Check back here frequently for regular updates from health agencies, as well as notable news alerts and stories of interest.
MARCH 29, 2020 – WHITE HOUSE ASKS FOR HOSPITAL TESTS. The Trump administration on Sunday sent a letter to hospitals Sunday requesting that they report their COVID-19 testing data to HHS on a daily basis. The request applies to hospitals with in-house labs. “Academic, university and hospital 'in-house' labs are performing thousands of COVID-19 tests each day, but unlike private laboratories, the full results are not shared with government agencies working to track and analyze the virus," Vice President Michael Pence wrote. Test results are due to HHS everyday at 5:00 PM ET. Hospitals are already being asked to share their daily bed counts with the government.
MARCH 29, 2020 – DONATION SITE FOR PPE. The Baker Administration announced an online portal where individuals and companies can easily donate or sell personal protective equipment (PPE) and volunteer to support the COVID-19 outbreak in Massachusetts. The Commonwealth’s COVID-19 PPE Procurement and Donation Program creates an easy portal allowing companies and organizations to sell or donate protective equipment that is in short supply given the global demands for such items.
MARCH 29, 2020 – DMH FREESTANDING HOSPITALS AND PPE. All DMH-licensed freestanding hospitals should submit their personal protective equipment (PPE) requests directly to DMH, as opposed to DPH. Use this Resource Request Form and send it toLiam.Seward@massmail.state.ma.us who will collect all forms and be the contact person between DMH and DPH. This single point of contact will allow DPH to reach out to Seward with any questions and ensure that requests related to DMH have raised visibility. Find information about the optimization of PPE, a PPE request flow chart, and a PPE frequently asked questions document by clicking here.
MARCH 28, 2020 – CMS OFFERS ADVANCED PAYMENTS. CMS has announced the expansion of its accelerated and advance payment program for Medicare participating healthcare provider, including hospitals and physicians. Accelerated and advance Medicare payments address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. Medicare will start immediately accepting and processing Accelerated/Advance Payment Requests that are submitted to the appropriate Medicare Administrative Contractor (MAC). CMS anticipates that the payments will be issued within seven days of the provider’s request. Repayment of the accelerated/advance payment begins 120 days after the date of issuance of the payment. An informational fact sheet on the accelerated/advance payment process and how to submit a request is here.
MARCH 27, 2020 -- APRN SCOPE OF PRACTICE. Responding to a request from the hospital community, the state today issued an order allowing more flexible, independent practice by Advanced Practice Registered Nurses (APRNs). The order from DPH Commissioner Monica Bharel, M.D., allows APRNs with at least two years of supervised practice experience to be exempt from physician supervision and written guidelines for prescriptive practice. Those APRNs with less than 2 years of supervised practice experience may engage in prescriptive practice with physician oversight as currently required by law. If that APRN during the state of emergency collaborates with a different M.D., the workaround in this order allows the APRN to work under any physician as long as they both have a signed record. The order applies to all types of APRNs except for certified nurse midwives. Regular limitations on scope of practice interfere with the rapid and agile provision of care needed during emergencies.
MARCH 27, 2020 – MEMA’s EMS FQAs. The Massachusetts Emergency Management Agency (MEMA) is holding weekly conference calls for all Massachusetts first responders, including EMS, during the outbreak of the novel coronavirus. The call this week generated a host of questions about treating those who refuse treatment, treating those with opioid use disorder, the use of masks, and more. View the FAQs in this document.
MARCH 27, 2020 – STATE-ISSUED FAQs ON PPEs. The commonwealth says it is as frustrated as anyone about the shortage of PPE. Today, the state issued this Frequently Asked Questions document on PPE. “Currently, DPH and MEMA are only able to serve as a bridge when an entity has a critically low supply,” the document notes. “The commonwealth is not able to supplant the normal supply chain for PPE.” State PPE guidance documents are here.
MARCH 26, 2020 – DOI TELLS INSURERS TO REACH OUT TO CONSUMERS. In Bulletin 2020-07, DOI said it expects insurance companies to take the following steps, among others, to help educate consumers about COVID-19 and what is available to them: insurance staff should inform covered members how to take steps to avoid coronavirus; they should explain telehealth options to members; explain to providers plan benefits and services related to COVID-19; increase resources as necessary to accommodate inquiries; clearly post coverage benefits, as well as appeal and grievance policies; warn consumers about scams; and proactively reach out to their members to explain to them all of the above. “Insurance coverage plays a critical role in the stability of the commonwealth’s economy and the protection of its residents, “ DOI wrote, “and COVID-19 imposes unique risks to our insurance market that Massachusetts has not faced for at least a generation.”
