Congress Passes Interim Bill Replenishing Resources for Small Businesses

An interim spending bill injecting $484 billion into COVID-19 stimulus programs has passed in Congress and is expected to be signed by the President as early as today. The majority of the funds will go towards replenishing SBA loan programs which ran out of appropriations last week. The remainder will go towards the healthcare system and testing programs. The funding will be distributed as follows:

  • $310 billion to the Paycheck Protection Program (PPP)
  • $60 billion to the Economic Injury Disaster Loan (EIDL) program
  • $75 billion to the HHS Provider Relief Fund – this is additional funding outside of the $100 billion initially allocated by the CAREs act
  • $25 billion to HHS to expand testing capabilities for facilities
  • $11 billion to states to expand testing capabilities

HHS Reimbursing COVID-19 Claims for the Uninsured

As previously communicated, starting April 27th, clinicians who have provided COVID-19 care of uninsured patients since February 4th can now sign up for a new program to be reimbursed for claims. The program will use the current year Medicare Physician Fee Schedule for reimbursement rates. Like the HHS Provider Relief Fund Payments, participants must agree to accept the terms and conditions of the program which have not been made available at this time. However, the HHS website on the program does state that providers will need to agree to not balance bill patients and will be subject to an audit review.

The program will cover the following types of claims:

  • COVID-19 testing-related visits including in the following settings: office, urgent care, or emergency room or via telehealth.
  • Specimen collection, diagnostic and antibody testing for COVID-19
  • COVID-19 treatment (including FDA approved drugs once available) which is administered in most settings.
  • COVID-19 vaccinations once they become available.

The program will not cover claims for treatment where COVID-19 is not the primary diagnosis (except in cases of pregnancy where COVID-19 would be the secondary diagnosis), hospice services, water or air ambulance services, and outpatient drugs covered under Medicare Part D.

For Advocate clients who choose to participate, they will need to inform us of that decision to enroll and will also need to create a unique insurance code in their system for uninsured COVID patients. This code should come over as the patient’s only insurance.

More information on the process of submitting claims will be made available once providers are able to sign up for the program on April 27th. The website for the program is available HERE.

For our earlier summary on the updates from HHS, CLICK HERE.

Plans on Re-Opening Released

As previously communicated, both the White House and CMS released their recommendations for states seeking to reopen their economies. For our earlier summary, CLICK HERE.

However, it is ultimately up to the governors to decide exactly when and how to reopen their state. The National Governor’s Association has released their own plan, a ten-step approach, which first focuses on building public health infrastructure before taking steps on reopening the economy. Key areas of the plan overlap with parts of the federal recommendations but also provide states with details on how to execute each step. The full plan is available HERE.

Most states are still in the process of releasing the full details on their reopening strategies so the extent as to how closely Governors will adopt these guidelines is still unclear.

HHS/CMS Launch New Resource Website for COVID-19

The Department of Health and Human Services, in partnership with CMS, launched a tool kit to aid healthcare decision makers in addressing workforce concerns related to the COVID-19 pandemic.  The website consolidates links to information released since the declaration of the health emergency and provides an ‘information sharing page’ where groups can share their own COVID-19 resources with each other. The website is available HERE.

CMS Updates Guidance Available for Plan Issuers on Prior Authorization, CAREs Act Implementation

CMS released an updated memo to all Medicare Advantage Organizations, Part D Sponsors, and Medicare-Medicaid Plans providing further details to flexibilities that can be implemented during the pandemic. This information supersedes their initial directions given earlier in March and largely pertains to COVID-19 testing, telehealth, involuntary disenrollment, and prior authorizations. Specific to prior authorizations, CMS states that plan facilitators may choose to waive or relax plan prior authorization requirements at any time in order to facilitate access to services with less burden on beneficiaries, plans, and providers. The full memo is available HERE.

In a separate memo released simultaneously, CMS addresses private payors on implementing flexibilities to prior authorization and utilization management during the pandemic. In the document, CMS states “we encourage issuers to relax otherwise applicable utilization management processes, as permitted by state law, to ensure that staff at hospitals, clinics, and pharmacies can focus their limited time and resources on care delivery, and to ensure that patients have no delay in receiving needed care.” The full memo is available HERE.

As always, ADVOCATE strives to keep you up to date on the changes impacting your business during these unprecedented times.

Todd Walker         

Kirk Reinitz