Coronavirus Disease 2019 (COVID-19)

School Mask Guidelines
DSHS COVID-19 Toolkit
COVID-19 Physician Wellness Guide

Messages from TPS President Dr. Tammy Camp

Messages from TPS Executive Director, Tricia Hall

For information on parenting resources related to COVID-19, please visit our Parent Resources page.
TPS/TMA Letter to HHSC re: Pediatrician Viability in Medicaid

Advocacy COVID-19 related efforts

Upcoming Events:

Recordings from Past Events:

  • CMS Lessons from the Frontlines: COVID-19
    Date: Friday, July 17, 2020

  • CDC COCA Webinar: Clinical Management of Multisystem Inflammatory Syndorome in Children (MIS-C) Associated with Covid-19
    Thursday, July 16, 2020
    During this COCA Call, clinicians will learn about clinical management of multisystem inflammatory syndrome in children (MIS-C) associated with Coronavirus Disease 2019 (COVID-19). Clinicians will share their experiences treating patients with MIS-C, present treatment details from published literature on patients with MIS-C, and provide an overview of the treatment guidelines published by the American College of Rheumatology.

  • Webinar Recording: Telemedicine Keys to Success
    Not sure where to start with Telemedicine? In light of COVID-19, many of you have "opened your doors" to telemedicine appointments. As a prequel to the TPS Annual Meeting, we are providing TPS members with a complimentary webinar to hone your telemedicine skills. If you are looking for telemedicine basics such as how to set up, manage, transform, best practices, address parent concerns, privacy and payment issues – this is the "101" you've been waiting for!

  • CMS Medicaid/CHIP Provider Relief Funds Webinars: CMS hosted 2 webcasts to answer questions about how to apply for the new Medicaid/CHIP Provider Relief Funds.  Youcan find a recording at the follwoing link.

