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Ohio Department of Medicaid Starts Process to Make Telehealth Services Permanent

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September 17, 2020

September 17, 2020

On September 1, 2020, the Ohio Department of Medicaid (“ODM”) announced it has started the process to make a current temporary rule related to telehealth services permanent. In March 2020, ODM implemented a temporary rule designed to expand the use of telehealth services in response to the COVID-19 pandemic.  Based on a significant increase in the usage of telehealth services, ODM now wishes to make the expansion permanent, and has submitted a proposed permanent rule for review and approval.

Prior to the COVID-19 pandemic, ODM providers submitted less than 1,000 telehealth claims per month for physical health services, and around 4,000 telehealth claims per month for mental health and addiction services.  Since the implementation of the temporary rule, ODM providers have submitted 1.3 million claims for physical health services, and 1.28 million claims for mental health and addiction services.

The proposed rule includes a change in the definition of telehealth.  Formerly, telehealth consisted of health care services provided by secure, synchronous, interactive, real-time electronic communication between the patient and the practitioner with both audio and video elements.  Under the proposed rule, telehealth would now include health care services that are provided via a communication that is asynchronous or that does not have both audio and video elements, including telephone calls, remote patient monitoring, and communication through secure e-mail and patient portals.  Under the previous rule, these activities were not considered telehealth.

The proposed rule also increases the types of practitioners eligible to render telehealth services to ODM patients. Additional eligible practitioners include dentists, optometrists, audiologists, and occupational and physical therapists.  The proposed rule also adds to the types of telehealth services that may be paid for by ODM.  Some of the additional covered telehealth services include:

  1. Remote evaluation of recorded video or images submitted by an established patient;
  2. Virtual check-in by a physician or other qualified health care professional who can report evaluation and management services, when provided to an established patient;
  3. Online digital evaluation and management services, when provided to an established patient;
  4. Remote patient monitoring;
  5. Audiology, speech-language pathology, physical therapy, and occupational therapy services;
  6. Limited or periodic oral evaluation; and
  7. Optometry services.

The proposed rule is currently under review by the Joint Committee on Agency Rule Review, with a hearing scheduled for October 1, 2020.  ODM anticipates the review being completed and the rule being approved before the current temporary rule expires on November 14, 2020.

The significant increase in the amount of ODM patients utilizing telehealth cannot be ignored.  Many healthcare professionals are taking steps to permanently modify their practice operations in order to accommodate the increased demand for telehealth services.

Kari Heinze is an associate in Walter | Haverfield’s Columbus office. She focuses her practice on business services within the healthcare and dental practice arena. Kari can be reached at kheinze@walterhav.com or at 614-246-2266.  

Vince Nardone is Partner-in-Charge of Walter | Haverfield’s Columbus office. He serves as a business advisor to owners and executives of closely-held businesses, counseling them on business planning, tax planning and controversy, cash-flow analysis, succession planning, and legal issues that may arise in business operations. Vince can be reached at 614-246-2264 or vnardone@walterhav.com.

Updated CDC Guidelines for Aerosol-Generating Procedures in Dental Practice Settings


June 3, 2020

June 3, 2020 

Ohio’s dental practices reopened for non-emergency services on May 1, 2020. The Ohio State Dental Board implemented several guidelines for dental practices to follow upon reopening, including a requirement to adhere strictly to infection control protocols and personal protection equipment (“PPE”) guidelines set forth by the American Dental Association’s Return to Work Toolkit and the Centers for Disease Control and Prevention (“CDC”). On May 19, 2020, the CDC updated its infection prevention and control guidelines with respect to dental practice settings during the COVID-19 pandemic.  The updated CDC guidelines included new recommendations for the use of PPE during aerosol-generating procedures.

The CDC continues to recommend that aerosol-generating procedures be avoided if possible. But, there are many situations in which aerosol-generating procedures must be performed. Prior to May 19, 2020, the CDC advised that aerosol-generating procedures should be performed only with the use of a n95 respirator mask. If a n95 respirator mask was not available, the CDC previously recommended that the aerosol-generating procedure not be performed. The CDC’s updated guidelines have revised this recommendation. The CDC still recommends that aerosol-generating procedures should be performed with the use of a n95 respirator mask, if available. But, if a n95 respirator mask is not available, the CDC now recommends that the aerosol-generating procedure should be performed with the use of a FDA-approved surgical mask and a full face shield. If a n95 respirator mask, or a FDA-approved surgical mask and full face shield are not available, the CDC advises that the aerosol-generating procedure should not be performed.

In addition to a n95 respirator mask or a FDA-approved surgical mask and full face shield, dental professionals should wear gloves, eye protection, and a gown or other protective clothing when performing an aerosol-generating procedure. Further, the CDC guidelines also call for the use of four-handed dentistry, high evacuation suction, and dental dams to minimize droplet spatter and aerosol release. The CDC also indicates that the number of dental professionals present during the aerosol-generating procedure should be limited to only those essential for patient care and procedure support.

