Last updated: 06/01/2020
LANGUAGE USE UPDATE:
The CNDA has conducted an analysis of recent FTC citation letters and is recommending that practices limit the use of the terms "COVID" and "coronavirus" to discussions around clinic hours and safety only, and not at all when discussing supplements or treatments. These targets are not specific to NDs but to any and all clinics that the FTC deems is using misleading and false information. While this may seem harsh, for the protection of the naturopathic community and your own practices we encourage you to heed these cautionary recommendations.
GETTING BACK TO FACE-TO-FACE PRACTICE:
- COVID-19 INDUSTRY GUIDANCE: Office Workspaces
- Cal/OSHA COVID-19 General Checklist for Office Workspaces
- CDC: Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic
- AANP ND Resource Page
- List of Current CA Executive Orders related to COVID-19
- Language Guidelines for Practitioners during COVID-19
- Malpractice coverage and COVID-19 (forwarded from Aegis Insurance)
- RHC Resource Page
- CDC - Evaluating and Testing Persons for COVID-19
- State of California Resource page
- California Counties Resource Page
- DEA Exceptions/Resources during State of Emergencies
- California Department of Public Health Guidance Documents
- Live Case Tracker
- COVID-19 Naturopathy Support Clinical Registry via NUNM
- ZOOM Webinar Support during COVID-19
- CARES Act Relief Funds Toolkit
- COVID-19 Federal Stimulus Summary
- US Chamber of Commerce Small Business Guide
- US Small Business Administration COVID-19 Loan Resources
- Understanding the Paycheck Protection Program - slide deck from SGR Legal Group webinar
BUILDING A VIRTUAL PRACTICE RESOURCES
- Meghan Walker ND Virtual Practice Toolkit - free with signup
- Dr. Tyna Moore ND Intro to Recession Proof Marketing - free with signup
TELEHEALTH INFO DURING COVID-19
We understand that interest and demand for working with patients remotely has increased during this time. Please see the below points and read the telehealth policy for NDs licensed in California. The AANP is in the process of putting together additional best practice guidelines for telehealth and we encourage you to review those once they are available.
- As a licensed ND in California you are able to conduct telehealth visits for patients residing within the state of California, or who have proof of residence within the State.
- Care may be established remotely (i.e. you may conduct an FOC via telehealth). However, not all malpractice insurers may cover this.
- Consent from the patient for telehealth must be documented. This can include documentation of a verbal agreement.
- Providers can TEMPORARILY use non-HIPAA compliant video conferencing platforms. This ends when the Public Health Emergency ends. Thereafter, HIPAA compliant platforms must be used.
- Popular platforms for telehealth include VSee, Doxy.me, Zoom
- Charm is currently allowing users to use their telehealth feature for free (normally $20/mo)
- As with all visits, you are responsible for the information shared with you; if you learn something that warrants an in-person assessment you must refer that patient for appropriate care.
- Proper judgement should be exercised in providing treatment recommendations for any diagnoses dependent on physical exam.
TOP Q&A FROM TOWN HALLS 1 & 2
Language use during this time
It is imperative to refrain from using language of "cure", "treat", "prevention" or anything that suggests these things when speaking about COVID-19. The NMC has already received numerous complaints about this and is taking disciplinary action. Please use good judgement when wording advice and care regaring COVID-19 to patients, your website, and social media platforms. Update: Clnics across the country are being raided for making claims involving COVID-19; it is unclear exactly what the FBI is looking for, but this is another example of these agencing being on heightened alert and enforecemnt of anything perceived as being a false or misleading statement to the public about protocols, products, or services claiming to "prevent, treat, or cure" COVID-19. Early May, the FTC sent warning letters to 45 health clinics for making "unsupported claims" regarding COVID-19 treatment. The CNDA is recommending that practices limit the use of terms "COVID" and "coronavirus" to discussions around clinic hours and safety, and not at all in conjunction with supplements or treatments.
Are NDs considered "essential" businesses in California?
Any and all healthcare providers are considered essential, however, it is advised that you do not conduct business for any voluntary procedures or treatments that are not immediately necessary. Please contact your local county health department if you need guidance on determining what treatments are considered essential and non-essential at this time, as these rules can vary by jurisdiction. Update: As reopening orders are announced that lessen the restrictions around this, you are encouraged to follow the public health guidance of your local jurisdiction to determine when and how to reintroduce face-face appointments. The list of counties with full stage-2 clearance appears to be changing often, so please check with your county. You can also visit the link below:
What is being done at this time to further the scope of practice for NDs in California? Can we get a temporary scope of expansion during this time so we can independently prescribe antibiotics for secondary infections or administer a Covid19 vaccine if it becomes available?
