. Anyone providing telehealth must hold an Alaska license to perform those services. Courtesy licenses for emergency situations are offered to physicians who come to the state to provide emergency medical care or emergency mental health care for 90 days.

Alaska Respond is recruiting health care professionals who volunteer to work across the state during a disaster or public health emergency. At this time only healthcare professionals, currently licensed in Alaska, can register with Alaska Respond.

Medicaid Behavioral Health Telemedicine Emergency Response Policy Guidance: During the Covid-19 public health emergency, telemedicine for Medicaid recipients in Alaska is temporarily being expanded to include telephone and online digital services. This guidance provides the hierarchy of billable services that providers should follow for individual and group services, as well as a list of appropriate billing codes. During this emergency, providers delivering individual services should follow the hierarchy of services below:

  • Level 1: In-person
  • Level 2: Video – providers may utilize any methods of face-to-face technology to facilitate telehealth service, such as Skype, Facetime, Zoom, Duo, etc.
  • Level 3: Telephone – providers may only utilize telephonic delivery if Level 1 or Level 2 is not an option. Providers must be cognizant of time based billing requirements per 7 AAC 105.230.
  • Level 4: Email – providers may use email or exchanges via secure patient portal when available. Providers must be cognizant of time based billing requirements per 7 AAC 105.230.
  • Level 5: Text Messaging – Text messaging is an absolute last resort for providing services. Text messaging should only be deployed as an option if there are directives from the State Emergency Operations to limit phone traffic in order to keep phone lines open for emergency responders. If no such directive has been issued services delivered via text must have documentation demonstrating no other telehealth modality was available. Providers must be cognizant of time based billing requirements per 7 AAC 105.230.

CMS has approved Alaska's request for an 1135 Medicaid waiver. The approved waiver enables Alaska to temporarily suspend FFS prior authorization requirements, temporarily enroll providers who are enrolled with another SMA or Medicare, and allow for reimbursement facility services in alternative settings for the duration of the public health emergency.

Patient Care Strategies for Scarce Resource Situations: The Alaska Department of Health and Social Services compiled these protocols, outlining crisis standard of care for healthcare providers.

Governor signs bill waiving licensure and telemedicine requirements: For the duration of the public health emergency, the bill allows the Department of Commerce, Community, and Economic Development to:

  • grant a license on an expedited basis to a healthcare provider who holds a corresponding license, permit, or certificate in good standing in another jurisdiction to respond to the public health disaster emergency. An expedited license will expire by November 15, 2020 or when the Governor declares that a public health emergency no longer exists.
  • temporarily waive or modify the continuing education requirements required for licensees to renew a professional license in 2020.
  • regulate the scope and duration of any license issued under this section.
  • require any individual granted a license under this authority to arrange and agree to supervision, in person or by other means.
  • regulate the scope and duration of any license, permit, or certificate.

Additionally, the bill would waive the requirement of an initial in-person physical examination for a healthcare provider to deliver telehealth, as long as the provider is licensed and the services are within the provider's authorized scope of practice.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

The State Medical Board Announces Telehealth Regulation for OUD Treatment: Standards of practice for telemedicine, is being amended to allow a physician or physician assistant to examine, diagnose and treat a patient for an opioid use disorder without a healthcare provider present with the patient, during a public health emergency disaster declared by the governor under AS 26.23.020. The physician or physician assistant must:

  • be a DATA-waived pracitioner
  • document all attempts to conduct a physical examination under statute and the reason why the examination cannot be performed
  • require urine toxicology screening as part of the patients’ medication adherence plan.

The Department of Health Announces First Responder Crisis Call Line: AK Responders Relief Line (1-844-985-8275) functions as a crisis counseling and general support line for healthcare and behavioral professionals impacted by COVID personally and professionally. The crisis call line is also available to immediate family members of first responders who may need help for a variety of behavioral health issues, and hard to label emotions, as a result of their loved one engaging on the front lines.

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Arizona

Governor's declaration March 11 requires insurers to cover telemedicine visits at a lower cost-sharing point for consumers than the same in-office service to encourage utilization of telemedicine for the duration of the state's public health emergency.

Waived Licensure: Governor Ducey’s March 11 Declaration of Emergency allows ADHS to waive licensing requirements to provide healthcare officials with assistance in delivering services during times of heightened demand.

CMS has approved an 1135 Waiver for Arizona:

  • 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.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment for non-Arizona providers

The Governor issued an executive order requiring health care insurance companies to expand telemedicine coverage for all services that would normally be covered for an in-person visit.

  • Requires all health insurance plans regulated by the Department of Insurance to provide coverage for all telemedicine services. It also includes Medicaid.
  • Must reimburse at the same level of payment as in person visit.
  • Includes physicians, PAs, ARNPs, optometrists, psychologists, dentists, occupational and physical therapists, pharmacists, behavioral health providers, chiropractors, athletic trainers, hearing aid dispensaries, audiologists, and speech pathologists.
  • Does not expand scope.

The Governor signed H.B. 2668 to bring more resources into Arizona’s health care system by increasing Arizona Health Care Cost Containment System (AHCCCS) provider rates for hospitals, doctors and more.

Arizona Medical Association is promoting the use of telemedicine and has partnered with CompuGroup Medical to provide a free telemedicine platform for six months to all physicians in Arizona.

The Governor issued an executive order allowing pharmacists to dispense emergency refills of maintenance medications for a 90-day supply and an additional 90-day supply if needed.

The Governor announced that the President and FEMA approved Arizona's request for a Presidential Major Disaster Declaration.

  • Expands mental health care through expanded mental health care and crisis counseling

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Arkansas

Emergency Declaration: March 11, 2020 – Governor Hutchinson signed an executive order to declare a public health emergency to facilitate coordination and provide increased support to state agencies that are involved in response to the virus. Waived licensure not included in emergency declaration.

Govenor Hutchison issued an executive order on telehealth:

  • Suspends provisions that require an in-person encounter or a face-to-face examination to allow time audio and visual means to establish a professional relationship;
  • Allows reimbursement to health care providers who take advantage of this provision; and
  • Suspends the Rules and Regulations of the Arkansas Board of Examiners in Counseling to allow licensed counselors to treat their clients by telephone.

Arkansas Department of Human Services Medicaid Guidance on Telemedicine:

  • Can be audio only
  • requirement for in-person establishment of relationship waived, provided the physician has access to health care record
  • updated on April 15 to include more Behavioral Health Providers, such as psychologists, counselors, and social workers, among others.
  • telemedicine may be used for Crisis Intervention Services

Telemedicine for FQHCs and RHCs:

  • Distant site telemedicine services can be furnished by any health care practitioner working for the RHC or the FQHC within their scope of practice

The Department of Insurance reminds all health care plans, including short term limited duration plans, that they must comply with Arkansas’ statutory reimbursement requirements for healthcare services provided through telemedicine.

COVID-19 Health Insurance Information for Consumers, Producers, and Providers:

  • Provides plan information for each payer in Arkansas
  • Links to each plan with more information

The Governor announced the Board of Medicine will grant emergency temporary licenses to Arkansas medical residents who have completed at least one year of postgraduate training and have the written recommendation of their program director.

Arkansas submitted an 1115 Waiver, asking for $116 million in additional Medicaid funding to support a number of initiatives to protect Arkansas health care workers and their patients and to support health care providers.

CMS has approved an 1135 Waiver for Arkansas:

  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.

Governor's Executive Order 20-06 suspended collaborative practice agreements for APRNs as a requirement for licensure through April 16, 2020.

Governor’s Executive Order 20-18:

  • Removes working hour limits on health care professionals
  • Health care workers will have immunity from liability in COVID-19 cases, other than for gross negligence, willful misconduct, or bad faith

NEW AS OF 4/16/2020; Governor’s Executive Order 20-19:

  • Frontline health care workers and first responders can seek workers compensation for exposure to COVID-19.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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California

Guidance for behavioral health programs regarding ensuring access to health and safety during the COVID-19 public emergency. (3/14/2020)

  • Updated guidance for behavioral health programs (3/19/2020): This notice addresses behavioral health services via telephone and telehealth, adapting oversight requirements to prioritize patient needs and accommodate workforce challenges, access to prescription medications, alcohol and other drug (AOD) residential and outpatient treatment facility application, and the process to request fee reductions or waivers.

Waived Licensure: Governor Newsom's March 4 Declaration of Emergency allows out of state personnel, including, but not limited to, medical personnel ENTERING California to provide services related to the emergency without California licensure.

1135 Waiver: (3/16/2020) Request For Medicaid Section 1135 Waiver Flexibilities Related to Covid-19 The waiver requests flexibility for telehealth and virtual communications to make it easier for providers to care for people in their homes. Specifically, flexibility to allow telehealth and virtual/telephonic communications for covered State plan benefits, including but not limited to, behavioral health treatment services, waiver of face-to-face encounter requirements for Federally Qualified Health Centers, Rural Health Clinics, and Tribal 638 Clinics relative to covered services via telehealth, allowance for reimbursement of virtual communication and e-consults for FQHCs, RHCs and Tribal 638 clinics and waiver of limitations around virtual/telephonic communications prior to or after an in office visit.

Medi-Cal Guidance for Waiver Flexibilities for FFS Prior Authorization: The Department of Health Care Services is issuing this guidance on the temporary suspension of Medi-Cal FFS prior authorization requirements under California's approved Medicaid State Plan for certain benefits, as well as extension of existing PAs, which will remain through the end of the COVID-19 public health emergency.

  • Medi-Cal Guidance for Waiver Flexibilities on Delivering Care in Alternative Settings: DHCS is issuing this guidance on the provision of care in alternative settings, hospital capacity, and blanket waiver flexibilities, which will remain in effect through the end of the COVID-19 public health emergency.
    • Guidance for Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital: CMS is waiving requirements to allow acute care hospitals with excluded distinct part inpatient psychiatric units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct part psychiatric unit to an acute care bed and unit. This waiver may be utilized where the hospital's acute care beds are appropriate for psychiatric patients and the staff and environment are conducive to safe care. For psychiatric patients, this includes assessment of the acute care bed and unit location to ensure those patients at risk of harm to self and others are safely cared for. DHCS is adhering to this flexibility and as long as the hospital providing the psychiatric care in an acute care setting is properly enrolled in Medi-Cal to provide psychiatric inpatient hospital services, the hospital should continue to bill the same as it would bill for a patient receiving psychiatric inpatient hospital services in a psychiatric unit of the hospital with their NPI, psychiatric revenue and accommodation codes, and annotate on the medical record and TAR to indicate the patient is a psychiatric inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the disaster or emergency. Also, hospitals that are not already enrolled in Medi-Cal may use the expedited enrollment process during the COVID-19 emergency

Insurance Commissioner Lara Directs Health insurance Companies to Increase Telehealth Access: The notice directs health insurance companies to expand telehealth services and encourage patients to use telehealth delivery options to limit the amount of in-person health care they seek while continuing to receive essential care. Cost-sharing requirements for services delivered via telehealth should be consistent with, or no greater than, the cost-sharing requirement for services delivered through in-person settings. The notice also requires health insurers to:

  • Allow all network providers to use all available and appropriate modes of telehealth delivery including, but not limited to, synchronous video, and telephone-based service delivery.
  • Immediately implement reimbursement rates for telehealth services that mirror payment rates for an equivalent office visit.
  • Eliminate barriers to providing medically and clinically appropriate care using appropriate telehealth delivery models.
  • Use telehealth service delivery methods to enable consumers to have access to mental health and substance use disorder services, family therapy, and behavioral health services, including services to treat autism, among others.

The Department of Health Care Services has compiled the following behavioral health resources for providers treating Medi-Cal patients:

Governor Newsom's Executive Order to Expand the COVID-19 Workforce: To address the needs of an anticipated wave of patients in California, the new executive order gives state officials the authority to expand the scope of practice for APRNs, PAs, and pharmacists for the duration of the current emergency.

Governor Newsom Issues Executive Order to Expand Telehealth Services: The order provides flexibility for the delivery of telehealth services by:

  • allowing the use of video chats and applications to provide health services without risk of penalty.
  • suspending the requirement that providers obtain and document verbal or written consent before the use of telehealth services.
  • suspending penalties applied to inadvertent, unauthorized access or disclosure of health information during the good faith of telehealth services.

California's Surgeon General releases new stress management playbooks: The new playbooks are intended to help individuals, caretakers, and parents manage stress during the COVID-19 emergency. Additional resources for those experiencing stress, anxiety or depression, facing substance abuse disorders, violence at home, or seeking to protect child welfare and address child abuse or neglect can be found here.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Colorado

Waived Licensure, Generally: DORA releases emergency measures for healthcare professional licensing in response to COVID-19.

Waived Licensure for Telemedicine: "Suspension of requirements that patients must be located in Colorado at time of consultation to expand treatment for traveling Colorado citizens, as currently required under § 12-240-107(1)(g), C.R.S., which defines telemedicine as the practice of medicine requiring a Colorado license to practice telemedicine on patients located in Colorado at time of consultation."

Waived prescription signature requirements due to public health emergency of COVID-19: Permits the utilization of telemedicine through interactive audio, video, or data communication to limit face-to-face visits between clients and health professionals.

Public Health Order 20-20 restricts visitors to all Colorado skilled nursing facilities, assisted living facilities, and intermediate facilities.

The Governor issued a "stay at home" executive order, exempting health care personnel.

Executive Order 2020-011 orders the temporary suspension of certain regulations, including suspending the requirement of a physical examination for a "medical marijuana" card for 30 days.

Executive Order 2020-016 pertains to the criminal justice system, suspending certain regulations related to populations.

Executive Order 2020-20 temporarily suspends certain statutes to expand the use of telemedicine.

  • Suspends the requirement that carrier reimbursements to a provider for telehealth services are subject to all terms and conditions of the health benefit plan.
  • Suspends the law that health benefit plans are not required to pay for consultation provided by a provider by telephone or facsimile unless the consultation is provided through Health Insurance Portability and Accountability Act (HIPAA) -compliant interactive audio-visual communication or the use of a HIPAA-compliant application via a cellular telephone.
  • Suspends the requirement that a person residing in and licensed or certified in another state as a psychologist, marriage and family therapist, clinical social worker, professional counselor, or addiction counselor does not exceed twenty (20) days per year of performing activities or services in Colorado.
  • Directs the Department of Insurance to promulgate rules.

Colorado Medical Society seeking volunteers to provide telemedicine: The Colorado COVID-19 Innovation Response Team, organized by Gov. Jared Polis, is preparing to introduce telemedicine service to uninsured and under-served Coloradans. The Colorado Medical Society is seeking physician volunteers, whose work may be conducted from home, primarily via telephone and/or video calls.

The Department of Insurance released rules requiring carriers to reimburse providers for telehealth services using nonpublic facing audio or video communication products during the coronavirus nationwide public health emergency.

The state received a $2 million emergency grant from SAMHSA:

  • The Emergency Grants to Address Mental and Substance Use Disorders During COVID-19 (Emergency COVID-19) Colorado project will provide evidence-based mental and substance use disorder treatment to children, adolescents, and adults with Serious Emotional Disturbance (SED), Serious Mental Illness (SMI) and/or Substance Use Disorder (SUD).
  • The Colorado Department of Human Services, Office of Behavioral Health (OBH) will consider alternative options for consumers in behavioral health crises, ensure psychiatric beds for consumers who are positive for COVID-19, and step-down behavioral health options for SMI/SUD consumers to ensure hospitals are able to prioritize treatment and bed availability for those needing intensive treatment for COVID-19.

Executive Order D 2020 063: Extends Executive Order D 2020 038, the Temporary Suspension of Certain Statutes and Rules to Expand the Healthcare Workforce for Hospitals and Other Inpatient Treatment Facilities Due to the Presence of COVID-19.

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Connecticut

Emergency Temporary Telemedicine Coverage (3/13/2020)

  • Waiving the homebound requirements for all otherwise coverable medical telemedicine services;
  • Addition of specified "New Patient" Evaluation and Management (E&M) Services; and
  • Waiving the originating site requirements for psychiatric diagnostic evaluations.

Department of Consumer Protection, Drug Control Division, issued guidance for practitioners prescribing refills for patients without in-person visits:

  • Schedule II controlled substance prescriptions cannot be refilled unless there prescriber has a pre-existing relationship with a patient, and have prescribed a Schedule II controlled substance in the past may reissue a Schedule II controlled substance prescription to that patient [without an in-person visit]. No prescription for Schedule II may contain more than one prescription.
  • Schedule III and IV controlled substance prescriptions may be refilled up to five (5) times in six (6) months as authorized by the prescribing practitioner.
  • Schedule V controlled substance prescriptions may be refilled as authorized by the prescribing practitioner.

New Coverage of Specified Telemedicine Services Under the Connecticut Medical Assistance Program (3/13/2020) – Includes specifics for behavioral health

Expanded Telemedicine and New Audio-Only (Telephonic) Services for Medicaid– Select E&M codes can be billed for telephone-only services provided to established patients.

Governor issues Executive Order addressing Medicaid telehealth:

  • Permits telehealth providers who are Medicaid-enrolled providers providing telehealth to "new or established patients" to engage in audio-only telehealth

DMHAS COVID-19 Protocol for Quarantine and Isolation

Provider Guidance for Mobile Crisis, Assertive Community Treatment, Inpatient Services, Residential Services.

Licensure Waiver: the Department of Public Health has waived licensure for health care practitioners licensed in other states to provide care within Connecticut, practicing within the scope of practice of Connecticut law. The provider may not balance bill the Connecticut patient.

DMHAS Private Non-Profit Provider Guidance:

  • SA Residential Levels of Care: usually a TB test is required, but due to pressures on labs right now, an assessment tool can be used instead.
  • Intensive SA Residential Treatment Programs: DMHAS permitting a reduction in face-to-face therapeutic interventions from 30 hours to 20 hours

CMS Approves 1135 Waiver for Connecticut:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

Governor Lamont Announces Protections From Civil Liability For Healthcare Providers During Pandemic: For the duration of the pandemic, health care professional and health care facilities shall be immune from suit for civil liability for any injury or death alleged to have been sustained because of the individual's or health care facility's acts or omissions undertaken in good faith while providing health care services. The includes, but is not limited to, decisions made due to a lack of resources, attributable to the COVID-19 pandemic, that renders the health care professional or health care facility unable to provide the standard level or manner of care.

Delivery of Methadone to Homebound Clients by Methadone Maintenance Clinics: A medical professional at a methadone maintenance clinic can deliver methadone to a client at home when a client notifies the clinic that they have symptoms consistent with an infection related to COVID-19, and a medical professional at the clinic determines that, based on the symptoms presented, for the health of that client and the staff and clients at the clinic, the client should be treated at home.

Governor Lamont issued an Executive Order to establish recovery centers in nursing homes for those who have been discharged from hospitals but cannot yet return to their own nursing homes.

Executive Order 7AA: approves temporary additional nursing home beds

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

The Governor issued Governor Lamont's Executive Order Addresses Healthcare Concerns. Among other actions, the order:

  • Temporarily suspends PA supervision restrictions and in-person supervision requirement for APRNs.
  • Temporarily allows Medicaid-enrolled providers and in-network providers for commercial fully insured health insurance to perform telehealth through audio-only calls. There is additional guidance on how these providers can deliver telehealth to patients not covered by Medicaid or covered by a fully-insured commercial plan.
  • Allows individuals who have completed all requirements to participate in intern, resident physician, or United States Medical Officer candidate training programs prior to permit issuance.
  • Allows individuals who have completed all requirements to participate in resident physician assistant programs prior to permit issuance.
  • Suspends continuing education requirements for healthcare providers.

The DOI issued health insurance rate filing submission guidelines removing the requirement to demonstrate compliance with NQTLs due to COVID-19.

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Delaware

Insurance Commissioner Navarro issues bulletin (3/9/2020) prohibiting carriers from excluding a service for coverage solely because the service is provided through telemedicine. Services may be provided through a variety of platforms, including telephones, remote patient monitoring devices, and other electronic means such as web cameras and mobile facetime.

  • Insurance Commission Navarro issue bulletin (3/20/2020) reiterates coverage of telemedicine and notes that Delaware residents do not need to be in Delaware at the time relevant services are provided. Additionally, out-of-state providers who would be permitted to provide these services in Delaware if they were licensed under Title 24 may provide telemedicine services to a Delaware resident if they hold an active license in another jurisdiction.

