Lisa Maurer, MD, FACEP
WACEP Legislative Chair

As we all continue to care for patients on the front line of this public health emergency, legislators and regulators have been working to support us.  Please see the summary below and visit our WACEP COVID-19 Resources page (link) for news and links to many external resources.  

Telehealth

• Wisconsin Medicaid now allows for parity for telehealth visits as compared to face to face encounters
• CMS has added typical ED codes 99281-99285 and 99291-99292 to the list of codes that are approved for telehealth.  These should be submitted using a 95 modifier and the typical Place of Service
• A telehealth encounter performed by a typical Qualified Medical Provider is sufficient for MSE requirements for EMTALA
• CMS loosened HIPAA requirements as it pertains to telehealth as to allow for a wider variety of allowed platforms

Liability

• The CARES Act passed limitation on liability for volunteer care by health care providers during response to the COVID-19 public health emergency
• WACEP is working with state officials and other medical organizations including WHA and WMS to push for other liability protections here in Wisconsin. Modeled after AMA-ACEP recommended language, we are specifically asking that those providing COVID-related care be immune to civil liability absent gross negligence

EMTALA

CMS is currently waiving a small part of EMTALA requirements, allowing redirection to another location (offsite alternate screening location) to receive a medical screening exam under a state emergency preparedness or pandemic plan, thus allowing hospitals to screen patients at a location offsite from the hospital's campus to prevent the spread of COVID

• The offsite location must be in compliance with the State's Pandemic\Emergency Preparedness Plan
• The waiver may obviate sanctions (citation/fines), but not necessarily an investigation
• The waiver may not necessarily limit your civil or regulatory liability
• Typical processes for MSE should remain in place if possible

CMS goes on to clarify what is and is not allowed during the Public Health Emergency regarding EMTALA, even without using the above described waiver. (see EMTALA Guidance)

• Patients presenting to the ED can be referred to "on-campus" screening sites such as tents, drive-thrus, etc.  
• Hospitals can post signage informing patients of these on-campus screening sites.  They can even post signage about off-campus testing sites, but these are for patients presenting for testing only, not for MSE
• It still must be a physician or APP (qualified medical provider) who performs the MSE (QMPs have not been expanded to nurses)

Reimbursement

• Medicare sequestration is temporarily lifted, resulting in a 2% increase in payments across the board through the rest of 2020 (CARES Act)
• The “geographic practice cost index” (GPCI) 1.0 floor has been extended through December 1, 2020, thus retaining a higher RVU for codes especially in rural areas where the GPCI would usually float below 1.0 (CARES Act)
• Gov Evers has proposed a bill for legislative consideration (LRB-5920), which would temporarily prohibit any increased out-of-pocket costs for patients who receive OON care as compared to care from in-network providers. In this case, provider reimbursement would be set at least 250% of Medicare rates directly from the payor
• There are several other opportunities for financial support from the federal government for hospitals and small physician groups