We are closely monitoring developments regarding the outbreak of the 2019 Novel Coronavirus (COVID-19), and we will be updating this page daily with new information and resources based on ongoing communication with the Mississippi State Department of Health (MSDH), the leadership of our Board of Trustees, and other medical experts who are following the guidance of the Centers for Disease Control and Prevention (CDC). As of August 11, 2020, there have been 68,293 confirmed cases of COVID-19 in Mississippi.

Today, we sent letters to Governor Tate Reeves and State Health Officer Thomas Dobbs, MD urging them to enact a statewide shelter-in-place order and take immediate action to obtain adequate personal protective equipment (PPE) for physicians and staff. You can view those letters using this links below.

MSMA Letter to Governor Tate Reeves
MSMA Letter to State Health Officer Thomas Dobbs

The Mississippi State Board of Medical Licensure released a proclamation on March 15, 2020, encouraging all physicians to use telemedicine to avoid unnecessary patient travel and providing other updates on prescriptions. The complete proclamation can be downloaded here.

MSDH and CDC continue to monitor and update their websites regarding COVID-19, and the MSDH website has information resources, preventative measures, and cases in Mississippi. We are taking measures to ensure a hygienic environment, including regular cleaning of common areas, and refilling of soap and hand sanitizers. We recommend that you do the same at home and at your workplace.

The National Institute on Drug Abuse has alerted the research community that populations with Substance Use Disorders (SUDs) may be impacted particularly hard. On Monday, the Substance Abuse and Mental Health Services Administration (SAMHSA) posted COVID-19 guidance providing potential flexibility for Opioid Treatment Programs (OTPs). We have included additional links to information and resources below.

Latest Information from Mississippi State Department of Health


Updates for Physicians and Providers

MSDH Health Alert Network Alert - March 19, 2020

Given the ongoing spread of COVID-19 in Mississippi and the shortage of protective medical equipment, elective medical procedures and non-essential medical visits must be postponed at this time.

The following measures must be taken:

  1. Physician, hospitals and medical centers must defer elective surgical and diagnostic procedures until COVID-19 spread has been diminished and the supply of protective medical equipment is restored.
  2. Physicians and providers should reschedule non-urgent medical appointments for a later date.
  3. Dentists must delay non-emergency or routine dental procedures.
  4. Patients should reschedule any non-essential procedures, surgeries or medical visits until the threat of COVID-19 is diminished.

These measures will protect patients and healthcare professionals by minimizing potential exposure to COVID-19 and preserving valuable protective equipment.

Alternatives to Viral Transport Media for COVID-19 Samples:
FDA has released new guidance that permits the use of saline for the transport of COVD-19 testing samples. The Mississippi State Department of Health will accept samples submitted according to the guidelines below.
Please see the FDA FAQ at: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2
 
Q: I am having trouble obtaining viral transport media/universal transport media (VTM/UTM) to collect and transport patient samples. Are there alternatives that I can use?
 
A: While VTM/UTM remains the preferred transport media, FDA believes that the following alternative transport media could be used to collect and transport patient samples for molecular RT-PCR SARS-CoV-2 assays in a manner that will stabilize the RNA without meaningful degradation:

  • Liquid Amies-based transport media.
    • Supplies:
      • E-Swab by Copan (Catalogue # 481C and 482C) with regular or flex minitip applicator
      • Opti-Swab by Puritan (Catalogue # LA-117), swab included in kit (Catalog#3317-H).
    • Storage: Up to 72 hours at 4℃, or frozen for longer storage.

If the above are not available, FDA believes that the following could be used to collect and transport samples for molecular RT-PCR sARS-CoV-2 assays:

  • Dry swab in saline
    • Supplies:
      • Puritan: 25-3317-H, 25-3316-U, 25-3316-H, 25-3317-U, 25-3318-U, 25-3318-H, 25-3319-H, 25-3320-U, 25-3320-U EMB 100MM, 25-3320-U EMB 80MM, 25-3320-H and 25-3320-H EMB 80MM
      • Copan: 501CS01, 503CS01, 516CS01, 518CS01 and 534CS01
    • Storage: Up to 72 hours at 4℃, or frozen for longer storage.

Please be aware that the CDC does not recommend use of calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing. MSDH is continuing to evaluate other options for specimen collection supplies, and we will update this list accordingly as this information becomes available. 

MSDH lab will only accept the approved options above, in addition to the approved VTM/UTM. Do not send unapproved VTM or re-aliquoted VTM.

  1. Swabs alone are not sufficient for COVID-19 testing. Swabs must be transported in viral media transport tubes.
  2. Clinics should contact local hospital labs and/or Labcorp for media and swabs. MSDH cannot meet the current demand.
  3. With increased volumes of testing expected, clinics should start using Labcorp and other private labs as they become available.
  4. When seeing a febrile patient with respiratory illness, the patient should have on a surgical mask, AND those providing care should wear a surgical mask, eye/face protection (if available), gloves, and a disposable gown. 
  5. MSDH recommends not wearing long sleeve lab coats.
  6. MSDH recommends frequent hand washing/gel use, especially after removing PPE.
  7. Try and keep acutely ill patients segregated from those not ill that are in clinic.
  8. Encourage patients not acutely ill from coming to clinic. Try and help them with their chronic medicine refills and push visits out, if possible and/or consider telemedicine visits for them, if available.

