COVID-19 updates and resources
AFMC’s Response to COVID-19: A letter from our CEO
AFMC is closely monitoring and assessing the situation of the coronavirus (COVID-19) and its implications for health care providers. Our top priority is to protect the well-being of our employees and their families, providers, clients, and the community at large, as we continue to focus on keeping you informed and answering your questions.
We have a plan in place to continue servicing your needs during this crisis and address any challenges that arise as a result of COVID-19.
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While AFMC has suspended travel and face-to-face visits, we are maximizing telework. Our staff is available to assist you by phone, email and virtual meetings. Any large group meetings, trainings and other gatherings that were scheduled in the near term will be conducted as virtual events, postponed or canceled. We will keep you informed as we make these adjustments.
Most AFMC employees have remote work capabilities with access to our documents and systems in a secure environment. We have implemented steps to help prevent the spread of COVID-19 within our offices, including limitations on travel, outside visitors, meeting attendance and social distancing policies.
We are constantly monitoring events, policies and issues that affect our providers, AFMC operations and the country’s health care delivery system. We will post regular updates of national, state and local action as events unfold. Please contact us with any questions.
Thank you for the opportunity to be of service and for your ongoing trust. We wish everyone good health during this challenging time.
Sincerely, Ray Hanley
AFMC President and Chief Executive Officer
Telehealth guidance
Crosswalk
Updated September 22, 2020
Telemedicine Decision Tree
Created August 31, 2020
Telehealth and in-office scripts to encourage patient visits
Added June 2, 2020
Use these messages to inform your patients you are open for business and are seeing patients using telemedicine visits or in-person visits in your clinic. These customizable scripts were developed in collaboration with Angie Walker from Dr. Randy Walker’s office and Jo Lynne Varner from Little Rock Pediatric Clinic. Scripts are available in English and Spanish. For easy reference, Spanish scripts are in the same order as English scripts.
Telehealth patient checklists
Added May 28, 2020
Webinars
Reduce the Impact of COVID-19 On Your Practice With Telehealth – March 27, 2020
Keeping Your Practice Financially Healthy – April 17, 2020
Implementing Telehealth – Providing Patient Care During COVID-19 – April 24, 2020
Implementing Telehealth – How to boost patient visits during COVID-19: Telehealth and in-office – May 8, 2020
HIPAA Considerations for Telehealth During and After COVID-19 – July 9, 2020
CMS and Medicare
Effective July 25, 2020 the U.S. Department of Health and Human Services Secretary of Health and Human Services, Alex M. Azar, II, issued a Renewal of Determination That A Public Health Emergency Exists for an additional 90 days.
Updated April 30, 2020
Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health. Innovative uses of this kind of technology in the provision of health care is increasing. And with the emergence of the virus causing the disease COVID-19, there is an urgency to expand the use of technology to help people who need routine care, and keep vulnerable beneficiaries and beneficiaries with mild symptoms in their homes while maintaining access to the care they need. Limiting community spread of the virus, as well as limiting the exposure to other patients and staff members will slow viral spread.
CMS Telehealth and Telemedicine Toolkit
List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth – Updated April 30, 2020
The Trump Administration announced March 18 expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of health care services from their doctors without having to travel to a health care facility. Medicare ‒ administered by the Centers for Medicare & Medicaid Services (CMS) ‒ will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
Fact Sheet from CMS on this announcement – March 17, 2020
U.S. Department of Health and Human Services Office of Civil Rights Issues Guidance on Telehealth Remote Communications Following its Notification of Enforcement Discretion and provides an FAQ on Telehealth and HIPAA during the COVID-19 nationwide public health emergency – March 20, 2020
Medicare Telehealth Frequently Asked Questions – March 17, 2020
Medicare Fee-for-Service Additional Emergency and Disaster-Related Policies and Procedures That May Be Implemented Only with a 1135 Waiver – March 15, 2020
Frequently Asked Questions to Assist Medicare Providers – Updated July 28, 2020
CMS’ Medicaid Telehealth Guidance to states – March 12, 2020
Additional information for general Medicaid Telehealth Guidance can be found here
Health and Human Services (HHS)
Updated 9/17/2020
HHS Telemedicine Hack
Clinical Best Practices and Tele-Physical Exam
State of Arkansas
On August 14, 2020 Gov. Hutchinson issued an executive order to renew the disaster and public health emergency to mitigate the spread and impact of COVID-19. EO 20-45 incorporated previously issued executive orders that will expire in sixty (60) days, unless renewed in whole or in part by a subsequent executive order.
