COVID-19 Compliance Updates | Texas Tech University Health Sciences Center
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Compliance COVID-19 Updates

The COVID-19 virus has invoked a number of regulatory changes at both federal and state levels. TTUHSC Office of Institutional Compliance remains diligent in monitoring these regulatory changes closely. To learn of updates regarding telehealth, HIPAA privacy & security, immigration compliance, billing and reimbursement, and vendor interactions, please click the tabs below.

HIPAA & Telehealth
On March 17, 2020, Office of Civil Rights (OCR) announced that it will exercise its enforcement discretion and will not impose penalties for HIPAA violations against health care providers that in good faith provide telehealth using non-public facing audio or video communication products during the COVID-19 nationwide public health emergency.
HIPAA FAQs for Implementing Telehealth Services (added 3/30)

Other Resources
HIPAA Considerations When Working from Home   (added 4/03)
Social Engineering Tips (added 3/26)
- SAMHSA COVID-19 Information
- Best Practices for Zoom Conferencing (added 4/9)

Under the 1135 waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020.  A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. CMS will now allow for more than 80 additional services to be furnished via telehealth, and providers also can evaluate beneficiaries who have audio phones only.

Telehealth Services (Factsheet from CMS)

Medicare Telehealth Frequently Asked Questions (FAQs)
 
HIPAA FAQs for Implementing Telehealth Services

- Telephone Consent
Medicare Coverage and Payment of Virtual Services (CMS MLN Video)
Telemedicine & COVID-19 FAQs (04/02)
- TTP Provider Quick Reference for Telehealth Visits (added 04/16)
- Informed Consent to Telemedicine (added 04/20)
- Telemedicine Coding Chart & Tree for COVID-19 (added 04/21)
- State Expediting Licensure in Response to COVID-19 (added 04/22)
- CMS Telehealth Covered CPT - COVID-19 (added 05/01)
- CMS Physicians & Practitioners (added 05/01)
- CMS Teaching Hospitals, Teaching Physicians, & Residents (added 05/01)
- CMS Final Rule with Comments Summary (added 05/01)
- Medical Student Documentation PHE  (added 06/02) 
- New Mexico License Exemption (added 07/06)
- Duration of Telehealth Waivers (added 07/21)

 

The escalating national crisis surrounding COVID-19 is resulting in unprecedented actions by the Dept. of Homeland Security (DHS), Dept. of Labor (DOL), and Department of State (DOS).  Other countries are announcing travel restrictions, both internally and externally.  Policies and procedures are changing rapidly -- and often daily -- and ICS is working diligently to keep up with these changes and ensure all employees maintain lawful immigration status.   It takes time to digest the impact of these ongoing shifts in law and procedure, and we thank you for your patience.  Be assure that we will continue to guide you correctly during this period of global stress.

DHS, DOL and DOS have issued visa status and other guidance for foreign students and employees.  Exchange Visitors (J-1 and J-2) should read all emails sent directly from the DOS Visitor Program.  DHS' immigration agencies (ICE, USCIS and CPB) provide updates on their websites and by email. 

USCIS News
CBP News
ICE News
DOS (Exchange Visitors)

DOS (Consulates & Embassies)

                        Zoom Recordings - Immigration Q&A During & After COVID-19

May 7, 2020 meeting (Password: 8A$@?&1.   The password ends with the period).
- April 23, 2020 meeting (No password needed).
 
 

 

 

 

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     Immigration Q&A Regarding Work-From-Home Mandate

The questions and answers below provide general information.  Please contact ICS with questions or concerns about your specific immigration situation.

Q.1.  Does my visa status allow me to work from home?

Yes. All international employees are permitted to work from home but with some visa statuses there may be reporting requirements specific to your visa status.  See the visa-specific requirements below:

  • F-1 and J-1 Students - Please let your DSO or ARO know that you are working from home.  Your DSO/ARO will update your SEVIS record, if required, with the new worksite address.  You must contact your DSO/ARO and update the worksite address again, when you return to on-campus employment.
  • F-1 OPT or STEM OPT Workers - Please let your DSO or ARO know that you are working from home.  Your DSO/ARO will update your SEVIS record, if required, with the new worksite address.  You must contact your DSO/ARO and update the worksite address again, when you return to on-campus employment.
  • J-1 Exchange Visitors (All Categories Except J-1 Students) - J-1 employees and non-employees who are working from home do not have to individually notify the Department of State.  TTUHSC sent an Incident Report to the Dept. of State notifying the agency of each phase of our work-from-home procedures.  The Dept. of State is aware that our J-1 employees and non-employees are working from home and we will update each SEVIS record with this information, if required. 
  • J-2 Exchange Visitors with an Employment Authorization Document (EAD) - J-2s with EAD do not have to notify the Dept. of State about changes in employment.  This is because EAD is an optional benefit available to J-2s and not a requirement. 
  •  Other Employees with Employment Authorization Documents (EAD) - Employees with EAD approval not related to OPT or STEM OPT, can choose to work or not work, so no reporting to USCIS is required.  
  •  H-1B Employees - H-1B regulations allow for short-term placements outside of the worksite listed on your LCA.  TTUHSC will take advantage of the 30-day short-term placement allowance, and will take advantage of the 60-day short-term placement allowance should the work-from-home mandate extend beyond April 18, 2020.  For those interested, the regulation is at 20 CFR § 655.735.  Please note that this regulation does not require TTUHSC to pay your travel, meals room and board because each H-1B employee is working from home. 
Q.2.  May I still extend my visa status?

Yes.  ICS is working with departments to extend visa status if employment will continue past the current expiration date.

Q.3.  USCIS suspended premium processing and I need an H-1B or O-1 approval in a few months.  What will happen?

ICS will continue to file all H-1B and O-1 petitions.  When the premium suspension is lifted, we will request premium processing.  We are not going to overly-worry about this until 60 days before the H-1B or O-1 start date because we anticipate that the suspension will be lifted in the next few weeks. 

USCIS is aware that H-1B and O-1 approvals are needed for upcoming employment, especially for medical providers.  If necessary we will use USCIS Expedite Request option if the job duties meet the criteria.  Not all of TTUHSC's positions meet the criteria for an Expedite Request so we will still join with other institutions to press for the premium processing suspension to be lifted.   

Q.4.  Should I travel outside the USA?

No.  We do not know when travel bans or shelter-in-place policies will be implemented in any country so it is best to stay where you are at this time.  If you have a travel emergency, please contact ICS and report your travel on the Institutional Health website.

Also, because all US consulates have suspended regular operations and in-person appointments, you may find it impossible to get a new visa in a timely fashion, if you need one before returning to the USA.  Travel abroad, or even out of Texas, is not advised at this time.  

Q.5.  I’m in H-1B status working under my Conrad 30 J-1 Waiver.  The program doesn’t allow the physician to do telemedicine.  My worksite has reduced clinical hours and I’m not doing telemedicine.   Will this be a problem?

The Conrad 30 program didn’t envision the problem of a global pandemic so none of the regulations address the situation we are now experiencing.  However, even though a Conrad 30 slot is not available to physicians who will only practice via telemedicine, it does not mean that telemedicine isn’t permitted. 

Conrad 30 physicians must physically reside in the medically underserved area and provide in-person medical services for at least 40 hours per week. As long as those two requirements are met, additional hours can be spent in telemedicine.  

We are waiting for USCIS to confirm that no Conrad 30 physician will be required to extend their Conrad 30 commitment because of reduced clinical hours.  All Conrad 30 physicians should keep a record of their in-person work hours and report clinic and hosptial hours to ICS at ICS@ttuhsc.edu.  We will update this answer as we receive additional information.

Q.6.  I need to extend my DS-2019, how will I get the new one?

ICS is extending all DS-2019s when the departments request an extension.  We are not permitted to send DS-2019s by email or fax, and each document must have a "wet ink" signature.  We will leave all signed DS-2019s in the department mailbox and send an email to the J-1 and department administrator when the document is left with Mail Services. 

Q.7.  My J-1 program is reaching it maximum duration in a few months.  Can I get an extension based on the State Department's recent announcement? 

The State Department recently announced that all exchange visitor programs that end, due to maximum duration, between April 1 - May 31, 2020 can be extended for 60 days.  The 60 day period is to  allow "exchange visitors the opportunity to complete either their educational or training programs, or continue to finalize travel plans to return home."  This benefit is only for J-1s whose have reached the maximum duration of their program. 

The benefit is only available to exchange visitor programs that end between April 1 - May 31, 2020.  If your J-1 program ends at a later date, this benefit is not guaranteed.  We believe the State Department will announce further extensions If the COVID-19 crisis requires that this benefit be extended.

Q.8 Is ICS suspending any immigration filings?

No.  USCIS has not automatic extensions of visa status so we are continuing to file our immigration petitions and extensions to ensure that no employee falls out of status or is unable to work.  Employees will notice one change with the Employee Questionnaire.  ICS is no longer using the PDF questionnaire and employees will be given access to eImmigration our immigration case management system.  The employee questionnaires will be accessed electronically and employees will upload the documents we request directly to eImmigration.  Department administrators will continue to use the PDF Department Questionnaire; nothing has changed for the departments.

