May 10, 2020
Additional COVID-19 Pandemic Healthcare Regulatory Changes
The COVID-19 pandemic continues, with the US being the current epicenter of the crisis. As of the first week in May, the worldwide death count reached nearly a quarter of a million people. Of that total, almost 80,000 deaths were in the US. Experts don't agree on the duration and severity of the viral outbreak. Still, they do agree that life will not return to normal until a vaccine or effective treatment is developed. In the meantime, Congress and the Trump Administration have created a second round of healthcare regulatory changes to battle the COVID-19 pandemic and support the healthcare system. Recent legislation and guidelines have been enacted to help contain the virus and support safely reopening the economy.
COVID-19 Diagnostic and Antibody Testing
COVID-19 testing has been a problematic issue in the US. Originally, the CDC made errors in their diagnostic testing that delayed implementation. After that initial issue, the government has had difficulty getting enough accurate tests and testing supplies to the states.
In the latest legislation, additional funds were allocated for the Paycheck Protection Program (PPP), but in that bill, money was also provided to increase healthcare efforts. Testing programs received $25 billion, and hospitals received $75 billion in addition to the $100 billion already allotted in the CARES ACT. The testing efforts will include identifying people who have already had the virus and who may have some degree of immunity due to antibodies in their blood. However, the medical community doesn't have enough evidence yet to determine if an immunity to the virus exists or how long it may last if it does. Also, the government, with the help of private insurance companies, has made coronavirus testing free for all Americans.
Coronavirus Treatment Costs
The average hospitalization cost for coronavirus treatment is around $30,000 per patient. CMS and private healthcare insurers are working to cover part or all of those costs so that Americans will seek treatment when they need it. Some people may have avoided going to the doctor or the emergency room because they worried about the expense of testing and hospitalization.
The healthcare.gov website is working to help people by allowing them to get or alter coverage due to employment changes and reduced income. People who are working fewer hours than before may qualify for lower premiums. Some Americans may be eligible for a special enrollment period depending on their individual circumstances.
CMS Waivers and Adjustments
Several CMS adjustments were released earlier this year, and further modifications have been added in the last few weeks. These new adjustments include the following:
Telehealth Regulatory Changes for COVID-19
Many regulatory restrictions for telehealth services were changed in early March for assisting in the fight against COVID-19 . CMS is also expanding the list of provider types who can bill for telehealth services rendered from a remote site. Now any provider who is allowed to bill Medicare for professional services may be reimbursed for telehealth services. Occupational therapists, physical therapists, speech pathologists, and other service providers are now allowed to charge for telehealth visits.
Also, providers can bill for audio-only telehealth in some instances, which has been broadened to include behavioral health and patient education services as well as certain evaluation and management (E&M) services. Payments for telephone visits have been increased to match similar office and outpatient visits, and payments are made retroactive to March 1, 2020.
ACOs and Medicare Shared Savings Program (MSSP) Regulatory Changes for COVID-19
CMS is also making regulatory changes for COVID-19 to the financial methodology for Accountable Care Organizations (ACOs) to be treated the same regardless of the affect COVID-19 is having on their patient population. This means relinquishing the annual application cycle for 2021 and giving a choice to extend for those ACOs whose participation is set to end this year. Another update allows ACOs to have the option to maintain their current risk level for next year, instead of being advanced automatically.
Reopening Guidelines Changes for COVID-19
The federal government issued guidelines in April for states to follow before reopening their economies. These recommendations are suggestions since states make the final decision to reopen. For instance, the guidelines suggest that a state should experience falling infection rates for 14 days before reopening, but states such as Georgia have decided not to follow that recommendation. Other states, such as New York, are adhering to the guidelines.
In addition, the CDC has released recommendations for preparing workplaces and schools for reopening, emphasizing disinfection, and social distancing. The cleaning process is vital for keeping people safe, and the CDC's process for proper disinfection is exhaustive. When businesses reopen, the staff will be spending hours every day cleaning all surfaces with various effective cleaning solutions.
Social distancing will remain a preventative staple, which means restaurants will need to limit their capacity by half or more. School districts are considering offering split shifts for their students to reduce crowding.
Healthcare Fund Distribution for COVID-19
The CDC will soon be disbursing government funds to state and local jurisdictions to further battle COVID-19. Through the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases cooperative agreement, the CDC will be handing out $631 million to 64 jurisdictions to help states safely reopen their economies. These funds will assist with:
- Assist with identifying positive cases and provide contact tracing
- Implement containment measures
- Improve morbidity and mortality surveillance
- Excellerate testing capacity
- Protect vulnerable or high-risk populations by reducing COVID-19 in high-risk settings such as assisted living facilities (ALF) and special needs facilities (SNF)
- Assist healthcare systems with capacity management
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