Resources and Tools for Addressing Coronavirus (COVID-19)

For more than 50 years, we have been working to promote health and wellness among our staff, stakeholders, members and the communities they support. With recent news of the novel coronavirus (COVID-19) inviting a heightened sense of uncertainty and apprehension, that commitment has never been stronger. In this time of confusion, there is hope. And there is help.

You are not alone. There are 3,325 member organizations that, like you, are working to keep their doors open, their staff safe and their communities healthy. To help you navigate this rapidly evolving situation, we are building a coronavirus resource directory and sharing tools and information to inform you every step of the way.

2.3 Million Masks Distributed to Members During the Pandemic

Please note: The information provided on this website does not, and is not intended to, constitute legal advice. All information available on this site and linked sites are for informational purposes only. Individuals and organizations utilizing this website should contact an attorney to obtain advice with respect to any legal matter. Some of the information provided on this website pertains only to the time during which a national emergency has been declared related to COVID-19.

COVID-19 Relief Packages: Overview and Next Steps

Last updated: May 4, 2020
Changes since prior update include details on the fourth COVID-19 relief package.

To date, Congress has enacted four COVID-19 relief and stimulus laws. The National Council worked to ensure supports for behavioral health providers were included in each of these packages. Additional details on provisions of these laws relevant to behavioral health providers can be found on this page.

  • The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (enacted March 4, 2020) provided funding for federal agencies to respond to the crisis and temporarily waived certain telehealth and Medicare restrictions, among other provisions.
  • The Families First Coronavirus Response Act (enacted March 18, 2020) established new paid leave policies and increased federal Medicaid funding, among other provisions.
  • The Coronavirus Aid, Relief, and Economic Security (CARES) Act (enacted March 27, 2020) provided $2 trillion in COVID-19 relief to health care providers, small business and more.
  • The Paycheck Protection Program and Health Care Enhancement Act (enacted April 24, 2020) provided $484 billion in funds to replenish programs established in previous COVID-19 relief packages.

Congress continues its work on another COVID-19 relief package, which is expected to contain more economic relief provisions and legislative fixes to previous packages. The National Council has been working hard to represent our members’ continued needs on the federal level, including by submitting a request to Congress for $38.5 billion to support behavioral health providers through the public health emergency and beyond. Click here to take action and urge your Member of Congress to support this emergency appropriation in the next COVID-19 relief package.  Subscribe to Capitol Connector for weekly behavioral health policy news delivered to your inbox, and check here regularly for updates related to COVID-19.

Questions? Contact Policy@TheNationalCouncil.org.

 

National Council Events

Upcoming Events
  • Check back soon for upcoming events related to COVID-19.
Previous Event Resources

Managing Organizational Finances and Operations

Guidance for Behavioral Health Residential Facilities

Managing Your Mental Health

Employers, Employees, Tax Incentives and Loans

Small Business Economic Injury Disaster Loans (EIDL)

Last updated: May 4, 2020
Changes since prior update include the Paycheck Protection Program & Health Care Enhancement Act’s impacts on the program.

The Small Business Administration’s (SBA) Economic Injury Disaster Loan (EIDL) can provide up to $2 million of financial assistance to eligible organizations who experience injury as a result of a declared disaster. More information on EIDL can be found here.

The Coronavirus Aid, Relief, and Economic Securities (CARES) Act expands eligibility for the EIDL.

During the crisis, the EIDL program also provides a $10,000 expedited grant advance to eligible businesses. These grants do not have to be repaid. The application can be found here.

Thorn Run Partners has created a resource on this program which includes answers to the following frequently asked questions:

Although funds for this program were exhausted in mid-April, the Paycheck Protection Program and Health Care Enhancement Act infused another $60 billion into the program – $50 billion of which was allocated to the SBA EIDL loan program, and $10 billion of which was allocated to the SBA EIDL grant program.

Questions? Contact Policy@TheNationalCouncil.org.

Tax Incentives

Last updated: April 10, 2020

The Coronavirus Aid, Relief, and Economic Securities (CARES) Act includes a number of tax incentives to small businesses.

