State Health and Value Strategies (SHVS), in partnership with Manatt Health, Georgetown’s Center on Health Insurance Reforms (CHIR), State Health Access Data Assistance Center (SHADAC), Bailit Health, and GMMB developed this resource page to serve as an accessible “one-stop” source of COVID-19 information for states. This resource is designed to support states seeking to make coverage and essential services available to all of their residents, especially high-risk and vulnerable people, during the COVID-19 pandemic. SHVS will update this page frequently with new resources as they become available.
| If you have materials you are willing to share with other states through this page, or if there are topics of particular concern that you would like addressed, please contact SHVS. |
HHS issued a fourth amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) to increase access to critical countermeasures against COVID-19. The fourth amendment makes two important changes. First, any licensed healthcare provider who is permitted to order and administer a Covered Countermeasure in any one state may now order and administer that Covered Countermeasure in any other state via telehealth, even if the provider is not licensed in the other state (subject to compliance with any rules established by the practitioner’s state of licensure). Second, the fourth amendment broadens the scope of protection afforded to all “covered persons” who manufacture, test, develop, distribute, administer, or use Covered Countermeasures (including those who provide telehealth services). Prior to the fourth amendment, PREP Act protection was limited to activities with a qualifying nexus to a government contract, grant, directive, or similar authorization. However, this broader protection applies only to on-label uses of a Covered Countermeasure; off-label uses, though common in the practice of medicine, would not qualify for the PREP Act’s liability shield absent a qualifying governmental nexus. HHS indicated that CMS will provide additional information on the implications of this Amendment for Medicaid and CHIP.
Describes the legal authority that permits states to continue to authorize Medicaid reimbursement for audio-only telehealth after the public health emergency ends
This document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. The November 25 update, following CMS’ November 25 announcement of expanded flexibilities under the Hospital Without Walls Program (“Program”), includes a waiver of the requirement at 42 CFR §482.23(b)(1) that requires hospitals to have a licensed practical nurse or registered nurse on duty at all times. The waiver applies only to ambulatory surgical centers (ASCs) enrolling as hospitals during the public health emergency (PHE) as part of the Program. Under the waiver, ASCs participating in the Program are required to provide 24-hour onsite nursing only when there is a patient present in the facility and may otherwise utilize a 24 hour on-call service for nursing coverage. The waiver authority applies only to federal requirements and does not supersede State requirements for licensure.
HHS issued a fourth amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) to increase access to critical countermeasures against COVID-19. The fourth amendment makes two important changes. First, any licensed healthcare provider who is permitted to order and administer a Covered Countermeasure in any one state may now order and administer that Covered Countermeasure in any other state via telehealth, even if the provider is not licensed in the other state (subject to compliance with any rules established by the practitioner’s state of licensure). Second, the fourth amendment broadens the scope of protection afforded to all “covered persons” who manufacture, test, develop, distribute, administer, or use Covered Countermeasures (including those who provide telehealth services). Prior to the fourth amendment, PREP Act protection was limited to activities with a qualifying nexus to a government contract, grant, directive, or similar authorization. However, this broader protection applies only to on-label uses of a Covered Countermeasure; off-label uses, though common in the practice of medicine, would not qualify for the PREP Act’s liability shield absent a qualifying governmental nexus. HHS indicated that CMS will provide additional information on the implications of this Amendment for Medicaid and CHIP.
FEMA issued guidance to state, tribal, and territorial (STT) governments on countermeasures they must implement to mitigate medical staff constraints prior to requesting supplemental medical staffing through FEMA. Specifically, STT governments must implement and attest to implementing the following measures prior to submitting any medical staffing requests to FEMA:
– Decompressing hospitals in the impacted area, executing only the most critical patient procedures and ceasing all elective procedures
– Maximizing coordination of healthcare providers internal to the state to balance patients and staff
– Expanding use of telemedicine
– Recalling retired clinicians and activating the Medical Reserve Corps
– Restructuring staffing models, staff-to-patient ratios, and licensing practices
– Communicating key staffing shortages and priority workforce needs to relevant partners, including the state workforce agency and the state unemployment Insurance office
– Implementing expanded scope of practice for pre-hospital care providers
– Soliciting medical volunteers through the National Governor’s Association or Emergency Management Assistance Compacts
HHS OIG issued a report summarizing its findings on the impact of the COVID-19 pandemic on opioid treatment programs (OTPs), derived from interviews with 142 programs through June 22. OTPs reported challenges related to:
(1) maintaining pre-pandemic service levels;
(2) managing impacts on facility operations;
(3) implementing and using telehealth;
(4) obtaining treatment medications, personal protective equipment, and cleaning supplies;
(5) maintaining patient participation in OTP activities;
(6) dealing with limitations posed by existing Federal guidance;
(7) providing take-home doses to patients; and
(8) implementing governmental guidance.
