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March 26, 2020
Senate Passes the Coronavirus Aid, Relief, and Economic Security (CARES) Act
Legislation includes provisions important to hospitals and health systems. Read more.
DHHS Information
Medicaid and Long Term Care
Q: Is written patient consent required prior to treatment via telehealth?
A: There is currently an emergency situation in effect in Nebraska related to COVID-19. This means written consent is not required prior to providing a treatment or service via telehealth, although obtaining written consent should occur when possible. The provider must document the reason the written consent was unable to be obtained. Even though written consent is not required to be obtained during this emergency situation, the patient must receive the following information verbally:
● Patient has the option to refuse telehealth without affecting patient’s right to future care
● Provider must inform the patient all existing confidentiality protections shall apply to service being provided by telehealth
● Sharing of any patient identifiable images or information from the telehealth visit to researchers or other individuals will not occur without the consent of the patient. If a patient does not want to receive treatment or services through telehealth the provider shall assist the patient in finding alternative care. All other, non-telehealth, consent practices remain in effect at this time. A parent or legal guardian may give the verbal consent for telehealth treatment or service.
COVID-19 FAQs
DHHS Informational Calls for Infection Prevention Guidance - Acute Healthcare Facilities

Mondays, Wednesdays and Fridays (recurring) | 12:00 - 1:00 p.m. CT
Dial-In Number: (415) 655-0003
Meeting Number: 924 627 702
Meeting Password (for Webex Link): ACU20

AHA News/Updates

Earlier this week the National Uniform Billing Committee (NUBC) approved the use of the “DR” (disaster related) condition code for services related to the COVID crisis, including services where the patient ultimately tests negative. When documented along with appropriate clinical codes and appropriate date of service – as far back as Jan 27 when the HHS Secretary declared a public health emergency – claims with the DR condition code can be accurately identified as COVID surge-related. NUBC also issued guidance on coding for hospitals utilizing off-campus testing locations.
View the announcement.
Additional resources and information:
DOL answers common COVID-19 workforce questions
The Department of Labor has released information on common issues employers and employees face when responding to COVID-19, and its effects on wages and hours worked under the Fair Labor Standards Act, job-protected leave under the Family and Medical Leave Act, and paid sick leave and expanded family and medical leave under the Families First Coronavirus Response Act. The new law allows employers of health care providers or emergency responders to elect to exclude such employees from eligibility for the leave provided under the Families First Coronavirus Response Act.
CMS grants more Section 1135 waivers; total up to 23 states nationwide. The Centers for Medicare & Medicaid Services says it has granted Section 1135 Medicaid waivers to an additional seven states. Nationwide, 23 states have been provided this accommodation, which generally provides relief from prior authorization and provider enrollment requirements, allows the suspension of certain nursing home pre-admission reviews and helps facilitate reimbursement to providers for care delivered in alternative settings due to facility evacuations.
Providers may request COVID-19 investigational treatment for sickest patients. The Food and Drug Administration is investigating whether convalescent plasma from recovered COVID-19 patients contains viable antibodies to treat SARS-CoV-2 in the sickest patients. While FDA trials continue, providers may request the plasma for investigational use in patients with the most serious and life-threatening COVID-19 infections. For more information, visit www.fda.gov.
AHA issues resource on FEMA's simplified public assistance application. The Federal Emergency Management Agency is simplifying its public assistance program application process for eligible state, territorial, tribal, local government entities and certain private non-profit organizations. To assist hospitals and health systems better understand the process of applying for public assistance funding, the AHA worked with Jones Day to produce an Advisory with additional details.
CMS Updates
CMS adds enforcement flexibility for exchanges' COVID-19-related payment decisions. The Centers for Medicare & Medicaid Services yesterday issued an FAQ to outline COVID-19-related payment and grace period flexibilities for issuers offering coverage on the federally-facilitated exchanges and state-based exchanges on the federal platform. The agency says it will "exercise enforcement discretion" if issuers extend premium payment deadlines and delay cancellations or terminations of coverage for non-payment of premiums, assuming these are done with the permission of applicable state regulatory authorities. CMS also is encouraging state-based exchanges to take a similar approach. CMS also released the following FAQs:
CMS provides information on 6.2% FMAP increase as part of recently-approved legislation. The Centers for Medicare & Medicaid Services issued an FAQ to address a temporary 6.2% increase to qualifying states' and territories' Federal Medical Assistance Percentage, enacted as part of the Families First Coronavirus Response Act signed into law on March 18. The document outlines the requirements states must meet for eligibility for the FMAP increase.

