I posted/wrote the below blog in 2017. I re-read my February 10, 2017, blog, which was entitled “NC DHHS’ New Secretary – Yay or Nay?” with the new perspective of COVID-19 being such a hot potato topic and sparking so much controversy. Interestingly, at least to me, I still stand by what I wrote. You have to remember that viruses are not political. Viruses spread despite your bank account, age, or location. Sure, variables matter. For example, I am statistically safer from COVID because I live on a small, horse farm in North Carolina rather than an apartment in Manhattan.
The facts are the facts. Viruses and facts are not political.
I was surprised that more people did not react to my February 10, 2017, blog, which is re-posted below – exactly as it was first posted. For some reason (COVID-19), people are re-reading it.
Our newly appointed DHHS Secretary comes with a fancy and distinguished curriculum vitae. Dr. Mandy Cohen, DHHS’ newly appointed Secretary by Gov. Roy Cooper, is trained as an internal medicine physician. She is 38 (younger than I am) and has no known ties to North Carolina. She grew up in New York; her mother was a nurse practitioner. She is also a sharp contrast from our former, appointed, DHHS Secretary Aldona Wos. See blog.
Prior to the appointment as our DHHS Secretary, Dr. Cohen was the Chief Operating Officer (COO) and Chief of Staff at the Centers for Medicare and Medicaid Services (CMS). Prior to acting as the COO of CMS, she was Principal Deputy Director of the Center for Consumer Information and Insurance Oversight (CCIIO) at CMS where she oversaw the Health Insurance Marketplace and private insurance market regulation. Prior to her work at CCIIO, she served as a Senior Advisor to the Administrator coordinating Affordable Care Act implementation activities.
Did she ever practice medicine?
Prior to acting as Senior Advisor to the Administrator, Dr. Cohen was the Director of Stakeholder Engagement for the CMS Innovation Center, where she investigated new payment and care delivery models.
Dr. Cohen received her Bachelor’s degree in policy analysis and management from Cornell University, 2000. She obtained her Master’s degree in health administration from Harvard University School of Public Health, 2004, and her Medical degree from Yale University School of Medicine, 2005.
She started as a resident physician at Massachusetts General Hospital from 2005 through 2008, then was deputy director for comprehensive women’s health services at the Department of Veterans Affairs from July 2008 through July 2009. From 2009 through 2011, she was executive director of the Doctors for America, a group that promoted the idea that any federal health reform proposal ought to include a government-run “public option” health insurance program for the uninsured.
Again, I was perplexed. Did she ever practice medicine? Does she even have a current medical license?
This is what I found:
It appears that Dr. Cohen was issued a medical license in 2007, but allowed it to expire in 2012 – most likely, because she was no longer providing medical services and was climbing the regulatory and political ladder.
From what I could find, Dr. Cohen practiced medicine (with a fully-certified license) from June 20, 2007, through July 2009 (assuming that she practiced medicine while acting as the deputy director for comprehensive women’s health services at the Department of Veterans Affairs).
Let me be crystal clear: It is not my contention that Dr. Cohen is not qualified to act as our Secretary to DHHS because she seemingly only practiced medicine (fully-licensed) for two years. Her political and policy experience is impressive. I am only saying that, to the extent that Dr. Cohen is being touted as a perfect fit for our new Secretary because of her medical experience, let’s not make much ado of her practicing medicine for two years.
That said, regardless Dr. Cohen’s practical medical experience, anyone who has been the COO of CMS must have intricate knowledge of Medicare and Medicaid and the essential understanding of the relationship between NC DHHS and the federal government. In this regard, Cooper hit a homerun with this appointment.
Herein lies the conundrum with Dr. Cohen’s appointment as DHHS Secretary:
Is there a conflict of interest?
During Cooper’s first week in office, our new Governor sought permission, unilaterally, from the federal government to expand Medicaid as outlined in the Affordable Care Act. This was on January 6, 2017.
To which agency does Gov. Cooper’s request to expand Medicaid go? Answer: CMS. Who was the COO of CMS on January 6, 2017? Answer: Cohen. When did Cohen resign from CMS? January 12, 2017.
On January 14, 2017, a federal judge stayed any action to expand Medicaid pending a determination of Cooper’s legal authority to do so. But Gov. Cooper had already announced his appointment of Dr. Cohen as Secretary of DHHS, who is and has been a strong proponent of the ACA. You can read one of Dr. Cohen’s statements on the ACA here.
In fact, regardless your political stance on Medicaid expansion, Gov. Cooper’s unilateral request to expand Medicaid without the General Assembly is a violation of NC S.L. 2013-5, which states:
SECTION 3. The State will not expand the State’s Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act, P.L. 111-148, as amended, for which the enforcement was ruled unconstitutional by the U.S. Supreme Court in National Federation of Independent Business, et al. v. Sebelius, Secretary of Health and Human Services, et al., 132 S. Ct. 2566 (2012). No department, agency, or institution of this State shall attempt to expand the Medicaid eligibility standards provided in S.L. 2011-145, as amended, or elsewhere in State law, unless directed to do so by the General Assembly.
Obviously, if Gov. Cooper’s tactic were to somehow circumvent S.L. 2013-5 and reach CMS before January 20, 2017, when the Trump administration took over, the federal judge blockaded that from happening with its stay on January 14, 2017.
But is it a bit sticky that Gov. Cooper appointed the COO of CMS, while she was still COO of CMS, to act as our Secretary of DHHS, and requested CMS for Medicaid expansion (in violation of NC law) while Cohen was acting COO?
You tell me.
I did find an uplifting quotation from Dr. Cohen from a 2009 interview with a National Journal reporter:
“There’s a lot of uncompensated work going on, so there has to be a component that goes beyond just fee-for service… But you don’t want a situation where doctors have to be the one to take on all the risk of taking care of a patient. Asking someone to take on financial risk in a small practice is very concerning.” -Dr. Mandy Cohen
RACMonitor published my daughter’s essay on living through the Coronavirus. Madison would like to share it here, on my blog, as well. She is a fifteen-year-old in North Carolina and attends high school at Thales Academy.
EDITOR’S NOTE: Coping with the COVID-19 pandemic has been difficult for just about everyone nationwide, but uniquely so for America’s young students, some of whom have been robbed of the opportunity to play their favorite spring sports, attend the junior or senior prom, or even enjoy a proper graduation ceremony. As such, we at RACMonitor have asked the children of several of our key contributors to pen essays describing their personal experiences amid these life-changing times.
My name is Madison Allen. I am a 15-year-old girl who loves spending her time outdoors or hanging out with her friends. If neither of those options are available, then I don’t really know what else to do to cure boredom.
I love technology, don’t get me wrong, but I would much rather be active and enjoy nature. I have been raised in a household that doesn’t tolerate being lazy, so sitting in my room and binge-watching Netflix all day is not an option. Despite the fact that I can’t have fun in the normal ways that I am used to, I have come up with three good ways that have kept me busy during this time. Before we get into that, I feel that it is necessary to talk about when COVID appeared in my life and my first impressions of the disease.
It was a very normal Saturday afternoon. I was out hanging with my friends Nicole and Ariana when their phones go off, saying that school has been cancelled for the next two weeks. I was so happy, because from there my dad told me that all schools are doing the same due to the growing concerns for coronavirus. I only had one week of the third quarter left anyway, so no schoolwork was going to be issued to do at home or virtually. About an hour after Governor Cooper announced that school was cancelled for two weeks, my school, Thales Academy, finally sent an email out to us that read, “due to the order from Governor Cooper as of 4:30 p.m. today, all Thales Academy locations will be closing on Monday, March 16th. On Tuesday, March 17th, school will be open from 8:00 a.m. to 3:00 p.m. for students to drop in and gather any items they need to from their lockers. Report cards will be issued to students on Tuesday, March 17th at noon. Students will return to campus for fourth quarter on April 13th.”
Me, being the child I am, thought that this was awesome, because I didn’t have to take my history test anymore. Yes, that is great but I didn’t realize the harm it is doing on the world. I wasn’t thinking about others’ lives, because I never thought that something bad would happen to me. I was really selfish when I thought about not taking the history test because I only thought of how I was benefitting, while other people were and still are suffering.
Anyway, I went through spring break, and it all got worse. I wasn’t allowed to see any of my friends, and trips, special events, and even celebrations got cancelled. When spring break was over, we were told to do online school on a website called Canvas and were given certain times to log onto Zoom to talk with our teachers. I am fortunate enough to live in a house with ample space and Internet to do schoolwork. I am also fortunate that I go to such a great school that will do their best to provide great education, no matter the circumstance.
While I have been in quarantine, I have thought of three ways to cure boredom without help from a phone. The first way is that I have been taking up a new hobby called “cleaning my room.” I haven’t made very much progress with that, though. Another way I have cured boredom is by decorating a secret room in my house and making it the ideal hangout spot. Lastly, I have been going outside and taking up hobbies that I once loved, such as bow and arrow, knitting, hiking, horseback riding, and basketball.
I am now in the third week of online school, and won’t be stopping until the end of the year. Summer break is just five weeks away, and it doesn’t look like quarantine will be ending soon. I will do my best to see the good out of this troubling time, but for now I am taking life day by day.
Published in Today’s Wound Clinic:
When I was asked to draft an article for Today’s Wound Clinic, it was approximately two weeks ago. I was asked to write about the current state of Medicare and Medicaid audits. Specifically, I was asked to provide a legal analysis about CMS suspending audits un-related to COVID-19. In the month of April, we have seen the spike of COVID-19, which has overturned our everyday world. We have been instructed by President Trump to “stay home” and “social distance” to decrease the spread of the virus. This “stay at home” instruction is unprecedented and has uprooted many of our most reliable and commonplace businesses, such as hairdressers, bowling alleys, and tattoo parlors.
Here is the answer: The current state of Medicare/Medicaid audits, at the moment, is dictated by COVID-19.
We can divide the post-COVID-19 audit rules into 3 categories:
- Those exceptions published by CMS to apply to all health care providers
- Those special, verbal exceptions given directly to an individual provider that were not published by CMS
- Effective immediately, new guidelines that CMS will follow until CMS believes it no longer needs to follow (by its own choice, of course).
An example of an “effective immediately” guideline is our current state of Medicare/Medicaid audits in the wake of COVID-19. CMS has not suspended all Medicare/Medicaid regulatory audits. But CMS has suspended most audits.
Effective immediately, survey activity is limited to the following (in Priority Order):
- All immediate jeopardy complaints (cases that represents a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect;
- Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses;
- Statutorily required recertification surveys (Nursing Home, Home Health, Hospice, and ICF/IID facilities);
- Any re-visits necessary to resolve current enforcement actions;
- Initial certifications;
- Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years;
- Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy.
See CMS QSO-20-12-ALL. You can see that these “effective immediately” guidelines are usually published on CMS letterhead. The “effective immediately” guidelines explain why CMS is taking the stated action, the stated action, and that the action is temporary and due to COVID-19.
Here are a few recent “effective immediately” guidelines due to COVID-19:
- On April 27, 2020, CMS said it would no longer expedite Medicare payments to doctors and be more stringent about accelerating the payments to hospitals as Congressional relief aimed at providers reaches $175 billion.
- The agency is not accepting any new applications for the loans from Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers. CMS will continue to process pending and new requests from Part A providers, including hospitals, but be stricter with application approvals.
- CMS expanded the Accelerated and Advance Payment Programs in late March as the pandemic continued to gain strength in the U.S. Since then, the agency has approved over 21,000 applications making up $59.6 billion in accelerated payments to Part A providers and almost 24,000 applications making up $40.4 billion in payments for Part B suppliers.
The $2.2 trillion Coronavirus Aid, Relief, and Economic Security stimulus package passed by Congress in March benchmarked $100 billion in funds for hospitals. On Friday, President Donald Trump signed legislation with a second round of emergency funding, called the Paycheck Protection Program and Health Care Enhancement Act, that allocates another $75 billion for providers — roughly three-quarters of what major provider trade associations requested.
An initial $30 billion from the fund was distributed between April 10 and April 17 based on Medicare fee-for-service revenue, sparking criticism that put facilities with a smaller proportion of Medicare business, such as children’s and disproportionate share hospitals, at a disadvantage. HHS on Friday began releasing an additional $20 billion in CARES payments to providers based on their 2018 net patient revenue, with more funding to roll out “soon,” the agency said, including $10 billion for hard-hit areas like New York.
How RAC/MAC auditors are compensated dictates their actions and/or aggressiveness.
RAC Auditors are paid by contingency. They are usually compensated approximately 13%, depending on the State. Imagine what 13% is of 1 million. It is $130,000 – more than most people make in a year. If you do not believe that 13% contingency is enough to incentivize a company, which, in turn, incentivize the employees, then you are sorely mistaken.
RACs were established through a demonstration program under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“MMA”), piloted between 2005 and 2008, and were later made permanent under the Tax Relief and Health Care Act of 2006, which required CMS to establish Recovery Auditors for all states before 2010.
MACs are not compensated by contingency, per se. CMS decided to structure the MAC contracts with 1-year base performance periods and four, optional, 1-year performance periods at the time. The MMA required that these contracts be recompeted at least once every 5 years. The recent enactment of the Medicare Access and CHIP Reauthorization Act of 2015 amended this requirement to authorize a maximum 10-year performance period before MAC contracts must be recompeted. The amendment, which applies to MAC contracts in effect at the time of enactment or entered into on or after enactment, would permit CMS to modify existing MAC contracts or enter into future MAC contracts for 1-year base performance periods and nine optional 1-year performance periods. See Pub. L. No. 114-10, § 509(a)- (b) (April 16, 2015). Therefore, while MACs are not compensated on contingency, MACs are compensated on performance. The less a MAC spends, the more services a MAC allows, the strict oversight a MCA ensues on its providers…all these “performance-based” measures may not be a contingency compensation relationship, but it’s pretty close. Saved money becomes profit for MACs.
Medicare and Medicaid auditors love rules. Even if the rules that auditors are instructed to follow really are not required by actual law. It goes without saying that auditors are not lawyers. Auditors are not trained to decipher whether statutes, regulations or policy are superseded by federal statutes and regulations. The fact is that, more times than one would hope, the auditors are wrong in their assessments that a claim should be denied, not out of malice, but because of a basic misunderstanding of what the law actually requires.
I have all kinds of stories about auditors claiming money is owed, when, really it was not owed because the RAC/MAC auditor failed to follow the actual, correct procedure or misconstrued a regulation. For example, I had a durable medical equipment provider, DME ABC, who was informed by the NSC Supplier Audit and Compliance Unit of Palmetto GBA that it owed $1,075,548.64. Palmetto is one of the MACs for Medicare – durable medical equipment. There was no demand letter. The alleged overpayment amount came to fruition in a telephone conference between the CEO of the company and an employee of Palmetto. Let’s call her Nancy. Nancy told CEO that company owed $1,075,548.64 based on an alleged violation of 42 C.F.R. § 424.58,
Even more disconcerting, was the fact that Palmetto claimed that its alleged, oral overpayment against DME ABC arose from a normal, reoccurring validation process pursuant to 42 C.F.R. §424.57, approved by CMS and in accordance with the requirements of 42 C.F.R. §424.58. No formal letter was necessary was Palmetto’s retort. Not correct; a formal demand letter is always required.
In this case, Palmetto began to backtrack once we pointed out that Palmetto nor Nancy ever sent a formal demand letter with any reconsideration review appeal rights or administrative appeal rights. We knew this was procedurally incorrect because federal law dictates that you receive a formal demand letter with appeal rights and notice of how many days you have to appeal. But out of fear of retribution, DME ABC was willing to write a check without pushing back. Obviously, we did not do so.
I tell this story as an example of how intimidating, scary, and overwhelming auditors can be. If someone off the street asked you for a million dollars, you would laugh them off your doorstep, right? After you tell them to don a mask and maintain social distancing.