MARCH 26, 2020 – DIV. OF INSURANCE GUIDANCE ON HEALTH PLANS & PRESCRIPTIONS. The Division of Insurance released Bulletin 2020-06 addressing prescription drugs and what is expected of commercial health plans. As detailed in the bulletin, fully funded Massachusetts carriers are expected to: Eliminate signature requirements for both in person pick up and in home deliveries (with the exception of federal requirements around controlled substances; Eliminate any obstacles to mailing prescriptions to members; Allow members to use their pharmacy benefit for early refills when appropriate; and Encourage third party administrators to follow the same provisions. In addition, plans will be implementing certain restrictions on dispensing of chloroquine and hydroxychloroquine for COVID-19 to prevent the hoarding of the drugs.
MARCH 26, 2020 – BORIM 90-DAY PROVISIONAL LICENSES. The Massachusetts Board of Registration inn Medicine making available an Emergency 90-Day Limited License for medical school graduates who received an appointment as an intern, resident, or fellow at a Massachusetts healthcare facility or in a BORIM-approved training program. To qualify for an Emergency 90-Day Limited License, the program or healthcare facility will be required to submit this application that will be filled out by the resident. The Emergency 90-Day Limited License will expire after 90 days. The emergency license is a temporary measure in response to the state of emergency to insure that trainees may start their program as scheduled, and is not a substitute for the regular Limited License process. (If the application for the Emergency 90-Day Limited License is not approved, the program or healthcare facility will be required to submit a Limited License application.)
MARCH 25, 2020 – DETERMINATION OF NEED WAIVED. DPH issued an order today waiving the Determination of Need process for anyone seeking approval for “a Substantial Capital Expenditure, Substantial Change in Service, or Transfer of Site necessary to address COVID-19.” The person must still notify the department and describe the proposal as outlined in this guidance document. DPH will then review the proposal to see if it meets state-of-emergency guidelines. DPH notes that if the construction or change in service is not temporary in nature, then it reserves the right to revisit the request after the state of emergency is lifted and require that the facility apply for a full Determination of Need.
MARCH 25, 2020 – GUIDANCE AFFECTS PHARMACY PRACTICE. Remote processing of prescriptions, garb conservation, and emergency authorization to practice pharmacy in the commonwealth are just a few of the pharmacy practice guidelines that are revised in this order issued today from DPH Commissioner Monica Bharel, M.D. Pharmacies will be allowed to do emergency prescription refills for patients whose provider is unable to refill the order, and a pharmacy engaged in “central filling” practices can provide filling for one or more pharmacies.
MARCH 25, 2020 – NEW MASS. SITE OFFERS TESTING. The Clinical Research Sequencing Platform at the Broad Institute of MIT and Harvard has launched a high throughput version of the CDC 2019-nCoV Realtime RT-PCR test and is now accepting samples from healthcare institutions, clinical laboratories, and departments of public health. Information on how specimens will be accepted and prioritized is here. For inquiries, please contact the laboratory at firstname.lastname@example.org or (617) 714-7569.
MARCH 24, 2020 – LABOR DEPT. GUIDANCE ON LEAVE. The U.S. Department of Labor’s Wage and Hour Division published guidance on how employees and employers can take advantage of the protections and relief offered by the Families First Coronavirus Response Act (FFCRA) when it takes effect on April 1, 2020. The FFCRA was signed into law March 18. FFCRA giving all American businesses with fewer than 500 employees funds to provide employees with paid leave, either for the employee’s own health needs or to care for family members. DOL provided in a Fact Sheet for Employees, a Fact Sheet for Employers, and a Questions and Answers document, all of which are available by clicking here.
MARCH 24, 2020 – OPTIMIZING PPE. In new guidance detailed on this chart, DPH outlines optimization of personal protective equipment (PPE). DPH lists facility category, the type of personnel operating within various categories, and the type of PPE they can use to optimize resources. DPH notes that PPE is being prioritized to medical facilities on the front lines. The Department notes in this guidance document that it is “deploying all possible resources to rapidly increase supplies through all possible avenues – without compromising on protective specifications.” Part of that effort involves continued advocacy to get more supplies from the federal Strategic National Stockpile. This DPH graphic shows the process for requesting PPE.
In addition, the following groups have entered the PPE-supply arena:
• Bethenny.com is run by Bethenny Frankle, whose emergency assistance foundation, B Strong, partners directly with the Global Empowerment Mission. Requests for donations can be made through email@example.com.
• Harbor Freight is donating its entire supply of PPE to hospitals with 24-hour emergency rooms. It is offering N95 masks, face shields, and 5 and 7 mil nitrile gloves. Harbor Freight is asking the office in charge of procurement to fill out this form to receive donations.
