CareOptimize COVID-19 Webinar series episode 2 continues with the most up-to-date news from CMS along with other regulatory changes affecting the healthcare industry. The primary focus is on a trio of distinct provider models and how each of them is managing their practices while adapting to the challenges of the pandemic. We also go over the technology CareOptimize has developed aimed at streamlining COVID-19 monitoring and reporting.

1. COVID-19 and Its Impact

2. Industry Updates

3. CMS
Updates
CMS Approves 12 Additional State Medicaid Waivers to Give States
Flexibility to Address the Coronavirus Disease 2019 (COVID-19)
CMS approved an additional 10 state Medicaid waiver requests under
Section 1135 of the Social Security Act (Act), bringing the total number
of approved Section 1135 waivers for states to 23.
Examples of waivers available under section 1135 of the Act include:
• Temporarily suspend prior authorization requirements;
• Extend existing authorizations for services through the end of the
public health emergency;
• Modify certain timeline requirements for state fair hearings and
appeals;
• Relax provider enrollment requirements to allow states to more
quickly enroll out-of-state or other new providers to expand access to
care, and
• Relax public notice and submission deadlines for certain COVID-19
focused Medicaid state plan amendments, enabling states to make
changes faster and ensure they can be retroactive to the beginning of
the emergency.
• These section 1135 waivers are effective March 1, 2020 and will end
upon termination of the public health emergency, including any
extensions.*
State by state information can be found here:
https://www.medicaid.gov/medicaid/section-1115-
demo/demonstration-and-waiver-
list/index.html?f%5B0%5D=waiver_authority_facet%3A1571#content#c
ontent
*www.Medicaid.gov

4. CMS
Updates
Under the new stimulus package just approved, providers can receive
accelerated or advanced Medicare payments. This applies to all hospitals,
physicians, durable medical equipment suppliers, and other Medicare
Parts A and B providers and suppliers.
The Coronavirus Aid, Relief, and Economic Security Act—CARES—which
President Donald Trump signed into law on Friday, enables all Medicare
providers to tap into an emergency fund in order to help with their cash
flows.
According to a CMS release, providers or suppliers must:
• Have billed Medicare for claims within 180 days immediately prior to
the date of signature on the provider's/supplier's request form,
• Not be in bankruptcy,
• Not be under active medical review or program integrity investigation,
and
• Not have any outstanding delinquent Medicare overpayments
As part of CARES, Medicare Sequestration will be suspended from May 1,
2020 to December 31, 2020. For Medicare Fee-for-service claims, this will
increase payments by 2%. For Medicare Advantage risk contracts, this will
increase the premium flowing into service funds by 2%.
CMS is accepting and processing requests now, with payments going out in
as little as seven days.

5. Loans
Available
Small Business Administration Loans
• Anyone with revenues less than $12 million
• Retroactive to February 15 and runs through June 30
• Will cover 2.5 times average monthly payroll up to $10 million
• Loans will be forgivable if you do not have any layoffs
• “HHS is authorized to reimburse eligible healthcare providers,
through grants or other instruments, for up to $100 billion of
healthcare-related expenses and losses that are attributable
COVID-19. Reimbursable expenses and losses include those
related to construction of temporary structures, property leases,
medical supplies and equipment, testing supplies, increased
workforce and trainings, emergency operation centers,
retrofitting facilities and surge capacity.”
https://www.sba.gov/page/coronavirus-covid-19-small-business-
guidance-loan-resources

6. Telehealth
Changing the way medicine is done
Reviewing labs, x-rays,
and consultant notes
Arranging referrals,
speaking to home health
nurses, etc.
Answering patient calls
and emails about chronic
conditions
Any telephone education
YOU GUYS CAN PUT RELEVANT
INFORMATION HERE. I KNOW BEN
JUST WANT IT TOUCHED UPON AS A
GROWING PART OF MEDICINE

7. CareOptimize
COVID-19
Template &
Report
As the number of COVID-19 cases rises, monitoring
and reporting of patients remain two challenging
areas. CareOptimize has developed two utilities to
help:
1) A report showing all
high-risk patients in
your organization who
should be considered
for additional
screening or other
preventative
measures.
2) A template for logging in data on patents
who test positive. This template also allows
streamlining notifications on those patients
to the CDC, state health agency, and/or local
health department.

8. Client Case Studies

9. Premier South
Fee-for-service Primary Care provider

10. The Premier South Plan
Patient Outreach Premier South is offering wellness classes, including
Zumba, on their Facebook page in a live feed.
Outside Triage at Clinics – No one is allowed in the clinics without first
having their temperature taken outside to determine it is safe to let them
in. All members coming into the clinic for an appointment must wear a
face mask. Inside, members wear masks, and staff is wearing face masks
and gloves. Not letting folks in without taking temps outside – have to
wear masks inside. All medical personnel are wearing masks and gloves.
Not canceling appointments – Fee-for-service appointments are directly
tied to income, so all appointments have been converted to telemedicine.

11. The Premier South Plan
Emergencies – Emergency calls are triaged over the phone for severity.
Patients are only sent to a hospital if a provider’s assessment determines
it is necessary.
Media Campaign – Flyers are available at every practice with information
on healthy habits and contacts. Every patient is also being contacted via
email and text to ensure all are well.

12. Sunrise Cardiology
Fee-for-service Specialty Care provider

13. The Sunrise Plan
Not canceling appointments – Fee-for-service appointments are directly
tied to income, so all appointments have been converted to telemedicine.
Necessary conversion - Converting to more of an internal medicine
consult instead of just cardiology.
Patient Outreach – All patents with highly chronic conditions are being
called and texted to ensure they are doing well. In the phone calls,
patients are being triaged. If they seem to have any COVID-19 symptoms
(according to CDC guidelines) they are instructed to go to nearest
community testing site. Sunrise is keeping an updated list of available
sites.

14. The Sunrise Plan
Elective Procedures – All elective diagnostic studies, including stress
tests, are being scheduled two months’ out. Only patients with severe
cardiac symptoms are being brought into the practice for diagnostic
testing. Dep on severity of case, scheduled for emergency hospital
procedures (complete blockage = bypass surgery)
Outside Triage at Clinics – No one is allowed in the clinic without first
having their temperature taken outside to determine it is safe to let them
in. All members coming into the clinic for an appointment must wear a
face mask. Inside, members wear masks, and staff is wearing face masks
and gloves. Not letting folks in without taking temps outside – have to
wear masks inside. All medical personnel are wearing masks and gloves.

15. CareMax
Global capitation full-risk provider in Florida serving low-income seniors.

16. Eight full-risk clinics in South Florida
• Transportation • Urology • Lab
• Primary Care • Optometry • Dental
• Cardiology • Pharmacy • Pain Management
• Podiatry • Gastro • Ultrasound
• Radiology • Home Visits • Psychiatry

17. The CareMax Plan
Vulnerable Population > Senior, Low-income, Multiple chronic conditions
The overall goal for CareMax is to keep patients home but ensure they are
comfortable, well stocked, and avoid the hospital except for emergencies due to
the risk of infection.
Closing Wellness Clinics - CareMax wellness clinics were closed early on. Medical
centers remain open.
Outside Triage at Clinics – No one is allowed in the medical centers without first
having their temperature taken outside to determine it is safe to let them in. All
members coming into the clinic for an appointment must wear a face mask.
Inside, members wear masks, and staff is wearing face masks and gloves. Staff and
members are practicing social distancing.
Wellness Check – Every CareMax member is being called every week for a
wellness check. These are primarily to answer any questions members might
have, make sure they have enough food, and to reiterate the importance of
healthy habits (washing hands, social distancing, etc.). The primary message is
“CareMax is here to help.”

18. The CareMax Plan
Inbound Calls – All inbound calls are screened with scripted screening questions:
• Are you having any symptoms?
• Have you traveled outside the US?
• Has anyone you’ve been in contact with traveled outside the US?
• Do you have a cough, fever, or shortness of breath?
• If any answer is “yes,” callers are immediately scheduled for a virtual visit . If the
answer is “no,” they are also welcome to schedule a video appointment.
Transportation - If a patient wants to be transported to a center, they must have
their temperature taken and answer all screening questions. If they have a fever,
exhibit any other symptoms, or answer “yes” to any of the screening questions, they
are not allowed on the van. They are, however, offered a virtual visit with a provider.
Virtual Appointments - CareMax purchased 20 tablets to be able to conduct virtual
visits with those who don’t have the technology or knowledge to do it themselves.
Drivers go to the member’s home and queue up the virtual visit . After the visit, the
tablet is disinfected, and the driver takes the tablet to the next appointment.

19. The CareMax Plan
Food deliveries –Daily food deliveries now top more than 500. This helps
keep patients happy and at home while ensuring they are eating.
Online wellness courses – These occur on Facebook Live feeds on the
CareMax Medical Centers Facebook page. Zumba, chair yoga, and
relaxation courses are available for CareMax members plus anyone
outside CareMax. Various classes will be in English and Spanish to reach
all the population.
Media Campaign – Flyers have been created in English, Spanish, and
Creole with safety protocols and ways members can contact CareMax for
questions. These were sent to all members. CareMax plans on sending
these flyers to all members every two weeks.
Call CareMax First Campaign – CareMax members are being encouraged
to Call CareMax First before going to a hospital. This forestalls any
unnecessary visits and gives members access to someone 24/7, even if
it’s just to talk or ask questions.

20. Resources
www.careoptimize.com/insights
https://www.cms.gov/About-CMS/Agency-
Information/Emergency/EPRO/Current-Emergencies/Current-
Emergencies-page
https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-
and-waiver-
list/index.html?f%5B0%5D=waiver_authority_facet%3A1571#content#co
ntent
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://www.sba.gov/page/coronavirus-covid-19-small-business-
guidance-loan-resources

21. CONTACT
Lauren.Picone@careoptimize.com
info@careoptimize.com