Covid-19 Resources

Covid-19 Resources


The SCMA has compiled state and federal resources below to facilitate answers on COVID-19 for South Carolina physicians. Members receive weekly updates via email. If you are not receiving these updates, please email info@scmedical.org

COVID-19 In the Storm with Dr. Helmut Albrecht


COVID-19 is changing rapidly, and we are all trying to stay on top of the latest medical information from trusted sources. Join Dr. Helmut Albrecht, Infectious Disease Specialist and Heyward Gibbes Distinguished Professor of Internal Medicine Chair, Department of Internal Medicine University of South Carolina Chair, Department of Internal Medicine Palmetto Health USC Medical Group and Society of America for a free webinar covering what he knows about the coronavirus outbreak. Recorded on Friday, April 17, 2020.

The SCMA Works for Physicians


It is hard to believe that the first COVID-19 case in South Carolina occurred on March 7, 2020. The Governor closed schools on March 15, and on March 17 the Governor asked that over the next 72 hours hospitals stop non-urgent care to preserve protective gear and protect patients from infection.  As COVID-19 spread, the Governor closed non-essential businesses on March 31, 2020. A lot has changed in the course of a few weeks, and physicians have been at the forefront of these issues and changes.  Whether serving in the ER or weathering the slowdown in your practice, each physician has been impacted in some way. 

The SCMA is here for you and has worked to help South Carolina physicians with all sorts of issues.   Below we have captured some of the SCMA's work over the past two months so that you can see the SCMA's action at work.  And, the SCMA appreciates the physician support in each of these endeavors - the organization cannot do it without your support, your input, and your willingness to assist us by being the physician voice. Many of you have joined late night phone calls, responded to early emails, or simply answered questions on issues we are tackling.  To this we simply say thank you. Together we have done a lot:

  • Opening Telehealth Codes: The SCMA urged private insurers to open telehealth codes for billing patient services as in-patient visits, meeting with the Governor's Office and the Department of Insurance (DOI) on this issue.  On March 17, the Governor called for private insurers to open telehealth lines with parity pay in his press conference, and by March 19 BlueCross BlueShield had done so. Other insurers quickly followed suit.  
  • Working with the Governor: At the beginning of the COVID-19 crisis, the Governor's Office solicited input on how to handle patient surge. The SCMA Executive Committee joined with the South Carolina Hospital Association to encourage the Governor to allow physicians and healthcare facilities to make decisions on non-urgent surgeries, and to ask instead of mandating, so that it would be easier to both draw down patient census and bring it back up to normal.  The SCMA Executive Committee met and provided a list of items for the Governor to consider, such as waiving CON laws during the pandemic to create additional bed space.  The SCMA has been in regular contact with the Governor's office, and the Executive Committee has spoken with the Governor about many of the issues facing South Carolina physicians due to the virus. 
  • Working with Congressional Leaders: The SCMA set up meetings with physicians and the offices of Senator Scott, Senator Graham, and Congressman Wilson.  The SCMA has also worked with those offices and other congressional offices to answer questions on specific legislation and ask for support on federal bills that support physicians during COVID-19. 
  • Obtaining CMS Waivers: The SCMA worked to obtain Medicare and Medicaid waivers for telehealth and other requirements. The SCMA spoke to South Carolina federal delegation leaders and the South Carolina Department of Health and Human Services (DHHS) about needed waivers.  And, the SCMA joined with the South Carolina Hospital Association to ask for state-specific waivers. Examples of waivers requested include the need to waive limits on using telehealth for nursing home patients, as well as waiving the need for a fit test every six months for durable medical equipment.
  • Board of Medical Examiners Hearings: The SCMA participated in Board of Medicine (BME) hearings and provided input on BME decisions related to COVID-19 issues.  In particular, the SCMA voiced its opinion in a letter to the Governor, the BME and the Board of Nursing (BON) on behalf of patient safety and the need to keep a physician-led team, while acknowledging the need to help hospitals quickly move around health care teams in the event of a patient surge. 
  • Working with State Agencies: The SCMA worked with the Department of Health and Environmental Control (DHEC) on various issues, to include surveying members on additional ventilators that could be used in a patient surge.  The SCMA has been in close contact with the Department of Employment Workforce providing feedback on unemployment claims and how unemployment provides more than some jobs at physician practices. The SCMA worked with the Department of Labor, Licensing, and Regulation (LLR) on many issues outside of the BME, such as waiving OSHA fit testing requirements during COVID-19. 
  • Governor's Emergency Management Division Work: The SCMA was part of the Governor's Emergency Management Division planning team to provide a plan to the Governor for staffing stand up hospitals if needed for expected patient surge. The SCMA represented the need to keep these physician-led for patient safety, as well as asking that physicians receive pay for staffing hospital-run overflow.
  • Pandemic Healthcare Ethics Advisory Council: The SCMA co-chaired the Pandemic Healthcare Ethics Advisory Council and had several physician members participate. This Council dealt with scarce resource issues and provided guidance for hospitals and physicians in the event these decisions were necessary.
  • COVID-19 Webinar: The SCMA hosted a free CME webinar, COVID-19 In the Storm with Dr. Helmut Albrecht, an Infectious Disease Specialist and Heyward Gibbes Distinguished Professor of Internal Medicine Chair, Department of Internal Medicine University of South Carolina Chair, Department of Internal Medicine Palmetto Health USC Medical Group and Society of America on coronavirus. This webinar can be found on the SCMA website.
  • Gathering Information/Weekly Calls: The SCMA staff attended weekly AMA legislative calls, weekly Congressional leader calls, weekly Hospital Association calls, and other informational calls to gather information to pass to physicians in our SC MedNews COVID-19 letters.
  • PPE Shortages: The SCMA sent out various ways to order PPE, make mask covers, and helped get the news out when the Charleston County Medical Society put together a group order form to help small practices order PPE. 
  • Free Telehealth Programs: The SCMA help secure free telehealth programs for members to utilize during COVID-19.
  • Billing Issues: The SCMA worked with practices to resolve billing issues with BCBS, getting many practices quick approval of telethealth usage.
  • Funding: The SCMA worked on getting funding for physicians, asking federal congressional leaders to support various funding.  SCMA has also asked South Carolina leaders for additional funds to assist physicians and will continue to do so as federal funds come to the state and the state provides funding for various needs.

