Harvey Update: What Physicians in Affected Areas Need to Know

Harvey Update

Sept. 8, 2017

Cleanup, Recovery Continue in Harvey-Affected Areas 

Since Hurricane Harvey slammed the Texas Coast on Aug. 25, state agencies have deployed resources to the affected areas, health plans have made policy changes, millions of dollars have been raised through donations, and thousands of Texas physicians have put in extra time and effort to address the public health concerns.
Four hospitals remain closed — two in Houston and two in Corpus Christi — and almost 3,000 patients have been transported from health care facilities affected by the storm, said Chris Van Deusen, spokesman for the state Department of Health and Human Services (DSHS).

In addition, Texas Mobile Medical Units have seen more than 1,200 patients and transferred 131 to health care facilities, Mr. Van Deusen said. Medical shelters for people who need specialized care remain open in Houston and San Antonio, but one in Austin has closed.

DSHS' medical response needs are largely covered, Mr. Van Deusen said, and some of the federal teams have been moving out of Texas and into Florida, which is bracing for Hurricane Irma.

In the Houston area, physicians have been in overdrive dealing with their own flooded homes or heavy patient load — or both — as cleanup continues.
"[Last] Wednesday was when the rain all stopped and the skies all cleared," said Greg Bernica, executive vice president and CEO of the Harris County Medical Society (HCMS). "But patients didn't want to get out, and in some cases couldn't get out because of the flooded roads. So everything was very slow last week. But this week, virtually everybody's back at work and the patient volume has been huge because of that pent-up demand — a week to 10 days of not having access to physicians."
One of the biggest issues patients are facing is finding dialysis machines, Mr. Bernica said. Many facilities that have them were shut down during the flooding.
Behavioral health issues also are a top priority, Mr. Bernica said.

"Many of these houses are flooding for the third and fourth times, but with much more water this time," he said. "So there are a lot of mental health issues. We had a meeting [Thursday] morning of all the community clinics in town and that's the number one thing they're seeing. And we have a shortage of psychiatrists, and that's going to be a challenge going forward over the next few weeks and months."

Most of the calls HCMS has received have been from physicians looking to volunteer, Mr. Bernica said. Hundreds of physicians have donated their time, he said. 

"We've had amazing numbers of physicians volunteer hours to help out at all the clinics," he said. 

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Certain Medicaid Extensions Granted; TMA Working to Clarify Others 

 Patients enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), and the Healthy Texas Women program who live in one of the 29 counties designated as a federal disaster area will be given a six-month extension of medical benefits, the Texas Health and Human Services Commission (HHSC) said.

“Anyone whose benefits were up for renewal in August, September, October, or November will have their certification periods automatically extended for six months,” HHSC said. “Clients do not need to take any action for this extension to be effective.”

Further, HHSC has waived copayments for CHIP patients who live in a federal disaster county through Nov. 30. HHSC is asking the Centers for Medicare & Medicaid Services (CMS) for funds to compensate physicians and other providers for any lost revenue as a result of waiving the copayments. These announcements were included in a Frequently Asked Questions document about Medicaid and CHIP published on the HHSC website.

The Texas Medical Association (TMA) also has learned HHSC is seeking federal emergency funds to compensate physicians and other health care providers who treat uninsured patients who reside in one of the disaster-declared counties. TMA joined provider and consumer groups in urging HHSC to pursue such funds. As additional details become available, TMA will release them. 

The FAQ’s and other Harvey-related information can be found on the HHSC website.

Meanwhile, CMS is delaying implementation of the federal requirement that physicians or providers who order, prescribe, or refer services for Medicaid patients must enroll in the program. 

“All medical and pharmacy claims will continue to pay through calendar year 2017 regardless of the ordering, referring, or prescribing provider’s Texas Medicaid enrollment status,” HHSC said in a statement. “HHS will begin enforcing the enrollment requirement in January 2018 for Medicaid, CHIP, the Children with Special Health Care Needs (CSHCN) program, and Healthy Texas Women. HHS will provide specific dates and details in the coming weeks.”

TMA is also working to further clarify the claims submission process for treating out-of-network patients affected by Harvey and has requested the Medicaid 95-day claims filing deadline be extended.

TMA Seeking Waivers to MACRA Requirements for Physicians Affected by Harvey  

TMA is requesting that physicians affected by Hurricane Harvey have the option to be exempt from Medicare’s 2017 Quality Payment Program (QPP), which is being implemented this year under the Medicare Access and CHIP Reauthorization Act (MACRA).

“We believe the hardship due to the extreme and uncontrollable circumstances from this natural disaster will prevent many of our physician members from spending the time necessary to learn about program requirements,” TMA wrote in a letter to David D. Teuscher, MD, the director of the U.S. Department of Health and Human Services (HHS) region that includes Texas. “Many physicians will be challenged and no longer in a position to submit data successfully on quality measures and activities in 2017.”

The Centers for Medicare & Medicaid Services (CMS) last week granted quality reporting exemptions to certain hospitals and other health care facilities affected by Harvey.

“Under the federal public health emergency declaration, TMA implores HHS and CMS to extend flexibilities to physician practices as it recently did for hospitals and facilities,” said the letter signed by TMA President Carlos J. Cardenas, MD.

