Issue 18 | May 01, 2020
Message from the Executive Director

Hope everyone is staying safe and healthy! As we move ahead in the year, and prepare for our upcoming events like AROC 2020 (see below) — we have published an infographic download that illustrates and highlight the advantages that NJAOPS memberships provides for practicing DOs in NJ. It's a good reminder to understand all the value and benefits that we offer. Click to the right on the image or below to access.

To follow up on our message from last week on the second wave of funding made available. We are asking physicians who applied for the PPP program originally, whether for your own private practice or for a hospital, to take our one minute survey regarding the funding request. This information is ANONYMOUS and we are not collecting ANY personal information. The purpose of this is to gather as much relevant data as we can to be able to approach the Murphy administration should we need to discuss additional funding for small HEALTHCARE businesses.
Our bi-weekly NJPhA “COVID-19 Critical Issues Call” continue to be productive. The pressing issue surrounding drug shortages continues to push our narrative. Just this week the FDA has informed us that we have a glass container shortage which is causing some of the drugs on their “shortage” list to be classified as such. In return this is causing medical distribution issues in New Jersey as well. We have added the following drugs to our shortage list including Dextrose 25%, 5% & 5-% Injection; Sodium Chloride 0.9%, 0.45% and 14.6% for injections. Polyethylene IV Bags and 50 ml IV bags are now on FDA’s shortage list as well. A full list of FDA Drug Shortages can be found by clicking here
On another note, HRSA is getting ready to launch a program that will provide claims’ reimbursement to health care providers for testing uninsured patients for COVID-19 and uninsured patients with a COVID-19 diagnosis. The DEA has update the production quotas regarding narcotic drugs! The DEA has informed the committee members that it is adjusting the established 2020 aggregate production quotas and assessment of annual needs for selected schedule II controlled substances and list 1 chemicals to be manufactured in the United States to provide for the estimated needs of the county. Based on the COVID-19 pandemic data, they believe these adjustments are necessary to ensure that the United States has an adequate and uninterrupted supply of these substances as the country moves through this public health emergency. Unfortunately, for End-of-Life comfort narcotics drug shortage, such as morphine sulfate oral/sublingual 20mg/l solutions, no national alarm has been sounded and this comfort narcotic drug continues to be in high demand without much insight into it’s production efforts.
I would like to take a moment to all acknowledge some of the COVID-19 data that has been released by New Jersey’s Department of Health on a daily basis. Below, you will see a breakdown of New Jersey’s COVID-19 reported data between Friday, April 24 th and today, Friday, May 1st. This data uses We have quantified this information into simplistic numbers that you can quickly analyze. In summary, the percentages of people who are tested on a daily basis for COVID-19 and who turn out to be positive for COVID-19 has decreased by 5.82%. New Jersey performed 5,612 tests between April 23 rd and April 24 th vs. 7,572 tests performed between April 30 th and May 1 st . More importantly, the number of hospitalizations and patients on ventilators has also decreased in just seven days. Our concern still seems to be with the long term care facilities where we have added 4,574 cases with 1,836 deaths in just seven days! We will continue to monitor our progress and provide you with another comprehensive update for next Friday’s Update.
Warm Regards,
Tajma Kotoric
Executive Director
New Jersey Association of Osteopathic Physicians (NJAOPS)

COVID19 State and Federal Legislative and Regulatory Highlights – May 1, 2020


Plan Includes Six Principles to Guide New Jersey's Re-Opening

On Monday, Governor Phil Murphy announced his plan for a gradual re-opening of the economy entitled, "The Road Back: Restoring Economic Health through Public Health," and will restart New Jersey and put the state on the road to recovery. Governor Murphy outlined six key principles and benchmarks to guide the process for restoring New Jersey's economic health by ensuring public health.

Governor Murphy's stay-at-home Executive Order, which has been in effect since March 21st, will remain in effect in its entirety until further notice. The following six principles and key metrics will guide the process for lifting restrictions and restoring New Jersey's economic health through public health.