The SCMA is still working on issues, like asking for telehealth parity on audio visits only as many patients do not have video capability, and working with the Governor and the federal delegation to find help with PPE and reagents for testing in our State.  We are also asking the legislature to waive liability for physicians who treated COVID-19 patients and for situations where a physician could not see patients due to the COVID-19 restrictions. We know that we are not at the end of this.

TELEMEDICNE/TELEHEALTH
TELEHHEALTH and COVID-19 TESTING:

The SCMA will continue updating telehealth resources below There are new options everyday as Medicare, Medicaid, and private insurance carriers continue to open telehealth resources. 

AMA Resources:

Still struggling with telehealth?

Visit the AMA website geared to give you all of the information you need. The AMA has created a quick guide to Telemedicine in Practice along with FAQs on COVID-19 and Telemedicine. Click here to access. The AMA also has outlined coding scenarios designed to assist in coding practices. The AMA Physician Innovation Network launched a virtual panel on the use of Telemedicine to deliver care to those who need it most during COVID-19. They are taking questions related to the latest policy & payment updates, best practices and tips from experts and peers. Click here to join the AMA's virtual panel discussion.  Also, the AMA has started a COVID-19 (2019 novel coronavirus) resource center for physicians.


Did you know you can use Skype and FaceTime?

Most providers are now following the examples set by Medicare and Medicaid and allowing Skype and FaceTime rather than requiring special telehealth programs. Check with your providers for updates on their policies as most private insurance companies are now allowing this. 

Private Insurance Codes for Telehealth:

If you are still looking for help gaining access to telehealth codes, the Department of Insurance is providing a page with the appropriate information of what each private insurer will cover linked here.  The details are provided under each company heading, and you can click the company heading to reach even more information.  

Summary of CMS Waivers:

Medicare has a page devoted to COVID-19 waivers.  The page lists special fact sheets for each practice area, located here. Medicare has also provided a summary of all of the waivers in one document that can be found here. The CMS fact sheet on telehealth can be found here.  

Medicaid Summary of Telemedicine Codes:

The South Carolina Department of Health and Human Services (SC DHHS) has issued a Medicaid Bulletin with all of its telemedicine codes, which you can access here

HIPAA Waiver:

The Health and Human Services (HHS) Office for Civil Rights (OCR) announced it will “waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency.”  This is effective immediately, and applies to “widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.”  For more information, click here

OIG Waiver:

The Office of Inspector General (OIG) issued a Policy Statement to notify physicians and other practitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations related to telehealth. You can read the statement here.

