Knowledge Base Article

MMP remains committed to continuing to monitor for COVID-19 updates specific to our reader base. This week we highlight key updates spanning from June 30th through July 6th.   

Resource Spotlight This Week: CMS Guidance Regarding Nursing Home and Hospital Visitation

CMS recently posted visitation guidance for hospitals and nursing homes on the CMS Current Emergencies webpage.

Nursing Home Visitation

First, on June 24th CMS posted the FAQ document discussing steps and recommendations for visitation in nursing homes. “Because nursing home residents are especially vulnerable, CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when:

• There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days (through phases one and two)
• The nursing home is not experiencing staff shortages
• The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents
• The nursing home has adequate access to testing for COVID-19
• Referral hospital(s) have bed capacity on wards and intensive care units” 

Hospital Visitation

Two days later on June 26, 2020 CMS released a document regarding hospital visitation during Phase II. CMS notes in the opening paragraph that “Because hospital patients are vulnerable to potential COVID-19 infection, CMS does not recommend completely reopening facilities to visitors until Phase III. However, CMS also recognizes the significant toll of separation of patients from family and other loved ones.

In collaboration with State and local public health authorities, hospitals should develop plans for visitors that both consider patient and public health safety, as well as the emotional and care needs of patients and their families who are facing illness or life-events in separation. As facilities enter Phase II, facilities may consider additional flexibilities so that patients and their families can visit.”

The remainder of this document is in the form of questions and answers related to moving forward with hospital visitation prior to Phase III.

June 25, 2020: AMA Announced New CPT code for COVID-19 Antigen Tests

According to AMA President Susan R. Bailey, M.D. in this AMA announcement, “The new CPT code for antigen testing to detect the coronavirus is the latest in a series of CPT codes developed in rapid response to the pandemic...Moving quickly during this crisis to meet the medical coding needs of the health care industry has enhanced the reporting of innovative tools now available to advance medicine's overarching goals of reducing the COVID-19 disease burden, improving health outcomes and reducing long-term care costs.”

New Category I CPT code:

• 87426: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

You can read the entire Press Release on the AMA website.

June 30, 2020: CDC Updates Training for Healthcare Professionals Webpage

Examples of topics available to Healthcare Professionals on this CDC webpage related to COVID-19 includes:

• Clinical Outreach and Communication Activity (COCA) Calls where you can learn the latest clinical information and guidance about COVID-19. Recent calls address infection control in nursing homes and dental settings, multisystem inflammatory syndrome in children (MIS-C0), and clinical perspective from across the nation’s healthcare systems.
• COVID-19 Prevention in Long-term Care Facilities
• COVID-10 Prevention in Hemodialysis Facilities
• Donning and Doffing PPE
• Optimization Strategies for Healthcare PPE
• COVID-19 in Animals

July 1, 2020: MLN SE20011 Medicare Response to Public Health Emergency on the COVID-19 Revised Again!

MLN article SE2011 is now in its’ ninth iteration. In this latest revision CMS revised the billing instructions for SNF. Changes include instructions to readmit the beneficiary on day 101 to start the Skilled Nursing Facility (SNF) benefit period waiver. All other information remains the same, for now.

July 1, 2020: New Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site

MLN article MM11836 initially released on June 12, 2020 and was updated on July 1, 2020 to reflect an updated Change Request (CR) that changes the implementation date to August 3, 2020. The CR announced a new Point of Origin (PoO) Code “G” to indicate a “Transfer from a Designated Disaster Alternative Care Site (ACS),” due to changes relative to the COVID-19 Public Health Emergency (PHE).

July 2, 2020: New OIG Work Plan Item – Use of Medicare Telehealth Services during COVID-19 Pandemic

Following is the detail regarding the new Use of Telehealth Services during COVID-19 Pandemic Work Plan Item:

• “In response to the coronavirus disease 2019 (COVID-19) pandemic, CMS made a number of changes that allowed Medicare beneficiaries to access a wider range of telehealth services without having to travel to a health care facility. Although these changes are currently temporary, CMS is exploring whether telehealth flexibilities should be extended. These two concurrent reviews will be based on Medicare Parts B and C data and will examine the use of telehealth services in Medicare during the COVID-19 pandemic. The first review will examine the extent to which telehealth services are being used by Medicare beneficiaries, how the use of these services compares to the use of the same services delivered face-to-face, and the different types of providers and beneficiaries using telehealth services. The second review will identify program integrity risks with Medicare telehealth services to ensure their appropriate use and reimbursement during the COVID-19 pandemic.”

There were also several Items related to COVID-19 added to the OIG Work Plan in June:

• A Review of Medicare Data to Understand Hospital Utilization During COVID-19,
• Trend Analysis of Medicare Laboratory Billing for Potential Fraud and Abuse with COVID-19 Add-on Testing,
• Medicaid Telehealth Expansion During COVID-19 Emergency,
• Audit of Foster Care Services During Coronavirus Disease 2019 (COVID-19),
• Meeting the Challenges Presented by COVID-19: Nursing Homes,
• Opioid Treatment Program Challenges During the COVID-19 Pandemic,
• Audit of Nursing Home’ Reporting of COVID-19 Information Under CMS’s New Requirements

July 2, 2020: FDA Warns Consumers about Dangerous Alcohol-Based Hand Sanitizers Containing Methanol

The FDA notes in this Press Announcement that they have seen an increase in hand sanitizer products labeled to contain ethanol (also known as ethyl alcohol) that have tested positive for methanol contamination. “State officials have also reported recent adverse events from adults and children ingesting hand sanitizer products contaminated with methanol, including blindness, hospitalizations and death. The agency continues to warn the public not to use specific products listed here and is communicating with manufacturers and distributors of these dangerous products about recalling them.”

July 5, 2020: CDC Health Advisory: Serious Adverse Health Events Associated with Methanol-based Hand Sanitizers

In the wake of the FDA’s warning to the public, the CDC posted an Official Health Advisory on Sunday July 5th highlighting the FDA’s June 19th warning to not use any hand sanitizer manufactured by “Eskbiochem SA de CV” in Mexico, due to the potential presence of methanol, a “toxic alcohol….which can cause blinding and/or death when absorbed through the skin or when swallowed.” This alert goes on to provide recommendations for Clinical and Public Health Officials as well as the general public.

July 6, 2020: Open Letter to the American Public Urging Simple Steps to Stop the Spread of COVID-19

The American Hospital Association (AHA), American Medical Association (AMA), and the American Nurses Association (ANA) posted an Open Letter to the American Public. This letter opens by noting that “Since the beginning of the COVID-19 pandemic, we have urged the American people to protect themselves, their neighbors and their loved ones amidst the worst global health crisis in generations.”

They drive home the fact that as the country has begun to “reopen” there has been “a dramatic uptick in COVID-19 cases” that is negating hard-won gains during the months of staying at home. According to the CDC as of July 6, 2020 the U.S. has had 2,886,267 total cases and 129,811 deaths. More significantly, from July 5th to July 6th there were 44,361 new cases and 235 deaths reported.

A key message in the letter is the urging for everyone to help stop the spread of the virus following three simple steps known to help:

• Wearing a face mask,
• Maintaining physical distancing, and
• Washing your hands.