Hospital News

Provider at Children’s Hospital & Medical Center receives positive test for COVID-19
All patient families & staff have been contacted and appropriate precautions taken
Omaha - A provider who worked at Children’s Hospital & Medical Center over the weekend has received a positive test for COVID-19. The provider was working in Children’s Neonatal Intensive Care Unit and had contact with 10 patients. The families of patients and staff members who came in contact with this person have been contacted and advised on the proper precautions they should take. Read more.
Governor's Office
Gov. Ricketts adds Lancaster, Saunders, and Dodge to Directed Health Measure for Cass, Douglas, Sarpy, & Washington Counties   
LINCOLN – On Wednesday, Governor Pete Ricketts announced that the state’s second COVID-19 related Directed Health Measure (DHM) includes Lancaster, Dodge, and Saunders counties, which will be in effect until May 6 unless renewed.  Washington County will also now be under a DHM until May 6. Read more.

LIVE Town Hall Thursday at 7 p.m. CT
Nebraska Gov. Pete Ricketts will answer questions during a one-hour NET News town hall meeting about COVID-19 and our state’s response.
This special episode of the discussion program "Speaking of Nebraska" will air Thursday at 7 p.m. CT on NET, NET Radio, and streaming online. 
Along with Gov. Ricketts, questions will be answered by Dr. Gary Anthone, chief medical officer for the Nebraska Department of Health and Human Services and Dr. Matthew L. Blomstedt, commissioner of education for Nebraska.
Submit your questions in advance OR call in during the program to ask your question: 800-676-5446 

CDC Guidance 

Coronavirus Update: CDC Updates Guidance on Discharging Patients with COVID-19
The Centers for Disease Control and Prevention (CDC) March 23 clarified that patients with COVID-19 can be discharged from a health care facility when clinically indicated. This information can be found under the blue heading, Disposition of Patients with COVID-19. For such patients, a discharge does not require that the patient meet CDC criteria for the discontinuation of COVID-19 transmission-based precautions (TBP). The discontinuation guidance also was updated yesterday and is posted on the CDC’s website under the blue heading, Discontinuation of Transmission-based Precautions for Patients with COVID-19.
Read more.

Quality/PPE

Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak

Business/Economy

Employment and HR Resources
Baird Holm | Cline Williams | LMC
Cybersecurity
Defending Against COVID-19 Themed Cyber Threats
There has been a significant increase in cyber threats since the COVID-19 pandemic. Given the increase in malicious activity, we believe this increases the overall risk posed as more hospitals enforce remote working, which creates increased exploitable opportunities for cyber criminals.  
Recommendations:
Be wary of unsolicited and COVID-19 themed emails or SMS (text) messages from untrusted users and be on the lookout for messages impersonating legitimate government agencies or organizations and attempting to lure recipients taking immediate action.
Abstain from opening any file attachments or clicking on any embedded hyperlinks, especially when the sender requests the receiver to visit a suspicious-looking site requesting personally identifiable information or other sensitive and confidential information. It’s always best to navigate to the legitimate website by typing the correct address into a web browser.
Always review the website address to ensure the legitimate website is properly displayed. 
Ensure operating systems and applications are updated with the latest patches as soon as they become available.
Use an antivirus and firewall solution and make sure they are always up-to-date with the latest patches and antivirus signatures.
All businesses should employ continuous user security awareness training and communication to ensure employees know how to spot and report suspicious activity.
(Information adapted from AHA Cybersecurity and Risk Division)
Stay informed. Visit our COVID-19 web page on our NHA website for information and resources.
Questions? Please reach out to the NHA via info@nebraskahospitals.org.

3255 Salt Creek Circle Suite 100 | Lincoln, NE 68504 US

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