The report also itemizes the countermeasures that OTPs have taken since the COVID-19 pandemic, which include:
(1) encouraging or requiring various personal safety measures for patients and staff;
(2) implementing or expanding the use of telehealth to continue providing services;
(3) increasing the number of take-home doses to reduce the number of patients visiting facilities;
(4) making physical changes to facilities and increasing staffing flexibilities; and
(5) ensuring that patients received treatment medications.
The report is intended to support HHS’s goal of reducing opioid morbidity and mortality and to help SAMHSA by providing information on the impact that the COVID-19 pandemic has had on OTPs. However, HHS OIG acknowledged that the report reflects the challenges of OTPs as of June 2020 and may not reflect the current environment.
HHS’s Office of the Inspector General (OIG) released an updated list of its Active Work Plan Items reflective of OIG’s audits, evaluations, and inspections that are underway or planned in determination of providers’ compliance with temporary authorities during the COVID-19 public health emergency. The six newly-announced COVID-related work plan items include:
– Audit of HRSA’s Controls Over Medicare Providers’ Compliance with the Attestation, Submitted-Revenue-Information, and Quarterly Use-of-Funds Reporting Requirements Related to the $50 Billion General Distribution of the Provider Relief Fund.
– Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks.
– Audit of National Domestic Violence Hotline and Shelter-in-Place Orders During the COVID-19 Pandemic.
– Indian Health Service Use of Critical Care Response Teams To Support Health Care Facilities During the COVID-19 Pandemic.
– Public Health Actions Affecting Unaccompanied Children: Coordination Between CDC and the Office of Refugee Resettlement.
During this COCA Call,Presenters of this webinar discussed the intersection of telehealth and health equity and implications for health services during the COVID-19 pandemic. Presenters identified long-standing systemic health and social inequities that contribute to COVID-19 health disparities, while highlighting opportunities and limitations of telehealth implementation as an actionable solution.
As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Telehealth is an essential tool in ensuring patients are able to access the healthcare services they need in as safe a manner as possible. In order to provide our clients with quick and actionable guidance on the evolving telehealth landscape, Manatt Health has developed a federal and comprehensive 50-state tracker for policy, regulatory and legal changes related to telehealth during the COVID-19 pandemic.
Telehealth increases convenience for both the doctor and patient and decreases everyone’s risk of exposure to COVID-19. But telehealth also has limitations, the most obvious of which are that it does not allow for physical exams or lab tests. Less obvious though, is the potential of telehealth to exacerbate health disparities.
The second edition of the Health Equity Guide for Public Health Practitioners and Partners is intended to support practitioners and partners engagement in multifaceted approaches to addressing health equity.
During this COCA Call, Presenters of this webinar discussed the intersection of telehealth and health equity and implications for health services during the COVID-19 pandemic. Presenters identified long-standing systemic health and social inequities that contribute to COVID-19 health disparities, while highlighting opportunities and limitations of telehealth implementation as an actionable solution.
CCIIO updated its FAQs on risk adjustment for telehealth and telephone services during COVID-19. The FAQs clarify which telehealth and telephone service codes are valid for data submissions for the HHS-operated risk adjustment program.
Considering both the public health crisis and future patient needs, Families USA has assembled state policy recommendations around three themes: 1) improving telehealth financing and implementation models to increase reach; 2) removing provider barriers to increase access to telehealth; and, 3) bridging the digital divide to improve patient access to telehealth services.
FCC issued an updated notice of awards for the COVID-19 Telehealth Program, providing $29.4 million in 77 awards to providers in this tranche. As of June 24, the FCC has awarded $157.6 million to 444 health care providers in 46 states plus the District of Columbia. The CARES Act appropriated $200 million for the FCC to award to healthcare providers to purchase and adopt telecommunication technologies to support telehealth services for patients. FCC announces awards on a weekly basis.
FCC issued an updated notice of awards for the COVID-19 Telehealth Program, providing $23.3 million in 62 awards to providers in this tranche. As of June 17, the FCC has awarded $128.2 million to 367 health care providers in 45 states plus the District of Columbia.