DMS and Medicaid
Updated August 7, 2020
In response to Gov. Hutchinson’s public health emergency declaration, Arkansas’ Division of Medical Services (DMS) issued response to COVID-19 for providers and public health emergency rule suspensions. With a notation that “guidance ends at the expiration of the public health emergency as declared by the Governor of Arkansas.”
DMS suspended the rule related to originating site requirements for certain behavioral health providers to provide certain counseling services. By suspending this rule, these licensed behavioral health professionals will be able to continue to provide critical services to established patients while they remain in their homes. Any technology deemed appropriate may be used, including telephones, but technology must utilize direct communication that takes place in real-time. Read more about the relaxed requirements. – Updated April 15, 2020
In response to the COVID-19 outbreak in Arkansas and consistent with CMS’s coverage and payment for COVID-19 diagnostic testing, DMS is suspending the prohibition on use of telemedicine technology for limited occupational, physical or speech therapy services provided to established patients during the COVID-19 outbreak and the declaration of public health emergency. Read more about the relaxed requirements. – Updated April 24, 2020
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HIPAA compliance
Updated August 7, 2020
HHS Office for Civil Rights has issued guidance to relax some HIPAA penalties for health care providers during the COVID-19 Nationwide Public Health Emergency. Below are the recent highlights and links to more information.
Releasing PHI on COVID-19 patients – March 24, 2020 Guidance issued on how providers may disclose PHI about an individual who has been infected or exposed to COVID-19 including fire fighters, paramedics, law enforcement and public health authorities.
https://www.hhs.gov/sites/default/files/covid-19-hipaa-and-first-responders-508.pdf
Telehealth – March 17, 2020 The Notification of Enforcement Discretion for Telehealth Remote Communications during the COVID-19 Nationwide Public Health Emergency waves certain provisions of the Security Rule. If you are seeking a temporary alternative for telemedicine, HHS has relaxed certain provisions of HIPAA compliance to allow nonpublic facing communications with patients. The list below includes some vendors that represent they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA. The following technology is listed on the HHS website:
- Skype for Business / Microsoft Teams
- Updox
- VSee
- Zoom for Healthcare
- Doxy.me
- Google G Suite Hangouts Meet
- Cisco Webex Meetings / Webex Teams
- Amazon Chime
- GoToMeeting
- Spruce Health Care Messenger
Any public-facing applications, including Facebook Live, Twitch, TikTok, and similar video communication applications should not be used by health care providers. The waiver can be found here: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
Cyber Scams – March 6, 2020 Guidance from CISA and Homeland Security on cyber activity. Recommend providing refresher training to staff on recent attempts by scammers regarding content on COVID-19.
https://www.us-cert.gov/ncas/current-activity/2020/03/06/defending-against-covid-19-cyber-scams
https://www.us-cert.gov/ncas/alerts/aa20-099a
Business Associates April 2, 2020 – This guidance now permits business associates to disclose PHI for public health activities to CDC or CMS without risk of a HIPAA penalty. Typically, this activity must be outlined in the business associate agreement before the BA can share PHI. When disclosing the PHI for this purpose, the BA must still follow security regulations.
https://www.hhs.gov/about/news/2020/04/02/ocr-announces-notification-of-enforcement-discretion.html
Community Based Testing Sites (CBTS) April 9, 2020 – created to encourage rapid growth of mobile testing sites. This includes mobile, drive-through, or walk-up sites that only provide COVID-19 specimen collection or testing services to the public.
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- Using and disclosing only the minimum PHI necessary except when disclosing PHI for treatment.