Telemedicine may be practiced without a physician-patient relationship [if] furnishing of medical assistance [occurs] by a physician in case of an emergency or disaster if no charge is made for the medical assistance.

Licensure Waiver: The Delaware Department of Health and Social Services and the Delaware Emergency Management Agency announced in their latest emergency declaration guidelines for licensure waivers for the duration of the public health emergency:

  • Nurses, doctors, mental health care providers, pharmacists and other health care professionals who have active licenses or certificates of good standing in any U.S. jurisdiction are authorized to provide in-person health care services in Delaware throughout the emergency, as well as telemedicine services.
  • Delaware health care professionals whose licenses expired in the last five years are authorized to provide health care services in Delaware, assuming their licenses were in good standing for the five-year period.

Delaware Medical Reserve Corp: All medical personnel — including out-of-state, retired, or inactive — who wish to volunteer to assist Delaware's response can sign up through ServDE, the State’s emergency response database.

Delaware 1135 Medicaid Waiver is Approved: The approved waiver enables Delaware to provide flexibilities in Medicaid provider screening and enrollment, forgo certain pre-admission screening and annual resident review assessments, and lift prior authorization requirements.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Governor Carney’s Update to Emergency Declaration Expands Telehealth: The declaration temporarily waives requirements for both audio and visual technology for the provision of telemedicine and telehealth under Title 24 of the Delaware Code, which will allow the use of non-smart phone or landline connections.

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Governor Carney issued his twelfth modification to his State of Emergency declaration, which will allow the Public Health Authority to activate more out-of-state health care workers to assist in Delaware’s fight against COVID-19. The modified declaration will allow physicians who previously held a license to practice in any United States jurisdiction, to serve as healthcare volunteer basis in the state. The provider must be appropriately trained, and their license must have been in good standing for a five-year period before it expired or lapsed. Additionally, the modified declaration will also allow pharmacists, respiratory therapists, PAs, paramedic, emergency medical technicians, nurses, or certified nursing assistants, who hold an expired license or certification from any United States jurisdiction to practice may be activated as a healthcare volunteer in Delaware if (1) the individual’s license or certification was active and in good standing for the duration of the five-year period prior to the date it went inactive, expired or lapsed, (2) the individual’s scope of practice is limited to examination, testing and treatment, and (3) the hospital that will use the individual’s services has provided training appropriate for the tasks to be performed.

District of Columbia

March 12 Guidance on the Use of Telehealth in DC: This guidance provides an overview of the licensure, standards of care, and reimbursement aspects of telehealth in DC, with the caveat that we are awaiting guidance on certain restrictions for Medicare beneficiaries.

March 13 Medicaid Use of Telehealth: On March 12, 2020, DHCF adopted an emergency and proposed rule that established authority for Medicaid reimbursable services to be delivered in a beneficiary's home to ensure the health, safety, and welfare of residents is not threatened by a lapse of in-person access to covered healthcare services due to the threat of infection with COVID-19. The policy change requires Medicaid telemedicine providers to ensure that any technology used meets the standards of care when the beneficiary receives telemedicine services at their home.

  • The rule will be subsequently published in the DC Register and will remain in effect for one hundred and twenty (120) days or until July 10, 2020, unless superseded by publication of a Notice of Final Rulemaking in the DC Register.
  • An update to this guidance provides that the Office of Civil Rights and the US Department of Health and Human Services will be using descretion in enforcing HIPAA, and that non-HIPAA compliant means of communicating with patients will be allowed during the public emergency.

Licensure Waiver: licensure requirements waived for healthcare providers already licensed in their home states and will be considered "temporary agents" in DC. However, those practicing as "temporary agents" can only provide healthcare at a licensed facility in DC (can include telehealth). Can also provide healthcare to patient with whom provider has existing relationship, keeping in line with March 12 guidance on telehealth.

Insurance Commissioner Order:

  • Carriers must enhance their coverage of telehealth services
  • Cost-sharing for telehealth may not be more than in person
  • Carriers must conduct utilization review and appeal processes as quickly as possible
  • Carriers may not cancel or non-renew any health benefit plan without express consent from the Commissioner

DC Medicaid Telemedicine Guide:

  • A primer to start providing telemedicine for Medicaid patients in DC

CMS Approves 1135 Waiver for DC:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Florida

Licensure Waiver: Florida DOH authorizing practice by health providers who are not licensed in the state for a period of 30 days, which includes telehealth.

1135 Waiver: Florida received federal approval for a Section 1135 waiver to provide more flexibility for the health care delivery system. The waiver allows Florida to provide flexibilities in Medicaid provider screening, forgo certain pre-admission screening and annual resident review assessments, lift prior authorization requirements, allow the provision of facility services in alternative settings, and extend fair hearing timelines.

Governor signed an Executive Order on 3/26/2020 relating to Telehealth.

  • Amends the state employee health benefits plan to include telehealth services at no additional cost to employees.
  • Ensures that all state employees have access to telehealth services through the state's contracted HMO plans and PPO organization plan without cost sharing effective immediately.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Georgia

Telemedicine for BH: Effective March 14, 2020 and through April 30, 2020, the following allowances for DBHDD Behavioral Health Services are in effect.

Telemedicine Allowances: Currently, the DBHDD Behavioral Health Provider Manual has this clause associated with several services:

To promote access, providers may use Telemedicine as a tool to provide direct interventions to individuals for whom English is not their first language (one-to-one via Telemedicine versus use of interpreters). Telemedicine may only be utilized when delivering this service to an individual for whom English is not their first language.

For the specific services which have this clause, through April 30, 2020, DBHDD will waive the Service Accessibility requirement to allow for individuals to access services via Telemedicine. All other service requirements must be met (practitioner requirements, documentation, consent, adherence to IRP content, etc.), especially content defined in Part II, Section I, 1.B.16.a-c.

Licensure Waiver: Georgia Composite Medical Board will approve and issue "emergency practice permits"; to physicians, physician assistants, advanced practice registered nurses, and respiratory care professionals who wish to practice medicine during the public health emergency response to novel coronavirus, known as "COVID-19."

Emergency Practice Permit Application: Expedited approval of out-of-state nursing licenses. March 20, 2020. Governor Kemp announced a 24-hour turnaround for any out-of-state nurses with active licenses.

The Department of Behavioral Health and Developmental Disabilities is calling all Mental Health First Aid, Youth Mental Health First Aid, licensed mental health professionals and retired mental health professionals to help staff a warmline to support Georgians during this coronavirus crisis, and needs volunteers to field calls. Interested parties should email MHFAvolunteer@dbhdd.ga.govif. See the complete flyer from DBHDD here.

CMS Approves 1135 Waiver for Georgia

  • Suspends Medicaid FFS prior authorization requirements.
  • Extends pre-existing authorizations from March 1.
  • Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and II for 30 days. After 30 days, new admissions with mental illness should receive a Resident Review as soon as resources become available.
  • Temporarily enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for reimbursement for residential psychiatric facilities in alternative settings.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Hawaii

Licensure Waiver: Governor Ige's proclamation allows out-of-state physicians, osteopathic physicians, and physician assistants to practice in Hawaii without a license, provided that they have never had their license revoked or suspending and are hired by a state or county agency or facility, or by a hospital, included related clinics and rehabilitation hospitals, nursing home, hospice, pharmacy, or clinical laboratory.

Governor Ige Announces Telehealth Licensure Waivers: For the duration of the COVID-19 crisis, licensed providers are able to deliver telehealth without an in-person consultation or a prior existing physician-patient relationship. Additionally, out-of-state physicians, osteopathic physicians, and physician assistants with a current and active license, or those who were previously licensed, but who are no longer current and active, will be allowed to deliver telehealth in Hawai‘i without a license. Requirements for in-person consultation and prior existing physician-patient relationship will be waived, provided that they have never had their license revoked or suspended and are hired by a state or county agency or facility or by a hospital, including related clinics and rehabilitation hospitals, nursing home, hospice, pharmacy, or clinical laboratory.

CMS Approves 1135 Waiver for Hawaii:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

COVID-19 Guidance for MedQuest Behavioral Health and Homelessness Care Providers: This guidance has been developed by Hawai'i Department of Health's Behavioral Health Administration, in partnership with the Governor's Coordinator on Homelessness and the Department of Human Services' Homeless Programs Office, to control of the spread of COVID-19 among behavioral health and homeless populations, while ensuring continuity of coverage of essential services. This guidance provides more details on expanding telehealth for MedQuest patients, including general principles of delivering telehealth, billing guidelines and training tips for staff. Additionally, the guidance highlights:

  • Effective immediately, providers and staff should offer telehealth services as an option to all patients while ensuring continuity of coverage of all services.
  • During the Governor's COVID-19 Emergency Proclamation period, services should be delivered via telehealth unless clinical judgement determines that an in-person visit is indicated or when the client lacks connectivity. This Telehealth Decision Tree is intended to help providers determine when telehealth is appropriate.
  • MedQuest will allow telephonic (audio-only) “visits”, in addition to other telehealth modalities, to provide medically necessary health care services [e.g., medical, behavioral health, substance abuse disorders, occupational therapy (OT), physical therapy (PT), speech therapy (ST)] during the public health emergency period.
  • Note: In coordination with relevant experts and partners, BHA will offer training to providers for the use of telehealth services.
  • Additional guidance is available for:

Hawaii Medical Service Association Telehealth Resources: In light of the pandemic, HMSA is waiving all cost sharing and deductibles for fully insured commercial, Medicare Advantage, and QUEST Integration members who use telehealth visits, virtual check-ins, and e-visits.

Online Registration System For Volunteer Health Care Professionals: As the state plans for the possibility of medical surge, health care professionals can register using this form to volunteer to serve in their respective island. During an emergency, volunteer health care professionals are often called upon to fulfill essential roles such as providing medical evaluation and care, vaccinations or assisting with the distribution of medications. Volunteers also support preparedness activities such as community education and training. Depending on needs and assignments, volunteers may or may not be deployed.

Hawaii announces new telehealth page: This site provides an overview to consumers who may be new to telehealth by explaining what to expect during a telehealth visit. Additionally, patients can see which insurers are providing coverage for telehealth services.

New Executive Order Provides Telehealth, SUD Treatment, and Licensure Guidance: Governor Ige issued an executive order that suspends current statutes for the remainder of the emergency to allow:

  • coverage of standard telephone calls for the delivery of telehealth services.
  • off-site dispensing of necessary take-home doses of medication for medication assisted treatment by opioid treatment programs as outlined in DEA’s latest COVID-19 guidance.
  • issuance of up to 28 doses of methadone to qualified patients in an opioid treatment program in accordance with the SAMHSA’s Opioid Treatment Program Guidance.
  • the Department of Commerce and Consumer Affairs to suspend or extend license renewal deadlines.
  • waiving the licensure and accompanying requirements to permit graduates of nursing education programs approved by the State Board of Nursing, within 180 days following graduation, to be employed to practice nursing.
  • waiving the licensure and accompanying requirements so as to permit graduates of an accredited graduate level education program preparing the nurse for one of the four recognized advanced practice registered nurse roles licensed by the State Board of Nursing, within 180 days following graduation, to be employed to practice as an advanced practice registered nurse, with the endorsement of the employing health care entity.
  • currently and actively licensed pharmacists, or pharmacy interns currently and actively permitted by the board, to fill, compound, or receive prescriptions by remote data entry.

Executive Order Provides Civil Liability Protections during COVID-19 Emergency: The Governor’s new order states that healthcare professionals, volunteers, and facilities that in good faith comply completely with all state and federal orders regarding the disaster emergency, shall be immune from civil liability for any death or injury to persons, or property damage alleged to have been caused by any act or omission by the health care facility, which death of or injury to persons, or property damage occurred at a time when the health care facility was engaged in the course of rendering assistance to the State by providing health care services in response to the COVID-19 outbreak, unless it is established that such death or injury to persons, or property damage was caused by willful misconduct, gross negligence, or recklessness of the health care facility.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Idaho

Licensure Waiver and Telehealth Waiver

Board of Medicine guidance:

  • Out-of-state MDs, DOs, and PAs licensed and in good standing in other state may practice in Idaho
  • Retired or inactive practitioners of any kind that have retired or gone inactive in last 5 years may apply for temporary license with MDs, DOs, PAs, and RTs receiving priority
  • Physicians may supervise PAs without registering with the Board and may supervise more than the currently allowed 4 PAs for at least 120 days
  • PAs do not need to submit usual documentation regarding supervision or practice
  • PAs may practice temporarily without adequate supervision or reduced supervision
  • Out-of-state physicians and PAs may practice telehealth without Idaho license
  • Out-of-state physicians may supervise PAs in Idaho after completing attestation
  • CME requirements are waived

The state has provided the following reference materials:

CMS Approves 1135 Waiver for Idaho:

  • Temporarily suspends Medicaid FFS prior authorization
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

Idaho Department of Health and Welfare - temporary rulemaking - Medicaid:

  • allows for Medicaid telehealth reimbursement of telephone calls (appears as though for physicians and APRNS)
  • allows staff to begin working for the department while criminal background checks are pending

In response to the Governor's Executive Order, the Department of Insurance issued guidance to health insurance carriers:

  • State licensing agencies and departments are authorized to temporarily exercise enforcement discretion, implement temporary rules, and waive licensing and related requirements to maximize access to health care services and provider support in response to COVID-19.
  • The Department of Insurance is notifying health insurance carriers that it is encouraging carriers to submit proposals designed to retain coverage for individuals and/or employees by waiving certain statutory requirements or not enforcing contractual provisions in filed forms, including but not limited to:
    • Extensions of grace periods for payment of premiums for individual policies;
    • Work requirements;
    • Allowing employees who are furloughed or have reduced hours due to the impacts of COVID-19 to retain coverage, if there is a reasonable expectation that the employee will return to work upon the expiration of this crisis;
    • Allowing employees who are laid off due to the impacts of COVID-19 to retain coverage, including through COBRA, and allowing carriers or agents to proactively explain alternatives to the affected employees;
    • Waiver of probationary periods for employees who were laid off due to COVID-19, but subsequently re-hired; and
    • Employer "Premium holidays" or refunds for services that could not be provided due to COVID-19.
  • It is the Department's intent to not enforce any otherwise applicable provisions of law and rule, and to allow carrier deviation from contractual language, so long as certain conditions are met, including that such actions are applied uniformly and without prejudice, to all similarly-affected individuals or employer groups.

Department of Insurance: Temporary Waiver Certain Pharmacy Benefit Requirements: Department authorizes health insurance carriers under Department jurisdiction to waive:

  • Policy limitations on the number of pharmaceutical refills and early refills;
  • Restrictions that would disallow coverage of a 90-day refill at a retail (as opposed to mail-order) setting, unless doing so would be inconsistent with an applicable prescription safety limits of the Social Security Act; and
  • Requirements for in-person pharmacy signature logs as well as the associated signature audits by insurers or pharmacy benefit managers.

Health insurance carriers are encouraged to work with their pharmacy benefit managers to implement this guidance.

Idaho Department of Insurance: Short-term health insurance plans join ACA plans in COVID-19 testing and treatment: While ACA plans don't exclude preexisting conditions, short-term health plans may exclude coverage for COVID-19 if purchased after diagnosis and there was no prior health coverage. The available short-term insurance carriers all provide coverage for COVID-19 testing, physician visits, and/or treatment, and they are waiving co-sharing as follows:

  • Blue Cross of Idaho Health Services: Co-sharing for testing, associated physician visits, and treatment are waived.
  • Companion Life Insurance Company: Co-sharing for testing is waived.
  • Everest Reinsurance Company: Co-sharing is not waived for any services.
  • Lifemap Assurance Company: Co-sharing for testing and associated physician visits are waived. Other costs including treatment are subject to normal co-sharing per plan.
  • Independence American Insurance Company: Co-sharing for testing and associated physician visits are waived.
  • SelectHealth Benefit Assurance Companies Co-sharing for testing and the related physician visit are waived. Co-sharing for treatment is waived if with in-network providers or in an emergency room.
  • Standard Life and Accident Company: Co-sharing for testing and associated physician visits are waived.

The state received a $2 million SAMHSA emergency grant. The Idaho Department of Health and Welfare, Division of Behavioral Health (DBH) plans to implement a 3-pronged approach to bring needed resources to Idahoans during this time of crisis: Emergency Department Behavioral Health Diversion and Triage: Idaho will stand up a Diversion and Triage unit to provide emergency services to patients with psychiatric conditions, but do not have critical medical health needs.

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Illinois

Homeless shelters guidance

Executive Order requiring reimbursement for telehealth during emergency :

  • Originating site can be residence
  • Department will reimburse for virtual check in

State is expediting licensing.

  • IDFPR issued a proclamation to allow out-of-state physicians, nurses, physician assistants, and respiratory care therapists to provide care to Illinois residents affected by COVID-19.
  • The Secretary of IDFPR has prepared a series of Variances allowing Illinois physicians, nurses, physician assistants, and respiratory care therapists whose license status is inactive, non-renewed, or expired that also satisfy an additional set of specific criteria to restore their licenses temporarily during this pandemic.
  • Out-of-state licensed physicians, nurses, physician assistants, and respiratory care therapists may practice in the State of Illinois in a limited set of circumstances as provided for by the IDFPR proclamation.

CMS approved Illinois' Medicaid Section 1135 Waiver. Highlights include:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements. Allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment -- Illinois may reimburse out-of-state providers for multiple instances of care to multiple participants, provided certain criteria are met. If a certified provider is enrolled in Medicare or with a state Medicaid program other than Illinois, Illinois 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 certain screening requirements so the state may provisionally, temporarily enroll the providers for the duration of the public health emergency.
    • CMS is also approving Illinois' request to temporarily cease revalidation of providers who are located in Illinois 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 -- 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.

Executive Order 2020-13 suspends admissions to the Illinois Department of Corrections from all Illinois county jails, except at the discretion of the Director of the Illinois Department of Corrections for limited essential transfers.

Governor JB Pritzker and Chicago Mayor Lori Lightfoot announced plans to set up a 3,000 bed alternative care setting for COVID-19 patients at the McCormick Place Convention Center in Chicago

CITY OF CHICAGO – Mayor Lori E. Lightfoot signed an executive order explicitly ensuring that all benefits, opportunities, and services provided or administered by the City of Chicago are accessible to all residents, regardless of birth country or current citizenship status.

Illinois Department of Healthcare and Family Services released rules that broaden telehealth rules to accommodate new places of service and means of engagement and communication during the coronavirus public health emergency. The Department (ie. Medicaid) will reimburse for:

  • Medically necessary and clinically appropriate telehealth services with dates of service on or after March 9, 2020 until the public health emergency no longer exists.
  • Brief communication technology-based service, e.g. virtual check-in that uses audio-only real-time telephone interactions or synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.
    • Virtual check-ins must be rendered by a physician, advanced practice registered nurse, or physician assistant who can report evaluation and management (E/M) services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. The Department will reimburse for this service at the rate established on the Department's fee schedule.
  • Online patient portal or "E-visit" services are non-face-to-face patient-initiated communications using online patient portals. These services can only be reported when the billing practice has an established relationship with the patient. For these encounters, the patient must generate the initial inquiry and communications can occur over a 7-day period. The patient must verbally consent to receive virtual check-in services. The Department will reimburse for HCPCS codes G2061, G2062 and G2063 and CPT codes 99421, 99422 and 99423 at the rate established on the Department's fee schedule.
  • All behavioral health services (substance use disorder and mental health disorder) detailed in Section 140.453 (except for Mobile Crisis Response and Crisis Stabilization as defined in Section 140.453(d)(3)) and behavioral health services (substance use disorder and mental health disorder) contained on an applicable Department fee schedule provided using audio-only real-time telephone interactions, or video interaction. The Department will reimburse for these services at the same rate paid for services provided on site.
  • An originating site will be eligible for a facility fee when it is a certified eligible facility or provider organization that acts as the location of the patient at the time a telehealth service is rendered, including but not limited to: substance use treatment programs licensed by the Department of Human Services' Division Substance Use Prevention and Recovery (SUPR), Supportive Living Program providers, Hospice providers, Community Integrated Living Arrangement (CILA) providers, and providers who receive reimbursement for a patient's room and board.

