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Medical Rehab

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Protecting our staffs, our residents in our facilities, and our communities are paramount as we face this public health issue. VitalCore Health Strategies has created a protocol response plan that provides a very clear COVID-19 pandemic response plan and we hope you find this document beneficial for the health and safety of your facility.

The response plan is based on current guidance from the Centers of Disease Control and Prevention (CDC). It provides an outline for infection prevention and control information that should be considered for facilities related to a COVID-19 response. Please keep in mind that the CDC’s guidance may continue to change so this plan may require updating. Please continue to visit the CDC’s website for updates. If you have any additional questions, please contact your RCPA Policy Director.

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Text of March 18 press release.

Harrisburg, PA — Health care professionals licensed under any of the Department of State’s Bureau of Professional and Occupational Affairs (BPOA) licensing boards can provide services to patients via telemedicine during the coronavirus emergency.

“Telemedicine provides health care professionals flexibility to continue treating their patients while following best practices on social distancing as outlined by the Department of Health,” Secretary Boockvar said. “The department requested, and Governor Wolf granted us, the authority to allow health care professionals from out-of-state to treat Pennsylvania residents using telemedicine, when appropriate, due to COVID-19.”

This new guidance applies to the following boards:

o Chiropractic
o Dentistry
o Medicine
o Nursing
o Optometry
o Pharmacy
o Podiatry
o Psychology
o Osteopathic Medicine
o Nursing Home Administrators
o Occupational Therapy Education and Licensure
o Physical Therapy
o Social Workers, Marriage and Family Therapists, and Professional Counselors
o Examiners in Speech-Language Pathology and Audiology
o Veterinary Medicine

Currently, no Pennsylvania law prohibits the practice of telemedicine.

Additionally, the department is working with the Governor’s office, the Department of Health, and Department of Human Services to identify regulations and requirements that can be suspended to give medical providers and facilities the flexibility they need to respond to the crisis. We will publish these notifications on our website as they become available.

Governor Wolf also granted the department’s request for a suspension to allow licensed practitioners in other states to provide services to Pennsylvanians via the use of telemedicine, without obtaining a Pennsylvania license, for the duration of the emergency. Out-of-state practitioners must:

o Be licensed and in good standing in their home state, territory, or country.

o Provide the Pennsylvania board from whom they would normally seek licensure with the following information prior to practicing telemedicine with Pennsylvanians:
• their full name, home or work mailing address, telephone number and email address; and
• their license type, license number or other identifying information that is unique to that practitioner’s license, and the state or other governmental body that issued the license.

Please submit the information requested above to the appropriate board resource account listed on the BPOA website.

All practitioners using telemedicine in Pennsylvania must remain informed on all federal and state laws, regulations and guidance regarding telemedicine, including a practitioner’s obligations under the Health Insurance Portability and Accountability Act (HIPAA) and recent guidance provided by the U.S. Department of Health and Human Services.

Authorization to engage in telemedicine from a professional licensing standpoint is separate and apart from any insurance coverage/payment issues that fall under the Department of Health, the Department of Human Services, the Department of Insurance, or any other state or federal agency.

The Department of Human Services issued guidance for Behavioral Health Services Telemedicine here. The Department of Drug and Alcohol Programs released Telehealth guidance for their programs and providers here.

Questions, please contact Jack Phillips.

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RCPA has been hearing from members regarding supplies they need to combat the COVID-19 epidemic. We have heard from members that they are running short on masks/respirators, hand sanitizers, gloves, etc. Regarding masks/respirators, RCPA understands there is a shortage of these items. Providers are in need of masks/respirators to take care of residents in group homes, inpatient facilities, etc. If a resident in one of these facilities is stricken with COVID-19, then staff will have to follow CDC protocol and be required to use masks/respirators. If providers do not have any to give to staff, then providers will have to transport the resident to the hospital. We understand hospitals would rather keep individuals in their current location.

In most instances, providers are working with their local hospitals to get masks/respirators, but there are limited quantities, if any. To try and combat this shortage, providers should contact their County Emergency Management office. RCPA understands that the mask/respirator issue is a major concern for providers and we are working with our state partners for assistance.

If providers are experiencing any other shortages such as medicine, food, or other supplies, please contact a member of the RCPA staff as soon as possible or as needs arise, so we can inform the applicable state agency. Questions, please contact Jack Phillips.

