|What to Tell Patients | Practice Protocols & Preparedness | What to Look For & How to Test|
|Precautions & PPE | Telehealth Resources | Employment Law Resources|
|Emergency Loans, Grants, & Tax Relief | Volunteer Opportunities | Resources for Physicians|
Last Updated November16, 2020
The following guidance is drawn primarily from the Centers for Disease Control and Prevention’s (CDC) resources for health care professionals on COVID-19. Additional information is provided based on resources from the American Medical Association, the Maryland Department of Health, and Montgomery County Health and Human Services. Every effort is being made by MCMS staff to keep this guidance up to date, but we recommend always referring to both MDH and CDC guidance for the most recent information. Please refer to the resource list at the bottom of this article for reference links.
Maryland Department of Health All-Physician COVID-19 Phone Calls – CME Accredited!
Coordinated by MedChi, The Maryland State Medical Society, these statewide, all-physician calls are hosted by Howard Haft, MD, of the Maryland Department of Health. Join for critical updates on the spread, treatment of, and resources for combating COVID-19. The calls are held on Wednesdays at 5 pm. To register for upcoming calls or listen to recordings and view past slide decks from these calls, click here.
The Montgomery County Health Department has created a resource page that is a helpful guide on what to say to patients, and to refer patients to. The CDC has created a handout for medical practices to make available for concerned patients. Click here to download the pdf, or visit the CDC’s web page of printable handouts and posters.
MCMS also recently launched the #CallYourPhysician campaign to encourage patients to seek care. Find out how you can help.
Practice Protocols & Preparedness
Pre-Screening: When scheduling appointments, instruct patients and persons who accompany them to call ahead or inform staff upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever) and to take appropriate preventive actions (e.g., wear a surgical mask upon entry to contain cough, follow triage procedures).
Promote Respiratory Hygiene: Take steps to ensure all persons with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and health care personnel with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use surgical masks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.
Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol-based hand sanitizer (ABHS), tissues, no touch receptacles for disposal, and surgical masks at healthcare facility entrances, waiting rooms, patient check-ins, etc.
Limit Exposure: Ensure that patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies. In some settings, medically-stable patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.
Rapid Triage: Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough):
- Identify patients at risk for having COVID-19 infection before or immediately upon arrival to the healthcare facility.
- Implement triage procedures to detect persons under investigation (PUI) for COVID-19 during or before patient triage or registration (e.g., at the time of patient check-in) and ensure that all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of SARS-CoV-2, the virus that causes COVID-19, or contact with possible COVID-19 patients.
- Implement respiratory hygiene and cough etiquette (i.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate the PUI for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available. See recommendations for “Patient Placement” below. Additional guidance for evaluating patients in U.S. for COVID-19 infection can be found on the CDC COVID-19 website.
- Inform infection prevention and control services, local and state public health authorities, and other healthcare facility staff as appropriate about the presence of a person under investigation for COVID-19.
The above is summary guidance for practices. Please visit the CDC’s protocol for full details; it is being updated on a rolling basis. MCMS encourages practices to utilize the CDC’s preparedness checklist for COVID-19 and the CDC’s interim guidance for community transmission preparation in various facility and practice modalities.
What to Look For & How to Test
Clinicians should use guidance from the CDC and MDH in screening for and testing patients under investigation for COVID-19. The CDC has developed clinical guidance for all care settings on the screening and treatment of PUI. The Maryland Department of Health sends letters with updates to clinicians out on a rolling basis; check their clinician letter compendium for the most up-to-date guidance.
Overall, since COVID-19 testing is available at commercial and some hospital labs, clinicians should send specimens to those laboratories for testing. These labs process but do not obtain specimens.
Clinicians do NOT need approval from the Maryland Department of Health or the local health department to order, collect, or submit specimens to commercial or hospital laboratories. You do NOT need to call the health department if you use a commercial or hospital lab for COVID-19 testing. You should check with these laboratories for specific information on specimen collection and packaging requirements. LabCorp and Quest Diagnostics have each posted web pages (1, 2) that they are updating on a rolling basis. For a list of designated testing sites across Maryland, searchable by zip code, click here.
Montgomery County testing sites, including updates related to extreme heat and other weather events, can be found on Montgomery County’s COVID-19 Testing Sites Portal.
The Maryland Department of Health is also maintaining a list of non-office based testing locations updated on a rolling basis. View the list of locations. MDH has also released an overview of how ImmuNet is being used during this time.
The Maryland Department of Health also recently published this guidance on contact tracing.
The following is contact information for clinicians to use for local health departments, as necessary:
- Montgomery County Department of Health and Human Services: M-F Business Hours – 240.777.1755 After Hours & Weekends – 240.777.4000
- District of Columbia Department of Health: 202.727.3616 or report cases using this web portal.