Executive Order 2020-19: Department of Corrections:

  • Suspends the phrase "for a period of time not to exceed 14 days,"" thus allowing furlough periods to be allowed for up to the duration of the Gubernatorial Disaster Proclamations as determined by the Director of IDOC.
  • Also suspends the phrase "to obtain medical, psychiatric or psychological services when adequate services are not otherwise available," allowing them to be allowed at the Director’s discretion and consistent with the guidance of the IDOC Acting Medical Director.

Illinois Exec Order 23-2020 allows the Department of Financial and Professional Regulation to expand scope of any license it oversees during the public health emergency. The Department oversees Physicians, Nurses, Pharmacies, Physical Therapists, Dentists, and numerous other health care and non-health care related professions.

  • Authorizes the Secretary of IDFPR to take action to increase the number of licensed professionals engaged in disaster response include (a) suspending requirements for permanent and temporary licensure of persons who are licensed in another state, (b) modifying the scope of practice restrictions under any licensing act administered by the Department, and (c) expanding the exemption in Section 4(a) of the Pharmacy Practice Act.
  • The Secretary shall work closely with the Directors of the Emergency Management Agency and the Department of Public Health to ensure any impacted licensed professionals are aiding in the response to the disaster.

DHFS Bulletin on 4/6: Temporary Prior Authorization Requirement Changes Related to COVID-19 Public Health Emergency:

  • The Department will remove prior authorization for physical, occupational, and speech therapies; home health; certain durable medical equipment and supplies.
  • The Department will identify current prior authorizations for certain codes and extend the prior authorization timeframe. Providers whose prior authorizations are not extended should contact the prior authorization unit for assistance. The Department's goal is to allow flexibility and accommodate all requests timely so that a participant's access to care is not impacted.
  • Face-to-face encounter requirements for ordering DME, Home Health, and therapy are waived.
  • See bulletin for complete details.

The Division of Mental Health established a mental health hotline in response to COVID "Call4Calm."

The Department of Health will begin to publish data related to COVID-19 outbreaks and deaths specific to certain nursing homes.

The Illinois Department of Human Services (IDHS), Division of Mental Health (DMH) and Division of Substance Use Prevention and Recovery (SUPR) received a SAMHSA emergency grant of $2 million in part for telehealth.

Governor Pritzker highlighted several measures designed to mitigate the impact of the pandemic in Illinois' Latino communities. The Latino individuals who have been tested for COVID-19 have a positive rate of 60%, nearly three times the state's average. The Governor called attention to "institutional inequities and obstacles for Latino communities, now being amplified during this global pandemic in Illinois and across our nation..." In response, the administration has, among other actions, increased testing in more vulnerable communities and required each of the state's seven drive-through testing sites to offer options for Spanish translation services. The Administration has also expanded emergency Medicaid criteria to cover undocumented individuals.

COVID-19 Elective Surgery and Procedure Guidance

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Indiana

Governor's Executive Order suspends face-to-face requirements for Medicaid and expands telehealth to mental health services and SUD treatment.

IHCP (Medicaid) Bulletin: telemedicine billing guidance for providers

State to allow opioid treatment programs the use of lockboxes; provide naloxone to help reduce spread of COVID-19 (updated 3/16/2020)

COVID-19 Interim Recommendations for Outpatient Facilities (updated 3/18/2020)

Guidance for Out-of-Hospital Facilities (updated 3/18/2020)

Guidance for Correctional Facilities (updated 3/18/2020)

Indiana to offer Psychological First Aid training in response to COVID-19 epidemic

No specific guidance on telehealth at this time.

Health and Professional Licensing

  • Mental health professionals are permitted to practice via telemedicine.
  • Advance Practice Registered Nurses are allowed to provide services in multiple locations.
  • The state health commissioner may waive requirements of the nursing home certificate of need statute to respond to COVID-19 issues for long-term care facilities.

Indiana's 1135 Medicaid Waiver Approved:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Expands provider enrollment for out-of-state providers
  • Authorizes care to be provided in alternative settings, including psychiatric residential treatment facilities
  • Lifts some prior authorization requirements

Modification to ASAM 3.5:

  • Provides some flexibility for assessment due to lack of in-person visits
  • Can include use of telemedicine to do assessments and follow up

Board of Nursing Executive Order Waiver authorizes temporary suspension of requirement for APRNs to submit documentation every 7 days. Governor's EO waived requirement that APRNs maintain multiple practice agreements for multiple locations of practice during the emergency.

Executive Order authorizes non-Indiana licensed EMS professionals to get temporary license in Indiana. Also authorizes physician assistants who have completed training but have not yet taken the PANCE to practice on a temporary basis.

Executive Order 2020-21 authorizes recent pharmacy graduates to receive a temporary license to practice. Waives continuing education requirements for health care workers for 2020.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Safe Recovery Site for Vulnerable Hoosiers: information on how to refer clients to safe recovery locations for homeless populations, people experiencing domestic violence, or clients of DMHA licensed residential sites

Updated list of ASAM Designated Addiction Residential Treatment Facilities

COVID-19 guidance for inpatient behavioral health providers: recommendations for monitoring patients and patient intake

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Iowa

Licensure Waiver and Telehealth: Effective March 16, 2020, Governor Kim Reynolds declared a state of emergency in Iowa due to the spread of COVID-19. The state of emergency shall expire on April 16, 2020, unless terminated or extended in writing by Governor Reynolds.

Here are the effects on the licensure and medical practice of physicians providing care in Iowa under the state of emergency:

  1. No Iowa Medical License Required: A physician may practice medicine/telemedicine in Iowa without an Iowa medical license on a temporary basis to aid in the emergency, if a physician holds at least one active medical license in another United State jurisdiction, and all medical licenses held by a physician in other United States jurisdictions are in good standing, without restrictions or conditions.
  2. Telemedicine and Telehealth Services: All rules which establish preconditions, limitations, or restrictions on the provision of telehealth or telemedicine services in Iowa are temporarily suspended. All rules which require face-to-face interactions with health care providers, and impose requirements for residential and outpatient substance use disorder treatment and for face-to-face visitations, are temporarily suspended.
  3. Lapsed or Expired Iowa Medical Licenses: A physician whose Iowa medical license lapsed or expired in good standing within five (5) years of the date of the Proclamation may provide medical care and treatment of victims of this public health emergency for the duration of the Proclamation.

***Delivery of emergency services pursuant to these provisions does not require special notification or registration with the Iowa Board of Medicine or any other state agency during this time of emergency.

Governor Reynolds signed legislation that expands the roles of physician assistants in Iowa. The legislation was purportedly aimed at combating COVID-19 makes changes related to the practice of a PA by allowing for full prescriptive rights, legal protections similar to other health care professions, the ability to be reimbursed by Medicaid and a range of other changes.

The Department of Human Services (DHS) issued a bulletin on 3/19 that specified:

  • All Medicaid services, including MH/SUD services, may be provided through telehealth. This may include telephone only, although the bulletin seemed to suggest that this may be limited to phones with video capabilities.
  • Providers should bill originating and distant site bill using HCPCS/CPT codes with POS code 02 The bulletin was updated to make clear that telehealth will be covered for services provided through the telephone and when a member is located at home

The Department of Human Services (DHS) issued a bulletin on 3/19 that specified:

  • All Medicaid services, including MH/SUD services, may be provided through telehealth. This may include telephone only, although the bulletin seemed to suggest that this may be limited to phones with video capabilities.
  • Providers should bill originating and distant site bill using HCPCS/CPT codes with POS code 02

The Division of insurance issued a bulletin to insurers on 3/27 specifying the following about telehealth coverage:

  • Requests that insurers work with providers to increase access to telehealth
  • Insurers "shall not" limit access to telehealth just to COVID-19 services
  • Insurers "shall" reimburse telehealth at same rate as in-person service delivery
  • Insurers "shall not limit, deny, or reduce coverage" of reimbursement for telehealth services
  • Insurers that administer self-funded plans "shall encourage" all employers to remove cost sharing and other financial barriers to telehealth

The Governor issued a public health proclamation on 4/10 that, among other things, specified the following (note that there are many provisions and only those that may affect physicians have been summarized):

  • Waives requirements that medical professionals be licensed in the state as long as they are licensed in another state
  • Waives the requirement that there be “clear definition of authority, responsibility, and functioning of each nurse to the extent that there is evidence that each nurse has been assessed competent in any area where they function.”
  • Waives the requirement that written procedures be posted in a hospital regarding the administrative and technical requirements of all personnel and that all staff be familiar with those procedures
  • Waives requirements about medical records and reporting, provided that all federal requirements must be followed
  • Waives requirements about authentication for verbal and standing orders
  • Waives requirements that hospital equipment be selected, maintained, and utilized within manufacturers specifications
  • Waives requirements that acute care units in hospitals have no more than 25 beds
  • Waives provisions that permit in-person visits for residential facilities and adult day service facilities

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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The Governor issued an updated proclamation on 4/27 that contained, among many other things, the following relevant orders:

  • Continues allowance for telehealth coverage through audio-only and reimbursement must be same as in-person (sec. 67, pg. 15)
  • Continues allowance for telehealth coverage for residential and SUD services that ordinarily require in-person treatment (sec. 68, pg. 15)
  • All healthcare facilities must continue to screen staff for COVID-19 at the beginning of each shift (pg. 8)
  • Continues suspension of requirement that nursing students must complete medication aide course or challenge exam before administering medications to patients with mental illness in nursing facilities and immediate care facilities (sec. 22, pg. 10)
  • Continues suspension of requirement that residential facilities update patients’ service plan every 30 days (sec. 26, pg. 10)
  • Continues suspension of requirement that residential facility staff have physical evaluation in prior 12 months if not possible (sec. 30, pg. 10)
  • Continues suspension of requirement that residential facility staff have TB screening (sec. 31, pg. 11)
  • Continues suspension of requirement that residential facility provide new resident orientation within 24 hours (sec. 33, pg. 11)
  • Continues suspension of requirement that medical staff be licensed in the state as long as they are licensed in another state (sec. 38, pg. 11)
  • Continues suspension of requirement that hospital medical record and report maintenance be sent to the state (sec. 48, pg. 12)
  • Continues suspension of in-person residential or adult day treatment (sec. 64, pg. 14)
  • Continues allowance of therapeutic substitution by pharmacist without consulting with prescriber (sec. 69, pg. 15)
  • Continues allowance that licensing board may issue emergency licenses without completing full requirements (sec. 74, pg. 16)
  • Continues allowance of practice by those whose licenses have expired in previous 5 years (sec. 75, pg. 16)
  • Continues suspension of CEU requirements (sec. 79, pg. 16-17)

Kansas

Coronavirus Disease 2019 (COVID-19) Guide for Acute Care Hospitals (ACH), Long-term Acute Care Hospitals (LTACH), Inpatient Psychiatric Facilities (IPF), and Inpatient Rehabilitation Facilities (IRF): Healthcare facilities in Kansas cannot and should not be turning away patients or refusing care for fear of COVID-19.

New restrictions on visitors and non-essential individuals entering the Kansas Neurological Institute, Parsons State Hospital and Training Center, Osawatomie State Hospital and Larned State Hospital are in place.

Executive Order 20-08: expands access to telemedicine and empowers the Board of Healing Arts to grant temporary emergency licenses.

  • Removes requirement of in person exam of patient by a physician prior to issuing a prescription.
  • Encourages physicians to utilize telemedicine and allows out-of-state physicians to treat Kansans through telemedicine.
  • Authorizes the Board of Healing Arts to grant a temporary emergency license to practice to any profession regulated by the board to an applicant whose qualifications the board determines to be sufficient to protect public safety and welfare within the scope of professional practice by the temporary emergency license for the purpose of preparing for, responding to, and mitigating COVID-19.

Kansas Section 1135 Waiver approved 3/24:

  • Temporarily suspends some prior authorization processes
  • Extends pre-existing authorizations throughout the public health emergency
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Authorizes provider enrollment for non-Kansas providers

Executive Order 20-19: Extends license renewal for professional occupations 90 days past the end of the public health emergency.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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The Governor issued an executive order expanding scope during the public health emergency, suspending physician supervision and delegation restrictions for registered nurses, licensed practical nurses, APRNs, and pharmacists provided certain conditions are met, including that they work for a healthcare facility, their services are necessary to respond to the COVID-19 pandemic, and the facility’s medical leadership made such a decision to expand scope.

Kentucky

Psychiatric Facilities: March 17, 2020 – The Governor announced the following steps to continue to respond to the COVID-19 pandemic: All acute care facilities should discourage all visitors except for visits in end-of-life circumstances. The Governor also advised psychiatric facilities to restrict visitation, only allowing it if deemed medically necessary by the attending physician, administrator and the medical director.

Emergency Licensure: Medical and Osteopathic physicians not already licensed to practice in the Commonwealth of Kentucky may register to practice within Kentucky during the state of emergency declared by Governor Beshear.

Telehealth Provisions: The Department of Insurance will not impose penalties for noncompliance with KRS 304.17A(47)(c) in connection with the good faith provision of telehealth using such non-public facing audio or video communication products. Insurers cannot require that the patient have a prior relationship with the provider in order to have services delivered through telehealth, if the provider determines that telehealth would be medically appropriate.

Telehealth Coverage and Reimbursement Law in Kentucky:

  • telehealth at parity with in person visit unless plan and provider contractually agree otherwise

Medicaid Telehealth Guidance for Behavioral Health Providers:

  • Must be HIPAA compliant; cannot be telephone only
  • following codes added temporarily: G2012 and G2010

KBML Guidance on Prescribing (Including MAT):

  • Telehealth can be used to prescribe controlled substances
  • Can screen patient for buprenorphine via telehealth

CMS has approved an 1135 Waiver:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Expands provider enrollment for out-of-state providers
  • Authorizes care to be provided in alternative settings, including psychiatric residential treatment facilities
  • Lifts some prior authorization requirements

An emergency regulation is being promulgated to remove copayments for 1915(c) waiver enrollees and members receiving services. More information will be added here in the future.

Requirements for APRNs to be in a practice agreement with a physician in order to prescribe are temporarily waived.

The Department of Insurance issued guidance in light of the change in scope of practice for health care providers giving care outside their normal scope of practice or setting. DOI urged providers to contact their licensing boards and insurance companies to receive further information on waivers and insurance company requirements on scope of practice, respectively.

Medicaid COVID-19 FAQs:

  • Behavioral health services are now available via telehealth or audio-only, for the duration of the emergency

This FAQ provides information on many different topics, including billing, audio-only, and narcotic treatment, among many others. The FAQ is updated weekly at this link.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Governor Beshear has commuted sentences of certain inmates in jails and prisons who are particularly vulnerable to COVID-19 and serving sentences for non-violent, non-sexual offenses with fewer than five years remaining on the sentence.

Louisiana

Telehealth: Novel Coronavirus Disease (COVID-19) Medicaid Provider Update: (3/17/2020) Louisiana Medicaid encourages the use of telemedicine/telehealth with an interactive audio/video telecommunications system, when appropriate, to decrease the potential for patient-to-patient transmission in shared spaces (e.g., waiting rooms) and patient-to-provider transmission. Generally, when an interactive audio/video system is not available, an interactive audio-only system (e.g., telephone), without the requirement of video, may be employed unless service- specific policy indicates that only an audio/video system is permissible. For use of an audio-only system, the same standard of care must be met and the need and rationale for employing an audio- only system must be documented in the clinical record.

Licensing Waiver: In Governor Edwards' Declaration of Emergency, he references the Louisiana Health Emergency Powers Act, which says, in part "(9) for the temporary appointment, licensing or credentialing of health care providers who are willing to assist in responding the public health emergency."

The Governor issued a proclamation outlining the use of telehealth and licensure.

  • Use of telehealth in the delivery of healthcare services within the scope of practice regulated by the licensing entity is hereby suspended during the term of this emergency declaration.
  • The practice of the healthcare provider administered via telehealth must be within the scope of the provider's license, skill, training, and experience.
  • The services provided to the patient must meet the standard of care that would be provided if the patient were treated on an in-person basis.
  • Prescribing of any controlled substances via telehealth must be medically appropriate, well-documented and continue to conform to rules applicable to the prescription of such medications.

BCBS LA has issued guidance for members.

Louisiana Psychiatric Medical Association resource page with guidance from Department of Health, private payers, and other government agencies.

The Board of Medical Examiners has waived fingerprinting for out-of-state and retired physicians joining the state work force. The revised application is now on-line.

CMS has approved an 1135 Waiver for Louisiana:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment for non-Louisiana providers
  • Provision of Services in Alternative Settings including inpatient residential psychiatric facilities

Pending the Governor's executive order, the collaborative practice agreement requirements of the Louisiana State Board of Medical Examiners and the Louisiana State Board of Nursing for advanced practice registered nurses, including certified nurse midwives, certified registered anesthetists, clinical nurse specialists, and nurse practitioners, are suspended for this public health emergency.

The Governor extended the Stay-At-Home Order until April 30th. This extends the telehealth provisions previously instated.

The Governor signed an Executive Order that creates additional protections from civil liability for healthcare workers and facilities assisting outside their normal operations in response to COVID-19.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Maine

Telehealth: Bureau of Insurance (3/12/2020) Health carriers are reminded that 24-A M.R.S. § 4316 requires parity between coverage of telehealth and in-person services, and are directed to review their telehealth programs with participating providers to ensure that the programs are robust and will be able to meet any increased demand.

  • Superintendent of Insurance Requires Insurers to Expand Telehealth: The Superintendent signed an order that requires insurance companies to provide coverage for clinically-appropriate services delivered by telephone, as well as via more commonly used apps, such as FaceTime, WhatsApp and Skype, as long as they are private. This provides flexibility to patients who may not have access to web-based applications traditionally used for telehealth.

DHHS issued release outlining the following provisions for Medicaid:

  • Allows prescribing through telehealth
  • No copays for prescriptions, office visits, emergency department visits, radiology and lab services
  • Allow early refills of prescriptions
  • No prior authorization requirements for asthma and for immune-related drugs
  • Lengthen the period that prior authorization applies for prescription medications
  • Lengthen the period that prior authorization applies for certain durable medical equipment, such as home oxygen therapy, glucose test strips, and Continuous Positive Airway Pressure (CPAP) supplies for individuals diagnosed with COVID-19, those with pending test results who are in self-isolation, and those in a high-risk category for infection
  • Extend the amount of time that home health providers have to submit plans of care from within five business days to within 30 business days from the start of services
  • Allow providers to extend 34-day supply maximums on brand prescriptions (MaineCare already allows 90-day supplies of generic prescriptions)

MaineCare Guidance Relating to Telehealth and Telephone Services During COVID-19 Emergency Period: This document provides a comprehensive overview for Medicaid providers to consider utilizing telehealth services for the delivery of MaineCare-covered services when appropriate and necessary. It outlines guidance for:

  • Utilizing Telehealth to Satisfy Face-to-Face Requirements in MaineCare Policies
  • Member and Service Criteria for Telehealth Eligibility (Updated March 20, 2020)
  • Delivery of Telehealth via Telephone (Updated March 20, 2020)
  • Prior Authorization (PA) Requirements
  • Telehealth and Pharmacy (Updated March 20, 2020)
  • Telehealth Sites
  • Telehealth Provider Eligibility
  • Billing for Telehealth Services
  • Reimbursement for Originating Sites
  • Waiver of Advance Written Notice (Added March 20, 2020)
  • Telephone-Only Evaluation and Management (Added March 20, 2020)
  • Buprenorphine and Buprenorphine Combination Products (Added March 20, 2020)
  • Selective Waiver of Comparable Quality Requirements (Added March 20, 2020)
  • Telehealth and Behavioral Health Services (Added March 20,2020)
  • Telehealth Resources for Providers

MaineCare Telehealth New Codes and Information

A Provider's Guide To Telehealth Reimbursement Coverage in Maine During COVID-19: This guide is meant to help healthcare providers and organizations get up to speed quickly on the expansions of telehealth policy and key changes to both public and private payer payment policies in Maine. This document will be updated frequently as new information and policies become available/are enacted.

