COVID-19 Resource Page

VMS Is Here to Support Our Members During COVID-19 Pandemic 
VMS wants to serve as an information resource during this critical time, please look below for COVID-19 specific guidance for your practice.
 
The VMS Rounds Newsletters also contain the most up-to-date information as we are publishing them twice weekly. Click here to read the latest issues. 
 
 
Small Business Support |
 
Financial Assistance:
 
PPP Flexibility Bill Passes U.S. House

A bill that would extend the period small businesses can use Paycheck Protection Program (PPP) loans from 8 weeks to 24 weeks (H.R. 7010) passed the U.S. House of Representatives by a vote of 417-1 Thursday.  A similar bill is being considered in the U.S. Senate. Vermont Congressman Peter Welch co-sponsored H.R. 7010 and said, “The Payroll Protection Program has provided much-needed funds for thousands of Vermont businesses devastated by the pandemic, but the strict SBA loan forgiveness requirements make the program unworkable for many businesses. Vermont businesses need urgent relief, and these reforms help provide the necessary flexibility so that these loans work for them. This bill is critical to help small businesses survive during this unprecedented crisis.” ThePaycheck Protection Program Flexibility Act of 2020 (H.R. 7010)will:

  • Allow forgiveness for expenses beyond the current 8-week covered period to 24 weeks and extend the rehiring deadline.
  • Increase the limit for nonpayroll expenses from 25 percent to 40 percent to better match business expenditures.
  • Extend loan terms from 2 years to 5 years for new loans.
  • Ensure full access to payroll tax deferment for recipients of PPP loans.

Latest CARES Act Funding - All Practices Must Submit Revenue InfoThe Department of Health and Human Services (HHS) announced the second wave of provider relief funds will begin to be distributed. Starting on April 24, a portion of providers were automatically sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to the General Distribution Portal exit disclaimer icon. The customer service line confirmed anyone who has a Billing TIN (including a pediatric or obstetric practice) who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal. Please see further FAQ and guidance from the AMA and the following HHS FAQs.

HHS has extended the deadline for healthcare providers to attest to receipt of payments from the Provider Relief Fund and to accept the Terms and Conditions. Recipients now have 45 days from the date they receive a payment from any of the allocations to attest and accept HHS terms or to return the funds. With the extension, not returning the payment within 45 days of receipt of payment will be viewed as acceptance of the Terms and Conditions. The allocations include:

  • HHS is distributing $50 billion across the healthcare system to providers and facilities that bill Medicare.
  • HHS is using a portion of the Provider Relief Fund to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured.

Additional Funding Related to Treatment of the UninsuredA portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured. Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding. Steps will involve: enrolling as a provider participant, checking patient eligibility and benefits, submitting patient information, submitting claims, and receiving payment via direct deposit. Providers can register for the program on April 27, 2020, and begin submitting claims in early May 2020. For more information, visit coviduninsuredclaim.hrsa.gov.

DVHA /Medicaid Funding Phase 2 of the Medicaid Retainer Program
As of April 27, 2020, the Vermont Agency of Services (AHS) is implementing a second phase of Medicaid retainer payments called the “COVID-19-specific Sustained Monthly Retainer Payment Program.” Interested eligible practices need to opt-in to the program, and will continue to receive fee-for-service reimbursement as well as the retainer payments. The advanced payments are based on the practice’s average monthly Medicaid fee-for-service reimbursement, less the total value of Medicaid fee-for-service claims received by the practice in the previous month. DVHA plans to run the program for the months of May and June, after which AHS will determine whether to extend it. Practices wishing to opt in for May will have to complete the opt-in form by May 5th. DVHA has provided specific conditions that each practice must meet in order to receive the funds and has specified that up to 10 percent of these payments may be recouped no sooner than six months after the conclusion of the State of Emergency. The recoupment amount for each provider will be calculated based on provider, provider type, regional, and/or system-level performance on the access to care and financial impact metrics that DVHA has established. For more information please read the guidance documents below:
 
Medicare Advanced Payment Program
On April 27, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B providers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments through the Provider Relief Fund, which is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. The Accelerated and Advance Payment (AAP) Programs were loans and not grants.

