COVID-19 UPDATE – FEDERATION OF TEXAS PSYCHIATRY

March 16, 2020
There is no higher priority to the Federation of Texas Psychiatry and our member associations than the safety of our members. Federation of Texas Psychiatry Executive Committee is closely monitoring all information presented by Austin Public Health, the Texas Department of State Health Services, the Centers for Disease Control and Prevention, and local city governments to stay on top of the rapidly evolving situation with the illness caused by the new coronavirus, COVID-19.

Federal Government Updates

3-29-20Pres. 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.


Texas Government Updates  

3-31-20 – 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
3-29-20 – Order now includes California and Washington, along with the major cities of Atlanta, Miami, Detroit and Chicago. Those choosing to travel by car from Louisiana to Texas must also follow the 14 day quarantine order. Click here to review the Order in place. 
3-26-20 – 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.

TEXAS CITIES/AREAS ISSUING ‘SHELTER IN PLACE’ ORDERS
3-24-20Travis County effective 3-24-20 thru 4-13-20
3-24-20Houston effective 3-24-20 thru 4-3-20
3-24-20San Antonio effective 4-24-20 thru 4-9-20
3-23-20 Waco effective 3-23-20 thru 4-3-20
3-22-20Dallas County effective 3-23-20 thru 4-3-20.

GOVERNOR ABBOTT ANNOUNCES HHSC REQUEST OF 1135 MEDICAID WAIVER
3-26-20 – 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
3-24-20 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
3-22-20 – 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
3/19/20 – 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
3/13/20Governor 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 registraiton 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 will also be providing more telehealth information in relation to COVID-19 later today. Keep an eye on the APA homepage for updates.
  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.

What can you do to keep your patients and yourself safe?

Stay abreast of the latest developments in Texas by checking the following websites:

Center for Disease Control (CDC)

World Health Association (WHO)

Texas Department of State Health Services (DSHS)

Texas Medial Board (TMB)

The Federation Executive Committee and it’s member association leadership will make decisions in the upcoming weeks regarding the cancellation or rescheduling of events and meetings based on continued guidance from our local health authorities and elected officials. We will make every effort to give our members advance notice of any changes in scheduled events.

Again, 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  or at 512-478-0605.

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