Summary of the COVID-19 Emergency Temporary Standard (ETS) Rulemaking

On June 21, 2021, the Occupational Safety and Health Administration (OSHA) released an emergency temporary standard (ETS) rulemaking with the goal of protecting health care workers from occupational exposure to COVID-19 in settings where people with COVID-19 are reasonably expected to be present.  

As an ETS, the rule because effective when published on June 21, 2021.  Health care employers are required to be compliant with the sections of the rule on July 6, 2021, or July 21, 2021, depending on the provision.  

NRHA feels the timeline for compliance with this regulation is onerous.  Additionally, we believe the 916-page ETS is overly burdensome for rural providers, requiring health care employers to go above and beyond what many have already put in place following CDC guidelines such as social distancing barriers, patient screening, and a wholistic COVID-19 plan.  

Some requirements to note within the ETS include:  

  • Providers must develop and implement a COVID-19 plan  
  • Providers must limit and monitor points of entry to mitigate COVID-19 exposure  
  • Providers must ensure employees wear facemasks when indoors and when operating a vehicle with another person (this includes employees who are not directly caring for patients) and other restrictions on PPE  
  • Providers must require employees stay at least six feet apart from all other people when indoors except in situations where that is not possible 
  • Employer must install cleanable or disposable solid barriers at each fixed workstation located outside of direct patient care areas, where each employee is not able to be separated by all other people by at least six feet 
  • Provisions regarding proper ventilation with their heating, ventilation, and air conditioning (HVAC) systems to ensure that the amount of outside air circulated is maximized  

The ETS applies to a number of settings where suspected or confirmed COVID-19 patients are treated, including hospitals, home health care works, nursing homes, assisted living facilities, EM, and ambulatory care facilities.  It does not apply to settings where all employees are full vaccinated, non-employees are screened prior to entry and suspected or confirmed COVID-19 patients are not present.   

NRHA believes these regulations listed above will be particularly difficult for rural providers to comply with. Additionally, we have already heard from several members that they believe the facemask and social distancing requirements will run contrary to both the science and the current state and Federal guidelines for individuals who have been vaccinated. Further, implementing overly burdensome cleaning guidelines, installing physical barriers, and ensuring proper ventilation will be particularly difficult for rural providers already operating on slim margins. Health care providers could have used the PRF allocations to implement these kinds of regulations over the past 15-months, but instead OSHA implemented this rulemaking after the deadline for the majority of rural providers use of the funds.   

NRHA plans to submit comments on this ETS ahead of the July 21, 2021, deadline. In our comments, NRHA will urge OSHA to remove, or at a minimum delay, this regulation from taking effect. Health care providers have done an outstanding job of keeping their patients and employees safe throughout the COVID-19 pandemic. Adding a burdensome regulation like the ETS proposes will not protect patients or employees.  Rather it will pull limited staff and financial resources in directions that could be better used providing health care to patients during the ongoing pandemic. Further, NRHA believes the rule is being implemented at an unnecessary point in the pandemic. Providers have had COVID-19 protocols in place for over 15 months. Adding new regulations from OSHA at this time is not needed for patients and employers to feel safe in the health care setting.  

NRHA encourages members to comment on this regulation if you believe it will be overly burdensome to comply with, especially given the tight timeline turnaround. OSHA released a subsequent message saying they have determined that no changes to the ETS are necessary at this time, so we believe comments expressing the need for removal, or delay, of the regulation will be important to OSHA’s decision-making process. NRHA will share our comments for the regulation in the coming days so you can read them as a guidepost in crafting your own comments.  

You can find the rule posted on Regulations.gov here. Additionally, OSHA has posted related summaries, fact sheets, and compliance assistance materials and tools hereComments are due to the Federal Register by July 21, 2021.

Legislative and Policy Updates – June, 2021

The following represents various state and federal legislative and policy updates as of June 1, 2021.