The NMC is working with the Dept. of Consumer Affairs and the Committee on Business and Professions to get an emergency policy in place to allow broader prescribing rights during this emergency. The ask has been made for the Governor to include this in an updated executive order although it is amongst many others, and we are waiting on a response; a list of current executive orders can be found here. Gaining independent prescription ability during this time may be depent on holding licensure in another state that allows independent prescribing and/or having taken the pharmacology elective of the board licencing exam. As a long term goal, the NMC will continue using this pandemic to show the need to allow CA NDs to have parity with neighboring states scopes.
What can NDs do individually during this time to help with scope expansion efforts?
Please contact your legislators and representatives with letters and calls to bring attention to how naturopathic medicine can alleviate the provider shortage and help at this time, especially if broader scope is in place; the more they hear from their constituents on these matters the more they pay attention. The CNDA is also forming an Advocacy Task Force and would like to ask members to sign up to participate when we are ready to launch various campaigns; this does not have to equate a big committment, but your interest in helping in any amount can go a long way. Please email firstname.lastname@example.org to be put on the list to be notified of future campaign asks.
Is it within our scope to volunteer our services at local hospitals or drive-up clinic sites?
Yes. Please contact hospitals directly as well as the EMSA who is coordinating ER efforts in the state. The NMC is also aware of the new research that is available regarding IV Vitamin C and shortened duration of hospital stays for COVID-19 patients, and are prepared to help get NDs into hospitals to assist with administering this therapy to patients should it be recognized as a treatment option.
Will patients be able to get COVID-19 testing ordered through NDs?
Ordering COVID-19 testing for patients with private insurance through the usual labs (Quest, LabCorp) should operate the same as other testing. ICD-10 guidance is provided here. No exceptions for NDs have been confirmed for Medicare patients during this time, i.e. tests ordered by NDs for Medicare patients are not likely to be covered.
Can we provide telemedicine across state lines with the new CMS guidelines?
Understand that CMS guidelines are federal guidelines and intended for Medicare and Medicaid persons, and without federal recognition many of these changes to not apply to us. If you are licensed to practice medicine in another state you may conduct telemedicine with individuals that are residents or have proof of residence in that state; this is not specific to current affairs. If you do not hold a license in the state in which the patient resides it is ill-advised to conduct telemedicine with them, especially if they reside in a pre-licensed state. While some practioners choose to act as health consultants in these situations, not providing explicit medical advice, there still remains a risk to your license with this. It is advised that you check with the naturopathic board in the state in which the patient resides to see if they will grant you temporary licensure (see the next question regarding WA and OR as examples). Please check out our Mitigating Risk In Virtual Practice webinar for more information, available free to you as a member.
When states have declared an emergency and lift restrictions to allow physicians licensed in another state to practice in California, if/how does this apply to us?
At this time, both Oregon and Washington have emergency policies in place which allow this. Any licensed California ND who is interested in volunteering in those states are urged to contact the licensing authorities in the respective states to apply. Further, out-of-state NDs who wish to provide services to CA patients must apply through the clinic that wishes to utilize their services at CA EMSA at https://emsa.ca.gov/covid19/ and scroll down to Authorization Request Form.
What about CE requirements during this time?
The NMC does not have the authority to waive CE requirements at this time but rules have been relaxed to allow online courses in lieu of in-person CE.
Can we get any unemployment?
Most Californians can apply for unemployment benefits if they are sick/quarantined. Contact www.edd.ca.gov and click on the COVID-19 Resources box near the bottom of the page. The Governor waived the one-week unpaid waiting period. There is more information on the EDD website.
If we reduce hours for staff, can they claim unemployment?
Yes, employees who have had hours reduced may also apply for unemployment insurance (UI). Contact www.edd.ca.gov and click on the COVID-19 Resources box near the bottom of the page.
Do we need to pay 3 months leave for staff?
This is a question that should be posed to the Ca EDD office. Employers planning a closure or major layoffs as a result of the coronavirus can get help through the Rapid Response program. For more information, refer to the Rapid Response Services for Business Fact Sheet or contact your local America's Job Center of California. There are also changes to requirements for Federal Emergency Medical Paid Sick Leave and Emergency Family Medical Sick Leave to be aware of. Legal counsel on this is advised.
This situation is fluid and things are changing daily, please check back frequently for updates. We will post the most recent updates on this page as soon as we have them. Thank you.