On Friday, June 12 at 12:00 p.m. ET, State Health & Value Strategies hosted a webinar during which experts from Manatt Health and Georgetown reviewed the current telehealth policy landscape and considerations for states as they design their post-apex telehealth policies. This webinar included a question and answer session during which webinar participants posed their questions to the experts on the line.
FCC issued an updated notice of awards for the COVID-19 Telehealth Program, providing $20.2 million in 67 awards to providers in this tranche. As of June 10, the FCC has awarded nearly $105.0 million to 305 health care providers in 42 states plus the District of Columbia. The CARES Act appropriated $200 million for the FCC to award to healthcare providers to purchase and adopt telecommunication technologies to support telehealth services for patients.
FCC issued an updated notice of awards for the COVID-19 Telehealth Program, providing $16.5 million in 53 awards to providers in this tranche. As of June 3, the FCC has awarded a total of $85.0 million to 283 health care providers in 41 states plus the District of Columbia. The CARES Act appropriated $200 million for the FCC to award to healthcare providers to purchase and adopt telecommunication technologies to support telehealth services for patients. FCC announces awards on a weekly basis.
HRSA created a Coronavirus-related funding FAQ resource page for health centers, providing new information on required progress reports related to the receipt of Coronavirus-related funding awards. Progress reports must include narrative updates on activities related to testing, maintaining or increasing health center capacity and telehealth, among others. The first progress reports will be available for awardees starting July 1, with a submission date of July 10.
CMS released an updated toolkit on state actions to mitigate COVID-19 prevalence in nursing homes. The actions enumerated in the toolkit are sourced from healthcare providers, state governors, and other stakeholders and include topics related to cleaning/disinfection, reporting/guidance, testing, workforce and staffing, cohorting, establishing infection control “strike teams” and surveys, nursing home communications, procuring and improving utilization of personal protective equipment (PPE), housing and sheltering, addressing transportation needs, patient transfer, and telehealth (among others).
HRSA awarded $15 million to 52 Tribes, Tribal organizations, urban Indian health organizations, and other health services providers to Tribes across 20 states. HRSA made these CARES Act awards in response to applications submitted through the Rural Tribal COVID-19 Response (RTCR) program. Applicants could request up to $300,000 in funding and were assessed based on their needs and capacity to implement COVID-19 related activities in their rural communities
NHeLP has prepared a list of principles that states should consider as they enact Medicaid policy on telehealth, as underserved populations are not using telehealth as widely as other demographic groups
This Health Affairs blog post highlights states’ policy responses to the COVID-19 pandemic, as well as their proactive approaches to addressing a wide range of health concerns.
The FCC issued an updated notice of awards for the COVID-19 Telehealth Program, providing $16.9 million to 50 providers in this tranche. As of May 20, the FCC has awarded a total of $50 million to 132 health care providers in 33 states plus the District of Columbia.
CDC issued a set of health considerations for states, tribes, localities, and territories as they begin phased re-openings of summer camps, schools, youth sports organizations, institutes of higher education, restaurants, and bars. Considerations are framed as strategies to assist leaders with promoting healthy behaviors, environments, and operations as well as mitigation strategies in the event of incident COVID-19 cases.
On May 13, HRSA awarded $15 million to 159 organizations across five health workforce programs to increase telehealth capabilities in response to the COVID-19 pandemic. The funding will go towards training students, physicians, nurses, physician assistants, allied health and other high-demand professionals in telehealth.
FCC issued an updated notice of awards for the COVID-19 Telehealth Program. As of May 13, FCC has awarded a total of $33.26 million to 82 health care providers in 30 states. The CARES Act appropriated $200 million for FCC to award to healthcare providers to purchase and adopt telecommunication technologies to support telehealth services for patients. FCC announces awards on a weekly basis.
CMS issued an interim final rule with comment period (IFC) that provides additional flexibilities for Medicare, Medicaid, and Exchange coverage programs as a result of COVID-19 and also implements regulations in response to recently enacted stimulus legislation.
CMS issued an interim final rule with comment period (IFC) that provides additional flexibilities for Medicare, Medicaid, Basic Health Program, and Exchange coverage programs as a result of COVID-19 and also implements regulations in response to recently enacted stimulus legislation. The IFC is scheduled to be published in the Federal Register on May 8. Public comments will be accepted for 60 days following posting to the Federal Register.
This updated document outlines COVID-19 emergency declaration 1135 “blanket waivers” for healthcare providers and is regularly updated by CMS. The April 30 updates add new telehealth-related flexibilities, relax physical environment requirements for providers, and make changes to a number of policies related to Community Mental Health Centers and long term care providers.