Questions? Contact Policy@TheNationalCouncil.org.

Paycheck Protection Program

Last updated: May 4, 2020
Changes since prior update include the Paycheck Protection Program & Health Care Enhancement Act’s impacts on the program.

The Coronavirus Aid, Relief, and Economic Securities (CARES) Act established the Paycheck Protection Program, a program in effect through June 30, 2020 and intended to provide funding for small businesses to maintain operations as well as incentive to retain employees. The application can be found here.

Summary of Program Benefits

Thorn Run Partners has created a resource on this program which includes answers to the following frequently asked questions:

Although funds for this program were exhausted in mid-April, the Paycheck Protection Program & Health Care Enhancement Act infused another $310 billion to allow the SBA to continue administering the Paycheck Protection Program.

Questions? Contact Policy@TheNationalCouncil.org.

Paid Sick Leave/Expanded Family and Medical Leave

The Families First Coronavirus Response Act (FFCRA), effective April 1, 2020, requires public employers and private employers with fewer than 500 employees to provide employees impacted by Covid-19 with paid sick leave or expanded family medical leave.

The Department of Labor (DOL) published an extensive document designed to provide answers to the many questions employers may have regarding how emergency paid sick leave and emergency expanded family medical leave applies to their organization. The document, that includes questions of eligibility and implementation, can be found here.

The FFCRA provides an exception to the paid sick leave/expanded family medical leave for employers who have employees who are health care providers.

What is the definition of an excepted health care provider under the FFCRA?

Questions? Contact Policy@TheNationalCouncil.org.

Personal Protective Equipment (PPE) and Other Financial Support for Providers

HHS Provider Relief Fund

Below is an overview. For additional information on both the Medicare and Medicaid Provider Relief Funds, please see HHS Provider Relief Fund FAQs (HHS resource) or call the HHS CARES Provider Relief line at (866) 569-3522.

 

Last updated: June 11, 2020
Changes since last update include new information on funding for Medicaid providers

Medicare Provider Relief Fund

Last updated: June 11, 2020

The CARES Act established a $50 billion relief fund for providers that is being automatically paid to those providers who have billed Medicare in 2018. The first round has been distributed as of April 17, 2020. The Second round is now being distributed as of April 24, 2020.

Providers who billed Medicare in 2018-2019 (regardless of total Medicare revenue):

Providers who were eligible for and received the first automatic Medicare payment, and who submitted their revenue information to HHS via the General Distribution Portal on or before June 3, are likely waiting to receive a second payment.

While the first allocation favored Medicare-heavy revenues, the second allocation is based on a provider’s net revenue and the formula weights all revenue streams together, in addition to Medicare, including Medicaid and state and county funding streams.

Important to note: HHS stated that provider must have taken action by June 3, 2020 in order to be considered for future access to Provider Relief Fund payments. This action is the de facto application to access the second round of Provider Relief Funds if your organization had not yet received a second payment based on total revenue (after April 24,2020), and for future funding via this stream. Providers can check the portal for the status of their information and application. HHS states that providers can expect total payments to equal at least 2% of revenues.

You may want to check your status and information submission on the Medicare General Distribution Portal or by calling the HHS CARES Provider Relief Line at (866)569-3522.

Medicaid Enhanced Provider Relief Fund (Medicaid and CHIP)

As of June 10, 2020, HHS Provider Relief Funds are now accessible to Medicaid providers who have not yet received COVID-related funding from HHS, and who did not bill Medicare in 2018 – 2019The deadline to apply for these funds is July 20, 2020.

Providers who billed Medicaid FFS or a managed care plan between Jan 2018 and June 2020 (and who did not bill Medicare) should go to the HHS Medicaid and CHIP Provider Relief portal to submit provider information including revenue. HHS states that providers can expect total payments from the Medicaid fund to equal at least 2% of gross revenue from patient care. Terms and conditions for the Medicaid Fund are here.

NOTE: PROVIDERS MUST STILL SUBMIT THEIR INFORMATION TO HHS VIA THE PORTAL, EVEN IF THEY PREVIOUSLY SUBMITTED THEIR INFORMATION TO THE NATIONAL COUNCIL.