State Update

Mississippi Medicaid has issued several policies that will affect rural clinics in Mississippi. Through an administrative procedures notice filing notice to the Secretary of State on May 20th, the notice highlights two main areas affecting clinics- an elimination of RHCs and FQHCs to perform EPSDT screening in the school setting, as well as a freeze of Medicaid payment rates. The latter of these is details on page 21 of the proposed Medicaid policy document under Rule 1.45: Reimbursement Methodology.

Given the potential impact that this may have with most Mississippi clinics, we highly encourage you to call-in and express comments during the open comment period on June 11, 2021 at 10 a.m. via the following telephone access information: 888-822-7517, access code 4282244.


Federal Updates

The Biden administration initially chose Memorial Day as the target date to decide which route to take on infrastructure: bipartisan or through reconciliation (the process to pass legislation in the Senate by 50 votes). On Thursday, a group of Senate Republicans announced a counterplan for $928 billion in infrastructure spending, much lower than the president’s $2.2 trillion plan. It is unclear which route the administration and Congress will take. NRHA continues to talk with offices on both sides of the aisle about the needs of rural providers. Key issues include the need for capital for rural hospitals, 100 percent broadband connectivity in rural areas, and the need for additional investment in the health workforce. You can read NRHA’s full letter to Congressional leadership here. NRHA will keep members up to date on infrastructure talks as they develop on Capitol Hill. 

Chiquita Brooks-LaSure Sworn in as CMS Administrator 

On Thursday, Chiquita Brooks-LaSure was sworn in as the Administrator of the Centers for Medicare and Medicaid Services (CMS).  She was confirmed by the full Senate on Tuesday by a vote of 55-44.

Senate HELP Committee Passes Rural MOMS Act

The Senate Committee on Health, Education, Labor, and Pensions (HELP) passed Senators Tina Smith (D-MN) and Lisa Murkowski’s (R-AK) Rural Maternal and Obstetric Modernization of Services (Rural MOMS) Act during this week’s executive session. Unfortunately, in rural America, pregnant women and new mothers have a significantly higher chance of dying from causes related to pregnancy and childbirth compared to their urban counterparts. This legislation provides needed investment in training and technology to offer greater maternal health services in rural America while taking significant strides to address the maternal mortality rate.

Important Federal Legislation to Watch

•          H.R. 341: Ensuring Telehealth Expansion Act of 2021- Williams (R-TX)

•          H.R. 769/S. 1491: Rural MOMS Act – Newhouse (R-WA); Smith (D-MN) 

•          H.R. 853: Closing Loopholes for Orphan Drugs Act – Welch (D-VT)

•          H.R. 1538: Binational Health Strategies Act of 2021 – Escobar (D-TX)

•          S. 104/H.R. 379: Improving Social Determinants of Health Act – Smith (D-MN); Barragan (D-CA)

•          S. 54: Strengthening America’s Health Care Readiness Act- Durbin (D-IL)

•          S. 368: Telehealth Modernization Act – Scott (R-SC)

•          S. 644/H.R. 1639: Rural Hospital Closure Relief Act – Durbin (D-IL); Kinzinger (R-IL)

•          H.R. 1887: Rural Hospital Support Act – Reed (R-NY)

•          H.R. 1783: Accessible, Affordable Internet for All Act – Clyburn (D-SC)

•          S. 773: A bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program, and for other purposes – Thune (R-SD)

•          S. 924: Rural America Health Corps Act – Blackburn (R-TN)

•          H.R. 2228: To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program – Kildee (D-MI)

•          H.R. 3259/S. 586: NOPAIN Act – Sewell (D-AL); Capito (R-WV)

•          S. 999: Save Rural Hospitals Act of 2021 – Warner (D-VA)

•          S. 1024/H.R.2255: Healthcare Workforce Resilience Act – Durbin (D-IL); Schneider (D-IL)

•          S. 620: KEEP Telehealth Options Act of 2021 – Fischer (R-NE)

•          H.R. 2454: To amend title XVIII to strengthen ambulance services furnished under part B of the Medicare program – Sewell (D-AL)

