IHA Daily Briefing: May 19

Tuesday, May 19, 2020
CMS Issues Nursing Home Re-Opening Guidance
New Sections of MCO Billing Guide Available
HFS Releases Provider Notices
Illinois COVID-19 Update
National COVID-19 Update

CMS Issues Nursing Home Re-Opening Guidance
The Centers for Medicare & Medicaid Services (CMS) announced yesterday new guidance for state and local officials to ensure the safe reopening of nursing homes across the country. The guidance details critical steps nursing homes and communities should take prior to relaxing restrictions implemented to prevent the spread of COVID-19, including rigorous infection prevention and control, adequate testing, and surveillance. The vulnerable nature of the nursing home population requires aggressive efforts to limit COVID-19 exposure and to prevent the spread within facilities. The recommendations issued yesterday would allow states to make sure nursing homes are continuing to take the appropriate and necessary steps to ensure resident safety and are opening their doors when the time is right. According to CMS, this also serves to help states and nursing homes reunite families with their loved ones in a safe, phased manner.

CMS recommends that decisions on relaxing restrictions be made with careful review of the following facility-level, community, and state factors:

  • Status of COVID-19 cases in the local community;   
  • Status of COVID-19 cases in nursing homes;   
  • Adequate staffing;   
  • Baseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control for residents and visitors (e.g., face coverings);   
  • Access to adequate personal protective equipment (PPE); and   
  • Local hospital capacity.

CMS urges state and local leaders to regularly monitor the factors for reopening and can adjust their plans accordingly, depending on local data about the circulation of the virus in their community.

A CMS press release is available here. A CMS FAQ document is available here.  


New Sections of MCO Billing Guide Available
The Illinois Medicaid Managed Care Organizations (MCOs), in collaboration with the Illinois Association of Medicaid Health Plans (IAMHP), continue to release new and updated sections of its Comprehensive Billing Manual for Medical Assistance Program providers. This manual provides a single source of information for submitting claims to the managed care organizations (MCOs) by provider type.

New sections have been added for the following provider types:

  • Substance use prevention and recovery;
  • Dental;
  • Psychiatric free-standing hospital;
  • Rehabilitation hospital;
  • Long-term acute care hospital; and
  • Transportation.

Updated Sections in the Billing Guide include:

  • Inpatient hospital - coding guidance and value codes;
  • Community-based behavioral services - coding and billing guidance;
  • Claim disposition - claim dispute;
  • Outpatient hospital – non-APL billing;
  • Hospice - patient credit file and value codes;
  • Long-term care skilled nursing facility – patient credit file;
  • Supportive living facility – patient credit file; and
  • Inpatient hospital (general acute care and children's hospital) - abortion condition code.

HFS Releases Provider Notices
The Illinois Dept. of Healthcare and Family Services (HFS) issued a provider notice yesterday reminding healthcare providers that COVID-19 diagnostic testing and testing-related services free of charge to all Illinois residents, regardless of insurance status or immigration status, and has initiated a new eligibility category to reimburse providers for these services.Details are outlined in the notice.

Also yesterday, HFS issued a provider notice on temporary prior approval requirement changes for durable medical equipment and supplies providers and home health agencies related to COVID-19.

IHA is reviewing the notices and will provide additional information shortly.


Illinois COVID-19 Update
The Illinois Department of Public Health (IDPH) today announced 1,545 new COVID-19 cases and 146 deaths. The total number of cases in the state is 98,030 in 100 counties, with a total of 4,379 deaths. IDPH says that in the past 24 hours, 18,443 specimens have been processed. Statewide COVID-19 hospitalizations in the past 24 hours have decreased from 4,120 patients to 4,002 patients. Of that figure, 933 patients are in ICU with 576 patients on ventilators. The statewide seven-day rolling COVID-19 positivity rate is 14%.

At his daily press briefing, Gov. J.B. Pritzker said that all four Reopen Illinois regions are on track to move to phase three at the end of the month. He noted that since we are only 10 days away from moving in the next phase, all Illinoisans should continue to follow the stay-at-home order to remain on course.

The Governor’s office has released a set of video messages and radio announcements through the ‘All In Illinois' initiative that focus on the disproportionate impact of the COVID-19 pandemic in communities of color. Details and messages are in the press release.

The Illinois Department of Public Health (IDPH) has issued guidance clarifying that “healthcare facilities (including hospitals) should allow patients with intellectual and/or developmental disabilities or cognitive impairments to be accompanied by a support person determined to be essential to their care. Persons with disabilities should be provided reasonable accommodations that afford meaningful access to information and an equal opportunity to benefit from the treatment. Individuals with intellectual and/or developmental disabilities (I/DD) may require accommodations in a healthcare facility that include permitting the presence of a support person, such as a guardian, family member, caregiver, or paid support worker, that essential precautions can be taken to contain the spread of infection.” Additional details are in an Illinois Dept. of Human Services press release.

IDPH will hold a COVID-19 EMS Update on May 21 from 3:30-4:30 p.m. Details and registration are available here.

Yesterday, Chicago Mayor Lori E. Lightfoot joined co-founders of Community Organized Relief Effort (CORE), Sean Penn and Ann Lee, to provide an update on the city’s COVID-19 testing facilities, which are strategically placed throughout Chicago to target the neighborhoods most in need. The first two sites were Maria Saucedo Scholastic Academy, which opened on Wednesday, May 13, in the Little Village neighborhood and Dr. Jorge Prieto Math and Science Academy, which opened on Friday, May 15, in the Belmont Cragin neighborhood. Collectively these sites conducted over 800 tests in the less than one week they have been open. Yesterday, the City opened another testing site for symptomatic residents in Columbus Park located on the far West Side of Chicago. The remaining sites will have staggered launches over the next several weeks.


National COVID-19 Update
Current Centers for Disease Control and Prevention (CDC) figures show more than 1.5 million confirmed and presumptive positive cases of COVID-19 in the U.S. in 55 states and U.S. territories, with 90,340 deaths. New York state leads the nation with more than 347,000 cases, followed by New Jersey which has more than 146,000 cases. There are 29 states reporting more than 10,000 cases of COVID-19.

The latest WHO situation report shows more than 4.73 million COVID-19 cases globally, with over 316,000 deaths. The Region of the Americas (includes the U.S.) now leads the world with more than 2.08 million cases and over 124,000 deaths. The European Region, is second with more than 1.9 million cases and more than 167,000 deaths.