Louisiana issued comprehensive telehealth guidance for its providers and MCOs. Louisiana Medicaid allows for the telemedicine/telehealth mode of delivery for several common health care services during the COVID-19 emergency.
This expert perspective summarizes the federal legislation and guidance and discusses actions state departments of insurance can take to encourage greater access to telehealth services.
FCC approved its fourth set of COVID-19 Telehealth Program applications, distributing an additional $4.2 million. FCC has awarded $13.7 million to date under the program, which allows for up to $200 million in funding, and continues to approve applications on a rolling basis.
CMS released a new toolkit for states to help accelerate adoption of broader telehealth coverage policies in the Medicaid and CHIP during the COVID-19 public health emergency.
HRSA announced nearly $165 million in awards to rural communities, including to support 1,779 small rural hospitals, and 14 HRSA-funded Telehealth Resource Centers (TRCs) providing technical assistance on telehealth in rural and underserved areas.
Webinar recording and slide deck from webinar hosted on March 18, 2020.
Medicaid program guidance allowing telemedicine to be provided and billed for payment when delivered via the school-based services program for counseling and occupational, physical and speech therapy.
This FAQ answers common provider questions regarding the provision of methadone and buprenorphin, including through the use of telehealth, for the treatment of opioid disorder during the COVID-19 crisis.
North Carolina website cataloging guidance on telehealth expansion during COVID-19, including recent policies related to enhanced behavioral health services, optometry services, postpartum care visits, and even self-measured blood pressure monitoring.
Medicaid memo to providers summarizing changes to program requirements, including expansion of telehealth coverage, provider licensure, and prior authorization for services, during the COVID-19 crisis. Content on behavioral health was updated in a subsequent memo.
TennCare Guidance on EPSDT/Well Child Visits during COVID-19
The FCC has established two new programs: 1) The COVID-19 Telehealth Program under which the FCC will distribute $200 million in CARES Act funding to help health care providers offer connected care services to patients at their homes or mobile locations, and 2) the Connected Care Pilot Program, which will also support connected care services to consumers, particularly for low-income Americans and veterans, with up to $100 million over three years.
This memo clarifies a section of the earlier Medicaid provider memo on flexibilities offered to providers of behavioral health and addiction and recovery treatment.
Guidance from New York State Office of Mental Health on adult Continuing Day Treatment (CDT) program expectations, changes in documentation requirements during the disaster emergency period, and reduction or elimination of minimum billing requirements.
North Carolina (NC) Medicaid released new telehealth guidance expanding the services and provider types eligible to deliver telehealth during the COVID-19 pandemic. This special bulletin expands telehealth codes and guidance to services delivered through local education and children’s developmental service agencies, and services pertaining to dietary evaluation and counseling, medical lactation, research-based behavioral health treatment for autism spectrum disorder, and diabetes self-management education. They published an accompanying billing code summary to equip providers with the new codes pertaining to telehealth.
Florida has issued COVID policies for contracted Medicaid MCOs, including this one on Telehealth coverage during the pandemic
Guidance from New York State Office of Mental Health on Assertive Communty Treatment (ACT) program expectations, changes in documentation requirements during the disaster emergency period, and the reduction or elimination of minimum billing requirements.
Illinois released guidance on the use of Live Video Visits, or teletherapy for the delivery of early childhood intervention services.
Guidance from Tennessee’s Medicaid agency (TennCare) on faciliating and billing for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and well child visits, including through the use of telemedicine.
This expert perspective, written by experts at Manatt Health, discusses strategies state Medicaid and CHIP agencies can pursue as part of their response to COVID-19.
FAQs include HRSA’s guidance for health centers related to COVID-19, which is updated on an ongoing basis. 4/7 updates to FAQs include guidance on infection control/prevention for health centers, health center obligations for paid sick leave/other benefits for staff, liability protections for volunteer providers, permissible adjustments to operating hours, telehealth, and scope of practice.
New guidance from CMS outlines a host of blanket waivers and flexibilities that the Administration is affording to healthcare providers. The release communicates 1135 blanket waivers issued in previous weeks as well as new waivers announced on 4/9/2020, including new flexibilities such as allowing doctors to care for patients across state lines via telehealth.
CMS releases an FAQ in support of communicating key changes outlined in the Medicare Interim Final Rule issued on 3/31/2020. Topics in the FAQ include payment for specimen collection, hospital services, ambulance services, RHCs, FQHCs, telehealth, and physician services.