- List of Contact Information for All Maryland Local Health Departments
*Each organization was contacted by MCMS staff to request the correct contact information for reporting. This listing will be updated on a rolling basis. Question? Call MCMS at 301.921.4300.
What Precautions to Take & PPE
Health care personnel should use standard precaution, contact precautions, airborne precautions and eye protection such as goggles or a face shield before entering the room. Please note that, in situations where fit-tested NIOSH-approved N95 or higher level respirator for healthcare personnel are in a shortage, surgical masks may be used. Eye protection, gown, and gloves continue to be recommended, but if there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.
Section 2 of this CDC web page emphasizes important PPE compliance for COVID-19. For full precaution guidance, refer to the CDC’s isolation precautions guideline.
Requesting Emergency Equipment and Supplies: The Maryland Department of Health (MDH) is working closely with the Maryland Emergency Management Agency (MEMA) to organize emergency suppliers of equipment and services that will help respond to the COVID-19 crisis. To request PPE supplies, fill out this request form online, or this Emergency Medical Material request form on pages 3 and 4 of this document, then send it to email@example.com. The online form is the preferred method to submit a request.
HandCraft Services Member Advantage Program: Montgomery County Medical Society and HandCraft Linen & Uniform Services have joined together to provide our members with critical personal protective equipment (PPE) that is currently in shortage, particularly isolation gowns, barrier gowns, and scrubs. Depending on order size and products, your first delivery could arrive within the next few weeks; no upfront fees and no ancillary fees ever (i.e. Delivery, Environmental, and Energy ETC fees.) Learn more.
The following are vendors referred to us that still have stock of some PPE items:
- Sunrise Hitek – Faceshields, masks, and hand sanitizer
- Hatch Exhibit – Faceshields, respirators, and latex gloves
- Medical Mega – Latex gloves, hand sanitizer, and swabs
- Lost Ark Distilling, Co (Columbia, MD) has begun production of hand sanitizer.
- BlueDyer Distilling, Co (Waldorf, MD) also is producing hand sanitizer. To order, email Walker Dunbar.
- Project N95 is a national clearing house for PPE procurement. Learn more.
- Dynamic Advertising Solutions – Safety signage, branded masks, acrylic counter barriers. Contact: Tyler Phifer at 267.331.6079 X118.
- Office Depot – Faceshields, masks, hand sanitizer, safety signage, surgical masks, acrylic counter barriers, contact free thermometers.
- Maryland Primary Care Program PPE Supplier List
- Maryland Manufacturing Network Supplier Portal – Please note that any vendor may add their organization to this portal without vetting.
- On-Demand Webinar: Rapid Implementation of Telehealth
- On-Demand Webinar: Rapid Implementation of Remote Patient Monitoring
- Telemedicine Vendor Options
- Remote Patient Monitoring Vendor Options
- From Our RPM Speaker: Remote Patient Monitoring Implementation Guide
- From MHCC: Telehealth Readiness Assessment (TRA) Tool
- Medicare Telehealth Coding/Billing Guidelines – March 26, 2020
- Telemedicine FAQ’s – Updated March 18, 2020
From the American Medical Association (AMA)
- AMA Quick Guide to Telehealth Implementation & COVID-19
- The AMA has created a Digital Health Implementation Playbook that is a thorough guide on the key steps, best practices and resources to help physicians and their practices integrate technology efficiently and effectively.
- March 17, 2020 – AMA applauds Medicare telemedicine policy change during pandemic
From the Centers for Medicare & Medicaid Services (CMS)
- Key Update – 5.1.2020 – In response to efforts by organized medicine, CMS will increase payments for audio-only telephone visits between Medicare beneficiaries and their physicians to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110, and the payments are retroactive to March 1, 2020. Learn more.
- General Provider Telehealth and Telemedicine Tool Kit
- FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency
- Medicaid Telehealth Guidance
- Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth
- Clinician Letter – 4.8.2020
From Private Payors
- An overview of How to Get Paid for Telehealth and their Telemedicine 101 Overview
- MCMS Webinar with SimpleVisit on Rapid Implementation of Telehealth
- Backline Overview: Telehealth Care Coordination in Real-Time
- In response the COVID-19 crisis, DrFirst, a Maryland-based company is offering their Backline Telehealth platform to Maryland providers free of charge for 30 days. To register for this service, please click here. Please contact Colleen George with questions.
From the Maryland Department of Health (MDH)
- March 26, 2020: Telehealth – Maryland State of Emergency – COVID-19 Frequently Asked Questions
- Notice: RE: COVID-19 #1: Temporary Expansion of Medicaid Regulations to Permit Delivery of Telehealth Services to the Home to Mitigate Possible Spread of Novel Coronavirus (“COVID-19”)
From the Maryland Healthcare Commission (MHCC)
From the U.S. Department of Health and Human Services (HHS)
The legal framework surrounding employment law as it relates to COVID-19 continues to evolve. MCMS held a Q&A session with Paley Rothman, a local law firm, two weeks ago. It is available to stream online: COVID-19 Employment Law Q&A. For frequently asked questions, please refer to the end of this slide deck.
