By Erik Skinner
People with underlying heart or lung conditions or compromised immune systems have a significantly higher risk of severe complications and death from COVID-19.
These diseases are also among the most prevalent chronic diseases in the United States and people with these conditions make up a significant part of the population. Since the onset of the pandemic, there has also been a decline in treatment due to a range of suspected causes including fears about contracting the virus in a health care setting, stress on emergency rooms and others factors.
Providers and health systems responded with an emphasis on routine and acute care for people with chronic conditions, as well as stressing healthy behaviors that can mitigate the symptoms or progression of chronic conditions.
Federal agencies, state lawmakers, governors, state agencies and private insurers have taken action to increase the capacity of the U.S. health system to control the spread of the virus and provide care to people with chronic conditions. Strategies include increasing telehealth use, providing funding for health providers and facilities and relaxing restrictions around delivering care.
Below are examples of how state legislatures have collaborated with health systems and state and federal agencies in the response to COVID-19, with a focus on policies that have facilitated the continuity of care for people with chronic conditions.
Due to unprecedented action at the federal, state and local levels, telehealth use increased nearly 12 times the daily average between March 14 and April 1. The increased use of telehealth across Medicaid, Medicare and private insurance allows providers and health systems to safely evaluate potential COVID-19 cases and continue essential care to populations with chronic conditions.
During the pandemic, at least four state legislatures enacted laws to support the use of telehealth. Alaska and New Jersey laid out licensure and professional requirements for providers conducting a telehealth appointment before an in-person visit. An enacted bill from New Jersey requires Medicaid and private insurance carriers to cover any telehealth services that would be covered in-person during the COVID-19 pandemic. Maine’s bill allows the state Medicaid program to reimburse for at least a portion of case management services provided via telehealth. Vermont’s bill allows for the expanded use of telemedicine for health, mental health and dental services, requiring reimbursement from Medicaid and private insurers.
Physicians and other providers for people with chronic conditions are also facing financial difficulties due to the COVID-19 pandemic. Providers and health care employees in hospitals, clinics, community health centers, school health centers, nursing homes and many other settings are seeking funding in order to stay open and provide care.
The Minnesota Legislature enacted SB 4334 to provide at least $1 million in grants to providers to plan for and respond to the pandemic. The Pennsylvania General Assembly enacted SB 841 which requires the Health Cost Containment Committee to author a report measuring the impact of COVID-19 on hospitals and health care facilities to determine estimates for federal assistance requests. Among other things, these programs allow providers to stay open and provide essential care to people with chronic conditions in the short term and a financial path forward for the long term.
Federal agencies also stand ready to assist state agencies and legislators to address continuing care for people with chronic conditions. The Centers for Medicare and Medicaid Services can provide guidance on final rules from the agency and answer questions about waivers for Medicaid requirements or state plan amendments. The Health Resources and Services Administration’s Bureau of Primary Health Care also offers funding and resources for states, health care systems and health care providers. In addition, the CARES Act recently included $1.3 billion in funding for community health centers.
Disease-specific organizations such as the American Cancer Society and the American Heart Association, patient access organizations such as the Alliance for Patient Access, and setting-specific organizations like the National Association for Community Health Centers can be helpful sources to learn more about specific challenges.
Erik Skinner is a policy associate in NCSL’s Health Program.