COVID-19 Guidance for MaineCare Providers of Behavioral Health, Community Support, and Rehabilitative and Community Support Services: This document will serve as supplementary guidance to behavioral health services provided to MaineCare recipients during the public health crisis associated with COVID-19. This guidance addresses frequently asked questions about authorizations, telehealth, staff/credentialing, children’s behavioral health, homeless population, and reimbursement.

Guidance for Behavioral Health Residential Settings: This additional guidance to behavioral health residential facilities intends to help them improve infection control and prevention practices to prevent the transmission of COVID-19.

Considerations for Outpatient Mental and Substance Use Disorder Treatment Settings: This document offers guidance for those treating persons with Serious Mental Illness served in outpatient treatment settings, that may be at an elevated risk for acquiring Covid-19 and may have a more complicated treatment course.

Considerations for Crisis Centers and Clinicians in Managing the Treatment of Alcohol or Benzodiazepine Withdrawal: This guidance is intended for those treating persons with alcohol use disorder, benzodiazepine use disorder, or other conditions that increase the risk of seizures. While there is high variability in the capacity for crisis centers and practitioners to receive and treat these individuals, this is precautionary guidance to those that are prepared and capable.

Considerations for the Care and Treatment of Mental and Substance Use Disorders: The guidance is intended to help behavioral health providers decrease the likelihood of infection and viral transmission of COVID-19, while continuing to deliver care.

Supporting Health Care Providers: Maine DHHS is working with the Maine Association of Psychiatric Physicians (MAPP), the MMA, and many others to set up a "warm line" to provide mental health and emotional support for medical providers and first responders during this high-stress time. The MAPP will be reaching out to clinicians to volunteer to help staff the warm line. Those interested in volunteering for this service can contact Dianna Poulin at: dpoulin@mainemed.com, Maine Association of Psychiatric Physicians.

Maine Responds: Health care providers can sign up for the "Maine Responds" Emergency Health Volunteer System, the system that organizes health care, public health, and emergency response volunteers to respond to emergency situations (particularly focused on licensed clinicians).

Licensure Waiver: Governor Mills announced an executive order that allows:

  • the expedited licensure (at no cost) of qualified retired physicians and physician assistants to provide assistance for the duration of the emergency. (COVID-19 Emergency Application)
  • the expedited licensure (at no cost) of qualified physicians and physician assistants licensed in other jurisdictions to provide assistance for the duration of the emergency. (COVID-19 Emergency Application)
  • licenses from expiring or needing to be renewed for 30 days after the end of declaration of the emergency (including CME requirements).

Any retired physician or physician assistant who is interested in obtaining an emergency COVID-19 license from the Board should contact:

  • Applicants with last names A-L call (207) 287-3602 tracy.a.morrison@maine.gov
  • Applicants with last names M-Z call (207) 287-3782 Elena.I.Crowley@maine.gov

CMS Approves Maine's Section 1135 Medicaid Waiver Request: The approved waiver enables Maine to temporarily suspend Medicaid fee-for-service prior authorization requirements, provisionally, temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare for the duration of the public health emergency, forgo certain pre-admission screening and annual resident review assessments, allow for reimbursement facility services in alternative settings, and extend fair hearing and appeals timelines.

Governor Mills Issues Executive Order to Expand Telehealth and Waive Licensure Requirements for Non-Physician Healthcare Workers: This order allows all health care providers licensed by the Office of Professional and Occupational Regulation (OPOR), such as a alcohol and drug counselors, clinical professional counselors, or social workers to:

  • provide their services via telehealth
  • have their license expiration dates extended until 30 days following the end of the declared state of emergency, if the license was scheduled for renewal during the state of emergency
  • not have to complete continuing education requirements for license renewals that occur through March 20, 2021.

In addition, certain health care providers licensed by OPOR, such as respiratory care therapists and pharmacists may:

  • Receive a temporary license to provide health care in person or through telehealth, with no application fee, if currently licensed in another state
  • Reactivate their Maine license immediately, with no application fee, if retired within the last three years.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Maryland

Medicaid telehealth guidance: I hereby temporarily expand the definition of a telehealth originating site under COMAR 10.09.49.06 to include a participant's home or any other secure location as approved by the participant and the provider for the purpose of delivery of Medicaid-covered services. Services provided through telehealth are subject to the same program restrictions, preauthorizations, limitations and coverage that exist for the service when provided in-person.

Licensure Waiver: INTERSTATE RECIPROCITY FOR HEALTH CARE LICENSES: Under the order, any person who holds a valid, unexpired license as a health care practitioner that is issued by another state may, at a health care facility in Maryland, engage in the activities authorized under that license. INACTIVE PRACTITIONERS: Any inactive practitioner may, at a health care facility in Maryland, engage in activities that would have been authorized under his/her inactive license without first reinstating his/her inactive license.

Governor Hogan signed Executive Order 20-03-20-01, expanding the use of telehealth to include previously unacceptable platforms. Audio-only telehealth calls for behavioral health services are now authorized for reimbursement by Medicaid providers or providers in a program of the Behavioral Health Administration.

  • Governor Hogan Amends Telehealth EO to Include Asynchronous Interactions: With this amended executive order, healthcare providers may now engage in asynchronous telehealth services, such as email, provided that any and all telehealth practices are clinically appropriate, properly documented, and otherwise comply with proper standards of care. These telehealth services are also eligible for reimbursement by Medicaid.

Governor Hogan signs emergency measure bills to expand telehealth reach:

  • HB448/SB402: allows providers to to establish a practitioner-patient relationship through an evaluation done in real-time (synchronous), or through an evaluation of data delivered at another time (asynchronous) and evaluated later by the practitioner. The exemption for this is that providers cannot prescribe a schedule II opioid for pain, unless the patient is in a healthcare facility or the Governor declares a state of emergency.
  • HB1208/SB502: requires Medicaid, subject to the limitations of the State budget, to provide mental health services appropriately delivered through telehealth to a patient in their home. The bill allows providers to offer general counseling for SUD via telehealth and requires the Maryland Department of Health to study whether SUD services may be appropriately provided through telehealth to a patient in the patient's home setting.

COVID-19: Frequently Asked Questions About Mental Health: This resource includes information about how to cope with mental health and stress and anxiety during this time for healthcare workers, parents of young children, adolescents and young adults, older adults, and individuals with disabilities.

CMS Approves Maryland's Request for an 1135 Medicaid Waiver: The approved waiver enables Maryland to temporarily enroll providers who are enrolled with another State Medicaid Agreement or Medicare, lift prior authorization requirements, and allow for reimbursement facility services in alternative settings.

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Massachusetts

Governor Baker issued an executive order requiring the following regarding telehealth:

  • Commercial insurers must cover telehealth for all in-network providers that is medically necessary
  • Insurers may not impose any specific restrictions on telehealth technology, including any limitations on audio-only or live video technologies
  • Payment must be the same as in-person
  • All COVID-19 services delivered through telehealth must have no cost sharing
  • No prior authorization for COVID-19-related telehealth services

Licensure and Telehealth (3/17/2020): Supporting Expedited Licensing Of Health Care Professionals: The Administration today announced four new emergency orders to expedite the onboarding of more licensed health care professionals during the COVID-19 emergency. Changes as a result of these orders include:

  • Licenses of physicians who have retired within the last year, without complaints at the time of retirement and in good standing, may be reactivated, and licenses that would otherwise be up for renewal may be extended for 90 days after the end of the public health emergency.
  • Providers in good standing licensed in other states may obtain emergency licenses to practice in person or through telemedicine.
  • The ability of residents to provide services, subject to appropriate supervision, will also be expanded.
  • Assures continuity of care for college and university students, licenses for nurses, pharmacists and physician assistants that would otherwise be up for renewal for 90 days after the end of the public health emergency may be extended, and no nurse, social worker, psychologist or medical doctor may be prohibited from providing telehealth services across state lines to college or university students who have returned home.
  • Recognizing the crucial need for sufficient EMS capacity during this public health emergency, these orders adjust minimum standards for ambulance staffing to ensure sufficient availability and capacity of EMS services.
  • Expands telehealth by facilitating telehealth services across state lines.

MassHealth issued a bulletin to providers specifying the following for fee-for-service Medicaid:

  • Services may be provided through telehealth, including telephone
  • Reimbursement will be same as in-person
  • Providers must use POS code 02 for telehealth billing
  • Medically necessary evaluation services provided through telephone should bill CPT codes for physicians: 99441, 99442, 99443
  • Children's Behavioral Health Initiative (CBHI) providers should use the regular CBHI codes when billing for CBHI services delivered telephonically
  • Will now allow for the following codes for home visits for physicians and outpatient hospital facilities: 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99509, 99511, and 99512
  • Will now allow for the following codes for home visits for community health centers: 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99509, 99511, 99512, and 99600
  • Psychiatric inpatient hospitals may bill MassHealth for members no longer requiring an inpatient level of care but who must be quarantined in the hospital or otherwise cannot be safely discharged due to COVID-19 by keeping the member as an inpatient, switching the member to administrative day status, and billing MassHealth accordingly. Psychiatric hospitals rendering COVID-19-related services to MassHealth members will be paid in accordance with the Amended and Restated Psychiatric Hospital Request for Applications Rate Year 2020 and Amended and Restated Psychiatric Hospital Contract.
  • Pharmacists are not allowed to give 90-day prescription for MH/SUD medications and those subject to the PDMP

CMS Approves 1135 Waiver for Massachusetts:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

The Department of Public Healthissued guidance to SUD providers who prescribe buprenorphine specifying that they may prescribe through telehealth without first conducting an in-person evaluation, provided that telehealth is "conducted using an audio-visual, real-time, two-way interactive communication system."

The Department of Public Health issued guidance to opioid treatment programs (OTPs) specifying the following regarding methadone dispensing:

  • The state is temporarily aligning state take home dosing quantities with the federal dosing schedule
  • All patients must have lockable take home container and written instructions about how to protect medications from ingestion by children and animals
  • Stable patients may be given a 28-day supply of take-home medication
  • Less stable patients may be given a 14-day supply of take-home medication if the OTP believes the patient can safely handle the supply
  • An OTP medical director may deem a patient stable even if she does not meet the 8-point criteria specified in state and federal regulations
  • Patients with confirmed COVID-19 or COVID-19 symptoms shall be given a 28-day take-home supply
  • Patients with chronic medical conditions or respiratory infections will be given a 28-day take-home supply
  • Patients with significant medical comorbidities and those over 60 will be given a 28-day take-home supply
  • Patients who cannot physically appear at the OTP may have surrogate pick up take-home supply, provided that a chain of custody form is completed
  • All patients receiving take home medication shall be given instructions of safe storage of methadone
  • Take-home medication is not appropriate for:
    • Patients who are not stable
    • When the patient is in the induction phase
    • When the dosage is being increased
  • OTPs must submit COVID-19 disaster plans to state
  • OTPs must continue to admit new patients
  • OTPs must provide patients with all types of medication options
  • OTPs should consider admitting new patients on buprenorphine or coordinating referrals to buprenorphine prescribers
  • OTPs must consider using telehealth for counseling
  • OTPs may use telehealth for dosing changes for stable patients
  • OTPs are advised to encourage patients to identify a surrogate to pick up take-home medication supplies, including filling out chain of custody form
  • OTPs should devise alternative staffing models in event staff becomes sick and cannot appear for work
  • OTPs should establish special dosing/pick up times to limit number of people at OTP at any given time

Governor Baker issued an order specifying that all graduates of foreign medical schools with at least 2 years of post-graduate training in a program approved by ACGME, AOA, or a Canadian program are eligible for licensure.

The Department of Health updated a previous order specifying that providers licensed in another state may practice in MA during the COVID-19 emergency either in person or across state lines through telehealth. The order specified that providers must practice “within the scope of practice authorized by the license in such profession” but did not specify if that means if this is governed by scope of practice laws in MA or their home state.

The Board of Registration in Medicine announced that they would be accepting applications for emergency temporary 90-day licenses for physicians that hold a Massachusetts limited license.

The Office of Health and Human Services issued an order that specifies:

  • APRNs with 2 years of experience may prescribe without physician supervision and written guidelines during the emergency
  • APRNs under supervision of a different physician may prescribe without written guidelines

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Governor Baker signed SB 2640, that provides liability protections for healthcare workers and facilities during the COVID-19 emergency.

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DPH issued guidance about about reporting requirements for healthcare facilities:

  • Facilities still must report immediately of any unexpected deaths, evacuations due to natural disasters, and code blacks (hospitals only)
  • Relaxation of reporting for many other incidents, most notably that opioid reporting is waived until 3 months after end of emergency

The Division of Insurance issued a bulletin that, in addition to reminding carriers of existing requirements under Governor Baker's executive order, urges them to relax prior authorization requirements for patients transition out of inpatient facilities into lower levels of care

The Bureau of Substance Addiction Services issued guidance regarding screening patients that covered the following:

  • Prescreening
  • Admissions
  • Transfers from another facility
  • Isolation
  • Cleaning

MassHealth issued follow-up guidance to previously-released guidance on telehealth (summarized above). This new guidance reinforced the previous guidance and contained the following clarifying information potentially relevant to behavioral health (there are other specifications not relevant to behavioral health that are not summarized here):

  • Providers may disregard delivery method specific requirements when billing and may simply bill the appropriate code for the service delivered, even if that code ordinarily specifies that it may only be used for in-person delivery (or audio/visual delivery)(pg. 2)
  • Providers serving dual-eligible members may submit billing to MassHealth for audio-only services that weren’t fully reimbursed by Medicare (pgs. 2, 3, and 4)

MassHealth issued guidance specifying that it will continue to cover the cost of members in 24-hour settings who are clinically ready to step down to a lower level of care if it is not possible to discharge them because of quarantine.

MassHeath issued guidance to managed care entities specifying that it will increase capitation rates through the end of 2020 for the purpose of supporting and maintaining Community Based Acute Treatment (CBAT) and Intensive Community Based Acute Treatment (ICBAT) programs.

MassHealth issued guidance to managed care entities specifying that it will increase funding to MCEs through 7/31/20 for the purposes of increasing reimbursement rates for certain services. Included among those services are several dozen outpatient behavioral health services that will receive increased reimbursement by 10 percent (see pages 10, 11, and 12 for specific services).

MassHealth issued guidance specifying that it will require its behavioral health vendors to pay eligible mental health centers a total of $94 million through the end of the year as long as each center meets various benchmarks (see page 2).

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Michigan

Medicaid Telehealth: Governor ordered Medicaid to reimburse for telehealth provided in recipients' homes.

Telemedicine Policy Expansion Bulletin for Medicaid: Codes for Behavioral Health and Developmental Disabilities Administration able to provide telephone-only services.

Licensure: Executive Order 2020-13 grants LARA and DHHS authority to waive or defer certain requirements in order to expedite the process of bringing additional care facilities online during the COVID-19 emergency. The order also empowers LARA to ensure an adequate supply of care providers during the emergency by granting the department additional flexibility in its decisions about licensing, registration, and workflow requirements. (Awaiting more specifics from LARA & DHHS).

Temporary restrictions on visitor entry to health care facilities

  • Includes all health care facilities

Governor Whitmer issued Executive Order 2020-29: The Michigan Department of Corrections must continue to implement risk reduction protocols to address COVID-19. Highlights include:

  • Screening all persons arriving at or departing from a facility, including staff, incarcerated persons, vendors, and any other person entering the facility, in a manner consistent with guidelines issued by the CDC.
  • Restricting all visits, except for attorney-related visits, and conducting those visits without physical contact to the extent feasible.
  • Limiting off-site appointments for incarcerated persons to only appointments for urgent or emergency medical treatment.
  • Developing and implementing protocols for incarcerated persons who display symptoms of COVID-19.
  • Providing, to the fullest extent possible, appropriate personal protective equipment to all staff as recommended by the CDC.
  • To mitigate the risk of COVID-19 spreading in county jails, strict compliance with the capacity and procedural requirements regarding county jail overcrowding states of emergency in the County Jail Overcrowding Act is temporarily suspended.
  • Anyone authorized to act under section 2 of this order is strongly encouraged to consider early release for all of the following, so long as they do not pose a public safety risk:
    • Older people, people who have chronic conditions or are otherwise medically frail, people who are pregnant, and people nearing their release date.
    • Anyone who is incarcerated for a traffic violation.
    • Anyone who is incarcerated for failure to appear or failure to pay.
    • Anyone with behavioral health problems who can safely be diverted for treatment.
  • Effective immediately, all transfers into the Department's custody are temporarily suspended. Beginning seven (7) days from the effective date of this order, and no more than once every seven (7) days, a county jail or local lockup may request that the director of the Department determine that the jail or lockup has satisfactorily implemented risk reduction protocols as described in section 1 of this order. Upon inspection, if the director of the Department determines that a county jail or local lockup has satisfactorily implemented risk reduction protocols, transfers from that jail or lockup will resume in accordance with the Department's risk reduction protocols. The director of the Department may reject transfers that do not pass the screening protocol for entry into a facility operated by the Department.

The Governor's Executive Order 2020-30 suspends scope of practice, supervision, and delegation for health care professionals (APRNs, physician assistants, pharmacists, and more) at health care facilities whose services are necessary to assist the facility in responding to the pandemic. Executive Order 2020-61 increased the broadness and duration of the temporary scope of practice expansion.

Governor's Executive Order 2020-37 prohibits nonessential entry into health care facilities, residential care facilities, congregate care facilities, and juvenile justice facilities in response to the coronavirus public health emergency. Makes exceptions for family members or guardians of those 21 and under.

CMS Approves 1135 Waiver for Michigan:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities
  • Approves Michigan's request for flexibility to modify the timeframes associated with tribal consultation

Governor's Executive Order 2020-84:

  • Creates regional hubs for long term care for those COVID-19 patients needing a higher level of care unavailable within their usual facility
  • Requires separate units in long-term facilities for patients with COVID-19 that do not need a higher level of medical care

The state received a $2 million SAMHSA emergency grant. The Michigan Department of Health and Human Services (MDHHS) created a needs assessment prioritization model to ascertain areas of specific vulnerability and need relative to the COVID-19 crisis. This model ranks county needs that utilizes per capita COVID-19 cases, percent of the low-income population, percent of the population that is uninsured, and the County Health Rankings data. As a result, MDHHS will work with five local Community Mental Health Services Program (CMHSP) provider partners in geographically and demographically diverse regions of the state in order to augment essential evidence-based behavioral health services in communities significantly impacted by and vulnerable to the effects of the COVID-19 pandemic.

The Governor signed an Executive Order creating the Michigan Coronavirus Task Force on Racial Disparities. The COVID-19 pandemic has disproportionately impacted communities of color throughout the state. While African Americans represent 13.6% of Michigan’s population, they represent 40% of the deaths from COVID-19. The task force will act in an advisory capacity to the Governor and study the causes of racial disparities in the impact of COVID-19 and recommend actions to immediately address such disparities and the historical and systemic inequities that underlie them. It is charged with suggesting ways to:

  • Increase transparency in reporting data regarding the racial and ethnic impact of COVID-19.
  • Remove barriers to accessing physical and mental health care.
  • Reduce the impact of medical bias in testing and treatment.
  • Mitigate environmental and infrastructure factors contributing to increased exposure during pandemics resulting in mortality.
  • Develop and improve systems for supporting long-term economic recovery and physical and mental health care following a pandemic.

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Exec Order 2020-62: Temporary COVID-19 protocols for entry into Michigan Department of Corrections facilities and transfers to and from Department custody; temporary recommended COVID-19 protocols and enhanced early-release authorization for county jails, local lockups, and juvenile detention centers:

  • Strict compliance with the capacity and procedural requirements regarding county jail overcrowding states of emergency in the County Jail Overcrowding Act is temporarily suspended.
  • County jails are strongly encouraged to consider early release for certain inmates, so long as they do not pose a public safety risk, including anyone with behavioral health problems who can safely be diverted for treatment.
  • All transfers into the Department's custody are temporarily suspended.
  • Juvenile detention centers are strongly encouraged to reduce the risk that those at their facilities will be exposed to COVID-19 by implementing certain measures.

Executive Order on pharmacists filling emergency refills:

  • pharmacists may dispense emergency refills of up to a sixty (60) day supply of any non-controlled maintenance medication
  • Continuation of previous Executive Order; updated to go through May 19

Executive Order No. 2020-86, Encouraging the use of telehealth services during the COVID-19 emergency:

  • All health care providers are authorized and encouraged to use telehealth services when medically appropriate and upon obtaining patient consent.
  • Healthy Michigan and private insurance carriers are authorized and encouraged to reimburse for telehealth services.