Prior approval from MSDH for submission of samples to the Mississippi Public Health Laboratory is no longer required. See the latest testing priorities in this document. View guidance.

Following the announcement of the first reported coronavirus (COVID-19) case in the state on 3/11/2020, Mississippi State Health Officer Thomas Dobbs, MD, MPH, and Mississippi Emergency Management Association (MEMA) Executive Director Gregory S. Michel held a press conference this morning announcing major updates and new community recommendations for preventing the spread of the virus. “The Mississippi State Department of Health (MSDH) is expanding access to COVID-19 testing. Physicians may now submit specimens to the Mississippi Public Health Laboratory or commercial labs without prior consultation with MSDH, just like any other lab test. This will streamline necessary testing as much as possible,” said Dr. Dobbs.

Additionally, Dobbs said the MSDH is expanding recommendations for long-term care visitors and mass social gatherings. “We know that this virus is easily spread person to person, so we recommend limiting visitations and discontinuing any group social activities in long-term care facilities,” he said. Regarding mass gatherings, the MSDH recommends that individuals, communities and organizations take specific steps when determining their safety or the need for cancellation. “Stay informed of the cases in your county and surrounding counties, and maintain social distancing as practical,” said Dobbs. “Our older population and chronically ill individuals should protect themselves by avoiding gatherings of more than 250 people.”

There is no recommendation at this time that schools should close. Complete details of the updated information and guidance are available on the MSDH website. Governor Tate Reeves and Dr. Dobbs have been working closely since the beginning of the outbreak. “With the outbreak of the coronavirus spreading throughout the country and the world, we anticipated it eventually reaching Mississippi and planned ahead. When it comes to the health and safety of Mississippians, we’re not taking any chances,” said Gov. Reeves.

“Thanks to the advance preparation and planning ahead of confirmed cases and Dr. Dobbs’s and Director Michel’s leadership, we are prepared to respond decisively and quickly. Mississippians should not panic — our approach will be calm and steady. We continue to prioritize our effort to protect public health and save lives,” he said. Executive Director of MEMA Greg Michel says MEMA is moving to a Level-One Activation in response to COVID-19. “This is a posturing move to make sure all of our emergency support functions are in place to assist the Mississippi State Department of Health. This activation is not to create panic. We at MEMA are ready to coordinate with our county emergency management agencies and MSDH to ensure there are no unmet needs during the response and recovery from COVID-19,” he said.

New MSDH COVID-19 Reporting Requirements for Hospitals. View here.

New MSDH COVID-19 Reporting Requirements for Nursing Homes. View here.

COVID-19 Health Alert: Postpone Elective Medical Procedures and NonEssential Medical Visits. View here.

COVID-19 Health Alert Update.
 View here.

Recommendations for Immediate Home Isolation for Individuals Tested for COVID-19.
 View here.

Instructions for Individuals Being Tested for COVID-19. View here.

FAQ's for COVID-19 Public Health Response in Mississippi. View here.

Coronavirus Aid, Relief, and Economic Security Act Updates

UPDATE FROM AMA:

Late Wednesday night the Senate approved a massive $2 trillion stimulus and COVID-19 relief package. Provisions of particular interest to physicians and their practices include the following:

  • Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
  • $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due to reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
  • Suspension of the 2% Medicare sequester in May through December 2020.
  • Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
  • A temporary waiver of the face-to-face visit requirement with home dialysis patients.
  • Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
  • Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.

Also of interest, the "health extenders" package that was set to expire on May 22 has now been extended to November 30. House passage is expected on Friday and the President is expected to sign the bill into law.

Flatten the Curve

New Healthcare Professionals Infection Control Guidance (CDC)

March 10, 2020: This updated guidance from the CDC provides updated PPE recommendations for the care of patients with known or suspected COVID-19. (Detailed information available on the CDC website.)

  • Facemasks are an acceptable alternative to N95 respirators when respirators are unavailable in healthcare settings. Respirators should be prioritized for procedures that are likely to generate respiratory aerosols.
  • When an adequate supply of respirators is available in a healthcare facility, facilities should return to use of respirators per their respiratory protection program.
    Continue to use eye protection, gown, and gloves.
  • If there is a shortage of gowns, they should be prioritized for aerosol-generating procedures, high contact patient care activities, and activities where splashes and sprays may occur.
  • Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients undergoing aerosol-generating procedures.
  • Full Update: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings

Mississippi Coronavirus Hotline (8 a.m. – 5 p.m., Monday through Friday): 877-978-6453

Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings

The CDC has recommended practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”). The recommendations are intended for use by professionals who manage respiratory protection programs in healthcare institutions to protect health care workers from job-related risks of exposure to infectious respiratory illnesses. Supplies of N95 respirators can become depleted during an influenza pandemic (1-3) or wide-spreadoutbreaks of other infectious respiratory illnesses (such as COVID-19). Existing CDC guidelines recommend a combination of approaches to conserve supplies while safeguarding health care workers in such circumstances. These existing guidelines recommend that health care institutions:

  • Minimize the number of individuals who need to use respiratory protection through the preferential use of engineering and administrative controls;
  • Use alternatives to N95 respirators (e.g., other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, powered air purifying respirators) where feasible;
  • Implement practices allowing extended use and/or limited reuse of N95 respirators, when acceptable; and
  • Prioritize the use of N95 respirators for those personnel at the highest risk of contracting or experiencing complications of infection.

Click here to read the full guidance from the CDC

.

American Medical Association (AMA) Resource Center

The American Medical Association has created a COVID-19 Resource Center, a curation of comprehensive CDC, JAMA and WHO resources, that will quickly help physicians prepare their practices, address patient concerns and answer the most pressing questions. Please bookmark the page as the AMA will be updating it regularly.

 

COVID HCPCS Coding

The Mississippi Division of Medicaid recently released a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories to test patients for Coronavirus (COVID-19) using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. 

The HCPCS code for this test is U00001. According to the Centers for Medicaid and Medicare Services, the Medicare claims processing system will be able to accept this code on April 1, 2020, for dates of service on or after February 4, 2020.

Using this code will allow labs conducting the tests to bill for the specific test instead of using an unspecified code, which means better tracking of the public health response for this particular strain of the coronavirus to help protect people from the spread of this infectious disease.

The Centers for Disease Control and Prevention has also developed additional ICD-10-CM codes for coding encounters related to COVID-19, which can be viewed here.

Symptoms of Coronavirus (COVID-19)

The symptoms of coronavirus are fever, cough, shortness of breath or difficulty breathing. The symptoms can appear in as few as 2 days or as long as 14 days after exposure.

 

How You Can Protect Yourself

According to the CDC, the virus is thought to spread mainly from person-to-person through respiratory droplets. Practice everyday preventive actions to help prevent the spread of respiratory viruses, including:

  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick. In fact, you should put six feet of distance between yourself and other people.
  • Stay home when you are sick.
  • Cover your mouth or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces.

According to MSDH, avoid gatherings of 250 people or more, especially if there is evidence of transmission in your county or adjacent counties. If you do attend, remember to practice the hygiene and distancing steps above.

  • To prevent illness in those most vulnerable, anyone 65 or older OR with a chronic medical condition should avoid any gathering of 250 people or more (corrected from 50 earlier).
  • Avoid unnecessary (non-urgent) air, bus or train travel.
  • Limit visitation to older relatives or friends (especially in nursing or care homes).
  • Prepare for the possibility that schools or day care centers may temporarily close.
     

Who is Most At Risk?

According to the CDC, the greatest risk of infection is for people in China, people who have traveled to China and for people who have had close contact with anyone diagnosed with the COVID-19 virus. There are also increasing numbers of cases that are confirmed in the United States. In addiction, higher risk individuals include:

  • Older adults
  • People who have serious chronic medical conditions like:
    • Heart disease
    • Diabetes
    • Lung disease

If you are at higher risk for serious illness from COVID-19 because of your age or because you have a serious long-term health problem, it is extra important for you to take actions to reduce your risk of getting sick with the disease.


If you think you have been exposed to coronavirus, contact your primary care physician immediately.


Myths and Misinformation

A malicious website pretending to be the live map for Coronavirus COVID-19 Global Cases by Johns Hopkins University is circulating on the internet waiting for unwitting internet users to visit the website (corona-virus-map[dot]com). Visiting the website infects the user with the AZORult trojan, an information stealing program which can exfiltrate a variety of sensitive data. It is likely being spread via infected email attachments, malicious online advertisements, and social engineering. Furthermore, anyone searching the internet for a Coronavirus map could unwittingly navigate to this malicious website. Please make sure to exercise caution when opening emails from outside organizations even if those organizations may seem reputable. The attached PDF provides additional information on this threat.

Paycheck Protection Program (PPP) Loans

Within the $2.2 trillion CARES Act, funding is included for the Paycheck Protection Program which was created to assist small businesses during the COVID-19 Pandemic. Beginning April 3, 2020 small businesses can apply to receive forgivable loans. You can apply through any existing SBA lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating. Other regulated lenders will be available to make these loans once they are approved and enrolled in the program. You should consult with your local lender as to whether it is participating. Visit www.sba.govfor a list of SBA lenders.

View PPP Overview 

View PPP Application

View PPP Borrower Fact Sheet

 

Medicaid Coding & Billing

 
Emergency Telehealth Policy – March 20, 2020

Emergency Telehealth FAQs – March 31, 2020

1135 Waiver Request – March 19, 2020

1135 Waiver Approval – March 24, 2020

1135 Waiver Addendum – March 30, 2020