Snapshot 4.2.20

Download PDF version here.

Links in this article:
AIMS Map and Regional Coordinator contact information
ADPH Guidance to LTC Facilities
Scope of Practice Matters
OCR Announcement re: HIPAA penalties
Notice of Enforcement Discretion
OCR COVID-19 webpage
CMS Stark Law Waivers
CMS Informational Bulletin re: telehealth delivery systems
Link to CMS conference calls
Guide for Small Business Loans

Link to confirmed cases and testing sites

AIMS Reporting – Data is requested three times a day as follows: 8:00 a.m. bed availability and ventilator use; 12:00 noon bed availability and ventilator use AND PPE needs, both current and projected for the next 30-days; 8:00 p.m bed availability and ventilator use. The ADPH asks that you not follow any guidance you may be given to the contrary with regard to reporting into AIMS.

IMPORTANT – While you are reporting urgent and immediate needs through AIMS, it is important for you to also contact your ADPH Emergency Preparedness Regional Coordinator for assistance with these needs.  Their role in helping to locate resources locally through a variety of sources is significant and complimentary to statewide efforts in responding to urgent needs.  Map and Regional Coordinator contact information attached.

ADPH Guidance to LTC Facilities
– Today, the Alabama Department of Public Health released guidance on long-term care transfers to hospitals, and release from hospitals back to long-term care facilities for confirmed or suspected COVID-19 patients (see attached).  Also attached, please find information that may be useful as you develop surge plans and response capabilities for hospital options for post-acute care for COVID-19 patients. Please consult with your facility legal counsel for assistance with items mentioned in the document.  If you have questions or need additional information, please reach out to Danne Howard

Governor Provides additional Relief – Today, Gov. Ivey issued a fifth supplemental proclamation to her original executive order calling for a state of emergency to, among other things, provide additional relief for healthcare facilities and providers based on the anticipated surge of COVID-19 patients who will need treatment.  Specifically, the amended order provides:

  •    Expanded scope of practice for certain health care providers
      • Allow certain health care professionals (CRNPs, CNMs, CRNAs, PAs, and anesthesia assistants) are allowed to practice to the full scope of their practice and directs certain licensing board and agencies to promulgate emergency rules (see attached summary).
  •    Expanded capacity for health care facilities
      • SHPDA, SHCC and CON are authorized and directed to promulgate emergency rules to provide for temporary waivers for CON to allow for new services, facilities, and resources.
      • The Board of Pharmacy is also ordered to adopt emergency rules to allow expedited temporary pharmacy permits.
  •     Emergency Procedures for Notaries
      • Notaries will be able to notarize and confirm witness signatures via video conference                   provided that they document it including the date and time of the signatures.
      • This provision will take effect Friday, April 3rd.
  •     In Person Meetings
      • State agencies, boards, and quasi-governmental entities will no longer require in person presence to establish a quorum, assuming they have followed the requirements of notification in the Open Meetings Act.
      • Non-essential meetings are also postponed.
  •     Shareholder Meetings
      • Businesses may provide alternate means of meeting for shareholders via remote communication.
  •     Slowing COVID-19 in jails
      • The order allows local officials to reduce the number of local inmates in a way that does not jeopardize public safety (i.e. certain probation or parole violators).

Board of Pharmacy Emergency Rule re MDIs – Today, the Alabama Board of Pharmacy approved for an emergency rule to be filed to help with the current shortages of Metered Dose Inhalers (MDI) within hospital institutional pharmacies and retail pharmacy locations.  Today’s rule, with proper labeling, will allow for a person to keep any MDI prescribed to them during their hospital visit, and take the MDI home after discharge.  This emergency rule will prevent premature disposal of MDIs and also cut down on any unnecessary trips of COVID-19 patients or persons under investigation from traveling to other locations to fill a prescription for a new MDI.

The Board also adopted a mechanism to allow other medications to be added to the emergency dispensing rule if approved by the Board and its Executive Secretary.  At this time only Metered Dose Inhalers have been added to that list.

