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.


CLARIFICATION OF HHS GRANTS – 4/14/20
As ASCA  announced last Friday , the US Department of Health & Human Services (HHS)  began distributing  $30 billion  in grants to healthcare providers, including ASCs. This grant fund is part of the $100 billion in relief included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 that was signed by President Trump on March 27, 2020.

Many members reached out with concerns about one of the Terms and Conditions to which providers must attest in order to keep the funds that indicated providers must be “currently” serving individuals with possible or actual cases of COVID-19. ASCA contacted HHS staff to confirm what we understood as the intent—that ASCs and other providers were eligible for the funds even if they were not directly serving COVID-19 patients.

HHS updated the  provider relief website  to confirm our interpretation:
“If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”

In addition, HHS has since updated the  Terms and Conditions  of the agreement so that the word “currently” is no longer in bullet #2.

New language: The Recipient certifies that it billed Medicare in 2019; provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked. 

These are payments, not loans, to healthcare providers, and will not need to be repaid. 

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 sometime this week. 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.

For additional information or to check on the status of your grant, please visit  hhs.gov/providerrelief  or call the CARES Provider Relief line at (866) 569-3522.


PHARMA UPDATE - 4/14/20
As we all continue to take things day by day, we can’t help but think about what the future holds for us when the ASC industry opens back up. Since we are experiencing downtime like never before, it can prove advantageous to begin strategizing for when elective procedure restrictions are lifted.

Centers should expect a higher than normal volume of procedures for a couple of reasons. One – simply catching up on the cases that have been cancelled during this down period. And two – With CMS’ “hospitals without walls” initiative, ASC’s and other temporary expansion sites are demonstrating their COVID-19 response efforts. Serving in this capacity will ultimately display their quality and gain public trust. The Coronavirus will force people to become more conscious about where they receive care, leading them to seek out ASC’s with lower exposure risks in contrast to hospitals. I think we will be seeing a big shift like this in the years to come.

If your typical monthly procedures are 500, it is not out of the question that you may do 700 or more in a month. You may even find yourself operating on the weekends to support your case load. In preparation, I’d recommend looking at drug inventories to meet higher than expected volumes. You may find a 20-30% increase in drug par levels.

The DEA announced last week that they are increasing aggregate production quotas to pharmaceutical manufacturers to meet the demand of controlled substances. The article can be found here .

According to JDJ Consulting’s benchmarking studies performed over the past five years, drug acquisition costs have either increased or decreased slightly, on average. Your drug inventory will need to be maintained in order to properly care for patients; preparation and analysis is key.

JDJ Consulting’s benchmarking study from February 2020 will be released within the next couple of weeks.

Thank you,
Sincerely,

John Karwoski
JDJ Consulting
(609) 313-7572

ICAR UPDATES – 4/14/20
Please see below for the following updates and resources:
  
Jessica Arias, Bridget Farrell, Carol Genese, Melody Lee - NJDOH ICAR Team

Melody Lee, MS
Infectious and Zoonotic Disease Program | Communicable Disease Service
Division of Epidemiology, Environmental, and Occupational Health | New Jersey Department of Health
Phone 609-913-5065 |Email  melody.lee@doh.nj.gov  | ICAR Email  CDS.ICAR@doh.nj.gov


SELECTED NEW JERSEY COVID RELATED LEGISLATION -4/14/20
The following bills were passed by both houses and sent to the Governor:

S2333/A3910 which provides immunity from civil and criminal liability for certain malpractice claims alleging injury or death incurred during the public health emergency and state of emergency declared by the Governor’s Executive Order 103 of 2020, issued on March 9, 2020. The bill would also authorize temporary reinstatement and recertification of certain professional certifications. The bill was amended on the floor to state in the findings and declarations section that the immunity and liability will only apply to medical professionals specifically involved in treating COVID19 emergencies and will not cover normal procedures in the "ordinary course of business" of a medical professional. The amendment also clarified that the immunity and liability would only apply to this specific State of Emergency and Public Health Emergency. In discussing the bill, the Senate President said that it is not the intent of this bill to grant immunity for procedures not related to the COVID19 emergency such as orthopedic, obgyn or cardiac procedures. The Senate President also stated that the bill had been negotiated with the Murphy Administration. This was the only bill on either agenda that had any significant discussion.
 
S2338/A3918 which extends the time to file a gross income tax or corporation business tax return or make payments from April 15, 2020 to July 15, 2020. Taxpayers will not be subject to penalties or interest if the taxpayer files a return, report, or makes a payment by the end of the extension. The bill also modifies the duration of State Fiscal Year 2020 to conclude on September 30, 2020 and sets October 1, 2020 as the start of State Fiscal Year 2021. The bill also requires that any additional spending required to support the operations of the State from July 1, 2020 through September 30, 2020 be made through the enactment of a general law that amends or provides for a supplemental appropriation to that annual appropriations act. The bill requires the State Treasurer to prepare a report on the financial condition of the State budget for State Fiscal Years 2020 and 2021, which must be submitted to the Legislature by May 22, 2020 and prominently display on the Office of Management and Budget’s website. The bill requires the Governor to formulate and transmit a revised budget message for State Fiscal Year 2021 by August 25, 20.  Late this afternoon, the Governor announced his intention to sign this bill.
 
S2349/A3922 which changes the date of the 2020 primary election from June 2, 2020 to July 7, 2020.
 
S2351/A3924 which provides certain employment protections for emergency medical responders who, because they are providing emergency medical services related to a state of emergency, fail to report to work. Under the bill, employers are prohibited from terminating, dismissing, or suspending an employee who fails to report to work because the employee is actively engaged in providing paid or volunteer emergency medical services related to a state of emergency. 
 