But in the new-age world of COVID-19, rules have been broken. This behavior would not be acceptable pre-COVID-19. But this provider honestly was going to pay.
The Trump Administration is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic.
Pre-COVID-19 if you were to state “paperwork over patients,” everyone in the industry would agree. There would be snickers and eyes rolling, because no one wanted paperwork to be over patients. But it was. Now the mantra has flipped upside down – now the mantra is: Patients over Paperwork.
Post-COVID-19, if documents are lost or misplaced, or otherwise unusable, DME MACs have the flexibility to waive replacements requirements under Medicare such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.
Post-COVID-19, CMS is pausing the national Medicare Prior Authorization program for certain DMEPOS items. CMS is not requiring accreditation for newly enrolling DMEPOS and extending any expiring supplier accreditation for a 90-day time period. CMS is waiving signature and proof of delivery requirements for Part B drugs and Durable Medical Equipment when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.
Post-COVID-19, in order to increase cash flow to providers impacted by COVID-19, CMS has expanded the current Accelerated and Advance Payment Program. An accelerated/advance payment is a payment intended to provide necessary funds when there is a disruption in claims submission and/or claims processing. CMS may provide accelerated or advance payments during the period of the public health emergency to any two Medicare providers/suppliers who submits a request to the appropriate MAC and meets the required qualifications. The process of obtaining the funds is a MAC-by-MAC process. Each MAC will work to review requests and issue payments within seven calendar days of receiving the request. Traditionally repayment of these advance/accelerated payments begins at 90 days, however for the purposes of the COVID-19 pandemic, CMS has extended the repayment of these accelerated/advance payments to begin 120 days after the date of issuance of the payment. Providers can get more information on this process here: www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf
The Future of Medicare/Medicaid Audits
The beauty of predicting the future is that no one can ever tell you that you are wrong. These are my predictions:
Auditors will deny claims for not having prior authorizations. Auditors will deny claims because the supplier accreditation expired after the 90-day time period. Auditors will deny claims because the percentage of face-to-face time was not met as described per CPT codes.
Obviously, these would be erroneous denials if the denials are within the dates that the COVID-19 pandemic occurred. The problem will be that the auditors will not be able to keep up with all the exceptions, not because the auditors are acting out of malice or dislikes providers. They will be simply trying to do their job. They will simply not be able to take into consideration all the exceptions that were given during the virus. Because, while we do have many written exceptions, if you call CMS with a personal and individualized problem, CMS will, most likely, grant you a needed exception. As long as the exception has the best interest of the consumer at heart. However, this personalized exception will not be written on CMS’s website. In five years, when you undergo a MAC or RAC audit, you better have proof that you received that exception. It will not be enough proof for you to state that you were given the exception over the phone.
So how can you protect yourself from future, erroneous audits?
Write everything down. When you speak to CMS, document concurrently the date, time, name of the person to whom you are speaking, the summary of your conversation, the COVID-19 regulatory exception, sign it and date it.
It is a hearsay exception. Writing down everything does not magically transform your note into the truth. However, writing down everything concurrently does magically allow that note that you wrote to be allowed in a court of law as an exhibit. Had you not written the note contemporaneously with the conversation that you had with CMS, then the attorney on the other side of the case would move to exclude your handwritten or typed note as hearsay.
Hearsay is defined as a statement that (1) the declarant does not make while testifying at the current trial or hearing; and (2) a party offers in evidence to prove the truth of the matter asserted in a statement. There are too many hearsay exceptions to name in this article.
Just know, for purposes of this article, that any health care provider who is relying on an exception to a normally required regulatory mandate – regardless what it is – either be able to: (1) cite the written exception that was published by CMS to the public; or (2) produce the written or typed contemporaneously written note that you wrote to memorialize the conversation.
2 years ago – Hindsight is 20/20. #COVID19
The United States currently spends more per person on health care than any other developed country. So when my daughter and I recently vacationed the “Highlights of Europe” tour, I was interested in learning about the varied health care systems, country-by-country. We visited England, France, Switzerland, Austria, Germany, the Netherlands, and Italy. It was awesome!! She turned 13 during the trip, and she starts 8th grade next week. Where does the time go?
While I do not protest to know all the answers, during our vacation, I researched the diverse countries’ healthcare system and methods of payment, but, most importantly, I interviewed people. I interviewed people who were begging for money. I interviewed my taxi drivers. I interviewed the bus drivers. I interviewed people on the streets. I interviewed shop owners. I interviewed the hotel concierge. I interviewed bartenders and waiters.
This blog is intended to memorialize my findings. It has not been fact checked. In other words, if a person told me something about the healthcare system and their personal experiences, I did not go back and review that country’s laws to determine whether that person was telling the truth or that the person’s rendition of their experience was compliant with the law. I did this for a reason. Sometimes what the laws dictate as to healthcare is not what actually occurs in reality. I wanted personal perspectives. I wanted an opinion from citizens of other countries as to how healthcare was or was not working in their country. I did not want to meet health care policy, rules, regulations. I wanted the cold, hard, real truth.
At least one person in every country – Austria, The Netherlands, France, England, Germany, Switzerland, and Italy told me, “[Country name] has the best health care in the world.” Obviously, they cannot all be right. And I certainly heard the worst case scenarios in country’s that claimed to be the best in the world.
This is what I learned:
England has the best health care system in the world! England’s healthcare system is drastically different from the USA’s. England’s National Health Service (NHS) is a free healthcare program for all permanent residents of United Kingdom. Reading the fine print, however, the NHS is not completely free. There are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care.
England relies on primary care more so than specializations. Mental health services, for example, are largely treated by the general practitioners (GPs). Provider trusts, fed by taxes, compensate most health care, the main examples in the hospital trust and the ambulance trusts which send the money allocated to them by commissioning trusts. Hospitals normally receive the lion’s share of NHS funding as hospital’s have the most expenses.
Our taxi driver (Jim) told me that paperwork is minimal with the NHS, which makes it super easy to use. Although he was quick to point out that the health care system in England does vary in quality and timeliness depending on where you live, but I believe we can say the same about the USA. Jim also told me that he and his family has had problems with wait-times to be seen by specialists. Jim’s wife suffered persistent and serious acid reflux. Her general practitioner referred her to a gastroenterologist. However, she could not get an appointment until 20 weeks later. But, in the end, she was seen, and had no waiting period on the day of her appointment. Generally, Jim is happy with the NHS. The costs are minimal, and, he believes that the quality of care is high.
The hotel concierge (let’s call him Blake) was extremely open about his experiences with the health care system in England. It appears from his enthusiasm that health care is just as big of a political issue in England than it is in the US. He told me that he has never waited more than four hours in an emergency room. Apparently, his children frequent it. However, I do place an asterisk on Blake’s comment. You will see below that Alice from France waited for 7 hours at the ER in the UK with her husband. Some of the stories that I heard contradicted each other.
Blake also told me that for traumatic experiences, such a broken arm due to a car accident, which his youngest daughter recently endured, the wait time is significantly less than when his best buddy got drunk at the pub and broke his finger. Blake also told me that, for day-to-day, general, “I have a tummy ache” appointments, English citizens do not get to choose appointment times. You leave a voice mail message for the nurse and the nurse informs you when you need to present yourself. While this may sound inconvenient, Blake stated that there are no wait times. I know that I have waited many an hour to see my general practitioner.
Dental insurance, on the other hand, is a whole new can of worms. Basically, general practitioners are free, but dentists are not. The wait times to see a dentist are extensive, and, if you do not have private dental insurance, the wait times can be even longer. My take-away? If I were a dentist, I’d move the the UK. This also explains a lot about English actors and actresses.
We cannot analyze any country’s health care system without taking into account the taxes that you must pay in order to maintain such a health care system, no matter how poor or amazing that health care system is. Income taxes in the UK are 40% if you make more than 46,351 pounds. Once you hit 150,000 pounds, then your taxes increase to 45%. Almost half of your wages are taken by the government, but you get, essentially, free health care. Does it balance out?
The Netherlands has the best health care system in the world! Every person that I asked in Amsterdam, informed me that Dutch health care is among the best in the world. It seemed that the Dutch took pride in their health care system. So, I wanted details. If Dutch health care is the best, why doesn’t everyone else mimic it?
I learned that everyone who lives or works in the Netherlands is legally obligated to take out standard health insurance. All insurers offer the same standard package. The standard insurance package includes general practitioners, some medications, dental care until the age of 18, nutritional and dietary care, medical aids, mental health services, and much more. It does not cover over-the-counter aspirin or cosmetic surgery procedures. But neither does insurance in America.
In Amsterdam, my daughter and I rented bicycles for two days. It was an absolute blast. The rental process, however, took a bit longer than expected. The gentleman behind the counter needed our passport numbers, information on our hotel, credit card information, and provided us with an instruction program on how to properly secure the bicycles. Given the length of the process, I took the opportunity to ask him about health care.
Let’s call the bicycle rental agent Stefan.
Stefan explained that the Dutch believe in misery first. According to him, regardless the affliction, general practitioners will tell you to take an aspirin and come back in two weeks if you are not dead. I am fairly sure that he was exaggerating. But I have always been of the opinion that exaggerations have some form of truth.
In the Netherlands, the general practitioners are called huisarts, which are expected to know all aspects of medicine. I liken the huisarts to attorneys who practice general law. What attorney could know all aspects of family law and criminal law? The answer is none. A generalist knows a tad about everything, but nothing much about anything.
Preventive care is rare in the Netherlands, certainly in terms of women’s health. For example, in the US, France, and Spain, it is typical to get a test for cervical cancer at least every 2 to 3 years. Here, in Amsterdam, insurance will only pay for one every 5 years. Hormone replacement therapy is also rare here, as most GPs are still following outdated guidelines, based on a flawed study from 2002.
It seems as though I am overly negative as to the health care in the Netherlands. All I can write is that I began this blog with an open mind because if any country has mastered health care then we should learn from it. I was also swayed by my interviewees.
While other countries maintained high income taxes to pay for “free health care,” the Netherlands does not use tax dollars to pay for health care. Every Dutch resident is required to buy their own health insurance on top of the taxes they pay to the government.
Taxes in the Netherlands is exorbitant. If you make over 66,421 euros, taxes are 52% of your income. These taxes, remember, do not include health insurance.
In Amsterdam, there was a pub across the river from our hotel Movenpick. A group of guys were “celebrating” an upcoming wedding and were drinking bottles upon bottles of wine at the river’s edge. Multiple times members of the group ended up swimming.
So, imagine my surprise when one of the intoxicated gentlemen sat at our table and ensued with a semi-intelligent conversation about health care. We will call him Henry. Henry had recently been married and his wife gave birth last year to a premature baby. I completely related because my daughter was born at 28 weeks and 2 pounds and 2 ounces. I asked Henry about the health care coverage for his premature baby girl’s birth and subsequent surgeries. He told me that, besides the meals that he ate during the two-month stay in the hospital, once his new daughter and wife were free to leave, his hospital bill was zero. His daughter endured a two-month stay in the neonatal department, his wife had a two-month, inpatient hospital stay, his daughter underwent multiple surgeries for her lungs and heart, and his daughter had 24-hour care for 60 days. All for zero euros. All children in the Netherlands are automatically insured by the government.
While I see the downside of paying 52% of your income to the Dutch government and having to pay for health insurance, I do see the benefit of Dutch insurance if you have a medical emergency, like a premature baby.
France has the best health care system in the world! In a 2000 World Health Organization (WHO) comparison of 191 different countries’ health care, France came out at number one. And they are not afraid to tell you. Even though the WHO ranking is from 2000, the French still tout its outcome because there have been no other such rankings since then. The French believe in the universal right to health care.
The entire population must pay compulsory health insurance.
Our two-hour ride on the Eurostar from Paris to London gave me a unique opportunity to ask other passengers about health care, especially since there is bar in one of the cabins. People congregated there to drink, eat, and talk, plus one nosy American asking about health care. The following are summaries of the stories I heard:
Nancy, who is from Devon, England and has lived in France with her family since 2006 thinks that French health care is the best. Since she moved to France her family has, unfortunately, undergone 6 operations. Her husband had cancer a couple of years ago and the Oncopole (oncologist) encouraged alternative therapies and even told him the taxi drivers (bringing patients home from the hospital) often go straight to a rebouteuse (a healer) after radiotherapy. A lot of doctors practice homeopathy, which is fantastic, according to Nancy. She also said that doctors prescribe “sacks full of medicine.” The good news is that Nancy’s husband is in remission.
Alice, a former British citizen, who moved to France told me the French health care system saved her husband’s life. Five years ago, her husband started to feel ill while visiting the UK. They couldn’t get a family/general practitioner to come to their home (I thought, my doctor wouldn’t come to my home in the US either). Over the phone, the general practitioner said, “take an aspirin and rest.” They also went to the ER but gave up after 7 hours waiting as her husband was in extreme pain (Juxtapose Blake’s recount that he never waited over 4 hours in the ER in the UK). A few days later they flew home, and her husband could not walk. Within an hour of arriving in France, her husband was admitted to a hospital. He was diagnosed with stage 4 kidney failure and stage 5 equates to dialysis. Needless to say, Alice is a French health care fan.
My daughter and I used a tour group company for our mommy-daughter vacation, and, while in France, I heard one person tout that health care is free in France. I will contend, from my travels, that French health care is great, but not completely free. I saw a presumably-homeless, elderly gentleman with no legs begging for money. In extremely, broken Frenglish and impromptu sign language, I asked the gentleman why he didn’t have health coverage and was he a French citizen? To the best of my ability, I interpreted his responses to indicate that, yes, he is a French citizen, but that free, French health care does not include prosthetics.
Taxes are approximately 41% if you make over $72,617. Whereas, in the US, if you make over $72,000 your tax bracket is 15.55%, barring extraordinary circumstances.
Italy has the best health care system in the world! From my travels, I gathered that Italians believe that their health care system is the best (over France’s – I believe that there is a bit of a friendly rivalry). In 2000, the World Health Organization (WHO) ranked Italy as the 2nd best health care system in the world, right under France. In 2012, WHO found Italy’s life expectancy to be 82.3 years.
Italy has a regionally organized National Health Service (“SSN” – Servizio Sanitario Nazionale) that provides citizens with free or low-cost healthcare. It’s funded through national income taxes and regional VAT, and generally the standard of care is very high. I was pleased to discover that foreign citizens living in Italy with a regular stay permit are entitled to all the same treatment and rights as Italian citizens. Retirement 2035 – here I come!
For a country with the best health care in the world, I saw the most homeless, medically-challenged beggars than any other country. Maybe there are more homeless, medically-challenged beggars in Italy than other country because the weather is so nice, the gelato is so delicious, the population is greater, mental health care is worse, or the food is so amazing…I do not know. But I saw the most homeless, medically challenged beggars in Italy than anywhere else. Oddly, the afflictions were the same. Their feet were misshapen and curled inward to a degree that did not allow them to walk. It was heartbreaking. I googled it and discovered that medical articles have been written on the anomaly of foot deformities in southern Italy.
Taxes in Italy are as follows:
- 23% for amounts up to $36,000
- 33% for the next band from $36,001 to $39,300
- 39% for amounts between $39,301 and $119,200
- 45% for amounts $119,201 and over.
I met Valentina in Roma. Europe has strict hourly limits for bus drivers and our original bus driver, apparently, over-drove. Valentina stepped in and was very chatty, unlike the original bis driver who spoke no English. Considering our group consisted of 21 English-speaking vacationers and one couple fluent in Spanish and English, a bus driver who only spoke French was unhelpful.
Valentina told me that in Italy, mainly in the south, public hospitals are very crowded and offer very limited and sometimes hasty assistance, so that patients are too soon sent to rehabilitation centers, very few of which are public. This almost entirely private field is financially sustained by the National Health Service, which pays a per diem for a patient’s clinic stay. If a patient still needs rehabilitation after 2 months in a rehabilitation clinic or center, reimbursement from the National Health Service will be in any case cut by about 40%. Private insurance is very rare and usually is not involved in rehabilitation.