    https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html

  • June 13th - Identifying Mental Health Issues, Child Abuse, and ACEs During a Pandemic: The TPS Committee on Mental Health is presenting a complimentary webinar on the possible impact of the COVID-19 pandemic on the mental health of children and adolescents and Adverse Childhood Experiences (ACEs). The webinar will include a discussion on ACEs and how pediatricians in the “telemedicine visit” arena can effectively identify child abuse in families, and screen for andidentify mental health disorders in the adolescent population.
  • June 4th - The Business Impact of COVID-19 On Pediatric Practices (Part 11): 6:00PM Central - "Join PMI's Paulie Vanchiere and PCC's Chip Hart as they follow up from the May 21st webinar where over 1,000 registered to learn about financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve."
  • May 21st - The Business Impact of COVID-19 On Pediatric Practices (Part 10): Video posted here. - "Join PMI's Paulie Vanchiere and PCC's Chip Hart as they follow up from the May 14th webinar where over 1,000 registered to learn about financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve."
  • May 19th - CDC COCA Call - Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19): "During this COCA call, clinicians will learn about the clinical characteristics of multisystem inflammatory syndrome in children, how cases have been diagnosed and treated, and how clinicians are responding to recently reported cases associated with COVID-19".
  • May 14th - The Business Impact Of COVID-19 On Pediatric Practices (Part 9): Recording posted here. - "Join PMI's Paulie Vanchiere and PCC's Chip Hart as they follow up from the May 7th webinar where over 1,000 people attended to learn about financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve."
  • May 7th - The Business Impact Of COVID-19 On Pediatric Practices (Part 8): Recording posted here. - "Join PMI's Paulie Vanchiere and PCC's Chip Hart as they follow up from the April 30th webinar where over 1,000 people attended to learn about financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve.As with the last webinar, we will bring in special guests to join the conversation so that practices can get the latest information they need to better prepare for the business impact of COVD19 on Pediatric practices..."
  • May 7th - Supporting Clinician Well-Being During COVID-19 Webinar: 12:30pm-2:00pm Central
    "The National Academy of Medicine (NAM)'s Action Collaborative on Clinician Well-Being and Resilience, which the ACGME co-chairs, is hosting "Supporting Clinician Well-Being During COVID-19," a 90-minute webinar Thursday, May 7 from 12:30-2:00 p.m. Central."
  • May 1st - The Science of Happiness, Health, and Well-being During COVID-19 - NIHCM Foundation
  • April 30th (Thursday) The Business Impact of Covid-19  on Pediatric Practices (Part 7): Recording posted here.  "This week's webinar will focus on marketing efforts practices around the country have utilized to engage with patients during the COVID19 pandemic and the impact their efforts have made to continue providing care for children."
  • April 25th - COVID-19 Update - National Academy of Sciences - 1PM CST
  • April 23rd (Thursday) The Business Impact of Covid-19  on Pediatric Practices (Part 6): Recording posted here.  "Join PMI's Paulie Vanchiere and PCC's Chip Hart as they continue their webinar series where over 1,000 people attended to learn about financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve.
  • April 22nd - FDA Regulatory Toolbox for COVID-19 Response, Research Highlights: Remdesivir, Hydroxychloroquine & Chloroquine - American College of Medical Toxicology - Recording posted here.
  • April 22nd (Wednesday) COVID-19 Conversations Webinar Series: COVID-19 Testing: Possibilities, Challenges, and Ensuring Equity- American Public Health Association - Recording posted here.
  • April 20th - TMA Tele-Town Hall Meeting on COVID-19 - Recording can be found here.
  • April 17th (Friday) CDC COCA Call: COVID-19 in the United States: Insights from Healthcare Systems: 1pm central -  Additional information can be found here.
  • April 16th (Thursday) CDC COCA Call: Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19): 1pm central - Additional information can be found here.
  • April 16th (Thursday) The Business Impact of Covid-19  on Pediatric Practices (Part 5): 6pm central - Recording posted here. Join PMI's Paulie Vanchiere and PCC's Chip Hart as they discuss financial and operational issues Pediatric practices are facing as 
  • April 7th (Tuesday) The Business Impact of Covid-19  on Pediatric Practices (Part 4): 6pm central - Recording posted here. Join PMI's Paulie Vanchiere and PCC's Chip Hart as they discuss financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve.  This webinar will provide tangible action items every Pediatric practice needs to consider over the coming days, weeks, and months.
  • April 2nd (Thursday) The Business Impact of Covid-19  on Pediatric Practices (Part 3): 6pm central - Recording posted here. Topics addressed include: SBA's Paycheck Protection Program (Forgivable Loan Program), Data Trends, Future Impacts (Short & Long Term), Well Visit Update, Legal Issues, and much more...
  • March 27th (Friday) CDC COCA Call 1 pm central - Underlying Medical Conditions and People at Higher Risk for Coronavirus Disease 2019 (COVID-19)
  • March 26th (Thursday) The Business Impact of Covid-19  on Pediatric Practices (Part 2) Click here to access the slide deck and video from this event - This webinar focused on Human Resource issues as related to staff & providers as well as follow up on key items discussed in the last webinar.
  • March 25th (Wednesday) CDC COCA Call COVID-19 Update: Optimization Strategies for Healthcare Personal Protective Equipment (PPE) - Recording found here: https://emergency.cdc.gov/coca/calls/2020/callinfo_032520.asp 
  • The Business Impact of Covid-19 on Pediatric Practices (Part 1) https://www.pediatricsupport.com/covid19 - Discussion of financial and operational issues pediatric practices are facing as COVID-19 continues to evolve and tangible actions for practices.

Printable Materials and Communication Toolkits:

Practice Finances:

Personal Protective Equipment and Testing:

  • New - Request PPE Through TMA Portal: Read about how to do this here. "Per the Texas Department of State Health Services (DSHS), physicians and other health care professionals who cannot obtain personal protective equipment (PPE) or other emergency supplies through their regular vendor and have exhausted other channels, such as other practices or facilities with PPE to spare, can submit a request for state-acquired PPE. Community physicians can request PPE for their practice, group, or office by completing the Texas Medical Association’s PPE Needs Assessment Request.(TMA members, and nonmembers with TMA website accounts, can log in using their TMA credentials. Others can create a new account.) Only one health care professional or staff member should fill out the form for each practice.

 These physician requests will be aggregated and sent to Regional Advisory Councils (RACs), which will allocate PPE for      counties in their region based upon need. County medical societies will have access to all PPE requests in their area and will fairly distribute to physicians the PPE they receive from RACs. TMA designed a prioritization system that will streamline allocation for societies. They can opt in to use this tool."

As of April 6, 2020, the Texas DSHS Laboratory has made the following changes regarding acceptable specimens for COVID-19 testing. 

The DSHS Interim COVID-19 Case Report Form (found at htps://www.dshs.texas.gov/coronavirus/public-health.aspxis no longer required with sample submission.