Principle 1: Demonstrate Sustained Reductions in New COVID-19 Cases and Hospitalizations

  • 14-day trend lines showing appreciable and sustained drop in new COVID-19 cases, hospitalizations, and other metrics reflecting decreasing burden of disease;

  • Hospitals stepping down from functioning under crisis standards of care.

  • Principle 2: Expand Testing Capacity

  • At least double current diagnostic testing capacity;

  • Prioritize testing for health care workers, essential personnel, and vulnerable populations;

  • Create a flexible testing plan accessible to all residents;

  • Expand partnerships with institutions of higher education, private-sector labs, and the federal government;

  • Ensure that those who test positive are linked to a health care provider.

  • Principle 3: Implement Robust Contact Tracing

  • Recruit and deploy an army of personnel who will identify and follow-up with contacts;

  • Leverage technological data and innovative solutions to increase efficiency;

  • Coordinate the approach of local and state health officials, which will have a coordinated county/regional component.

  • Principle 4: Secure Safe Places and Resources for Isolation and Quarantine

  • To the greatest extent possible, provide individuals who do test positive in the future with a safe and free place to isolate and protect others from COVID-19;

  • Ensure that quarantined contacts are provided supportive services, if needed.

  • Principle 5: Execute a Responsible Economic Restart

  • Create the Governor's Restart and Recovery Commission to advise on the process and recommend responsible and equitable decisions;

  • Plan for a methodical and strategic return to work based on level of disease transmission risk and essential classification;

  • Continuation of social distancing measures, requirements for face coverings, and work-from-home directions where feasible and appropriate;

  • Leverage any available federal funds and programs to support health care, individual, and small business recoveries.

  • Principle 6: Ensure New Jersey's Resiliency

  • Learn from the lessons of COVID-19 and prepare for the possibility of resurgence;

  • Ensure hospitals, health care systems, and other health delivery facilities have inventories of personal protective equipment and ventilators;

  • Build our own state personal protective equipment and ventilator stockpile;

  • Create a playbook for future administrations for the next pandemic.

We hope to be able to announce the parameters regarding the lifting of the ban on elective procedures in the near future.

NJ Department of Health Issues Guidance on COVID19 Diagnostic Tests

On April 28, Dr. Thomas J Kirn – Medical Director of Public Health and Environmental Laboratories issued a guidance letter detailing the specific tests that should be used in both inpatient and outpatient settings.

With the large of amount of tests aggressively marketed to physicians at present, it is important to be especially mindful of this guidance. It is also significant to note that although CMS testing guidance was released yesterday, New Jersey law and regulations supersede the federal. Please see the attached links to both documents.  

New Jersey Child Care for Essential Employees

NJ Human Services Commissioner Carole Johnson and Children and Families Commissioner Christine Beyer announced that the state will continue to help pay for child care for essential employees through at least the end of May. These services could prove very beneficial to office staff or additional personnel who meet the financial criteria.

(see article below)

CMS Approves New Federal Waivers

Yesterday, CMS announced new waivers of importance to providers across many care settings. This includes:

New rules to expand and support COVID -19 diagnostic testing for Medicare and Medicaid
beneficiaries. This includes allowing any healthcare professional authorized by state law
to order testing. Pharmacists can work with practitioners to provide assessment and 
specimen collection services. There are also several billing and payment related additions
including that Medicare and Medicaid will cover certain serology antibody tests

Indirect medical education payments will not be reduced for teaching hospitals that have
increased the number of temporary beds.

Inpatient psychiatric and inpatient rehabilitation facilities can admit more patients from acute care hospitals without facing reduced teaching status payments.

Inpatient rehabilitation hospitals can accept patients from acute care hospitals experiencing a surge even if the patients do not require rehabilitation care.

Long term care hospitals can accept any acute care hospital patient and be paid at a higher Medicare payment rate as required under the CARES Act.