The CDC continues to remind dental practices of the importance of ensuring that the dental practice has the appropriate amount of PPE and supplies to support its patient volume. If PPE and supplies are limited, the CDC advises dental practices to prioritize dental care for the highest need, most vulnerable patients first. To review the CDC’s updated guidelines, please visit the CDC’s website.

For more information on the new infection prevention and control guidelines set by the CDC for dental practices in response to COVID-19, or if you have questions regarding the application of these guidelines, please contact Kari Heinze.

Kari Heinze is an associate at Walter | Haverfield who focuses her practice on business services within the healthcare and dental practice arena. She can be reached at kheinze@walterhav.com or at 614-246-2266.

Ohio Nonprofit Develops Mobile Ventilator for COVID-19 Patients


May 5, 2020

Venti-Now President, John Molander

May 5, 2020

A Cincinnati-based nonprofit corporation, Venti-Now™, has received FDA temporary Emergency Use Authorization to create a portable ventilator to meet the ventilator shortage caused by the COVID-19 pandemic.

Venti-Now™, a Walter | Haverfield client, created the Venti-Now Class II medical device unit in three weeks with professionals from Proctor & Gamble (P&G) as well as the University of Cincinnati’s Medical Center, Children’s Hospital, and its Biomedical Engineering program.

“We built and tested a breakthrough ventilator design which can be manufactured rapidly with very few components,” said John Molander, president of Venti-Now™ and retired Proctor & Gamble engineer. “We believe our product will make an immediate impact.”

“It is an honor to collaborate with and counsel the Venti-Now team to swiftly and effectively bring a life-saving product to market,” said Vince Nardone, a Walter | Haverfield partner who, among others within Waler | Haverfield, assisted Venti-Now™ with its business formation, licensures, trade-mark, and patent processes, and continues to assist with similar matters. “The Venti-Now team’s dedication and passion exemplifies the ingenuity of individuals to pull together and help others during times of need.”

The ventilator, which is light enough to be carried with one hand, is an electro-pneumatic ventilator for patients in the early stages of acute respiratory distress syndrome (ARDS). It uses hospital compressed air to drive the unit and 110v to power it.

Venti-Now™ units will be sold at a fraction of the cost of devices currently on the market, and they have lower operation and maintenance costs. The team also aims to provide low-cost ventilators to regions of the world that cannot afford multi-modal ventilators.

Since 1932, Walter | Haverfield attorneys have served as strategic counselors to private businesses, public entities and high-net-worth individuals, providing creative and customized solutions that deliver outstanding results at an exceptional value. Our track record has allowed us to sustain year-after-year growth. Walter | Haverfield has doubled its size in the past decade to become one of the top ten Cleveland-based law firms. Today, our team of nearly 90 attorneys is focused primarily in the areas of business services, real estate, intellectual property, labor and employment, education, tax and wealth management, hospitality and liquor control, litigation and public law.

Medical Providers Receive Pandemic-Related Federal Stimulus Payments


April 17, 2020

April 17, 2020

As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the U.S. Department of Health and Human Services (HHS) began distributing $30 billion on Friday, April 10, 2020 to U.S. medical providers who received Medicare fee-for-service (FFS) reimbursements in 2019. The funds, which are not loans and do not need to be paid back, are being directly deposited into providers’ accounts.

Providers are receiving about 1/16th of his/her Medicare FFS reimbursements in 2019 in the form of a stimulus payment. If a provider did not bill Medicare in 2019 for FFS, the provider will not receive money from this distribution.

The funds are meant to be used to cover health care-related expenses or lost revenue due to the coronavirus pandemic. Examples of expenses identified in the CARES Act include building or construction of temporary structures, leasing of properties, buying medical supplies, personal protective equipment and testing supplies, increasing one’s workforce and holding trainings, and retrofitting facilities. However, providers can essentially use the funds as they see fit, as long as they do not use them to reimburse expenses or losses that have been reimbursed from other sources, or that other sources are obligated to reimburse.

Providers are required to document how the stimulus payment is used. They will also be required to submit reports to ensure compliance with the payment. But details of what those reports will entail have not been made available yet.

Additionally, those who receive stimulus payments from HHS are not exempted from receiving other forms of relief.

The $30 billion distribution is part of $100 billion relief fund appropriated in the CARES Act to the Public Health and Social Services Emergency Fund (PHSSEF), also called the CARES Act Provider Relief Fund. HHS intends to distribute more relief funds in the future, particularly to providers hit hard by the pandemic as well as those who serve rural areas, the Medicaid population and the uninsured, and those with lower shares of Medicare FFS reimbursement.

If you have further questions, please reach out to us here. We are happy to help.

Lacie O’Daire is chair of the Tax and Wealth Management Group at Walter | Haverfield. She can be reached at lodaire@walterhav.com and at 216-928-2901.