•          S. 1512/H.R. 2903: CONNECT for Health Act – Schatz (D-HI); Thompson (D-CA)

•          S. 165/H.R. 588: Stopping the Mental Health Pandemic Act – Smith (D-MN); Porter (D-CA) 



Funding Opportunities

HRSA Releases Rural Health Clinic Vaccine Confidence Program NOFO

On May 4, the White House announced they will make over $100 million available to support rural health clinics across the country to support vaccine outreach in rural communities. The Health Resources and Services Administration (HRSA) has announced the availability of the notice of funding opportunity announcement titled the Rural Health Clinic (RHC) Vaccine Confidence Program. The purpose of the program is to support rural health clinics as they work towards improving vaccine confidence, counter vaccine hesitancy, and help with access to the vaccination in rural communities that are experiencing low COVID-19 vaccination rates. Eligible applicants include Medicare-certified RHCs and organizations that own and operate Medicare-certified RHCs. HRSA has streamlined the application process. Every eligible RHC that applies will be funded. For further information on the NOFO, please visit Grants.Gov and for additional information regarding the program, please email RHCVaxConfidence@hrsa.gov.

HRSA Community-Based Workforce to Increase Vaccine Access

HRSA expects 121 awards with total funding of $121 million to expand the public health workforce at the local level in response to COVID-19. This includes mobilizing community health workers, patient navigators, and social support specialists to conduct face-to-face outreach to community members. Eligible applicants are local and/or regional community-based organizations applying as a single entity or as a network of partnering organizations. Applications are due June 9.

New Funding Available for the HRSA Telehealth Technology-Enabled Learning Program

HRSA expects to make nine awards of up to $475,000 each to connect specialists at academic medical centers with primary care providers in rural areas to improve patient care in their communities via new funding for the administration’s Telehealth Technology-Enabled Learning Program. More specifically, these learning opportunities will address unmet needs for their target population, which could include populations who have historically suffered from poorer health outcomes. Applications from public, private, and nonprofit entities are due on June 25. 

FDA  Approves Storage of Pfizer Vaccine for Up to One Month

The Food and Drug Administration (FDA) updated its guidance for healthcare providers administering the vaccine and allows for undiluted, thawed Pfizer-BioNTech COVID-19 Vaccine vials to be stored in refrigeration for up to one month. The previous time span was up to five days. 

RHC Payment Change and Sequestration Delay

Beginning on April 1st the Rural Health Clinic (RHC) per visit upper payment limit increased from $87.52 to $100. The increased upper payment limit is a direct result of the payment changes included in Section 130 of the Consolidated Appropriations Act of 2021. Some Medicare Administrative Contractors have already sent out letters to RHCs informing them of the increased upper limit and how it will affect their All-Inclusive Rate payments.

Meanwhile, on Capitol Hill, the House is expected to pass legislation after they return from recess (April 12th) that includes a grandfathering fix for RHCs and delays the resumption of a 2% Medicare sequestration cut until the end of 2021 that affects all providers.  The likely vehicle to do this is H.R> 1868.

While H.R. 1868 is not yet law, the expectation that this bill will pass is so strong that CMS announced that they will temporarily hold claims with dates of service on or after April 1, 2021, pending Congressional Action. This includes RHC claims that would have otherwise been subject to the 2% sequester reduction.

For context, when COVID-19 began last year, Congress temporarily waived the standing 2% across-the-board reduction in Medicare reimbursement (the sequester) until the end of 2020, and then later through March 31, 2021. H.R. 1868 will now extend this waiver through the end of 2021.

Specifically, section 2 of the Senate-passed version of H.R. 1868 contains the RHC grandfathering fix which will:

– Fix the grandfathering date for under 50-bed hospital RHCs from December 31, 2019, to December 31, 2020;

– Allow under 50-bed hospital entities that submitted applications to become an RHC by December 31, 2020, to be grandfathered-in; and

– Establish a methodology for setting the upper payment limits for grandfathered RHCs that did not have reimbursement in 2020.