For further details, please see the COVID-19 Specimen Collection and Submission Instructions located on the DSHS Laboratory website

PUI ID is no longer required.  However, ALL specimens for COVID-19 testing require preapproval.   Contact your Local Health Department or DSHS Public Health Region (https://www.dshs.texas.gov/regions/2019-nCoV-Local-Health-Entities/) to ensure patient meets Patient Under Investigation (PUI) criteria for testing and to obtain DSHS approval to test. Specimens MUST meet DSHS PUI criteria prior to shipping and WILL NOT be tested without prior approval.  Please DO NOT ship specimens prior to receiving this approval.

             Includes information such as the following:
                  -Laboratory Testing
                  -Contact information for Local Health Entities for disease reporting and/or local assistance
                  -Guidance re: infection control & personal protective equipment (PPE) with links to additional CDC guidance.
                  -Instructions on Requests for Assistance from DSHS (PPE, etc.) :

                     “Hospitals and healthcare professionals should follow their normal process of trying to locate emergency medical    supplies, personal protective equipment (PPE), and other healthcare resources with their regular vendors and exhaust all possible options. These options may include contacting any sister facilities for coordination, reaching out to local partners or stakeholders, looking at any possible reallocations within the Public Health Region, Healthcare Coalition, Regional Advisory Council regions, or other medical supply agencies, given established priority groups. If hospitals and healthcare professionals cannot obtain any PPE from their vendor(s) and have exhausted all alternative options, they should send their official requests to their local office of emergency management via the STAR process. Please ensure you provide all relevant details for your request, to include type of item, POC information, and delivery address.”

  • DSHS Information on PPE (posted 3/22/2020)
  • CDC’s strategies for optimizing the use of eye protection, isolation gowns, facemasks, and N95 respirators: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
  • Region-Specific PPE Information:

    • Updated 4/24 - Region P (located here) Information on PPE Requests from Student Alliance for Emergency Response- They are focusing on clinics, including pediatric clinics, in San Antonio and surrounding areas. If you are in region P, you can fill out the Google Form below on behalf of your clinic to request PPE. They are not allowing pick-ups from the BCMS and are providing deliveries of PPE to pediatric clinics in Region "P". Recipients will be contacted using the information they provide on the Google Form. They highly recommend that the form be filled out by the physician or clinical manager for each pediatric clinic and that cell phone numbers be used when filling out the form.

       https://forms.gle/GTrRcptfRkMq7XDs7  

Telemedicine:

  • NEW: HHSC FAQ Document re: Texas Health Steps Telemedicine Well Child Visits
  • TMA List of Telephone Only Consultations and Payments: Lists payers and what they are currently covering. https://www.texmed.org/TexasMedicineDetail.aspx?id=53117&utm_source=Informz&utm_medium=Email&utm_campaign=TMT&_zs=gCJgK1&_zl=lv8g5
  • TMA Telemedicine Webpage: Provides a wide variety of information regarding providing telemedicine during the Coronavirus pandemic including how to get started, the latest updates, and information on different payer policies. https://www.texmed.org/Telemedicine/
  • HHSC Telemedicine Information for Medicaid and CHIP: Select Medicaid and CHIP Services dropdown on website: https://hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-covid-19-provider-information
  • AAP Telehealth information: AAP Guidance: Telehealth Payer Policy in Response to COVID-19 (outlines policy changes aiming to alleviate barriers to telehealth care) and webinar on telehealth and guidance on structuring your practice during the pandemic.
  • Texas Department of Insurance: 3/18/20 Notice from TDI:

    "Governor Greg Abbott waived certain regulations and directed the Texas Department of Insurance (TDI) to issue an emergency rule to help doctors across Texas continue to treat their patients while mitigating the spread of COVID-19. State actions include:
              
    -TDI filed an emergency rule requiring insurers to pay the same amount for telemedicine services, including   covered mental health services, as they do for in-person services. The rule applies to in-network services for state-regulated health plans.
    -Governor Abbott suspended a state law limiting insurance coverage for medical visits and consultations by phone.
    -The Governor approved the Texas Medical Board's (TMB) request to suspend state rules blocking the use of phone consultations to establish a physician-patient relationship. Before the change, telemedicine services could be provided only after the physician-patient relationship had been established during an in-person visit...

    State-regulated plans cover about 15% of the Texas market, including plans purchased through Healthcare.gov. The insurance cards for state-regulated plans have either 'DOI' (for department of insurance) or 'TDI' (Texas Department of Insurance) printed on them."