In private rehabilitation centers, physicians often have to deal with overworked nurses and angry, worried patients and relatives.
Valentina said that her mother went to her general practitioner complaining of frequent headaches, depression, anxiety, dizziness, and recurrent fatigue. Her general practitioner, diagnosed her as “a hysteric neurotic,” and she was prescribed anxiolytics. Her headaches continued. When she finally was able to see a specialist, her magnetic resonance image report showed that she had several cerebral metastatic lesions from an otherwise silent neoplasia – basically, a death sentence.
Switzerland has the best health care system in the world! The Swiss health care system is regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country) (country #2 on my options for retirement).
Like every country we visited, Switzerland has a universal health care system, requiring all to buy insurance. Switzerland holds a special place in my heart. My mother’s mother, Martha Zuin (imagine an umlaut over the ‘u’), immigrated to the US from Switzerland, so I still have family living in Switzerland.
The plans in Switzerland resemble those in the United States under the Affordable Care Act: offered by private insurance companies, community-rated and guaranteed-issue, with prices varying by things like breadth of network, size of deductible and ease of seeing a specialist. Almost 40% of people get subsidies offsetting the cost of premiums, on a sliding scale pegged to income. Although these plans are offered on a nonprofit basis, insurers can also offer coverage on a for-profit basis, providing additional services and more choice in hospitals. For these voluntary plans, insurance companies may vary benefits and premiums; they also can deny coverage to people with chronic conditions. Most doctors work on a national fee-for-service scale, and patients have considerable choice of doctors, unless they’ve selected a managed-care plan.
Both Swiss and German systems cost their countries about 11 percent of GDP.
Mia, the hotel clerk at Lake Maggiore, is a Swiss resident. She informed me that insurance premiums are not adequately adjusted to income, and they have doubled in price since 1996, while salaries have risen by just one-fifth. It comes as no surprise, then, that just over a quarter of the population needed government assistance to pay their premiums in 2014. She says that over 1/2 of Swiss residents owe money for medical bills.
You can be blacklisted from reimbursement for health insurance in Switzerland. Some 30,000 blacklisted patients so far have lost their right to be reimbursed for medical services under basic insurance and can be refused care, save for emergencies. A policy initially designed to encourage people to pay up has instead come under fire for going against the principle of basic health coverage for all. In 2017, EHR became mandatory for most, which increased the costs for many health care visits.
Research told me that Switzerland is the second most expensive country for health care other than USA with The Netherlands, Sweden, Germany, and Denmark closely following.
Germany has the best health care system in the world! The German health care system and Switzerland’s have a lot in common. According to interviewees, Germany has slightly better access to health care, especially with respect to costs. Switzerland has higher levels of cost-sharing, but its outcomes are hard to beat — arguably the best in the world – for real.
A majority of Germans (86%) get their coverage primarily though the national public system, with others choosing voluntary private health insurance. Most premiums for the public system are based on income and paid for by employers and employees, with subsidies available but capped at earnings of about $65,000. Patients have a lot of choice among doctors and hospitals, and cost sharing is quite low. It’s capped for low-income people, reduced for care of those with chronic illnesses, and nonexistent for services to children. There are no subsidies for private health insurance, but the government regulates premiums, which can be higher for people with pre-existing conditions. Private insurers charge premiums on an actuarial basis when they first enroll a customer, and subsequently raise premiums only as a function of age — not health status. Most physicians work in a fee-for-service setting based on negotiated rates, and there are limits on what they can be paid annually.
Though mostly public, the German health insurance system is not a state-run system like the National Health Service in the United Kingdom. In fact, more than 100 different health insurers, known as sickness funds, compete for members in Germany’s comparatively decentralized system. These sickness funds are non-profit, non-governmental organizations that operate autonomously. Most Germans’ health insurance contributions are deducted from their paychecks by their employers. The amount, however, is capped at 14.6% of a person’s salary, split fifty-fifty between the employer and the employee, so 7.3% each way. But coverage is not dependent on the employer, so when Germans change or lose their jobs, nothing changes in their health insurance. Recent changes in health care have allowed the wealthy to obtain higher quality and more efficient health care services. Anyone who makes over 57,600 euros/year can opt out of public health care and pay for private health care. Doctors are more prone to be more attentive of their privately-insured patients.
We met Emma at a beer garden; she was our waitress. Emma was as equally inquisitive about American health care as I was about German health care. She said that she could not get her head wrapped around HIPAA. Privacy, she indicated, is not a hot topic issue in Germany. Emma said that doctors in Germany “get it wrong a lot.” When I asked her what she meant, she said that she went to her general practitioner for chest pain. Whereas, in America, chest pain is considered serious, Emma said that her doctor did not even place a stethoscope on her chest. Instead, he told her to go home, rest, and take an Ibuprofen. Emma’s friend had a baby with a problem in one eye. She went to several doctors and they told her nothing can be done. She finally went to a specialist in Spain and received a concrete diagnostic and special glasses for the 7 month-old-baby, because the eye movement was related to the eye condition.
Austria has the best health care system in the world! If European health care were on a bell curve, Austria would be at the bottom (hmmmmm…..although I have not compared Austria to the US). Dr. Clemens Martin Auer is the President of the European Health Forum Gastein and Director General at the Austrian Federal Ministry of Health.
Dr. Auer is focused on digital health and access to drugs. Talking to people in other European countries, who complained about over prescribing, Austria, apparently, has a high cost issue barring many people from receiving prescriptions.
In Austria, the health care system is largely financed by social security contributions and taxes, to a lesser part also by private sources, such as prescription charges, compulsory personal contributions, per-diem charges for hospital stays or contributions to private health insurance.
Each month a contribution will be taken from your tax payment, which is worked out according to how much you earn. This gives you access to basic healthcare including treatment in hospitals, medication, dental care, and some specialist appointments. If you make over 31,000 euros, you pay 41% tax.
According to Tobias, the man I met in Innsbruck, people wait months to see a specialist. So, if you have a cold, you are good, but of you have cancer, then get on the waiting list. Tobias also told me that people do not go to hospitals unless they have a severe injury or serious surgery. Instead, the general practitioners are heavily relied on. I am not sure I like the idea of going to a generalist for everything. If I have stark knee pain, I want to see an orthopedic, not a general internist. But I am learning that free health care may not equate to the best health care.
To listen, please click here.
Highlights of this episode include:
- Background on why CMS will forego all audits unrelated to the coronavirus.
- What types of audits will CMS continue during the coronavirus pandemic?
- What providers need to know about complying with current audits, such as TPE audits.
- How providers can protect themselves by documenting exceptions such as two-day admissions.
- And more…
Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®.
As a result of the COVID-19 crisis, the government has suspended most auditing activities for providers. To sort out what that means for hospitals, I’m joined by Knicole Emanuel. Knicole is an attorney at Potomac Law Group in Raleigh, North Carolina, where she concentrates on Medicare and Medicaid regulatory compliance litigation. Knicole, welcome to the show.
Knicole Emanuel: Thank you and thank you for having me.
Mike: Knicole, the government announced that it is suspending survey activities. Practically what does that mean for providers?
Knicole: Well, so right now because of the Coronavirus, CMS has decided to forego audits that are unrelated to the coronavirus. So actually effective April 3, 2020. The only audits that will be conducted will be those audits that are germane to all immediate Jeopardy complaints. Those kind of cases that represent a situation in which an entities non-compliance has placed the health and safety of recipients in its care at risk for serious injury. So we’re talking about potential serious injury or serious harm.
Another audit that’s going to continue would be complaints alleging infection control concerns because that would obviously be impacted by the coronavirus. Any sort of statutorily required recertification surveys are going to be conducted. I would assume that they’re going to be conducted telephonically. They’re not going to be going on-site and revisits necessary to resolve current enforcement actions. That’s important because when this Coronavirus all came about, there were hundreds and hundreds and hundreds, perhaps thousands upon thousands of healthcare providers already in the middle of TPE audits or RAC audits or MAC audit. And they’d already had on-site visits, they’d already had maybe perhaps a lower accuracy rating. And they’re going to be stuck in this cycle of being stuck in the audit until they can get a resurvey because with this coronavirus the penalties that they’re enduring, whether it’s a suspension of admission, or whether it’s a monetary penalty. These penalties are being administered even if they cannot have a secondary or a revisit of the audit to get them off of the penalty that they’re currently on. So it’s really important that people who are in the middle of audit and when all this came down to get them off of the audit cycle so they can go back to providing care.
Mike: So essentially, there are a number of activities that are suspended. But it’s important for providers to know that there is a subset of activities that will continue even during this period.
Knicole: Correct. But they’re all going to be activities that are of the utmost importance. The items that take lower priority are going to be pushed down.
Mike: Okay, and you mentioned the TPE audits a second ago. So that’s the targeted probe and education. Are they going to continue during this time period as far as you know?
Knicole: Well, so as far as I know, they are not going to continue as in they’re not going to start new TPE audit. Now the question then becomes, “Well, I received a document request a month ago for a TPE audit. Do I need to comply now?” And the conservative safe answer is to go ahead and keep complying with these document requests. Although the deadlines for these document requests, those are going to be extended. I’m sure you’ll be able to get extensions for trying to comply with those. And in reality, if you contact the people who are conducting the audit, you may find that the entire audit in general is put on pause. But don’t assume it’s put on pause. Try to make sure you comply, unless you find out it’s on pause. And if you get something over the email or over a phone that says that your TPE audit is paused currently, follow up with an email and get it in writing. Because future audit, they’re not going to remember that your particular audit was with pause during the coronavirus.
Mike: That’s great advice, Knicole. Do you have any other recommendations for providers as they’re navigating through this time?
Knicole: Yes, I do. There are a number of providers right now that are asking for exceptions, and I can give examples. So for example, in the hospital setting, there are hospitals that are asking for waivers for the inpatient admission standards or the two-day admission, or the moon rules. All those kind of things are asking for exceptions, and a lot of the hospital, A lot of the providers are getting the exceptions they need to allow people to have to stay longer in their hospitals because they have nowhere to discharge them. They can’t go back to their nursing homes where the coronavirus may or may not be. And so, because they’re getting all these exceptions, five years from now when you’re undergoing an audit, no one is going to remember that you had this exception that this particular consumer can stay in my hospital for two extra days or five extra days. And five years from now, you may get audited and say, “Well, you got to recoup all this money because you let them stay in for too long of a time.” When in reality, you are given an exception, write all the exceptions down. Keep one place, keep a computer program, keep a hard copy, whatever you want to do, and notebook, if that you want to get down to not having any technology involved. But keep track of all of these exceptions that you get as little as they may be because if you’re getting an exception for one person, and that one person can stay longer than the two-day allowance for the outpatient stays, and you multiply that by, okay, well, now you’ve got to take that exception and extrapolate it again, 200 people over the course of a year, that’s a lot of money we’re talking about. So you need to make sure you keep track of all the exceptions, no matter how small. And keep track of them somewhere that you’re not going to lose them. If your attrition rate is high with executives, you need to make sure that the next people in line had that knowledge so that in future audit, you can explain that you did not abide by the regulations for good reason. You had an exception, but no one’s keeping track of all these exceptions.
Mike: And so, it’s great advice, Knicole. And I know you’ve got a great blog of your own that people can follow. If people wanted to read more about what’s going on here on that blog or get in touch with you, how can they do that?
Knicole: Well, you’re more than welcome to go onto my blog, which is Medicare and Medicaid law. It is at medicaidlawnc.com. You can also contact me at any time. I’m at Potomac Law Group. I help providers across the country and not only in North Carolina, but in 33 states. And so, I am pretty well versed on all the exceptions that I’m seeing. It’s really fast-paced right now. It’s scary. It’s surreal. But it is really important to make sure that everything is written down because in the future– I mean, that old saying that old adage for nurses, if it’s not written, it doesn’t exist, is really going to matter in the future years.
Mike: Knicole, thanks for adding some clarity around this very complex issue. We appreciate you coming back to the show today.
Knicole: Absolutely. Thank you.
Written by my partner, Isaac Mamaysky. This article is germane to health care providers during this COVID19 pandemic.
The governor of Ohio recently made national headlines by telling employers across the state to check employees’ temperatures every day before work. Whenever employers conduct health screenings or otherwise make decisions based on their employees’ health, the Americans with Disabilities Act becomes a key consideration.
The ADA regulates employer-mandated medical examinations, the medical questions employers are allowed to ask employees, and of course, the provision of reasonable accommodations to disabled individuals, including during a pandemic.
During the 2009 H1N1 swine flu pandemic, the U.S. Equal Employment Opportunity Commission published a document called Pandemic Preparedness in the Workplace and the Americans With Disabilities Act. Having faded into relative obscurity in the intervening years, the EEOC’s guidance once again became relevant when COVID-19 was named a global pandemic.
Since that time, employment attorneys have referenced the 2009 guidance and wrestled with its implications for 2020. Last week, the EEOC updated its H1N1 guidance to clarify exactly how the principles apply today. The EEOC also updated a separate guidance document called What You Should Know About the ADA, the Rehabilitation Act, and COVID-19 and released a supplemental webinar titled Ask the EEOC.
Perhaps not surprisingly, the Ohio governor’s request aligns with the EEOC’s compliance guidelines, which help employers navigate ADA considerations while keeping COVID-19 out of the workplace. While medical examinations are normally prohibited under the ADA, the EEOC explains that examinations are appropriate when an employee would pose a “direct threat” to others by transmitting COVID-19.
Taken together, the EEOC’s updated guidance materials provide the following key takeaways for employers.
Employers should not ask questions related to disabilities, such as whether an employee has a compromised immune system or a medical condition that makes the employee more susceptible to COVID-19.
Employers can ask questions about symptoms of COVID-19 to ensure that sick employees stay home. Likewise, when employees call in sick without giving details, employers can ask about symptoms of COVID-19 in order to protect the rest of the workforce. However, employers should not ask these questions of employees who are already working remotely and have not been interacting with customers or coworkers.
Employers can check temperatures and conduct COVID-19 screenings of current employees, and of new employees but only after making a conditional job offer. If an employer has a reasonable belief based on objective evidence that a particular employee might have COVID-19 (due to a hacking cough, for example), the employer may conduct a health screening only of that one employee, rather than the entire workforce.
If an employee refuses to answer COVID-19 screening questions or refuses a temperature check, then the employer may bar the employee from the workplace. The EEOC encourages employers to assure employees that their medical information will remain confidential, which may make employees more likely to comply with employer requests.
Any records resulting from medical screenings should be maintained in a separate medical file (i.e., not as part of an employee’s personnel file) and treated as a confidential medical record. If a manager receives medical information while teleworking, and thus cannot follow the employer’s usual confidentiality protocols, the medical information should be safeguarded to the greatest extent possible until it can be properly filed when the manager returns to the workplace. This may mean documenting medical information using initials or ensuring that laptops and devices cannot be accessed by others in the household.
Likewise, employers who send an employee home should keep the decision confidential. Employers can tell other employees that they were exposed to a coworker with COVID-19, and then send home all employees who worked in close proximity to that person, but employers should not identify the coworker in question.
That person’s identity should only be shared with those who have a need to know, such as a supervisor who interviews the coworker about who might have been exposed to them in the workplace. Likewise, if an employee is teleworking due to having COVID-19, the employer can share the fact that the employee is teleworking but should not share the reason the employee is teleworking.
Employers can delay the start date of an employee who has symptoms of COVID-19. If an employer needs an employee to start working immediately, then the employer can withdraw a job offer to an employee with COVID-19.
Employers can request that employees who recently traveled to affected areas or were exposed to a person with symptoms of COVID-19 stay out of work until a certain number of days passes without symptoms. Employers should not specifically ask employees if they have a family member with COVID-19, which would be prohibited by the Genetic Information Nondiscrimination Act. Employers can ask, more generally, if employees have been exposed to any person with symptoms of COVID-19.