Nurse practitioners, clinical nurse specialists and physician assistants can now order, certify and recertify and establish plans of care for home health patients.

ASCs will be allowed to have physicians and other practitioners whose credentials have
expired to continue caring for patients.

Certain partial hospitalization services provided in temporary expansion locations will be
paid by CMS.

Expansion of telehealth will include additional practitioners such as physical, occupational
and speech therapists.

Hospitals may bill as the originating site for telehealth services furnished by hospital-
based practitioners to Medicare patients registered as hospital outpatients when the patient is at home.

Increase in telehealth payments for audio-only telehealth visits.

Video requirements for certain telephone evaluation and management services are waived under Medicare.

Several ACO-related changes related to financial predictability and extension of ACO agreements for another year.
Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic | CMS

At President Trump’s direction, and building on its recent historic efforts to help the U.S. healthcare system manage the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services today issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens.

Governor Murphy Names 21-member Economic Restart and Recovery Group
Group will be responsible for plotting the timeline to lift COVID-19 businesses restrictions
Gov. Phil Murphy unveiled 21 picks to a commission that will gauge the order and timeline in which businesses should reopen, and how the state’s economy can get moving once COVID-19 restrictions are lifted.

Like with the  six-step guideline  for how the state can lift the restrictions and stomp out the virus, the Governor’s Restart and Recovery Commission also has no set dates or timelines.

Murphy indicated the span would be a “number of weeks, not months,” with a slim chance that some progress can be made before Memorial Day weekend.
The commission will be co-chaired by the immediate past president of Princeton University Shirley Tilghman and Merck Chief Executive Officer  Ken Frazier , Murphy said on Tuesday.

“It will be their task to balance multiple competing needs to ensure we arrive at equitable decisions that work for every community in our state,” the governor said on Monday.
“I will ask them to help us, and our businesses, leverage any and all available federal funds and programs to support our recovery.”

Other members include incoming Rutgers University President  Jonathan Holloway , former Federal Reserve Chair Ben Bernanke; labor union AFL-CIO President Richard Trumka; former acting director for the Centers for Disease Control and Prevention Richard Besser; and Tony Coscia, Windels Marx partner and board chair of Amtrak and Suez North America.

Lt. Gov. Sheila Oliver; Murphy Chief Counsel Matt Platkin,  Chief of Staff George Helmy  and Chief Policy Advisory Kathleen Frangione; and State Health Commissioner Judith Persichilli will sit on the commission in an ex-officio capacity.

All told, the commission will look at how to  boost new industries  while reviving the economy, securing more federal dollars, making sure that no businesses are left out of the recovery, and to “advise the governor on the timing of the restart,” according to a Tuesday afternoon press release from the governor’s office.

The group will start virtual meetings “very soon,” Murphy said Tuesday, but he did not have a timeline for when the commission will deliver its recommendations to him.
“I am confident that with input from thoughtful people, including scientific and health care experts, we will be able to recommend a responsible path forward to reopen the economy while continuing to keep New Jersey citizens safe,” Frazier said in that press release.
The formation of the group is the fifth step of Murphy’s six-step guideline for how COVID-19 restrictions can be lifted throughout New Jersey and how the state economy can be reopened.

For nearly six weeks, New Jersey has been in a near-total  state of lockdown , in a bid to halt the spread of COVID-19, which has shown increasing signs of success.
As of Tuesday afternoon, the virus infected 113,856 New Jersey residents and claimed 6,442 lives. Still, state health officials pointed out that the rate of new cases, hospitalizations, ventilators and critical care usage have flatted in recent weeks, and begun to drop in recent days.