 

Small Business Administration Funding
Small Business Administration Paycheck Protection Program Provides small businesses with funds to pay up to 8 weeks of payroll costs including benefits.
Economic Injury Disaster Loans and Grants - Provides an emergency advance of up to $10,000 to small businesses and private non-profits harmed by COVID-19 within three days.
 
FCC Telehealth Funding Opportunities
As part of the CARES Act, the FCC is providing $200 million for eligible health care practices to update their telehealth telecommunications capabilities, information services, and devices during the COVID-19 pandemic. This funding is not a grant, rather it is a reimbursement program. To read the FAQ for this program click here.  There are other telehealth funding opportunities including:
HRSA Telehealth Network Grant Program Deadline: June 15, 2020
 
Changes to Family/Sick Leave:
 
Back-to-Work Resources:
Vermont Agency of Commerce and Community Development (ACCD) Update on New Work Safe Additions to the Be Smart, Stay Safe Order - 7.10.2020
 
Practice Resources:
 
QPP and VT All Payer Model:
MIPS Performance Year 2019 Submission Extended to 4.30.2020
The Quality Payment Program (QPP) data submission window has been extended to April 30, 2020. 
CMS has moved the deadline. 
OneCare Financial Relief Programs for Vermont Clinicians
Click here for OneCare practice relief initiatives. 

Telehealth Resources, Info and Coverage

VPQHC Telehealth Virtual Office Hours on Wednesdays from 12 pm - 1 pm and Thursdays from 8-9 am Contact telehealth@vpqhc.org 
Bi-State VT Telehealth Update
 
Payer's Coding and Reimbursement Policies
Medicare
Guidance Document
On April 30, 2020 CMS lifted Medicare restrictions on the use of telehealth services during the COVID-19 emergency. Key changes effective March 1, and lasting throughout the national public health emergency include:
  • Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19.
  • Patients can receive telehealth services in all areas of the country and in all settings, including at their home.  
  • Increased reimbursement rates for audio-only telemedicine. The change, which is retroactive to March 1, boosts payments for telephonic evaluation and management services (CPT codes 99441-99443) to match those of regular, in-office E/M visits (99212-99214). Payments will increase from about $14-$41 to about $46-$110.
  • CMS expanded the list of services eligible to be reported via telehealth (link here)
  • CMS will permit reporting of telehealth E/M office or other outpatient visits based on time or Medical Decision Making (MDM).
  • The Qualified Healthcare Professionals that are eligible for telehealth has been expanded. Additional codes for these services were also added to the CMS telehealth list.
  • CMS has clarified that telehealth services are permitted with both new and established patients.
  • Physicians can reduce or waive cost-sharing for telehealth visits. In addition, all cost-sharing for Medicare beneficiaries is waived for COVID19 testing and visits related to the testing. Modifier CS – Cost sharing must be appended to these claims to ensure cost-sharing.
  • Physicians licensed in one state can provide services to Medicare beneficiaries in another state. State licensure laws still apply.
CMS Physician Fee look-up tool -  reimbursement rates by claim
Office of Civil Rights: Telehealth and HIPAA – allowing use of non-HIPAA compliant audio/video platforms like FaceTime, ZOOM, Skype
 
Tips/Notes:
Telephone only Codes: covered (during emergency only), limited to: 98966-98968; 99441-99443 
Virtual Check-in Codes covered, G2012; G2010 (5-10 min.)
Modifiers Add 95 for all telehealth services and usual POS code; Add CS for 100% reimbursement of Covid-19 testing E&M visits or virtual visits (whether or not testing was performed)
Patient Consent necessary - can be verbal
Prior authorization -  necessary only when necessary for in-person
 
Medicaid
DVHA Vermont Medicaid Payments for Telephonic Services During the Emergency to COVID-19 - Updated 4.9 Start with March 13, 2020 as the service date and March 23, 2020 as the claims date
 
