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ForwardHealth has published Alert 009, titled "Temporary Changes for Durable Medical Equipment and Disposable Medical Supplies Face-to-Face Requirements," to the ForwardHealth COVID-19 Portal Page (link). Beginning March 12, 2020, ForwardHealth will not require a face-to-face visit with a physician or authorized non-physician practitioner for an initial prescription of any durable medical equipment or disposable medical supplies. A prescription will continue to be required for durable medical equipment and disposable medical supplies.
Governor Evers released a 65-page draft piece of legislation and a draft joint resolution on Saturday night aimed at addressing COVID-19. The Governor also released a chart outlining the proposal. The Legislative Fiscal Bureau also provided a Summary of provisions of Governor Evers’ proposed legislation and Joint Resolution indefinitely extending public health emergency to state legislators.
The bill includes several healthcare provisions, including language related to out-of-network bills that occur during the public health emergency. The language caps physician payment rates at 250% of the Medicare rate.
Health Care Workforce
The bill contains several provisions related to voting during public health emergencies. Specifically, for elections held during a declared public health emergency, it would:
Governor Evers and Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm today exercised their authority under Article V, Section 4 of the Wisconsin Constitution and Sections 323.12(4) and 252.02(6) of the Wisconsin Statutes to simplify healthcare license renewals during the COVID-19 public health emergency and to encourage recently retired professionals with expired licenses to re-enter practice. This full order is available online (link).
The order includes the following policy changes:
The order is effective immediately and will remain in effect through the duration of the public health emergency.
The full version of the Governor’s press release is available online (link).
For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available (link).
Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.
This Action Alert 08 and others are available on the ForwardHealth website (link).
In response to the COVID‐19 pandemic, ForwardHealth is temporarily altering certain procedures in order to prevent further spread of the disease and effectively treat existing cases. These altered procedures will only be in effect during the public health emergency declared by Governor Tony Evers for the State of Wisconsin under Executive Order 72.
Temporary Phone Number Change for Urgent Prior Authorization Requests
For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available.
Governor Evers directed the Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to temporarily order the suspension of evictions and foreclosures amid the COVID-19 public health emergency. The full order is available online (link).
The order prohibits landlords from evicting tenants for any reason unless failure to proceed with the eviction will result in an imminent threat of serious physical harm to another person and mortgagees from commencing civil action to foreclose on real estate for 60 days. Wisconsinites who are able to continue to meet their financial obligations are urged to do so. This order does not in any way relieve a person's obligation to pay their rent or mortgages.
The full press release is available on the Governor’s website (link).
Governor Evers announced today that he be issuing a “Safer at Home” order effective Tuesday, March 24. Organizations and individuals providing essential care and services will be allowed to continue travelling to and from work. This includes healthcare professionals, grocers and family caregivers. The full details of the order to be announced by the Governor’s office. Everyone else is asked to not take any unnecessary trips, and to limit travel to essential needs such as getting medications and groceries.
This order is based on the advice and counsel of public health experts, healthcare providers and first responders on the front line of our state’s response to the pandemic. These unprecedented measures are necessary to reduce rate of spread in COVID-19 cases. We must do everything we can to keep our healthcare systems from becoming overwhelmed, and protect both the public and essential healthcare workers who are taking care of the critically ill.
Opioid Treatment Program (OTP) Guidance
SAMHSA recognizes the evolving issues surrounding COVID-19 and the emerging needs OTPs continue to face. SAMHSA affirms its commitment to supporting OTPs in any way possible during this time. As such, we are expanding our previous guidance to provide increased flexibility.
Fox 6 Now / Amanda St. Hilaire
View the full article and watch the news report here.
MILWAUKEE -- When Dr. TJ Harrington's patients struggle to quit smoking, he can instantly connect them with options like the nicotene patch.
But the Aurora Health Care Senior Chief Resident of Family Medicine says getting patients help for opioid addiction has been much more complicated.
"He actually ended up overdosing and passing away," Harrington said, describing a patient who struggled with addiction. "It was upsetting, it was heartbreaking, and I think frustrating knowing that maybe we could have had a different outcome."
Now, that different outcome is within reach. Aurora, along with health systems like Ascension and ProHealth, is part of a statewide effort to make it easier for patients to access buprenorphine, a medication used for addiction treatment.
"Thank goodness," Harrington said with a sigh. "I’ve got something that can maybe help."
