COVID 19: New and Updated Information and Resources
NJAASC has curated authoritative information and a list of resources for our Membership’s reference. We will continue to update this as more information becomes available.


HHS Announces $30B in Grants to Medicare Providers, Including ASCs - 4/13/20
This morning, the US Department of Health & Human Services (HHS)  announced  how it will allocate $30 billion in grants to Medicare providers, including ambulatory surgery centers. These grants are part of the $100 billion in relief funds included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 that was signed by President Donald Trump on March 27, 2020.

The $30 billion is being distributed immediately—with payments arriving via direct deposit beginning today, April 10, 2020—to eligible providers. An email with the subject line “CARES Act Provider Relief Fund: Action Required” was sent this morning on behalf of HHS to eligible providers. According to the HHS website, “This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.”

These are grants, not loans, and will not need to be repaid.

Who is eligible?
All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution. All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN).

How are disbursements calculated?
Providers will receive a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.

A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments by $484,000,000,000 and multiply that ratio by $30,000,000,000. This comes to approximately 6.2 percent of your FFS payments in 2019.

HHS gave the example of a community hospital that billed FFS Medicare $121 million in 2019.

$121,000,000 / $484,000,000,000 x $30,000,000,000 = $7,500,000

What do providers need to do to receive payments?
Providers will be paid via Automated Clearing House account information on file with the Centers for Medicare & Medicaid Services (CMS) or United Health Group (UHG), who CMS is partnering with to distribute the funds. The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description. Providers who normally receive a paper check for reimbursement from CMS will receive a paper check in the mail for this payment as well, within the next few weeks.

Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the  Terms and Conditions  of payment. The portal for signing the attestation will be open the week of April 13, 2020. If a provider receives payment and does not wish to comply with the Terms and Conditions, the provider must contact HHS within 30 days of receipt of payment and remit the full payment to HHS.

Please note this program is separate from the accelerated and advance payments. The CMS accelerated and advance payments are a loan that providers must pay back. For more information, visit the  CMS website .

The remaining $70 billion will be allocated shortly, and targeted distributions will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans.

LIFE SAFETY CODES CONTINUE DURING THE EXECUTIVE ORDER – 4/13/20
 
A:  Yes, CMS has not waived LSC, nor has DOH. We did waive the need for someone from  the outside  to come in and do an inspection.
 
Stefanie Mozgai, BA, RN, CPM
Assistant Commissioner
Department of Health
Health Facility Survey & Field Operations

Q : So what about in-house so to speak LSC.
I know the DOH letter from the other month talks about this but only as a third party inspection -waived.
My assumption would be that centers would have to keep up with this even during this time?

Q&A: ASCs ENROLLING AS HOSPITALS - 4/13/20
A :  The guidance is on the  cms.gov  website. They do not need to be affiliated with a hospital. They have to keep in mind that if they do this, they are suspending their asc license and cannot bill as an asc while operating under a hospital license.
 
Q:   Can an ASC also register independently without a hospital partner?
 

HOSPITAL CONVERSION QUESTIONS - 4/13/20
We are working with a neighboring hospital to convert one of our ASCs into a temporary hospital. Do you have any further information on the partnership other than the link below? The questions we have are:
  1. Can the ASC still operate as an ASC a day or two a week when it is not billing as a hospital? Meaning can it be both on different days?
  2. If the hospital is billing for the cases, how does the ASC get reimbursed for it costs, e.g. Overhead Costs, FTE’s….?

A: If you are going to convert to a hospital, well that is what you are for the duration! You cannot switch back and forth.
You would have to essentially get a waiver from all insurance carriers to bill as a hospital. ASCs that I have spoken to that are going this route, are making separate deals with the hospital they are working with regarding payment.

PUBLIC HEALTH EMERGENCY EXTENDED 4/8/20
Yesterday the Governor extended the public health emergency he originally declared on March 9, as it was for 30 days and set to expire today.
So the extension is through May 8 th .
Some people have said to me: ‘I heard we can do any cases as of May 1 st ’.
I have no idea where that came from, maybe a misunderstanding of the extension of the health emergency above, but the answer is a big NO!!!!!!!
The limitations on cases were from Executive Order 109. There is no time frame in that EO. Indeed EOs usually have to be either rescinded by the Governor, or they would expire upon completion of his term in office.
So as of today, there is no rescinding of EO 109.
Again, come to NJAASC for your information and questions- not from hearsay.  

TRANSFERRING CONTROLLED AND NON-CONTROLLED SUBSTANCES TO HOSPITALS-4/8/20
Many of you have already reached out to me this past week regarding the transfer of controlled and non-controlled substances to hospitals who are in desperate need. 

If you find yourself transferring non-controlled substances, use your standard invoice to transfer. More information can be found in our policy here .

