COVID-19 Updates

Important UOTA and AOTA Updates Regarding Telehealth and COVID-19


59 Mental Health Resource for Health Care Providers

For home health agencies and OT practitioners working in home health:

Medicaid 1915(c) Appendix K waiver allowing flexibilities in the home and community based services (HCBS) waiver.

https://www.medicaid.gov/state-resource-center/downloads/ut-combined-appendix-k-appvl.pdf


For new incoming OT practitioners to Utah who are seeking licensure:

The Division of Professional Licensing has announced temporary suspension of fingerprinting services. Because of the temporary suspension of FBI fingerprint background checks, DOPL is issuing temporary licenses based on Utah-only background checks. At this time, applicants will be required to obtain the FBI fingerprint check within 180 days of receiving their temporary license. If an applicant's later fingerprint check does not reveal any concerning information, their license application will be considered complete. If concerning information is revealed, DOPL may investigate and take action against the license. Applicants who fail to obtain the required fingerprint check may face disciplinary action.

https://dopl.utah.gov/covid19.html


National insurers, Governor Herbert, and DOPL have been making modifications to existing regulations that previously limited patient utilization of telehealth OT/OTA services. Governor Herbert’s response can be found in the following two documents:

Telehealth Executive Order
Live CE Temporary Suspension DOPL

Coverage updates for Utah private insurances are listed here.
AOTA is regularly posting updates regarding telehealth services on their website here. They have also produced a chart summarizing the current status of telehealth services state-by-state which can be reviewed here. AOTA has organized regular webinars for updated COVID trainings and CE which can be found here. AOTA also offers a support forum for COVID through CommuneOT.
Finally, in Salt Lake, there is a community of volunteers called Mutual Aid SLC providing vital services in the valley. There may also be volunteer groups popping up in other Utah communities.

Please do not hesitate to contact the UOTA for more information or help through our contact page listed here. Stay safe and healthy during this challenging time.


AOTA resources to support Telehealth Services during COVID-19 to occupational therapists practicing in Utah:

 

AOTA Telehealth decision guide
Starting Monday, AOTA members can view a webinar regarding providing OT services via Telehealth here.

COVID-19 Mutual Aid SLC

This support group has been working from the beginning of this crisis to provide essential services such as grocery delivery to households who must self-isolate or who are otherwise in need.  People can call or go to this website to request services or volunteer:  https://www.covid19mutualaidslc.com/


AOTA is hosting a series of FREE virtual CE programs to equip occupational therapy practitioners, educators, and students to navigate through the evolving coronavirus pandemic. This series is free for AOTA members and non-members. Earn from 1 to 1.5 contact hours per session. Browse and join here: Free AOTA Webinar CE Series


The Role of Occupational Therapy: Providing Care in a Pandemic

http://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/OT-Pandemic.aspx

This is an unprecedented time in health care that is evolving every day. Due to the outbreak of COVID-19, many organizations and occupational therapy practitioners are struggling with the question, “what is the appropriate role of occupational therapy during a pandemic?” Guidance from federal agencies is continually shared as the status of the pandemic within the United States is evolving on a daily basis. AOTA urges occupational therapy practitioners to continue to check guidance from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) for the most up-to-date information.

On March 19, the Department of Homeland Security released a Memorandum to further respond to a March 16 statement from President Trump stating that:

 “If you work in a critical infrastructure industry, as defined by the Department of Homeland Security, such as healthcare services and pharmaceutical and food supply, you have a special responsibility to maintain your normal work schedule.”

The Memorandum identifies workers who conduct a range of operations and services that are essential to continued national critical infrastructure viability. The list includes occupational therapists as critical workers within health care in the following category:

Caregivers (e.g., physicians, dentists, psychologists, mid-level practitioners, nurses and assistants, infection control and quality assurance personnel, pharmacists, physical and occupational therapists and assistants, social workers, speech pathologists and diagnostic and therapeutic technicians and technologists).

At the same time, the CDC now recommends that “Healthcare facilities and clinicians should prioritize urgent and emergency visits and procedures now and for the coming several weeks.” This includes delaying all elective ambulatory visits. The CDC recommendations are regularly updated to reflect the best available information and the environment.

This is an extremely difficult time, but it does not minimize the value of occupational therapy. Clients and practitioners should be aware of the risks associated with both providing care and delaying care in order to make an informed decision regarding next steps. This is where your clinical judgement and leadership skills in navigating your unique setting to engage in decision making with your care teams is of vital importance to the health of the community and country at large.