TMA was instrumental in CMS’ decision to suspend certain Medicare enrollment screening requirements for physicians and health care providers and suppliers who are assisting with Hurricane Harvey recovery in Texas and Louisiana.

In addition, noncertified Medicare Part B health care physicians and others in the two states will receive temporary billing privileges, the CMS announced Thursday. CMS also is waiving requirements that physicians and other health care providers report their practice location if they are working in a temporary location. 

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Individual Patient Medication History Available Through EHR

Physicians who are trying to prescribe medication to patients displaced by Hurricane Harvey can access medication history through several services, including their electronic health records (EHR) provider’s e-prescribing module.

Physicians can also contact a patient’s preferred pharmacy, where individual medication history information should be available — with the exception of any cash-pay medications not paid via the patient’s insurance. SureScripts is allowing pharmacists free access to its system to query medication history.

Healthcare Ready, a Washington, DC-based nonprofit that coordinates private-sector response to health care disasters, maintains an up-to-date map of pharmacies in Texas, including those in areas affected by Harvey. 

Physicians can also receive prescription history from a patient’s primary physician via DocbookMD, a HIPAA-secure messaging system available on mobile devices and the internet. Access to DocbookMD is a free member benefit available to TMA members.

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Mobile App Can Help Physicians Find Medical Information STAT

Physicians looking for easily accessible information on disease control, drug dosing, and drug interaction can turn to Epocrates Mobile as they respond to Hurricane Harvey.
The mobile app is being offered to free to all TMA members for one year from the date of activation.

Epocrates, a service of AthenaHealth, is mobile medical reference app that provides information on drugs and diseases, and links to patient resources and medical insights from AthenaHealth.

Visit the company’s website to enroll in the service or to update your enrollment status if you are currently a paid subscriber.

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Some Medicare Enrollment Requirements Lifted During Harvey Recovery Efforts

Sept. 7, 2017  

Thanks to ongoing advocacy efforts by the Texas Medical Association, certain Medicare enrollment screening requirements will be suspended for physicians and health care providers and suppliers who are assisting with Hurricane Harvey recovery in Texas and Louisiana.

In addition, noncertified Medicare Part B health care physicians and others in the two states will receive temporary billing privileges, the Centers for Medicare & Medicaid Services (CMS) announced today.

A hotline has been set up for physicians working in the affected areas to enroll in the federal health programs. 

The hotline, which will be staffed from 7 am to 5 pm CST, can be reached at (855) 247-8428.

Temporary billing privileges will begin Monday, Sept. 11. Any calls to the hotline Thursday and Friday will be returned Monday, CMS Director Seema Verma said.

CMS is also waiving requirements that physicians and health care providers report their practice location if they are working in a temporary location. CMS will not take administrative actions against physicians who fail to report their temporary work location. “This temporary process will remain in effect from the declared disaster effective dates (August 25, 2017, for Texas and August 28, 2017, for Louisiana) until the disaster designation is lifted, after which the provider shall resume all reporting requirements,” CMS said in the announcement.

In addition, CMS is:

Allowing physicians and providers who are not currently enrolled to initiate temporary billing privileges by providing limited information, including, but not limited to, National Provider Identifier, Social Security number, or a business employer identification number or taxpayer identification number, and valid in-state or out-of-state licensure, and

Temporarily ceasing revalidation efforts for Medicare physicians and providers located in Texas, Louisiana, and areas otherwise directly impacted by Hurricane Harvey.

More information from CMS on Hurricane Harvey recovery is available on its website.

TMA’s Disaster Preparedness & Response Resource Center also has everything physicians need to stay informed during the recovery effort, as well as ways to help.

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Patient Evacuations Continue as Texans Recover From Harvey

Sept. 5, 2017

Patient Evacuations Continue as Texans Recover From Harvey 

Recovery efforts continue throughout areas affected by Hurricane Harvey, which hit the Texas coast on Aug. 25, bringing torrential rains, high winds, and catastrophic flooding.

As of Tuesday morning, almost 3,000 patients had been evacuated from affected areas, according to the Texas Department of State Health Services (DSHS).

A mobile medical unit that is supporting medical operations in Orange County has seen more than 160 patients in the last 24 hours, DSHS officials say. More than 40 people are at a medical shelter in San Antonio, and capacity at a shelter at Houston’s NRG Stadium has been increased in anticipation of evacuees from Louisiana in the next 24 to 48 hours, officials say.

The Red Cross maintains a map of open shelters on its website. Clicking on a particular shelter reveals its address and current population.

Gov. Greg Abbott issued a disaster declaration for 58 Texas counties, and a Presidential Disaster Declaration was approved for 33 counties. The presidential declaration allows for individual assistance and assistance with debris removal and emergency protective measures.

The state has put a variety of resources in place, but rescue, recovery, and public health initiatives will be coordinated mostly by local officials and facilities in the affected areas. If you’re a physician who is part of the recovery effort, or if you wish to help, TMA’s Disaster Preparedness Resource Center has plenty of information specifically tailored to you. Governor Abbott’s office has an online Texas Hurricane Center that provides open shelter information and preparation tips from the Texas Department of State Health Services as well as links to the Red Cross and the Texas Department of Insurance.  

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Help Reopen Practices Damaged by Harvey 

The Texas Medical Association and the TMA Foundation are asking physicians statewide to help their colleagues rebuild or repair practices damaged by Hurricane Harvey.