Employers can require a doctor’s clearance prior to allowing an employee to return to work. Note, however, that the Centers for Disease Control and Prevention tells employers not to require a doctor’s note to validate symptoms, because that discourages employees from staying home.
Employers can require employees to adopt infection-control practices in the workplace, such as prohibiting handshakes and requiring frequent hand-washing, wearing masks, maintaining six feet of distance from other employees, and related measures.
For the moment, much of this guidance applies to essential businesses, such as supermarkets and transportation companies, which are still open despite quarantines and other social distancing measures. Many nonessential businesses, which are currently closed, aspire to reopen as soon as possible.
While the exact timeline is still unclear, many businesses will likely reopen while COVID-19 is more controlled than it is today but still a risk, especially for employees with compromised immune systems and other medical conditions (such as lung disease and heart issues).
Since employers cannot ask questions related to disabilities, how can they determine which employees may be unavailable when they reopen? The EEOC explains that an inquiry is not disability-related if it identifies nonmedical reasons for absence on the same footing with medical reasons.
So, for example, an employer is permitted to ask a survey question along the following lines: In the event our business reopens in the near future, would you be unable to come to work for a reason such as your child’s day care center being closed, public transportation being sporadic, other dependents needing care, or having a compromised immune system or other health condition?
In this way, employers can determine which staff will be unavailable without running afoul of the ADA.
Depending on how early a particular business reopens, certain vulnerable employees might need to continue working from home for some period of time. Of course, employers are not absolved of their obligations to provide reasonable accommodations during a pandemic.
The EEOC observes that the rapid spread of COVID-19 has increased the number of requests for reasonable accommodations. This number will continue to increase if businesses reopen while the virus is not fully contained.
If an employer’s usual reasonable accommodation processes are delayed due the volume of inquiries, the EEOC encourages employers to implement temporary solutions that enable employees to keep working while the discussion and potential provision of reasonable accommodations is pending. The EEOC’s webinar provides extensive details on this topic.
Reflecting the general uncertainty surrounding current events, the EEOC is still unsure whether COVID-19 is a disability under the ADA. As the EEOC observes, our knowledge of COVID-19’s spread and containment changes day by day and its status as a disability will become clearer as time goes on.
As employers and their attorneys have seen, federal and state laws and regulations are changing equally fast. For now, while much of the country is on pause, employers should watch the changing landscape closely.
In the coming weeks and months, and especially as businesses reopen, states are expected to implement many new safety protocols. Perhaps a number will even follow Ohio’s lead by beginning each workday with a temperature check.
This article originally appeared in Law 360’s Expert Analysis section on March 31, 2020.
To learn more about the issues raised by this client bulletin, please contact Isaac Mamaysky at email@example.com
Note: This bulletin is for general use and should not be construed to provide legal advice as to particular factual situations.
Effective March 10, 2020, the Division of Health Benefits (DHB) implemented a 5% rate increase for the Medicaid provider groups listed below. See DHHS Update. (This update was published April 3, 2020, but retroactively effective).
DHB will systematically reprocess claims submitted with dates of service beginning March 10, 2020, through the implementation date of the rate increase.
Claims reprocessing for Skilled Nursing Facility providers will be reflected in the April 7, 2020, checkwrite. All other provider groups claim reprocessing will be included in subsequent checkwrites beginning April 14, 2020.
Providers receiving a 5% increase in fee-for-service reimbursement rates:
- Skilled Nursing Facilities
- Hospice Facilities
- Local Health Departments
- Private Duty Nursing
- Home Health
- Fee for Service Personal Care Services
- Physical, Occupational, Respiratory, Speech and Audiology Therapies
- Community Alternatives for Children (CAP/C) Personal Care Services (PCS)
- Community Alternatives for Disabled Adults (CAP/DA) Personal Care Services (PCS)
- Children’s Developmental Service Agency (CDSA)
[Notice that none of the increased rates include Medicaid services managed by managed care organizations (“MCOs”). No mental health, substance abuse, or developmentally disabled services’ rates are included].
Reprocessed claims will be displayed in a separate section of the paper Remittance Advice (RA) with the unique Explanation of Benefits (EOB) codes 10316 and 10317 – CLAIMS REPROCESSED AS A RESULT OF 5% RATE INCREASE EFFECTIVE MARCH 10, 2020 ASSOCIATED WITH THE COVID-19 PANDEMIC. The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite (there is no separate 835). Please note that depending on the number of affected claims you have in the identified checkwrite, you could see an increase in the size of the RA.
Reprocessing does not guarantee payment of the claims. Affected claims will be reprocessed. While some edits may be bypassed as part of the claim reprocessing, changes made to the system since the claims were originally adjudicated may apply to the reprocessed claims. Therefore, the reprocessed claims could deny.
This Medicaid rate increase could not come faster! While it is a small, itsy-bitsy, tiny, minuscule semblance of a “bright side”…a bright side it still is.
Article courtesy of Law360. Updated April 1, 2020.
Notice the article does not expound on the closings or openings of administrative law courts across America. If you are defending a Medicare or Medicaid overpayment, tentative notice of overpayment, or other alleged penalties, you will, most likely, be in administrative court.
At least, here, in NC, the administrative courts are open for Motions. Physically, the courts are closed except for a clerk. No in-person hearings are being held. But emergency, telephonic hearings can be heard.
FEDERAL APPEALS COURTS
U.S. Supreme Court
The high court postponed oral arguments scheduled for this month’s session running March 23 to March 25 and March 30 to April 1. The court’s regularly scheduled order list will be posted on the court’s website at 9:30 a.m. March 23. Hard copies will not be released. Opinions will be issued by the court at 10 a.m. the same day.
The court closed to tourists on March 12 until further notice, but the building will remain open for official business.
The deadline to file any petition for a writ of certiorari due on or after March 19 is extended to 150 days from the date of the lower court judgment, order denying discretionary review or order denying a timely petition for rehearing. The court said it will generally grant motions for time extensions if parties have difficulties related to the coronavirus.
Federal Circuit Court of Appeals
All cases scheduled for argument during the April 2020 sitting will be conducted remotely and no in-person hearings will be held. All existing deadlines in cases are still in effect. All requirements to provide paper copies of documents submitted electronically are suspended for all documents filed on or after March 2 until further notice. Pro se parties are permitted to submit case-initiating documents by fax or email.
The public is prohibited from entering the National Courts Building complex unless preauthorized by court staff and only as necessary to conduct or support essential court functions, effective March 16. Those who have tested positive for the coronavirus or had possible exposure to the virus are prohibited from entering the courthouse.
D.C. Circuit Court of Appeals
The court of appeals for the D.C. Circuit has suspended all in-person onsite oral arguments until further notice.
The Court of Appeals for the D.C. Circuit is limiting access to its courthouse to “judges, court staff, members of the media, and visitors with official business with the courts,” effective Friday. The court asked that those who have tested positive for the coronavirus, have had contact with someone who has been exposed to the virus, been asked to self-quarantine or are experiencing flu-like symptoms not enter the courthouse. Pro se litigants may email filings to ProSeFilings@cadc.uscourts.gov as PDF files and should not send duplicate paper copies to the court.
First Circuit Court of Appeals
Oral arguments scheduled for the month of April are canceled.
Second Circuit Court of Appeals
All filing dates and other deadlines between March 16 and May 17 are extended by 21 days.
Those who do not have business with the court will not be admitted until further notice. Arguments may be conducted remotely.
Lawyers or pro se parties scheduled to argue before the court should contact the clerk of court if they: visited or have been in contact with someone who was in China, Iran, Italy, Japan or South Korea in the past two weeks, have been asked to self-quarantine, have tested positive for the coronavirus or have been in contact with someone who has tested positive, or if they have a verifiable health condition.
Third Circuit Court of Appeals
Oral arguments will continue as scheduled pending further order of the court. The merits panel will determine the manner of argument. Parties may file a motion requesting to appear by audio conference. The majority of staff in the clerk’s office will be working remotely. The three-day time limit for requesting extensions is relaxed until the clerk’s office resumes normal operations. The filing of paper copies of briefs and appendices is deferred until further notice.
The Third Circuit Judicial Conference scheduled for May 13-15 in Philadelphia has been canceled.
Fourth Circuit Court of Appeals
Cases previously scheduled for argument during the March 17-20 and April 7 argument sessions will be heard at a later session, heard remotely or submitted on the briefs, at the direction of the assigned panels. The court temporarily suspended its oral argument requirement for published opinions.
The Powell Courthouse in Richmond, Virginia, is closed to the public. Papers may be filed in the courthouse lobby, but those who have tested positive for the coronavirus, those with symptoms of COVID-19 and those who may have been exposed to the virus are prohibited from entering the building.
Fifth Circuit Court of Appeals
All requirements to file paper copies are suspended until further notice. Extensions with justification may be requested from the clerk’s office. All outstanding deadlines for incarcerated and nonincarcerated pro se filers are extended for 30 days after their due dates. The court canceled in-person oral arguments scheduled for March 30 to April 2 in New Orleans.
Sixth Circuit Court of Appeals
All nonessential court functions are postponed until further notice. Judges, parties, attorneys and some court staff are allowed to appear via video conference. The requirement that nonprisoner pro se litigants file exclusively in paper format is temporarily suspended until April 17.
Those who have tested positive for the coronavirus or come into contact with someone who has tested positive are barred from entering any courtroom. That restriction also applies to those who have been asked to self-quarantine, are exhibiting cold or flu symptoms, have visited Italy, Iran, China or South Korea in the past two weeks, or have had close contact with someone who has visited those countries in the past two weeks.
Seventh Circuit Court of Appeals
All cases scheduled for oral argument from March 30 through the end of April will be argued via telephone. The courtroom in Chicago will be closed to the public, and the court is operating with reduced staff. Arguments will be recorded and posted on the court’s website. If all parties agree among themselves to waive oral argument, they may jointly file a motion with the court seeking permission to do so.
Eighth Circuit Court of Appeals
The public is not being admitted to the Eighth Circuit Clerk’s Office. Those who come to the Burger Courthouse in St. Paul, Minnesota, or the Eagleton Courthouse in St. Louis to file may leave their documents at the front door to the office.
Ninth Circuit Court of Appeals
Ninth Circuit courthouses are closed to the public during noncourt weeks until further notice. The court is evaluating arguments currently scheduled for March, April and May and will give orders to the cases individually. Panels may exercise their discretion to submit cases without argument, postpone argument to a later date or hold argument via telephone or video. Arguments will be livestreamed for the public.
Tenth Circuit Court of Appeals
The Tenth Circuit closed its sole courthouse to the public from March 17 until further notice. The Denver courthouse will be restricted to judges, court staff, court security officers and service providers with official business with the court. All filings should be made electronically or via mail until further notice.
Eleventh Circuit Court of Appeals
In the Eleventh Circuit, only judges, court staff, members of the media and visitors with official business with the court will be allowed into the two Eleventh Circuit buildings. Paper filing requirements are temporarily waived. Panels can hear oral arguments remotely, and those hearings will be livestreamed for the public when feasible. Recordings of oral arguments will also be available on the court’s website. Anyone who is experiencing flu-like symptoms or who has had a known contact with a person who tested positive for the coronavirus will not be allowed inside.
The court has canceled its judicial conference, which had been scheduled for May 6 through May 9 in Atlanta.
FEDERAL DISTRICT COURTS AND STATE COURTS
The Northern District of Alabama is prohibiting those who have tested positive for the coronavirus and those who may have been exposed to the virus from entering its courthouses. Also prohibited are those who have visited China, Italy, Japan, Iran or South Korea in the past two weeks.
In the Middle District of Alabama, no jurors will be summoned for civil or criminal jury trials for 30 days as of March 17. All jury trials and trial-specific deadlines scheduled during that period are postponed for 30 days, as are all grand jury proceedings. Initial appearances, arraignments and detention hearings before the magistrate judges will continue remotely. Any proceedings that can’t be conducted remotely will be coordinated with the duty magistrate judge. Case-by-case exceptions to the procedures may be ordered for nonjury matters at the discretion of the court after consultation with counsel.
All the Middle District’s bankruptcy court, hearings will be held by telephone through May 31
The Middle District is prohibiting those who have tested positive for the coronavirus and those who may have been exposed to the virus from entering its courthouses. Also prohibited are those who have visited China, Italy, Japan, Iran or South Korea in the past two weeks.
The Southern District of Alabama is prohibiting those who have tested positive for the coronavirus and those who may have been exposed to the virus from entering its courthouses. Also prohibited are those who have visited Europe, China, Italy, Iran or South Korea in the past two weeks.
In the state court system, all in-person court proceedings are suspended through April 16, with exceptions for jury trials in progress as of March 13 and other essential and emergency matters. Any court deadlines set to expire before April 16 are extended to April 20, excluding statutes of limitation.
In the District of Alaska, all civil and criminal jury trials set to begin on or before May 1 are postponed until further notice. Trial-specific deadlines in civil and criminal cases set to begin before May 1 are postponed until further notice. All noncase-related activities scheduled in the James M. Fitzgerald U.S. Courthouse in Anchorage and the U.S. Courthouses in Fairbanks and Juneau are canceled until further notice. All grand jury proceedings scheduled to be held from Feb. 18 through May 1 are postponed. No hearings in bankruptcy appeals pending before the court scheduled from March 23 through May 1 will go forward, except for emergency time-sensitive matters.
In Alaska’s state court system, all Superior Court and District Court proceedings are suspended through April 3 except for certain priority hearings, including arraignments, felony first appearances and bail hearings. All trial court proceedings are suspended through May 1 except for certain priority hearings. Criminal jury trials are suspended through May 1, but trials underway as of March 23 may continue. Filing deadlines are extended to May 1 in suspended cases. The court is encouraging those with COVID-19 symptoms or possible exposure to the virus not to come to any state courthouses.
The District of Arizona has postponed all civil and criminal jury trials scheduled to begin on or before May 4 until further notice. All trial-specific deadlines in criminal cases scheduled to begin before May 4 are postponed until further notice, and judges may postpone deadlines for civil cases at their discretion. All grand juries that were scheduled to convene on or before April 17 are suspended. For those charged with felonies during this time, the period of time for presenting the case to the grand jury is extended 30 days from the indictment deadline. All court proceedings in the Tucson division through March 29 are postponed. Judges will conduct proceedings remotely where feasible. Noncase-related activities at courthouses in Phoenix, Tucson and Yuma, including naturalization ceremonies, are canceled until further notice.
The Flagstaff Courthouse will be closed to the public, except for necessary court appearances, through at least April 10. The public admitted to the courtroom will be limited to no more than two people in the public seating area at any time.
The court is asking those who recently traveled from an area with widespread COVID-19 — and those who are exhibiting symptoms of the disease — not to visit its courthouse.
In the state court system, no new petit juries will be empaneled through April 17.
In the Eastern District of Arkansas, all civil jury trials scheduled between March 18 and April 20 are canceled. All criminal jury trials scheduled to take place between March 23 and April 30 are postponed until further notice. All grand jury proceedings scheduled between March 18 and April 30 are postponed until further notice. Attorneys and parties must provide notice of potential exposure to the coronavirus. The court will use videoconferencing in preliminary criminal proceedings as needed. All large scale public events scheduled for March and April are postponed.
In the Western District of Arkansas, all civil and criminal bench and jury trials are postponed and will be rescheduled to a date after May 1. Other civil and criminal matters that can be resolved without oral argument or handled remotely are unaffected. Those who have tested positive for the coronavirus or may have been exposed to it are prohibited from entering any courthouse.
In the state court system, in-person proceedings in the appellate, Circuit and District courts are suspended until April 17. Exceptions include certain emergency, time-sensitive and other necessary proceedings. All summonses for people to participate in jury panels are suspended until May 1.
In the Southern District of California, civil and criminal jury trials are postponed until April 16. For the district’s bankruptcy court, all hearings will be conducted by telephone through April 16.