AOTA considers occupational therapy services as essential because they are a key part of client care plans and may often be the reason a client is receiving care in a certain setting. Delays in rehabilitation have been associated with worsening symptoms and adverse events for children, adolescents, and adults.

Consider the role of occupational therapy in:

  • Reducing the likelihood of hospitalization or readmission;
  • Decreasing the likelihood of contractures and joint deformities;
  • Improving resistance to infection via movement and activities proven to enhance immunity;
  • Combatting disruptions to mood as a result of social isolation;
  • Addressing clients’ occupational deprivation and establishing habits, roles, and routines;
  • Promoting participation in education, play, and learning in the home or school; and
  • Increasing independence in occupations, thereby reducing the need for caregivers to be in close proximity to clients.

Access to personal protective equipment (PPE) may be limited during this emergency, but it is an important part of following CDC Recommendations for infection control. AOTA is advocating for immediate solutions to the shortage of PPE. While the CDC guidance on extending the life of PPE is necessary during this crisis, it is not sufficient. For example, at this time, many clients want to stay in their home or return home to minimize their risk of exposure to COVID-19. Occupational therapy practitioners have a critical role in treating patients in home health and are also competent in infection control procedures across settings. Occupational therapy practitioners also need access to PPE for the safety of their clients and themselves to avoid further spread of the virus.

Regardless of the setting, there may be long-term negative physical, cognitive, and psychosocial effects for clients who do not receive the therapy they need. But in this unprecedented time, there are many factors that will affect care delivery, such as population, geographic location, staff availability (due to possible exposure requiring self-isolation), etc. Some therapy may need to be suspended or modified based on the client. Therapy practitioners may be advised not go to multiple buildings in one day. In addition, therapy practitioners in some facilities may be asked to provide additional public health support activities in order to meet other clients’ basic needs such as taking vitals or completing screening questions.

Each individual facility must determine who is an essential health care worker in accordance with their own policies and procedures. In addition, they must comply with the CDC, their state governor, and state health departments. Additional CDC Guidance includes this Q&A:

Q: Should any diagnostic or therapeutic interventions be withheld due to concerns about transmission of COVID-19?

A: Patients should receive any interventions they would normally receive as standard of care. Patients with suspected or confirmed COVID-19 should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed. Healthcare personnel entering the room should use Standard and Transmission-based Precautions.

If there are interruptions to service that delay continued access to care, CMS provides the following guidance to assist providers:

  • Review clients’ plan of care and consider making any updates or modifications that may be necessary to account for client access issues related to COVID-19;
  • Communicate with clients and their families/caregivers as appropriate to help them understand the situation and assure them that you are doing all that you can to provide (or resume) services; and
  • Ensure that all members of the care team are documenting in the medical record their efforts to adhere to the client’s plan of care, including all refused attempts to see clients in person and all alternative methods used to perform client visits (e.g., phone calls and virtual visits).

Occupational therapy practitioners work in a variety of settings and treat populations that each present unique challenges. Practitioners should consider the AOTA Code of Ethics as they collaborate with clients to determine the best way to meet occupational therapy needs in a way that is as safe as possible for both clients and practitioners.

While telehealth seems like a practical option, the current reality is that each state determines whether telehealth is allowed. Therapy practitioners must follow their state and local laws, regulations, and policies. AOTA is tirelessly advocating for coverage of telehealth services provided by therapy practitioners at the state and federal levels. State telehealth policies are evolving every day as a safe option to provide patient care. Please check our website for updates.

We are working hard to provide accurate guidance to our members, and we encourage occupational therapy practitioners to make every reasonable effort to meet client needs and avoid interruptions and delays in care while keeping clients and themselves safe and healthy. Please continue to watch our website for updates.

Additional Resources

Memorandum on Identification of Essential Critical Infrastructure Workers during COVID-19 response. U.S. Department of Homeland SecurityCybersecurity & Infrastructure Security Agency, Office of the Director (March 19, 2020).

American Occupational Therapy Association (AOTA) Occupational Therapy Code of Ethics (2015).

American Health Care Association (AHCA) guidance The Role of Physical and Occupational Therapy and Speech-Language Pathology Personnel in LTC Facilities During the COVID-19 Pandemic

AHCA Coronavirus Resources

National Association for Home Care & Hospice (NAHC) Coronavirus Resources

Occupational Therapy’s Role in Home Health (AOTA Fact Sheet)

Skilled Nursing News article

DC Information on COVID-19 for Pregnant Women and Children


Trump Administration Releases COVID-19 Checklists and Tools to Accelerate Relief for State Medicaid & CHIP Programs
New tools to help speed states’ access to emergency flexibilities and resources

Today, the Trump Administration released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of tools available to maximize responsiveness to state needs. The agency has created four checklists that together will make up a comprehensive Medicaid COVID-19 federal authority checklist to make it easier for states to receive federal waivers and implement flexibilities in their program. 