Make a tax-deductible donation today to support TMA's Disaster Relief Program, administered by The Physicians Benevolent Fund, which provides grants to affected physicians. 
 
Donate Now Button

Established originally after Hurricane Rita, the TMA Disaster Relief Program helps cover expenses (not covered by insurance or other funding) related to relocating or rehabilitating a physician’s medical office. This may include replacing equipment, aiding needed staff, rebuilding patient records, and other similar costs — all towards the goal of helping physicians once again begin treating their patients. 

Thank you for donating to the TMA Foundation, the philanthropic arm of TMA, and supporting “Physicians Caring for Texans.” 

Note: Contributions are deductible for federal income tax purposes in accordance with applicable law.

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Want to Volunteer to Help Texans Recover? 

Physicians who want to lend their expertise to the Hurricane Harvey relief effort have several ways to register to help.

Sign up for the Texas Disaster Volunteer Registry to be connected with established responder organizations.

Physicians also can register with Healthcare Ready, a Washington, DC-based nonprofit, which will distribute physicians’ information to national volunteer coordinators.

In addition, physicians can apply online to become a Red Cross volunteer and register with the Medical Reserve Corps to serve in Harris County.

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Health Plans Provide Some Policy Guidance for Harvey  

Commercial health plans and the Texas Health and Human Services Commission (HHSC) have posted some information and guidance on policy updates related to Hurricane Harvey.

The Texas Medical Association sought information on Texas’ major health plans, including Medicare and the Children’s Health Insurance Program (CHIP), and compiled the latest information in the links below.

In addition, Healthcare Ready, a Washington, DC-based nonprofit that coordinates private-sector response to health care disasters, published helpful information related to prescriptions, including phone numbers for major health plans.   

UnitedHealthcare

Blue Cross and Blue Shield of Texas (BCBSTX)

BCBSTX officials shared the following frequently asked questions with TMA:

Q: Do we need to set up providers under the Type 2 NPI and/or TIN of the Harvey-affected clinic?

A:  If your billing system will allow you to continue to bill under the deployed physician's existing Type 2 NPI and TIN, please do so. This is the recommended approach. If your billing system will not support this, then we will need to work together to urgently get new provider records associated to the Harvey-affected clinic Type 2 NPI and TIN set up for the deployed physicians before submitting claims. 

Q: Do we need to submit address changes for the deployed providers?

A: Address changes are not required for claim filing. We only recommend this if you are deploying providers for an extended period of time and want them to be represented in the online Provider Finder. We will need to work closely together to ensure that the address is removed once the provider returns to his or her home office, as we do not want to provide inaccurate information to our members.

Q: We may be moving clinics to temporary locations.  Do we need to submit address changes for these?

A: Address changes are not required for claim filing. We only recommend this if the temporary location will be used for an extended period of time and you want this location to be represented in the online Provider Finder. We will need to work closely together to ensure that the address is removed once the clinic returns to its permanent location, as we do not want to provide inaccurate information to our members.

Q: We will be bringing in locum tenens physicians to supplement our staff or fill in for Harvey-affected physicians. Do we need to have records set up and have them credentialed by BCBSTX?

A: You do not need to have records set up for these physicians or have them credentialed by BCBSTX. Claims should be filed under an existing physician record using the Q6 modifier according to the locum tenens instructions found at www.bcbstx.com.

Cigna

  • Commercial Business  
  • Medicare Advantage Plan Business
    • See press release above 
     

Humana

Aetna

Medicaid and CHIP

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Other Helpful Links  

More information on Hurricane Harvey recovery can be found in TMA's Disaster Preparedness & Response Resource Center.

Physicians looking for more information on Hurricane Harvey can contact the TMA Knowledge Center at knowledge[at]texmed[dot]org or by calling (800) 880-7955 or (512) 370-1544. 

The Department of Health and Human Services website contains information on HIPAA and Public Health as well as HIPAA and Emergency Preparedness and Response

The DSHS website also contains information on Harvey disaster relief as well as Laboratory Specimen Handling and Newborn Screening Guidance.  

The Texas Department of Insurance has information for injured employees, health care providers, and workers’ comp carriers. TDI also has an online guide for homeowners on filing claims, deadlines, and resources

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Response Resources  

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Recovery Efforts in Full Swing After Harvey Moves Out of Texas

Aug. 31, 2017  

Houston Physician: “We’ve Got to Take Care of What We’ve Got”

Like most Houston physicians, cardiologist Tom Garcia, MD, has had a pretty wild ride since Hurricane Harvey hit the city Friday.

“It's been awful,” he said. “I've been here since Friday, and they sent me home [today] because I look like [crap].”

“Here,” in this case, is West Houston Medical Center in the Kirkwood neighborhood. Dr. Garcia, the 2015-16 TMA president, has been the only cardiologist available at the hospital during the storm. The hospital itself remained untouched by the flood waters. But on Tuesday, officials there were told a flood control dam west of town was giving way.

“We were told that dam was going to bust,” he said. “So as a precaution, we closed the hospital [to new arrivals] for 24 hours to prepare for the flood.” 

That was a huge inconvenience for the many people who needed the hospital, most of whom had to go into more flooded areas to get health are.

“But we didn’t have any choice,” Dr. Garcia said. “We have 200 patients in our hospital, and we’ve got to take care of what we’ve got.”

