IMS and the AMA continue to work closely with our state and federal partners to push for additional resources and regulatory flexibility for clinics responding to COVID-19. This includes immediate action to meet urgent clinical needs and action to help address the long-term implications this pandemic will have on Iowa practices.
Many Iowa practices are reporting low or exhausted medical supplies, especially personal protective equipment (PPE) and basic testing supplies. IMS has been working with our partner associations on a state level to push for local donations to serve as a stop-gap until new shipments of supplies arrive. We have also been pushing the Iowa Congressional Delegation to fight for federal measures to help. The Families First Coronavirus Response Act, signed into law on Tuesday, includes a provision to waive federal limitation on the sale and use of commercial PPE for healthcare providers. IMS and the AMA are urging Congress and the Trump Administration to speed resources and production of additional PPE and necessary testing supplies to clinics responding to the pandemic.
Iowa’s State of Public Health Disaster Emergency Declaration has put in motion steps for the Department of Human Services to begin offering additional child care assistance for front-line health care workers. IMS and the AMA are pushing for additional federal action to help with this unmet need. Clinics and ambulatory surgical centers that are temporarily closing or reducing non-urgent services are being forced to temporarily layoff staff or reduce staff hours. Staff on temporary layoffs may qualify for unemployment benefits. The federal government is allowing states to amend their laws to provide unemployment insurance benefits related to the virus. Information about the changes to Iowa’s laws, such as waiving employer charges for unemployment claims made by employees affected by COVID 19, is available here. IMS is assembling details as they become available. IMS and the AMA are pushing for additional federal action to expand paid family, medical, and sick leave, and to ensure that practices have immediate access to federal grants, interest-free loans, or tax relief to offset these costs.
Electronic Prescribing Mandate
As state and federal officials rush to expand telehealth capabilities, clinics add additional screening options, and federal HIPAA enforcement is being relaxed to allow the utilization of otherwise non-compliant platforms, IMS has received inquiries about how practices are supposed to work within the context of Iowa’s electronic prescribing mandate. Especially for those physicians utilizing non-traditional telehealth platforms that lack eRX capabilities, this mandate has the potential to disrupt patient care. IMS has worked with Iowa Board of Medicine and the Iowa Board of Pharmacy to ensure that they will not be penalizing prescribers who issue a written or verbal prescription during Iowa’s public health emergency declaration, so long as that prescription follows all other laws and regulations.
Surge Capacity Support
As practices experience a surge in demand for COVID-19 testing and treatment, our state continues to lack a sufficient supply of testing equipment and lacks sufficient bed capacity for the projected increase in need once more Iowans become ill. The state’s emergency declaration includes a suspension of the Certificate of Need law to allow facilities to add beds for the treatment of COVID-19 patients, however, many facilities lack the resources and staffing capacity to be able to do so. IMS and the AMA are urging our state and federal partners to devote additional resources to help expand capacity. This includes urging Congress to appropriate $100 billion for front-line providers and facilities.
IMG Physician Waiver
Federal orders to remove barriers for cross-state medical practice and allow for expanded telehealth service failed to address the limitations placed upon international medical graduate physicians whose VISAs limit the practice locations at which they may practice. IMS and the AMA are pushing federal officials to relax these limitations to allow these physicians to provide additional services during the pandemic.
RHC Telehealth Waiver
Federal telehealth expansion efforts similarly failed to address existing limitations on rural health centers (RHCs) initiating telehealth visits or billing as the provider of those services. IMS has escalated this issue to our federal partners and is pushing for flexibility to allow these practices to also provide expanded telehealth services to patients. We are also working with our Congressional Delegation to push for a fix to this issue as part of the next wave of COVID-19 federal legislation.
CME & Professional Licensure Waivers
Iowa’s original emergency declaration failed to address pending professional license renewals and the associated continuing medical education (CME) mandates that are a condition of license renewal. IMS worked closely with the Governor’s Office and the Board of Medicine to resolve this issue as part of the governor’s March 22 public health emergency declaration. The new order suspends license expiration dates for the duration of the emergency declaration as well as CME deadlines, and allows physicians to continue providing care.
Revenue lost as a result of canceling elective surgical and non-urgent medical procedures is going to have substantial financial implications for many Iowa practices. Similarly, the costs of donated medical supplies for shuttered clinics, and the increase staffing, supply, and operational costs for those practice providing COVID-19 testing and treatment is going to be significant. IMS and the AMA are urging Congress to move forward with any potential measures to help restore the long-term fiscal sustainability of medical practices once the pandemic has stabilized and the healthcare system is able to return to normal operations.
Good Samaritan Protections
Iowa’s emergency declaration provides Good Samaritan liability protections for healthcare workers who volunteer to help fill workforce shortages in clinics responding to COVID-19. IMS is pushing for greater legal protections to protect all healthcare workers as they meet the challenge facing our state. On the federal level, IMS and the AMA are also pushing for Congressional action to ensure sufficient Good Samaritan protections are in place.
3/23/2020: This is a rapidly evolving situation. Please continue to consult the IMS COVID-19 Resource Page for the latest information. For more information IMS efforts or assistance for your clinic, please contact Kady Reese or Dennis Tibben with IMS.