         Governor’s news release
         TDI emergency rule
         FAQs on TDI rule

Well Child Visits:

Centers for Disease Control and Prevention:

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-

testing.html https://www.whitehouse.gov/wp-content/uploads/2020/05/Testing-Guidance.pdf

  • Added 5/14- CDC issued a Health Advisory on Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19):

On May 14th, the CDC issued a Health Advisory on Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19).

"The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.

Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C)

  • An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
  • No alternative plausible diagnoses; AND
  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

iFever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
iiIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin

Additional comments

Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C

Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection"

Texas Department of State Health Services:

  • NEW (8/27) - DSHS COVID-19 Toolkit - Recently, the Texas Department of State Health Services (DSHS) created COVID-19 communication tools to help you operate your business safely. Tools include videos, social media graphics and animations, plus printable posters. You also have access to minimum recommended health protocols for safe operation. Materials are available in English and Spanish.

    The materials promote health safety practices. You can display posters in high-traffic areas such as entrances, lobbies, restrooms and break rooms. You can post social media content on your channels. You can also feature these messages in employee communication. And you can share these resources with others to use.

    To access these materials, please visit the DSHS COVID-19 Communication Tools webpage.
  • Preliminary Impact of COVID-19 on Vaccines - Texas Department of State Health Services
  • DSHS Interim Guidance for Persons Isolated at Home, including Healthcare Personnel, with Confirmed COVID-19 (PDF, V.2.0, updated 4/13/2020)
  • April 13th - COVID-19 Testing Notice: DSHS Austin Laboratory:

    "As of Monday, April 13, 2020, the Texas DSHS Austin Laboratory will begin utilizing the PerkinElmer New Coronavirus Nucleic Acid Detection Kit and chemagic extraction platform to expand capacity for COVID-19 testing. The CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel will continue to be available until current supply resources are exhausted.

    Please continue to use the COVID‑19 Specimen Collection and Submission Instructions located on the DSHS Laboratory website for specimen collection, handling, and shipping guidance.

    ALL specimens for COVID‑19 testing require preapproval. Contact your Local Health Department or DSHS Public Health Region to ensure patient meets Person Under Investigation (PUI) criteria for testing and to obtain DSHS approval to test. Specimens MUST meet DSHS PUI criteria prior to shipping and WILL NOT be tested without prior approval. Please DO NOT ship specimens prior to receiving this approval."

  • DSHS Notice regarding testing and submission of specimens for COVID-19 testing to the DSHS Austin Laboratory:

As of April 6, 2020, the Texas DSHS Laboratory has made the following changes regarding acceptable specimens for COVID-19 testing. 

The DSHS Interim COVID-19 Case Report Form (found at htps://www.dshs.texas.gov/coronavirus/public-health.aspxis no longer required with sample submission.

For further details, please see the COVID-19 Specimen Collection and Submission Instructions located on the DSHS Laboratory website

PUI ID is no longer required.  However, ALL specimens for COVID-19 testing require preapproval.   Contact your Local Health Department or DSHS Public Health Region (https://www.dshs.texas.gov/regions/2019-nCoV-Local-Health-Entities/) to ensure patient meets Patient Under Investigation (PUI) criteria for testing and to obtain DSHS approval to test. Specimens MUST meet DSHS PUI criteria prior to shipping and WILL NOT be tested without prior approval.  Please DO NOT ship specimens prior to receiving this approval.

Texas Health and Human Services Commission:

  • NEW: HHSC FAQ Document re: Texas Health Steps Telemedicine Well Child Visits
  • NEW 5/26/19: HHSC has moved to extend the following Medicaid/CHIP flexibilities through June 30, 2020:
    • Telemedicine/audio only delivery of Texas Health Steps “well child” check-ups (original notice posted to TMHP 5/12/2020)
    • Telemedicine/audio only delivery of “acute care” E&M codes (99201-99205; 99211-99215) (original notice posted to TMHP 3/20/2020)
    • Telemedicine/audio only delivery of certain behavioral health services (90791, 90792, 90832, 90834, 90837, 90846, 90847, 90853, H0038, 99408, G2011, H0049, H0001, H0004, H0005, H0034, H2011, H2012, H2014, H2017) (original notice posted to TMHP 3/20/2020)
    • FQHC and RHC reimbursement for telemedicine and telehealth services (original notice posted to TMHP 4/2/2020)
    • Waiver of office visit co-pays in CHIP (original notice posted to TMHP 4/2/2020)
      The official TMHP notices should be posted shortly. The HHSC provider-facing COVID-19 website will be updated shortly to reflect these extensions. Please note that this a non-exhaustive list of extensions.
  • April 10th Notice re: EMS:
    EMS providers and personnel- Due to the current COVID-19 state of disaster in Texas, the Department of State Health Services (DSHS) requested and the Office of the Governor granted EMS waivers and extensions.
    EMS/Trauma Systems - Designated Facilities:
    Due to the suspensions of onsite reviews affecting all designation programs, facilities may request an extension to their designation expiration date.
    View complete details on the Office of EMS/Trauma Systems website.
     