• Healthcare providers may send requests for supplies or expertise Massachusetts Life Sciences Emergency Supply Hub by firstname.lastname@example.org. The supply hub will share this information with DPH, which is coordinating and triaging requests.
• Projectn95 rapid response teams have been coordinating with manufacturers globally with the capacity to produce. The organization is working with governments to determine where demand is and where it is most urgent. Use this medical equipment request form.
MARCH 24, 2020 – NEW DIRECTIVES/TIMELINES/GUIDANCE FOR EMS. DPH is suspending all ongoing or approved EMT and paramedic courses with in-person components, as well as all psychomotor examination. In addition, first responder refresher training credentials and CPR certificates of completion that are or have expired since February 1, 2020, are valid through July 1, 2020. DPH’s Office of Emergency Medical Services also has changed the time limit allowed for candidates to obtain National Registry of EMTs (NREMT) certification in order to obtain Massachusetts certification as an EMT-Basic, Advanced EMT, or Paramedic. DPH has created this video protocol update course. Ambulance services may provide this (or other existing) videos to its EMTs, document their successful viewing, and meet the requirement for its EMTs completing this training. The deadline for compliance with this Statewide Treatment Protocol update remains April 1, 2020 The full protocols are available here.
MARCH 23, 2020 – NEW DRG CODE FOR COVID. As requested by AHA, CMS has issued a corrected announcement regarding the Medicare Severity-Diagnosis Related Group Grouper to recognize the new ICD-10-CM diagnosis code, U07.1, for COVID-19. The initial MS-DRG assignment posted March 20 would have resulted in significant reimbursement reductions for hospitals.
MARCH 23, 2020 – DOI URGES PREMIUM RELIEF. In an administrative bulletin today (Bulletin 2020-05) the Division of Insurance informed insurance companies that it expects them to “take all necessary steps to preserve individual and employer access to insurance coverage during this emergency period.” Specifically, DOI urged carriers to be “flexible in collecting premiums,” clearly explain grace periods, and work on a case-by-case basis to find “the best ways to address concerns with the timing of premium payments.” Specifically for health insurers, DOI said they should have personnel available to discuss COBRA or other coverage for the recently unemployed, and to work with employers to allow flexibility.
MARCH 23, 2020 – GOVERNOR’S ESSENTIAL SERVICES ORDER. Governor Baker today issued an emergency order, mandating that all “non-essential” business must close their doors to their workers and the public effective tomorrow, March 24, at noon. This is a step that MHA and many hospitals have been seeking. We had been in contact with the administration on this issue throughout the past week. Today’s order designates a list of COVID-19 Essential Services that will be allowed to continue operations. Medical professionals and caregivers, along with a whole host of hospital personnel, are included in the essential services list, along with those in law enforcement, energy, transportation, and more. Here is the full Exhibit A list of COVID-19 Essential Services that was attached to the governor’s order. And here is the order.
MARCH 22, 2020 – FDA VENTILATOR GUIDANCE. The Food and Drug Administration (FDA) published additional information focused on mitigating disruptions to or shortages in the ventilator supply chain. First, the agency released updated guidance to provide flexibility around and expand the availability of ventilators and other respiratory devices to treat patients during the public health emergency. The FDA also released a letter to healthcare providers in an effort to supplement the updated guidance and provide recommendations directed at providers. Due to the urgency of this issue, the guidance was issued without public comment and will remain in effect only for the duration of the public health emergency.
MARCH 22, 2020 – CMS REPORTING WAIVED. CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs. Specifically, CMS is implementing extensions for upcoming measure reporting and data submission deadlines for a host of programs, including: Quality Payment Program; Medicare Shared Savings Program Accountable Care Organizations; Hospital-Acquired Condition Reduction Program; Hospital Inpatient and Outpatient Quality Reporting Program; and the Hospital Readmissions Reduction Program—among many others. Read the media release here.
MARCH 22, 2020 -- DMH: ADMISSION OF YOUTH TO FACILITIES. Because there have been delays in admission of minors to DMH-licensed facilities due to the unavailability of the minor’s legal guardian to provide an in-person signature upon admission, DMH is issuing the following guidance: For the duration of this state of emergency, DMH is asking facilities to accept fax authorizations with follow up whenever the legal guardian can come to the facility. E-mail authorization should also be sufficient if the receiving facility has reasonable confidence that the sender is in fact the legal guardian. (A DCF e-mail, for instance, would be sufficient.) DMH says it recognizes that, under the circumstances, in person follow up may not be possible for the duration of the admission. The same principles for accepting fax authorizations for admission will apply if a facility is admitting someone with an authorized health care agent, when the admitting physician has invoked the person’s health care proxy (HCP). DMH Assistant Commissioner for Clinical and Professional Services/ Director of Licensing Janet Ross issued the guidance by e-mail to all licensed facilities.
