The COVID-19 pandemic has brought an unprecedented strain on health care communities worldwide as we rush to flatten the curve. Federal and state governments in the United States have been putting out a flurry of new policies to help facilitate care and coverage of care. We have compiled these policies and will discuss how insurers, with the right technologies in place, can best respond to the policies to quickly solve this crisis.
Federal policies:
• The Centers for Medicare and Medicaid Services (CMS) required Medicare Advantage and Part D prescription drug plans to waive cost-sharing for testing and treatment of COVID-19, including emergency room and telehealth visits.
• The U.S. House of Representatives approved an $8.3 billion funding bill for ongoing COVID-19 efforts. The legislation also grants HHS the authority to temporarily waive or modify certain Medicare requirements like geography and site origination for telehealth services provided during the emergency period.
• CMS announced new flexibility protections for providers, including waiving requirements that critical access hospitals limit the number of beds to 25 and length of stay to 96 hours; enabling acute care hospitals to house acute care patients in a separate unit; waiving replacement requirements when durable medical equipment gets damaged or unusable; allowing long-term care hospitals to exclude patient stys from the 25-day average length requirement.
• CMS also announced new waivers for states and territories for Medicare, Medicaid and the Children’s Health Insurance Program. States can seek waivers for prior authorization requirements in fee-for-service programs, and can temporarily suspend particular provider enrollment and revalidation requirements. They can also waive requirements physicians and other professionals be licensed in the state where they provide services, as long as they have equivalent licensing in another state.
• The U.S. Food and Drug Administration granted emergency use authorization for two new commercial COVID-19 diagnostic tests.
• The Trump Administration announced that telehealth services would be covered by Medicare.
• The Internal Revenue Service put out guidance that health saving account (HSA) eligible high deductible health plans can pay for COVI-19 related testing and treatment without jeopardizing their status.
• CMS published FAQs detailing existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19. The FAQs clarify which COVID-services qualify as essential health benefits.
• CMS issued a memorandum that allows Medicare Advantage Organizations to make changes benefiting enrollees, including reductions in cost-sharing and waiving prior authorization. MAOs may also waive or reduce enrollee cost-sharing for COVID-19 lab tests, telehealth benefits or other services.
State policies:
• New York, California, Washington, Vermont, Maryland, Nevada and Oregon have required state insurers to waive fees related to COVID-19 testing.
• Colorado, Connecticut, California and other states created new special enrollment periods for uninsured people to enroll in coverage amidst COVID-19, especially as people lose jobs and therefore insurance in some cases.
• The Trump administration has approved the first state Medicaid waiver in Florida. Florida will waive prior authorization requirements, simplifying the process for out-of-state providers to provide care, allow care in alternative settings, suspend certain nursing home screen requirements to lower administrative burden and extend deadlines for appeals and state fair hearing requests.
Insurer policies:
• After insurer executives met with Vice President at the White House in which the Vice President said insurers would waive cost-sharing for COVID-19 testing and expand coverage for treatment, major private insurers have said they will cover COVID-19 testing. Some have agreed to waive telehealth costs or co-pays.
For insurers to respond to these policies efficiently, it is important that their technology is easily configurable to the changes that must be made. For example, insurers operating in states with new special enrollment periods (SEP) must have technology that can quickly put this new demand in place. Softheon’s agile technology is flexible enough to address new SEPs, elongated grace periods and more.
Plus, our technology is powered by automated processes, so even as we have a virtual workforce, the important work of making healthcare affordable, accessible and plentiful continues during these unprecedented times.