Provider Resources and Education

The CARES Act (passed and signed on March 27, 2020) directs CMS to reimburse RHCs and FQHCs as a telemedicine distant site during the COVID-19 emergency period. Further guidance on billing and reimbursement is pending from CMS.

Effective for services starting March 6, 2020, Medicare will make payment for Medicare telehealth services furnished to patients in all areas of the country in all settings (including any healthcare facility and the patient’s home, regardless of rural/urban designation).

New Telemedicine Services (Medicare): For dates of service beginning March 1, 2020, Medicare has approved approximately 80 new codes to be billed via telemedicine. (Note: These services must be provided by a Medicare qualified distant site provider in order to be billed to Medicare).

For dates of service on or after March 17, 2020, Louisiana Medicaid has expanded coverage for several Physical, Occupational, and Speech Therapy services provided via telemedicine. Effective for dates of service March 21, 2020, has also expanded coverage for mental health services provided via telemedicine. See Medicaid Informational Bulletins for more information.

Effective March 17, 2020, the HHS Office for Civil Rights (OCR) will waive penalties for HIPAA violations against healthcare providers that serve patients in good faith through everyday communications technologies without a Business Associate Agreement, such as FaceTime or Skype. Providers should attempt to utilize HIPAA compliant technology to deliver telemedicine services if possible. Public facing communications apps such as Facebook Live, Twitch, and TikTok should NOT be used.

Effective March 31, 2020, Medicare has expanded “virtual check-ins” for utilization by new patients and practitioners such as licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech-language pathologists. Medicare will now also reimburse several telephone codes which are normally considered non-covered services (only available for certain providers).

Beginning with dates of service on or after March 17, 2020, Medicaid, will reimburse audio-only services when an interactive audio/video system is not immediately available at the time it is needed (unless noted otherwise). 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.

General Allocation: $50 billion

On Friday, April 24th, HHS announced plans for distributing another $20 billion from the “general allocation” to providers. This $20 billion comes in addition to the $30 billion HHS administered to providers between April 10th and April 17th based on their Medicare reimbursements from 2019 to create the $50 billion general allocation. These funds will not have to be paid back but do come with terms and conditions which you can attest to here.

All providers who received money from the initial $30 billion, including those who automatically received money again last week, need to go this link to verify their 2018 net patient revenue in the general distribution portal. However, providers who have not received funding from the general allocation as of 5:00 pm EST on April 24th should NOT use the general distribution portal.

The first tranche of money ($30 billion) allocated, was based on roughly 6.2% of Medicare reimbursements from 2019. The second tranche of money ($20 billion), will be based on 2% of 2018 net patient revenue MINUS what you may have already received from the first allocation. For providers with large portion of Medicare patients, your first allocation may be more than 2% of your 2018 net patient revenues. In this scenario, you will likely not receive any additional funds in this second round. At this time, we do not believe that providers in this situation will have money recouped back to HHS, but we are in the process of confirming this.

If, however, your first payment did not exceed 2% of your 2018 net patient revenue, you can expect an additional payment. Provider-based RHCs should have already received this second payment last week based upon their 2018 cost report. Independent RHCs will receive their second payment after they verify their net patient revenue at the general distribution portal again.

Allocation for Rural Providers: $10 billion

HHS announced on Wednesday that $10 billion from the provider relief fund created by the CARES Act would go specifically to rural health clinics and hospitals. The details of how this will be administered are still being worked on however we do know that it will be based on “operating expenses.” This is a “targeted allocation” and considered separate from the general allocation pot. NARHC is meeting with HHS tomorrow to discuss how this might be operationalized. Funds from this targeted allocation may be distributed as early as this week.

Allocation for treatment of the uninsured: unspecified amount

This allocation is designed to ensure that providers are paid for testing and treatment related to COVID-19 they provide to uninsured patients. Beginning yesterday, providers should register here if you have provided testing or treatment for uninsured patients. Providers will be reimbursed “generally” at Medicare rates (subject to available funding) and claims submission is expected to begin on May 6th.

Rural Health Clinic specific grant/allocation: $225 million

An additional $225 million was set aside and dedicated specifically for RHCs in the phase 3.5 legislation more formally known as the “Paycheck Protection and Healthcare Enhancement Act.” The details of this program are being worked out but you can read our full article on this allocation here. This money must be “used to provide additional funding for COVID-19 testing and related expense…”

The Paycheck Protection Program was re-opened again yesterday after the first $349 billion was loaned out to businesses with less than 500 employees. The Paycheck Protection and Healthcare Enhancement Act, which was signed into law by President Trump last week, added another $310 billion to the program. Details on the PPP can be found here.

Notably for the rural health community, the Small Business Administration issued an interim final rule clarifying that hospitals owned by government entities ARE ELIGBLE for a PPP loan if they would otherwise qualify. The only caveat is that the government-owned hospital must receive less than 50% of its funding from state or local government sources (not including Medicaid).

As of April 26th, CMS announced that it is suspending its Advance Payment Program and reevaluating its Accelerated Payment Program. These programs allowed providers to receive advanced/accelerated payments from Medicare, but these payments would have to be repaid back to Medicare typically within the year. This program was designed to help providers get through liquidity issues but is now being suspended/reevaluated “in light of the $175 billion recently appropriated for health care provider relief payments.”