COVID-19 UPDATE – FEDERATION OF TEXAS PSYCHIATRY

Dear Colleagues,

As you are all aware, it’s been an incredibly difficult time for everyone. We’re all concerned about those we love and about ourselves, our communities, and the overall health of our economy, nation, and planet. It’s a lot to process.

And yet, as we’re learning to navigate the logistics of living with social distancing and nagging uncertainty, people are working together to do whatever it takes to solve problems and support each other so it’s important to remind ourselves and others, you are not facing this crisis alone. Together, we will get through this and we, your organizations, are there to support you to the best of our abilities and provide you with all of the tools that are needed at this time.

The Federation of Texas Psychiatry Delegate Assembly and its’ member organization’s leadership will make decisions in the upcoming weeks regarding the rescheduling of events and virtualizing our live meetings based on the continued guidance from our state and local health authorities and elected officials. We will make every effort to give our members advance notice of any changes in scheduled events.

And over the last few weeks, the Federation of Texas Psychiatry’s office has been flooded with emails pointing us to countless resources to support Texans through this difficult time. We’ve organized these resources to make them easy for you to access in one place and will routinely update these pages so they are as timely and helpful as possible.

We will take all measures necessary to keep our members safe and healthy. If you have any questions or need further information, please do not hesitate to contact the Federation of Texas Psychiatry offices at txpsychiatry@aol.com, tsppofc@aol.com, or you may leave a voice mail message at 512-478-0605.

Stay Safe and Stay Well,

J. Clay Sawyer, MD
Chairman, Federation of Texas Psychiatry

IMPORTANT FEDERAL LICENSE INFORMATION

Updated list about licensure waivers from 4/10

Updated list of waivers for telehealth from 4/10

RESOURCES TO KEEP YOU AND YOUR PATIENTS SAFE

Center for Disease Control (CDC)

CDC Print Resources

World Health Association (WHO)

Texas Department of State Health Services (DSHS)

Texas Medial Board (TMB)

Personal Protective Equipment and Testing

Texas Medical Association – Personal Protective Equipment Supply and Shortage

Texas Department of State Health Services Information for Hospitals and Healthcare Professionals includes information such as the following:

  • Laboratory Testing
  • Contact information for Local Health Entities for disease reporting and/or local assistance
  • Guidance Regarding Infection Control & Personal Protective Equipment (PPE) with links to additional CDC guidance.
  • Instructions on Requests for Assistance from DSHS (PPEE, etc.): “Hospitals and healthcare professionals should follow their normal process of trying to locate emergency medical supplies, personal protective equipment (PPE), and other healthcare resources with their regular vendors and exhaust all possible options. These options may include contacting any sister facilities for coordination, reaching out to local partners or stakeholders, looking at any possible reallocations within the Public Health Region, Healthcare Coalition, Regional Advisory Council regions, or other medical supply agencies, given established priority groups. If hospitals and healthcare professionals cannot obtain any PPE from their vendor(s) and have exhausted all alternative options, they should send their official requests to their local office of emergency management via the STAR process. Please ensure you provide all relevant details for your request, to include type of item, POC information, and delivery address.”

Department of State Health Services Information on Personal Protective Equipment

CDC’s strategies for optimizing the use of eye protection, isolation gowns, facemasks, and N95 respirators

Printable Materials and Communication Toolkits

DSHS

CDC

RESOURCES FOR PSYCHIATRISTS’ PRACTICE AND THEIR PATIENTS

American Psychiatric Association

American Psychiatric Association – To provide support in the response to COVID-19, the American Psychiatric Association is providing authoritative and timely resources.

APA Practice Guidance for COVID-19 released by the Department of Health and Human Services, FDA and at the state level to assist psychiatrists with providing health and substance use services.

  • REMS (Risk Management and Mitigation Strategy)
  • Medicare Quality Reporting
  • Telehealth
  • Substance Use Disorders
  • Inpatient Psychiatric Settings
  • Commercial Payers

APA Resources and Webinars for Psychiatrists: Physical Impact of the Coronavirus and Its’ Potential Mental Health and Psychosocial Issues and Responses, Telepsychiatry. With COVID-19 evolving rapidly across the world, APA’s Committee on Psychiatric Dimensions of Disasters and the APA’s Council on International Psychiatry compiled the following list of resources for psychiatrists. The resources cover not only the physical impact of the coronavirus, but on its potential mental health and psychosocial issues and responses. The resources also include a section on telepsychiatry, to prepare for the possibility of isolation and/or quarantine.

Free APA Webinars

How to Address COVID 19 Across Inpatient, Residential and other Non-Ambulatory Care Settings

Telepsychiatry in the Era of COVID-19

Managing the Mental Health Effects of COVID-19

For Patients, Family Members or Friends in Need of Immediate Assistance

Disaster Distress Helpline (SAMHSA)
Call 1-800-985-5990 or text TalkWithUs to 66746

National Suicide Prevention Lifeline
Call 800-273-8255 or Chat with Lifeline

Crisis Textline
Text TALK to 741741

Veterans Crisis Line (VA)
Call 800-273-8255 or text 838255

American Academy of Child and Adolescent Psychiatry

AACAP Resources

AACAP has compiled resources for parents, patients, and clinicians to help with the impact of the novel coronavirus (COVID-19).