Clearing the hurdles
Buprenorphine is a medication used to assist in addiction treatment. Many patients know it by the brand name Suboxone, which is a combination of buprenorphine and naloxone.
Buprenorphine works by partially acting like an opioid and binding to the same receptors in the brain, without getting patients high. Doctors say the medication protects their patients from cravings and withdrawals, allowing them to focus on counseling and therapy.
"I didn't have the cravings all the time," Tina Kasten, a woman who says buprenorphine helped her fight heroin addiction, told FOX6. "It wasn't constantly on my mind like, 'OK, am I going to use? Am I not? Am I going to use? Don't do it. Oh, but you should.' It's like the devil and the angel and [buprenorphine] tells them to be quiet and go home."
Methadone and naltrexone, often known by the brand name Vivitrol, are also medications used to help treat addiction. But there are strict regulations surrounding the administration of methadone, and naltrexone requires the patient to first abstain from opioid use for several days.
Buprenorphine is seen as the most accessible option, because patients can start taking it right away. It also tends to be more affordable for the uninsured or under-insured.
Because burprenorphine acts like an opioid, doctors need a waiver to prescribe it for addiction treatment. That waiver requires training that family doctors, OB-GYNs, and other primary care providers traditionally have not had.
That means instead of being able to get a buprenorphine prescription at their regular doctors appointments, patients have had to deal with barriers like transportation, additional cost, and wait times in order to see an addiction specialist.
"Addiction is a terminal illness," Ascension All Saints Medical Director of Addiction Services Dr. David Galbis-Reig. "Without treatment, you end up dying."
Galbis-Reig is also president of Wisconsin Society of Addiction Medicine.
"If we're talking a four week gap in treatment, in four weeks if someone continues to use, every day is a risk of overdose and death," Galbis-Reig said.
Not all addiction treatment facilities offer buprenorphine.
Federal data from the Substance Abuse and Mental Health Services Administration shows 104 published addiction treatment facilities within 50 miles of Milwaukee. Only 40 percent are listed as prescribing buprenorphine.
"I'm old enough to have delivered some of my patients who are now adults," Dr. Jake Bidwell, Advocate Aurora Health Wisconsin VP for Medical Education said. "It's very frustrating to not be able to help them through a chronic problem in their life."
There is a statewide push in Wisconsin to expand training so that more primary care doctors can prescribe buprenorphine directly to their patients, eliminating barriers to treatment.
"When you ask personal questions to someone that you know really well, that trust and that rapport that's there actually provides the foundation to open up and say, 'Yeah, you know what? Something isn't right, Doc,'" Harrington said.
Aurora is now making buprenorphine training a resident requirement for Wisconsin OB-GYNs, family doctors, and internal medicine physicians. The health system will roll out its program, in which those doctors can directly prescribe buprenorphine to patients, over the summer.
Ascension has a full-service addiction unit, along with a program to get patients burprenorphine prescriptions immediately in the emergency room.
ProHealth started its push to expand buprenorphine access when doctors noticed a trend of babies born dependent on opioids.
"It was often unexpected," ProHealth Medical Director of Opioid Use Disorder Program Dr. Susanne Krasovich said. "Often mom's use was unknown or undisclosed. And we really wanted to figure out how to get a handle on that."
ProHealth now requires family medicine residents to train to prescribe buprenorphine.
"Without that type of collaboration and partnership between health systems, we're not going to make that large of an impact," Wisconsin Department of Health Services Director of Opioid Initiatives Paul Krupski said.
DHS helps coordinate buprenorphine training, with the goal of allowing more patients to get their medications at regular doctors appointments. Since that effort started at the end of 2018, there's been a 43 percent jump in doctors who are able to prescribe the medication in Wisconsin.
DHS is also in the process of getting input to eventually update state rules about addiction treatment.
"The changes that you can make are literally saving lives, saving families, making communities safer," Krupski said.
*NOTE: The following information and the attached document are from Wisconsin's State Opioid Authority (download the full document here)
The following information is meant to support opioid treatment programs (DHS 75.15 certified agencies) in their response to COVID-19. This guidance contains recommendations and resources that will be updated as this is an evolving situation. All OTPs are to contact the state opioid treatment authority (SOTA) if they have a patient that tests positive for COVID-19.
How do we reduce transmission in our program facility?
The Centers for Disease Control and Prevention has provided interim infection prevention and control recommendations in health care settings.
SAMHSA has issued guidance for specifically for OTPs.