Questions? Contact Policy@TheNationalCouncil.org.

SAMHSA COVID-19 Response Funds

Last updated: April 29, 2020

The CARES Act provided $425 million to SAMHSA to support the behavioral health sector during the public health emergency. Some funds have already been released to clinics and states, but additional details on how the remainder of this fund will be distributed are not yet available; stay tuned to Capitol Connector for more information.

  • Funding for States: To date, SAMHSA has announced the availability of $110 million to help states with their behavioral health response to the crisis.
  • CCBHC Expansion: On April 27, SAMHSA announced 166 awards for Certified Community Behavioral Health Clinic (CCBHC) expansion grants. The grant funding includes $200 million in annually appropriated funding in addition to $250 million in emergency COVID-19 funding for Fiscal Year 2020 as part of the CARES Act. While the National Council applauds SAMHSA’s efforts to expand the number of CCBHCs nationwide, we are disappointed that the $250 million in emergency COVID-19 funding was not made available to all community behavioral health organizations. The National Council has urged Congress to act swiftly to provide $38.5 billion in COVID-19 relief funds dedicated to behavioral health providers nationwide. Visit our Take Action page to ask for your legislators’ support.

Questions? Contact Policy@TheNationalCouncil.org.

FEMA Private Non-Profit Funding (PPE)

Last updated: April 10, 2020

Under the President’s nationwide emergency declaration related to the coronavirus, certain private non-profits who own or operate an eligible facility and who have taken eligible emergency protective measure in response to the coronavirus, may eligible for funding through FEMA.

  • For a fact sheet related to eligibility, see here.
  • For a list of emergency management agencies in your state, see here.
  • For a detailed policy guide on the public assistance program, see here.

Questions? Contact Policy@TheNationalCouncil.org.

 

Procedures and PPE for Residential Settings

The National Council partnered with Atrium Health to create a series of videos of proper procedures and PPE use for behavioral health residential facilities during the pandemic.

Proper PPE and Procedures – Full Series

Gyms and Recreation Areas

Code Blue: Proper PPE and Procedure During a “Code Blue” for a COVID-19 Patient

Cafeteria Procedures

Proper Mask Usage

Group Activities

Shared Bathrooms and Showers

Single vs. Double Patient Rooms

COVID-19 Testing Considerations

Telehealth

Prescription of Controlled Substances via Telemedicine

Last updated: April 10, 2020

The Drug Enforcement Administration has issued new guidance waiving the prior in-person medical evaluation requirement for the prescription of controlled substances via telehealth from March 16, 2020 through the duration of the public health emergency. To be applicable, certain conditions must be met; for a full description of the policy change and new requirements, read the DEA’s summary of the new guidance here.

Additionally, DEA has issued a letter to registered prescribers outlining temporary changes to the DEA requirement that practitioners register separately with DEA in every state where they prescribe controlled substances. Full details are available here.

These changes alleviate barriers to medication access for patients with mental health and substance use disorders, a long-sought goal of the National Council. While the current changes are temporary for the duration of the public health emergency, we are working with federal agencies to permanently remove barriers to medication access for patients receiving telehealth services.

Questions? Contact Policy@TheNationalCouncil.org.

Medicare Telehealth

Last updated: May 7, 2020. Changes since prior update:
Additional information regarding the new CMS interim final rule which increased some reimbursement and flexibility to bill for additional Medicare audio-only telehealth services. The National Council is continuing to review and analyze this rule.

