By Haley Nicholson and Samantha Scotti
With an increase in COVID-19 cases across the U.S., the federal government and states are working to ensure that access to health care does not hold people back from getting COVID-19 testing and services.
The recently passed Coronavirus Aid, Relief and Economic Security (CARES Act) and the Families First Coronavirus Support Response Act, the second surplus package that passed before the CARES Act, both include provisions to ensure patient access to and the affordability of COVID-19 testing and treatment.
The Families First Coronavirus Response Act also requires insurers and Medicare Part B to cover a COVID-19 vaccine without cost-sharing, once a vaccine is developed and approved.
In terms of access to care, the CARES Act requires health insurers to reimburse providers for all COVID-19 testing and related visits, with costs based on the cash price the provider lists online. Providers won’t have to list prices online if they have a previously negotiated rate or negotiate a new rate that is less than the cash price. Providers who do not list prices online during the emergency could be penalized up to $300 per day.
Health insurance plans and providers can also take immediate steps to register with the National Disaster Medical System to begin receiving reimbursement for providing services to uninsured patients. Plans and providers will also need to establish systems to track these services and reconcile payments retroactively if coverage and reimbursement rules change in the future.
With pending stimulus packages coming from Congress and further actions by the administration, providers and plans should plan for additional regulatory requirements.
The CARES Act also contains $100 billion for the Public Health and Social Services Emergency Fund that will only cover non-reimbursable expenses attributed to COVID-19. The fund has been designed to immediately respond to providers’ needs. The Department of Health and Human Services (HHS), which is expected to release guidance on the application process soon, has been instructed to review applications made to the fund and make payments to qualified applicants on a rolling basis. Some of the expenses that can qualify for funding include:
- Building or retrofitting new intensive care units.
- Increasing staff or staff training.
- Personal protective equipment.
- Building temporary structures.
Other provisions included in the bill that will help providers with unexpected costs and lost revenue include Medicare payment support for community health centers.
The administration has also released guidance on new flexibilities for federal health programs from Centers for Medicaid and Medicare Services and HHS. Private insurers have also made several announcements on covering patient costs related to COVID-19 treatment including waiving copays and coinsurance cost sharing. Find out more about what providers are doing during this time.
States have also taken action to ensure individuals have access to affordable testing and treatment. Many state policymakers are looking to reduce or waive cost-sharing requirements for testing and treatment (such as co-payment, deductible or coinsurance). Others states aim to ensure continuity of coverage by allowing longer grace periods for premium payments or placing moratoriums on the cancellation of insurance policies for the non-payment of premiums. For individuals without health insurance, 11 states and the District of Columbia have created a special open enrollment period on their state-based exchange allowing anyone to buy a plan.
Ensuring access to COVID-19 testing and other related services is critical at this moment. Federal and state officials are working to ensure access and that costs do not deter individuals from the services they need, which is an important part of addressing the overall impact of this pandemic.
Haley Nicholson is senior policy director in NCSL's State-Federal Relations Division.
Samantha Scotti is a senior policy specialist in NCSL's Health Program.