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PAST COVID E-BLAST HAVE BEEN ARCHIVED DUE TO SPACE RESTRAINTS AND TO KEEP THINGS CURRENT.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

INFORMATION ON COVID TESTING AND SEROLOGY FROM DOH – 4/30/20
I am familiar with the document you’ve attached. http://njaasc.org/wp-content/uploads/2020/04/COV2-Antibody-Testing-1.pdf

The serology testing is a source of confusion for many.
 
If you would like to do a serology test there are 4 waived FDA/EUA test at this time. They are presumptive tests. The serology tests require a Certificate of Compliance as they are moderately complexed and a NJ State Laboratory License. You can contact  joan.mikita@doh.nj.gov  for an application and information.
Read the package insert for type of specimen before buying any serology test as many are not approved for finger stick/capillary blood. If you would like to perform the test on capillary blood the test would then elevate to high complexity and Performance Specifications would be necessary to validate the test method.
This would include method comparison, accuracy, sensitivity and specificity.
 
At this time there are 3 FDA/EUA waived/POC tests that can be used with a Certificate of Waiver. They are molecular and will let the user know if the patient has COVD19 at that time.
 
The FDA/EUA web site lists all tests approved at this time and changes daily.
Unfortunately a lot of mis-information has been provided by sales representatives and is not accurate.
 
I hope I have answered your question.

Melanie Rinaldi
Manager of CLIA program
Clinical Lab Evaluator 3
Off: 609-406-6832
Fax 609-406-6827

NEW YORK GUIDELINES FOR SURGERIES – 4/30/20


QUESTIONS ABOUT PPE – 4/30/20
Q: We are going to reopen when we get the ok, but having difficulty with getting PPE, of course, mostly masks.
We found kn95 but are only 95% for filtration efficiency and not 99.9% like an np5
Will we be safe if we where those and then put a regular level 2 or 3 over it, and then change that over mask every patient??

 
There are varying degrees of PPE needed based on what you are doing……
 
Stefanie Mozgai, BA, RN, CPM
Assistant Commissioner
Department of Health
Health Facility Survey & Field Operations
PO Box 367
Trenton, NJ 08625-0367

VIOLATIONS OF EXECUTIVE ORDERS – 4/30/20
I have been asked the question, so I am answering.
I hope no-one has to use this!
 
If you need to report a violation of an Executive Order- click here to report:

ICAR UPDATE – 4/30/20
Hi ICAR partners,
 
The  CDC LTC mini webinars  are now  live ! They are all published on the Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs)  web page  at the bottom under a “Webinar Series” section. These new webinars will be a great training tool/resource for frontline long-term care staff members.
 
Here are the direct links to each webinar:
 
 
Additionally, we would like to provide some additional   ICAR resources , including our Infection Control Auditing Guidance and our Caught Red-Handed exercise for proper hand hygiene.
Both documents can be accessed directly through the links below:
 
Jessica Arias, Bridget Farrell, Carol Genese, Melody Lee - NJDOH ICAR Team

BIPARTISAN GROUP OF SENATORS URGES REOPENING OF CERTAIN SECTORS OF ECONOMY INCLUDING ASCS FOR ELECTIVE PROCEDURES- 4/29/20 
Trenton –  Senate President Steve Sweeney and Senators Paul Sarlo, M. Teresa Ruiz, Steve Oroho, Declan O’Scanlon and Troy Singleton issued the following joint statement today offering Governor Murphy’s Economic Commission a plan to continue the public safety measures needed to counter the COVID-19 crisis and to offer some strategic steps to guide the reopening of New Jersey’s economy.

For more than a week, the bipartisan group of Senators have been consulting with the business community regarding strategies for reopening. The Senators stress the need for advance planning so it will bolster the state’s economic recovery, restore jobs and businesses, and rebuild the fiscal stability of state and local government while protecting the public’s health and safety.

“We implore the Governor’s commission to move swiftly with advancing a plan to support economic recovery for New Jersey. The Senate has been engaged in conversations with business owners and organizations who are experiencing this crisis and we have been communicating their needs with the Governor’s office and our legislative colleagues.

“Collectively, we need to make sure the communities that have struggled the most during this crisis have their issues carefully considered and addressed.
“We look forward to continuing this productive working dialogue with the Governor’s economic workgroup.

“With the Institute for Health Metrics and Evaluation projecting that New Jersey may be able start opening up on May 27, we do not have much time. We are fortunate that social distancing and stay at home orders have resulted in positive results. The Governor mentioned today, as he has for several days, that our trends continue to move in a positive direction.

“As we are developing plans for a full scale re-opening, we should consider how low-risk businesses and industries can safely reopen now, such as:
  • Construction;
  • Car sales;
  • Outdoor recreation like parks, golf courses;
  • Beach activities where social distancing can be sustained; and,
  • Elective Surgeries and other needed medical needs.