MARCH 22, 2020 – REIMBURSEMENT FOR COSTS INCURRED (MEMA). The Massachusetts Emergency Management Agency (MEMA) has issued guidance on how costs incurred from the COVID-19 response may be eligible for reimbursement through FEMA or other federal agencies. It is important that applicants track their costs for the duration of the response to be ready to submit for reimbursement once the crisis has passed. Costs will be evaluated at that time and routed to the appropriate federal agency for reimbursement. See the original March 20 notice from FEMA below and review this MEMA document that discusses eligible costs and contains a link to a question-and-answer forum.
MARCH 22, 2020 – ALTERNATIVE HOSPITAL SPACES. In addition to CMS waiving requirements to allow acute care hospitals to house patients in excluded distinct part units, DPH is allowing acute care hospitals to care for admitted patients in alternate acute inpatient space. All hospitals operated by the DPH, or licensed pursuant to 105 CMR 130 may implement procedures as necessary to accommodate the surge of patients requiring care for COVID-19, to use alternate acute inpatient space that would be appropriate for inpatient care, including but not limited to: post-anesthesia care unit beds, beds out of service, and inpatient rehabilitation units. Beds considered appropriate for acute inpatient care use must be equipped with medical gases (one oxygen outlet and one vacuum outlet for each bed), be spaced at least six feet apart from another bed, and have access to hand washing sinks and privacy partitions. The complete guidance is here.
MARCH 20, 2020 – WAIVER REQUEST TO CMS. The Massachusetts Executive Office of Health and Human Services, acting on behalf of “its partners in the healthcare community” including MHA and its membership, has filed with CMS a request for a Section 1135 waiver. CMS can grant such waivers under the national emergency declaration the president made on March 13. EOHHS’ request ask for waivers from current rules relating to revalidation of providers; enforcement of MassHealth ordering, referring, prescribing provider requirements; claims filing deadlines; patient transfers; bed limits and staffing in nursing homes; physician oversight of physician assistants; certain laboratory guidelines; upper payment limits; and much, much more. The entire waiver request is here. EOHHS notes that it may be asking for additional waivers as the situation develops.
MARCH 20, 2020 — TELEHEALTH. Today CMS released two toolkits on telehealth that are specific to general practitioners as well as providers treating patients with end-stage renal disease. Each toolkit contains electronic links to sources of information on telehealth and telemedicine, which will reduce the amount of time providers spend searching for answers and increase their time with patients. On MARCH 22, the toolkits were updated. You can find the updated telehealth toolkit for general practitioners here, and the updated end-stage renal disease providers toolkit here.
MARCH 20, 2020 – RESOURCE DATA. The Society of Critical Care Medicine has updated its statistics on critical care resources available in the United States. Its goal is to provide information regarding the resources both available and needed to care for a potentially overwhelming number of critically ill patients, many of whom may require mechanical ventilation. In the report here, the Society addresses the most current data and estimates on the number of acute care, ICU, and step-down (eg, observation, progressive) beds; ICU occupancy rates; mechanical ventilators; and staffing. It also provides context to the data.
MARCH 20, 2020 – PRICE GOUGING. Attorney General Maura Healey announced today that her office has filed an emergency regulation to prohibit price gouging of essential products and services during the COVID-19 public health emergency. The amendment to regulation 940 CMR 3:18, filed today with the Secretary of State’s Office and effective immediately, prohibits price gouging of goods and services necessary for public health and safety during a declared statewide or national emergency. Previously under the state’s consumer protection law, the only existing regulation related to price gouging addressed the sale of gasoline and other petroleum products.
MARCH 20, 2020 -- FEMA FUNDING. Under the national emergency declaration, eligible emergency protective measures taken to respond to the COVID-19 emergency at the direction or guidance of public health officials may be reimbursed by FEMA. FEMA will not duplicate assistance provided by U.S. HHS (including CDC), or other federal agencies. States and local governments – as well as certain private non-profit organizations – are eligible to apply for public assistance. Information is available here, including a link to FEMA’s Public Assistance (PA) Program and Policy.
MARCH 19, 2020 -- HEALTHCARE WORKFORCE. DPH has issued new guidance, based on CDC guidance, which outlines how providers may consider allowing asymptomatic healthcare personnel, who have had an exposure to COVID-19, to continue working after a series of conditions have been met. If a facility has fulfilled guidelines relating to its emergency staffing plan and curtailing elective surgeries, among other mandates, then it can allow the employment of asymptomatic workers who have been exposed to COVID-19 as long as the worker meets conditions relating to daily assessment of temperature, continually wearing a mask, and ceasing work at the first sign of symptoms – among other guidelines. Read the full guidance here.