Commercial
 
BCBSVT Open Codes for All Virtual Well Child Visits
BCBSVT has agreed to reverse a policy it had in place restricting reimbursement for virtual well-child care to children only over age 2 and will now cover virtual well-child care for all children regardless of age. This change will be retroactive and is due to advocacy led by the AAPVT Chapter in coordination with the Vermont Academy of Family Physicians and the Vermont Medical Society. AAP reminds all pediatric clinicians about followingAAP guidelines for well visits during this time and in the future:
  • Well-child care should occur in person whenever possible.
  • Well-childcareshould be provided consistentwiththeBright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents(4thEdition)and the correspondingBright Futures/AAP Recommendations for Preventive Pediatric Health Care(Periodicity Schedule).
  • Well-child care should occur within the child’s medical home where continuity of care may be established and maintained.
  • Where community circumstances require pediatricians to limit in-person well visits:
  • Clinicians are encouraged to prioritize in-personnewborn care, and well visits and immunization of infants and young children (through 24 months of age) wheneverpossible.
  • Well visits for children may be conducted through telehealth, recognizing that some elements of the well exam should be completed in clinic once community circumstances allow.These elements include, at a minimum: the comprehensive physical exam; office testing, including laboratory testing; hearing, vision, and oral health screening; fluoride varnish; and immunizations.

(Up to the Top)

Legal
 
Practice Guidelines
AMA Guidance for Ethical Practice in Telemedicine
 
Technical Support/Misc.
NGS is available to answer Medicare Telehealth Billing Questions email KATHERINE.DUNPHY@anthem.com
Telemedicine Quick Set-up Guide in Response to COVID-19 National Emergency developed by Drs. Sylvia Romm, Adam Maghrabi, Tisha Rowe, Aditi Joshi

Caring for Our Caregivers


State Resources

 
VMS Weekly COVID-19 CALLS With VDH 
Tuesday, April 7th, 12:15-12:45pm

Please join VMS, for a weekly COVID-19 update from 12:15-12:45 pm hosted by Vermont Department of Health (VDH) Commissioner Mark Levine.
Join Skype Meeting 
Join by phone: Dial-in number: +1 (802) 552-8456        
Conference ID: 993815551
Forgot your dial-in PIN? |Help  

VT Practitioner and Licensing Resources

Vermont Physician License Renewal to Open in August; CME Requirement Reduced - June 9.2020

The license renewal process for physicians for the next biennium (Dec. 1, 2018 to Nov. 30, 2020) will begin August, 2020 and will close at the end of November, 2020. As an acknowledgement of the cancellation of many CME programs and conferences and the many hours of professional development performed by licensees to learn about COVID-19, the Board of Medical Practice has reduced the CME requirement from 30 hours to 15 hours of AMA PRA Category 1 Credit™, including 1 hour addressing palliative care, hospice care, OR pain management, and 2 hours addressing prescribing-controlled substances for physicians with DEA registrations. These three subject-specific activities count towards the 15-hour requirement (and cannot be waived by the Board as they are required by Vermont State statute).  Licensees who have not completed the 15-hour CME requirement may file ‘make-up plans’ along with their license renewal application. For online, free or low cost CME options,click here.For more information about license renewal, see theBoard of Medical Practice webpage.

 


Federal Resources


Open Enrollment Information for VT Patients 

Mental Health Facility Policies and Resources
Vermont Designated Agencies and Crisis Lines
Vermont’s designated and specialized service agencies are still here to help with mental health, substance use disorder and developmental services needs via video and phone. Clinical assessment, individual therapy, and 24/7 mental health crisis response – among other services – are all just a phone call away and are generally covered by your insurance, Medicaid, or other public funding. Find your local agency. Intake phone numbers and crisis lines are here.

Volunteer Information
VMS Seeking Peer Support Volunteers for COVID-19 Response While many of our physician and physician assistant members are being called upon to respond to the COVID-19 public health crisis, the Vermont Medical Society (VMS) is seeking peer-to-peer support volunteers from any member who is able to provide emotional and practical support at this time. Please click here if you are interested in serving as a peer support volunteer or receiving support.

President Trump Signs $2 Trillion Stimulus Package 

Click here for AMA Summary of CARES Act.

H.742, Vermont COVID-19 State Emergency Legislation  - For a summary of the health care provisions in the bill click here 

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