Key Policy Changes in Medicare Coverage for Telehealth

In response to the COVID-19 Public Health Emergency, Congress and CMS have expanded coverage of telehealth in Medicare. Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020. CMS announced the details around implementing the expansion Medicare’s telehealth benefits under the 1135 waiver authority and the new law. Additionally CMS released an interim final rule released on March 30. Summary of key provisions can be found here and CMS released a list of FAQs. On April 30, CMS issued another interim final rule which added additional flexibilities, including for audio-only services. These changes apply for the duration of the Public Health Emergency. Changes include, but are not limited to:

  • Telehealth permitted in homes. Beneficiaries can receive telehealth services within their homes or nursing facilities. Telehealth services be furnished using telecommunications technology that has audio and video capabilities that are used for two-way, real-time interactive communication, with exceptions for certain codes.
  • Site restrictions removed. Originating site and geographic restrictions are removed.
  • “Established relationship” waived. Services provided via telehealth and remote patient monitoring and virtual check-in can be provided to new and established patients.
  • Providers can bill for telehealth visits at the same rate as in-person visits. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services.
  • Cost-sharing flexibility. HHS is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
  • Coverage for certain audio-only interactions. Previous guidance permitted billing for audio-only telehealth visits for certain CPT codes, including virtual check-ins and some evaluation and management codes. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is increasing payments for certain audio-only telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. Please note that state Medicaid programs have authority to make their own decisions on whether to allow audio-only encounters (see below for our section on Medicaid telehealth).
  • Additional codes and services. MS will now pay for more than 80 additional services when furnished via telehealth. See the additional services and codes here.
  • Expansion of qualified providers. Licensed clinical social workers and clinical psychologists may furnish telehealth services within their scope of practice and consistent with Medicare benefit rules that apply to all services.
  • Direct supervision via telehealth. The requirement for direct supervision remains but can be provided using real-time interactive audio and video technology.
  • Opioid Treatment Programs. Previous guidance permitted therapy and counseling to take place via audio-only telehealth in OTPs. OTPs will now be able to do periodic assessments via audio-only calls.
  • New process for adding additional services. Previously, CMS only added new services to the list of Medicare services that may be furnished via telehealth using its rulemaking process. CMS is changing its process during the emergency, and will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible. This will speed up the process of adding services.

FAQ

  • Will Medicare reimburse for audio-only telehealth encounters? Providers may evaluate beneficiaries who have audio phones only via “virtual check-in”. Providers may also communicate with beneficiaries via “E-visit” which is done via a patient portal and does not require audio or visual. Additionally, certain CPT codes can now be reimbursed by Medicare when they are conducted by audio only.  We urge members to keep good records of what services were delivered via telehealth/audio-only should they be subject to future audit.  Please note that state Medicaid programs have authority to make their own decisions on whether to allow audio-only encounters
  • Who are qualified providers? Medicare has expanded the types of providers who may conduct visits via telehealth to include licensed clinical social workers, clinical psychologists, and other non-physician practitioners. See CMS: Medicare Telehealth FAQs
  • What are the new services and billing codes? The expanded telehealth coverage applies to previously covered Medicare-approved telehealth services as well as additional services identified in the interim final rule. Telehealth codes can be found here.

Questions? Contact Policy@TheNationalCouncil.org.

Medicaid Telehealth

Last updated: April 10, 2020

CMS Medicaid Telehealth Guidance to States offers states broad flexibility to cover telehealth using various methods of communication including audio-only, telephonic, video technology commonly available on smart phones and other devices.

No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services. Note: States themselves, not CMS, are responsible for making these options, including audio-only telephonic services, available to providers.

CMS has released an extensive Medicaid COVID-19 FAQ document, which includes answers to these FAQs (April 2, 2020):

CMS has also issued updated guidance on Rural Health Care and Medicaid Telehealth Flexibilities, and Medicaid Substance Use Disorder Treatment Services Furnished via Telehealth, which can be found here (April 2, 2020).

Questions? Contact Policy@TheNationalCouncil.org.

Telehealth Billing and Coverage Guidance

Last updated: April 15, 2020
Changes since prior update include a new National Council quick reference guide for Commercial Payers’ Expansion of Telehealth Services

A number of private payers have issued detailed guidance for behavioral health providers on telehealth service expansion and billing throughout the COVID-19 crisis. The National Council has developed this quick reference guide for behavioral health providers that details changes in telehealth policies, allowable services and billing guidance across commercial payers.

This is not an exhaustive list; the National Council will continue provide updates as we become aware of more information. We encourage providers to check with their own payers to determine what services may now be paid for as telehealth encounters.