MARCH 19, 2020 – SUBSTANCE USE DISORDER/SAMHSA. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has provided this guidance relating to the use and disclosure of patient identifying information (such as substance use disorder records) during a medical emergency. SAMSHA emphasize that under the medical emergency exception providers make their own determinations whether a bona fide medical emergency exists for purposes of providing needed treatment to patients.
MARCH 19, 2020 (UPDATED MARCH 24) – PHARMACY FAQs. The State’s Board of Registration in Pharmacy has issued this Frequently Asked Questions document the covers such topics as signature requirements for prescriptions, filling clozapine without lab results, compounding, and more.
MARCH 17, 2020 – EMERGENCY CREDENTIALING. DPH issued this order allowing for Expedited Credentialing Procedures for Licensed independent Practitioners and Expedited Transfers of Licensed Clinical Staff Among Facilities. All DPH regulated hospitals and facilities must immediately implement expedited credentialing procedures pursuant to the hospital’s or facility’s emergency management plan in order to process applications from licensed practitioners seeking to practice at the hospital during the public health emergency. During the emergency, all licensed clinical staff, including but not limited to nurses, respiratory technicians, and licensed independent practitioners who are employed by or work at any DPH regulated facility are hereby authorized to work at any other DPH regulated facility.
MARCH 18, 2020 – EMS DIRECTIVES. The state’s Office of Emergency Medical Services (OEMS) has issued directives extending its recertification deadlines for CPR and Advanced Cardiac Life Support; designating the type of continuing education that will be allowed for EMS personnel with certificates expiring; and issuing a waiver to reduce required staffing of each ambulance to one EMT and/or one paramedic, depending on level of ambulance, with a driver who is a first responder.
Also, DPH issued an order requiring local board of health to disclose to those administering emergency calls within a jurisdiction the address of persons within that jurisdiction who the board knows have tested positive for COVID-19. The disclosure is of the address only , not the name of the person. Further details are in this March 18 order.
MARCH 18, 2020 -- CHILDCARE GUIDANCE. Governor Baker issued this executive order today closing all child care programs by the end of day, Sunday, March 22, but empowering the Department of Early Education and Care with the flexibility to issue new policies and procedures for the creation, approval, operation, staffing, and oversight of emergency child care programs, and to provide funding for them. The order states that vulnerable children and children of families, who work to maintain the health, safety, and welfare of all commonwealth residents addressing the COVID-19 pandemic, including hospital employees, shall receive priority access to these emergency programs. If your facility is interested in setting up a childcare facility, you must begin the process by completing an Exempt Emergency Child Care Inquiry Form. And here is a list of Exempt Emergency Childcare sites.
MARCH 17, 2020 -- Governor Baker issued two orders today relating to healthcare staffing. The first expands access to physician services by allowing the Board of Registration in Medicine to reactivate the licenses of retired physicians; fast-tracks license renewals; permits Massachusetts to extend emergency licenses to practice to physicians from other states; and allows “limited licensees” to operate beyond their specialty training program as long as they have the proper oversight. Retired physicians may visit here to access the necessary application.
The second order extends the registrations of certain licensed healthcare professionals -- RNs, LPNs, pharmacists, and physician assistants. The relevant board of registration can waive requirements for training and continuing education for those with extended licenses. And during the state of emergency, licensed nurses, social workers, psychologists, or MDs in good standing cannot be prohibited from providing services using telemedicine to patients across state lines who during the current school year were enrolled in a Massachusetts college or university.
MARCH 17, 2020 – As a reminder, pharmacists may process patient-specific prescriptions remotely in accordance with standing Massachusetts Board of Registration in Pharmacy policy. Although the policy only addresses pharmacists, the Board announced it is actively working on remote processing guidance for pharmacy technicians and interns, and hopes to have new guidance soon.
MARCH 17, 2020 – The FDA has updated its policy relating to laboratory diagnostic testing for COVID-19. First, the new policy FDA allows states to take responsibility for tests developed and used by laboratories in their states. States can set up a system in which they take responsibility for authorizing such tests and the laboratories will not engage with the FDA. Second, the FDA will not object to commercial manufacturers distributing, and labs using, new commercially developed tests prior to the FDA granting an Emergency Use Authorization (EUA). As noted in the guidance, the FDA believes that 15 business days is a reasonable period of time to prepare an EUA submission for a test whose performance characteristics have already been validated by the manufacturer. Finally, the updated policy provides recommendations for test developers who may wish to develop serological tests for use during the coronavirus outbreak. Serology tests are less complex than molecular tests and are solely used to identify antibodies, which limits their effectiveness for diagnosis; however, as stated in the updated guidance, the FDA does not intend to object to the distribution and use of serology tests to identify antibodies to SARS-CoV-2 where the test has been validated, notification is provided to the FDA, and warning statements are included with the tests.