Minnesota

Telehealth: SF 4334 signed into law 3/17, effective 3/18 (section expires Feb 1, 2021): Section 1. COVERAGE OF TELEMEDICINE SERVICES PROVIDED DIRECTLY TO A PATIENT AT THE PATIENT'S RESIDENCE; RESPONSE TO COVID-19.

  1. The definition of "originating site" under Minnesota Statutes, section 62A.671, subdivision 7, includes a patient's residence if the patient is receiving health care services or consultations by means of telemedicine.
  2. The definition of "telemedicine" under Minnesota Statutes, section 62A.671, subdivision 9, includes health care services or consultations delivered to a patient at the patient's residence.
  3. Under Minnesota Statutes, section 62A.672, subdivision 2, a health carrier shall not exclude or reduce coverage for a health care service or consultation solely because the service or consultation is provided via telemedicine directly to a patient at the patient's residence.
  4. "Telemedicine" as defined in Minnesota Statutes, section 256B.0625, subdivision 3b, paragraph (d), includes the delivery of health care services or consultations with a patient at the patient's residence and the licensed health care provider at a distant site.
  5. This section expires February 1, 2021.

Governor signed EO 20-12 on 3/20: Allows flexibility regarding telehealth and other electronic strategies for communicating with providers or patients. Provides the Department of Human Services with short-term flexibility to alter background study requirements, licensing and certification standards, requirements for in-person assessments, eligibility renewal standards for public programs, work or community engagement requirements, service delivery standards including treatment setting and staffing ratios, payment procedures, and more.

Governor signed EO 20-11 on 3/20: allows the Department of Human Services to seek federal authority to waive or change federal requirements for all programs and services, including the Minnesota Family Investment Program (MFIP), Medical Assistance, MinnesotaCare, and other programs to maximize federal funding, maintain enrollee coverage and provider participation, and to ensure public health and safety.

Governor signed EO 20-10, which, in part, prohibits price gouging for essential goods and services including medical supplies and health care goods.

Minnesota's 1135 Waiver Approved:

  • Authorizes provision of care in alternative settings
  • Extends provider enrollment to non-Minnesota providers
  • Temporarily suspends some prior authorization requirements
  • Other waivers continue

Minnesota Department of Human Services' Commissioner, under the Governor's peacetime emergency order, has waived or modified certain requirements in order to:

  • Allow telemedicine alternative for School-Linked Mental Health services and Intermediate School District Mental Health services for children and their families
  • Allow phone or internet use for targeted case management visits
  • Allow 90-day refill limits for prescription maintenance medications
  • Postpone provider screening and re-enrollment

On 3/28, the Governor signed legislation (HF 4531) into law, in response to COVID-19, which in part:

  • Establishes a Coronavirus Minnesota fund.
  • Appropriates funding for emergency child care grants for essential workers, veterans impacted, food shelter programs, housing, small business loans; etc.
  • Eliminates refill timelines for opiate or narcotic pain relievers.
  • Empowers the medical director of the Department of Corrections to make a health care decision for an inmate incarcerated in a state correctional facility or placed in an outside facility on conditional medical release if the inmate's attending physician determines that the inmate lacks decision-making capacity and other conditions are met.

Emergency Executive Order 20-26: Ensuring Continuing Operations of the Medical Cannabis Program during the COVID-19 Peacetime Emergency: In order to keep immunocompromised individuals at home and to lessen the burden on healthcare providers during the COVID-19 pandemic, permits the following:

  • Extends medical cannabis patient enrollments that were set to expire.
  • Allows the Commissioner of Health to permit a health care practitioner to certify a patient’s qualifying medical condition after a visit through videoconference, telephone, or other remote means.
  • Authorizes the Office of Medical Cannabis to register emergency temporary caregivers to assist registered patients in accessing medical cannabis.
  • Allows curbside pick up.

Emergency Executive Order 20-28: Allowing Out-of-State Mental Health Providers to Render Telehealth Aid and Permitting Certain Licensing Boards to Provide License and Registration Relief During the COVID-19 Peacetime Emergency. Authorizes out-of-state mental healthcare providers who hold a current license, certificate, or other permit in good standing issued by a U.S. state or Washington, D.C. to render aid via telehealth to meet the needs of this emergency, including licensees in: Psychology, Social Work, Marriage and Family Therapy, and Behavioral Health and Therapy. Must first register with the appropriate licensing board in the state.

DHS has added three webpages for adult and children's mental health and substance use disorder partners and providers with news about the pandemic response from the Behavioral Health Division.

Minnesota received federal approval to expand telemedicine in health care, mental health and substance use disorder settings, allow phone or video use for targeted case management: The Department of Human Services received federal approval to temporarily expand access to health care services, including mental health and substance use disorder treatment, through telemedicine and to allow telephone and televideo for certain targeted case management services. These waivers have a retroactive effective date of March 19.

The Department of Human Services modified the requirement under state law that the responsible social services agency must ensure an annual physical examination of a foster child and an exam within 30 days of the child's initial placement. To ensure a foster child's physical health during the emergency, the agency must:

  1. continue to seek the child's medical records from appropriate sources to determine if the child has had a physical examination within the 12 months preceding placement;
  2. continue to take appropriate actions to ensure that the child's immediate health care needs are addressed; and
  3. consider telemedicine as a temporary substitute for the face-to-face physical examination.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Governor Tim Walz signed Executive Order 20-46, authorizing out-of-state healthcare professionals, including nurses, LPNs, and APRNs, to provide aid in Minnesota during the COVID-19 peacetime emergency. The order allows hospitals and care providers the flexibility to temporarily hire qualified professionals who would otherwise be required to obtain a license from the Minnesota Board of Medical Practice or the Minnesota Board of Nursing to provide intensive care services and meet the healthcare needs of Minnesotans.

The Department of Human Services issued a waiver on school-linked mental health and intermediate mental health services:

  • Authorizes reimbursing school mental health providers for expanded telemedicine services through grant funds;
  • Increases flexibility to no longer require the first visit be in person;
  • Waives the three-day-per-week limit on telemedicine; and
  • Allows telephone and other non-secured electronic communications platforms, such as Skype.

COVID-19 information available for nursing facility providers: A new webpage for nursing facility providers with COVID-19 news, information and resources has been launched. Current information includes reimbursement for emergency expenses, communicative technology grants for virtual social and telehealth visits, health care response grant, CARES Act provider relief fund and FEMA public assistance.

Resources for people with autism, their families, providers and educators during the COVID-19 pandemic: Minnesota state agencies have compiled a list of resources for people with autism, their families, providers and educators to utilize during the COVID-19 peacetime emergency. As the COVID-19 situation evolves, return to the Minnesota Autism Resource Portal for the latest information.

Mississippi

Telemedicine Licensure: Out of state physicians may provide telemedicine without being licensed in Mississippi.

  • The Board of Medicine has amended their proclamation to no longer allow out-of-state physicians to practice telemedicine with new patients. Out-of-state physicians may only practice telemedicine with existing patients.

CMS has approved an 1135 waiver for Mississippi:

  • 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.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment for non-Mississippi providers
  • Provision of Services in Alternative Settings, including inpatient residential psychiatric facilities

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Missouri

Medicaid Telehealth: Medicaid will waive requirement of pre-existing relationship prior to providing services via telehealth and allow services to be provided to enrollee while at home via telephone.

The state legislature passed a supplemental budget, which also includes COVID-19 funding.

The Governor signed Executive Order 20-04, allowing state agencies to suspend laws and rules that would hinder response to COVID-19. In addition, he temporarily suspended the law that requires a physician-patient relationship prior to prescribing, along with the prohibition on dispensing based on an internet or telephone questionnaire.

Anthem provided a telemedicine announcement in response to COVID 19: it is expanding telehealth benefits for individual, family, and employer plans. It includes connecting with a doctor through the Sydney Care mobile app's Virtual Care text session or LiveHealth Online video and covers telehealth visits by phone with the primary care doctors in network until June 14, 2020.

CMS approved Missouri Medicaid Section 1135 Waiver on 3/25:

  • Temporarily waives some prior authorization requirements
  • Authorizes care to be provided in alternative settings
  • Extends enrollment to non-Missouri providers
  • Current waivers continue

On 3/26, Governor Parson held a press conference emphasizing the importance of mental health during the COVID 19 crisis and highlighting resources.

The Governor issued a press release on April 4, recruiting medical personnel to boost the state's COVID-19 response.

  • To supplement the state's current health care workforce, the Missouri Department of Health and Senior Services, the Missouri State Emergency Management Agency, and the Missouri Department of Economic Development's Missouri One Start Division are teaming up to recruit medical professionals not currently part of the workforce to join a specialized state team that responds to critical health emergencies.
  • Selected medical professionals will become part of the Missouri Disaster Medical Assistance Team, which operates throughout the state and deploys when necessary to provide patients with on-site medical care.
  • Individuals are asked to consider this opportunity even if they are a health care student or graduate, are a retiree of the health care workforce, or have a recently expired professional registration.

The Governor signed HB 2014 into law, providing supplemental appropriations in response to COVID-19. The bill largely appropriates funds to the Department of Health and Senior Services to purchases PPE for health care workers.

The state received a $2 million SAMHSA emergency grant. Under the Emergency COVID-19, Directed Treatment Services program, the state of Missouri will address the needs of individuals with mental health and substance use disorders (co-occurring disorders) impacted by the COVID-19 pandemic. The program will enhance Missouri's delivery of direct treatment services through telehealth and will focus on meeting the needs of healthcare professionals who need mental health care due to COVID-19.

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Montana

DPHHS guidance on COVID 19 - awaiting telehealth guidance.

Telehealth: State enacted private insurance telehealth parity law in 2013. Medicaid also reimburses with few restrictions.

Medicaid will reimburse for telemedicine via telephone or live video.

CMS approved Montana's Medicaid Section 1135 Waiver

  • Temporarily waives some prior authorization requirements
  • Authorizes care to be provided in alternative settings
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Extends enrollment to non-Montana providers
  • Current waivers continue

The Governor released a report analyzing COVID-19 cases in Montana (4/14/20). The report was produced by state epidemiologists examining 377 cases of COVID-19 in Montana that helps the state understand who is impacted by the new virus, how it spreads, and patient outcomes.

The state received a $2 million SAMHSA emergency grant. The Montana Emergency COVID-19 project will strengthen the capacity of nine counties and four tribal behavioral health programs to provide mental health and substance use services, including crisis services, during COVID-19 pandemic to individuals with serious emotional disturbance (SED) for youth, serious mental illness (SMI) for adults, and substance use disorder (SUD) for youth and adults.

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Nebraska

DHHS COVID 19 guidance for health care professionals - awaiting telehealth guidance.

3/16: Aetna offering zero co-pay telemedicine visits for any reason and offering its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members.

The Governor issued an Executive Order expediting licensing for physicians, surgeons, and non-physician providers. The order also suspends requirements, allowing physicians to supervise any number of physician assistants and allows physicians to use their personal judgment in determining if these physician assistants need to have a written agreement.

Nebraska's Section 1135 Waiver Flexibilities for COVID-19 granted 4/2

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
  • Provides flexibility for temporarily delay scheduling of Medicaid fair hearings and issuing fair hearings decisions during the emergency period.
  • Provider enrollment:
    • Allows Nebraska to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as criteria are met.
    • If a certified provider is enrolled in Medicare or with a state Medicaid program other than Nebraska, Nebraska 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 screening requirements of site visits and in state licensure requirements, so the state may provisionally, temporarily enroll the providers for the duration of the public health emergency.
  • 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.

Executive Order providing relief for hospitals and health care facilities:

  • Waives the time limit on complex nursing interventions in assisted living facilities.
  • Modifies the training and testing requirements for nurse aides, medication aides, and dining assistants to allow individuals with sufficient training and appropriate supervision to serve temporarily in these capacities.
  • Defers requirements for the renewal and implementation dates of facility licenses and extends the licenses so that they do not need to be renewed during this emergency.
  • Waives the Certificate of Need Act to allow hospitals to add or convert any beds into long-term care beds or rehabilitation beds in appropriate locations to care for COVID-19 patients who no longer require acute care support.
  • Waives the licensed bed limit if additional unlicensed beds are available or could be added for use in treating COVID-19 cases or to meet the needs of non-COVID-19 patients.
  • Directs the Nebraska Department of Health and Human Services (DHHS) to establish guidance for payment of Medicaid services via telehealth.

Nebraska Dept of Insurance Telehealth Questions And Responses. Health insurers have responded to COVID-19 by voluntarily expanding coverage beyond what is mandated by the federal government. Insurers' expansion of telehealth coverage encourages people to stay home, stay safe, and stay connected to their health care providers, whenever telehealth is medically appropriate. The Department received several inquiries from providers regarding insurers' expanded telehealth coverage, and facilitated this survey to provide clarity.

The state received a $2 million SAMHSA emergency grant. Nebraska Native Emergency COVID-19 will provide culturally appropriate crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults Native Americans throughout Nebraska who are impacted by the COVID-19 pandemic.

The Governor announced that the State will issue a new Directed Health Measure to allow elective surgeries to resume on May 4, 2020, under certain guidelines.

  • Hospitals can resume elective surgeries if they maintain 30% general bed availability, 30% ICU bed availability, 30% ventilator availability, AND have a two-week supply of necessary personal protective equipment (PPE) in their specific facility.
  • Procedural guidelines for resuming elective procedures will be at the discretion of the hospital or health clinic.

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Nevada

Telehealth: A health insurer shall issue guidance to inform its insureds and network providers about available benefits, options for medical advice and treatment through telehealth, and preventive measures related to COVID-19.

CMS Approves 1135 Waiver for Nevada:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities
  • Approves Nevada's request for flexibility to modify the timeframes associated with tribal consultation

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Curbside Nevada, a warm line for the frontline workers and staffed by volunteer psychiatrists, has launched.

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New Hampshire

Telemedicine: Pursuant to RSA 415-J, health carriers may not deny coverage simply because it was provided through telemedicine.

Expanded Telemedicine: Telehealth will be paid at same rate as in-person. No restriction on originating site.

Licensure: Any out-of-state personnel, including medical personnel, entering New Hampshire to assist in preparing for, responding to, mitigating the effects of, and recovering from COVID-19 shall be permitted to provide services in the same manner as prescribed in RSA 21-P:41 and any other applicable statutory authority with respect to licensing for a period of time not to exceed the duration of this emergency.

CMS Approves New Hampshire's Section 1135 Medicaid Waiver Request: The approved waiver enables New Hampshire to provide flexibilities in Medicaid provider screening and enrollment, forgo certain pre-admission screening and annual resident review assessments, lift prior authorization requirements, allow for reimbursement facility services in alternative settings, and extend fair hearing and appeals timelines.

NH Responds: Governor Sununu announced NH Responds, an effort to register medical and non-medical volunteers who can quickly mobilize if needed during the public health crisis. NH Responds is part of a nationwide volunteer management system that was established after 9/11 to get medical professionals quickly, and properly deploy them during a public health emergency or disaster.

Governor Sununu Announces Emergency Funding for Child Protection Services: To address the increase in the number of Domestic Violence and Substance Use related referrals, Governor Sununu issued Emergency Order 22, which authorizes emergency funding for child protection services, including domestic violence support, substance use support, the Strength to Success program, technology to support youth family services families, and the family resiliency support line.

Governor Sununu Announces Emergency Funding for Child Protection Services: To address the increase in the number of Domestic Violence and Substance Use related referrals, Governor Sununu issued Emergency Order 22, which authorizes emergency funding for child protection services, including domestic violence support, substance use support, the Strength to Success program, technology to support youth family services families, and the family resiliency support line.

COVID-19 Emergency Guidance for Community Behavioral Health Programs: The Bureau of Mental Health Services has compiled this guidance to address questions surrounding staffing, medications, documentation and service planning, billing, and other issues.

Guidance for Substance Use Disorder Treatment Providers: The Bureau of Drug and Alcohol Services has compiled this guidance to address questions surrounding protocols, staff safety, telehealth, medication management, and other issues.

DHHS Announces Resource Guide And Warm Line To Support Families: The Division for Children, Youth and Families (DCYF) has developed two new resources to help children, youth, families and caregivers during the COVID-19 emergency. The first is "Supporting Child and Family Wellbeing During the COVID-19 Emergency," a new resource guide with practical tips on how to support children and families during COVID-19. The guide also provides a list of resources available to families statewide. The second resource is the Family Support Warm Line, a partnership between DHHS and Waypoint. The Family Support Warm Line is a no-cost, confidential phone support line focused on promoting family resiliency. Residents can call 800-640-6486 and speak with family support professionals and parent partners for help with managing family challenges, coping strategies, or emotional support during COVID-19.

Board of Medicine Emergency Order regarding prescribing via telemedicine: The prohibition in RSA 329:1-d, III of prescribing schedule II through IV controlled drugs by means of telemedicine is hereby suspended for the duration of the State of Emergency.

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New Jersey

Emergency legislation (A 3860) enacted 3/19 specifies the following about telehealth:

  • Practitioner licensed in any state may practice telehealth in NJ, within scope of practice of practitioner's home state
  • Services must be limited to COVID-19 unless practitioner already has existing relationship with patient

Department of Human Services directed managed care plans that:

  • Should provide reimbursement for telehealth, including mental telehealth, at same rate as in-person
  • Should waive site-of-service requirements for licensed practitioners in NJ
  • Should allow use of alternative telehealth technologies such as phone or smartphone app

Department of Banking and Insurance directed commercial payers that they should:

  • Review telehealth networks to determine adequacy and allow out-of-network exceptions when in-network providers are not available
  • Waive cost sharing for any telehealth services, COVID-19 or otherwise
  • Encourage providers to use telehealth
  • Reimbursement for telehealth should be no lower than in-person
  • Allow for telephonic telehealth service delivery
  • No prior authorization for telehealth services

Department of Treasury has advised Horizon Blue Cross that it should:

  • Cover in-network telehealth with no cost sharing

Department of Children and Families specified that for all MH/SUD and IDD non-residential services:

  • Cover telehealth at same rate as in-person
  • Waive site of service requirements
  • Allow alternative telehealth technologies such as phone and smartphone apps

Division of Consumer Affairs within Department of Law and Public Safety specifies:

  • Allow practitioners to establish new patient relationships through telehealth, allow alternative technologies for telehealth, and patients do not need to establish address of location

CMS approved New Jersey's Section 1135 Medicaid waiver request: The approved waiver enables New Jersey to provide flexibilities in Medicaid provider screening and enrollment, forgo certain pre-admission screening and annual resident review assessments, lift prior authorization requirements, allow for reimbursement facility services in alternative settings, and extend fair hearing and appeals timelines.

Guidance for Opioid Treatment Programs: As the NJ Department of Human Services, Division of Mental Health and Addiction Services (DMHAS) learns more about COVID-19 (the coronavirus), it will provide updated guidance to assist Opioid Treatment Programs (OTPs) in their response to mitigate exposure and spread of this disease.

Guidance of Telehealth/Telemedicine by Psychiatric Emergency Screening Service Providers in Response to COVID-19

Governor Murphy Announces Funding Sources Assist Healthcare Organizations with COVID-19-Related Expenses: The Governor's two initiatives include:

  • A $140 million prepayment, which advances $67.3 million in Charity Care, $60.5 million in Graduate Medical Education, and $14.6 million for University Hospital, to support increasing capacity to meet the anticipated patient growth including workforce demands, supplies, and medications. The Charity Care and Graduate Medical Education funds will be an advance of remaining fiscal year 2020 budget allocations for those programs.
  • A $6 million emergency loan program to assist New Jersey's healthcare organizations offset some of the unforeseen expenses incurred by this pandemic.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Governor Murphy Signs Bill on Expanding Liability Protections for Healthcare Workers: This bill goes one step further than the Governor's initial executive order on civil liability protections for healthcare workers during the COVID-19 emergency. The bill includes criminal liability protections and specifies that the immunity is only attached to providing care for COVID-19 patients, not just during the time of COVID.