- Template: MedChi Transportation and Child Care Essential Employee Letter (Fillable Document)
- Order of the Governor of the State Maryland – No. 20-03-25-01 Amending and Restating the Order of March 13, 2020, Controlling Child Care Access
- The Families First Coronavirus Response Act (FFCRA or Act) One pager from Department of Labor – The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to COVID-19. These provisions will apply from April 1, 2020 through December 31, 2020
Additional resources will be posted here on a rolling basis, but please contact MCMS staff if your questions are not answered by these materials.
Emergency Loans, Grants, & Relief
Montgomery County Primary Care and Dental Grant Program
This program will provide a maximum grant of up to $60,000 to an eligible practice. The ranking and review system for the grants will include consideration of whether the practice is serving patients from communities and neighborhoods disproportionately impacted by COVID-19 or if the practice fills specific needs. The program application and instructions will be posted on Wednesday, Nov. 18 here. All applications must be submitted by 11:59 p.m. on Sunday, Nov. 29. For further details, visit our resource article.
HHS announced on October 1, 2020, that it will be disbursing another $20 billion in CARES Act Provider Relief Funds. Under this Phase 3 General Distribution allocation, physicians that have already received Provider Relief Fund payments may apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Recognizing the negative impact of the COVID-19 pandemic has increased anxiety and depression in the country and behavioral health providers have continued to provide care through telehealth and other means, HHS is also announcing that the nation’s behavioral health care providers, including psychiatrists, are now eligible for funding. Previously ineligible physicians, such as those who began practicing in 2020, will also be eligible to apply. Physicians will have from October 5, 2020 through November 6, 2020 to apply for Phase 3 General Distribution funding.
HHS Medicaid/CHIP Provider Relief Fund: Payment Forms and Guidance
HHS expects to distribute $15 billion to eligible Medicaid/CHIP programs or Medicaid managed care plans. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve. The data submission period has been extended. Physicians must now submit their data by August 3, 2020. Before applying through the Enhanced Provider Relief Fund Payment Portal applicants should:
- Read the Medicaid Provider Distribution Instructions
- Download the Medicaid Provider Distribution Application Form
MCMS hosted two recent webinars to assist our practices in seeking financial relief and with planning over the short and longer term. They are available online:
Telehealth Grant Funds
- The medical practice and medical license are in Maryland
- The medical practice is a private, independent group of five or fewer physicians
- The practice enrolls in Backline after March 1, 2020 as the result of the COVID-19 crisis
- MedChi has confirmed the practice’s enrollment with DrFirst
- Enrollment in Backline occurs before December 31, 2020
- Although some physicians will automatically be sent an advance payment based off the revenue data they submit in CMS cost reports, those physicians without adequate cost report data on file will need to submit their revenue information to the General Distribution Portal. (If you are unsure if you need to complete the portal, call the CARES Provider Relief line at 1-866-569-3522.)
- This portal should be accessed and completed by anyone who lost revenue in March and/or can estimate lost revenue for April. You will need you Tax Identification Number (TIN) to access the portal.
These resources can help you navigate the portal:
- The American Medical Association (AMA) has developed guidance on the fund portal.
- This fact sheet on the general distribution might be helpful as well.
- This slideshow can guide you through the process.
You should also be aware that a portion of the Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured.
Each practice should consult their tax attorney and or accountant when deciding on an option.
The PHEG grant has closed based on volume of applications. Visit the link above for further details.
Please note: The Paycheck Protection Program has hit its cap and no new loans will be issued until more money is appropriated for it by Congress.
Contact your lender to determine if they are an SBA-approved lender. Loans will not be issued by financial institutions that borrowers do not have an existing relationship with.
The application is online however some lenders may also require additional information or a separate application. Please contact your lender ahead of time to determine if they are prepared to issue loans.
- List of banks and lenders participating in the SBA’s Paycheck Protection Program (PPP) small business loans
- PPP Loan Calculator
The SBA’s Economic Injury Disaster Loan Program provides loans to qualified entities that are impacted by the Coronavirus (COVID-19). The estimated time for completing this entire application is two hours and ten minutes, although you may not need to complete all parts.
This loan advance will provide up to $10,000 of economic relief to businesses that are currently experiencing temporary difficulties.
This loan enables small businesses who currently have a business relationship with an SBA Express Lender to access up to $25,000 quickly.
The SBA is also providing a financial reprieve to small businesses with existing loans during the COVID-19 pandemic.