Free Telemedicine Sources:
  • The free website Doxy.me has a free telehealth platform that can be used immediately with same day service. 
  • CompuGroup Medical, your local Software-Provider from Columbia (SC), teamed up with the SCMA to give you its telemedicine services free for 6 months. Call CGM’s Telemedicine hotline at 602-680-2255 or fill out the contact form from the following linked here.
  • The NC Medical Society launched a telemedicine platform branded as "Presence". Presence will be made available to all health care providers until the pandemic is over/90 days at no charge and is linked here
Medicare and Medicaid Waivers and Updates
  • Advance Payment Option: The Centers for Medicare and Medicaid Services (CMS) has provided for accelerated/advance payments to allow a provider to request up to 100% of the Medicare payment amount for a three-month period. Some facilities may be eligible to receive up to 6 months of advance payments.  For more information, click here for the Medicare Fact Sheet. 
  • One Document Summary of CMS Waivers: Medicare has provided a summary of all of the waivers in one document that can be found here. The CMS released additional waivers over the weekend, providing for an increased access to telehealth. The CMS fact sheet can be found here
  • Medicaid Summary of Telemedicine Codes: The South Carolina Department of Health and Human Services (SC DHHS) has issued a Medicaid Bulletin with all of its telemedicine codes, which you can access here
  • AMA Resources: Still struggling with telehealth? Visit the AMA website geared to give you all of the information you need. The AMA also has outlined coding scenarios designed to assist in coding practices.  


*The SCMA will continue to highlight new CMS waivers.  If you are looking for past information on specific waivers or you would like to see all of the current waivers, please visit the CMS emergency site located here

 

PRACTICE VIABILITY

The SCMA is advocating for funding to support physicians and their practices.  The SCMA has spoken with South Carolina congressional delegation members about these issues, and on March 25 signed a letter of support with the AMA  and other state medical societies.  The SCMA is also working with local officials about additional resources for physicians.

THE CARES ACT - FORGIVABLE LOANS, PAYMENT FOR LOST REVENUE, AND UNEMPLOYMENT BENEFITS

Below is a quick overview of provisions in The CARES Act you may be interested in pursuing for your business. 

SBA Loans

If you are a small business or solo proprietorship, you should know that the CARES Act creates a new Business Loan Program under the Small Business Act (SBA). Quick facts to see if this may assist your business short term:

  • Between February 15, 2020 to June 30, 2020 the SBA is providing 100% federally-backed loans up to a maximum amount to eligible businesses to help pay operational costs like payroll, rent, health benefits, insurance premiums, utilities, etc.
  • Sole proprietors, independent contractors, and eligible self-employed individuals are included in these loans.
  • Subject to certain conditions, loan amounts are forgivable (see more detailed discussion on loan forgiveness below).
  • Business are presumed to qualify for complete payment deferment relief (for principal, interest, and fees) for six months to one year.
  • The loan can be forgiven (and excluded from gross income) in an amount equal to the following costs incurred and payments made during the covered period: payroll; interest payments on mortgages; rent; and utility payments.
  • If an employer reduces the number of employees in the period, but fills these spots back by June 30, 2020, the employer can still qualify for the loan forgiveness. 
Premature Distributions

The CARES Act waives the 10% additional tax for premature distributions from retirement plans and IRAs if the distribution is related to COVID-19 with a maximum distribution of $100,000 from all plans.  Distributions may be repaid at any time over the next three years, beginning on the date the distribution was made.  This distribution provision applies to those diagnosed with SARS-CoV-2 or COVID-19 by a test approved by the Centers for Disease Control (CDC), their spouse or dependent who has been diagnosed by such a test, or a person who experiences adverse financial consequences as a result of being quarantined, furloughed, laid off, or suffered reduced working hours, or who is unable to work due to lack of child care. 

Payroll Credits

The CARES Act provides eligible employers – including tax-exempt organizations – a refundable credit against payroll tax (Social Security and Railroad Retirement) liability equal to 50% of the first $10,000 in wages per employee (including value of health plan benefits).  In order to qualify, you must have had business operations fully or partially suspended due to orders from a governmental entity limiting commerce, travel, or group meetings; or experience a year-over-year (comparing calendar quarters) reduction in gross receipts of at least 50%. 

Funding for lost Revenue

$100 billion is available through the Public Health and Social Services Emergency Fund to provide immediate financial relief by covering non-reimbursable expenses attributable to COVID-19. Health care entities, including physician practices, that provide health care, diagnoses, or testing are eligible. Non-reimbursable expenses may include lost revenue due to COVID-19. HHS is reviewing applications and making payments on a rolling basis.  HHS will be releasing guidance soon on the application process, which we will provide in a MedNews once posted.

Unemployment Benefits

The CARES Act has a provision to allow an additional $600/week for up to four months and additional 13 weeks of Unemployment benefits for states that choose to participate. States can also enter agreements with the federal government to receive funding for state-enacted “short-time compensation” programs to subsidize employees who have their hours reduced in lieu of a layoff. 

