The federal government is continuing to respond to COVID-19 with a series of emergency congressional legislative actions. Following President Trump’s signing of the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R. 6074) on March 6, a second emergency response package (H.R. 6201), the Families First Coronavirus Response Act, was enacted on March 18.
While the majority of this multi-billion-dollar bill addresses broader economic issues such as emergency paid leave and unemployment/food security funding, there are several key provisions of immediate interest to healthcare providers.
Cost Sharing Prohibited for COVID-19 Testing, Regardless of Payer
The United States is currently grappling with challenges related to COVID-19 screening and testing, including the availability of FDA-approved tests. Top of mind for legislators are the potential patient costs and provider reimbursement associated with COVID-19 testing. H.R. 6201 aims to immediately alleviate those concerns.
This legislation specifies any ACA-compliant commercial insurance plan, Medicare or Medicare Advantage plan, and state Medicaid or CHIP plan cannot impose any patient cost-sharing elements—including deductibles, copayments, and coinsurance—for diagnostic testing associated with COVID-19. The bill also includes $1 billion in funds from the National Disaster Medical System to reimburse providers for the costs of testing uninsured individuals. Similar “no cost-sharing” provisions have also been added for TRICARE, veteran coverage, and anyone covered by the Indian Health Service.
Creation of New Claims ModifierCost sharing is also prohibited for services related to COVID-19 testing under Medicare. The US Department of Health and Human Services will create a new modifier to specify COVID-19 testing-related services, which can be used for the following categories of HCPCS evaluation and management (E&M) codes:
Paid Leave Exemption for Health Workers
While H.R. 6201 specifies up to 12 weeks of paid sick time and outlines public health emergency leave requirements, one notable exception called out is that an employer can elect to exclude healthcare providers or emergency responders from this benefit. This is a noteworthy exemption as providers begin to wrestle with acute workforce shortages as a result of COVID-19.
Workforce challenges may continue to increase as practitioners or their families contract COVID-19 and/or attempt to address child care needs. This provision gives healthcare employers a lever to maintain staff in a period that is predicted to put massive strain on the healthcare workforce.
The last seven days have seen a flurry of activity from health systems and hospitals that are attempting to address the demand for COVID-19 screening and testing. As the availability of COVID-19 diagnostic tests grows, the Family First Coronavirus Response Act will enable more testing for patients, regardless of their payer source, and will ensure that providers are reimbursed for providing that care.
There is likely to be additional COVID-19 emergency legislation, including a predicted “phase three” of legislative action that we will continue to monitor for healthcare implications.Additional ResourcesThe funding package passed Congress on March 6 expands telehealth options for providers. CMS offered additional guidance on telehealth shortly thereafter.
With an expected influx of COVID-19 cases, now is the time for hospitals to focus on capacity planning.
Concerned how coronavirus will affect accountable care organizations? Policies based on reactions to previous emergencies may offer clues to how CMS will respond to financial losses.