RURAL HEALTH CLINIC CHANGES INCLUDED IN FINAL COVID BILL

During the final negotiations of the COVID relief package from late December, 2020, Sen. Chuck Grassley (Iowa) led efforts to include modified language from the Rural Health Clinic Modernization Act. This language was included in the final bill, which does the following:

  • Raises the Independent RHC cap to $100 on April 1, 2021, and set to rise each year thereafter to $190 by 2028.
  • Newly established RHCs would now also be subject to the increased cap, which means that no new RHCs (even those purchased or established by hospitals with less than 50 beds) could receive uncapped cost-based reimbursement.
  • Uncapped RHCs in existence today would be grandfathered-in at their current All-Inclusive Rate and would still see year-over-year increases but would be constrained to their current AIR plus an adjustment for MEI (the Medicare Economic Index).
  • RHCs will now be allowed to bill for hospice attending physician services.

Although this is great news for independent RHCs, this may come at the cost of our provider-based RHCs. It does not appear that any clinics will have a reduction in their all-inclusive rate, which is a very important positive factor. But, this new language will prevent hospitals from establishing new RHCs and receiving the more lucrative uncapped AIR. Again, it’s important to note that this will not affect the AIR that any provider-based clinics are currently receiving…they are grandfathered-in to this new policy.

The board and legislative committee of the Mississippi Rural Health Association will examine this language more closely and determine its effects to Mississippi clinics. Stay tuned for more information.

Rep. Sam Mims Awarded State Legislator of the Year by Rural Health Association

State Representative Sam Mims, District 97, was recently awarded the Mississippi Rural Health Association’s ‘State Legislator of the Year Award.’  This award is presented to one lawmaker each year for his or her work to advance healthcare policy in support of rural Mississippi.

Rep. Sam Mims

Representing Adams, Amite, Franklin, Pike Counties, Rep. Mims understands rural Mississippi very well.  Not only does he have a professional background in the healthcare field, but he has served as chair of the House Public Health and Human Services Committee for nine years.  In this role, Rep. Mims has advanced legislation related to reimbursement for services, expansion of telehealth, growth of broadband connectivity, support of emergency management services, and greater flexibilities of hospitals and clinics.

In 2020, Rep. Mims authored and passed legislation creating a new ‘Center for Rural Health’ within the Mississippi State Department of Health.  This new Center will allow efforts from the existing State Office of Rural Health and Primary Care to be magnified for obtaining grants and contracts from partner agencies.  It will also allow the office to better support rural hospitals and clinics with new payment methodologies and expanded ways to treat and provide access to patients.

Rep. Mims was awarded this recognition during the Mississippi Rural Health Association’s 25th Annual Conference, which was held as a virtual conference due to COVID-19 restrictions. 

For more information about this award or the Mississippi Rural Health Association, please contact the association at 601.898.3001.

HRSA E-mail to RHCs for COVID Reporting


We have received word that RHCs throughout Mississippi recently received this notification from HRSA via e-mail. This is a follow-up to the requested attestation for funding received by RHCs from the CARES Act. Please be sure to comply with the reporting requirements in order to not jeopardize the funding that you received earlier this year in support of COVID response.


Dear Rural Health Clinic Administrators and Managers,

You are receiving this email because the Federal Office of Rural Health Policy (FORHP) within the Health Resources and Services Administration (HRSA), recently compiled an email list (RHC-COVID-19-TESTING-PROGRAM) of Rural Health Clinic (RHC) administrators and managers in order to better communicate Rural Health Clinic COVID-19 Testing Program information and updates.

The Paycheck Protection Program and Health Care Enhancement Act authorized the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), to provide $225 million to RHCs for COVID-19 testing and related expenses. Beginning May 20, 2020, HRSA issued funding as one-time payments to RHC organizations of $49,461.42.