MARCH 17, 2020 – The Massachusetts Division of Insurance (DOI) has updated its guidance (Bulletin 2020-04) for commercial insurers as follows: “When delivered via telehealth by in-network providers, [insurers are to] forego any prior authorization requirements and any cost-sharing (deductibles, coinsurance or copayments) for medically necessary Coronavirus treatment in accordance with DPH and CDC guidelines.” The order stresses the need to allow providers to conduct treatments – not just for COVID-19 – by telehealth and for insurers to reimburse them as they would for face-to-face care. Read the entire order here. And here is Bulletin 2020-02 which the new Bulletin supersedes.
MARCH 16, 2020 – Effective March 18, all hospitals licensed by DPH and all ambulatory surgical centers must postpone or cancel any non-essential, elective invasive procedures until May 31, 2020. This guidance explains the details of the order.
MARCH 16, 2020 – This Memorandum from DPH explains the hospital visitation guidance the state has instituted effective immediately. Among the series of restrictions hospitals must impose, hospitals must urge potential visitors to defer visitation until further notice, and they must require all visitors to perform hand hygiene before visiting a patient.
MARCH 16, 2020 – This Order from DPH’s Board of Registration in Pharmacy authorizes Massachusetts pharmacies and pharmacists to compound and sell hand sanitizer over the counter, as long as a series of conditions are met. The Board said it “expects pharmacies and pharmacists to price products fairly, to use judgment to avoid bulk sales that may result in hoarding or resale, and to uphold the integrity of the profession during this emergency.”
MARCH 16, 2020 – On March 10, Governor Charlie Baker declared a state of emergency, giving the Administration more flexibility to respond to the Coronavirus outbreak. On March 15, he issued a series of executive orders, including the ones detailed above dealing with elective surgeries, hand sanitizers, and hospital visits. This page on the state’s COVID-19 website lists all of the March 15 orders and guidance documents.
MARCH 16, 2020– The Joint Commission has suspended all regular surveying beginning today. Read the brief notice here.
MARCH 15, 2020 – DPH announced today that clinicians no longer must receive authorization to conduct COVID-19 testing on patients. DPH has implemented the CDC’s updated guidance on clinical testing protocols, which means clinicians are required to only submit one nasal swab, rather than the previous requirement to submit both nasal and throat swabs. In addition, in Massachusetts, clinicians now have more flexibility to determine which patients should be tested without having to call DPH’s Epi Line. Clinicians can submit specimens for testing directly to FDA-approved labs; they no longer must only use the DPH state lab, which is now processing up to 400 tests daily.
MARCH 13, 2020 – MassHealth/ EOHHS have released provider bulletins and additional guidance in response to COVID-19. These policies expand telehealth coverage, including telephonic coverage, expand coverage through Hospital-Determined Presumptive Eligibility (HPE), provide information for providers to bill for COVID-19 lab testing, cover 90-day refills of prescriptions and early refills, and remind providers that there are no copays for lab tests and pharmacists cannot deny medications if a member cannot pay.
The following bulletins and guidance have been posted:
• All Provider Bulletin 289: MassHealth Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19)
• Managed Care Entity Bulletin 20: Coverage and Reimbursement for Services Related to Coronavirus Disease 2019 (COVID-19)
• All Provider Bulletin 288: Coverage Provided via Hospital-Determined Presumptive Eligibility
• Pharmacy Facts: Updates Related to Coronavirus Disease 2019 (COVID-19) Effective March 14, 2020
• Community Day Program Settings (e.g. Adult Day Health, Day Habilitation, Councils on Aging, etc.) 2019 Novel Coronavirus (COVID-19) Guidance
• Non-Agency Based In-Home Caregivers (e.g. PCAs, Independent Nurses, etc.) 2019 Novel Coronavirus (COVID-19) Guidance
• Agency-Based In-Home Caregivers & Workers (e.g. Home Health Agencies, Personal Care Management Agencies, Home Care Agencies, Adult Foster Care, etc.) 2019 Novel Coronavirus (COVID-19) Guidance
MARCH 13, 2020 – Starting in April, laboratories performing the COVID-19 test can bill Medicare and other health insurers for services that occurred after February 4, 2020, using the newly created HCPCS code (U0001). This code is only to be used for the tests developed by the CDC. Laboratories performing non-CDC laboratory tests for COVID-19 can bill for them using a different HCPCS code (U0002). Full guidance is here. And here are Frequently Asked Questions relating to the Massachusetts State Public Health Laboratory
MARCH 12, 2020 – Today CMS posted these Frequently Asked Questions to the Medicaid.gov website to aid state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their response to the COVID-19 outbreak.