Following Governor Wolf's executive order allowing elective procedures to resume beginning Tuesday, May 26th, the NJ Department of Health released guidance on elective medical and dental procedures. The guidance details information for Hospitals, Office Settings and Ambulatory Surgery Centers

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New Mexico

Licensure Waiver: The Department of Health and the Department of Homeland Security and Emergency Management shall credential out-of-state professionals who can render aid and necessary services during the pendency of this order. NSMA 1978 12-10-10.1 through 12-10-13.

The Governor announced New Mexico's Medicaid Program is requiring managed care organizations to reimburse doctors, behavioral health providers and other health care professionals for telephone and video patient visits. Additionally, managed care organizations are now required to:

  • Waive all prior authorizations for members to obtain COVID-19 testing and treatment services;
  • Expand nurse advice lines to operate 24/7;
  • Coordinate with home care providers to ensure coordinated care for those patients requiring telemedicine services;
  • Allow for replacement of durable medical equipment through telemedicine; and,
  • Reimburse for prescriptions dispensed in amounts up to a 90-day supply.

CMS has approved an 1135 Waiver for New Mexico:

  • Temporarily suspends 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.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days

The Governor issued an updated Executive Order extending the public health emergency through 4/30/2020.

The Human Services Department is providing $35 million in financial assistance through the Medicaid program to the state’s safety-net hospitals.

The Governor announced measures authorizing emergency dispensing by a pharmacist through prescription adaptation without practitioner approval where limited access to prescribing health care practitioners interferes with the pharmacist’s ability to provide patient medication in a timely manner.

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SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

New York

March 17 Supplemental Guidance Regarding Use of Telehealth for People Served by Medicaid: Providers who submit a Self-Attestation containing all of the elements below will be authorized to deliver services via telemental health for a time-limited period, not to exceed the disaster emergency. Telemental health for Medicaid-reimbursable services is temporarily expanded to include telephonic and video, including technology commonly available on smart phones and other devices. Telemental health for Medicaid-reimbursable services is temporarily expanded to include telephonic and video, including technology commonly available on smart phones and other devices. They will certify to the following:

  • That the practitioner(s) will possess a current, valid license, permit, or limited permit to practice in NYS.
  • That the transmission linkages will be dedicated, secure, and meet minimum federal and NYS requirements.
  • That confidentiality will be maintained as required by NYS Mental Hygiene Law Section 33.13 and 45 CFR Parts 160 and 164 (HIPAA Privacy Rules).
  • That claim modifiers "95" or "GT" will be used on each claim that represents a service via telemental health.

Comprehensive Guidance for Medicaid Provider Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency: The following information applies to all Medicaid providers and providers contracted to serve Medicaid members under Medicaid managed care plans. However, the Office of Mental Health (OMH), the Office for People with Developmental Disabilities (OPWDD), and the Office of Addiction Services and Supports (OASAS) have issued separate guidance on telehealth and regulations that will align with state law and Medicaid payment policy for Medicaid members being served under their authority.

Licensure guidance: Permits unlicensed individuals, upon completion of training deemed adequate by the Commissioner of Health, to collect throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing; and to the extent necessary to permit non-nursing staff, upon completion of training deemed adequate by the Commissioner of Health, to perform tasks, under the supervision of a nurse, otherwise limited to the scope of practice of a licensed or registered nurse.

Governor Cuomo calls on health, mental health, and related professionals to set up a reserve workforce interested in supporting the state's response to COVID-19.

OMH COVID-19 Guidance RE: Clozapine and Blood Test Monitoring Prescribers and pharmacies have discretion to order and dispense clozapine without an absolute neutrophil count reported within the specified timeframes.

CMS Approves 1135 Waiver for New York:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

The Department of Financial Services issued a circular letter specifying the following regarding coverage of telehealth:

  • Reminds insurers that they cannot exclude coverage of any service simply because it is provided through telehealth
  • No cost sharing for telehealth services during COVID-19 crisis (any services, not just COVID-19)
  • Telehealth services still must be provided through technology that allows for compliance with HIPAA and 42 CFR Part 2

Governor Cuomo's executive order allows Pas and APRNs to practice without supervision .

  • To the extent necessary to permit a physician assistant to provide medical services appropriate to their education, training and experience without oversight from a supervising physician without civil or criminal penalty related to a lack of oversight by a supervising physician
  • To the extent necessary to permit a nurse practitioner to provide medical services appropriate to their education, training and experience, without a written practice agreement, or collaborative relationship with a physician, without civil or criminal penalty related to a lack of written practice agreement, or collaborative relationship, with a physician
  • All APRNs can practice without supervision

Governor Cuomo's executive order allows medical students graduating in 2020 to practice with physician supervision: To the extent necessary, this order will allow any physician who will graduate in 2020 from an academic medical program accredited by a medical education accrediting agency for medical education by the Liaison Committee on Medical Education or the American Osteopathic Association, and has been accepted by an Accreditation Council for Graduate Medical Education accredited residency program within or outside of New York State to practice at any institution under the supervision of a licensed physician.

The Department of Health issued a checklist for long-term care facilities to use during the COVID-19 emergency.

The Department of Health issued guidance specifying that adult day health care facilities may provide telehealth services, including telephone only.

Guidance for Opioid Treatment Program Support: While the state remains under a stay-at-home order, OTPs should remain operational to reduce the risk of overdose. This guidance offers approaches OTPs can take to ensure safe continuity of medication.

OMH issued guidance regarding telehealth that specified the following:

  • For duration of the emergency Medicaid telehealth includes telephone and synchronous smartphone video
  • For duration of the emergency Medicaid providers must use “95” or “GT” modifier when billing telehealth, including phone only
  • Intensive outpatient services will be reimbursed when provided through telehealth
  • Some residential services will be reimbursed when provided through telehealth
  • Many outpatient and ancillary supportive services can be provided through telehealth
  • Supplementary telehealth services are allowed for Comprehensive Psychiatric Emergency Programs (CPEP), provided that in-person psychiatric services must still occur
  • Telehealth NOT allowed for restraint and seclusion, and NPs and PAs may temporarily perform these functions

OMH issued guidance that specifies treatment and billing expectations for Providers of Adult Behavioral Health Home and Community Based Services.

OMH issued guidance that specifies documentation expectations for adult and children’s residential facilities.

OMH issued guidance that specifies documentation expectations for clinic treatment programs.

OMH issued guidance that specifies treatment and billing expectations for ACT programs.

OMH issued guidance that specifies treatment and billing expectations for children’s day treatment programs.

OMH issued guidance that specifies treatment and billing expectations for partial hospitalization programs.

OMH issued guidance that specifies treatment and billing expectations for personalized recovery-oriented services (PROS) programs.

OMH issued guidance that specifies treatment and discharge expectations for children’s residential treatment facilities.

OMH issued guidance that specifies treatment, documentation, discharge, and seclusion and restraint procedures for hospital-based mental health care.

OMH issued guidance on clozapine and blood test monitoring for patients who may have contracted COVID-19.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

DOH issued updated guidance about telehealth coverage that specifies the following:

  • Telehealth includes telephonic, telemedicine, store and forward, and remote patient monitoring
  • Originating site can include patient's home
  • Distant site can be located anywhere in the United States including any FQHC
  • Specifies that any provider can use telehealth but must be within scope of practice
  • The guidance includes numerous details about specifics related to billing (please check within link above)

OMH issued guidance specifying the following:

  • Certain time requirements for various billing codes have been relaxed (see guidance for list)
  • Specifies billing procedures for Medicare/Medicaid crossover
  • Specifies billing procedures for providers not covered by Medicare who are serving dual eligibles

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North Carolina

NCDHHS COVID 19 Guidance as of 3/16: Consider using telemedicine, nurse triage lines and other options to prevent people with mild illnesses from coming to clinics and emergency rooms.

Insurance Commissioner Bulletin (3/12/2020): Insurance Commissioner requests insurers to remove barriers of treatment, including making sure their telehealth programs are "robust" and able to meet the demand.

BCBS NC 3/13/2020: (in effect for 30 days) telehealth will be paid at parity with office visits, provided they are medically necessary, meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy, and occur on or after March 6, 2020.

  • These temporary measures include virtual care encounters for patients that can replace in-person interactions across appropriate care settings, including outpatient clinics, hospitals, and the emergency departments.
  • Please do not file telehealth claims with Blue Cross NC until March 21, 2020 and use Telehealth as Place of Service (02).
  • For providers or members who don’t have access to secure video systems, telephone (audio-only) visits can be used for the virtual visit. Please use both Telehealth as Place of Service and CR (catastrophe/disaster-related) modifier for audio-only visits.
  • If you believe an eligible telehealth claim has been improperly denied, please resubmit it after March 21, 2020.
  • Some commercial members can access MDLIVE or TeleDoc as a virtual care benefit, as noted on their member ID card. Federal Employee Program (FEP) members can only access virtual care through the Teledoc service.
  • Teledoc offers both video or audio virtual services. You can view COVID-19 benefits for the Federal Employee Program here.

Licensure Waiver: licensure requirements are waived for health care professionals licensed in other states

CMS has approved an 1135 Waiver for North Carolina:

  • Provider Enrollment for providers not licensed in North Carolina
  • Provision of Services in Alternative Settings, including psychiatric residential treatment facilities
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • 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.

NC Department of Health and Human Services has asked for volunteers to bolster the clinician workforce. Please access the registration form here.

Guidance for Behavioral Health Group Homes: this link will download a document.

Updated NC Medicaid Telemedicine and Telepsychiatry Coverage Policy:

  • Retroactive to March 10
  • Reimbursement for telehealth or telepsychiatry services at parity with in-person
  • Waives prior authorization and in-person exam requirements.
  • Originating and distant site requirements can be anywhere. HOWEVER, must still use video technology.
  • Providers who can provide telehealth expanded to include: clinical pharmacists, licensed clinical social workers, licensed clinical mental health counselors, licensed marriage and family therapists, licensed clinical addiction specialists, and licensed psychological associates.
  • Mental health treatment:
    • FQHCs may use telephone only
    • Only licensed prescribers can bill Medicaid for psychiatric diagnostic eval codes and psychotherapy codes.

Governor Cooper's Executive Order grants the Secretary of Health and Human Services authority to waive or modify many regulations limiting the number of and grants to each professional health care licensure board the authority to modify regulations (including scope of practice and licensure regulations) to increase the number of professionals available to treat patients.

The licensing boards for physicians, APRNs, PAs, pharmacists, and others were given the authority to waive practice requirements, including scope of practice.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Governor Cooper issued an Executive Order granting regulatory flexibility for high-risk health care facilities to make sure hospitals and other health care facilities are able to respond during the continuing pandemic.

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North Dakota

ND Dept of Health COVID 19 guidance: as of 3/16:

  • Healthcare facilities can increase the use of telephone management and other remote methods of triaging, assessing and caring for all patients to decrease the volume of persons seeking care in facilities.
  • If a formal “telehealth” system is not available, healthcare providers can still communicate with patients by telephone (instead of visits), reducing the number of those who seek face-to-face care.
  • Health plans, healthcare systems and insurers/payors should message beneficiaries to promote the availability of covered telehealth, telemedicine, or nurse advice line services.

Licensure Waiver: Governor issued emergency declaration on 3/13. State's Emergency Services statute provides "if a person holds a license, certificate, or other permit issued by any state or political subdivision evidencing the meeting of qualifications for professional, mechanical, or other skills, the person may render aid involving that skill in this state to meet an emergency or disaster, and this state shall give due recognition to the license, certificate, or other permit."

North Dakota's Section 1135 Waiver approved 3/24. Highlights:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
  • Provider Enrollment:
    • Allow the state to enroll providers who are not currently enrolled with another State Medicaid Agency or Medicare so long as the state meets the following minimum requirements.
    • Temporarily cease revalidation of providers who are located in North Dakota or are otherwise directly impacted by the emergency.
  • State Plan Amendment Flexibilities: Tribal Consultation: Flexibility to modify the timeframes associated with tribal consultation, including shortening the number of days before submission or conducting consultation after submission of the SPA. This approval applies only with respect to SPAs that provide or increase beneficiary access to items and services related to COVID-19 (such as cost sharing waivers, payment rate increases, or amendments to ABPs to add services or providers) and that would not restrict or limit payment or services or otherwise burden beneficiaries and providers, and that are temporary, with a specified sunset date that is not later than the last day of the declared COVID-19 emergency (or any extension thereof).

Executive Order 2020-20: suspends certain licensure requirements under the health care and behavioral health licensing statutes, including:

  • suspending nationwide criminal history checks
  • suspends licensure requirements for respiratory care therapists and respiratory care practitioners

Executive Order 2020-28 allows for changes necessary to maintain critical operations for vulnerable youths being served in Psychiatric Residential Treatment Facilities (6 programs with total of 82 beds) and Qualified Residential Treatment Programs (4 programs with total of 92 beds) during the COVID-19 pandemic. The facilities worked with the North Dakota Department of Human Services to identify necessary changes. The executive order:

  • Suspends state regulations that require routine medical and dental check-ups that are not urgent or available.
  • Suspends requirement that every inpatient youth has a written treatment plan for medical and dental care until May 15, 2020.
  • Allows for alternative service options such as telehealth.
  • Suspends certain in person staff training. Allows employees to utilize online training.
  • Suspends staffing requirements for psychiatric residential treatment facilities, but requires each facility to have sufficient staffing and have at least two qualified employees on-site at a time.
  • Allows for state background checks while national checks are suspended during this emergency.
  • Extends the expiration date of programs by 120 days to delay routine on-site visits and inspections.

The state received a $2 million SAMHSA emergency grant.

  • The ND Emergency COVID-19 project will provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic.
  • North Dakota plans to focus efforts on the following populations: individuals with a SMI and/or SUD who are at high risk for further behavioral health/health problems and at high risk for COVID-19.

ND Department of Health Recommendations for Long Term Care Facilities:

  • Detailed daily preventative measures
  • Actions to take if suspected, probable, or confirmed COVID-19 cases

NDDoH COVID-19 Response Long Term Care Site Visits

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Ohio

Ohio Department of Insurance issued a bulletin that specified the following regarding telehealth:

  • Issuers that provide coverage for services delivered via telemedicine are expected to provide such coverage for COVID-19 testing and treatment
  • Requests that issuers comply early with telehealth law scheduled to take effect 1/2021 that prohibits denials of a service just because it was delivered through telehealth and requires telehealth to be covered "on the same basis and to the same extent."

Ohio Department of Health (ODH) issued a director's order regarding health screening for admission to state psychiatric facilities and youth service facilities. Potential psychiatric admittees and youth services admittees:

  • Must be screened for COVID-19 prior to admission
  • Answer questions about exposure
  • Will be refused admittance if meeting criteria and do not have negative COVID-19 test results
  • Must have medical clearance attestation from physician stating negative results within prior 48 hours
  • Presumably, positive test allows disallows admission

Ohio Department of Mental Health and Addiction services issued emergency order to reduce restrictions on telemedicine (can't find anything more specific than this website from Gov. Dewine):

  • In partnership with the Ohio Department of Medicaid, Director Criss announced emergency orders that reduce restrictions on telehealth, ensuring that every Ohioan has access to behavioral health Care via telehealth services by landline or cell phone.

Guidance from the Board of Medicine on Telemedicine: Effective March 9, 2020 until Executive Order 2020-01D expires, providers can use telemedicine in place of in- person visits, without enforcement from SMBO. This includes, but is not limited to:

  • Prescribing controlled substances
  • Prescribing for subacute and chronic pain
  • Prescribing to patients not seen by the provider
  • Pain management
  • Medical marijuana recommendations and renewals
  • Office-based treatment for opioid addiction

Providers must document their use of telemedicine and meet minimal standards of care. The Medical Board will provide advance notice before resuming enforcement of the above regulation when the state emergency orders are lifted.

Emergency Licensure: The Medical Board will partner with the Ohio Emergency Management Agency (EMA) or other necessary government entity if the need arises to temporarily license out-of-state physicians and physician assistants.

The Department of Health (ODH) issued an order specifying the following:

  • All adult day support or vocational habilitation services for those with IDD cannot be provided in a congregate setting with more than 10 people
  • This does not apply to residential settings

ODH issued an order specifying the following regarding nursing homes and similar facilities:

  • No visitors shall be admitted except for end-of-life situations
  • Personnel may only be admitted after being screened for COVID-19 each time they attempt to enter
  • Points of access to each facility should be limited to as few as possible
  • Access will be granted only to those with official state or federal identification

The Ohio Department of Medicaid (ODM) issued an emergency rule specifying the following about telehealth:

  • No limitations on location of originating or distant site
  • Broadened definition of telehealth to include phone, fax, and email
  • Broadened type of providers who may be reimbursed for telehealth (no apparent scope expansion)
  • Providers may use telehealth technologies that do not fully comply with HIPAA specifications
  • Providers should still try to obtain and review medical records to the greatest extent possible
  • Originating and distant sites should be "consistent with" CPT and HCPCS guidelines for services delivered
  • Initial visit face-to-face encounter requirement is suspended
  • Services performed by a resident outside of a teaching facility are permitted
  • Assertive community treatment (ACT) may bill for telephone only and secure video transmission service delivery
  • Intensive home-based treatment may bill for telephone only and secure video transmission service delivery
  • Therapeutic behavioral services and psychosocial rehabilitation may be reimbursed through telehealth
  • Behavioral health crisis intervention may be provided through telehealth
  • Peer support may be delivered through telehealth if the facility can demonstrate that initiation of peer support in person occurred before the COVID-19 emergency
  • Practitioners may bill for an originating fee and an E&M fee on the same day
  • Reimbursement for telehealth Medicaid services are allowed even if they are otherwise payable under the Medicaid school program
  • The face-to-face requirement for FQHCs and rural health centers is waived

ODH issued an order that closes all adult day care services and senior centers. The order does specify that these facilities may still provide non-congregate services in the community to assist seniors but does not specify what that may entail.

The Board of Pharmacy is authorizing the delegation to an Ohio-licensed APRN who is designated as a certified nurse practitioner (CNP), clinical nurse specialist (CNS), certified nurse midwife (CNM) or physician assistant (PA) the management of a pharmacist consult agreement. The delegation authorized in this resolution is limited to consult agreements in hospitals (inpatient/ambulatory) and other institutional facilities.

CMS Approve 1135 Waiver for Ohio:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities
  • Temporarily allows service provided under certain state waiver programs to be provided in settings that have not been determined to meet the home and community-based settings criteria.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Governor DeWine issued an order requiring state agencies, collectively, to reduce expenditures by $775 million for the remainder of fiscal year 2020. Agencies are advised to:

  • Limit employee travel to only COVID-related activities
  • Freeze new hiring except for those related to COVID
  • Freeze all new contracting and suspend all new purchasing authority not related to COVID

Additionally, the order requests that the Department of Medicaid identify cost-containment measures.

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Oklahoma

Licensure Waiver: Allows health professionals licensed in states that are members of the Emergency Management Compact to practice, so long as they meet certain other conditions; and allows state occupational licenses for health care professionals that are set to expire to be temporarily extended during the crisis.

Medicaid announces 3/20 that behavioral health providers may provide telehealth services through the telephone when enrollee does not have typical telehealth technology available.

  • Same link as above indicates that on 3/16 providers can use telehealth for all services that can be safely provided through telehealth. Indicates that the following codes can be submitted for telephone service delivery: "For providers who bill E&M codes, the codes for telephonic services are 99441, 99442 and 99443. Other healthcare professionals can bill using 98966, 98967 and 98968."

Oklahoma Insurance Departmentissued a bulletin specifying the following for insurers:

  • Should waive cost sharing for COVID-19 testing
  • Should ensure that telehealth capabilities are "robust" and waive copayments for telehealth and reimburse the provider for the cost of the copayment
  • Provide out-of-network access at in-network cost sharing when in-network providers are not available to meet demand for COVID-19 services
  • Should not impose prior authorization of COVID-19 services
  • Make expedited formulary decisions for those who may be affected by COVID-19
  • Should not cancel coverage of someone who may be infected and extend grace period for nonpayment of premiums to 60 days from 30 days

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Oregon

March 16 Medicaid Telehealth Guidance: Coverage for physical health telemedicine services include Telehealth (synchronous audio/video visits), Patient to Clinician services (electronic/telephonic) and Clinician to Clinician Consultations (electronic/telephonic).

  1. Telehealth patient visits using a synchronous (live two-way interactive) video and audio transmission resulting in real time communication between a licensed health care provider located in a distant site and the recipient being evaluated located in an alternate site, are covered when billed services comply with the guideline notes set forth by the Health Evidence Review Commission (HERC) and correct coding standards;
  2. Patient to clinician services using electronic and telephone communications are covered when billed services comply with HERC guideline notes and correct coding standards;
  3. Clinician to clinician consultations using electronic and telephone communications are covered when billed services comply with HERC guideline notes;
  4. For purposes of physical health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person subject to the requirements outlined in the Prioritized List and associated guideline notes.

During an outbreak or epidemic, the Authority shall provide coverage and reimbursement of patient to clinician telephonic and electronic services for established patients using the Division's maximum allowable rate setting methodology:

(6) Providers billing for covered physical health telemedicine services shall:

  1. Comply with HIPAA and the Authority's Confidentiality and Privacy Rules and security protections for the patient in connection with the telemedicine communication and related records;
  2. Obtain and maintain technology used in the telemedicine communication that is compliant with privacy and security standards in HIPAA and the Authority's Privacy and Confidentiality Rules set forth in OAR 943 division 14;
  3. Ensure policies and procedures are in place to prevent a breach in privacy or exposure of patient health information or records (whether oral or recorded in any form or medium) to unauthorized individuals;
  4. Comply with the relevant HERC guideline note for telehealth, teleconsultation and electronic/telephonic services. Refer to the current prioritized list and guidelines.
  5. Maintain clinical and financial documentation related to telemedicine services as required in OAR 410-120-1360.

(7) Performing / Rendering Providers of covered physical health telemedicine services shall:

  1. Hold a current and valid license without restriction from a state licensing board where the provider is located;
  2. Have authority to provide physical health telemedicine services for eligible Oregon Medicaid beneficiaries;
  3. Comply with correct coding standards using the most appropriate Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes

Updated Medicaid Guidance for coverage of telehealth services: The guidance outlines additional E/M codes for payment of telephone services for behavioral health providers, as well as ways to decrease administrative burden.

OHA is submitting a State Plan Amendment to increase Medicaid reimbursement for telehealth and telephone services

Limiting or restricting entry into inpatient psychiatric programs for patients and also testing visitors.

Limiting or restricting entry into MH treatment programs

Licensure Guidance: The Oregon Medical Board (OMB) will allow physicians and physician assistants licensed in another state to provide medical care in Oregon under special provisions through the public health emergency. Out-of-state health care professionals who wish to provide care in Oregon during this time must complete this authorization application.

Physicians and PAs with an active status license to practice medicine in Oregon may provide care via telemedicine to their Oregon patients. Out-of-state physicians with a telemedicine license may provide remote care to their Oregon patients. For more information regarding telemedicine rules and licensure qualifications in Oregon, see here.

Department of Consumer and Business Services and the Oregon Health Authority's Telehealth Guidance for Commercial plans and Medicaid health plans: The state expects health plans of all types to provide increased access to health care services through telehealth delivery platforms and to encourage patients to use telehealth delivery options to limit the amount of in-person health care services they seek. Health plans shall use telehealth service delivery methods to ensure patients maintain access to behavioral health services, including the following:

  • Psychotherapy
  • Team psychotherapy
  • Team conferences
  • Crisis psychotherapy
  • Group therapy
  • Mental health assessments
  • Service plan development
  • Substance use disorder services
  • Peer-delivered services (for the Oregon Health Plan)

Guidance on Telehealth Billing codes for the Oregon Health Plan

CMS Approves 1135 Waiver for Oregon:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities.

Guidance about COVID-19 Risk for Harm Reduction and Syringe Service Programs

Guidance for Opioid Treatment Programs

The Oregon Medical Board Suspends Supervision Requirements for PAs During Pandemic: The OMB is waiving the requirement for 8 hours of on-site supervision of physician assistants for the months in which Oregon is under a declared state of emergency. Supervising physicians do not need to submit a letter requesting the waiver during this emergency.

Telehealth Insurance Coverage FAQs for Consumers: This FAQ has been compiled by Oregon’s Division of Financial Regulation to address concerns about private insurance coverage of telehealth during the COVID-19 crisis.

The Oregon Health Authority announced Lines for Life, a virtual wellness room to offer support to helpers, mental health professionals, first responders, social workers and anyone considered an essential worker during the COVID-19 pandemic in Oregon. The meetings will each have a facilitator to guide the conversation. The meetings are held using Zoom conference calls from 12:30 p.m. to 1 p.m. every Monday, Wednesday and Friday at this link: https://zoom.us/j/4848426773.

The Department of Consumer and Business Services has shared with OPPA that the following private insurers have implemented pay parity for telemedicine services:

  • Cambia (Includes Regence and Bridgespan)
  • Pacific Source
  • Moda – per CMS telehealth coding guidelines
  • Providence
  • Health Net
  • Samaritan
  • Kaiser

Insurers will only reimburse for telehealth appointments that meet the qualification of the appointments, meaning phone calls back to the patient relaying tests results, etc. may not be covered. The services required to be appropriate for the telehealth modality.

Governor Brown introduces new plans for COVID-19 testing and contact tracing. Ensuring adequate testing capacity and contact tracing will allow Oregon's health care system to effectively identify and treat new cases of COVID-19, trace contacts with new cases to identify those at risk for infection, and contain new outbreaks before community spread can occur. The Governor reiterated that these are critical steps to reopen the state.

The Oregon Health Authority issued new guidance for restarting non-emergency medical procedures in:

  • Hospitals
  • Ambulatory surgical centers
  • Other medical and dental settings

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Pennsylvania

Telehealth Guidelines Related to COVID-19 (3/15/2020)

Office of Mental Health and Substance Abuse Services specifies:

  • Preference for use of telehealth services
  • Medicaid FFS and MCOs will allow telehealth through smartphone apps and telephone only service delivery
  • Staff trained in the use of telehealth not necessary during emergency
  • LCSWs, LPCs, and LMFTs can provide telehealth now in addition to already-allowed providers
  • Other provider types may bill for telehealth reimbursement
  • Procedure codes are expanded to ones beyond what had been covered (unspecified but presumably means any reasonable code)
  • Delivery of at home services no longer limited to: Assertive Community Treatment, Dual Diagnosis Treatment Team, or Mobile Mental Health Treatment
  • Requirements for the number or percentage of face-to-face contacts for various behavioral health services may be met with the use of telehealth
  • Program limits on the amount of service that can be provided through telehealth are temporarily suspended

Delivery of BHRS Services During School Closures Due to COVID-19 (Updated March 16, 2020)

Use of telehealth for Outpatient Drug and Alcohol Services funded by the Single County Authority (3/18/2020)

  • Outpatient SUD facilities can provide counseling and other clinical services through telehealth
  • Services provided through telephone are permitted
  • Specifies this is consistent with OMHSAS guidance summarized above

Insurance Department issued a bulletin specifying that insurers are encouraged to:

  • Waive prior authorization and cost sharing for COVID-19 testing
  • Work with insureds to secure access to in-network or publicly-funded services and avoid balance billing
  • Increase use of telehealth and provide "coverage of costs"
  • Check directories to ensure network adequacy and allow out-of-network utilization at in-network costs
  • Expedite utilization review decisions
  • Expedite formulary decisions and grant early prescription refills
  • Coordinate with self-funded ERISA plans they may act as TPAs for

CMS Approves 1135 Waiver for Pennsylvania:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

OMHASAS issued guidance to residential treatment facilities and long-term care facilities that specifies:

  • Prohibits visitation by non-employees except when medically necessary or court ordered
  • Any visits that are deemed necessary must occur in designated area
  • All visitors must be screened and those who fail will be barred
  • Must maintain enhanced hygiene and sanitation
  • Allowed visitations must be staggered
  • Visitors who are not permitted may be given opportunity for video visitations

The Office of Medical Assistance Programs issued guidance regarding telehealth in school settings that specifies:

  • Occupational, physical, and speech therapy along with social work and counseling may be provided through telehealth
  • All services must be provided through audio-visual technology
  • Provider must indicate "telemedicine" in the "daily progress note" section of EasyTrac

Office of Medical Assistance Programs issued guidance regarding telehealth specifying that the FFS program will cover telehealth, including telephone only, for the following providers:

  • Physician
  • Inpatient
  • Home health
  • Hospice
  • Clinic
  • Certified registered nurse
  • LCSW
  • Podiatry
  • Nursing
  • Therapist
  • Psychologist
  • Audiologist
  • Case manager
  • Dentist
  • Certified nurse midwife

The Office of Medical Assistance issued guidance specifying the following about prior authorization for all Medicaid recipients:

  • No prior authorization for emergency or urgent inpatient admissions, except that retrospective review is allowed
  • No prior authorization for first 30 days at long-term acute care hospitals
  • No prior authorization for first 28 days of home health services
  • No prior authorization for first 30 days of hospice care
  • No prior authorization for Radiology services
  • No prior authorization for Medical supplies and durable medical equipment
  • No prior authorization for Shift nursing
  • No prior authorization for first 30 days of inpatient rehab
  • No prior authorization for first 30 days of skilled nursing facility

The Department of Health released a detailed set of guidelines for crisis standards of care during the COVID-19 emergency. This document was originally planned as a general crisis standards of care resource in the fall of 2019. It was expedited and modified to reflect the current pandemic in April, 2020.

The Department of Health released guidelines for death reporting during the COVID-19 emergency for health care facilities. The guidance covers:

  • Mandatory electronic reporting of death
  • Reporting the cause of death
  • Reporting the manner of death
  • Medical certifiers
  • Collection of postmortem specimens
  • General guidance and training

The Department of Health issued guidance to hospitals specifying that they complete the Essential Elements of Information tool 3 times a day that reports on the availability of numerous items or elements, including psych beds.

The Office of Medical Assistance programs issued guidance specifying that managed care organizations must cover through telehealth (including phone only) all of the services, facilities, and provider types covered by the fee-for-service program (summarized above).

The Department of Drug and Alcohol Programs issued guidance making opioid treatment programs aware that SAMHSA has authorized OTPs to:

  • Prescribe take-home doses of medication to stable patients for up to 28 days
  • Prescribe take-home doses of medication to less stable patients for up to 14 days

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Rhode Island

HIC on March 13, 2020: Update telemedicine policies to include telephone-only services within the definition of telemedicine for primary care and behavioral health providers. Telephone-only primary care and behavioral health services coded using CPT codes 99211 or 99212 (or equivalent) with a code modifier shall not be subject to cost sharing. This instruction supports guidance from the Centers for Disease Control (CDC) and the Rhode Island Department of Health (RIDOH) to have patients call their health care providers before seeking in-person care.

Telehealth: Today the Governor signed an executive order directing health insurers to follow previously announced instructions to cover visits conducted over the phone and online during this crisis. This order for an expansion of Telemedicine coverage will apply to primary and specialty care, as well as mental and behavioral health care.

The Department of Business Regulation, Insurance Division issued further guidance on telehealth on 4/6/2020. Governor Raimondo issued an Executive Order (above) that required insurers to allow and pay for telemedicine. The Department's guidance makes it clear that this applies to ALL insurance carriers, not just those under the Office of the Health Insurance Commissioner.

Licensure Waiver: If someone holds a valid license in good standing in another state, that person will be able to get a 90-day temporary license to practice in Rhode Island. This is applicable for physicians, APRNs, mental health counselors, pharmacists, and many other health professions. This temporary license can be renewed one time. There will be no cost to obtain the license or for the one-time renewal. RIDOH is also extending the expiration dates for any of these professionals whose license is set to expire in the next 90 days.

CMS Approves Rhode Island's 1135 Waiver Request:

  • Expands provider enrollment to cover non-Rhode Island licensed providers
  • Lifts some prior authorization requirements

Recording of Department of Health Provider Update Call: RIDOH will hold these calls regularly on Wednesdays at 12:30 pm. Please visit this link for call-in details.

No visitors to Eleanor Slater Hospital: only exception end of life

Governor Raimondo's Executive Order 20-21:

  • Suspends statutes and regulations so that hospitals and other facilities can prepare for COVID-19 surge functions
  • Other facilities, such as psychiatric hospitals (Eleanor Slater Hospital is named), must prepare to take patients from other facilities. Each facility must accept patients from their respective specialty service area
  • The EO also provides for alternative nursing care sites

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Beacon Mutual Insurance Company will expedite workers' compensation claims filed by frontline healthcare workers who contracted COVID-19 while providing care.

Rhode Island Releases COVID-19 Crisis Standards of Care for Hospitals

Coordination of Health Coverage Executive Order:

  • Insurers may not change their formularies unless the changes benefit patients
  • Requires insurers to cover behavioral health services without referrals and the Office of Health Insurance Commissioner can place reasonable limits on utilization review, including prior authorization

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South Carolina

Licensure Waiver: The state medical board can expedite temporary licensure for out-of-state physicians, physician assistants and respiratory care practitioners within 24 hours. These licenses are free.

CMS has approved 1135 Waiver for South Carolina.

  • Extends pre-existing authorizations for previous prior authorizations from March 1.
  • Suspends Pre-Admission Screening and Annual Resident Review (PASSR) Level I and II for 30 days. After 30 days, new admissions with mental illness should receive a Resident Review as soon as resources become available.
  • Temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare.
  • Allows for reimbursement of psychiatric residential treatment facilities in alternative settings.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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South Dakota

South Dakota Department of Health COVID-19 Hub (mostly provides links to CDC for health care providers).

Section 1135 Waiver. Highlights include:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment
  • Provision of Services in Alternative Settings: 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.

Executive Order 2020-07: Suspends regulatory provisions that limit or restrict telemedicine. It removes the requirement that face-to-face contact be required for reimbursement for treatment, visits, interviews, and sessions with providers.

Executive Order suspends various requirements during the public health emergency, including requiring that a prior provider-patient relationship for telehealth; real-time visual technology for telehealth services or prohibiting audio-only transmission thereof; supervision of physician assistants and advanced life support personnel when caring for or treating COVID-19 positive patients; submitting proof of continuing education by physician assistants, advanced life support personnel, chiropractic radiographers, chiropractic assistants, nutritionists, dieticians, genetic counselors, and chiropractors; physical presence of an occupational therapist on the premises where a patient is being cared for by an occupational therapy assistant; nonresident pharmacies obtaining a state license; and more.

The state received a $2 million SAMHSA emergency grant.

  • South Dakota's Emergency COVID-19 response funding will support crisis intervention services, mental health and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic.
  • As the Single State Authority and State Mental Health Authority, the South Dakota Department of Social Services, Division of Behavioral Health, will lead the project in collaboration with community behavioral health providers to identify and address the needs of individuals with serious mental illness (SMI) or serious emotional disturbance (SED), individuals with substance use disorders (SUD), and individuals with mental disorders that are less severe than serious mental illness, including those in the healthcare profession.

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Tennessee

Telehealth: Department of Commerce and Insurance issued bulletin to insurers that, among other things, specified:

  • Reminded insurers to review existing statute regarding coverage of telehealth
  • Recommended that insurers refrain from imposing prior authorization on COVID-19 services
  • Requests that insurers waive cost sharing
  • Request that insurers review provider directories and also allow enrollees to go out-of-network if no provider qualified to screen or treat COVID-19 is available in-network

Licensure Waiver: If out of state health care professional is assisting in the medical response to COVID-19, can practice without Tennessee licensure.

Executive Order Suspending Certain Laws and Regulations

  • Licensing for out-of-state healthcare professionals
  • Pharmacists to dispense maintenance medications for 90 days without prior authorization
  • Allow NPs and PAs to prescribe independently
  • Pharmacists may process computer-based Rx's from alternate locations
  • Suspends CON

The Governor signed an Executive Order to better mobilize health care workers, by:

  • Loosening restrictions around retired medical professionals returning to the workforce;
  • Temporarily suspending continuing education requirements so professionals can continue to work through the pandemic;
  • Calling for the availability of phone assessments for individuals with mental illness or emotional disturbances; and
  • Expanding telemedicine efforts.

CMS has approved an 1135 Waiver for Tennessee.

  • Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and II for 30 days. New admissions with mental illness should receive a Resident Review as soon as resources become available.
  • Temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare. Criminal background and fingerprint checks are waived.
  • Allows psychiatric residential treatment facilities to be fully reimbursed.

The Division of TennCare issued a memo specifying that certain speech, occupational, and physical therapy would be covered by MCOs until 6/18/2020.

The Division of TennCare issued a memo specifying that behavioral health services, generally speaking, will be covered through telehealth, including through phone-only service delivery. Any services that are provided through telehealth should be billed with the POS 02 code. The home may serve as an originating site.

The Division of TennCare issued a memo specifying the following regarding telehealth coverage of behavioral health group therapy:

  • Group therapy includes partial hospitalization and intensive outpatient services
  • Technology that allows visual connection is preferred (not required)
  • Participants are urged to participate in a private room in their dwelling
  • Session leaders should notify everyone that privacy cannot be guaranteed due to other residents of dwelling possibly interrupting
  • Participants should be encouraged to use earbuds
  • If telephone only is used, consider conducting smaller groups

The Division of TennCare issued a memo specifying the following regarding telehealth coverage of psychosocial rehabilitation (PSR):

  • PSR 15 minute sessions and PSR per diem provided through telehealth can be billed using POS 02 code
  • Providers should begin sessions by discussing privacy and confidentiality concerns
  • If the per diem is used, there should be at least 3 one-hour sessions focused on skills development in vocational, educational, and personal growth, and the sessions do not need to be consecutive

The Department of Health issued a memo to long-term care facilities specifying the following:

  • Have adequate PPE on hand
  • Screen all staff for symptoms before each shift and send staff home that have warning signs
  • Restrict all visitors, volunteers, and non-essential staff except for end-of-life
  • Cancel field trips
  • Require all residents who leave for medically necessary purposes to wear masks
  • Notify local health department immediately of any sudden hospitalizations or deaths for respiratory causes, clusters of 2 or more residents with respiratory infections, or known or suspected COVID-19 infections
  • Discuss testing with TDH to ensure all testing is performed rapidly
  • Actively screen residents daily for symptoms and immediately isolate if symptoms are present
  • Cancel all group and communal activities
  • If COVID-19 is detected isolate all residents to their rooms and implement universal mask usage by staff; prioritize masks for direct service personnel if there are shortages
  • Assess supply of PPE
  • Designate specific area for treating COVID-19 residents and monitor those residents at least 3 times a day and move to higher level of care quickly when necessary

The DMHSAS issued guidance specifying the following for congregate care and residential facilities:

  • Restrict non-essential personnel and visitors
  • Maintain 3-4 week supply of medication
  • Maintain supply of cleaning products and PPE and improvise with bandanas and other materials if supplies of PPE run low
  • Frequently use hand sanitizer with at least 60-95% alcohol content
  • Cancel communal dining, educate on symptoms of COVID-19, and educate on social distancing
  • Contains a frequently asked questions regarding COVID-19
  • Implement sick-leave that is non-punitive, flexible, and consistent with public health guidelines
  • Remind staff to consistently monitor themselves for fever and respiratory symptoms
  • Screen staff at beginning of each shift for fever and respiratory symptoms
  • Start planning for potential staff shortages by designing contingency plans for longer shifts and hazard pay
  • Implement daily screening practices on all residents
  • Contact Department of Health if current or past resident has tested positive
  • Segregate resident to private room if infected or suspected of being infected
  • Visitors prohibited unless for end-of-life situations
  • New admissions shall be asked if they have had symptoms, been in contact with anyone diagnosed with COVID-19, or travelled abroad

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

DMHSAS issued guidance to office-based opioid treatment programs (OBOTs) that specified the following:

  • The requirement for annual physical/medical exam is temporarily relaxed
  • The weekly, bi-weekly, and monthly office visit requirements may be provided through telehealth, including telephone only
  • OBOT staff has discretion to determine which patients may not need weekly drug screens
  • Weekly, monthly, and bi-monthly case management services may be provided through telehealth, including telephone only
  • Bi-weekly and monthly counseling services may be provided through telehealth, including telephone only

The Division of TennCare issued guidance regarding EPSDT services specifying:

  • The following services for children 24 months and younger may NOT be provided through telehealth:
    • Immunizations and screenings
    • Preventive medicine CPT codes 99381, 99382, 99391, 99392
  • The following services CAN be provided through telehealth:
    • Developmental Screening 96110
    • Emotional/Behavioral Screening 96127
    • Preventive Medicine, Individual Counseling Anticipatory Guidance 99401 - 404
    • Vaccine counseling but NOT vaccine administration
  • For children over 24 months of age, EPSDT services can be provided through telehealth
  • For children over 24 months immunizations may be referred to the local health department

The Division of TennCare issued guidance to MCOs regarding their practices during COVID-19 that specified:

  • MCOs shall refrain from denying acute-care hospital claims or conducting normal utilization management practices
  • MCOs shall refrain from performing prior authorization on discharges from acute-care to post-acute levels of care
  • MCOs shall not require use of specialty pharmacies for dispensing of prescription drugs
  • MCOs shall offer “appropriate” reimbursement for emerging medications to treat COVID-19
  • Requests for experimental medications or devices shall be expedited
  • MCOs may unbundle payment for readmissions from initial admissions from April 21 through May 15
  • MCOs shall not deny reimbursement to PCPs who are not members’ usual PCP
  • MCOs should consider giving extensions beyond the 180-day limit for appeals and external reviews
  • MCOs shall not require submission of medical records before claims adjudication
  • MCOs shall suspend audits and recoupments
  • MCOs shall reimburse for hospital-based services to providers not yet credentialed
  • MCOs shall suspend recredentialing
  • MCOs shall not deny claims based on being provided in unlicensed spaces
  • MCOs shall reimburse hospitals for providing services in non-traditional spaces
  • MCOs shall suspend manual medical record collection for HEDIS and in-office reviews

Governor Lee announced a $10 million grant program for small and rural hospitals facing financial strain due to COVID. The grants are capped at $500,000 per hospital.