The terms and conditions for this program specify that, “The Recipient shall submit reports as the Secretary determines are needed to ensure compliance with conditions that are imposed on this Payment, and such reports shall be in such form, with such content, as specified by the Secretary in future program instructions directed to all Recipients.”  

To monitor and assess the program, HRSA has established a set of proposed measures that funded RHCs report back to HRSA at the Tax Identification Number (TIN) level. This brief set of proposed measures includes basic information on the RHC organization, the number of and location of testing sites (active and inactive), information on the use of funds, the total number tests conducted, and the number of COVID-19 positive tests. 

HRSA proposes to use this information to evaluate the effectiveness of the program at an aggregate level. As proposed, funded organizations must report the number of tests conducted and the number of positive tests on a monthly basis for the duration of the reporting period retroactively to May 2020. No personally identifiable, patient-level information is being requested.  

HRSA will be in contact with RHCs in the coming weeks with more information on the RHC COVID-19 Testing Reporting (RHC CTR) website, upcoming webinar, and other additional information. Please forward the email to the best contact for your RHCs COVID-19 Testing Program and cc: RHCCOVID-19Testing@hrsa.gov if you are the incorrect recipient. HRSA has funded the National Association of Rural Health Clinics to provide technical assistance to RHCs on the RHC COVID-19 Testing Program. If you have additional questions you may emailRHCcovidreporting@narhc.org.   

Trump Administration Announces Details of New Rural Health Model

The Centers for Medicare and Medicaid Services (CMS) recently unveiled the details of the Trump Administration’s long-awaited, new rural health payment model, the Community Health and Rural Transformation (CHART) Model. The CHART Model aims to, “[Unleash] innovation through new funding opportunities that will increase access and improve quality,” by allowing a limited number of rural health providers to participate in one of two tracks, the Community Transformation Track and the Accountable Care Organization (ACO) Transformation Track. According to CMS, this new model comes as a response to President Trump’s Executive Order on Improving Rural Health and Telehealth Access that was made on August 3rd, as well as the President’s Medicare Executive Order and CMS’s Rethinking Rural Initiative.

The Community Transformation Track will include up to 15 lead organizations. These lead organizations are entities representing a rural communities comprised of either a single county or a set of contiguous or non-contiguous counties. This track will create a $75 million grant program for the 15 organizations to share. This experimental track aims to give these up-front dollars to providers and allow them greater flexibility to create their own health care programs with a patient focus.

The ACO Transformation Track builds on the successes the very popular and successful ACO Investment Model (AIM) program. In this model, CMS will select 20 rural-focused ACOs to receive advanced payments to engage in value-based payment efforts aimed at improving outcomes and quality of care for rural beneficiaries. We are supportive of this new and exciting opportunity, but we also want to acknowledge that how CMS currently sets spending benchmarks disadvantages certain rural providers. Currently, CMS compares the per-patient costs of a region’s ACO with the operating expenses of its non-ACO competitors, but rural ACOs are often the only significant provider in their region. Thus, rural ACOs often face a much lower spending benchmark, because urban and suburban regions often have more non-ACO providers. We are calling upon CMS to fix this ‘rural glitch’ within the MSSP. This is a critical and common-sense step towards establishing greater payment for rural providers that are providing high quality care to their communities while decreasing health care spending. Unlike the earlier AIM program, participants in the ACO Transformation Track will enter into two-sided risk arrangements as part of the Medicare Shared Savings Program (MSSP), which could be a barrier to entry for many rural hospitals unwilling to bear risk without being able to define that risk completely. Additionally, a CHART ACO is limited to 10,000 covered lives which could increase actuarial volatility in participating in a dual-sided risk program.

The timeline indicates that a Notice of Funding Opportunity (NOFO) for the Community Transformation Track will be available in September on the Model Website and the Request for Application (RFA) for the ACO Transformation Track will be available in early 2021.

All Known Policies and Resource Updates Related to COVID-19

The Mississippi Rural Health Association has been working to develop policies and flexibility for providers in order to best protect themselves and meet the needs of their patients in a safe and effective manner.

