In The News

COVID Updates Governor Polis March 20, 2020

From Governor Polis’ community engagement team! We know that sharing information is key, especially during a crisis. In an effort to continue to provide you with an official update from the Governor’s office, below includes the latest steps we are taking to respond to the Coronavirus threat.

New Executive Orders to Protect Public Health


Over the last 48 hours, Governor Polis has taken more executive action to slow the spread of coronavirus and protect vulnerable populations:

  • A public health order limiting gatherings to 10 people or less

  • Temporary closure of nail salons, hair salons, spas, tattoo and massage parlors, horse racing and off track betting facilities until April 30th

  • Allowing restaurants and bars that are maintaining delivery and takeout service to make alcohol sales alongside food sales to help with revenu

  • Temporarily suspending elective surgeries and procedures through April 14th to preserve important medical equipment, like personal protective equipment and ventilators, needed to combat COVID-19.

  • Allowing workers who have lost their jobs and their health coverage, as well as those uninsured, to sign up for health coverage on the state's exchange starting today through Friday April 3rd. Please visit the Connect for Health Colorado website for more information or dial 855-752-6749 to enroll or speak to an expert about your eligibility.

Update on #DoYourPartCO, COVID-19 Relief Fund, Help Colorado Now

In the last week, Gov. Polis has:

  • Launched our viral #DoYourPartCO campaign,

  • Announced the COVID-19 Relief Fund and

  • Stood up our volunteer effort Help Colorado Now.

We’ve already raised about $3.8 million to date, which includes $318,000 raised online from almost 2,000 individual donors.

On the volunteer side, we have already secured commitments from 4,342 volunteers.

Please visit HelpColoradoNow.org to get involved!

Economic Stabilization, Recovery, and Growth Agenda

We know that the past two weeks have been tough, and there are more tough times ahead. But this week has been particularly difficult with many businesses closing their doors, leaving many without a job. The Polis administration is doing everything we can to support Coloradans in the short term while  ensuring that we can stabilize, recover and grow our economy.

Here are a few recent actions / accomplishments to help our boost economy:

  • Colorado has qualified for the federal Small Business Administration's Economic Injury Disaster Loan Program. This means that small businesses, private non-profit organizations, small agricultural cooperatives and small aquaculture enterprises in all 64 counties that have been impacted by COVID-19 can seek individual low-interest small business loans up to $2 million to pay key needs such as fixed debts, payroll, and accounts payable. Eligibility information, loan application links and emerging economic recovery resources can all be found at choosecolorado.com.

  • Governor Polis has extended the state tax filing deadline for 90 days for both individuals and businesses.

  • The Polis administration is working on executive actions to:

    • Expedite unemployment insurance claim payments so families get relief now,

    • Recommend financial institutions provide temporary relief from debts including mortgages, credit card payments, student debt, and others,

    • Recommend landlords and property owners provide temporary relief to tenants and renters impacted by COVID-19,

    • Recommend that all public utilities suspend service disconnections for delayed or missed payments from residential and small business consumers related to the impacts of COVID-19.

  • Governor Polis established the Governor’s Emergency Council on Economic Stabilization and Growth, chaired by former Denver Mayor and U.S. Transportation Secretary Federico Peña.

Letter to Federal Delegation

Action at the state level is important, but we need as much help as we can get from the federal government at this time and there are certain steps that only the federal government can take. Governor Polis sent a letter to Colorado’s federal delegation asking them to take a number of steps to bolster our economy:

  1. Increase the Federal Medical Assistance Percentages (FMAP) -- the funding match rate provided to state Medicaid agencies by the federal government;

  2. Deliver cash payments of at least $2,000 per person, with additional relief measures for workers in small business retail, food and beverage service;

  3. Increase child care funding and SNAP benefits, and suspend the Trump administration’s executive order that would rip SNAP benefits away from thousands of hungry Coloradans;

  4. Tax relief, cash payments, and additional loan assistance for Colorado’s small businesses;

  5. Minimize delays in U.S. Labor Department processing of Unemployment Insurance claims;

  6. Relief from debt collection and a suspension of interest for student loans, credit card and consumer debt as well as a suspension of late fees both individuals and businesses.