In the Eastern District of California, all civil and criminal jury trials are postponed until May 1. All courthouses are closed to the public. All civil matters will be decided on the papers or by remote hearings, if necessary. All criminal initial appearances, arraignments and other essential proceedings will proceed before magistrate judges unless the parties agree to postpone them. Proceedings should be conducted remotely when possible. District judges may postpone criminal matters to a date after May 1.
In the Central District of California, all courthouses are closed to the public through May 1, except for certain criminal hearings. Courthouse tours are canceled. No civil hearings will go forward, except for emergency time-sensitive matters. Any hearings on emergency civil matters will only proceed by telephone. All matters before the bankruptcy court will proceed by telephone.
In the Northern District of California, all civil and criminal jury trials are postponed until May 1. Anyone with symptoms should not appear in court. As of March 24, the San Jose courthouse was closed to both staff and the public until at least April 7 after a visitor was treated for COVID-19. All other district courthouses are closed to the general public until at least April 7. Essential courthouse operations for the Oakland, San Jose and Eureka/McKinleyville courthouses will be consolidated and relocated to the San Francisco courthouse until April 7.
The Central District and Eastern District of California are prohibiting anyone who visited China, South Korea, Japan, Italy or Iran in the past two weeks from entering any of their courthouses. The restriction also applies to those who have had close contact with someone who has visited those countries in the past two weeks, those who have tested positive for the coronavirus or have been in contact with someone who has tested positive, those who have been asked to self-quarantine and those experiencing fever, cough or shortness of breath.
The California Supreme Court suspended in-person oral argument sessions until further notice. Counsel will only appear remotely. All oral argument sessions will be held in the court’s San Francisco headquarters courtroom with limited seating. More information on California state court restrictions is available here.
In the District of Colorado, all civil and criminal trials set to start from March 27 through May 1 are postponed. All grand jury proceedings are suspended through May 1. Hearings will be held remotely when possible. Only those with official court business are allowed to enter the district’s courthouses and probation offices. Those who have tested positive for the coronavirus or may have been exposed to it are prohibited from entering any courthouse.
In the state court system, all jury calls are suspended through April 3 except those for criminal trials facing imminent speedy trial deadlines.
The District of Connecticut said Wednesday that all civil and criminal jury trials and jury selections scheduled to start before April 10 are postponed until further notice. The courthouses will remain open for all other business. The clerk’s office is closed to the public until further notice, and all manual court filings can be made at a designated box in the entrance lobby of each courthouse.
The court is also prohibiting visitors who have been to China, South Korea, Japan, Italy, Iran, or any locale that is quarantined in the past two weeks. The court specified that those who have visited New Rochelle, New York — other than in a car or train — are also prohibited from visiting courthouses and probation offices.
All scheduled hearings and conferences in the district’s bankruptcy court will be conducted by telephone, unless the matter is withdrawn, resolved, postponed or the court determines the proceeding is not necessary.
In the state court system, all civil and criminal jury trials are suspended. The courts will only schedule and hear certain high-priority matters. The Connecticut Supreme Court postponed oral arguments in cases scheduled to have been heard between March 24 and April 2. The Supreme Court and Appellate Court have suspended the time requirements for all filings until further notice and have requested that no paper briefs be filed until further notice. On March 13, the court ruled that no appellate preargument conferences will be held for the next 30 days.
In the District of Delaware, the J. Caleb Boggs U.S. Courthouse and Federal Building in Wilmington is closed until further notice. All civil and criminal jury selections and trials scheduled to begin before April 30 are postponed until further notice. Sitting grand juries are authorized to continue to meet, but no new grand juries will be empaneled before April 30. All changes of plea, sentencings and supervised release violation hearings scheduled before April 30 are postponed unless otherwise ordered by the presiding judge.
Attorneys are asked to inform the appropriate court if they have appeared in court and have since developed symptoms or tested positive for the coronavirus and to inform the courts about any scheduled proceedings that will require the attendance of a person who has tested positive for coronavirus or has been in contact in the past 14 days with a person who has tested positive for coronavirus.
Also, the courts will conduct conferences and hearings by phone when possible and will consider any request to change a scheduled in-person proceeding to a telephone proceeding.
The Delaware Bankruptcy Court has halted all nontime-sensitive proceedings until at least April 15. Unless otherwise ordered by the presiding judge, all court hearings held prior to April 15 will be held via telephone or video conference.
In the Delaware Chancery Court, all hearings and trials will be conducted remotely for 30 days beginning March 16.
The Delaware Supreme Court canceled all in-person oral arguments through May.
All state trial courts will have the discretion to postpone for 30 days both civil and criminal trials and hearings. Proceedings will be conducted by telephone when possible and the court will consider all requests for in-person hearings to be conducted by phone. Attorneys and self-represented parties scheduled for trial must notify the court if the trial will require the attendance of a person who has tested positive for coronavirus or has been in contact in the past 14 days with a person who has tested positive for coronavirus.
In the Florida Southern District Court, all jury trials scheduled to begin March 16 through March 30 are postponed until further notice. All trial-specific deadlines in criminal cases scheduled to begin before March 30 are also postponed until further notice. All grand jury sessions are postponed until April 27.
Court security officers are screening people who enter the federal courthouse and denying entry to anyone who has recently visited Italy, Iran, South Korea or China. Anyone who resides with or has had recent close contact with someone who has traveled to one of those countries, has been asked to self-quarantine, has tested positive for the coronavirus or had contact with someone tested positive also will not be able to enter any of the federal courthouses in the district.
In the Middle District of Florida, those with symptoms of COVID-19 and those who may have been exposed to the coronavirus are prohibited from entering any courthouse. All jury trials in the Orlando Division scheduled to begin before June 30 are postponed, as are all trial-specific deadlines in criminal cases scheduled to begin before June 30.
In the Northern District of Florida, jury trials and grand jury proceedings have been canceled for the month of March, and naturalization ceremonies have been canceled for the months of March and April. Proceedings will be held remotely when possible.
In the state court system, the Florida Supreme Court ruled that all grand jury proceedings, jury selection proceedings, and criminal and civil jury trials are suspended through April 17. Proceedings that already began may continue if the presiding judge and chief judge determine it is required “by the interests of justice.” All time periods involving the speedy trial procedure in criminal and juvenile court proceedings are suspended through April 20. Time periods for those charged with first-degree murder are suspended through April 17. The chief judges of each state Circuit Court were ordered to cancel or postpone nonessential court proceedings, unless the proceedings can be conducted remotely.
The Northern District of Georgia said Wednesday it is denying entry to anyone who has visited China, South Korea, Japan, Italy or Iran in the past two weeks. The restriction also applies to those who have had close contact with someone who has visited those countries in the past 14 days, has tested positive for the coronavirus, been in contact with someone who has tested positive or been asked to self-quarantine by any hospital or health agency. Those denied entry may appear by teleconference with approval of the presiding judge.
In the Middle District of Georgia, no jury trials will be held for 60 days. Grand juries are not affected by the moratorium. All criminal hearings are canceled through May 16 except for certain proceedings, including initial appearances, arraignments and detention hearings. Those who have tested positive for the coronavirus or may have been exposed to the virus are prohibited from entering any courthouse.
In the Southern District of Georgia, only those with official court business will be admitted into the courthouse. Those who have symptoms of COVID-19, have tested positive for the coronavirus or may have been exposed to the virus are prohibited from entering the building. Any jury trials between March 17 and April 17 may be postponed. Grand juries will continue to meet. Criminal matters before magistrate judges will continue to take place as usual.
In the Georgia Supreme Court, filing deadlines are suspended through April 13. After that, attorneys will have the same amount of time to file their documents that they had when the court order went into effect on March 14. The court encourages attorneys to file briefs and other documents where practical, since the court is still working on cases.
The Georgia Supreme Court asked all attorneys, parties and other visitors to stay away from the court if they have a fever or symptoms of respiratory illness or if they have been exposed to anyone tested positive for the coronavirus or has the flu.
In the District of Guam, all jury selections and trials set to begin before April 26 are postponed until further notice. Criminal matters before the magistrate judge will proceed as usual. All grand jury proceedings are postponed to April 26, but the U.S. attorney may schedule proceedings for emergency or essential matters. All sentencing and revocation hearings scheduled to be heard on or before April 3, and any related deadlines, are postponed until further notice.
The court and the U.S. District Pretrial and Probation Office are closed to the public from March 20 through April 3. All naturalization ceremonies and noncourt-related events scheduled for March and April are canceled. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering the district court.
In the District of Hawaii, all civil and criminal trials scheduled to start between March 17 and May 3 are postponed. All civil hearings, including settlement conferences, scheduled for that time period will either be conducted remotely or taken off the court’s calendar. Nonessential criminal matters will be postponed to a date after May 3, but the court will continue to conduct initial appearances, arraignments, detention hearings and other time-sensitive matters. The court is generally closed to the public, but there is limited seating for in-person hearings, available by request.
The court is prohibiting those who have visited China, Iran, Italy, Japan and South Korea within the past two weeks from entering the courthouse, as well as those who have had contact with someone who has been in those countries, tested positive for the coronavirus, been in contact with someone who has been exposed to the virus or have been asked to self-quarantine.
In the state court system, all ongoing trials will be postponed to a date after April 30, as will civil trials and hearings. Criminal trials, grand jury proceedings and hearings will be postponed to a date after April 30 to the extent possible. In the courts of appeal, all oral arguments scheduled before April 30 will be rescheduled or the matter resolved without oral argument. Those who have symptoms or may have been exposed to the coronavirus are prohibited from entering judiciary facilities.
In the state court system, all in-person appearances for civil and criminal dockets are excused, except for emergency matters, child protection hearings, domestic violence hearings and evidentiary hearings in criminal cases. The state Supreme Court ordered that all civil trials, hearings and motions should be postponed and rescheduled for a later date unless the assigned judge finds the proceedings can be held remotely. Any civil trial or hearing currently in progress shall be postponed or completed at the discretion of the presiding judge.
In the District of Idaho, all jury trials scheduled to begin on or before May 11 are postponed until further notice. All grand jury proceedings set to begin before May 11 are suspended. No in-person bankruptcy or civil proceedings will take place until further notice. Various criminal hearings before district judges will be postponed until after May 11, and all preliminary felony and post-conviction proceedings conducted by a magistrate judge will be conducted remotely.
The federal courthouse in Pocatello was closed until April 6 after a person working in the building tested positive for the coronavirus. All in-person evidentiary hearings in civil, criminal and bankruptcy cases scheduled before any judge in the Pocatello courthouse are postponed.
Those with symptoms of COVID-19 and those who may have been exposed to the virus are prohibited from coming to court.
In the state court system, all in-person appearances for civil and criminal dockets are excused, except for emergency matters, child protection hearings, domestic violence hearings and evidentiary hearings in criminal cases. The state Supreme Court ordered that all civil trials, hearings and motions be postponed and rescheduled for a later date unless the assigned judge finds the proceedings can be held remotely. Any civil trial or hearing currently in progress shall be postponed or completed at the discretion of the presiding judge. All criminal jury trials scheduled to be heard from March 26 through April 30 are postponed for at least 30 days.
In the Northern District of Illinois, all civil case deadlines are extended by 21 days. Civil case hearings, trials and settlement conferences scheduled from March 17 through April 3 are canceled and will be rescheduled by the presiding judge on or after April 6. All criminal case proceedings in any division that can’t be postponed will be conducted in the Eastern Division by district judges serving in emergency capacity.
The court is still accessible for electronic filing and phone and video conferencing in emergency situations.
The court said on March 12 that all civil jury trials and jury selections scheduled to start before April 3 are postponed until further notice. Second chance reentry court proceedings, veterans treatment court proceedings and non-telephone settlement conferences scheduled before April 3 are also postponed. The courthouses will remain open for all other business, including criminal case proceedings, and grand juries will continue to meet.
The court suspended all mass public gatherings outside of court proceedings at the federal courthouses in Chicago and Rockford, Illinois, and limited deliveries to the court. Judges are encouraged to conduct proceedings by phone or video conference where practicable.
In the Central District of Illinois, all civil and criminal jury trials scheduled to begin before May 18 are postponed and will be rescheduled by the presiding judge. All petty offense proceedings are postponed and will be rescheduled by the presiding judge. All civil hearings, including settlement conferences, should be conducted by telephone or video conference. Criminal sentencing hearings and hearings on the revocation of supervised release are postponed until after May 18. Those who have symptoms or may have been exposed to the virus should contact the court before appearing.
In the Southern District of Illinois, all in-person civil matters are postponed until further notice. All civil case deadlines are extended by 30 days. Grand jury proceedings are unaffected. Only essential in-person criminal matters will occur. Any emergency hearing required before April 7 in a criminal case will be held remotely. Those who have tested positive for the coronavirus or may have been exposed to the virus are prohibited from visiting the courthouse. All scheduled bankruptcy hearings will be held by telephone.
For the Cook County Circuit Court, all matters are postponed for 30 days from their originally scheduled date, but some proceedings will continue, including certain criminal matters, juvenile detention hearings, temporary custody hearings and mental health hearings, among others. Discovery in civil matters will continue, and emergency civil hearings may be conducted in-person or remotely.
In the Southern District of Indiana, all jury trials are postponed through May 1. All other civil court proceedings will continue, although they may be done remotely at the judge’s discretion. Naturalization ceremonies through May 1 are canceled. Those with symptoms and those who may have been exposed to the coronavirus are prohibited from visiting courthouses.
The Indianapolis Division, Terre Haute Division and New Albany Division are closed to the public as of March 18.
In the Northern District of Indiana, the Fort Wayne, Hammond, Lafayette and South Bend divisions, as well as the district’s bankruptcy court and probation office, are closed to the public. The court will conduct necessary proceedings remotely as ordered by the presiding judge in each case. Necessary criminal proceedings will continue to be held before magistrate judges unless the parties agree to postpone them. Those proceedings will be conducted remotely as much as possible.
The Indiana Supreme Court has tolled all deadlines for appellate filings through April 6. Various matters in the Circuit, Superior and Municipal courts have been tolled, including all laws and procedures setting time limits for speedy trials in criminal and juvenile proceedings; public health, mental health and appellate matters; judgments and other orders; and statutes of limitation. Those restrictions apply to the Indiana Tax Court as well.
In the Northern District of Iowa, those who have tested positive for the coronavirus are prohibited from entering the courthouse, as are those who have been asked to self-quarantine, those experiencing symptoms and those who may have been exposed to the virus.
In the Southern District of Iowa, all civil and criminal jury trials set from March 16 to May 4 are postponed until further notice. Any further grand jury proceedings for the month of March are canceled.
In the state court system, any criminal trial that is not in progress is postponed and will be rescheduled for after April 20. All civil jury trials that haven’t started as of March 13 but were scheduled to begin before May 4 are postponed. All civil bench trials and other hearings set to start before May 4 are postponed until May 4 at the earliest or should be conducted by telephone, at the discretion of the judge. As of March 17, statutes of limitation for filing an action in district court are extended by 48 days.
The Iowa Supreme Court ordered that attorneys and parties notify their opposing counsel and appropriate clerk of court’s office if they suspect a participant in any proceeding has an elevated risk of transmitting the novel coronavirus. No one who has an elevated risk can attend any state court proceeding in person without court authorization. Attorneys must also ask their clients and witnesses whether they have an elevated risk of transmission, the order said.
Potential state court jurors must notify the jury manager if they have an elevated risk of transmitting coronavirus, and the jury manager must reschedule them to a new service term. The court said it will also promptly consider requests from parties to change in-person proceedings to remote proceedings.
In the District of Kansas, all criminal cases and matters scheduled for nonemergency hearings are postponed until further notice. Grand jury proceedings are postponed for at least 30 days. Those who have tested positive for the coronavirus, have symptoms or were potentially exposed to the virus are prohibited from coming to court.