We have provided an update, below, of all policy changes enacted by various state and national organizations related to COVID-19.  Please read carefully and call us at 601.898.3001 if you have any questions or need additional information.

Mississippi Division of Medicaid (DOM)

The Mississippi Division of Medicaid has added new procedure codes that can be used by providers and laboratories to bill for certain Coronavirus Disease 2019 (COVID-19) diagnostic to increase the testing and tracking of new cases.

The Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002 were developed by the Centers for Medicare and Medicaid Services (CMS), and DOM is in the process of entering them into its claims processing system. They should be available for billing later this week, and they will apply to dates of service on or after Feb. 4, 2020. Providers will be notified once the codes are available in the system.

The HCPCS code U0001 is specifically used for CDC testing laboratories to test patients for SARS-CoV-2. HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). The published fees for the two codes will be:

U0001 = $32.33

U0002 = $46.20

These fees do not include cutbacks, assessment fees, etc. Payment is not guaranteed.

For more information on the coverage or the evaluation and testing of COVID-19, find the following resources online:

Medicaid and CHIP Coverage and Payment Related to COVID 19

CDC Guidance on Evaluating and Testing Persons for COVID-19

Medicaid Updated Telehealth Regulations

In response to the coronavirus outbreak, the Mississippi Division of Medicaid (DOM) will expand its coverage of telehealth services throughout the state in alignment with Governor Tate Reeves’ recommendations on leveraging telemedicine to care for patients while limiting unnecessary travel, clinic visits and possible exposure.

Effective immediately through April 30, 2020, DOM’s Emergency Telehealth Policy will allow additional use of telehealth services to combat the spread of Coronavirus Disease 2019 (COVID-19). Details of enhanced services include the following:

  • A beneficiary may access telehealth services from his or her home.
  • A beneficiary may use his or her personal cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care with a qualified distant-site provider.
  • The requirement for a telepresenter to be present with the beneficiary is waived when the beneficiary receives telehealth services in the home.
  • Any provider that is eligible to bill DOM for services is now allowed to serve as a distant site provider, including Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
  • Any limitation on the use of audio-only telephonic consultations is waived.

These enhanced telehealth options will be available in fee-for-service Medicaid, Medicaid managed care, and the Children’s Health Insurance Program.

The agency also is seeking federal approval for an 1135 Medicaid waiver to give the program a wider range of flexibilities during the emergency. If approved, the 1135 waiver would give DOM the discretion, when necessary and proper, to relax prior authorization requirements, eliminate Preadmission Screening and Annual Resident Review (PASRR) reviews at nursing homes, suspend revalidations for current providers, and expedite new provider enrollment.

Other requested Section 1135 flexibilities include allowing care to be provided in alternative settings, revising rules for critical access hospitals, and relaxing telehealth security requirements so that providers can use readily available platforms like Facetime and Skype to facilitate telehealth visits with patients.

Additional information on policies, coding, and reimbursement related to the COVID-19 outbreak will continue to be added to a resource page on the agency’s website at https://medicaid.ms.gov/coronavirus-updates/.

Providers are asked to direct their questions to 800-884-3222.

Note: To confirm, this now allows RHCs and FQHCs to be a distance site provider for Medicaid-reimbursed telehealth in Mississippi.  

Blue Cross Blue Shield of Mississippi   NEW

In response to the COVID-19 pandemic, Blue Cross & Blue Shield of Mississippi is ensuring expanded access to care, to include enhanced telemedicine coverage. This is important given the nature of the COVID-19 outbreak and the Centers for Disease Control and MS State Department of Health direction to self-isolate, not use the emergency room and call your primary care provider. Effective March 16, 2020, the BCBSMS COVID-19 Pandemic Telemedicine Policy allows Healthcare Providers to provide medically necessary services that can be appropriately delivered via audio and/or visual consultation. The BCBSMS COVID-19 Pandemic policy is effective March 16, 2020 through April 30, 2020, and will be reassessed as needed.