Download tips for telehealth billing during the pandemic from SMI Adviser.

Questions? Contact Policy@TheNationalCouncil.org.

FCC Funding for Telehealth Services

Last updated: April 13, 2020

The Federal Communications Commission (FCC) established a $200m COVID-19 Telehealth Program which allows eligible providers including community mental health and substance use organizations to apply for grants to fund technology and equipment to bolster service delivery via telehealth.

The order states that community mental health centers and other types of health care providers are eligible for funds. The application portal is accessible here. The FCC has issued application guidance explaining the process, eligibility and application requirements. The National Council encourages members to apply as soon as possible, as funding is distributed on a rolling basis.

Questions? Contact Policy@TheNationalCouncil.org.

 

USDA Funding for Telehealth Services

Last updated: April 20, 2020

The U.S. Department of Agriculture (USDA) opened a second application window for funding under the Distance Learning and Telemedicine grant program. This program helps rural communities use the unique capabilities of telecommunications, including telemedicine, to connect and overcome the effects of remoteness and low population density. The application is open now and National Council encourages members in rural areas to apply.

Questions? Contact Policy@TheNationalCouncil.org.

State-by-State Telehealth Resources

Last updated: April 10, 2020

Several organizations are compiling and frequently updating state changes to telehealth policy, including behavioral telehealth, which can be found here:

Many states are also waiving or modifying state licensure requirements to help facilitate cross-state delivery of telehealth services. The Federation of State Medicaid Boards is keeping an updated resource of these actions taken by states: States Modifying In-State Licensure Requirements for Telehealth in Response to COVID-19.

Questions? Contact Policy@TheNationalCouncil.org.

Telehealth Best Practices

Last updated: May 27, 2020

The National Council has developed a document to provide you with the background and resources necessary to help you begin or expand your use of telehealth. This list is not exhaustive and we expect additional changes to laws and regulations.

Questions? Contact SamanthaH@TheNationalCouncil.org.

CCBHCs

Certified Community Behavioral Health Clinics (CCBHCs)

Last updated: April 10, 2020

The CARES Act included an extension of the current CCBHC Medicaid demonstration program though November 30, 2020. It also expanded the demonstration to two additional states from among those that had originally applied for the program. The National Council and our members have long championed the extension and expansion of the CCBHC demonstration, and we are grateful to Congress for taking this next step toward making CCBHCs available throughout the U.S.

  • How will the two states be selected for the expansion? SAMHSA has up to six months to announce the next two states that will be selected. Selections will be made from the applications states previously filed to participate in the demonstration.
  • What does this mean for organizations receiving CCBHC expansion grants? The two-year expansion grants are not affected by the extension and expansion of the demonstration. However, grant recipients in the two states that are ultimately selected for the expansion may have new options for sustainability beyond the end of their grant term if they become certified by their state as CCBHCs in the Medicaid demonstration.
  • Will the COVID-19 crisis affect the timing of the awards from the latest expansion grant FOA? SAMHSA had announced in the FOA that awards would be made by August 2020; we do not have information at this point as to whether the agency expects that timeline to be affected.

Questions? Contact Policy@TheNationalCouncil.org.

FMAP Bump for CCBHC Demonstration Services

Last updated: April 15, 2020

The Families First Coronavirus Relief Act (FFCRA) included a 6.2% FMAP increase for states contingent upon meeting certain maintenance of effort conditions. On April 13, CMS issued a set of Frequently Asked Questions clarifying that the FMAP increase enacted in FFCRA has the effect of further increasing the enhanced CCBHC federal match rate: “Match rates for…CCBHC expenditures will be indirectly increased as a result of the 6.2 percentage point FMAP increase under the FFCRA.” (p. 12)

This increase applies only to services subject to the enhanced match rate for the CCBHC Medicaid demonstration; it does not apply to services funded by SAMHSA CCBHC Expansion Grants.

For an explanation of the formula used to determine the amount of the FMAP increase, please see this prior FAQ from CMS.

Questions? Contact Policy@TheNationalCouncil.org.