MARCH 11, 2020 – The World Health Organization (WHO) this morning declared the COVID-19 a “pandemic,” meaning it will likely spread across the globe. "WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “We have therefore made the assessment that COVID-19 can be characterized as a pandemic … Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.” Tedros said the virus can be suppressed and controlled with concerted action. “If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of COVID-19 cases can prevent those cases becoming clusters, and those clusters becoming community transmission,” he said.
MARCH 11, 2020 – The University of Washington’s UW Medicine system has developed a model for “drive through” testing of coronavirus for staff that minimizes the chances of spreading the virus. Rather than having staff who present with common symptoms of coronavirus enter into the medical facility, thereby increasing the odds of spreading the virus to others, the UW Medicine system directs staff, who have been pre-screened, to a parking garage where a nurse, wearing appropriate PPE including a face shield, will swab the noses of employees while they remain inside of their vehicles. The samples are then sent for testing and employees are sent home while they await notification of test results. MHA strongly urges healthcare facilities to explore replicating this model, which could be expanded to patients in addition to employees. This two-minute video from UW Medicine shows how the drive-through testing works.
MARCH 11, 2020 – CDC updated its personal protective equipment (PPE) recommendations for healthcare workers caring for patients with known or suspected COVID-19. Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable temporary alternative when the supply chain of respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to healthcare providers. (Facemasks protect the wearer from splashes and sprays; respirators, which filter inspired air, offer respiratory protection.) The recommendations cover use of eye protection, medical gown, airborne infection isolation rooms, and more. Read the full CDC guidance here.
MARCH 10, 2020 – The Centers for Medicare & Medicaid Services (CMS) has published this memorandum to State Survey Agency directors providing guidance to hospitals with emergency departments (EDs) on patient screening, treatment, and transfer requirements for infectious diseases, including COVID-19. CMS said Medicare-participating hospitals should continue to follow both CDC guidance for infection control and Emergency Medical Treatment and Labor Act (EMTALA) requirements. That is, Medicare-certified hospitals with EDs are to provide a federally required, appropriate medical screening examination to every patient that comes to the ED, including those suspected of having COVID-19. If the examination indicates a possible COVID-19 case, hospitals should isolate the patient following the guidance the CDC established to minimize the risk of cross-contamination. Hospitals should also immediately contact state or local public health officials for direction on next steps, including cases where a patient may need to be transferred. Here are FAQs on EMTALA.
MARCH 10, 2020 – The well-respected medical journal, The Lancet, has created a coronavirus research center that brings together content from across The Lancet’s many journals (for example, The Lancet Global Health, The Lancet Infectious Diseases, and The Lancet Respiratory Medicine) as it is published. The content on the website is free.
MARCH 9, 2020 – DPH has issued a circular letter about reducing or eliminating the need for boarding of patients in the hospital emergency department, and authorization and guidelines for use of alternate space for treatment of ambulatory patients presenting with possible COVID-19. To address the potential influx of patients with possible COVID-19 exposure or symptomology to hospital ED, DPH issued the guidance to acute care hospitals.
MARCH 15, 2020 – Governor Charlie Baker announced at a 6 p.m. press conference that all non-urgent elective surgeries must be cancelled, effective Wednesday. Some Massachusetts hospitals had already begun to phase out such surgeries, undertaking various facility-specific strategies. The state directive creates a uniform policy that will free up beds and resources to counter any COVID-19-generated surge. The state is also barring visitors to any post-acute or nursing facility. In addition, hospitals now must screen all visitors to the facility and can deny visitation to anyone. This applies across all facilities, even those licensed by the Department of Mental Health. Governor Baker also announced an important strategy for which MHA had been advocating. Effective immediately, all telehealth services in the state – not just those related to COVID-19 – must be covered by private and public insurers.
MARCH 13, 2020 – Massachusetts has now begun to see some initial evidence of community spread of COVID-19 and DPH has made recommendations consistent with a transition into the community mitigation phase of the response. In addition, several commercial laboratories have begun offering testing for COVID-19 although their capacity is still being ramped up. As a result of these changes, DPH has made some changes in testing prioritization.
MARCH 13, 2020 – Governor Baker, exercising his authority under the state of emergency he declared earlier this week, suspended part of the Massachusetts open meeting law. Essentially the decree allows meetings to take place in locations other than “a public place” accessible to the public. Meetings can now take place remotely. The governor also issued an order prohibiting gatherings of 250 or more people in confined indoor or outdoor spaces. Some spaces, such as medical facilities, are exempt as are restaurants although the order said restaurants should encourage social distancing.