Specific guidelines are noted below:

  • Telemedicine, in this Policy, is appropriate for visits for either low complexity, routine or ongoing evaluation and management for established patients, as well as addressing new and established patient needs related to COVID-19 symptoms.
  • Member cost-sharing (co-pays, deductibles, etc) and benefit levels will apply according to the Blue Cross and Blue Shield Member’s Health and Wellness Benefit Plan. BCBSMS will waive the co-pay for all Network Provider covered telemedicine visits for fully-insured Members.
  • For routine evaluation and management of established patients, Healthcare Providers (MDs, DOs and professional Allied Providers, such as Nurse Practitioners) may bill for established patient evaluation and management codes up to a Level 3 (CPT codes 99211, 99212 and 99213) with a place of service 02 (Telehealth), regardless if provided telephonically or using visual equipment. Please note, however, providers should only bill for telephonic visits when the provider speaks directly to the patient. Providers should not bill BBSMS for services when only office staff and/or a nurse speaks with the patient, regardless if a provider was consulted.
  • To address new patient needs relative to COVID-19 symptoms, Healthcare Providers (MDs, DOs and professional Allied Providers, such as Nurse Practitioners) may bill for new patient evaluation and management codes up to a Level 2 (CPT codes 99201 and 99202) with a place of service 02 (Telehealth), regardless if provided telephonically or using visual equipment. Please note, however, providers should only bill for telephonic visits when the provider speaks directly to the patient. Providers should not bill BCBSMS for services when only office staff and/or a nurse speaks with the patient, regardless if a provider was consulted.
  • Behavioral Health Providers (Psychiatrists, Psychologists, Licensed Professional Counselors, and Licensed Certified Social Workers) may bill for established patient visits and evaluation and management codes as follows with a place of service 02 (Telehealth): -CPT codes 99211, 99212 and 99213 – CPT code 90832
  • All services must be medically necessary and documented as part of the Member’s permanent health record, to include the amount of time spent with the patient. Patient must give consent to be treated virtually and/or telephonically and appropriately documented in the medical record prior to initiation of telemedicine.
  • This policy only applies to medically necessary visits that are patient-initiated or are replacing a previously scheduled visit.

Mississippi Board of Medical Licensure (MSBML)

The Mississippi Board of Medical Licensure created recent policy changes that are in effect during the Governor’s State of Emergency:

1. Providers are highly encouraged to utilize telemedicine whenever possible for treating patients to avoid unnecessary clinic visits and possible exposure

2. The Mississippi Board of Medical Licensure shall allow non-Mississippi licensed physicians to provide telemedicine within Mississippi

3. Urine drug screens are not required for controlled substances, but use of the MPMP is still enforced.

View all changes

Mississippi Board of Nursing (MSBN)

The Mississippi State Board of Nursing created recent policy changes that are in effect during the Governor’s State of Emergency:

1. APRNs are highly encouraged to utilize telemedicine whenever possible for treating patients to avoid unnecessary clinic visits and possible exposure

2. Non-Mississippi licensed APRNs with an unrestricted out of state licensure are allowed to provide telemedicine within Mississippi

3. Point of service drug testing is not required for controlled substances, but use of the MPMP is still enforced.

View all changes

Mississippi State Department of Health (MSDH)

Prior approval from MSDH for submission of samples to the Mississippi Public Health Laboratory is no longer required.

TESTING SITES: The MS State Department of Health has posted a list of testing sites on its website.

Centers for Disease Control and Prevention (CDC)

CDC Infection Control Guidance: This updated guidance from the CDC provides updated PPE recommendations for the care of patients with known or suspected COVID-19. (Detailed information available on the CDC site.)

  • Facemasks are an acceptable alternative to N95 respirators when respirators are unavailable in healthcare settings. Respirators should be prioritized for procedures that are likely to generate respiratory aerosols.
  • When an adequate supply of respirators is available in a healthcare facility, facilities should return to use of respirators per their respiratory protection program.
  • Continue to use eye protection, gown, and gloves.
  • If there is a shortage of gowns, they should be prioritized for aerosol-generating procedures, high contact patient care activities, and activities where splashes and sprays may occur.
  • Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients undergoing aerosol-generating procedures.