Other Medicare Policy Changes

Medicare Incident to Billing

Last updated: April 20, 2020
Changes since prior update: confirmation that supervising clinicians do not need to be dialed into the encounter when supervising remotely.

Certain changes CMS has made to telehealth and supervision requirements in Medicare will allow providers to expand services delivered by licensed professional counselors (LPCs) and marriage and family therapists (MFTs) during the public health emergency.

  • CMS has expanded the types of Medicare services that may be delivered by telehealth during the public health emergency.
  • Additionally, for the duration of the public health emergency, CMS has relaxed the “direct supervision” requirement that previously required supervising physicians to be in the same physical location as the clinician delivering the “incident to” service. Now, supervision may be conducted by audio/video communication technology, meaning that LPCs and MFTs may conduct “incident to” encounters when they are not in the same place as the supervising physician. The supervising physician does not need to be dialed into the encounter, but must be available for immediate audio/video supervision if needed, much as they would be available in an office suite during a typical encounter. (All other “incident to” billing rules remain in place; please consult the National Council’s “incident to” billing guide for additional information.)

For more information, view CMS’ summary of the Medicare telehealth and supervision changes and FAQs.

The National Council and our member organizations have advocated over many years to make LPC and MFT services more accessible to Medicare beneficiaries. We will be fighting to make these temporary changes permanent after the end of the public health emergency. Comments on these changes are due by June 1, 2020. The National Council will be providing template comments to our members; stay tuned to Capitol Connector or check back to this site to view the template when it is available.

Questions? Contact Policy@TheNationalCouncil.org.

Other Medicaid Policy Changes

FMAP Increase

Last updated: April 15, 2020.
Changes since prior update: application of enhanced FMAP to CCBHC services

Congress enacted a 6.2% Federal Medical Assistance Percentage (FMAP) increase in the Families First Coronavirus Relief Act. The FMAP increase is in effect from January 1, 2020 through the last day of the calendar quarter in which the public health emergency ends. Full details are available here from CMS.

To be eligible for the increase, states and territories must meet certain requirements (e.g. maintaining eligibility standards, covering COVID-19 treatment, and more). The increase applies to both child and adult services: it is a direct addition to the FMAP for most Medicaid covered services, and it factors into the formula for calculating the enhanced FMAP for CHIP services. The FMAP increase also has the indirect effect of increasing FMAP for services in the CCBHC Medicaid demonstration (see p. 12 of CMS’ April 13, 2020 FAQ).

Questions? Contact Policy@TheNationalCouncil.org.

Patient Privacy and Confidentiality

HIPAA and 42 CFR Part 2

Last updated: April 15, 2020

To support providers for the duration of the national emergency, the Department of Health and Human Services (HHS) issued guidance regarding the applicability and subsequent enforcement of federal laws and regulations pertaining patient privacy and confidentiality. HHS announced that it will not penalize HIPAA covered health care providers or their business associates for the use and/or disclosure of protected health information when it is intended to assist in combating the Coronavirus.

Additionally, the Substance Abuse and Mental Health Services Administrations (SAMHSA) announced 42 CFR Part 2 guidance that allows for disclosure of Part 2-protected information without consent during a bona fide emergency.

Feldesman, Tucker, Leifer & Fidell has created a resource document regarding patient privacy and confidentiality that can be found here.

Please Note: State and local laws and regulations may provide additional protections to patient records. Where a state law or regulation provides greater privacy protections or privacy rights, HIPAA covered entities and Part 2 programs must follow the state law or regulation. The guidance from HHS does not address the application and enforcement of state confidentiality laws or regulations.

HIPAA Guidance and Compliance Tips

42 CFR Part 2 Guidance and Compliance Tips

Frequently Asked Questions

Questions? Contact Policy@TheNationalCouncil.org.

Additional Resources

Vaccine Information

COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit

The CDC recommends early vaccination of long-term care facility health care personnel and residents. Read their Long-Term Care Facility toolkit to:

  • Prepare for COVID-19 vaccination
  • Build confidence in the vaccine

Additional Vaccine Resources

National Council Resources
General Resources for Providers
Strategic Partner Resources