Before restrictions could be lifted, the state has to achieve major milestones including two weeks of consistent declines in new cases and hospitalizations, an expansion of the state’s testing and quicker turnaround for results, and the ability to use contact tracing to track down and isolate potential COVID-19 positives.
Restart and Recovery Commission
  • Princeton University Immediate Past President Shirley Tilghman
  • Merck CEO Ken Frazier

  • Former Campbell’s CEO Denise Morrison
  • Spartina Productions Vice President Evelyn McGee Colbert
  • InCharged, VendX and Lux-UVC CEO Jessica Gonzalez
  • Apple Vice President of Environmental, Policy and Social Initiatives Lisa Jackson
  • Former U.S. Homeland Security Security Jeh Johnson
  • Prudential Financial Chairman and CEO Charles Lowrey
  • Center for American Progress President and CEO Neera Tanden
  • Former U.S. Department of Labor Chief Economist William Rodgers
  • Rev. Regena Thomas of the American Federation of Teachers
  • Incoming Rutgers University President Jonathan Holloway
  • Former Federal Reserve Chair Ben Bernanke
  • AFL-CIO President Richard Trumka
  • Former Acting Director for the Centers for Disease Control and Prevention Richard Besser
  • Windels Marx Partner and board chair of Amtrak and Suez North America Tony Coscia

Ex-officio members:
  • Lt. Gov. Sheila Oliver
  • Chief Counsel to the governor Matt Platkin
  • Chief of Staff for the governor George Helmy
  • Chief Policy Advisory for the governor Kathleen Frangione
  • State Health Commissioner Judith Persichilli
Graduation Day for RowanSOM
Congratulations to RowanSOM  medical students  who are graduating today! This marks yet another milestone in your journey to becoming a  physician ! From receiving that acceptance letter from RowanSOM, to receiving your whitecoat and attending AROC for the first time, so many wonderful memories have been made right in the halls of RowanSOM’s campus.

Just to think that four years ago, we stood right by your side watching you receive your  whitecoats  to now proudly watching you graduate  medical school  and becoming a “D.O.” is truly a surreal moment. When you look down on this  whitecoat  that you will be retiring soon, on one side you will see  RowanSom ’s seal and in the other  NJAOPS ’.

We will always be here for you especially as you embark this new chapter of your life as a  resident ! May your  coffee mugs  be filled with endless coffee and your hearts even fuller with excitement.