Frequently Asked Questions
What banks are issuing PPP loans?
Fortune Magazine has a rolling list available on their website. You must register with their website, but access is free. List of banks and lenders participating in the SBA’s Paycheck Protection Program (PPP) small business loans
Can I apply for a PPP loan if I have laid off or furloughed employees?
SBA will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for payroll, rent, mortgage interest, or utilities. The eight-week period begins on the date the lender makes the first disbursement of the PPP loan to the borrower. The lender must make the first disbursement of the loan no later than ten calendar days from the date of loan approval.
What about the additional unemployment compensation from the federal government?
The Federal Pandemic Unemployment Compensation (FUPC) program which provides the additional money is being administered through the Maryland state unemployment program. If your employees qualify and begin receiving unemployment through the state, they will automatically see the increase from the Federal program once it is disbursed to the state.
The best website for applying for unemployment is https://www.dllr.state.md.us/employment/unemployment.shtml.
Can I apply for both state and county/federal loans or funding programs?
If you have applied for state assistance, you will not be disqualified if you apply for other assistance through federal or local means. Though please be advised, if you have already applied for federal assistance, you should verify federal program eligibility terms through the
U.S. Small Business Administration. (FAQ – COVID-19 LOAN & GRANT)
Maryland business and individual income taxpayers will be given a 90-day extension for tax payments. No interest or penalty for late payments will be imposed if 2019 tax payments are made by July 15, 2020. See 90-day extension for tax payments for more information.
The federal tax filing deadline has been moved to July 15. Learn more.
Comptroller Franchot also extended business-related tax filing deadlines to June 1. Get additional information regarding business tax returns – including sales and use tax, alcohol tax, etc. – and income tax extensions.
Businesses who paid their Maryland Sales & Use Taxes for March early may request a refund of their payment by emailing firstname.lastname@example.org or by calling 410-260-4020.
The Maryland Responds Medical Reserve Corps are seeking volunteers to staff clinics and field hospitals. To register for Maryland Responds, please visit the Medical Reserve Corps here.
For the A-Z resource guide, and additional information on how to help – including Red Cross blood donations, Meals on Wheels, and other ways – visit Maryland Unites.
Montgomery County is also looking for volunteers – both clinical and non-clinical. If you are interested in assisting the community, please visit their website here. Physician volunteers are encouraged to contact Jessica Pryor at email@example.com.
Bethesda Transit has also provided information on essential transportation updates and how to help local businesses here.
Resources for Physicians
OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Learn more.
On Saturday, March 14, 2020, MedChi, The Maryland State Medical Society, hosted a Q&A session with Howard Haft, M.D. from the Maryland Department of Health. Click here to stream or download the audio.
Information on Maryland’s emergency COVID-19 regulations, including requirements to waive copayments and deductibles. Maryland Medicaid has expanded coverage of telemedicine services, as has Medicare. CPT has released new billing codes for COVID-19 related care.
From the Centers for Disease Control and Prevention
- Resource Center for Health Care Professionals
- Situation Summary
- Latest HAN Update Summary
- Factsheets, Handouts, and Posters
From the World Health Organization (WHO): WHO Coronavirus Home which is updated on a rolling basis with technical guidelines on a rolling basis.
From the Journal of the American Medical Association (JAMA): Guidance for diagnosis and treatment, updated on a rolling basis.
Local Maryland/Montgomery County Resources
- MDH Coronavirus Clinician Letter — Revised Guidance Regarding Health Care Personnel – 5.1.20
- MDH Coronavirus Clinician Letter — ImmuNet – 5.1.20
- MDH Directive Regarding Various Healthcare Matters
- MDH Coronavirus Clinician Letter — 3.26.20
- COVID-19 – Surgical Procedures Guidelines
- MDH Directive Regarding Availability of Testing — 3.20.20
- Emergency COVID-19 Regulations
- Maryland Department of Health’s (MDH) web page for the latest updates on the virus
- MDH Coronavirus Clinician Letter — 3.13.20
- MDH Coronavirus Clinician Letter — 2.28.2020
- Montgomery County’s Health Department’s general information page for the public
- MedChi, The Maryland State Medical Society’s resource page
In the News
- The Washington Post‘s live updates page
- AMA’s COVID-19 Resource Center
- From the AMA Wire, “When global health emergencies strike, how should doctors respond?”
- MedChi, The Maryland State Medical Society’s press release on nCoV
For an up-to-date incidence map, see the Johns Hopkins School of Public Health GIS map.
Rockpointe Webcourse CME: MedChi developed a webcourse in partnership with Rockpointe and the Maryland Nurses Association to prepare healthcare providers who work in an ambulatory-care setting to properly manage patients who present to their outpatient facility with symptoms of COVID-19. This no-cost 1.5-hour webcourse will be available on-demand for the next 12 months.