The Wisconsin Department of Health Services has a COVID-19 webpage that is updated daily. It includes materials created by DHS for partners and providers.
Anyone with a respiratory illness (e.g., cough, runny nose) should be given a mask before entering your facility.
Provide hand sanitizer at the front desk.
Clean all surfaces and knobs several times each day with EPA-approved sanitizers.
Can we dose someone in a separate room if they present with a fever or cough?
Develop procedures for OTP staff to take clients who present at the OTP with respiratory illness symptoms, such as fever and cough to a location other than the general dispensary and/or lobby, to dose clients in closed rooms as needed.
OTP staff should use interim infection prevention and control recommendations in health care settings published by the Centers for Disease Control and Prevention.
If someone presents and is diagnosed with or directed to self-quarantine, can we provide them with take-home dosing?
Individuals who present with symptoms of a respiratory infection and cough and fever may be eligible for up to two weeks of take-home dosing at the discretion of their OTP physician.
For individual client cases, please submit exceptions through the SAMHSA OTP extranet website. Consider communication outreach to clients through phone calls, emails, and signage on-site to let them know if they become sick to contact the OTP before coming on-site, so take-home approval can be prepared in advance for dispensing.
Can we provide delivery of medication to our clients who are diagnosed with COVID-19 or ask to self-quarantine if they cannot leave their home, or a controlled treatment environment?
This may be possible with appropriate staff to transport the medication (at least 2 staff one being a nurse) that have appropriate personal protective equipment (PPE) and can secure the medication (locked container), although resources to offer this level of service may vary by program. For information on how to attain approval for take-home dosing please see previous question and answers.
What should we do if we need to allow for more take-homes than permitted by state rule or do not have the ability to meet state staffing requirements due to illness, etc.?
All state certified entities have the ability to request a variance or waiver to state rules that govern their programs.
What warrants a shutdown of an OTP?
You must consult with both your local public health jurisdiction and the Wisconsin State Opioid Treatment Authority (Elizabeth Collier) before making decisions about operations.
OTPs are considered essential public facilities and should make plans to stay open in most emergency scenarios to be able to induct new clients. No OTP can hold new client admissions at this time.
What else should my OTP be doing to prepare for or respond to COVID-19?
Ensure you have up-to-date emergency contacts for your employees and your clients.
Ensure your program leadership has the contact information of the State Opioid Treatment Authority Elizabeth Collier:
Develop procedures for OTP staff to take clients who present at the OTP with respiratory illness symptoms, such as fever and coughing to a location other than the general dispensary and/or lobby, to dose clients in closed rooms as needed.
Develop protocols for provision of take-home medication if a client presents with respiratory illness such as fever and coughing.
Develop a communications strategy and protocol to notify clients who are diagnosed with or exposed to COVID-19, and/or clients who are experiencing respiratory illness symptoms such as fever and coughing, that whenever possible the client should call ahead to notify OTP staff of their condition. This way OTP staff can have a chance to prepare to meet them upon their arrival at an OTP with pre-prepared medications to be dispensed in a location away from the general lobby and/or dispensing areas.
Develop a plan for possible alternative staffing/dosing scheduling in case you experience staffing shortages due to staff illness. Develop a plan for criteria for staff members who may need to stay home when ill and/or return to the workforce when well.
OTPs may want to ensure they have enough medication inventory onsite for every client to have access to two weeks of take-home medication or more. Every Wisconsin OTP should be at least two weeks ready.
Current guidelines recommend trying to maintain a six-foot distance between clients on-site in any primary care setting, as best as possible. We realize in an OTP setting that this guidance may be difficult to achieve, but should be attempted to the best of everyone’s ability in an aspirational sense, while considering the space and patient flow within your OTP’s physical location. OTPs may want to consider expanding dosing hours to help space out service hours to help mitigate the potential for individual clients queuing in large numbers in waiting room and dosing areas.
Should your clinic experience an identified exposure to COVID-19, consider how you will continue to dose patients that are at risk and cannot safely manage their medications. Referring patients to the hospital to be dosed is not an acceptable backup plan.
Consider a plan for the self-pay patients who may not be able to work due to illness and/or business closures and have no sick/vacation pay or benefits.
Prepare for periodic surges to help other clinics. Communicate with area clinics regarding your plans and how you can help one another. Review with staff how they will verify doses and identify patients.
Ensure that all patient information is up to date in Lighthouse.
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