In the state court system, all civil and criminal jury trials scheduled to begin on or after March 18 are postponed until further notice. Trials in progress as of March 18 may continue to conclusion at the discretion of the presiding judge. All district and appellate courts will be restricted to emergency operations until further notice.
In the Eastern District of Kentucky, civil and criminal trials scheduled to begin on or before May 1 are postponed for at least 30 days. Grand jury proceedings will continue.
All currently scheduled hearings in criminal cases and in-person hearings in civil cases scheduled on or before May 1 are postponed, with some exceptions for emergency matters. All hearings in emergency matters will be conducted remotely “absent exceptional circumstances,” according to a district order.
In the Western District of Kentucky, civil and criminal trials scheduled to begin before April 17 are postponed for at least 30 days. All trials in progress will be completed at the discretion of the presiding judge. With certain exceptions, grand jury proceedings are also postponed.
In the state court system, all in-person appearances for civil and criminal dockets are canceled through April 24 except for emergency and time-sensitive matters. All scheduled civil trials, hearings and motions are postponed, and any civil trial or hearing currently in progress will be postponed or completed at the discretion of the presiding judge.
In the Eastern District of Louisiana, all civil and criminal bench and jury trials are postponed until May 1 and will be rescheduled by each presiding judge. The postponements do not include deadlines other than the trial dates. Civil and criminal in-person hearings scheduled before May 1 are postponed. All grand jury proceedings are suspended until May 1. The clerk’s office will not accept sealed paper documents for filing through May 1. All noncase-specific events, including naturalization ceremonies, scheduled before May 1 are canceled and will be rescheduled later.
The court is prohibiting those who have traveled to China, South Korea, Japan, Iran or Italy in the past two weeks from entering the New Orleans courthouse. The restriction also applies to those who have had close contact with someone who recently traveled to those countries, those who have tested positive for the coronavirus, those who have come into contact with someone who has tested positive, those who have been asked to self-quarantine and those with symptoms of COVID-19.
In the Middle District of Louisiana, all criminal and civil trials are postponed until at least May 1. All in-person civil hearings scheduled through April 10 are postponed and will be rescheduled by the presiding judge. All grand jury proceedings are postponed until further notice. Criminal matters before magistrate judges will take place remotely or in-person. Rearraignments and sentencing hearings scheduled before April 10 are postponed. Statute of limitations deadlines are interrupted until April 13. No in-person filings will be accepted before April 13. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from the courthouses.
In the Western District of Louisiana, all jury trials set to begin before May 1 are postponed and will be rescheduled by each presiding judge. Grand jury proceedings will continue. Judges may hold in-person hearings, and parties are encouraged to participate in nonsentencing hearings remotely. Noncase-related events scheduled through May 1, including naturalization ceremonies, are canceled. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from courthouses.
Public access to the Louisiana Western District Clerk of Court Offices in the Alexandria, Lafayette, Lake Charles, Monroe and Shreveport divisions is suspended. Any court filings may be time-stamped and placed in the drop box located in each division.
For state courts, all legal deadlines are suspended until at least April 13. All jury trials scheduled to start before April 13 are postponed until at least April 14. All civil trials, hearings and court appearances scheduled before April 13 are postponed, except for certain emergency proceedings. Essential court functions will be conducted remotely when possible.
In the District of Maine, all jury selections and jury trials set to begin before any district or magistrate judge are postponed until further notice. All grand jury proceedings are also postponed until further notice.
Public access to scheduled hearings will be permitted only with the prior permission of the presiding judge. The clerk’s office will be open by appointment only. In-person court proceedings are limited to, among other things, certain criminal matters; the issuance of search warrants; motions seeking immediate, emergency relief; and essential administrative functions.
In the state court system, the courts will schedule and hear only certain proceedings, including arraignments and first appearances of defendants held in custody; requests and hearings related to protection from abuse; child protection petitions and hearings; and hearings granted on motion. Other proceedings will not be scheduled or heard before May 1, and all previously scheduled cases are postponed.
The District of Maryland has postponed until further notice all civil and criminal jury selections scheduled to begin before April 24. All nonemergency proceedings are postponed through April 24, and all filing deadlines between March 16 and April 24 are extended by six weeks. The court will remain open for emergency criminal, civil, and bankruptcy matters related to public safety, public health and welfare, and individual liberty. All misdemeanor, traffic and petty offense proceedings scheduled through May 31 are postponed until further notice.
As of March 31, all in-court proceedings will be heard on Mondays, Wednesdays or Fridays unless a presiding judge orders otherwise. Emergency proceedings may be heard on Tuesdays or Thursdays when necessary.
As of March 27, the requirement to deliver paper courtesy copies to the clerk’s office is temporarily suspended, unless otherwise ordered by a presiding judge.
All in-court proceedings in the Southern Division U.S. Courthouse in Greenbelt, Maryland, are suspended until further notice. All emergency matters in the Southern Division will be heard in the U.S. Courthouse in Baltimore.
Courthouse access is limited to litigants with scheduled proceedings, counsel, investigators or employees of counsel and credentialed press. The court is also prohibiting those who have visited China, Iran, Italy, Japan, South Korea, Egypt, Washington State and New Rochelle, New York, within the past two weeks from entering the courthouse, as well as those who have had contact with someone who has been in those areas, tested positive for the coronavirus, been in contact with someone who has tested positive or have been asked to self-quarantine.
On the state side, the Court of Appeals has ordered that all courts in the Maryland Judiciary, court offices, administrative offices, units of the judiciary, and clerk’s offices of the Circuit Courts are closed to the public on an emergency basis, effective March 16. Certain matters scheduled to be heard between March 16 through April 3 are postponed until further notice.
The Massachusetts District Court announced that while the courthouses in Boston, Worcester and Springfield will remain open, all jury trials scheduled to begin before April 27 are postponed until further notice.
The court said that while trial-specific deadlines before April 27 in criminal cases are also postponed, judges can delay trial-specific deadlines for civil cases at their own discretion. Individual judges can continue to hold hearings, conferences and bench trials if they want, but the court is encouraging them to do so by telephone or video conference.
The court will continue to hold criminal proceedings involving personal liberty or public safety issues. Other criminal proceedings will be postponed 60 days as of March 16 with exceptions for certain proceedings, including initial appearances, detention hearings and arraignments. Those proceedings may be conducted remotely when feasible. Pretrial deadlines are also extended by 60 days. Grand jury proceedings are postponed until April 27.
The court is prohibiting visitors who recently traveled to China, Italy, Japan, Iran and South Korea from entering any courthouse or probation office in the district. Those who have had close contact with someone who visited those countries — as well as those who have symptoms of COVID-19, have tested positive for the virus or have been instructed by a doctor to self-quarantine — are also prohibited from visiting.
In the state court system, the only in-person proceedings that will be held in state courthouses through at least April 6 are emergency matters that can’t be handled remotely. Only essential parties can enter courthouses, and only up to three members of the news media will be allowed in for an emergency in-person proceeding. All civil and criminal jury and bench trials scheduled to begin before April 17 are postponed until at least April 21, unless the proceeding is a civil bench trial that can be conducted remotely. All statutes of limitation are tolled through April 21. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering any state courthouse.
The state appeals court has ordered that all cases scheduled for oral argument during the remainder of March will be held by telephone.
The Eastern District of Michigan is prohibiting people who have visited China, South Korea, Italy and Iran in the last two weeks from entering any district courthouse until further notice. All civil and criminal matters scheduled for in-person appearances are postponed until further notice, as are grand jury proceedings. Case-by-case exceptions to postponements may be ordered for nonjury matters. Criminal matters before magistrate judges will continue to take place as usual.
The Theodore Levin U.S. Courthouse in Detroit closed to the public on March 25, and will remain closed to the public until the building owner can clean the courthouse according to federal guidelines. The district announced on March 27 that 10 court security officers showed COVID-19 symptoms, four were hospitalized, and two tested positive for the virus.
In the Western District of Michigan, judges will handle matters remotely as much as possible. All facilities in the district are closed to public access through April 13, except for the Ford Building in Grand Rapids and the Marquette Facility. Those facilities will be open by appointment only.
The district is also prohibiting: those who have had close contact with someone who has visited those four countries, have recently traveled to U.S. areas with widespread community transmission of the coronavirus, have been asked to self-quarantine, have tested positive for the virus or who exhibit the symptoms of COVID-19.
In the state court system, trial courts are limiting courtroom access to no more than 10 people at a time, including staff. The courts are practicing social distancing and limiting court activity to essential functions. All criminal jury trials are adjourned until after April 3. Most civil and business court matters, including trials, will be conducted remotely or adjourned until after April 3.
All criminal and grand jury proceedings are postponed until April 16. All jury trials are postponed through April 27, as are trial-specific deadlines. The clerk’s office intake desks will not accept cash payments, and the requirement that the filing party provide courtesy copies to the judge hearing the motion is suspended through April 27. The clerk’s office intake desks in Minneapolis, St. Paul, Duluth and Fergus Falls are closed to the public until further notice.
Video conferencing and telephone conferencing are allowed for several types of proceedings, including detention hearings, initial appearances, arraignments, felony pleas and felony sentencings.
The District of Minnesota is prohibiting those who have visited China, Iran, Italy and South Korea within the past two weeks from entering the courthouse, as well as those who have had contact with someone who has been in those countries, tested positive for the coronavirus, been in contact with someone who has tested positive or been asked to self-quarantine.
In the state court system, appellate courts can grant extensions for deadlines to initiate appeals or requests for review up to 30 days. The appellate courts may determine for any case that oral argument is unnecessary. In district courts, trials that have started as of March 13 will continue unless there is a need to suspend them. No new jury trials will begin before April 22 or until further order of the Minnesota Supreme Court. Public access to courtrooms will be limited.
In the Northern District of Mississippi, all proceedings should be conducted remotely where possible. For petty offenses, the hearing dates set to address misdemeanor citations in April and May will be continued until June and July, respectively. The cases set for the March hearing date will be disposed of at the discretion of the presiding judge. Public access to courthouses is limited to essential business.
In the Southern District of Mississippi, all nonessential matters set for hearing or trial through March 31 are postponed until further notice. Those who have symptoms or have tested positive for the coronavirus must notify the judge and counsel involved if they intend to come to court.
In the state court system, courts are limiting in-person contact through remote proceedings. When remote proceedings are not feasible, the court will conduct certain in-person proceedings, including jury trials currently in progress, emergency child protection matters, and other emergency and time-sensitive matters. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering state courts.
In the Eastern District of Missouri, all civil and criminal jury trials scheduled to begin before May 31 are postponed. Proceedings should be held remotely where possible. In-person proceedings that a presiding judge determines are nonessential will be postponed until further notice. Naturalizations are postponed through April 6.
Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from visiting any courthouse. All requirements related to in-person participation in alternative dispute resolution are suspended until May 31.
In the Western District of Missouri, all civil and criminal jury trials and grand juries are postponed through March 29, and trial-specific deadlines are postponed through the same date. All nonemergency criminal and civil hearings are postponed through March 29. Criminal matters before magistrate judges will continue to take place. Bankruptcy hearings and trials through March 29 will be held remotely or postponed.
In the state court system, all in-person proceedings are suspended through April 17, except for certain emergency and essential proceedings. Judges in each Circuit and appellate court will determine how the in-person proceedings are carried out.
In the District of Montana, all jury trials set to begin on or before May 1 are vacated, to be reset by order of the presiding judge. The order does not vacate any pending deadlines other than trial dates and final pretrial conferences. Grand jury proceedings are also vacated through May 1. Individual judges may hold nontrial proceedings in-person or remotely at their discretion. Group tours, attorney admission ceremonies and naturalization ceremonies are canceled through May 1. Continuance of creditors meetings in bankruptcy court will be suspended through April 16. Section 341 meetings will be postponed or conducted remotely. The court will not accept cash payments until further notice.
In the state court system, the Montana Supreme Court recommended that judges in district courts, the Montana Water Court and courts of limited jurisdiction reset civil jury matters through April 30 at the earliest. Judges should conduct necessary matters remotely whenever possible, the Supreme Court recommended. Priority must be given to necessary work in criminal matters, requests for orders of protection, and child abuse and neglect proceedings, the court said.
All jury trials set to begin in March are postponed until further notice, as are all grand jury proceedings scheduled for the month of March. The District of Nebraska has ordered that those who have recently visited China, South Korea, Japan, Italy or Iran should not attend in-person proceedings without court authorization.
The restriction also applies to those who have had contact with someone who has been in those countries, have tested positive for the coronavirus, been in contact with someone who has tested positive, have been asked to self-quarantine or exhibit symptoms of an infectious respiratory illness.
In the District of Nevada, all trials and their associated deadlines are postponed until April 10. All noncase events are postponed. Naturalization ceremonies through March are postponed. The court is trying to conduct hearings remotely whenever possible. The clerk’s office is closed to the public as of March 20, but all filing deadlines are still in effect unless otherwise ordered by the presiding judge.
Those who have tested positive for the coronavirus, may have been exposed to it or show symptoms of COVID-19 are prohibited from visiting any courthouse.
In the district’s bankruptcy court, all hearings will be conducted remotely.
In the state court system, the Nevada Supreme Court and appellate courts have postponed all oral arguments until further notice.
The New Hampshire District Court has postponed all civil and criminal jury trials scheduled to begin before May 1 and all grand jury proceedings scheduled before May 1. All criminal hearings scheduled before April 13 are postponed. All civil hearings and conferences scheduled to occur after March 20 will be conducted remotely. The court will conduct in-person hearings at the Rudman Courthouse in Concord on Tuesdays and Thursdays, with certain restrictions regarding the number of people who can be in a courtroom.
The court has also canceled all naturalization events that were scheduled before May 1.
Prospective jurors experiencing any flu-like symptoms, coughing, sneezing or fever should contact the district court before appearing. The court said it will make reasonable accommodations and reschedule appearances and hearings as needed.
In the state court system, all in-person proceedings in the Circuit, Superior and Supreme courts are suspended through April 6. Exceptions include certain emergency and essential proceedings.
For the New Jersey District Court, all civil and criminal jury selections and trials scheduled to begin before April 30 are postponed until further notice. Judges can continue to hold proceedings at their discretion and are encouraged to conduct proceedings remotely. No new grand juries will be empaneled before April 30, but sitting grand juries may continue to meet. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering any district courthouse.
Both district courthouses in Newark were closed from March 26 through April 6 after several employees tested positive for the coronavirus. No one is permitted to enter the buildings during the closure except for authorized cleaning staff.
For New Jersey state courts, new jury trials are suspended until further notice. Proceedings will be conducted remotely where possible. Time constraints for discovery will be relaxed and extended from March 16 through March 30. Pending motions will be subject to telephone conferencing as of March 18. All municipal court sessions are suspended through March 27.
Schedules for nonjury proceedings such as landlord-tenant and small claims hearings will be staggered to prevent large groups of people from gathering in a confined area. Out-of-state travel has been suspended for staffers, and nonessential court events like student tours have been canceled.
The District of New Mexico postponed all civil and criminal jury trials set to begin on or before April 10 until further notice. It also postponed all trial-specific deadlines in criminal cases scheduled to begin before April 10. All grand jury proceedings are postponed until further notice.
In the state court system, no more than 15 people will be allowed in each courtroom. Judges must conduct civil and criminal proceedings remotely except when an emergency requires an in-person appearance. Civil and criminal jury trials that have not started yet are suspended, and payment deadlines for fines and fees between March 19 and May 29 are extended by 30 days.
The Southern District of New York has postponed until further notice all civil and criminal jury trials that were scheduled to begin before April 27. While case-related activities and naturalizations will continue, other noncase activities such as Continuing Legal Education events and school visits are canceled until further notice. All bankruptcy hearings and conferences scheduled to be held in the courthouses of the Manhattan Division, White Plains Division and Poughkeepsie Division of the bankruptcy court will be conducted by telephone unless the presiding judge decides otherwise.