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In response to President Trump’s declaration of a National Emergency on March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) issued blanket emergency waivers (known as 1135 waivers) to certain Medicare regulations that include rules for post-acute care (PAC) providers. Included in these post-acute waivers:

Inpatient Rehabilitation Facilities (IRFs):
Waiver of 60 Percent Rule: CMS is waiving requirements to allow IRFs to exclude patients from the hospital’s or unit’s inpatient population for purposes of calculating the 60 percent rule, if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such. CMS will also, during the applicable waiver time period, apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain classification as an IRF.

Acute Care Patients in IRF Units: CMS is waiving requirements to allow acute-care hospitals to house acute-care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute-care inpatient. The Inpatient Prospective Payment System (IPPS) hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute-care inpatient being housed in the excluded unit because of capacity issues related to the disaster or emergency.

Rehabilitation Patients in Acute Care Beds: CMS is waiving requirements to allow acute-care hospitals with excluded distinct part inpatient rehabilitation units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct part rehabilitation unit to an acute-care bed and unit. The hospital should continue to bill for inpatient rehabilitation services under the inpatient rehabilitation facility prospective payment system (IRF PPS) for such patients and document in the medical record to indicate the patient is a rehabilitation inpatient being cared for in an acute-care bed because of capacity or pressing circumstances related to the disaster or emergency.

Skilled Nursing Facilities (SNFs): CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay. CMS is also providing relief to SNFs on the timeframe requirements for Minimum Data Set (MDS) assessments and transmission.

Home Health Agencies: CMS made adjustments to the timeframes for Home Health Agencies for OASIS transmissions. In addition, Medicare Administrative Contractors (MACs) have been granted permission to extend the auto-cancellation date for Requests for Anticipated Payment (RAPs) during emergencies.

CMS also made it clear that they will accept and review provider-specific requests for relief on a case-by-case basis and have provided additional information regarding how to apply for a waiver.

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Harrisburg, PA – To help make the public aware of COVID-19 preparedness and procedures, the Wolf Administration has created a library of free outreach materials for businesses, organizations, and anyone interested in displaying important messaging on COVID-19.

The materials are available at PAcast.

“The goal is for everyone to have access to and be encouraged to share the information important to stopping the spread of COVID-19,” Gov. Wolf said. “Please help us share awareness while using caution and protecting yourself.”

Posters are available in multiple sizes and every Pennsylvanian is encouraged to make them accessible to their community of friends, community or religious group members, and business associates to print and post. The administration also expects the posters to be available in newspapers across the state for residents to tear out and post throughout their communities.

Properly sized graphics are available at PAcast for social media. Gov. Wolf also encourages everyone to make use of COVID-19 social media content on the Pennsylvania Department of Health’s Facebook and Twitter pages.

The most up-to-date information, including video graphics, footage of all of the governor’s press conferences and b-roll, is also available at 08PAcast. Additional materials will be added to the library as they become available and as the situation evolves.

MEDIA CONTACT: Lyndsay Kensinger, 717-783-1116

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The Wage and Hour Division (WHD) provides information on common issues employers and employees face when responding to influenza, pandemics, or other public health emergencies, and their effects on wages and hours worked under the Fair Labor Standards Act, and job-protected leave under the Family and Medical Leave Act.

Use this link to view the recently posted guidance on WHD’s website.

Also, the Department issued a press release with links to this guidance, as well as guidance from OSHA and OWCP.

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Over the past several days, RCPA has been in contact with numerous DHS and Department officials to brainstorm issues and ideas in this time of crisis. There have been some emergency relief efforts already released (e.g., ODP, OCYF), and there are no doubt more to come from other departments.

Many providers have also brought their ideas to RCPA and we have, in turn, incorporated them in submissions to DHS.

Most importantly, we are emphasizing the following:

  • This is not “business as usual.” If there was ever a time to put aside standard rules and operations, it is now.
  • The Governor has declared this an “emergency.” So let’s take emergent action.
  • Waive rules around alternative ways to reach out to individuals, such as paying for all telehealth and telephonic contact.
  • Implement alternative payment mechanisms (e.g., via BH-MCOs) to allow providers to do what is necessary to outreach to individuals and keep them engaged.
  • Understand that if traditional services decrease (e.g., program closures, increased no- shows), then billable units disappear along with cash flow. Measures need to be taken immediately to ensure that agencies are solvent and services – even non-traditional – are available for consumers.

We are also urging as streamlined an approval process as possible. It is a fluid situation and we cannot wait days, let alone weeks, to discuss these ideas.

If any providers have specific ideas or suggestions, please reach out to RCPA and we can, in turn, bring them forward. We are hopeful that our discussions with DHS will lead to some creative and critically needed solutions.

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