- Setting up canopies or similar opaque barriers at a CBTS to provide some privacy to individuals during the collection of samples.
- Controlling foot and car traffic to create adequate distancing at the point of service to minimize the ability of persons to see or overhear screening interactions at a CBTS. (A six-foot distance would serve this purpose as well as supporting recommended social distancing measures to minimize the risk of spreading COVID-19.)
- Establishing a “buffer zone” to prevent members of the media or public from observing or filming individuals who approach a CBTS, and posting signs prohibiting filming.
- Using secure technology at a CBTS to record and transmit electronic PHI.
- Posting a Notice of Privacy Practices (NPP), or information about how to find the NPP online, if applicable, in a place that is readily viewable by individuals who approach a CBTS.
Additional HIPAA Resources
Additional information about HIPAA Security Rule safeguards
Technical assistance on telehealth from HealthIT.gov
NIH: COVID-19 Treatment Guidelines
These Treatment Guidelines have been developed to inform clinicians how to care for patients with COVID-19. Updated July 17, 2020
HHS Announces Additional Allocations of CARES Act Provider Relief Fund
Updated June 16, 2020
$50 billion of the Provider Relief Fund is allocated for general distribution to Medicare facilities and providers impacted by COVID-19.
Relief Funding Options:
- COVID-19 Relief Funding Options
- Our nation’s small businesses are facing an unprecedented economic disruption due to the Coronavirus (COVID-19) outbreak. On Friday, March 27, 2020, the President signed into law the CARES Act, which contains $376 billion in relief for American workers and small businesses.In addition to traditional SBA funding programs, the CARES Act established several new temporary programs to address the COVID-19 outbreak.
- Payroll Protection Program Closed August 8, 2020
- Paycheck Protection Program Flexibility Act of 2020
This bill modifies provisions related to the forgiveness of loans made to small businesses under the Paycheck Protection Program implemented in response to COVID-19 (i.e., coronavirus disease 2019).
Specifically, the bill establishes a minimum maturity of five years for a paycheck protection loan with a remaining balance after forgiveness. The bill also extends the covered period during which a loan recipient may use such funds for certain expenses while remaining eligible for forgiveness. The bill raises the non-payroll portion of a forgivable covered loan amount from the current 25% up to 40%.
The bill extends the period in which an employer may rehire or eliminate a reduction in employment, salary, or wages that would otherwise reduce the forgivable amount of a paycheck protection loan. However, the forgivable amount must be determined without regard to a reduction in the number of employees if the recipient is (1) unable to rehire former employees and is unable to to hire similarly qualified employees, or (2) unable to return to the same level of business activity due to compliance with federal requirements or guidance related to COVID-19.
Additionally, the bill revises the deferral period for paycheck protection loans, allowing recipients to defer payments until they receive compensation for forgiven amounts. Recipients who do not apply for forgiveness shall have 10 months from the program’s expiration to begin making payments.
The bill also eliminates a provision that makes a paycheck protection loan recipient who has such indebtedness forgiven ineligible to defer payroll tax payments.
Lastly, the bill is designated as an emergency requirement pursuant to the Statutory Pay-As-You-Go Act of 2010 (PAYGO) and the Senate PAYGO rule.
Laboratory testing for COVID-19
Updated August 7, 2020
In response to the COVID-19 outbreak in Arkansas and consistent with CMS’s coverage and payment for COVID-19 diagnostic testing, DMS has published a list of laboratory services now covered. – Updated May 19, 2020
Additional resources
Updated August 7, 2020
Coronavirus (COVID-19) Partner Toolkit
- Stop the Spread of Germs – Infographic
- Symptoms of Coronavirus (COVID-19)
- COVID-19 Social Media Toolkit – English and Spanish
For information specific to CMS, please visit the Current Emergencies Website where you can find these NEW resources
- NEW – CMS- COVID Patient Counseling Talking Points for Providers (July 30, 2020)
- NEW – CMS – COVID Patient Counseling Check List (July 30, 2020)
- NEW – CMS-COVID Patient Counseling Provider Q&A (July 30, 2020)