The Rule will be effective for 120 days per current Administrative Code regulations or when the Governor proclaims the termination of the State’s public health emergency related to SARS-CoV-2 pandemic, whichever is sooner.

“Emergency dispensing” is defined as prescribing/providing necessary medications to patients being treated by institutional facilities within the physical institutional facility or to be taken with the patient upon discharge.

Requirements for “Emergency Dispensing” labeling must include, but is not limited to:

1.             The name and address of the facility from which the prescription was dispensed

2.             The directions for use

3.             The name of the drug as it is dispensed

4.             The strength per dosage unit

5.             Any additional information that is a true statement of fact may be included as deemed essential for proper storage, handling, safety, and/or usage of the prescription.

Presidential Order to Increase Supply of Ventilators
– Today, the President directed the Secretary of HHS, in consultation with the Secretary of Homeland Security, to “use any and all authority available under the Act to facilitate the supply of materials to the appropriate subsidiary or affiliate of the following entities for the production of ventilators:  General Electric Company; Hill-Rom Holdings, Inc.; Medtronic Public Limited Company; ResMed Inc.; Royal Philips N.V.; and Vyaire Medical, Inc.”

OCR announce no HIPAA penalties for certain violations
– Today, the HHS Office for Civil Rights (OCR)announced, effective immediately, that it will exercise its enforcement discretion and will not impose penalties for violations of certain provisions of the HIPAA Privacy Rule against health care providers or their business associates for the good faith uses and disclosures of protected health information (PHI) by business associates for public health and health oversight activities during the COVID-19 nationwide public health emergency.

Notice of Enforcement Discretion – View   OCR COVID-19 webpage – View

CMS Issues Stark Law Waivers for Physicians and Hospitals
– The Stark Law, also known as the physician self-referral law, prohibits a physician from making Medicare or Medicaid patient referrals to an entity that physician has a financial relationship with, unless an applicable exception applies. CMS’ March 30th blanket waiver gives providers the flexibility to respond to the current crisis by temporarily removing sanctions on self-referrals related to coronavirus cases.  The attached announcement includes several blanket waivers, which are retroactively effective to March 1, 2020 and apply nationwide, including

  • Waivers for physician compensation arrangements; like limits on incidental benefits provided by the hospital to the physician.
  • Waivers for referral arrangements based on type of facility; like a waiver for referrals by a physician to an entity with which the physician’s immediate family member has a financial relationship if the patient who is referred resides in a rural area.
  • Waivers for loans with favorable terms; like a loan with an interest rate that is below fair market value from a hospital to a physician or a physician to a hospital.
  • Waivers for referrals to physician-owned home health agency; like a physician’s referral of a Medicare beneficiary to a home health agency that the physician has an ownership or investment interest in and is not rural.
  • Waivers for location of group practice services; like a physician referral in a group practice for medically necessary care furnished by the group practice in a location that does not qualify as a “same building” or “centralized building” or to a patient in the patient’s private home, an assisted living facility, or independent living facility.

These waivers will be available for the duration of the public health emergency. Health care providers do not need to submit documentation or notice to HHS or CMS before using the blanket waivers, but documentation is vital and providers should consider using a form to ensure all relevant information is captured.  This is particularly important as there is no current waiver authority for the anti-kickback statute, which is predicated on intent.  Hospitals need to document the intent/purpose of providing certain supports to physicians as needed for responding to COVID-19.

CMS Guidance re. Medicaid coverage of SUD and telehealth – Today, the Centers for Medicare & Medicaid Services (CMS) released an Informational Bulletin to states that identifies opportunities for telehealth delivery methods to increase access to Medicaid services and federal reimbursement for services and treatment for substance use disorders under Medicaid using services delivered via telehealth.  This Informational Bulletin is composed of two parts: Rural Health Care and Medicaid Telehealth Flexibilities; and Medicaid Substance Use Disorder Treatment via Telehealth.

Link to CMS conference calls – Click this link to listen to recordings of the various CMS calls.

Guide for Small Business Loans – The U.S. Chamber of Commerce has released a small business guide and checklist for emergency loans during the COVID-19 outbreak.  View document.