MARCH 12, 2020 – The Massachusetts Department of Mental Health (DMH) informed all DMH-licensed facilities and units today that it supports the use of “a rigorous screening process for all admissions, visitors, contractors, attorneys, clergy, community treaters, and agency representatives, prior to allowing access to treatment environments.” DMH went on to state: “At this time, the situation does not warrant a blanket prohibition of visitors to DMH licensed units without a positive screening concern. Patients receiving services in DMH licensed settings have protected rights to receive visitors of their choosing while they are receiving treatment in a locked environment. Absolute prohibitions of visitors is likely to trigger reactions in patients experiencing an exacerbation of a mental illness which could provoke additional problems for direct care staff on units to manage.” DMH continued: “We understand that the populations of some units for older adults may have a cohort of persons with especially high risk factors related to susceptibility to the COVID-19 virus. In these instances, there may be a clinical reason for a more rigorous restriction of visitors. Even in these situations, patients must be allowed access to ‘an attorney, legal advocate, physician, psychologist, clergy member or social worker’ consistent with GL ch 123 s 24. These individuals should be screened as negative for all questions prior to entering units."
MARCH 11, 2020 – DPH issued this Circular Letter to nursing home and rest home administrators outlining policies and procedures for restricting resident visitors in nursing homes and rest homes, as well as detailing personal protective equipment recommendation updates. Nursing homes and rest homes should implement the provisions effective March 12.
MARCH 11, 2020 – DPH issued this memorandum in which it “strongly recommends” that individuals returning from countries identified having as widespread COVID-19 transmission, or those having upper respiratory tract symptoms including fever and/or cough avoid visiting patients in hospitals. “While federal and state statutes enumerate patients’ rights in hospitals, patients’ rights are not without limitations,” according to the memorandum. “…DPH reminds hospitals that through the hospital’s existing written policies and procedures on visitation rights, the hospital may restrict or limit visitations to patients for any clinically necessary reason, including for infection control concerns.”
MARCH 10, 2020 – Massachusetts Governor Charlie Baker declared a state of emergency on Tuesday afternoon in response to the spread of COVID-19. There are now 92 total cases in the state – 51 are considered presumptive positive, up from 41 presumptive positive on Monday. Seventy of the 92 cases have been traced to the Biogen conference, 4 are related to travel, and 18 are still under investigation as to their origin, state officials reported at a press conference Tuesday. When asked if the risk level in Massachusetts was still “low”, the governor responded, “I would have to say the risk has increased.” Baker issued an order for all executive branch employees restricting their travel and meetings, and urging them to stay away from work if they feel ill. He urged all private employers in the state “to follow suit” if feasible. The governor said at the top of the list “of the things we want the feds to do right away” is to have the FDA sign off on allowing laboratories at Massachusetts academic medical centers to perform COVID-19 tests. Currently the only lab that can perform the testing is DPH’s facility. That lab, according to DPH Commissioner Monica Bharel, M.D., recently received CDC approval to automate a portion of the testing, which will now allow DPH to process up to 200 tests per day as opposed to the current 50-test daily limit. The state is expected to shortly receive a delivery of personal protective equipment (PPE: gloves, masks, gowns, eye protection) from the national stockpile, Bharel reported.
MARCH 9, 2020 – The Joint Commission announced today that it will continue to conduct surveys until it is no longer safe for its employees to do so. However, TJC has cancelled surveys in Seattle, Washington because of evidence of sustained community spread of COVID-19. “Our surveys will have an intensified focus on infection control processes and emergency management planning,” TJC said in this statement.
MARCH 6, 2020 – South Shore Hospital is restricting visitors to one primary caregiver designated by the patient (e.g. a spouse, parent, or legal guardian). Designated primary caregivers must be over the age of 18; be free from symptoms such as fever, cough, sore throat, sneezing, vomiting, and diarrhea for at least 48 hours before visiting; wear a mask or other protective equipment if asked to do so; wash hands frequently; and go directly home after leaving the patient and not to the dining room or other public areas. It is strongly recommended that whenever possible, primary caregivers contact the patient by telephone or via video technology such as FaceTime or Skype, rather that visiting in person.
MARCH 3, 2020 – The World Health Organization (WHO) raised concerns that the global supply of personal protective equipment is leaving caregivers ill-equipped. WHO called on the PPE industry to increase manufacturing by 40%.
MARCH 2, 2020 – The Massachusetts Department of Public Health today announced its first presumptive positive case of COVID-19 since testing started Friday, February 28, at the State Public Health Laboratory. The woman is in her 20s and lives in Norfolk County. She recently traveled to Italy with a school group and was symptomatic. She is recovering at home.