Best Practices

The best thing you can do right now is encourage your family and friends to stay home. This will help reduce the spread. Also, practice good hygiene and social distancing in order to keep yourself and others safe -- especially vulnerable populations like older Coloradans and those with underlying health conditions:

  • Avoid close contact with people who are sick.

  • Practice social distancing from others -- at least six feet apart.

  • Avoid touching your eyes, nose, and mouth.

  • Stay home when you are sick and keep your children home if they are sick.

  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. 

  • If someone at your home is sick, avoid sharing dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people in your home. After using these items, wash them thoroughly with soap and water.

  • Choose a  separate room in your home that can be used to separate sick household members from those who are healthy.  Identify a separate bathroom for the sick person to use, if possible. Plan to clean these rooms as needed when someone is sick. All of these ways of preventing the spread of CO-VID 19 are also effective in preventing the transmission of the flu or seasonal colds. Smart hygiene practices make us all healthier. 

Thank you for spreading the word to your organizations and networks. 

Coloradans are counting on leaders throughout our state to step up and do our part to help us weather both the public health emergency and the economic repercussions.

These times are difficult, but they will be temporary. And we thank you for your patience, your participation, and your faith. as we navigate these uncharted waters.

 

COVID Resources from University of Washington

March 20, 2020

Ad Washington State's experience with COVID-19 continues, the University of Washington has made available some valuable resources to assist us at this time.

COVID ED Resources Link Here

COVID-19 UW Medicine Resources

 

ECHO Colorado Cultivating Personal Resilience in Uncertain Times

March 19, 2020

When faced with challenges in your work or life, how do you respond? Resilience is a set of skills that enable us to bounce back during challenging times. In this ECHO series, you'll learn practical tools to integrate into your daily life to cultivate personal resilience.

Cultivating Personal Resilience in Uncertain Times


AUDIENCE
Professionals working in Region VIII
(Colorado, Wyoming, Montana, Utah, North Dakota, South Dakota)

COMMITMENT
Four weekly ECHO sessions held virtually
Thursdays 12:00 - 1:00 PM MST
April 2 - 23
SIGN UP FOR THIS SERIES
In Partnership With
 

MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET

March 28, 2020

Medicare coverage and payment of virtual services 

INTRODUCTION:

Under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the President’s emergency declaration. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19  – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.   

Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health. Innovative uses of this kind of technology in the provision of healthcare is increasing.  And with the emergence of the virus causing the disease COVID-19, there is an urgency to expand the use of technology to help people who need routine care, and keep vulnerable beneficiaries and beneficiaries with mild symptoms in their homes while maintaining access to the care they need. Limiting community spread of the virus, as well as limiting the exposure to other patients and staff members will slow viral spread. 

EXPANSION OF TELEHEALTH WITH 1135 WAIVER: Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020.  A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients.  Additionally, 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.

Prior to this waiver Medicare could only pay for telehealth on a limited basis:  when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.  

Even before the availability of this waiver authority, CMS made several related changes to improve access to virtual care.  In 2019, Medicare started making payment for brief communications or Virtual Check-Ins, which are short patient-initiated communications with a healthcare practitioner. Medicare Part B separately pays clinicians for E-visits, which are non-face-to-face patient-initiated communications through an online patient portal.

Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves and others at risk. 

TYPES OF VIRTUAL SERVICES:

There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries summarized in this fact sheet:  Medicare telehealth visits, virtual check-ins and e-visits.

MEDICARE TELEHEALTH VISITS:  Currently, Medicare patients may use telecommunication technology for office, hospital visits and other services that generally occur in-person.  