 Resources for Families

Resources for Clinicians

American Psychiatric Association (APA) COVID-19 Mental Health Impacts:  Resources for Psychiatrists

Telepsychiatry Resources

New guidance on telehealth, announced by CMS and the DEA on March 17, as well as recent Congressional action, has changed the landscape of telehealth and expanded the ways in which physicians can provide care to patients.

 Other Resources

MALPRACTICE INSURANCE AND RESPONSES TO COVID-19

American Professional Agency, Inc. Telehealth and the Coronavirus

Professional Risk Management Services, Inc.

Specialized Malpractice Protection for Psychiatric Individual and Group Practice. PRMS risk managers have assembled frequently asked questions related to the Coronavirus:

PRMS Clients: We recognize that there will be an increased need for mental health counseling and services due to the COVID-19 crisis. Your professional liability insurance policy through the PRMS Psychiatrists’ Program covers you for the rendering of psychiatric services as a volunteer in the state where you are licensed. As a policy holder, your volunteer hours will not count against your total practice hours. For further information about state-specific guidelines for providing volunteer services, please contact your state government. Learn more about your telepsychiatry coverage. Those not insured with PRMS should check with their insurance providers for coverage details.

We wanted to make sure you were aware of all of the various resources related to telepsychiatry and COVID-19:

FROM THE FEDERAL GOVERNMENT

  • DEA
    • The DEA has issued a statement confirming the public health emergency declaration exception to the required one in-person visit prior to prescribing controlled substances under the Controlled Substances Act, as amended by the Ryan Haight Act.  
  • FDA
    • The FDA has issued guidance related to REMS requirements, such as required lab monitoring that cannot be done by home-bound patients. 
  • OCR has issued several HIPAA-related resources: 
    • Telemedicine platforms
      • The Office for Civil Rights (OCR), the agency responsible for HIPAA enforcement, has exercised “its enforcement discretion and will waive potential penalties against health care providers that serve patients through everyday communication technologies during the COVID-19 nationwide public health emergency.  This exercise of discretion applies to widely available communication apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.”  
      • FAQs 
    • Information sharing 
    • Coronavirus-related cyber scams 
  •  SAMHSA has put out various resources including: 

CMS has relaxed several requirements for the provision of and payment for telemedicine services to federal healthcare program beneficiaries, such as Medicare patients.

From professional organizations:

We are continuing to update our Telepsychiatry Resources as well, so please continue to check the website.

Federal Government Updates

Pres. Trump Extends Social Distancing thru April 30.

Drug Enforcement Agency (DEA) updates on national drug supply, controlled substances, and Federal rules on telemedicine can be found here.

Federal Resources

Texas Government Updates  

For the Latest Updates Visit https://gov.texas.gov/coronavirus

Message from the Governor of Texas
The state of Texas is strong; our people, resilient.

As we have seen in years past, when tested by fire, flood, or hurricane, Texans respond with resilience and calm resolve. And just as we overcame those challenges, we will overcome this one.

When neighbors help neighbors, our resilience is redoubled.

I have no doubt that Texans will continue to work together in that spirit over the coming days and weeks.

And we are here to help.

Governor Greg Abbott
Stay Well, Texas

Share These Health Tips With Your Family

What to do if you’re Sick, Testing Information, Symptoms, and Prevention Tips
Or dial 2‑1‑1, then choose Option 6
Hours: 7:00 a.m. – 8:00 p.m., 7 days per week

Other Resources

  • Call 2-1-1 for Health, food, housing, and other assistance
  • Call 7-1-1 for Relay Service
  • To report price gouging, call the Consumer Protection Division of the Office of the Attorney General: 1-800-621-0508

Waivers Issued by the Governor

Governor Abbott extends order to limit public gatherings through April 30. In addition, schools will remain closed until May 4.

GOVERNOR ABBOTT ISSUES MANDATORY 14-DAY QUARANTINE FOR TRAVELERS COMING TO TX FROM NEW YORK TRI-STATE AREA & NEW ORLEANS. 

Click here to review the Order in place. 
The order to self-quarantine shall not apply to people traveling in connection with military service, emergency response, health response, or critical-infrastructure functions, as may be determined by the Texas Division of Emergency Management.

GOVERNOR ABBOTT ANNOUNCES HHSC REQUEST OF 1135 MEDICAID WAIVER
Governor Greg Abbott today announced that the Texas Health and Human Services Commission (HHSC) has submitted a Section 1135 Medicaid Waiver to the Center for Medicare and Medicaid (CMS). If approved, this would grant Texas flexibility in administering Medicaid while the state continues to respond to COVID-19.  Read full order here.