The fears of flooding also meant the staff had to move all the equipment from the first floor to the second floor and close its emergency department.

“Yesterday, we called in 12 helicopters,” he said. “And one would land, we’d put the patient in, and they would go to Dallas. And another one would land, and we’d put another one in, and that one would go to San Antonio. Our ICU was vacant within four hours.”

Getting sent home to rest allowed Dr. Garcia a chance to fix a pressing problem with his practice — his phone service was partly out. He said some patients still have been able to call him, but they can’t physically reach him without driving a circuitous route around the flood waters.

“So I have to tell them for their own benefit do not do that,” he said. “If you’re having chest pain, go to the nearest facility. I don’t care if it’s the fire department — that’s where you go.”

West Houston Medical Center reopened its emergency department Thursday morning, and Dr. Garcia says he’s headed back into work.

“It's only going to get worse,” he said. "People are getting sick. They’re having injuries. They’re starting to clean up. There are car accidents and all kinds of other stuff. And it’s getting crazy in the emergency room.” 

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Houston, Beaumont-area Pharmacies Open

Some pharmacies are now open in and around the Houston area:

Below are maps of currently operating pharmacies, courtesy of Healthcare Ready’s Rx Open project. Zoom in for more detail. Click on a dot for a pharmacy's name, address, and phone number.

Houston, Victoria, and Beaumont-area open pharmacies:

 

 Corpus Christi-area open pharmacies:

 

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Want to Volunteer at a Red Cross Shelter? Follow These Steps 

Physicians who want to lend their expertise to the Hurricane Harvey relief effort can volunteer at one of the dozens of American Red Cross shelters in the areas where Harvey hit.

Red Cross shelters provide health services for disaster-related conditions, ‘such as first aid, refilling lost prescriptions, or replacing lost eyeglasses,” according to the Red Cross website. Mental health services also are available at the shelters. 

You can apply online to become a Red Cross volunteer. 

According to the application page, volunteers:  

  • Must be at least 18 years old,
  • Must commit to a minimum of 10 days,
  • Should expect to volunteer 10 hours per day, and
  • Must authorize a background check after completing the application.  

The Red Cross also maintains a map of open shelters on its website. Clicking on a particular shelter reveals its address and current population. Also, the Harris County Medical Society maintains a list of shelters open in the Houston area. 

TMA has asked the Red Cross for specific information on needs for physician help at its shelters. The Red Cross has forwarded the request to its health services department. We will provide more information from the Red Cross if it becomes available. 

You can register to become a volunteer through the Texas Disaster Volunteer Registry, a system the Texas Department of State Health Services maintains as a tool for local responder organizations. You also can register with the Medical Reserve Corps to serve in Harris County.  

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Use DocbookMD to Securely Receive Displaced Patient Medical Record Information   

Physicians treating patients in areas affected by Hurricane Harvey or people displaced from the storm can obtain medical record information by messaging regional health insurance exchanges (HIEs) through the DocbookMD app.

Representatives from HIEs currently are stationed at evacuation shelters, but have access to online data on more than 4 million patients in the Houston/Beaumont areas and another 4 million patients in the San Antonio/Corpus Christi areas. 

DocbookMD is a HIPAA-secure messaging system available on mobile devices and the internet. Physicians can request patient records from HIE representatives via DocbookMD by following these steps: 

  1. Open the DocbookMD app, go to the “CareTeam” tab, and tap “Invite.”
  2. Enter the name and phone number of an HIE staff member:  
  • Kimberly Harris — (210) 834-1011 (San Antonio/Austin),
  • Storey Sheriff — (830) 279-9728 (San Antonio/Austin),
  • Jim Hoag — (972) 375-7512 (North Texas),
  • Phil Beckett — (832) 496-4442 (Houston), or
  • Gijs Van Oort — (210) 215-1677 (All).
  1. The HIE staff member will be added to your CareTeam allowing you to request and receive patient information direct to your phone through the HIPAA-secure app.

The DocbookMD user manual covers this process (and every other function of the app) in depth and is accessible right inside the app under the “Support” tab.

Any TMA physician member can access DocbookMD for free by downloading the app from the Apple or Android app stores, or by visiting www.docbookmd.com/pricing.

You also can obtain patient information directly from HIEs by contacting HIE representatives. Representatives can provide specific information on patients over the phone, and they also can produce an electronic “CCD” document that summarizes patient data such as problem lists, allergies, active medications, lab results, and imaging reports. Be prepared to provide demographic information to help them look up your patient.

Greater Houston Healthconnect is the health information exchange for Houston, and Healthcare Access San Antonio is the regional HIE for the San Antonio and Corpus Christi areas.

If you are treating a Medicaid patient, registered Texas Medicaid providers and physician offices who see Medicaid patients have access to the free online portal www.YourTexasBenefitsCard.com. Information on the portal includes past Medicaid visits, health events, vaccines, prescription drugs, and lab data; this information is primarily claims and encounter based.  

More information also is available on the TMA website

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Mobile App Can Help Physicians Find Medical Information STAT

Physicians looking for easily accessible information on disease control, drug dosing, and drug interaction can turn to Epocrates Mobile as they respond to Hurricane Harvey.

The mobile app is being offered to physicians for free during Harvey disaster relief efforts.