The court urges= counsel to check individual judges’ webpages for possible orders, including orders extending time in civil matters and adjourning conferences.
The Thurgood Marshall Courthouse in Manhattan is closed for all district activities, except grand jury matters, through at least April 11. The Daniel Patrick Moynihan Courthouse in Manhattan is open only for certain urgent matters.
The Southern District is prohibiting those who have visited China, Italy, Iran, Japan or South Korea along with a slew of European countries, according to signs posted at courthouse entrances on March 12. The Eruropean countries are Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Vatican City, Iceland, Liechtenstein, Latvia, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Sweden, Switzerland, San Marino and Spain.
The court is also barring those with a fever, cough or shortness of breath, and the executive office in that district will not be issuing new attorney service passes until further notice. Access to courthouses is restricted to certain groups, including those with official court business, courthouse employees, certain contractors, mail carriers, law enforcement, credentialed press, family members of criminal defendants and jurors in ongoing trials.
In bankruptcy court, debtors with Chapter 13 cases before Chief Judge Cecelia G. Morris and Judge Sean H. Lane are waived from in-person court appearances. Attorneys and unrepresented debtors who are showing signs of illness must adjourn their cases. The contact for Judge Morris is Vanessa Ashmeade, (845) 451-6367. The contact for Judge Lane is Arturo Tavarez at (914) 467-7094.
The Eastern District of New York has postponed until further notice all civil and criminal jury trials that were scheduled to begin before April 27. All naturalization ceremonies are suspended for 45 days, as of March 16. All petty offense proceedings scheduled to begin before April 27 are postponed until further notice. In-person attorney admission ceremonies at all courthouses are suspended until further notice. For all criminal matters that had preliminary hearings before magistrate judges scheduled for March 18 through April 27, preliminary hearing deadlines are extended 60 days after the initial appearance.
The district is allowing video or telephone conferencing for several types of proceedings, including detention hearings, initial appearances and arraignments.
Access to court buildings is restricted to “those whose presence is essential,” according to an order. The court is prohibiting those who have traveled to China, Italy, Iran, Japan or South Korea and a slew of European countries in the past two weeks. Also prohibited are those who have come into close contact with anyone who has traveled to those countries within the past two weeks, have been asked to self-quarantine, tested positive for the coronavirus or have come into contact with someone who has tested positive.
In the Northern District of New York, all civil and criminal jury selections and trials — including for grand juries — scheduled to begin through April 30 are postponed until further notice. Other criminal matters before magistrate judges will continue to take place as usual. All mass public gatherings, including naturalization ceremonies, are suspended. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering any courthouse.
In the Western District of New York, all civil jury trials and grand jury selections are postponed for 60 days as of March 16. The court encouraged judges to reduce personal appearances for all other proceedings as much as they can. No naturalization ceremonies will be conducted for 60 days as of March 16. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering any courthouse.
For state courts, new civil and criminal jury trials will be suspended starting on March 16. Jury selection will also be halted, and grand juries will not be empaneled “absent exceptional circumstances,” although current grand juries will remain on duty along with some trial jurors. An executive order from Gov. Andrew Cuomo tolled all proceeding deadlines through April 19. No nonessential filings, paper or electronic, will be accepted by the courts until further notice. New York City Criminal Court will start holding proceedings through videoconferencing on March 25 and New York City Family Court will start holding remote proceedings on March 26.
New York state announced on March 11 that it is prohibiting anyone who has traveled to China, South Korea, Japan, Italy or Iran in the past 14 days from its 350 state-run courthouses.
Also banned from state courts are people who live with or have come into close contact with anyone who has been in one of those countries during that period, been asked to self-quarantine, and those who have either tested positive for the coronavirus or come into contact with someone who has tested positive.
The U.S. Court of International Trade in Manhattan is prohibiting entry to those who have visited China, Italy, Iran or South Korea in the past two weeks, as well as those who have been asked to self-quarantine. The restriction also applies to those who have tested positive for the coronavirus or have come into close contact with someone who has tested positive. The court is allowing teleconferencing and video conferencing with the approval of a presiding judge.
In the Eastern District of North Carolina, all civil and criminal jury trials set to begin on or before May 1 are postponed until further notice. All other hearings are subject to the presiding judge’s discretion. Grand jury proceedings will continue as usual, until further notice. Parties are encouraged to participate in proceedings remotely. Noncase events scheduled before May 1 are canceled. Those who have tested positive for the coronavirus, have symptoms of COVID-19 or may have been exposed to the virus are prohibited from visiting any courthouse without permission from the chief judge.
In the Middle District of North Carolina, all civil trials scheduled to begin before April 16 are postponed until further notice. All criminal cases are postponed to a date on or after April 16. Grand jury proceedings scheduled for March are canceled. Only those with official business are permitted to enter the district’s courthouses unless they have prior permission from the chief judge. Those who have tested positive for the coronavirus, have symptoms, or may have been exposed to the virus are prohibited from visiting any courthouse without permission from the chief judge.
In the Western District of North Carolina, judges are staggering their hearings, and hearings will be held in the largest courtroom available. Nonevidentiary hearings should be conducted remotely where possible.
In the state court system, the filing deadlines for documents previously due between March 16 and April 17 are extended to the end of the day on April 17. The order does not apply to the appellate courts. All civil and criminal District and Superior Court matters are postponed unless they are essential for constitutional or public safety reasons.
In the District of North Dakota, all jury trials scheduled before April 10 are postponed, as are trial-specific deadlines. Trial-specific deadlines in civil cases remain but may be postponed by individual judges. Criminal matters before magistrate judges will take place as usual. Grand jury proceedings scheduled through April 21 are postponed.
The North Dakota Supreme Court suspended all state jury trials until after April 24, but state courts are holding nonjury proceedings to the extent possible.
Northern Mariana Islands
In the District of the Northern Mariana Islands, all scheduled civil and criminal jury selections and trials are postponed until further notice. All grand jury proceedings are postponed unless otherwise ordered by the chief judge. The schedule for all other civil and criminal hearings will be determined on a case-by-case basis by the presiding judge. All noncase proceedings, including naturalization ceremonies, are postponed. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering the courthouse.
In the Southern District of Ohio, certain in-court proceedings will continue but on a limited basis. The court will not have additional jury trials for 30 days beginning March 17. Proceedings that don’t require in-person meetings will continue at the discretion of each judge. Naturalization ceremonies are postponed until at least April 13.
In the Northern District of Ohio, all civil jury trials, reentry court proceedings and petty offense proceedings scheduled to begin before May 1 are postponed until further notice. Criminal trials will not proceed unless absolutely necessary, and grand juries will not meet unless absolutely necessary. Judges may conduct pretrial proceedings remotely where practical. All mass public gatherings, including naturalization ceremonies, are suspended until at least May 1. All courthouses in the district are closed to the public until May 1. Cash payments will not be accepted in the court until May 1.
The Ohio Supreme Court has provided guidance for state courts, including waiving appearances for pretrial hearings and using video conferencing or other technology to conduct proceedings including arraignments, hearings, pretrial hearings and probation meetings.
In the Northern District of Oklahoma, all civil and criminal matters scheduled for in-court appearances are postponed until further notice, as are their related deadlines. All grand jury proceedings are postponed until further notice. Case-by-case exceptions to nonjury matters may be ordered. Civil and criminal motions that can be resolved without oral argument are unaffected.
In the Western District of Oklahoma, jury trials on the April docket are postponed. The presiding judge will address trial-related deadlines. Three grand jury sessions scheduled for March and April are canceled.
In the Eastern District of Oklahoma, all jury trials, grand jury sessions and naturalization ceremonies scheduled to start on or before April 17 in the Ed Edmondson Federal Courthouse in Muskogee are postponed. Those who have COVID-19 symptoms, have tested positive for the coronavirus or may have been exposed to the virus are prohibited from entering the courthouse.
On the state side, the Oklahoma Supreme Court and Court of Criminal Appeals ordered on March 16 that all state courts cancel all jury terms for 30 days and release jurors from service. All deadlines in any civil, criminal and juvenile cases are also suspended for 30 days. The statute of limitations is extended by 30 days in all civil cases, and judges will handle emergency matters and required proceedings on a case-by-case basis. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering any courtroom or other facility used by the state courts.
In the District of Oregon, civil and criminal jury selections and trials scheduled to begin before April 26 are postponed until further notice. All grand jury proceedings scheduled before that date are postponed. All other civil and criminal matters scheduled for an in-court appearance before April 26 are postponed unless they can be resolved remotely or without oral argument. The District Clerk’s Office is closed to the public in all locations but available by phone. Filings will be processed electronically and by mail.
In the state court system, trials and hearings scheduled to start between March 19 and March 27 are postponed, with limited exceptions. The Oregon Court of Appeals has canceled oral arguments scheduled between March 17 and March 27. Trial courts throughout the state are reducing the number of people summoned as jurors. Potential jurors who are in high-risk categories for severe illness can contact the court to reschedule their jury service.
In the Eastern District of Pennsylvania, all civil and criminal jury trials and grand jury selections are postponed until April 13.
In the Western District of Pennsylvania, all civil and criminal jury trials and grand jury selections are postponed until April 26.
In the Middle District of Pennsylvania, all hearings and proceedings in civil and criminal cases are postponed for 60 days as of March 13, with exceptions for certain individual cases.
The Supreme Court of Pennsylvania ordered all trial and intermediate appellate courts, with exceptions for certain essential functions, to close their doors entirely through April 3 at the earliest. The state Supreme Court’s argument session scheduled for April 20 through April 22 is canceled, and cases listed for that session will be decided on the briefs.
In the District of Puerto Rico, all civil and criminal nonjury trials, hearings and conferences are postponed until further notice, but certain ongoing trials will continue. Grand jury proceedings will continue as scheduled. All deadlines set from March 16 through April 9 are extended until April 10.
The bankruptcy court will not be open to the public through March 30. All hearings scheduled from March 16 through March 30 are postponed and will be rescheduled individually.
In the District of Rhode Island, the courthouse building at One Exchange Terrace, Providence, is closed to the public until further notice. The court operations in the John O. Pastore Building in Providence will be closed Tuesdays and Thursdays and will be open for limited purposes only on Mondays, Wednesdays and Fridays. The presiding judge’s case manager will cancel all in-person civil matters and arrange remote hearings where possible. All grand jury proceedings and ongoing criminal hearings are postponed unless the person’s liberty interests are involved.
Those who are required to appear in Rhode Island’s district court, including those who are called as jurors, must contact the court before appearing if they are experiencing any flu-like symptoms. Those who have traveled to China, Italy, Iran and South Korea in the past two weeks are prohibited from entering the courthouse, as are those who may have been exposed to the virus.
In the state court system, all Superior Court jury trials are postponed until after April 17. All Superior Court grand jury proceedings are suspended until after April 17. All other matters in the state courts are postponed until after April 17 except for emergency and essential matters. All payment dates and filing deadlines are extended for 30 days as of March 17. The courts will entertain requests for extensions to statutes of limitation after the 30 days if they arise from the current health crisis.
In the District of South Carolina, all civil and criminal jury selections and trials scheduled to start through May 8 are postponed until further notice. All grand jury proceedings scheduled through May 8 are postponed unless otherwise noted by the chief judge. In all civil cases, deadlines are extended 21 days, but statutes of limitation are not tolled. All other civil and criminal matters scheduled for an in-court appearance before May 8 and their associated deadlines are postponed, unless the matter can be resolved remotely.
In the state court system, all oral arguments scheduled before appellate courts as of March 20 are canceled until further notice. Parties do not need to file additional document copies with the South Carolina Supreme Court or the Court of Appeals. In the Circuit Courts, only emergency hearings shall be held at the discretion of each chief administrative judge. All jury trials are postponed, and all large gatherings are canceled until further notice. Hearings that can be held by video may be held remotely.
In the District of South Dakota, all civil and criminal jury trials scheduled to begin on or before April 24 are postponed until further notice. Nonjury matters will proceed as scheduled unless otherwise ordered by the presiding judge, and parties are encouraged to participate remotely where possible. All grand jury proceedings scheduled before April 24 are postponed until further notice.
The South Dakota Supreme Court declared a judicial emergency and authorized the presiding judges of the state’s seven judicial circuits to adopt rules and orders regarding court operations. Each circuit put forward policies to address requests from high-risk individuals to be excused from in-person court appearances.
In the Eastern District of Tennessee, civil and criminal jury trials set to begin on or before April 24 are postponed. Cases not scheduled for a trial will proceed as scheduled, but oral proceedings will be conducted remotely where possible. Grand jury proceedings in Greeneville and Chattanooga are suspended through April 24. All misdemeanor, petty offense and traffic dockets scheduled through April 24 are postponed. Tours and naturalization ceremonies are canceled until further notice.
In the Western District of Tennessee, all civil judicial proceedings currently scheduled are postponed until after April 17. Criminal proceedings that don’t require in-person appearances are postponed until after April 17. All civil and criminal jury selections and trials scheduled to begin on or before April 17 are postponed until further notice. All grand juries already selected will not meet until after April 17. The federal courthouse at 111 S. Highland Ave. in Jackson is closed to the public until further notice.
The Middle District of Tennessee has postponed civil and criminal jury selections that were scheduled to begin March 17 through March 30. All grand jury proceedings scheduled to take place between March 17 and April 30 are postponed, as are related deadlines.
Tennessee’s state and local courts have suspended all in-person proceedings from the close of business on March 13 through April 30, with certain exceptions including: bond-related matters for criminal defendants, plea agreements for incarcerated people, civil and criminal jury trials that are in progress as of March 13, and proceedings related to relief from abuse, emergency child custody orders, petitions for temporary injunctive relief, emergency mental health orders, emergency protection of elderly or vulnerable people and proceedings related to COVID-19.
Deadlines — including statutes of limitations, orders of protection and temporary injunctions — that are set to expire between March 13 and May 5 are extended through May 6.
The Northern District of Texas has postponed all civil and criminal bench and jury trials scheduled to begin through May 1 until further notice. The postponement does not include other deadlines besides the trial date. All grand jury proceedings through May 1 are postponed, and all deadlines, including the statute of limitations, are suspended through May 1. Public tours and naturalization ceremonies scheduled through May 1 are canceled and will be rescheduled later.
The Southern District of Texas said Thursday that it is suspending all jury trials until April 1. The federal courthouse in Houston will remain open for other matters, including matters scheduled for hearing in bankruptcy court, the district said.
In the Eastern District Court, attorneys and parties were ordered to communicate if court proceedings could cause someone to come into contact with an individual exposed to or infected with the virus.
The Western District of Texas postponed all civil and criminal bench and jury trials scheduled to begin before May 1. Each presiding judge will reset those dates, and the postponement does not apply to any pending deadlines other than the trial dates. Grand jury matters will proceed normally. Parties are encouraged to participate in nonsentencing proceedings by telephone or video. Other matters such as tours and naturalization ceremonies that were scheduled to take place before May 1 are canceled.
The Western District of Texas postponed scheduled proceedings in all civil and criminal bench and jury trials set to begin before May 1, with the exception of pleas, sentencings, criminal matters before magistrate judges and the issuance of warrants. All deadlines in a scheduling order, besides the trial date, remain in effect unless modified by the assigned judge. Parties are encouraged to participate in nonsentencing proceedings by telephone or video. Other matters such as tours and naturalization ceremonies that were scheduled to take place before May 1 are canceled.
On the state side, the Texas Supreme Court issued guidance Thursday calling on courts to suspend proceedings or schedule them to avoid gatherings of large groups of people until at least April 1, including jury trials and large docket calls. It is encouraging courts to implement remote appearances by phone or video for all proceedings that may occur remotely.
The Harris County Civil District Court, serving the Houston area, has suspended civil jury trials for the rest of March and has suspended criminal jury trials through March 20.
Dallas County has canceled all jury trials through May 8.