PSYCHIATRIC HOSPITALS EXEMPT FROM REPORTING BED CAPACITY
Gov. Abbott issued order for hospitals to report bed capacity in compliance with Fed regulations. All hospitals licensed under Chapter 241 of the Texas Health and Safety Code, and all Texas state-run hospitals, except for psychiatric hospitals, shall submit to DSHS daily reports of hospital bed capacity, in the manner prescribed by DSHS.  DSHS shall promptly share this information with the CDC.

GOVERNOR ABBOTT – POSTPONE ELECTIVE SURGERIES & CREATE SUPPLY CHAIN STRIKE FORCE
Governor Abbott issued Executive Orders to postpone all surgeries and procedures that are not immediately, medically necessary to correct a serious medical condition or to preserve the life of a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician. This does not apply to any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the personal protective equipment needed to cope with the COVID-19 disaster.

Additionally, the Governor announced the creation of a temporary Supply Chain Strike Force. The Supply Chain Strike Force will be tasked with guiding collaboration between the public and private sectors to ensure health care facilities have the supplies and resources they need to respond to COVID-19. In addition to working with the federal government and businesses to secure necessary personal protective equipment, the team will work to ensure day-to-day resources (including food) are available for Texas’ medical personnel, first responders and those who have contracted COVID-19.  

NO GATHERINGS OF 10 OR MORE PEOPLE
Dr. John Hellerstedt, Commissioner of the Department of State Health Services, also declared a public health disaster in Texas (First time since 1901).  Texas Gov. Abbott prohibits gatherings in the State of Texas of 10 or more people statewide at midnight March 20, 2020 through April 3, 2020.

STATE OF DISASTER IN TEXAS
Governor Abbott has declared a State of Disaster in the State of Texas declaring a state of disaster which will facilitate and expedite the use and deployment of resources to enhance preparedness and response.

TEXAS MEDICAL BOARD (TMB) & CONTINUING MEDICAL EDUCATION (CME) REUIREMENTS
The TMB has extended license renewals and registration extensions. To read the entire notice visit the TMB website.

The relevant information is:

  • To assist our license and permit holders affected by and/or assisting with the repose to COVID-19, the TMB will automatically extend license and permit expiration dates as indicated below. In addition, Continuing Education requirements related to this renewal extension will be waived.
  • Physician and physician assistant licensees whose current permit expired/expires on 2/28/2020 or 5/31/2020 will automatically be extended through 8/31/2020, and any late fees previously accrued will be waived. Newly licensed physicians and physician assistants whose initial registration is due in March, April, May or June of 2020 will have that due date extended to 8/31/2020 as well.

HEALTH AND HUMAN SERIVES (HHS) PROHIBITION OF NON-ESSENTIAL VISITORS TO PRIVATE PSYCHIATRIC HOSPITALS
GL 20-2007 providing guidance to Texas hospitals (general, special, and private psychiatric) regarding the prohibition of nonessential visitors because of the significant health and safety risk to patients posed by COVID-19 has been posted.

TELEMEDICINE REQUIRMENTS IN TEXAS TEMPORARILY SUSPENDED
Governor Abbott approved TMB’s request to temporarily suspend Texas Occupation Code 111.005 (a)-(b) and Title 22, Chapter 174.6 (a)(2)-(3) of the Texas Administrative Code. The Texas Medical Board asserts that strict compliance with these laws could prevent, hinder, or delay timely delivery of necessary medical services in relation to efforts to cope with the declared disaster.  Pursuant to this development, the following new procedures are in effect during the declared disaster period:

Allowing Phone Consults. Telemedicine, including the use of telephone only, may be used to establish a physician-patient relationship. This expanded use of telemedicine may be used for diagnosis, treatment, ordering of tests, and prescribing for all conditions. The standard of care must be met in all instances.

For ALL license and permit holders regulated by the TMB, the agency will take into account extenuating circumstances surrounding the completion of license/permit renewal requirements such as renewal deadlines and completion of continuing education hours.

How can you use telemedicine in your practice now?

  1. If you are considering seeing patients using telehealth, review the APA’s Telepsychiatry Toolkit. Of particular interest is the April 2018 “Best Practices in Videoconferencing-Based Telemental Health” document.
  2. The APA website also provides more telehealth information in relation to COVID-19 on the APA homepage.
  3. The most important considerations are to think about how you will treat your patients. Consider setting up your own clinical protocols for each patient’s appropriateness/ability for using telehealth visits, ensuring patient safety (starting visits with documentation of immediate alternate contact information for both patient, provider, and patient emergency contact), and ensuring patient privacy (i.e., no spouses wandering by your desk during a session). Putting these considerations in writing is the beginning of a Policy & Procedure process that will be helpful.
  4. Research and procure a HIPAA-compliant video platform that you and your patients can use for visits.
  5. This article may be helpful, as it includes a couple of suggestions for platforms that are free or low cost for solo practitioners.