“Over the past few days, over 4,000 clinicians have taken advantage of this free Epocrates Plus offer to aid them as they work to relieve disaster-affected areas,” said Anne Meneghetti, MD, executive director, Epocrates Medical Information.

Epocrates, a service of AthenaHealth, is mobile medical reference app that provides information on drugs and diseases, and links to patient resources and medical insights from AthenaHealth.

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Other Helpful Links:  

More information on Hurricane Harvey recovery can be found on the TMA's Disaster Preparedness & Response Resource Center.

Physicians looking for more information on Hurricane Harvey can contact the TMA Knowledge Center at knowledge[at]texmed[dot]org or by calling (800) 880-7955 or (512) 370-1544. 

Physicians who wish to volunteer should register at the Texas Disaster Volunteer Registry or contact the American Red Cross

The Texas Department of Insurance has information for injured employees, health care providers, and workers’ comp carriers. TDI also has an online guide for homeowners on filing claims, deadlines, and resources

The Department of Health and Human Services website contains information on HIPAA and Public Health as well as HIPAA and Emergency Preparedness and Response

The Department of State Health Services website also contains information on Harvey disaster relief as well as Laboratory Specimen Handling and Newborn Screening Guidance.  

 

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Harvey Update: Storm Moving Out of Houston, But Public Health Concerns Remain

Aug. 30, 2017

Harvey Moving Out of Houston, But Public Health Concerns Remain

Tropical Storm Harvey has moved out of Houston and drenched the Beaumont area on its way to Louisiana. Its effects — including widespread flooding — will be felt for quite a while.

Harvey is gradually weakening as it moves further inland, the National Hurricane Center said Wednesday. “It should be noted that the forecast weakening will not eliminate the risk of continued heavy rainfall and flooding along Harvey’s path,” the Hurricane Center said in a statement.

The threat of heavy rains has ended around Houston and Galveston, but more flooding is expected in those areas as well as in Beaumont, Port Arthur, and other parts of East Texas for the rest of the week.

As of Wednesday morning, almost 1,000 patients had been transported out of health care facilities affected by Harvey, the Texas Department of State Health Services (DSHS) said in a statement

“Texas Mobile Medical Units have seen 139 patients and transferred 31 to health care facilities,” the DSHS statement said. “Medical shelters are open in San Antonio and Austin and are being set up in Houston. Some hospitals in Victoria and Corpus Christi that had closed are beginning to re-open for emergency services or return to normal operations. However, many hospitals along the middle Texas coast and in the Houston area remain closed.”

The state has put a variety of resources in place, but rescue, recovery, and public health initiatives will be coordinated mostly by local officials and facilities in the affected areas. If you’re a physician who is part of the recovery effort, or if you wish to help, TMA’s Disaster Preparedness Resource Center has plenty of information specifically tailored to you. Governor Abbott’s office has an online Texas Hurricane Center that provides open shelter information and preparation tips from DSHS as well as links to the Red Cross and the Texas Department of Insurance.

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Medical Personnel Needed at Harris County Shelters

In Harris County, several local shelters are in need of medical personnel to assist with assessments and triage of people as they arrive, a spokeswoman for Harris County Public Health said Tuesday. 

Martha L. Marquez said there will be a growing need for medical volunteers in shelters.

TMA will provide information on how to volunteer at shelters once it becomes available.

“Our response team is assessing the shelters and seeking information regarding the current status of the facilities,” Ms. Marquez said. “We are particularly interested in the number of clients, the age range of the clients, any medical needs and the sanitary conditions of the shelters.” 

Harris County’s Children’s Health Insurance Program refugee and tuberculosis clinics will be closed until at least Thursday, along with Women, Infants, and Children offices. However, the animal shelter is open for about two hours to allow families to reclaim lost animals, Ms. Marquez said. 

Some pharmacies are now open in and around the Houston area:

Below are maps of currently operating pharmacies, courtesy of Healthcare Ready’s Rx Open project. Zoom in for more detail. Click on a dot for a pharmacy's name, address, and phone number.

Houston, Victoria, and Beaumont-area open pharmacies:

 Corpus Christi-area open pharmacies:

 

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Before Responding to Harvey Efforts, Are Your Vaccinations Up to Date?

First responders, including physicians who are part of the Hurricane Harvey relief effort, should be up to date on their vaccines, officials with the Texas Department of State Health Services said in a statement. 

“While documentation of vaccination is preferred, it should not be a prerequisite to work,” officials said. 

Specifically, people exposed to unsanitary conditions commonly seen in mass flooding should be up to date with their tetanus-containing vaccine, officials said. 

“Health care workers and first responders who routinely come into contact with blood and other body fluids should be immunized against hepatitis B,” according to the statement. 

However, vaccinations for hepatitis A, meningococcal disease, typhoid, and cholera are not needed, officials said. 

Furthermore, any evacuee living in crowded group settings should be given the following vaccines, unless the person has written documentation of having already received them, officials said:   

  • “Influenza: Everyone 6 months of age or older should receive influenza vaccine. Children 8 years old or younger should receive 2 doses. 
  • Varicella: Everyone 12 months of age or older should receive one dose of this vaccine unless they have a reliable history of chickenpox.
  • MMR: Everyone 12 months of age or older and born during or after 1957 should receive one dose of this vaccine unless they have a documented record of 2 doses of MMR.” 