Governor Lee issued an order that mainly continued previous temporary healthcare (and other) provisions. However, the expanded scope of practice previously allowed for NPs and PAs were NOT extended as the state feels that they are no longer necessary due to the flattening of the epidemic curve.

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Texas

Telehealth: The Governor granted waivers to allow hospitals to increase the total number of unused beds without having to apply or pay additional fees in addition to directing the Texas Department of Insurance to issue an emergency rule regarding telemedicine care for patients. Doctors will be eligible for payment from insurance plans regulated by TDI for medical visits they conduct over the phone instead of in-person at the same rate they would receive for in-person visits. Medical providers seeking guidance on the impact of the new rule can expect guidance from the Texas Medical Board to be issued in the coming days, including administrative guidance for billing to ensure that claims are processed smoothly.

Texas Medical Association offering members help ramping up telemedicine practice in light of COVID-19.

Telemedicine: Texas Medical Board received authorization from Governor Abbott to allow telephone-only consults and ease some licensing regulations (mainly around continuing education).

Governor Abbott is requiring daily reporting of hospital beds, but has exempted psychiatric beds.

CMS has approved an 1135 Waiver.

  • Extends pre-existing prior authorizations.
  • Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a Resident Review as soon as resources become available.
  • Can temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare.
  • CMS waives screening requirements including application fees, criminal background checks to include fingerprinting, and site visits.

The Governor temporarily waived licensure regulations to allow Physician Assistants (PA), Medical Physicists, Perfusionists, and Respiratory Care candidates to work under an emergency license and to provide greater flexibility between physicians and the PAs and the Advanced Practice Registered Nurses they supervise in provision of services. Supervision and delegation is still required.

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Utah

Telehealth: COVID-19 Task Force task force discussed several other mitigation steps in their Friday morning meeting, including developing outreach plans to address vulnerable populations, identifying ways to increase capacity to test for COVID-19 and ensuring access to telehealth care for residents statewide. More information is forthcoming.

On 3/25 the Governor issued an order that specifies the following about telehealth:

  • Providers do not have to meet security and privacy requirements of HIPAA and HITECH to the extent that it interferes with the ability to offer telehealth
  • Provider must notify patients if telehealth capabilities in place do not meet HIPAA or HITECH standards and provide patient opportunity to decline telehealth services

Medicaid is suspending work requirements for benefits in response to COVID-19.

CMS Approves 1135 Waiver for Utah:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities
  • Approves the State of Utah’s request for flexibility to modify the timeframes associated with tribal consultation

Utah Medicaid has online guidance regarding telehealth that specifies:

  • Any clinically appropriate service that can be “reasonably accommodated” will be covered, statewide
  • Phone only is allowed
  • Use POS 02 when billing service provided through telehealth
  • Reimbursement is same as in-person
  • Providers must attempt to use technology that complies with HIPAA, if possible
  • Some permanent changes are coming, including allowing phone-only for certain services and reimbursement for originating site and store and forward

The Utah telehealth web portal notes that Aetna will waive cost sharing for telehealth services, regardless of diagnosis, through June 4, 2020.

The same website reports that Cigna will waive cost sharing for office visits and telehealth related to screening and testing for COVID-19

The same website reports that Regent Bluecross Blueshield will cover telehealth services will be reimbursed same as in-person services

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Governor signed SB 3002 into law providing physician immunity treating COVID patients during public health emergency

Executive Order 2020-07 suspends enforcement of statutes relating to telehealth services to broaden the use of telehealth by providers.

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Vermont

Updated Telemedicine Guidance from the Department of Financial Regulation:

  • all health insurance plans and workers' compensation insurance carriers shall provide coverage for telehealth or audio-only telephone
  • payment parity for telehealth and in-person visit
  • mental health parity: Health insurance plans may not establish any rate, term, or condition that places a greater burden on an insured for access to treatment for a mental condition delivered remotely through telehealth, audio-only telephone, store-and-forward, and brief telecommunication services than for access to treatment for other health conditions.

Governor signed H 742 into law, which codifies telephone-only telehealth during the pandemic, and authorizes out-of-state licensees to provide telehealth during the emergency. The legislation also authorizes the Board of Health to waive supervision requirements for physician assistants and waive collaborative practice agreement requirements for APRNs, allowing them to practice independently.

Medicaid Payments for Telephonic Services During Emergency Response:

  • telephone only will be permitted
  • telemedicine reimbursed at same amount as in-person (as per Vermont law)
  • includes further information about specific billing practices and codes.

Vermont Department of Health Advisory for Congregate Care Settings (Including State Psychiatric Hospital):

  • Visitors limited to medically-necessary personnel and visitors to those receiving end of life care.
  • Details equipment that should be available at the facilities
  • Makes recommendation about tiering care in case patients within the facility contract COVID-19.

Vermont Crisis Standards of Care: includes information about the Health Action Network

CMS has approved an 1135 Waiver for Vermont:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

Governor Scott’s Executive Order Addendum provides health care facilities, health care providers, and health care volunteers immunity from civil liability for any death, injury, or loss resulting from COVID-19 related emergency management services or response activities, except in the case of willful misconduct or gross negligence.

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

Governor Scott announced that Vermont's hospitals can restart nonessential procedures, such as outpatient clinic visits, diagnostic imaging and outpatient surgeries and procedures. Health care providers who can recommence these procedures have been provided guidance and must meet specific mitigation criteria to protect patients and clinicians from possible infection.

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Virginia

Licensure Waiver: During the declared coronavirus emergency in Virginia, the board of medicine is making accommodations to its licensing process for the following professions: medicine and surgery, osteopathic medicine and surgery, physician assistant, podiatry, and respiratory therapy. If a report is directly submitted by the National Practitioner Data Bank to the board, the following will not be required in the application process: Transcripts of professional education; Form b employment verifications; State verifications of licensure

CMS has approved an 1135 Waiver for Virginia:

  • FFS prior authorization is waived
  • Previously approved prior authorizations are extended
  • MCO beneficiaries may proceed to fair hearing within one day
  • MCOs must adjudicate appeals within one day
  • Enrollees have an additional 120 days to request fair hearing after initial 120 days elapse

Updated 3/30/20: VDH issued guidance to long term care facilities that, among other things, specified the following:

  • Restrict visitors except for end-of-life situations
  • Restrict all non-essential volunteers and health care providers
  • Consider telework for staff when possible
  • Screen all staff for symptoms before shifts
  • Residents who must leave facility for other health care delivery must wear masks
  • Screen residents at least once daily and isolate anyone with symptoms
  • Immediately notify VDH if there is an outbreak
  • Consider suspension of new admissions if there is an outbreak
  • Consider short-term closures, cleaning, and contact tracing if there is an outbreak
  • Consider longer-term closures and quarantine until outbreak resolves
  • Implement universal mask and PPE wearing by staff if outbreak occurs when interacting with patients
  • Infected staff follow isolation and return-to-work guidelines before returning to work
  • Asymptomatic infected staff may work only while wearing mask and must not have any interactions with immunocompromised patients

Governor Northam encouraged medical professionals to join the volunteer organization Virginia Medical Reserve Corps. Applicants should visit https://vvhs.vamrc.org/.

VDH issued a letter that, among other things, specified the following for long-term care facilities in addition to what was specified on 3/30 (scroll to bottom of letter):

  • Limit points of entry and bar visitors and non-essential personnel except for end-of-life
  • Restrict residents to their rooms and cease any group activities
  • Residents should leave facility only for medically necessary reasons
  • Create location for residents of confirmed or suspected cases
  • Identify cases early and screen residents daily for fever a respiratory symptoms
  • Screen staff for symptoms before each shift
  • Require all staff to wear masks
  • Designate staff for COVID-19 care delivery

DBHDS issued guidance to psychiatric hospitals and community hospitals regarding admissions and transfers that specified:

  • Community hospitals may follow their own internal protocols for screening and treating psychiatric patients who may have COVID-19
  • State psychiatric hospitals shall not transfer patients who have been exposed to COVID-19 to community hospitals if symptoms do not warrant
  • Patients who are positive for COVID-19, or there is high suspicion of infection, will be transferred to community hospitals and then transferred back to the psychiatric hospital once COVID-19 treatment is completed

The Governor announced $2.5 million in emergency funding to provide housing options to Virginia's homeless population.

  • Covers approximately 1,500 people
  • Includes medical transportation and case management

Governor signed Executive Order Number 57 that expands the use of telehealth. It also allows physicians with out-of-state licenses but have Virginia patients to continue to treat their patients via telehealth

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

The Governor is extending the current ban on non-emergency medical procedures until May 1st. Licensed physician’s assistants with 2 or more years of clinical experience will be allowed to practice without a collaborative agreement, along with nurse practitioners.

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Governor Northam issued an executive order limiting liability for healthcare professionals during COVID-19 emergency. The order invoked existing statute that gives the Governor this authority and limits the protections to instances that do not involve gross negligence or willful misconduct.

The Virginia Department of Health issued updated guidance for long term care facilities. The guidance was for planning for point prevalence surveys (PPS) and covered:

  • Checklist prior to conducting PPS
  • Facility PPS strategy
    • For facilities with a COVID outbreak
    • For facilities without a COVID outbreak
    • How to conduct a PPS
  • Recommendations based on results
    • Resident placement and infection prevention
    • Healthcare professionals exclusion from work
  • Implementing a resident cohorting plan
  • Relocating residents
  • Repeat testing
  • New admissions or readmissions after a PPS

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Washington

Licensure Waiver: If volunteers are registered in the volunteer health practitioner system and verified to be in good standing in all states where they are licensed, they may practice in Washington without obtaining a Washington license once activated and assigned by DOH.

In-state practitioners can become volunteers in two ways:

  • Via RCW chapter 70.15 by registering and completing the Emergency Volunteer Health Practitioners Application which can be found here.
  • Via registering with their local Medical Reserve Corps; more information can be found at: https://mrc.hhs.gov

Out-of-state practitioners may:

  • Become volunteers via RCW chapter 70.15 by registering and completing the Emergency Volunteer Health Practitioners Application which can be found here.
  • Out of state MDs and DOs that would like an expedited Washington license and to volunteer, may use the Interstate Medical License Compact and become registered under RCW 70.15. At this time, we are limiting our request for health care practitioners to U.S. jurisdictions due to technical issues. We may expand the call to international jurisdictions in the future as needs arise, and if that remains available to us based on federal restrictions.

DSHS limits visits at its 24/7 facilities including behavioral health.

Approved 1135 Medicaid Waiver: Along with several other provisions, the waiver requests flexibility for provision and payment of telehealth services. Apple Health has already opened new billing codes for both telehealth and telephonic services, including for behavioral health services to cover telehealth services in the same manner and at the same rate as in-person care.

Guidance for Opioid Treatment Programs (OTP) Medical Directors: This guidance contains recommendations and resources from state and federal partners. Among the many issues addressed, the guidance expands on what OTPs need to know about the use of telemedicine or telephonic services to provide medically necessary services for the continuity of care for OTP clients.

Guidance for Buprenorphine Prescribers: This interim guidance contains recommendations and resources, including telehealth recommendations for this patient population. The Health Care Authority will continue to update resources for BUP prescribers on this site.

This ASAM resources provides guidance to addiction treatment providers and programs (regarding making adjustments to drug testing protocols to address the COVID-19 pandemic.)

Parity for Telemedicine: The Governor's proclamation increases parity between health care providers who deliver in-person and telemedicine care. The measure encourages the use of telemedicine and specifically prohibits insurance carriers from:

  • Reimbursing in-network providers for telemedicine claims for medically necessary covered services at a rate lower than the contracted rate that would be paid if the services had been delivered through traditional (in-person) methods.
  • Denying a telemedicine claim from an in-network provider for a medically necessary covered service due to an existing provider contract term with that provider that denies reimbursement for services provided through telemedicine.
  • Establishing requirements for the payment of telemedicine services that are inconsistent with the emergency orders, rules or technical advisories to carriers issued by the Office of the Insurance Commissioner.

Governor Inslee Waives Requirements for Healthcare Worker Licensing: To ensure uninteruppted delivery of care as the state continues to address the pandemic, the Governor is waiving licensing requirements for healthcare workers to practice in the state, including ongoing education requirements.

Washington State PPE Conservation Strategies: The Department of Health is asking healthcare facilities to implement their PPE conservation strategies to the greatest extent possible.

Behavioral Health Provider COVID-19 Information: This document is regularly updated based on the questions presented during the HCA’s weekly webinars and emails. It provides an overview of telehealth guidance, claims billing, prevention, involuntary treatment, and other safety concerns.

CMS Approves Washington’s Proposed 1115 Medicaid Waiver. The waiver grants Washington new flexibilities in its Medicaid long term services and supports program and home and community-based services.

Guidance on Social Distancing During Recovery Meetings

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West Virginia

Medicaid Telehealth: Allowing non-emergent E&M services via telehealth in Medicaid.

West Virginia Bureau of Medical Services within Department of Health and Human Resources issued a guidance specifying:

  • Nonemergent E&M visits can be rendered through the Telehealth for Medicaid recipients
  • Codes 99211 and 99212, may be billed with place of service 02 will be allowed.
  • All existing telehealth statutes still apply

A separate guidance from same entity specifies:

  • Psychological testing for Medicaid enrollees may be delivered through telehealth through May 30
  • This affects the following codes:
    • 96130
    • 96131
    • 96132
    • 96136
    • 96137
    • 96113

Same entity issued guidance announcing that the requirement for MAT-related counseling in order to receive MAT is suspended (Medicaid recipients can get MAT without such services)

Insurance Commissioner issued a bulletin specifying that issuers should:

  • Suspend cost sharing for COVID-19 testing
  • Urged that their telehealth programs are "robust and will be able to meet any increased demand"
  • If in-network providers with training to provide COVID-19 services are not available, allow out-of-network utilization at in-network cost sharing
  • Should not impose prior authorization for COVID-19 services and should expedite other utilization review
  • Should make expedited formulary decisions

CMS has approved an 1135 Waiver for the state.

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations.
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

DHHR issued detailed guidelines for long-term care facilities regarding COVID-19. The guidelines contained specifications on:

  • Preventing an outbreak
  • What to do if a case is identified
  • Measures to control an outbreak
  • Lab testing
  • Staff exposures to COVID-19
  • Managing new residents or those returning from a higher level of care
  • Criteria for removing residents from isolation
  • Criteria for return to work for exposed staff
  • Criteria for return to work for suspected or confirmed infected staff
  • Cleaning and disinfecting

DHHR issued an order allowing hospitals to refuse transfers of patients with COVID from out-of-state facilities.

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Wisconsin

Wisconsin Department of Health Services COVID 19 guidance

Telehealth: Health Plan Issuers are reminded to review provisions in current policies regarding the of the Commissioner of Insurance (OCI) is issuing this Bulletin to assist individuals delivery of health care services via telehealth and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.

Guidance for Correctional Facilities: screening of individuals in custody and determine measures for isolation ahead of time if an individual becomes ill.

Guidance for Long Term Facilities: limit visitors and screen those who do visit

Emergency Order Related to Certain Health Care Providers and the Department of Safety and Professional Services Cleaning:

  • Allows physicians licensed out-of-state to treat Wisconsin residents via telemedicine.
  • Encourages insurers to reimburse for telemedicine.
  • Provides avenue for licensed out-of-state practitioners to practice in Wisconsin without first requiring an in-state credential.
  • Eliminates time limits for temporary licenses.
  • Enables nursing students close to graduation to be a part of the state's COVID-19 response by adjusting some clinical education requirements.
  • Suspends practice restrictions for advanced practice nurses.
  • Allows physician assistants to practice beyond the scope of the supervising physician and allows physician assistants to supervise other health care professionals. Removes the limit on how many physician assistants a physician may supervise at once.

Emergency Order Related to Certain Health Care Providers and the Department of Safety and Professional Services Cleaning:

  • Enables nursing students close to graduation to be a part of the state's COVID-19 response by adjusting some clinical education requirements.
  • Suspends practice restrictions for advanced practice nurses.
  • Allows physician assistants to practice beyond the scope of the supervising physician and allows physician assistants to supervise other health care professionals. Removes the limit on how many physician assistants a physician may supervise at once.

The Department of Veterans Affairs released rules that implement and administer the veterans outreach and recovery program, to assist and support veterans who are homeless or at risk of homelessness and who have a mental health or substance abuse disorder, to receive housing and treatment service, and to assist the veterans with all aspects of daily living with a focus on home, health, recovery, purpose, and community.

Governor Evers signed Wisconsin Act 185. In part, during periods of a public health emergency, this law prohibits a policy or plan that covers prescription drugs from doing the following:

  • Requiring prior authorization for early refills of a prescription drug or restrict the period of time in which a prescription drug may be refilled.
  • Imposing a limit on the quantity of prescription drugs that may be obtained if the quantity is no more than a 90-day supply.
  • The prohibition does not extend to prescription drugs that are a controlled substance.

CMS Approves 1135 Waiver for Wisconsin

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities
  • Approves Wisconsin’s request for flexibility to modify the timeframes associated with tribal consultation

SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.

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Wyoming

No guidance on licensure or telehealth at this time.

Awaiting action/ announcements from the Governor's COVID-19 task force.

CMS approved Wyoming's Medicaid Section 1135 Waiver:

  • Temporarily waives some prior authorization requirements
  • Authorizes care to be provided in alternative settings
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Extends enrollment to non-Wyoming providers
  • Current waivers continue

Wyoming Board of Medicine Guidance on Telehealth:

  • If you are an out of state provider, you may continue to provide care to EXISTING patients via telehealth (including telephone only).
  • You may not initiate a patient relationship for telehealth without being licensed in Wyoming.

Wyoming Board of Medicine Public Health Emergency Licensure Exemption Application Form: emergency, temporary application for out of state physicians and physician assistants

CDC Team Deployed to Wyoming to Supplement Existing Efforts: Approximately five CDC team members will support the Wyoming Department of Health through added efforts in part involving prevention, infection control, and containment of infections in long-term care facilities and psychiatric facilities, as well as community mitigation and infection prevention and control among tribal communities.

The state received a $2 million SAMHSA emergency grant. The Wyoming Department of Health (WDH), Behavioral Health Division (Division), Mental Health and Substance Abuse section (MHSA) will focus the Wyoming Emergency COVID-19 Project on adults and adolescents with serious mental illness (SMI), substance use disorders (SUD), and those with co-occurring SMI and SUD.

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