- CMS took further action Tuesday to ease access for people affected by the novel coronavirus. For Medicare Advantage and Part D plans, the agency is requiring them to waive cost-sharing for testing and treatment of COVID-19, including emergency room and telehealth visits.
- The changes, mirroring earlier steps from commercial payers, come as the United States hit the grim milestone of more than 1,000 cases reported. Insurance executives met with White House officials on Tuesday and promised, among other actions, to forego any coronavirus-related surprise billing.
- Also Tuesday, the Centers for Disease Control and Prevention rolled back guidance on the type of masks healthcare workers should use when caring for COVID-19 patients, saying facemasks "are an acceptable alternative when the supply chain of respirators cannot meet the demand." A nurses union decried the change, saying it will "gravely endanger nurses, health care workers, patients, and our communities."
Federal public health agencies continue to ramp up efforts to respond to the coronavirus outbreak in the U.S. amid reports of how attempts at early intervention were botched. More states declared public emergencies Tuesday and more Americans are being asked to work from home or self-quarantine if they have COVID-19 symptoms.
The number of reported confirmed cases in the U.S. is likely to jump as testing becomes more widely available. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said Tuesday nearly 80 state and local public health labs have the capacity to test 75,000 people. The big commercial labs Quest Diagnostics and LabCorp have made tests available in recent days, and she said within the next couple of weeks the majority of tests will likely come from that sector.
The changes from CMS announced late Tuesday include removing MA and Part D prior authorization requirements, waiving prescription refill limits and easing restrictions on prescription delivery. Older people are at a particularly risk from COVID-19, according to public health officials.
CVS made a similar announcement Monday, saying it would waive prescription delivery charges. Those most vulnerable to the disease have been told to keep extra supplies of necessary medication on hand.
CMS has already rolled back some Medicare restrictions on telehealth services, enabled in an $8.3 billion funding package last week. That included removing geographic and site origination regulations.
All the major private payers have said they will cover COVID-19 testing and some are waiving telehealth costs or co-pays so that more people can receive treatment without leaving their homes. Those actions, however, won't necessarily remove cost barriers for patients. Most payers have not extended the coverage promises to employers' self-insured plans that cover the majority of Americans. And the companies have not addressed other issues that can keep people from seeking services, like high deductibles.
When you hear an insurer is covering COVID-19 testing, here are some questions to ask:— Larry Levitt (@larry_levitt) March 10, 2020
What about the cost of the doctor or ER visit?
What about copays and deductibles?
Could there be surprise bills from out-of-network labs?
What about the 61% of workers in self-insured plans?
President Donald Trump and Vice President Mike Pence met payer executives at the White House on Tuesday afternoon. "[W]e want the American people to know that they are covered through private insurance," Pence said. "They are covered through Medicare and Medicaid. And there will be no surprise billing."
For hospitals, one of the biggest concerns has been supplies of personal protective equipment, and masks in particular. Hospital associations from California and New York told Healthcare Dive earlier this week some of their members have dipped into emergency stockpiles of PPE.
The FDA had already said healthcare workers could use N95 masks not specifically approved for their settings, such as those typically used for construction work. But facemasks offer even less protection. HHS is buying 500 million N95 masks over the next 18 months for the Strategic National Stockpile, but with community spread established in multiple places in the U.S., shortage worries are mounting.
The supply chain crunch prompted CDC's updated guidance, posted Tuesday, for providers who don't have enough respirators. "Special care should be taken to ensure that respirators are reserved for situations where respiratory protection is most important, such as performance of aerosol-generating procedures on suspected or confirmed COVID-19 patients or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella)," CDC said.