In addition, students who have been displaced by Harvey can be enrolled in school for up to 30 days without proof of immunization, the Texas Health and Human Services Commission said in a letter to school officials. Schools with electronic access to ImmTrac2, the state immunization registry, will be able to verify immunization status for many students.

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Own or Manage a Practice Affected by Harvey? 

If you own or manage a practice that has been affected by Hurricane Harvey, the Texas Workforce Commission (TWC) has several online resources that will assist you as an employer as well as your employees.

The commission’s website features a “frequently asked questions” section that addresses common and important questions employers have been asking related to Harvey.

The topics covered in the FAQs include: 

  • Relief from unemployment claims filed by laid-off workers,
  • Staying within the law if mail service is not available to distribute paychecks, and
  • Can a small business file unemployment claims if it has to shut down temporarily? 

The website also has information and ways to apply for unemployment benefit services, including disaster unemployment assistance, for workers who have been laid off or unable to work because of the storm in certain counties. “Individuals should specify that their applications are related to the damage caused by Hurricane Harvey,” TWC said in the announcement.

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Other Helpful Links:  

More information on Hurricane Harvey recovery can be found on the TMA's Disaster Preparedness & Response Resource Center.

Physicians looking for more information on Hurricane Harvey can contact the TMA Knowledge Center at knowledge[at]texmed[dot]org or by calling (800) 880-7955 or (512) 370-1544. 

Physicians who wish to volunteer should register at the Texas Disaster Volunteer Registry or contact the American Red Cross

The Texas Department of Insurance has information for injured employees, health care providers, and workers’ comp carriers. TDI also has an online guide for homeowners on filing claims, deadlines, and resources

The Department of Health and Human Services website contains information on HIPAA and Public Health as well as HIPAA and Emergency Preparedness and Response

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Relief Efforts Continue as Flooding From Harvey Overwhelms Parts of Texas

Aug. 29, 2017

Relief Efforts Continue as Flooding From Harvey Overwhelms Parts of Texas   

As Tropical Storm Harvey continues to churn its way slowly north-northeast Tuesday, catastrophic and life-threatening flooding is expected to continue along the Gulf Coast and Southeast Texas.

“Rainfall totals of nearly 50 inches have been observed at several locations in the Greater Houston area and southeastern Texas,” the National Weather Service said Tuesday. “Storm totals could reach higher amounts in some locations, which would be historic for the area. Additional rainfall accumulations of 6 to 12 inches are expected across the upper Texas coast into southwestern Louisiana.”

The state of Texas learned some important lessons about public health response and disaster medical care during hurricanes Katrina, Rita, and Allison. State officials are now putting those lessons to use. 

As of Tuesday morning, 54 counties were on Gov. Greg Abbott’s State Disaster Declaration, and the Federal Emergency Management Agency has granted the governor’s request for a Presidential Disaster Declaration. 

Relief efforts continue statewide, and evacuation shelters have been set up to help the thousands of people who have been displaced and the many more who are expected to be evacuated in the coming days and weeks. 

The state has put a variety of resources in place, but rescue, recovery, and public health initiatives will be coordinated mostly by local officials and facilities in the affected areas. If you’re a physician who is part of the recovery effort, or if you wish to help, TMA’s Disaster Preparedness Resource Center has plenty of information specifically tailored to you. Governor Abbott’s office has an online Texas Hurricane Center that provides open shelter information and preparation tips from the Texas Department of State Health Services, as well as links to the Red Cross and the Texas Department of Insurance.

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Medical Personnel Needed at Harris County Shelters

In Harris County, several local shelters are in need of medical personnel to assist with assessments and triage of people as they arrive, a spokeswoman for Harris County Public Health said Tuesday. 

Martha L. Marquez said there will be a growing need for medical volunteers in shelters.

TMA will provide information on how to volunteer at shelters once it becomes available.

“Our response team is assessing the shelters and seeking information regarding the current status of the facilities,” Ms. Marquez said. “We are particularly interested in the number of clients, the age range of the clients, any medical needs and the sanitary conditions of the shelters.” 

Harris County’s Children’s Health Insurance Program refugee and tuberculosis clinics will be closed until at least Thursday, along with Women, Infants, and Children offices. However, the animal shelter is open for about two hours to allow families to reclaim lost animals, Ms. Marquez said. 

Some pharmacies are now open in and around the Houston area:

Below are maps of currently operating pharmacies, courtesy of Healthcare Ready’s Rx Open project. Zoom in for more detail. Click on a dot for a pharmacy's name, address, and phone number.

Houston, Victoria, and Beaumont-area open pharmacies:

 Corpus Christi-area open pharmacies:

 

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A Message From TMA to Texas Physicians:

Harvey is having an unprecedented and catastrophic impact on Texans and Texas physicians. This event is not over and will continue to impact more of our friends and families. 

Senior TMA staff Monday morning reached out to board and delegation members in Houston, Beaumont, and along the Gulf Coast. The question is, “What can TMA do to help?” The answer universally has been, “We don’t know yet.” The flooding not only has made transportation difficult if not impossible in many parts of Houston, but also it’s made it almost impossible for anyone who wants to help to be able to get to the city. To avoid adding to the confusion, we are reminded not to arrive unannounced or unrequested. 

