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.


PAST COVID E-BLAST HAVE BEEN ARCHIVED DUE TO SPACE RESTRAINTS AND TO KEEP THINGS CURRENT. 
TO VIEW PREVIOUS E-BLASTS, CLICK HERE

REMINDER: IF A  LICENSED ASC , YOU MUST REGISTER WITH DOH FOR THE PORTAL BY THE END OF BUSINESS, TODAY! - 6/18/20
I am getting a lot of calls/e-mails about this that you are not getting a response.
If you have already registered,  don’t worry ,  you will get a response after today, as registration is open until end of today, so after today they will send you password and instructions!
The Department of Health Executive Directive 20-016 states that all ambulatory surgical facilities (ASC) must comply with Governor Murphy’s Executive Order No. 111 (2020) concerning reporting of data, including PPE inventory and weekly cases. The portal designated by the New Jersey Office of Emergency Management under Executive Order No. 111 (2020) is maintained by the New Jersey Hospital Association. In order to receive access to the portal please send an email to  ASC.ResponsePlan@doh.nj.gov   with  the name and license number of your facility in the subject line , the NAME and CONTACT information including Email for a maximum of two people that will be entering information into the portal.
DOH will send a link to the portal with registration and log-in instructions in a separate communication. Please send your email no later than  Thursday June 18, 2020  by close of business. 

ASSESSMENT NEWS – 6/18/20
Today the Assembly passed unanimously A4201 which would delay the June 15 th  ACT tax payment for 90 days. Obviously the June 15 th  deadline has come and gone and so other than sending a message about the dire financial situation facing some ASCs the effect of the bill is moot. I had also hammered home this theme when I testified before the Senate panel last month.
 
This is distressing to me, as three months ago I identified this as an issue of paramount importance for the ASC industry. However the wheels of government move slowly, and with the pandemic and everything else- like budget, it was unfortunately a last minute issue- despite the valiant efforts of our lobbyist Joe Simonetta, Senator Sarlo and Assemblyman Greenwald.

We continue to press the administration to find ways to assist the ASC industry in areas that would facilitate a quick rebound. We are monitoring the new proposed budgets including the 90 day interim budget and the 9 month FY 2021 budget to oppose any additional taxes and fees that might be proposed on the industry. NJAAASC has been in daily contact with the Administration and the legislature throughout this difficult time to represent the industry. We will update you as these developments occur.
 
Jeff

EXECUTIVE DIRECTIVE 20-016- 6/18/10
As stated yesterday, this is clarification of the previous ASC Guidelines.
This ED reflects further thought on the previous guidelines, from both the Department and from NJAASC who had suggested changes and clarification.
NJAASC wants to thank the Department for their cooperation in this collaborative effort.
 
It amazes me that I still have to say this, but -this is part of EO 145.
This and the previous guidelines  are not discretionary , they are  mandatory  and to be followed as part of EO 145.

Unfortunately, there are centers and doctors out there willingly and knowingly not following these guidelines, or the Executive Order. That impacts all centers, especially the majority who does things the right way.
I have repeatedly urged the Department to issue a statement regarding enforcement and to implement such, as that is sadly the only way this will end.

Some points of interest:
Of course the 6 days for testing/results- up from 96 hours.
Day 6, after collection of specimen. 
While EVERYONE still must be tested, there is now provision for ‘time sensitive’ cases in which the procedure not being performed prior to the test results received would endanger patient health if delayed.
Strict documentation applies, as does PPE and air exchange protocols for these cases.
This is not meant to be an alternative just because you did not get test results within the 6 day time frame, but as an EXCEPTION for urgent, time sensitive cases. 
 
The Department is strongly suggesting-indeed urging, that centers contract with a lab for testing.
 
As a licensed ASC in New Jersey, you MUST have a hospital transfer agreement. This of course should not be anything new, as it has always been part of the regulations- NJAC 8:43A-15.3 ( c).
 
A lot of informative links- for instance the Hippocrates hyperlink takes you to hospitals currently under divert, so easy now to find them, as part of your hospital transfer.
 
The strongly worded clause about testing and what tests can be used. The link provided is the one NJAASC has suggested everyone refer to if there is a question. If in the technology column it says Molecular, you can use it.
Again-  no blood plasma or finger sticks!
 
There is no change in the Department’s interpretation of hospital transfer despite the language in the ED. As previously stated by DOH, sending a letter to your hospital transfer partner notifying them that you are resuming elective surgery is still sufficient- and I would assume everyone has already done this in any case.
 
The PPE/case reporting is not daily- that is for hospitals and was clarified previously by DOH- ASC reporting will be weekly. 
As part of the PPE/case reporting, there will questions of issues with testing- akin to what NJAASC had been asking from you, so now DOH will be collecting it.


TIME SENSITIVE CASES – 6/18/20
Per the ED 20-016, please refer to page 8, section e.
This provides guidance for performing ‘time sensitive’ cases in ASCs.
In the event of such a case where the health of the patient will be endangered if delayed, you  MUST STILL TEST .
There are provisions however for you to perform the case without a  current test result .
The physician must document that the patient’s health would be endangered if the procedure were delayed to wait for test results,
AND
You must follow the listed infection control protocols regarding PPE and air exchange, otherwise they cannot be performed.
This then allows some leeway, but hopefully will not be abused!

PROVIDER RELIEF PAYMENTS AND OUT OF POCKET EXPENSES FROM BRACH EICHLER- 6/18/20 
The Terms and Conditions for the Provider Relief payments require that for care for a presumptive or actual case of COVID-19, the provider must certify that they “will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient.” Questions arose regarding the definition of a “presumptive” case of COVID-19, i.e., whether the ban on balance billing applies to all patients and/or all care. The source of the confusion was one of the other Terms and Conditions pursuant to which providers were eligible for grant payments only if they provide or provided after January 31, 2020, diagnoses, testing or care for individuals with “possible” or actual cases of COVID-19. HHS previous guidance had stated that HHS broadly views every patient as a “possible” case of COVID-19. The key question, therefore, was whether “possible” cases and “presumptive” cases are the same. HHS clarified in a guidance last month that the prohibition against balance billing reaches only to care for presumptive and actual COVID-19 cases, not to all patients or all care. The prohibition applies only to “case[s] where a patient’s medical record documentation supports a diagnosis of COVID-19, even if the patient does not have a positive in vitro diagnostic test result in his or her medical record.”
 
HHS also provided guidance on how providers will identify COVID-19 patients’ in-network rates to assure that they only bill a presumptive or actual COVID-19 patient for cost-sharing at the in-network rate. HHS explained that providers accepting the Provider Relief Fund payment should submit a claim to the patient’s health insurer for their services. Most health insurers have publicly stated that they will reimburse out-of-network providers that treat patients for COVID-19-related care at the insurer’s prevailing in-network rate.  If the health insurer is not willing to pay the in-network rate, then the out-of-network provider may seek to collect from the patient out-of-pocket expenses, including deductibles, copayments, or balance billing, in an amount that is no greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.

John D. Fanburg, Esq.

101 Eisenhower Parkway | Roseland, New Jersey 07068
Direct: 973-403-3107 | Firm: 973-228-5700 | Fax: 973-618-5507
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Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com