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COVID-19 Resources

A message from the South Dakota State Medical Association to physicians: While you are working tirelessly to prepare your organization to safely meet the needs of South Dakota patients, the SDSMA is here to support you and to ensure that you have the information and resources you need to stay safe, deliver high quality care, and manage public concerns. Read more.

SDSMA COVID-19 Update: March 30

News Release: SDSMA Urges Stronger State Response to COVID-19

SDSMA Letter to Gov. Noem Regarding Nonessential Surgeries and Procedures and Closure of Nonessential Businesses

Joint Open Letter to the Public: Stay Home -- signed by SDSMA, SDNA and SDAHO

Where can I find the latest information on COVID-19?
CDC Updates - What's new

South Dakota Department of Health (SDDOH)
CDC Information for Healthcare Professionals

Telehealth
Given the need to expand the use of telehealth to slow the spread of the COVID-19 pandemic, the White House, HHS Office for Civil Rights and the State of Minnesota have revised rules associated with the practice. On March 17, the Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of health care services from their physicians without having to travel to a health care facility. Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk. Private insurers including Avera Health Plans, Sanford Health Plan, and Wellmark are following Medicare guidelines. Providers should check with each insurer regarding instructions for billing for telehealth services.

The OCR determined on March 17 that it will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). Physicians may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and their use, may not fully comply with the requirements of the HIPAA Rules.

The OCR announcement means that physicians who want to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing service that is available to communicate with patients.

Physicians using their professional judgement may request to examine a patient exhibiting COVID-19 symptoms, using a video chat application connecting the physician’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a physician may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19.

Under this Notice, physicians may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules. Physicians should not use Facebook Live, Twitch, TikTok or other public facing communication services. Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA).

In the White House announcement, the Centers for Medicare & Medicaid Services (CMS) said it is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of COVID-19.

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home. Clinicians can bill immediately for dates of service starting March 6, 2020.

Information about expanded telehealth benefits for Medicare beneficiaries: Provider Fact Sheet and Medicare FAQ Document.
Also: Medicaid telehealth coverage update/waiver,

HHS Office of Civil Rights Easing Enforcement of HIPAA Standards for Telehealth Services - Notification of Enforcement Discretion

Elective Surgeries and Procedures
CMS Recommends Delaying All Elective Surgeries and Non-Essential Medical Procedures - see CMS Procedural Recommendations

More
CMS Relaxes Provider Enrollment Standards
MIPS & ACO Reporting Requirements

What does SDDOH recommend for evaluating Persons Under Investigation (PUI) for COVID-19 infection?

Medical providers who are concerned that a patient may be infected with COVID-19 can use the table below to aid their clinical decision-making for whom to test, per SDDOH. Because influenza is still at widespread activity and other respiratory pathogens (e.g., RSV) are also circulating, SDDOH encourages medical providers perform an influenza test and respiratory pathogen panel (RPP) as part of the medical evaluation. If submitting a patient’s specimen for COVID-19 testing, the patient should be informed to self-isolate at home until test results are provided. The South Dakota Department of Health announced March 19 that it has now received supplies to process COVID-19 testing. This comes after a shortage of supplies led to the South Dakota Public Health Laboratory halting test processing on March 16. See state lab alerts here.

Avera Health and Sanford Health in Sioux Falls announced March 23 that they will begin coronavirus test processing.

Priority Level	Clinical Features	Risk Exposure*
Low	Fever OR Cough OR Shortness of Breath	None identified
Medium	Fever OR Cough OR Shortness of breath AND Elevated risk for severe infection**	None identified
Medium	Fever OR Cough OR Shortness of Breath	Identified risk
High	Fever OR Cough OR Sore Throat OR Shortness of Breath	Identified healthcare risk***
High	Fever AND Cough OR Shortness of Breath	Identified risk

*Individual meets the risk exposure criterion if they have one of the following: Close contact to a laboratory-confirmed case within 14 days of symptom onset; History of travel to a geographic area with community transmission in a state within 14 days of symptom onset. Visit CDC website for the current list of states; History of travel from a country under a Level 2 or Level 3 Travel Advisory. Visit CDC website for thecurrent list of countries.