We will be watching and continuing to support ALL of your initiatives! Congratulations RowanSOM Class of 2020!
Emergency Child Care for Essential Workers
The coronavirus public health crisis that we are facing has presented a number of child care issues for those New Jersey residents who are defined as “essential.” Under Governor Murphy’s  Executive Order No. 110 , child care centers that want to remain open for emergency child care for essential workers had to apply to do so, and all other of the state’s child care centers were closed on April 1, 2020. A  number of centers  have applied to remain open for the critical work of serving the child care needs of essential employees. In addition, family child care programs do not fall under the Executive Order and can continue to operate.
As part of the emergency, the state is launching an Emergency Child Care Assistance Program (ECCAP) to help support child care costs when a parent or guardian is an essential employee, regardless of your income. The Department of Human Services’ Division of Family Development will administer the program. 
If you are an “essential” employee needing child care, you must register with the Department’s county-based Child Care Resource and Referral (CCR&R) Agencies. “Essential” employees who are normally eligible for the Child Care Subsidy Program must enroll in the ECCAP to continue receiving child care services. Your CCR&R will follow-up with you within two business days to gather additional information about you and your needs and help you identify a child care provider.
Who is considered “Essential” for Emergency Child Care Assistance?
  • Health care workers, including staff working in health care facilities and in community-based services including home health and behavioral health; 
  • Law enforcement personnel, fire and emergency services personnel, and correctional facility staff; 
  • Individuals employed at emergency child care centers operating on or after April 1, 2020; 
  • Staff working for entities that provide essential social services, including, but not limited to, group home and shelter staff; 
  • Essential government employees who are unable to work from home, including child protection services workers, child welfare workers, foster care workers, unemployment compensation processing staff, and public health employees; and,
  • Certain critical workers, as defined by the Commissioner of DCF, at essential retail businesses, as defined in Executive Order No. 107 (2020) and subsequent Administrative Orders, which includes, for example, grocery store and gas station employees.
How much will child care cost?
If you currently receive child care assistance under the state’s Child Care Subsidy Program or are eligible for it, your child care costs will be fully covered by the state. To give you a sense of whether you would be eligible for the Child Care Subsidy Program, the income maximum for a family of four is $52,400 annually. Use our  calculator  to see if you are likely to be eligible or visit our  parent page  to learn more about this program.
For all other families, the Emergency Child Care Assistance Program is now available. Under this program, the state will pay the following rates and you will be responsible for the difference between that and what the child care center is charging. What the child care center can charge you is subject to limits based on the center in which you enroll. Tuition for center services, including Emergency Child Care Assistance, cannot exceed 110% of the rate the center charged in February 2020.
Below is how much the state will pay per week for one child.
INFANT $450.35
TODDLER     $415.70
PRESCHOOL  $415.70
SCHOOL-AGE $336.00
How long will the state pay for child care?
The state is committed to paying for child care in this way through the end of May and will revisit the situation at that time as we get additional information about federal resources to address this critical need.
How to enroll?
  • If you meet the definition of an essential employee and have child care needs, register here
  • You will be contacted by one of the state’s Child Care Resource and Referral (CCR&R) Agencies within two business days. Your CCR&R will follow up on next steps to gather information about your household and help you identify a participating child care provider.  
  • If your child is currently enrolled in a center that is now serving as an emergency child care center, you can continue to utilize its services while your application is pending. 
  • If you are income-eligible for the state Child Care Subsidy Program, the CRR&R will use the information you provide to establish that you are an essential employee and help enroll you in the Child Care Subsidy program, which will provide a child care subsidy that will be considered payment in full.
  • For all other families, the CCR&R will use the information you provide to establish that you are an essential employee, enroll you in Emergency Child Care Assistance, and to ensure that the center is paid the state portion for May.

CMS Flings Telehealth Floodgates Wide Open with Sweeping New Measures

In a major escalation of its already expansive COVID-19 Public Health Emergency (PHE) regulatory waivers, CMS will now allow any clinical practitioner to provide telehealth services to Medicare beneficiaries, one of the biggest changes announced in an April 30 policy release.

The new rules explicitly allow physical therapists, occupational therapists, and speech pathologists to furnish and bill for telehealth services. CMS will also allow more E/M codes to billed as telehealth services using only a phone, without real-time video. Other provisions will allow patients to get a COVID-19 test without the need for a physician order, hospitals to be paid for services rendered in temporary locations like parking lot tents, and more.

A bullet list of highlights from  the full CMS document  is below:

Telehealth changes
  • Limitations on practitioner type are waived. For the duration of the COVID-19 PHE, CMS will waive restrictions on which provider type can bill for telehealth services. Now, other practitioners besides physicians, nurse practitioners, and physician assistants can bill for telehealth. This includes physical therapists, occupational therapists, and speech language pathologists.
  • Audio-only telehealth list is expanded. CMS will allow a variety of therapy-related E/M codes to be billed as telehealth services with an audio-only connection, i.e. over the phone, without requiring real-time video. This includes psychotherapy services, medical nutrition counseling, diabetes self-management training, tobacco use cessation counseling, and more. The full list can be found on the CMS telehealth-eligible code list, which was just updated again on April 30.
  • Payments increased for audio-only services. In addition to allowing many behavioral health and patient education and counseling services to be billed using only audio communication, CMS is bumping up the payment for these services from the current range of $14-$41 to a range of $46-$110, bringing them in line with payments for similar office/outpatient visits. This payment change will be retroactive back to March 1, 2020.
  • Hospitals may bill as the originating site for telehealth, even when the patient is located at home. This will be allowed for telehealth services furnished by hospital-based practitioners to Medicare patients who are registered as hospital outpatients.