If you find yourself transferring controlled substances, there are a few more requirements. CII's will require a DEA 222 form completed by the hospital and sent to you before the drugs can be transferred. Once you receive the DEA 222 form from the hospital, the transaction should include the date and quantity signed out of the ASC inventory by two staff members. Additionally, your drug transfer log should include the drug name, drug strength, quantity, lot numbers, and expiration dates. Those drugs will then be transferred via FedEx or two people in one car. The hospital (2 people) will sign in the quantity and provide the date received. The monetary amount can be decided by your organization, but it is usually what was paid for the drugs originally. More information can be found in our policy here .

Both parties should keep a copy of the transaction for at least 3 years.

Please reach out with any questions at  john@jdjconsulting.net .


WE STILL NEED YOUR HELP- SEND IN YOUR ACF LETTER IF YOU HAVE NOT DONE SO ALREADY! – 4/7/20
Thank you for the tremendous response to our request for letters regarding the ACF.
Some two dozen have been included as  attachments to the Commissioner .
Now begins the negotiations!

SBA LOAN- SEND A LETTER TO YOUR REPRESENTATIVE TODAY – 4/7/20
The SBA loan has issues for some ASCS- particularly those with a hospital partner and/or management company. These are considered majority owners and thus the loan application would be aggregated.  Here is a good template to send a letter to your Representative concerning this issue.

QUESTION ABOUT PPE AND EQUIPMENT – 4/7/20
Q: If a center voluntarily donates PPE, ventilators etc to a hospital should it let OEM know? If so, how?

A: The facility can notify the county OEM as a courtesy, but it is not required.
 
Stefanie Mozgai, BA, RN, CPM
Assistant Commissioner
Department of Health

ASCS TEMPORARILY ENROLLING AS HOSPITALS - - 4/6/20
Here is additional guidance from CMS.


ADDITIONAL GUIDANCE FOR SBA LOANS- HOSPITAL AFFILIATES - 4/6/20
Please make sure you understand the parameters for the SBA loan filing. Additional clarification- tests- were made available on Saturday, to see if you qualify, if you have a hospital partner/management company.


JOIN THE WEBINAR TODAY- RECENT NJ & CMS TELEHEALTH REGULATIONS - 4/6/20

ACF TAX RELIEF REQUEST LETTER SENT TO DEPARTMENT OF HEALTH – 4/3/20
Thank you for the tremendous response to our request for letters regarding the ACF.
Some two dozen have been included as attachments to the Commissioner .
Now begins the negotiations!
 
EXECUTIVE ORDER 113
Here is the full text of Executive Order 113 allowing for the potential commandeering of PPE and other vital equipment.


STATE POLICE HAS POWER TO COMMANDEER PPE AND EQUIPMENT 4/2/20
Today Governor Murphy announced a new EO- it is not finalized yet, that gives the state police the power to commandeer medical equipment and supplies from businesses that have stocks and have not yet donated to any hospitals. The Governor further stated that he hopes the state police will not have to use this order, but he wanted it in place.


AAAHC CHANGES AND INFORMATIONAL WEBSITE - 4/2/20

Dear AAAHC Organization,

Due to the evolving COVID-19 outbreak, until further notice, AAAHC is waiving the Change Notification requirement for clients with service scope changes directly associated with COVID-19. These include temporary closures and suspension/expansion of services.

For more information, please visit  www.aaahc.org/covid-19

Sincerely,
The Accreditation Association for Ambulatory Health Care


MORE PHARMA INFORMATION - 4/2/20
Things to remember if you are closed.



EXECUTIVE ORDER 112 – 4/2/20
This EO is important as it defines and relaxes rules for healthcare professionals looking to volunteer and assist.
They would have immunity from liability.



PLEASE CONTINUE TO VOICE YOUR OPINION ON THE ACF – 4/2/20
A lot of centers responded yesterday, but we need more.
Below is a sample that you can use to state your cases.
 
Then e-mail to:  shoisington@msnj.org
 
I am the Administrator of ___________  .  _________  has been serving the community providing quality outpatient surgical care since 1985. We have been paying the ambulatory care facility gross receipts assessment at the maximum rate since its inception. 
Due to the catastrophic events restricting our ability to provide patient care, our finances are at a critical level. Our case volume has decreased from 200 patients a week to 10. Yet our fixed costs remain constant. We have been working with our hospital partner to redeploy clinical staff, but we still have payroll costs including health insurance and other benefits, and other operating expenses. Without financial relief, we are not going to be able to continue meeting these obligations.
We need to maintain our facility in a state of good repair to be able to quickly ramp up to handle the surgical volume after this crisis has ended. We will also most likely need to replace equipment and supplies that will be reallocated to other providers needed to treat COVID-19 patients. We are predicting the cost of these goods and services to be significantly higher.
In the spirit of Governor Murphy’s efforts to protect New Jersey’s health care delivery system and small businesses, we are seeking relief from the New Jersey Ambulatory Care Assessment. That money will be much needed for investment back into our surgery center so that we may resume normal operations as quickly as possible. 
We thank you for your efforts to allow us to voice our grave concerns.
Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com