Q.9  May I accept the Stimulus Payment without triggering a public charge determination?

Yes. If you qualify to receive the Stimulus payment you can accept it.  The federal stimulus payment is not a federal or state benefit that you received because your specific financial situation was reviewed and you were found to need public benefits.  The stimulus payment is given to every tax filer who had an adjusted gross income of $75,000 or less ($150,000 or les for married filing jointly) on the 2019 or 2018 federal tax return.  The payment is not a public charge benefit and it does not have to be repaid.  Also, the payment will not reduce any tax refund you are expecting in 2019.

IRS FAQs are at https://www.irs.gov/coronavirus/economic-impact-payment-information-center?mod=article_inline

Q.10  How do I know if I qualify for the Stimulus Payment?

The stimulus payment is only available to persons who qualify as resident-aliens-for-tax-purposes.  An international person qualifies for resident-alien-for-tax-purposes based on visa status and any exemptions or requested tax treaty benefits.  Please review your Glacier international tax record to confirm whether you are a resident-alien-for-tax-purposes or nonresident-alien-for-tax-purposes. 

If you are a nonresident-alien-for-tax-purposes and accidentally or incorrectly filed your tax return(s) as a resident-alien-for-tax-purposes, the IRS will likely incorrectly send you a stimulus payment.  This will create two problems for you:  first, that you filed taxes incorrectly and may owe the IRS fines and penalties; and second, you are receiving a stimulus payment that you are not entitled to have. If you believe this is situation applies to you, please contact ICS, TTU Tax or a tax preparer who has experience with nonresident tax filings.  Do not compound the tax filing error or delay in fixing your tax filing.  

Q.11  May I accept medical benefits such as reduced or free medical care for COVID-19 treatment without triggering a public charge determination?  

USCIS has also made clear that nonimmigrants who obtain medical treatment  and accept medical benefits due to COVID-19 will not be negatively affected by the public charge review.  https://www.uscis.gov/greencard/public-charge.  If you are concerned about anything changing, please print or save the USCIS information.

 

Stark Law Blanket Waivers
On March 30, 2020, the Secretary of Health and Human Services issued 18 blanket waivers of enforcement of the Stark law under his 1135 waiver authority. These waivers provide vital flexibility for physicians and providers in the fight against COVID-19.
Stark Law Blanket Waivers During COVID-19

Anti-Kickback Statute Enforcement Discretion
On April 3, 2020, Office of Inspector General (OIG) released a Policy Statement indicating OIG will exercise its enforcement discretion not to impose administrative sanctions under the federal Anti-Kickback Statute (“AKS”) for certain financial arrangements related to COVID-19 purposes that are covered under the Stark Law Blanket waivers issued by the Secretary of the U.S. Department of Health and Human Services on March 30, 2020.
OIG Policy Statement 4.3.20

Compliance Updates Discussions
Held April 3rd through July 10th to keep TTUHSC staff and faculty updated 
throughout the COVID-19 pandemic


Q&A - Compliance Updates

Controlled Substances
In response to the COVID-19 public health emergency declared by the Secretary of Health and Human Services, the Drug Enforcement Administration (DEA) has adopted policies to allow DEA-registered practitioners to prescribe controlled substances to patients for whom they have not conducted an in-person medical evaluation.
Controlled Substances Prescribing During COVID-19
- DEA COVID-19 Information

Vendor Access Policy Update
In response to COVID-19, TTUHSC has implemented a restricted vendor access policy to include only essential core functions and critical services. Currently, all non-essential vendors should conduct business remotely. Only essential vendors may come onto TTUHSC premises, but only with prior approval by your TTUHSC point of contact. TTUHSC has also implemented additional safeguards to help protect the health and safety of vendors and our institution. Please review the following document for details.
- Vendor Access Policy Update (added 4/8/20)
- Vendor Access Policy Update Presentation (Meeting on 4/10/20)

CMS Open Payments Program Update
Open Payments is a federal program that collects and makes information public about financial relationships between the health care industry and physicians and teaching hospitals. CMS publishes this data twice annually: Initial Publication (June 30 of each year) and Refresh Publication (early part of the calendar year after submission). Physicians have 45 days starting April 1st to review and dispute. 

The Review & Dispute period, during which physicians could review and dispute the 2019 data reported about them, ended May 15th, 2020. There will be some changes to the CMS Open Payments Program in 2021. In 2021, data will be collected about nurse practitioners, PAs, CRNAs, etc. Please see the details summarized in the following document:
- CMS Open Payments 2020

 

Compliance Training

 

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