“The Trump Administration is marshaling all its support behind states battling the Coronavirus,” said Administrator Seema Verma. “CMS is making it easier and faster for state Medicaid agencies to get the regulatory relief and additional support they need to respond as rapidly and effectively as possible to protect their most vulnerable residents from this disease.”

The four tools CMS is announcing today will permit states to access emergency administrative relief, make temporary modifications to Medicaid eligibility and benefit requirements, relax rules to ensure that individuals with disabilities and the elderly can be effectively served in their homes, and modify payment rules to support health care providers impacted by the outbreak. President Trump has also called on states to allow Medicaid beneficiaries to receive services through telehealth. While this doesn’t require federal approval in many cases, these tools can also help states quickly remove state-specific restrictions on telehealth.

All of the options that CMS is providing to states are aimed at helping states by reducing burdensome red tape and making it possible for states to provide the best care to their residents during this outbreak. We are providing states the option to request these waivers and other authorities be made effective retroactively, to at least March 1, 2020, the effective date of the national emergency declared by the President. These options include:

1115 Waiver Opportunity and Application Checklist

CMS is releasing a State Medicaid Director Letter (SMDL) #20-002, which outlines a new section 1115 demonstration opportunity to aid states with addressing the public health emergency.  States will be able to waive federal rules to streamline enrollment into long-term care programs and home and community-based services, as well as access broad authorities to vary and target services based on population needs.

The SMDL includes a waiver checklist to streamline state application requirements. Due to the extraordinary circumstances of this emergency, CMS has determined that an exception to the normal state and federal public notice procedures is warranted. 

https://www.medicaid.gov/medicaid/section-1115-demonstrations/1115-application-process/index.html

1135 Waiver Checklist 

CMCS has pre-packaged relevant and commonly requested 1135 authorities into a checklist template to share with states. This will expedite their ability to apply for and receive approval for these waivers that are now available under the President’s national emergency declaration. Examples of flexibilities include the ability to temporarily suspend prior authorization requirements, provide beneficiaries more time for appeals and fair hearings, relax rules to more quickly enroll providers, and allow providers from out of state to bill for services delivered to Medicaid beneficiaries.

https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/cms-1135-waivers/index.html

 1915(c) Appendix K Template

 CMS developed the Appendix K to help states accelerate changes to their 1915(c) home and community-based services waiver operations or to request emergency amendments. To support the specific types of flexibilities that states are asking for during the COVID-19 outbreak, CMS has designed an Appendix K template addendum that has been pre-populated with commonly requested and relevant program changes. Examples of the types of flexibilities that states can access through this process include adding an electronic method of service delivery for certain services allowing continuity of service without face to face interaction, adding services to address additional needs of waiver recipients during the time of emergency, and adjustments to process requirements to decrease state burden during this time.

https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/hcbs/appendix-k/index.html

Medicaid Disaster State Plan Amendment Template

The Medicaid state plan is the document that describes the state’s rules related to eligibility, benefits, and payments. States have wide discretion within a broad federal framework to design their programs, and changes are processed through state plan amendments. Sometimes, states might wish to make changes that are only temporary during a disaster or emergency situation. To streamline and support this process, CMS has developed a Disaster State Plan Amendment (SPA) template that would allow a state to submit one combined request for temporary changes that we expect states may wish to make in their programs. This includes expanding temporary coverage to optional eligibility groups, adding specialized benefits, expanding telehealth coverage, and temporarily increasing provider reimbursement, among other temporary changes.

https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/state-plan-flexibilities/index.html

The tools released today further CMS’s commitment to providing our state partners the resources they need at this time.  Additionally, the agency recently approved its first section 1135 public health emergency waivers for the state of Florida on March 16, and the first 1915(c) Home and Community-Based Services waiver Appendix K approval on March 18th for the state of Pennsylvania in response to the COVID-19 outbreak. These approvals have granted these states a wide range of Medicaid and CHIP flexibilities, and we encourage other states to apply for the additional flexibilities they need in this situation. All state requests will be reviewed on a case-by-case basis to ensure they may be approved under applicable law.

These tools, and earlier CMS actions in response to the COVID-19 emergency, are all part of ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit www.coronavirus.gov. For a complete and updated list of CMS actions, guidance, and other information in response to COVID-19, please visit the, please visit the Current Emergencies Website.