Collin County District Courts are rescheduling all nonessential court matters from March 16 to April 1. All in-person hearings and trials will be rescheduled during this time, unless designated as “essential,” a list that includes temporary restraining orders, temporary injunctions and any suits or hearings with jurisdictional deadlines. Attorneys must contact each court regarding each setting. No uncontested matters will be heard. The courts are developing a plan for electronic appearances.
U.S. Virgin Islands
In the District of the Virgin Islands, all civil and criminal jury and bench trials scheduled from March 18 through April 16 are postponed until further notice. Sitting grand juries are not authorized to meet before April 16, and no new grand juries will be empaneled during that time. The 30-day time period for filing an indictment is tolled through April 16. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from visiting the courthouses.
The Supreme Court of the Virgin Islands ordered that all nonessential functions of the judicial branch be suspended until further notice. In the Supreme Court, deadlines in appeals pending as of March 20 are extendedeither by 14 days or to April 27, whichever is longer. Deadlines in original proceedings, such as for mandamus or other writs, are still in effect unless the presiding judge has ordered otherwise. The time to file a notice of appeal or other initiating document is tolled through April 26, and the period from March 23 through April 26 is excluded from the 120-day period for the Superior Court to rule on post-judgment motions.
In the Superior Court, all deadlines in cases pending as of March 20 are extended either by 14 days or to April 27, whichever is longer. All previously scheduled depositions may occur as scheduled, and new depositions may be scheduled, but parties are encouraged to agree to postpone depositions if possible.
In the District of Utah, all civil and criminal jury trials scheduled to begin before May 1 are postponed until further notice. All trial-related deadlines in criminal trials scheduled to begin before May 1 are postponed until further notice, but criminal trials already underway as of March 16 will continue. Judges can postpone trial-related deadlines in civil cases at their discretion. All grand jury proceedings are suspended through May 1.
All currently scheduled hearings in criminal cases are postponed, but the assigned judge in each case may proceed with the hearings remotely.
In the state court system, those with symptoms of COVID-19 and those who may have been exposed to the coronavirus are not allowed to enter any courthouse. The Utah Supreme Court directed state court judges to grant motions for extensions of time liberally. Hearings will be conducted remotely or on the papers, “absent exigent circumstances,” according to the state Supreme Court’s order. District Court and Justice Court judges were directed to suspend all criminal and civil jury trials until after June 1.
In the District of Vermont, all civil and criminal matters scheduled for in-person court appearances are postponed until further notice. The court’s order does not affect motions that can be resolved remotely or without oral argument. All grand jury proceedings are postponed until April 23.
In the state court system, all nonemergency superior court hearings, including jury trials, are postponed until at least April 15. The courts will only schedule and hear certain emergency matters. Parties may participate in nonevidentiary proceedings remotely.
Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering state courthouses.
In the Eastern District of Virginia, all civil and criminal proceedings scheduled to occur through March 31 are postponed and will be rescheduled for a later date. The grand jury is not meeting, but the district is permitted to seek documents and testimony for return dates after March 31. All filing deadlines between March 17 and March 31 are extended by two weeks unless otherwise ordered by the presiding judge. The court’s order does not apply to the statute of limitations.
The Eastern District of Virginia has postponed all naturalization ceremonies for the remainder of March and has suspended all noncase-related events, tours and other gatherings in the courthouses.
In the Western District of Virginia, all in-person civil, criminal and bankruptcy proceedings scheduled on or before May 1 are postponed and will be rescheduled at a later date. All civil and criminal jury trials scheduled on or before May 1 are postponed and will be rescheduled. All misdemeanor, traffic and petty offense dockets on or before May 1 are postponed, and all Veterans Treatment Court, Reentry Court and Drug Treatment Court sessions on or before May 1 are canceled. Grand jury proceedings scheduled on or before April 17 are postponed.
In the state court system, the Virginia Supreme Court and Rose Lafoon Building in Richmond are closed to the public until further notice. All filings related to appeals to the Court of Appeals that are filed in a Circuit Court are extended by 21 days, as of March 16. The Court of Appeals will conduct remote arguments at least through June 30.
In the Western District of Washington, all civil and criminal hearings and trial dates scheduled to occur before June 1 are postponed until further notice. Individual judges may decide to proceed with remote conferences as appropriate. All grand jury proceedings scheduled before June 1 are postponed. All initial criminal appearances and detention hearings will be conducted remotely with the defendant’s permission, unless the court directs otherwise. The bankruptcy court will continue with scheduled nonevidentiary hearings by telephone as posted on www.wawb.uscourts.gov and announced by the individual bankruptcy judge.
In the Eastern District of Washington, all in-court hearings in civil and criminal cases scheduled through April 14 are vacated until further notice, and case-related deadlines are suspended. All grand jury sessions before April 13 are vacated. Magistrate judges can evaluate their essential proceedings on a case-by-case basis. Naturalization ceremonies have been canceled through April 30.
In the state court system, all civil jury trials are suspended until after April 24. Trials already in session may proceed or may be postponed to a later date at the discretion of the judge or by agreement of the parties. All nonemergency civil matters are postponed until after April 24, and emergency matters must be held remotely, if possible. All criminal jury trials are postponed until after April 24. Criminal trials already in session with sworn juries may proceed if public health measures are strictly observed, but may be postponed if the defendant agrees to do so.
All federal civil and criminal jury trials in D.C. federal courts have been put off starting March 17 until at least May 11, while other proceedings are postponed until April 17. Federal trial and bankruptcy courts in D.C. will remain open with limited operations.
The D.C. Superior Court has postponed citation arraignments scheduled for March 17 through April 15 for eight weeks from their originally scheduled date. New jury trials in criminal cases are postponed until at least March 30. The court will hear only emergency matters in the civil, family court, probate and tax divisions and auditor master. In general, all other matters are postponed.
The D.C. Court of Appeals has canceled all oral arguments scheduled through March 31. Filing deadlines on or after March 16 are also being delayed until March 31.
The U.S. Tax Court building is closed until further notice, and various trial sessions through March and April have been canceled.
In the Northern District of West Virginia, those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering any courthouse.
In the Southern District of West Virginia, all civil and criminal jury trials and grand jury proceedings are postponed until further notice. Those who tested positive for the coronavirus, have symptoms or may have been exposed to the virus are prohibited from entering any courthouse.
In the state court system, all proceedings and judicial deadlines through April 10 are stayed, except for certain emergency proceedings. Deadlines set to expire before then, including statutes of limitation, are extended to April 11. Proceedings previously scheduled between March 23 and April 10 are postponed and will be rescheduled by the presiding judge. Emergency proceedings should be conducted remotely when possible
In the Eastern District of Wisconsin, all civil and criminal jury trials scheduled to begin before May 1 are postponed and will be rescheduled for a later date. All petty offense, reentry court and grand jury proceedings are also postponed. Civil hearings should be conducted remotely. Naturalization ceremonies scheduled before May 1 are canceled. Those who are experiencing COVID-19 symptoms or may have come into contact with the virus are prohibited from visiting any courthouse.
In the Western District of Wisconsin, the Kastenmeier Courthouse in Madison will remain open and proceedings will go on as scheduled. Those who feel ill should stay away from the courthouse.
In the state court system, all civil and criminal jury trials scheduled to begin on or before May 22 are postponed and will be rescheduled by the presiding judges. All in-person proceedings in appellate and Circuit courts, with certain exceptions, are suspended through April 30.
In the District of Wyoming, judges are conducting matters remotely where possible. Those who have tested positive for the coronavirus, have symptoms or may have been exposed to the virus — including those who have recently visited Iran, China, South Korea or a host of European countries — are prohibited from entering the courthouse.
In the state court system, all District and Circuit courts have suspended in-person proceedings, with certain exceptions. The Wyoming Supreme Court ordered that all civil trials in state courts be rescheduled and that the courts make reasonable attempts to reschedule criminal trials. The Wyoming Supreme Court building in Cheyenne is closed to the public. The rules requiring paper copies of documents that can be filed electronically are suspended in the Wyoming Supreme Court.
The U.S. Department of Justice’s Executive Office for Immigration Review has postponed all immigration court hearings for immigrants who aren’t in detention through May 1, although hearings on the docket for detainees are continuing.
Four courts in Miami, San Francisco, Kentucky and New Jersey were fully closed as of April 1.
Filings intended for Miami’s Krome center and San Francisco’s Montgomery St. court can be submitted to other courts in those cities. Filings for the Elizabeth, New Jersey, court can be sent to the Newark court.
The Louisville, Kentucky, immigration court has been closed since August for reasons unrelated to the virus, but filers can submit to the Memphis, Tennessee, immigration court.
Filings in closed courts may also be submitted by email, EOIR announced on March 31.
These 20 courts are fully open: Adelanto, California; Baltimore; Batavia, New York; Conroe, Texas; Eloy, Arizona, El Paso, Texas, Service Processing Center; Falls Church, Virginia, Immigration Adjudication Center; Fishkill, New York; Florence, Arizona; Fort Worth, Texas; LaSalle, Louisiana; Oakdale, Louisiana; Otay Mesa, California; Otera, New Mexico; Pearsall, Texas; Port Isabel, Texas; Stewart, Georgia; Tacoma, Washington; Ulster, New York; and York, Pennsylvania.
The remainder of immigration courts have been kept partially open, and in some cases reopened, for the limited purpose of accepting filings, and if applicable, holding hearings for detained immigrants.
U.S. PATENT AND TRADEMARK OFFICE
All examiner and examining attorney interviews, Patent Trial and Appeal Board and Trademark Trial and Appeal Board oral hearings and other similar in-person meetings scheduled to take place at USPTO offices on or after March 13 will be conducted remotely by video or telephone until further notice.
European Court of Justice & General Court of the European Union
Both the ECJ and the General Court have partially closed their doors. The courts will hear only urgent matters until further notice. All other cases already scheduled until March 27 at the ECJ and April 3 at the General Court will be heard at a later date. The filing deadlines for all cases will not change. The ECJ has also advised staff not to go into the court buildings from March 16 to 27 unless it is necessary for a specific case.
–Additional reporting by Stewart Bishop, Dorothy Atkins, Suzanne Monyak, Matt Chiappardi and Melissa Lipman. Editing by Jill Coffey.
Effective immediately, survey activity is limited to the following (in Priority Order):
- All immediate jeopardy complaints (cases that represents a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect;
- Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses;
- Statutorily required recertification surveys (Nursing Home, Home Health, Hospice, and ICF/IID facilities);
- Any re-visits necessary to resolve current enforcement actions;
- Initial certifications;
- Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years;
- Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy.
See CMS QSO-20-12-ALL.
Obviously, there are so many questions. Providers across the country are asking whether they need to comply with document requests. Are TPE audits continuing? Do they need to comply with ongoing ADRs?
Every bulletin that CMS publishes instigates more detailed and complex questions. With all these relaxed guidelines, won’t RACs, etc. have a field day when this is all over? Of course they will.
- Be proactive.
- Document everything.
- Deadlines will be extended.
- Exceptions will be made.
- Keep all email correspondence.
- Maintain copies of everything that you submit. (Do not rely on electronic computer software programs).
- Keep track of CMS updates.
Email me questions, and I will try to respond.
Also, feel free to reach out to the government: QSOG_EmergencyPrep@cms.hhs.gov.
Effective date: 30 days from the memo, which equals April 3, 2020.
Emergency room physicians or health care providers are a discrete breed – whales in a sea of fish. Emergency room doctors have – for the most part – been overlooked by the RAC auditors or TPE, ZPIC, or MAC auditors. Maybe it’s because, even RAC auditors have children or spouses that need ER services from time to time. Maybe it’s because ER doctors use so many different billers. Normally, an ER doctor doesn’t know which of his or her patients are Medicaid or Medicare. When someone is suffering from a a broken leg or heart attack, the ER doctor is not going to stop care to inquire whether the patient is insured and by whom. But should they? Should ER doctors have to ask patients their insurer? If the answer includes any sort of explanation that care differs depending on whether someone is covered by Medicare or Medicaid or has private insurance, then, sadly, the answer may be yes.
ER doctors travel to separate emergency rooms, which are owned by various and distinct entities, and rely on individual billing companies. They do not normally work at only one hospital. Thus, they do not always have the same billers. We all know that not all billers are created equal. Some are endowed with a higher understanding of billing idiosyncrasies than others.
For example, for CPT codes 99281-99285 – Hospital emergency department services are not payable for the same calendar date as critical care services when provided by the same physician or physician group with the same specialty to the same patient.
We all know that all hospitals do not hire and implement the same billing computer software programs. The old adage – “you get what you pay for” – may be more true than we think. Recent articles purport that “the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care.” – Think a comment like that would red-flag ER doctors services by RAC, MAC and ZPIC auditors? The white whale may as well shoot a water spray 30 feet into the air.
Will auditing entities begin to watch ER billing more closely? And what are the consequences? When non-emergency health care providers are terminated by Medicare, Medicaid, or a MAC or MCO’s network, there is no emergency – by definition. Juxtapose, the need for ER health care providers. ER rooms cannot function with a shortage of physicians and health care providers. Even more disturbing is if the termination is unwarranted and seemingly inconsequential – only affecting under 4 surgeries per month – but acts as the catalyst for termination of Medicare, Medicaid, and private payors across the board.
I have a client named Dr. Ishmael. His big fish became the MAC Palmetto – very suddenly. Like many ER docs, he rotates ERs. He provides services for Medicare, Medicaid, private pay, uninsured – it doesn’t matter to him, he is an ER doctor. He gets a letter from one MAC. In this case, it was Palmetto. Interestingly enough, Palmetto is his smallest insurance payor. Maybe 2 surgeries a month are covered by Palmetto. 90% of his services are provided to Medicaid patients. Not by his choice, but by demographics and circumstance. The letter from Palmetto states that he is being excluded from Palmetto’s Medicare network, effective in 10 days. He will also be placed on the CMS preclusion list in 4 months.
We appeal through Palmetto, as required. But, in the meantime, four other MACs, State Medicaid and BCBS terminate Dr. Ishmael’s billing privileges for Medicare and Medicaid based on Palmetto’s decision. Remember, we are appealing Palmetto’s decision as we believe it is erroneous. But because of Palmetto’s possibly incorrect decision to terminate Dr. Ishmael’s Medicare billing privileges, all of a sudden, 100% of Dr. Ishmael’s services are nonbillable and nonreimburseable…without Dr. Ishmael or the hospital ever getting the opportunity to review and defend against the otherwise innocuous termination decision.
Here, the hospital executives, along with legal counsel, schedule meetings with Dr. Ishmael. “They need him,” they say. “He is important,” they say. But he is not on the next month’s rotation. Or the next.
They say: “Come and see if ye can swerve me. Swerve me? ye cannot swerve me, else ye swerve yourselves! man has ye there. Swerve me?”
Billing audits on ER docs for Medicare/caid compliance are distinctive processes, separate from other providers’ audits. Most providers know the insurance of the patient to whom they are rendering services. Most providers use one biller and practice at one site. ER docs have no control over the choice of their billers. Not to mention, the questions arises, who gets to appeal on behalf the ER provider? Doesn’t the hospital reap the benefit of the reimbursements?
But one seemingly paltry, almost, minnow-like, audit by a cameo auditor can disrupt an entire career for an ER doc. It is imperative to act fast to appeal in the case of an ER doc. But balance speed of the appeal with the importance of preparing all legal arguments. Most MACs or other auditing entities inform other payors quickly of your exclusion or termination but require you to put forth all arguments in your appeal or you could waive those defenses. I argue against that, but the allegations can exist nonetheless.
The moral of the story is ER docs need to appeal and appeal fast when billing privileges are restricted, even if the particular payor only constitutes 4 surgeries a month. As Herman Melville said: “I know not all that may be coming, but be it what it will, I’ll go to it laughing.”
Sometimes, however, it is not a laughing matter. It is an appealable matter.