We have been contacted by several American Medical Association friends and AMA board members around the nation saying their thoughts and prayers are with us and they stand ready to help and assist. We also have received an outpouring of support and concern from our friends at the Georgia, Florida, North Carolina, California, and Connecticut state medical societies plus other organizations with whom we work. All want to know how they can help.

As TMA did after Hurricane Ike in 2008, we are looking into ways we can provide long-term help to the practices that have been hit hard (or demolished) by this storm. We will have a plan for the Harvey Relief Fund shortly and will present it to the Board of Trustees for approval.

For all our TMA family involved, please know that the rest of us are praying for you, for your families, and for your communities. If there is anything we can do, please do not hesitate to ask.

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Follow These Steps to Prevent Infectious Disease Outbreaks in Shelters

TMA reminds physicians of the risk of infectious diseases in areas affected by Hurricane Harvey. As you work with patients in the affected areas or who have been displaced to other parts of the state, be aware of what can lead to the spread of infectious diseases and other public health risks. 

Jane Siegel, MD, chair of TMA’s Committee on Infectious Diseases, and Philip Huang, MD, a consultant for TMA's Council on Science and Public Health and medical director and health Authority for Austin/Travis County, offered this advice on preventing further public health outbreaks, specifically in shelters:  

  • There must be established rules about setting up the shelters, including adequate space between beds; managing dirty linens; providing clean linens; and appropriate disposal of waste, especially dirty diapers.
  • Be on the lookout for diarrhea outbreaks, and it’s important to document their etiology. Norovirus was the main culprit in Dallas and Houston during Hurricane Katrina in 2005. Workers who are cleaning bathrooms need to be educated about infection control, and they should wear masks in anticipation of potential airborne norovirus infections.
  • Water contamination, including well water exposed to sewage, is especially important to be aware of, and people should heed all boil-water advisories. Bottled water should be used whenever possible.
  • Hand hygiene is critical, and water and soap should be used frequently along with hand sanitizer. However, clean water might not be available, and hand sanitizer might not be effective against norovirus.
  • Medical equipment and supportive equipment — such as nebulizers, walkers, and wheelchairs — should be cleaned regularly. Shelters also should have plenty of disinfectants on hand.
  • Triage patients to identify people at high risk for infectious diseases. This is a time to ask patients about tuberculosis exposure and treatment.
  • Vibrio infections are a possibility in open cuts for those who were exposed to floodwaters.
  • Cuts and bruises may occur during recovery activities and cleanup, so make sure tetanus vaccination status is up to date.
  • Shelters need a large supply of infant diapers and adult diapers. They also should have plenty of infant formula and an appropriate place to store it.
  • Arrangements should be made for pregnant women who are likely to go into labor. Pregnant women should drink bottled or boiled water only.
  • Outside of shelters, decrease any standing water in places that are not massively flooded.
  • Watch out for injuries and carbon monoxide poisoning.   

More information on infectious diseases and how to prevent them can be found on the TMA’s website.

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Accessing Medical Information for Displaced Texans

It is difficult to watch as our beloved state suffers from the catastrophic effects of Hurricane Harvey. Even more difficult is the number of Texans displaced as they evacuate to safe places. This means many Texans are seeking medical care outside of their usual region or network of physicians. It helps to know that health information exchanges (HIEs) are available to help provide access to a patient’s information at the point of care. 

If you are treating a Houston-area resident, there is a good chance that Greater Houston Healthconnect (GHH) has at least some clinical information on that patient. Healthcare Access San Antonio (HASA) is the regional HIE for San Antonio, Corpus Christi, and the Dallas-Fort Worth region. The two HIEs have established a special arrangement for physicians and providers in dealing with the current hurricane crisis.

GHH and HASA, which have more than 8 million patients in their systems, determined a simple pathway for physicians to access patient health information for most of the Gulf Coast region. As people are quickly evacuated from hospitals and homes and need medical attention, physicians and providers can see their new patients’ information, such as problem lists, allergies, active medications, labs, radiology reports, and even diagnostic images.

  • To access records from the Houston region, call (832) 564-2599 (available 24/7), and GHH representatives will assist with access. 
  • To access records from the Corpus Christi region, call (210) 918-1361 (available 24/7), and HASA representatives will assist with access.
  • If you are treating a Medicaid patient, registered Texas Medicaid physicians have free access to the online Medicaid portal, www.YourTexasBenefitsCard.com

The Medicaid portal aggregates data from disparate sources into one central hub. All of this information is collected and displayed in a consolidated health summary form with the ability to see more details. The portal lets you:

  • View Medicaid patients’ available health information, including past Medicaid visits, health events, vaccines, prescription drugs, and lab data; this information is primarily claims and encounter based;
  • View Texas Health Steps alerts;
  • Verify Medicaid patient eligibility and view patient program information;
  • Authorize provider-level functionality to a delegate;
  • Use the Blue Button to request a Medicaid patient’s available health information in a single tool;
  • Check in and check out patients at time of appointment;
  • View and print the patient’s Medicaid ID card; and
  • Use the YourTexasBenefitsCard portal on mobile devices — the portal adjusts to view available information from your tablet or smart phone.

If you need help or have questions about YourTexasBenefitsCard, contact the help desk by calling (855) 827-3747 or emailing ytb-card-support[at]dxc[dot]com

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What to Do About a Flooded Computer

If Hurricane Harvey flooded your practice and submerged computers and other devices that hold patients' protected health information, there are some important “don’ts” that go along with the “do’s.”