“These are consistent with New York and Pennsylvania where these activities are allowed:
  • Passive Recreation in the parks of Pennsylvania;
  • Passive Recreation in the parks of New York;
  • Golf in Pennsylvania as of May 1;
  • Golf in New York for individuals only;
  • Elective surgeries in New York; and,
  • Elective surgeries in Pennsylvania.”

QUESTION REGARDING ASCS AND TESTING- CLIA LICENSE- 4/29/20
Q: I have been asked if the rapid test is available to a facility or medical practice for staff and pts...does NJDOH require them to have a CLIA license to do so?

A: A CLIA certificate is required to perform any laboratory testing. Testing falls under a Certificate of Waiver or Certificate of Compliance.
Currently there are 3 FDA/EUA waived COVID19 tests available. They are POC molecular tests. At this time there are no serology waived tests. Moderate or High complexity tests require a NJ State Laboratory License. Please contact  joan.mikita@doh.nj.gov  for information.
 
The FDA/EUA website lists the approved tests available and their complexity.
 
Please contact me with any further questions.
 
Melanie Rinaldi
Manager of CLIA program
Clinical Lab Evaluator 3
Off: 609-406-6832
Fax 609-406-6827

PRIOR AUTHORIZATIONS DURING THE CRISIS - 4/29/20
You need to check with insurance carriers regarding prior authorizations for surgery considered elective during the crisis.
Some carriers are extending these for 90 days or more.
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NOTIFICATION OF CENTERS RE-OPENING – 4/28/20
A lot of queries from centers who are going to reopen.
Yes you do have to notify the Department if you have closed (notified them) and are going to reopen.
Use this for notification:

CMS REEVALUATES ACCELERATED PAYMENT PROGRAM- 4/28/20
CMS announced that it is reevaluating the Accelerated Payment Program, and it is also suspending the Advanced Payment Program for Part B providers.

PENNSYLVANIA OPENS UP FOR ELECTIVE SURGERIES – 4/28/20
Pennsylvania became one of the latest states to allow hospitals and ACFs to open for elective surgery.
 
As New Jersey is part of the Regional Task Force of Governors, and per Governor Murphy they try to act alike, hopefully this gets us closer. Remember as well that New York allowed elective surgeries last week, though under tight restrictions.
 

FROM BRACH EICHLER- DOBI ALLOWS PIP CARRIERS TO USE TELEHEALTH – 4/28/20
DOBI: PIP Carriers to Permit the Use of Telehealth
Effective immediately, the New Jersey Department of Banking and Insurance (DOBI) has released Bulletin 20-19 allowing PIP carriers to permit the use of telehealth. In pertinent part, the Bulletin outlines the following directives:
  • Encourage the use of network providers to use telemedicine/telehealth whenever appropriate in treating PIP patients due to the public health emergency
  • Update procedures for telehealth/telemedicine to include telephone-only services
  • Carriers cannot require specific technologies to be used for telehealth/telemedicine treatment during the state of emergency (i.e., audio only or live video)
  • Reimburse providers for telehealth/telemedicine no less than the in-person rates
  • Notify providers of any specific billing requirements for billing telehealth/telemedicine
  • Set requirements to substantiate the treatment including documentation and recordkeeping, but cannot impose more restrictive requirements than an “in-person” visit
  • Carriers may not impose in-state license restrictions, so long as the provider is in compliance with P.L. 2020, c. 4
  • Carriers cannot require additional prior-authorization (precertification) requirements
  • These updates should be disseminated on the PIP carriers’ websites or other reasonable means to keep individuals informed. 
Bulletin 20-19 is published on the DOBI website and can be found  here .

AMENDMENTS TO EO 107 FROM EMERGENCY MANAGEMENT – 4/28/20

YOU NEED TO VIEW THE NJAASC WEBINAR REGARDING EXECUTIVE ORDER 109 - 4/27/20
Every day I get a myriad of questions and phone calls regarding performing cases. EO 109 DID NOT shut down ASCs, cases can still be performed within the parameters of said EO.

As of this writing, there is no relaxation- Executive Order 109 is in effect, period. There is no ‘opening date’, nothing like that.

Remember two issues- the Governors Health Care Emergency, which he renewed and runs thru 5/7, and the various Executive Orders he has issues.

Executive Orders are in place until they are rescinded by the Governor, or he leaves office.
 
NJAASC has been in close contact with NJDOH and the Governors Office regarding all of this- indeed EO 109 largely reflects NJAASC recommendations to them.
Since there was misunderstanding and questions about EO 109 from the beginning, NJAASC put together a webinar to help ASCs understand exactly what was going on.
From the question I get, a significant number of centers and personnel DID NOT tune in!
 
I would strongly suggest that everyone who has not watched/listened to the webinar do so.
It is up on NJAASC website- for everyone, for free of course.


To make an informed decision regarding your ASC, you need to be informed! 