Guidance from Massachusetts related to the provision of early intervention services during the COVID-19 crisis.
This analysis describes flexibilities given to providers under Section 1135 waivers, such as enabling providers to deliver care in alternate care settings and expand workforce capacity.
In response to the COVID-19 pandemic, Washington State is offering a limited number of free Zoom videoconferencing licenses to providers to help providers continue seeing patients using telehealth technology.
This page includes guidance and templates for the Medicaid State Plan Disaster Relief SPA and CHIP Disaster Relief SPA.
This resource provides guidance for health care providers on the provision and billing of services telehealth, including telephone and video conferencing
This resource provides guidance for health care providers on the provision and billing of services telehealth, including telephone and video conferencing
CMS issues guidance for clinicians on flexibilities related to accelerated/advance payments, telehealth services, COVID-19 testing, and claims process modifications during the COVID-19 public health emergency.
CMS released an interim final rule with comment period that proposes several changes to the Medicaid and Medicare programs. For the Medicaid program, the rule amends health home regulations by allowing other licensed practitioners to order home health services, without physician sign-off.
This comprehensive resource page on COVID-19 guidance includes multiple funding opportunities to support telehealth for behavioral health services, naloxone distribution, and Opioid Treatment Program facilities.
NC developed a Special Bulletin detailing the changes to its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care.
This letter to behavioral health managed care plans outlines efforts from NC DHHS to provide flexible funding to stabilize providers and respond to the changing needs of consumers.
This guidance allows practitioners further flexibility in prescribing and dispensing buprenorphine to new and existing patients with opioid use disorder via telephone without examination in person or via telemedicine.
This memo includes flexibilities to expand telehealth coverage and waive certain program requirements in light of the public health emergency, including specified service authorization and prescription drug limitations.
CCIIO FAQs on telehealth coverage
CMS released guidance for rural health care and Medicaid agencies on telehealth flexibilities provided by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act.
This guidance allows OTPs to make “door stop” deliveries for medications for opioid use disorder in a lock-box for patients under quarantine.
This guidance allows OTPs to make “door stop” deliveries for medications for opioid use disorder in a lock-box for patients under quarantine.
This guidance allows prescribers and practitoners to issue time limited prescriptions of schedule II drugs via oral communication (e.g., telephone) under limited circumstances.
This guidance allows practitioners to dispense schedule II-IV drugs (including methadone, buprenorphine and opioids) not only in their home states but also in states with which their home stateshave reciprocity.
Compilation of COVID-19 FAQs on private insurance issues.
Recordings and transcripts of CMS calls on COVID-19 with states and other stakeholders
Compilation of resources for state on Medicare, Medicaid, and CHIP, including transcripts and recordings of all-state calls
This order allows pharmacists and pharmacy interns to administer methadone and buprenorphine for the treatment of opioid use disorder.
This memo provides interim guidance to assist Opioid Treatment Programs with providing medications to patients, aligning state policy with federal take home exceptions of 14 and 28 days.
This FAQ provides guidance to narcotic treatment programs, including information on services that may be provided by telehealth.
MA developed a managed care plan bulletin that outlines requirement’s for coverage and billing related to COVID-19.
This FAQ includes guidance for behavioral health providers, partners, and the greater community to develop coordinated prevention and response plans for COVID-19.
Interactive 50-state map on state DOI actions re: COVID-19
NY established telehealth reimbursement parity in Medicaid programs during the state of emergency.
NY allowed out-of-state providers and providers in New York that are not currently registered to provide telehealth services.
MS Mississippi State Board of Medical Licensure has waived state licensure restrictions to allow out-of-state physicians who already have a pre-existing doctor-patient relationship to treat patients in Mississippi through telemedicine.
NY waived cost-sharing for telehealth visits with in-network providers.
MS submitted a Medicaid State Plan Amendment Telehealth Emergency Waiver to allow for telehealth service flexibilities during a state of emergency.
MS Division of Medicaid is allowing beneficiaries to access telehealth services from home; promoting the use of personal cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care; and waiving limitation of the use of audio-only telephonic conversations until April 30, 2020.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
In MA, through executive order, Governor Baker expanded access to telehealth services in all commercial insurers and MassHealth programs, waived all cost-sharing for any medically necessary treatment delivered via telehealth related to COVID-19 at in-network providers, waived any prior authorization barriers needed to obtain medically necessary telehealth services, and established a 24-hour process to allow medical professionals to receive a license to practice in Massachusetts
This page includes guidance and a template for COVID-19 1115 waiver demonstrations.