First, don’t panic: Just because a device carrying protected health information is damaged doesn’t necessarily mean the data are gone forever. Second, if your damaged device is a computer, don’t try to turn it back on. That can make things worse.

If the compromised device is the only copy of your patients’ protected health information (i.e., it’s not backed up on another device or in cloud storage), TMA recommends you send the device or its damaged hard drive to a data recovery service.

HIPAA allows you to send a damaged device with patient health information — such as a hard drive, thumb drive, or iPhone — through the U.S. Postal Service or UPS without entering into a business associate agreement with those mail carriers.

If you don’t know how to locate and remove a damaged hard drive on your computer, do a search of Google or YouTube that includes your computer’s brand and model number. There are countless how-to videos involving computer hardware, and you may well find one that provides the proper guidance.

TMA recommends using a data recovery service, such as DriveSavers, though the company is not a TMA-endorsed vendor. DriveSavers is available 24/7 and meets HIPAA security standards for electronic data. The company says it will offer financial help for Hurricane Harvey victims who need data recovered. Sept. 1 Update: DriveSavers announced that it will offer to recover information on one device per office or household free of charge as long as devices are sent by Sept. 15, with a 50-percent discount after that date.

 DriveSavers has a drop-off location in Houston at the American General Center, 2929 Allen Pkwy., Suite 200. For more information, visit the company’s website at www.drivesaversdatarecovery.com

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State Waives Some Health Insurance Rules for Harvey 

The Texas Department of Insurance (TDI) has suggested that health insurers and HMOs waive common out-of-network penalties and restrictions on health insurance — including the need to obtain prior authorizations — for people seeking medical or dental care in counties that have been declared a disaster area

The waiver, which is common during disasters like hurricanes, is designed to allow people to obtain health care quickly when their usual physicians and health care facilities are not available, TDI spokesman Ben Gonzalez said.

The waiver, which was issued Saturday, covers a variety of restrictions typically required by health insurance companies, including prior authorizations, referrals, notification of hospital admissions, and medical necessity reviews.

“For someone [from the Houston area] who’s coming to Austin or Waco [to obtain medical care] or something, we tell the providers to reach out to the [person’s insurance company],” Mr. Gonzalez said. “If there’s a problem down the road with getting paid, that’s where the complaint process can come in with TDI.” 

Separately, TDI has suggested that all health insurers and HMOs should authorize payment to pharmacies for up to a 90-day supply of any prescription medication” regardless of the date upon which the prescription has been filled.”  

“We’re dealing with people who may not have access to their health care networks, or may not even have their health insurance information on them,” Mr. Gonzalez said. “We expect the companies to be good corporate citizens in this time of crisis.”

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Ask for a Health Insurance Claims Filing Deadline Extension 

Under Texas prompt payment laws, you may be able get an extension of the 95-day claims filing deadline if you believe you will not be able to meet it for some claims because of a catastrophic event, like a hurricane or a flood. 

But you have to act quickly after your disaster. You must notify the Texas Department of Insurance (TDI) of your inability to meet claims filing deadlines by letter within five days after the catastrophic event. 

Let TDI know your practice address, contact information, and the names of the physicians in the practice. Mail the letter to: Life/Health and HMO Intake Team, Texas Department of Insurance, PO Box 149104, Mail Code 106-1E, Austin, TX  78714-9104.  

Then, once your practice has returned to normal business operations, you’ll need to notify TDI of this fact within 10 business days of normal operations. You must send TDI — to the address above — a notarized letter certifying:     

  1. The specific nature and date of the catastrophic event that caused you to be unable to meet the timely filing deadlines, and
  2. The length of time the catastrophic event caused an interruption in your claims submission or processing activities.

The deadlines are delayed by the period you certify under No. 2 above.   

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Affected by Harvey? You Might be Eligible for a MIPS Hardship Exception

If you or your practice has been affected negatively by Hurricane Harvey, and you will be unable to meet the requirements for the Merit-Based Incentive Payment System (MIPS) Advancing Care Information category, you can file a hardship exception application with the Centers for Medicare & Medicaid Services.  

You will be required to attest that you faced “extreme and uncontrollable circumstances” in the form of a natural disaster in which your electronic health records system was damaged or destroyed.

For more information about the hardship exception application, see this article from TMA.

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How Out-of-State Physicians Can Help in Hurricane Recovery 

Gov. Greg Abbott on Tuesday allowed licensed health care professionals who are employed in good standing by a hospital in another state to practice in Texas during the response to Hurricane Harvey.  

Hospitals must submit each out-of-state physician’s name, type, state of license, and license identification number to the applicable licensing entity or to TMBtransition[at]tmb[dot]state[dot]tx[dot]us. The Texas Medical Board also is issuing expedited temporary permits for out-of-state physicians assisting with the response to Harvey. The permits are good for 30 days and are free of charge.   

Out-of-state physicians must be sponsored by a licensed Texas physician, including facility-based physicians such as department directors where the visiting doctor will practice. “Applications will be reviewed and immediately expedited upon verification and status of the out-of-state physician’s license,” TMB’s website says

Action Special, Aug. 29, 2017

Last Updated On

September 11, 2017