New Paid Leave Law In Effect April 1, 2020

The Families First Coronavirus Response Act (FFCRA) takes effect April 1, 2020 and provides new types of leave for employees. The FFCRA applies to employers with less than 500 employees. Employers may claim an exemption if they have less than 50 employees, but employers must document why providing such leave will jeopardize your business. The Department of Labor has yet to set forth the criteria for documenting this, but has promised guidance is forthcoming.  The Department of Labor issued  Guidance and FAQs on the new law. Also, there is a mandatory poster employers must hang in their office, found here.  Read below for the key provisions.

1. Exception for Health Care Providers and Emergency Responders -   An employer can choose to exempt employees who are health care providers or emergency responders from receiving such leave.  But this does not mean that every person in a health care facility receives the exemption. The definitions are specific, click here for a great legal article explaining who is  a qualifying health care employees.  Employers may want to review exemptions with human resources personnel or legal counsel. 

2. The Act provides that covered employers must provide to all employees:

  • Two weeks (up to 80 hours) of paid sick leave at the employee’s regular rate of pay if the employee is unable to work because the employee is quarantined (pursuant to Federal, State, or local government order or advice of a health care provider), and/or experiencing COVID-19 symptoms and seeking a medical diagnosis; or
  • Two weeks (up to 80 hours) of paid sick leave at two-thirds the employee’s regular rate of pay because the employee is unable to work because of a need to care for an individual subject to quarantine (pursuant to Federal, State, or local government order or advice of a health care provider), or care for a child (under 18 years of age) whose school or child care provider is closed or unavailable for reasons related to COVID-19, and/or the employee is experiencing a substantially similar condition.
  1. A covered employer must also provide to employees that have been employed for at least 30 days:
  • Up to an additional 10 weeks of paid expanded family and medical leave at two-thirds the employee’s regular rate of pay where an employee is unable to work due to a need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19.
  1. What if an Employer Closes -The FAQs state that if an employer closes or furloughs an employee, the employer no longer must provide paid sick leave or expanded family and medical leave. The same is true if you reduce an employee's hours.  

    5. What if the Business Offers Paid Leave - An employee must pick one leave or the other.  There are some hybrid choices an employee can make if the employer agrees, including intermittent use of leave. 

    6. The FFCRA has Maximum Dollars and Provides Tax Credits: Employers qualify for "dollar-for-dollar reimbursement" through tax credits for all qualifying wages paid under the FFCRA, and can extend to dollars paid for health insurance coverage. The Act sets forth a maximum per diem and aggregate payment caps. The IRS will provide guidance next week on recovering these amounts, but generally has said employers will be able to retain an amount of the payroll taxes equal to the amount of qualifying sick and child care leave that they paid, rather than deposit them with the IRS.   See the DOL Fact Sheet or the IRS page for more information.
PPE

The Charleston County Medical Society is coordinating a joint order of N95 masks and possibly other supplies for smaller practices. As many physicians have learned, those with large contracts can more easily get supplies.  The coordination of a large order from small practices will help provide the needed supply.  Keep in mind that South Carolina is expected to “peak” around the end of April/beginning of May, it is likely supplies will be limited through the end of May.  Below is a link to order N95 Masks for your practice or for donating to other practices.  CCMS has worked hard to vet the supplier that it has obtained through its contacts and believes that the items are from a reliable source. Information on the supplies is provided through the link.  Once the order arrives, orders will be distributed to sites in Charleston, Columbia and Greenville for pick up. A big thank you to CCMS for coordinating this!  Click here to purchase

Quick Resources

ADDITIONAL RESOURCES YOU CAN USE 

Where can you find information on next steps? The CDC has published Criteria to Guide Evaluation of a Person Under Investigation for COVID-19 and Clinical Guidance for Management of Patients with Confirmed COVID-19 among other great resources. The CDC also has a latest updates button on the COVID-19 outbreak here. Current information, including the location of known cases in the U.S., are provided.

Looking for local resources? The South Carolina Department of Health and Environmental Control (DHEC) has its own site with local resources and updates here. The SCHA has a resource page for hospitals with up-to-date information here.  And the AMA has a website with information here.

Tired of answering the same questions all day? The CDC has handouts and posters you can use in your office to inform the public on what to do, how best to stop the spread of germs, and the symptoms of COVID-19. The handouts are available for download in English, Spanish, and Chinese.

Click here to view the American Medical Association’s Physician’s Guide to COVID-19.

Advertisement