  • March 27th Notice re: Ambulatory Surgical Center Services and Reporting Requirements:

    "GL 20-2012 IMMEDIATE ATTENTION REQUIRED Ambulatory Surgical Center (ASC) Services and Reporting Requirements in Response to COVID-19

    GL 20-2012 related to ASC services and reporting requirements in response to COVID-19 has been posted. ASCs are now permitted to:

  • Expand their services beyond surgical services,
  • Keep patients longer periods of time in response to the COVID-19 pandemic.                                     
  • Licensed ASCs must IMMEDIATELY do the following:

  • Report the number of functioning ventilators and other respiratory support equipment it has, and any other information as required, to the Department of State Health Services (DSHS), using the form found at this link: https://app.smartsheet.com/b/form/d8a40549d4f64694b9022854a09d4884.
  • Please read the letter at the link and if you have questions regarding the letter, contact HCQ_PRT@hhsc.state.tx.us.

  • March 27th Notice: Albuterol Shortage Prompts Change in Preferred Status- Please see the notice below from the Texas Health and Human Services Commission: "On March 21, VDP changed the preferred drug list status of certain Albuterol products from non-preferred to preferred. This is a temporary change to address reported drug shortages for short-acting agents in the bronchodilators, beta agonist drug class. The full list of drugs is available on the VDP website.

This change allows providers to prescribe these drugs without requiring a non-preferred prior authorization and allow        people on Medicaid continued access to necessary medication. VDP will continue to update providers on the status these drugs.

Contact vdp-formulary@hhsc.state.tx.us for questions or more information."

Texas Medical Board:

Texas Department of Insurance:

  • 3/18/20 Notice from TDI:

"Governor Greg Abbott waived certain regulations and directed the Texas Department of Insurance (TDI) to issue an emergency rule to help doctors across Texas continue to treat their patients while mitigating the spread of COVID-19. State actions include:

Governor's Office:

Johns Hopkins Center for Systems Science and Engineering:

American Academy of Pediatrics:

"As COVID-19 continues to spread in communities, pediatricians can prepare to handle suspected cases in their patient population in the same way they prepare for other infectious disease outbreaks, such as influenza or RSV. The same principles apply:

-Keep children out of the health care system if it's not necessary
-Advise individuals to stay home if they are sick.
-Review infection-control measures. This can include asking patients with symptoms to call ahead, so they can be evaluated in isolation from other patients.
-Collaborate with hospitals and health systems on local response and to prepare for surges. 
-Check with local and state health departments for information on specific local and state responses.

We have also heard from members that children and adolescents in their practice have expressed fear and anxiety about the outbreak. Pediatricians can be a calm, reassuring voice that can help alleviate these fears. 

As a general pediatrician myself who has been in practice through especially severe RSV and flu outbreaks, I understand how important it is to remain reassuring to worried parents, clear in my guidance and practical and transparent in my approach to talking to patients who are old enough to understand what's going on.

David Schonfeld, MD, FAAP, a member of the AAP Council on Disaster Preparedness and Recovery, recommends keeping the conversation straightforward and direct, while avoiding graphic details. More information is available in the HealthyChildren.org article on talking to children about disasters and other events in the news.  He also offers advice specific to COVID-19 in this interview for CNN.

AAP also offers general information for parents on COVID-19 in the HealthyChildren.org article authored by H. Cody Meissner, M.D., FAAP. This article will be updated to reflect the most recent information as the outbreak evolves. 

AAP continues to be in close communication with leaders at the Centers for Disease Control & Prevention. We are committed to providing you with updates and information about practice recommendations and infection-control measures as it is developed.  

Updated information will also be posted on the Red Book Online Outbreaks page and in AAP News."

Texas Medical Association:

World Health Organizaiton:

National Institutes of Health:

National Library of Medicine:

Mountain State Genetics: