As state stay-at-home orders proliferated in mid-March, ASPS leadership was faced with a difficult choice: cancel the June Northeast/Midwest Regional Fly-In and lose a precious opportunity to meet face-to-face with congressional offices, or keep it in place and risk a disruptive, costly last-minute cancellation. In the interest of ASPS member safety and recognizing the epidemiological reality more-and-more with each passing day, the in-person event was officially canceled on April 1. With that, planning immediately began for a "virtual" experience.

The structure of the event – slated for September 15-16, 2020 – strives to offer an experience as similar as possible to the typical Regional Fly-In. It will have training for inexperienced fly-in participants and a briefing on the issues. It will have a congressional guest speaker, two if you are in the PlastyPAC Member Benefits Program at the Chairman's Club level or higher. And it will have face-to-face interaction, albeit through Zoom, with members of Congress and the healthcare staff that help them make decisions. Experiences to-date operationally at ASPS have shown that this can absolutely produce high-quality interactions.

This Guidance is directed at Ambulatory Surgery Centers (ASC) Office Based Surgery practices (OBS), and Diagnostic and Treatment Centers (DTC) that are located in counties without a significant risk of COVID-19 surge and are deemed eligible to perform Deferred Procedures, (i.e., elective surgeries and non-urgent procedures).

These centers and practices are required to meet the same provisions  required of hospitals in these eligible counties that are also resuming deferred procedures.

Any ASC, OBS, or DTC that fails to comply with this Guidance may be subject to civil penalties.

The purpose of this weekly publication is to provide healthcare providers in New York State with a consolidated update of guidance released by the New York State Department of Health (NYSDOH) related to the COVID-19 pandemic response.

This will show only current guidance for any given topic and will be updated to reflect new guidance.

As a reminder, all advisories and informational messages (including webinar invitations) are distributed through the Integrated Health Alerting Network System (IHANS), an application housed on the Health Commerce System (HCS). If you are not receiving IHANS notifications, please work with your site’s HCS coordinator.

Additional COVID-19 resources may be found on the NYSDOH webpage under Information for Healthcare Providers. Recordings of COVID-19 Weekly Healthcare Provider Updates are also available on the NYSDOH webpage.

Access the publication here

The Congressional package also provided $75 billion more for the CARES Act Health Provider Relief Pool, to assist hospitals and physicians. This is in addition to $30 billion dedicated to physicians and hospitals, in early April, based on 2019 Medicare payments, and $20 billion was just made available to physicians and hospitals based on 2018 total patient revenue.

As with its first survey, MSSNY wants to gather data to determine how much New York physicians are benefiting from these new resources, to better guide our advocacy for further stimulus bills.

Please help us evaluate this by taking a few minutes to fill out and submit the following Survey Monkey questionnaire.

The New York State Department of Health has issued the following interpretative guidance:

The March 23 and April 4 directives to suspend all non-essential elective surgeries and non-urgent procedures did not preclude general hospitals, ASCs, OBSs and D&TCs from performing certain surgeries and procedures related to the diagnosis of cancer (e.g., lumpectomies, biopsies), the treatment of intractable pain, or other diagnostic or treatment services for highly symptomatic patients.

The Department considers such surgeries or procedures to be "Tier 3a" as defined by CDC rules for urgent and emergency surgeries and procedures (see Attachment A).

Therefore, such surgeries or procedures should not be postponed or otherwise delayed, and should be scheduled and performed in accordance with the medical judgment of the treating physician. This interpretative guidance is applicable to all general hospitals, ASCs, OBS practices, and D&TCs in 811 counties of the State.

Read the full directive here

This Executive Order permits certain hospitals in certain New York State counties to begin performing non-essential, i.e., elective, surgeries. The criteria consists of the following:

• Eligible counties where non-essential surgeries can be performed must have total available inpatient and ICU capacity of over 30% with a total change in number of hospitalized COVID-19 positive patients during the period of April 17 – April 27 of less than ten.
• For each hospital within an eligible county, the hospital must meet the numerical criteria set forth above.
• General hospitals not meeting the criteria may seek a waiver from the New York State Department of Health (“DOH”) by submitting a plan.
• DOH shall issue guidance for non-essential surgeries that will require all pre-operative patients to test negative for COVID-19.

Here is a list of eligible counties: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Delaware, Dutchess, Essex, Franklin, Fulton, Genesee, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Putnam, Saratoga, Schoharie, Schuyler, St. Lawrence, Steuben, Sullivan, Tompkins, Ulster, Wayne, Wyoming and Yates.

Read the full order here

The US Health and Human Services (HHS) has indicated that the application portal is open for physicians to avail themselves of a portion of the $20 billion allocation from the CARES Act Provider Relief Fund.  

The AMA has advised that  anyone who has a Billing TIN who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal.   

The AMA has also put together this guide to help physicians pull together the information they need to submit to the portal. Here is additional information from HHS regarding the distribution.

This week, both chambers of Congress passed and President Trump signed into law The Paycheck Protection and Health Care Enhancement Act, which allocates an additional $321 billion for Paycheck Protection Program (PPP) loans and an additional $60 billion for the Economic Injury Disaster Loan program. New applications can be submitted starting on Monday, April 27, 2020 at 10:30am. Any borrower that applied for a PPP loan prior to the issuance of this guidance and repays the loan in full by May 7, 2020 will be deemed by SBA to have made the required certification in good faith
> Read our legal counsel's alert.

Set aside in the $321 billion of additional funds approved for the PPP is $60 billion for small- to medium-sized banks and other financial institutions. The legislation also includes an additional $75 billion for the Public Health and Social Services Emergency Fund.

SBA Paycheck Protection Program

The Northeast region is fairly diverse in how it has been impacted by COVID-19. With that said:

Non-COVID-19 care should be offered to patients as clinically appropriate and within a state, locality, or facility that has the resources to provide such care and the ability to quickly respond to a subsequent surge in COVID-19 cases, if necessary. The recommendations outlined here are a working document and are subject to change and will be updated as the COVID-19 situation continues to evolve.

Maximum effective utilization of facilities to meet elective surgery patient needs requires that each practice setting (hospital, ASC or office-based) independently develop prioritization plans within the scope of its individual capabilities and conforming to all state and local regulatory safety standards as outlined in this document.

To begin this process, certain principles must be considered

• FCC Establishes New Covid-19 Telehealth Program
• Centers For Medicare And Medicaid Services Expands The Accelerated And Advance Payments Program For Participating Providers And Suppliers
• What Documentation Should Employees Provide Employers In Order To Obtain Federal Covid-19 Leave Benefits
• CMS Issues Stark Law Blanket Waivers in Response to COVID-19 Pandemic  
• New York State Budget Implements Major COVID-19 Liability Protections for Health Care Facilities and Providers