LabCorp

• LabCorp is accepting COVID-19 test orders and samples from physicians and other healthcare providers, clinics, and hospitals anywhere in the U.S. We are processing tests in the order received.

• COVID-19 tests can be ordered directly from LabCorp. We are not aware of any requirements that state or local health authorities must provide approval for LabCorp to perform testing. However, healthcare providers who are evaluating or treating patients under suspicion for COVID-19 may be required to coordinate with or provide information to their local or state health authorities. As noted above, testing should be conducted on appropriate patients in accordance with the latest

clinical guidance from the CDC and other expert organizations. Please check with those authorities for more information.

• LabCorp is reporting COVID-19 test information to public health authorities as may be required, but the ordering provider may also be required to report results and other information as well.

• CMS has established reimbursement in the amount of $51.31 for COVID-19 testing, and an HCPCS code for billing. LabCorp will use that rate for all customers, payers, and patients.

Please visit LabCorp’s COVID-19 website for the most current

Centers for Medicare and Medicaid Services (CMS)

Medicare will pay doctors and hospitals for a broad range of telehealth services on a temporary basis, effective March 6. The program will pay for office and hospital telehealth visits and include a wide range of providers including nurse practitioners, clinical psychologists and social workers. Telehealth visits will be reimbursed for the same amount as in-person visits.

CAH Swingbed Flexibility

CMS issued a Section 1135 waiver to allow CAHs and rural (non-CAH) swing-bed hospitals to move patients from their acute care beds to swing beds for extended care services without a 72-hour prior hospitalization. This clarification will help utilization review processes in rural hospitals to better maximize use of patient care beds.

Elimination of Geographic Restrictions

March 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telehealth services residing across the entire country. In addition, the beneficiary generally could not get telehealth services in their home

Services and Providers

Under this Section 1135 waiver expansion, a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, can offer a specific set of telehealth services. The specific set of services beneficiaries can get include evaluation and management visits (common office visits), mental health counseling, and preventive health screenings. Beneficiaries can get telehealth services in any health care facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

Diagnostic Billing Code Tookit

CMS recently published a telehealth toolkit to assist providers in the new telehealth policies and diagnostic billing codes.

Co-Pay Requirements Waives

The Office of Inspector General stated that if a provider wishes to waive collection of the 20% coinsurance, they can and the OIG will not consider this a violation of the anti-kickback rules. This is voluntary.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/factsheets/

Department of Health and Human Services (HHS)

During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies.  Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.

OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.  This notification is effective immediately.

This may include:

  • Facetime
  • Skype
  • Unencrypted Zoom / GoToMeeting, etc

This should not include:

  • Facebook live
  • YouTube
  • Other publicly facing streaming services

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CARES Act

As part of the CARES Act, Congress has authorized Rural Health Clinics to be the “distant site” for telehealth visits. Until now, RHCs could only be the originating site for these visits. CMS is working on the guidance necessary to allow you to begin submitting claims for these visits but you can begin doing these visits as of March 27th Providers may need to hold these claims until billing guidance is issued.

The CARES Act establishes a $100 billion grant fund exclusively for health care providers who are enrolled in the Medicare and Medicaid program. The purpose of this fund is to provide grants to healthcare providers who have experienced a reduction in revenue due to the COVID19 pandemic.

The CARES Act creates the Paycheck Protection Loan Assistance program which expands and modifies an existing Small Business Administration (SBA) Loan program. What makes this “loan” program unique is that the government will be able to FORGIVE all or most of this loan if the business does not terminate employees during the pandemic. If the small business uses the loan to cover monthly expenses such as: payroll, continuation of health benefits for employees, rent, mortgage, utilities and interest on other loans you may have, then that portion of the loan will be forgiven.