COVID-19 testing changes
  • Physician order no longer required for testing. Medicare patients no longer need a written practitioner’s order to receive a COVID-19 test or certain laboratory tests required to diagnose COVID-19.
  • Pharmacists can collect specimens and bill Medicare. Pharmacists can work with a physician or other practitioner credentialed to bill Medicare to provide assessment and specimen collection services relating to COVID-19 diagnosis, and the physician or other practitioner can bill Medicare. Pharmacists may now perform COVID-19 tests if they are currently enrolled with Medicare as a laboratory, provided this is allowed under their state scope-of-practice laws. This allows Medicare patients to be tests at parking lot test sites that are often operated by pharmacies.
  • CMS will now cover serology tests. To help determine whether a patient has developed an immune response to COVID-19 and may therefore no longer be at immediate risk of infection, CMS will cover serology tests that look for antibodies to the virus. This includes processing patient-collected samples from home as part of FDA-authorized COVID-19 serology tests.

Workforce changes
  • Non-physician practitioners may provide home health services. In keeping with provisions in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, nurse practitioners, clinical nurse specialists, and physician assistants may now provide home health services. This means these providers may order home health services, create and review plans of care for home health patients, and both certify and re-certify homebound status to determine whether patients continue to be eligible for home health services.
  • PT/OT assistants can perform outpatient maintenance therapy. CMS will allow physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants working in outpatient settings. The move is intended to free up PT/OT providers so they can perform other services and improve patient access to care.

Hospital changes
  • Services performed in temporary expansion locations will be paid for. Outpatient hospital services including provider-administered drugs, behavioral health services, and wound care that are delivered in temporary expansion locations will be paid. Such locations could be parking lot tents, converted hotels, or even patients’ homes if they are temporarily designated as part of a hospital.
  • OPPS payments will apply to off-campus locations. CMS will allow provider-based hospital outpatient departments that relocate off the hospital campus to apply for a temporary exception in order to continue receiving payment under the Outpatient Prospective Payment System (OPPS) rather than under the Medicare Physician Fee Schedule. Hospitals may relocate outpatient departments to more than one off-campus location or partially re-locate off-campus while continuing to deliver care at the original on-campus sites.
New Payment Options Available!
Now - there are more ways to #InvestInYourself! Times are very tough right now but we don’t you still want to be involved and represented so we are offering payment installments for your 2020 membership! R enewing your membership today with 3 easy installments of $183.33 to be paid by September 2020!
To take advantage of this unique opportunity, please email Pat McNamara or call him at 732-940-9000 ext 306 to set up these installments. It's just THAT easy.
Early Bird Pricing - Extended through June 30th
Due to the situations in Atlantic City, and throughout the State and region, NJAOPS will be postponing  AROC 2020  and it  WILL NOT  be held April 22-25. As of today, we have confirmed with your venue, the Hard Rock Atlantic City, that the event will now take place from  September 9th - 12th , a Wednesday through Saturday schedule as usual. Please note the following:

  • Current AROC 2020 Attendees (that have already registered): Your registration is valid and will be honored in September - no further action is needed.

  • Current Exhibitor and Sponsors: The dates for the Exhibit Hall Expo are September 9th - 10th. All Booth registrations and location assignments will remain the same

Additionally, the Hard Rock has informed us that any rooms that have already been booked under our group Room Discount Code (GOPS420 $79 discount), will be AUTOMATICALLY CANCELED. Please be advised, you WILL NOT NEED TO CALL HARD ROCK TO CANCEL. However, IF you booked a hotel rooms outside of the AROC group code, you will need to call Hard Rock to cancel. Hard Rock will provide NJAOPS new discounted group codes for the same $79 per night room rate in few weeks once operations have returned to normal.

We will keep you posted on any updates on these matters as soon as we receive confirmation. Please stay tuned for a follow up with confirmed dates in early September. We will have more updates to share, as we reconfirm aspects of our program and speakers.