  • The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.  Distant site practitioners who can furnish and get payment for covered telehealth services (subject to state law) can include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.  
  • It is imperative during this public health emergency that patients avoid travel, when possible, to physicians’ offices, clinics, hospitals, or other health care facilities where they could risk their own or others’ exposure to further illness.  Accordingly, the Department of Health and Human Services (HHS) is announcing a policy of enforcement discretion for Medicare telehealth services furnished pursuant to the waiver under section 1135(b)(8) of the Act.  To the extent the waiver (section 1135(g)(3)) requires that the patient have a prior established relationship with a particular practitioner, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

KEY TAKEAWAYS:

  • Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances. 
  • These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
  • Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings. 
  • While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.
  • 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.
  • To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

VIRTUAL CHECK-INS: In all areas (not just rural), established Medicare patients in their home may have a brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. We expect that these virtual services will be initiated by the patient; however, practitioners may need to educate beneficiaries on the availability of the service prior to patient initiation.  

Medicare pays for these “virtual check-ins” (or Brief communication technology-based service) for patients to communicate with their doctors and avoid unnecessary trips to the doctor’s office. These virtual check-ins are for patients with an established (or existing) relationship with a physician or certain practitioners where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available). The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would generally apply to these services.

Doctors and certain practitioners may bill for these virtual check in services furnished through several communication technology modalities, such as telephone (HCPCS code G2012). The practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal.  Standard Part B cost sharing applies to both. In addition, separate from these virtual check-in services, captured video or images can be sent to a physician (HCPCS code G2010).

KEY TAKEAWAYS:

  • Virtual check-in services can only be reported when the billing practice has an established relationship with the patient.  
  • This is not limited to only rural settings or certain locations.
  • Individual services need to be agreed to by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient agreement.  
  • HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management 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; 5-10 minutes of medical discussion.
  • HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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.
  • Virtual check-ins can be conducted with a broader range of communication methods, unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.

E-VISITS:  In all types of locations including the patient’s home, and in all areas (not just rural), established Medicare patients may have non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals. These services can only be reported when the billing practice has an established relationship with the patient. For these E-Visits, the patient must generate the initial inquiry and communications can occur over a 7-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.

Medicare Part B also pays for E-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (for instance, physicians and nurse practitioners) can bill the following codes:

  • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
  • 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes 
  • 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes: 

  • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  •  G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
  • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

KEY TAKEAWAYS:

  • These services can only be reported when the billing practice has an established relationship with the patient.  
  • This is not limited to only rural settings. There are no geographic or location restrictions for these visits.
  • Patients communicate with their doctors without going to the doctor’s office by using online patient portals.
  • Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.  
  • The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G206, as applicable.
  • The Medicare coinsurance and deductible would generally apply to these services.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA):  Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

 

 

Tell Congress to increase personal protective equipment (PPE) distribution now

March 18, 2020

Nurses continue to do what they do best – serving on the frontlines, as they work to contain the outbreak of COVID-19 and treating the patients who have fallen victim to this extraordinary pandemic. This is despite widespread stories of severe shortages in personal protective equipment (PPE) such as masks and N95 respirators, forcing them to reuse equipment or make their own – resulting in increased unsafe conditions for nurses and patients. 
 
 
These equipment shortages for frontline health care personnel are unacceptable in the wake of a global pandemic. Not only do we need Congress to immediately distribute PPE to RNs from the Strategic National Stockpile (SNS), but also mandate that minimum PPE levels should be maintained at the SNS in advance of the next emergency. Send your letter today >>
 
First and foremost, Congress needs to address the current shortage to protect the conditions of RNs and patients, but we also need to request a General Accountability Office (GAO) study to review the actions of all applicable federal agencies to identify root causes of these systemic failures. Finally, a study of the supply chain of PPE needs to be thoroughly studied both in the United States and worldwide to prevent future avoidable shortages.
 
 
Thanks for helping to ensure that nurses working on the frontlines have the support and equipment needed to combat the outbreak of COVID-19. 
 
 
Ingrida Lusis 
Vice President, Policy and Government Affairs 
American Nurses Association
 
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