S2357/A3943  which provides that the Commissioner of Health is to require hospitals to report to the Department of Health demographic data, including the age, ethnicity, gender, and race of persons in this State who have tested positive for the coronavirus disease 2019 or who have died from the coronavirus disease 2019, as well as the number of persons who attempt to get treatment for the coronavirus disease 2019, the number of persons who are admitted for treatment for the coronavirus disease 2019, and the number of persons who attempt to get tested for the coronavirus disease 2019 and were turned away, until the end of the State’s declared public health emergency related to the coronavirus disease 2019. The Department is to publish the data on its website.
 
S2363/A3921 which would provide that, while a public health emergency or a state of emergency is declared by the Governor and is in effect, in response to the COVID-19 emergency, the Governor may issue a rent suspension executive order to provide that a distressed small business tenant, as defined by the bill, may assert an emergency rent suspension, meaning a period of time during which rent payment obligations would not be paid. An emergency rent suspension would commence upon notification from the distressed small business tenant to the landlord, or the landlord’s agent, that the tenant is asserting an emergency rent suspension. The rent suspension executive order would indicate the length of time, not to exceed three months, that an emergency rent suspension may remain in effect.
 
S2374/A3913 which expands the "Family Leave Act" to include leave from employment so that an employee may provide care to a family member made necessary by an epidemic of a communicable disease, a known or suspected exposure to a communicable disease, or efforts to prevent spread of a communicable disease. The amendments to the FLA will allow employees forced to care for family members during the COVID-19 outbreak to take up to 12 weeks of family leave in a 24-month period without losing their jobs.  
 
The Senate amended the following bills which the Assembly passed on March 25th. The Assembly concurred and sent the bills to the Governor. 
 
A3901 which allows the director of the Division of Consumer Affairs, with the approval of the Attorney General, to reactivate a license, registration or certification on an expedited basis when the Governor has declared a state of emergency. The bill provides that the director may reactivate a license, certificate of registration or certification on an expedited basis to any individual who held a corresponding license, certificate of registration or certification, in good standing at the time that the individual retired from active practice or was placed on the inactive status, within the last three years, or such other timeframe as the director may specify. A3901 was amended to add a provision that waives compliance by any individual granted a license, certificate of registration or certification under the bill with liability insurance required by statute or regulation, for acts or omissions undertaken in the course of providing health care services in support of the State’s response to the declared emergency. 
 
A3903 which will, as amended in the Senate, allow remote notarial acts, and other acts executing and verifying certain documents, by notaries public and other authorized officials during the public health emergency and state of emergency declared by the Governor’s Executive Order 103 of 2020. The amendments added other authorized officials to the provisions of the bill. 
 
A3904 which permits the use of virtual or remote instruction to meet the minimum 180-day school year requirement under certain circumstances. The amendments to A3904 added occupational therapy services, physical therapy services and behavioral health services to those services that may be provided remotely or virtually to special education students.

S2344 which requires carriers (insurance companies, health, hospital, and medical service corporations, health maintenance organizations, and State and School Employees' Health Benefits Program contracts), that offer a health benefits plan which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, as well as the State Medicaid program, to provide coverage of prescription drug refills even when the covered person has not yet reached the scheduled refill date, provided that the prescription itself would remain valid beyond the refill date, in a manner calculated to ensure an enrollee’s ability to maintain at least a 30-day supply, or a 90-day supply of a maintenance medication supply at home.

S2347 establishes the Employment and Business-Related Tax Deferral Assistance Program to be administered by the New Jersey Economic Development Authority, to provide financial relief to New Jersey small businesses suffering economic hardship due to the outbreak of the coronavirus disease 2019 (COVID-19). The bill requires the EDA to review and approve applications of eligible small businesses seeking financial relief, make and enter into agreements that allow eligible small businesses to defer payment and remittance of certain employment and business-related taxes imposed and collected on behalf of the State, and monitor and evaluate the effectiveness of the program. Under the program, small businesses are to be allowed to defer payments and remittances including those regularly collected pursuant to the sales and use tax, the motor fuels tax, the petroleum products gross receipts tax, the gross income tax, workers' compensation contributions, unemployment compensation contributions, temporary disability leave benefits contributions, and family temporary disability leave contributions.
 
S2348 which allows qualified taxpayers to claim a credit equal to 20 percent of the credit they receive under the Employee Retention Credit of the federal CARES Act which is a credit that can be claimed against employment taxes in an amount equal to 50 percent of qualified wages paid to eligible employees. The federal credit only takes into account wages paid after March 12, 2020 and before January 1, 2021. The federal credit also only takes into account up to $10,000 of qualified wages paid during the period, so the maximum federal credit is $5,000 per employee. The credit allowed by this bill, to be claimed against the Corporate Business Tax or the Gross Income Tax, is 20 percent of the amount the taxpayer received under the federal credit for each employee, so the maximum State credit is $1,000 per employee.
 
S2354 which would would authorize the Commissioner of Banking and Insurance, upon the declaration by the Governor of a public health emergency or a state of emergency, or both, and upon a determination by the commissioner, after consultation with the Governor, that the emergency or emergencies are of such duration and severity as to require certain actions with respect to policies of insurance, to issue a bulletin requiring that for a period of at least 60 days, no policy of insurance issued to an insured in this State and subject to regulation pursuant to Title 17 of the Revised Statutes, or Title 17B of the New Jersey Statutes could be cancelled or not renewed for nonpayment of premium. The bill applies to all lines of insurance subject to regulation by the Department of Banking and Insurance. It takes effect immediately and is retroactive to March 1, 2020. The Assembly did not pass this bill or the identical Assembly bill, A3920 which was on the Assembly agenda.
 
SR64 which urges financial institutions to waive bank fees and suspend credit card penalties, late fees, and interest payments for the duration of the coronavirus disease 2019 pandemic. 


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