RESTARTING NEW JERSEY’S ECONOMY – 4/27/20
Today’s briefing had a lot to do with getting the economy of New Jersey restarted.
That is important for everyone- but for ASCs in particular.
 
The Governor noted that the regional task force of governors tries to act in concert. Last week, NY announced resuming elective procedures (with strict controls/guidelines) in hospitals and ASCs. So hopefully Governor Murphy will take that lead and run with it.
We have been talking to the Governor’s Office about this issue, so stay tuned.
 

ONE CENTER’S THANKS TO NJAASC, AND IT IS APPRECIATED! - 4/27/20
I cant tell you enough how much I ( and others) have come to rely on you and NJAASC for the most up to date and correct information regarding COVID . Not only have you been able to educate us on what is happening federally but in our own state of NJ. Because of the changes happening, sometimes daily, its so important that all of us stay current and up to date with what is happening - thanks for fulfilling that need, and I would urge any center who is not a member to join NJAASC.

Bonnie Brady Lavoie, RN,CNOR,CASC
VP Operations
West Morris Surgery Center
66 Sunset Strip Suite 101
Succasunna NJ 07876

NJAASC & COALITION PETITION GOVERNOR FOR ASF TAX RELIEF - 4/27/20
As you know, I have been talking to NJDOH regarding the ASF Tax.  The Director of the Assessment Department understands and indeed is on our side on this one.

However his attempts to get relief only resulted in the postponement of the filing deadline- which quite honestly does not do a thing for us, that is unless there would have been a corresponding postponement of the payment schedule.  

I had our Government Affairs people get a special meeting of the Coalition (of which NJAASC is a member) and we hashed out a  letter that was delivered directly to the Governor .

I am especially concerned with the June 15 th  payment as it is the last quarterly payment for the FY declared, and failure to completely pay your assessment would result in non- renewal of your license.
 
Jeff

INSURANCE DENIALS DUE TO EXECUTIVE ORDER 109 - 4/27/20
As you know EO 109 limited the types of cases to be performed at ASCs.

NJAASC outlined all of this in our webinar (please view it on our website if you have not done so-free, for everyone), and in numerous e-blasts to all ASCs.

I have heard that some MVA carriers are denying pre-cert requests based on:  ‘The proposed procedure is found to be elective and non-compliant with Governor Murphy’s March 23, 2020 Executive Order 109’

I have doubts as to if said carriers have any legal right/ability to do this, but they have so it will get played out in arbitration.
 
NJAASC had circulated to all ASCs and strongly recommended that they have their doctors wishing to perform procedures, fill out an attestation-  The Confirmation of Non-Elective Form,  for just such a reason as this.

Centers must be careful (and you need to protect yourself), and the doctors themselves as well- which is the reason for the form, which would be kept in your chart.

You could as well send it as part of your pre-cert request.

$20B in Grants to Eligible Healthcare Providers, including ASCs, Available Tomorrow - 4/27/20
The US Department of Health & Human Services (HHS) will allocate an additional $20 billion in grants to Medicare providers, including ambulatory surgery centers, starting tomorrow, April 24. 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.

Fifty billion dollars of the Provider Relief Fund is being allocated for general distribution to Medicare facilities and providers impacted by COVID-19, based on eligible providers' 2018 net patient revenue. As you are aware, HHS started distributing an initial $30 billion on April 10. In the interest of getting funds to providers as quickly as possible, the $30B was distributed using a different formula based on information HHS already had—providers’ share of Medicare fee-for-service (FFS) reimbursements in 2019.

On April 24, providers that submit Centers for Medicare & Medicaid Services (CMS) cost reports will automatically be sent an advance payment based off the revenue data they submit. Providers without adequate cost report data on file will need to submit their revenue information to a portal opening this week linked on  this page  in order to obtain additional general distribution funds.  Since ASCs do not submit cost data, facilities that wish to obtain additional grant money through this program will have to submit revenue information to the portal.  Visit the  Provider Relief Fund page  to apply beginning tomorrow, April 24.

Payments will go out weekly, on a rolling basis, as information is validated.


ECONOMIC IMPACT STUDY FOR NEW JERSEY- YOU MAY WANT TO FILL IT OUT- 4/27/20
On Thursday, NJBIA started soliciting responses from members for our new Recovery Survey. The second part of the survey questions mirror many from the Recovery and Reinvention Framework document. We invite you to share the survey with your members to insure we get as much feedback as possible. Please do not elicit responses via social media as we want to ensure we have legitimate businesses/nonprofits only answering this.

As we discussed, the goal of this survey is to have businesses/nonprofits inform us of the economic impacts resulting from the COVID-19 response, and to shed light on what it will take to bring them back online when the state reopens. We will, of course, use this data to help inform our policymakers as they contemplate a reopening, as well as to advocate for appropriate policies and actions on behalf of our collective members.

Please let your members know that they can fill out the survey  here  for a limited time.

Thank you for your continued collaboration!
Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com