**Elevated Risk for Severe COVID-19 Infection: Hospitalized patients; Older adults (65 years of age and older; Individuals with certain pre-existing conditions (e.g., heart disease, lung disease, diabetes, and immunosuppressed)

***Any healthcare worker who was caring for or who had unprotected direct contact with infectious secretions or excretions of a suspected COVID-19 patient or laboratory-confirmed case within 14 days of symptoms onset.

Emergency Declaration

Gov. Kristi Noem Signs Emergency Declaration
President Trump Declares National Emergency

Executive Order
March 23 Executive Order Issued by Gov. Noem

Does a declaration of emergency help decrease the spread of COVID-19 by encouraging social distancing?
People should stay 6 feet from others to decrease the spread of COVID-19.
CDC has developed several guidance documents that discuss use of social distancing based on the amount of community spread.

Cleaning of high-touch areas:
For healthcare settings (environmental infection control)

Who can I call if I have questions?
General questions can be directed to the COVID-19 Helpline: 800-997-2880
Epidemiology questions can be direct to the SDDOH Office of Disease Prevention: 605-773-3737
Laboratory questions can be direct to the South Dakota Public Health Laboratory (SDPHL): 605-773-3368

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Pain Management and Prescription Drug Abuse

The problem of prescription drug abuse and its related health consequences is a significant public health problem. The SDSMA is at the forefront on this issue by providing physicians with helpful, evidence-based guidelines for prescribing opiate analgesics to both effectively treat pain and minimize patient risk. Through a special committee on pain management and prescription drug abuse, the SDSMA has developed the whitepapers, Opiate Analgesics for Chronic Non-Cancer Pain, and Effective Management of Acute Pain to serve as a resource for physicians and prescribers. This committee has researched evidence-based guidelines based on a review of the literature by a diverse group of highly trained physicians.

Download the SDSMA whitepaper, Opiate Analgestics for Chronic Non-Cancer Pain.

Download the checklist for prescribing opiates for chronic, non-cancer pain.

Download the SDSMA whitepaper, Effective Management of Acute Pain.

Marijuana

Download the SDSMA's whitepaper, Marijuana as Medicine.

Medicaid/CHIP

Medicaid is a state and federally funded health care program that provides essential health care services to low-income patients. Without Medicaid, thousands more South Dakotans would be uninsured. Currently, Medicaid covers 116,000 South Dakotans.

To qualify, patients must be low income, though being poor does not mean a patient will qualify. For example, low-income childless adults are not eligible even if their income meets the state’s Medicaid income requirements.

Medicare and Medicaid, which now cover 35 percent of health care in the U.S., often pay physicians less than it costs them to provide services. Commercial insurance companies’ payment rates, computed largely as a percentage of Medicare, have followed the government-run programs. This leaves many South Dakota physicians struggling to keep their practices open. As a rural state, South Dakota faces tough challenges in providing access to quality, affordable care for all of our citizens.

The medical community understands the financial challenges facing South Dakota and our country, and that there are no easy decisions for policymakers when it comes to balancing the needs of the state with the resources available. However, cutting payments for health care services is not an effective tool for controlling health care costs, and often exacerbates the cost of care. Without physicians to see patients, the health care delivery system cannot be effective.

The SDSMA advocates not just for adequate funding for the Medicaid program, but for Medicaid eligibility expansion for those who make less than 100 percent of the federal poverty level, and for the program to promote wellness and prevention, coordinated care for those with chronic diseases, and assurance that all Medicaid patients have a medical home.

Medicare

Every year for more than a decade, physicians faced a significant Medicare payment cut — the result of a flawed sustainable growth rate (SGR) formula. In 2015, after years of advocacy from the SDSMA, AMA, and other state medical societies, Congress passed historic SGR repeal legislation. This legislation contains core elements of a more reasonable and better-functioning Medicare program.

Strengthening Primary Care

A primary care task force created by Gov. Dennis Daugaard in 2012 aimed to expand the state's educational capacity to train more primary health care providers for rural areas of South Dakota. The group was comprised of medical and health professionals, as well as policymakers. SDSMA Past President Robert L. Allison, MD, represented the SDSMA on the task force.

Task force recommendations focused on medical school class size, components of rural training for medical students, residency programs in the state, and physician assistant and nurse practitioner program capacity. Dr. Allison continues to serve on the task force's Oversight Committee to ensure accessibility to primary care for all South Dakotans -- particularly in rural areas of the state.