COVID Impact On U.S. Health Insurers Less Than Expected

Best's: COVID Impact On U.S. Health Insurers Less Than Expected ...Source: Business Wire

The first-quarter 2020 earnings of publicly traded U.S. health insurance companies show that the impact of the COVID-19 pandemic has been less severe than anticipated, according to a new AM Best commentary.

The Best’s Commentary, titled, “COVID-19 Impact on Health Insurance Companies Smaller Than Expected,” notes that while there have been more than an estimated 1.5 million reported cases of COVID-19 across the United States, the majority of the individuals diagnosed have not been hospitalized and have been isolating at home. For health insurance companies, the decline in medical care for non-COVID conditions has more than offset the impact from COVID-19 claims. Sicne the deferral of medical care did not begin until the last few weeks of March, concurrent with the dramatic rise of COVID-19 cases, the impact was not meaningful in first-quarter statutory earnings. AM Best expects claims to increase in the second half of 2020, as many states re-open and allow providers to schedule elective procedures and conduct routine care office visits, assuming the pandemic subsides.

According to the commentary, first-quarter 2020 statutory earnings will decline year over year, primarily driven by the return of the health insurer fee (HIF), which is expensed in full in the first quarter. Health insurers largely pass on the HIF, which is approximately $15.5 billion in 2020, via premiums, and as a result, earnings will normalize over the course of the year.

Claims volumes could decline again if there were to be a second wave of COVID-19, which could again lead to the deferral of non-essential surgeries and visits. Additionally, consumers and providers have embraced tele-health/virtual visits as an alternative to in office care, a trend that is likely to continue. Certain carriers have reported that the number of tele-health visits increased substantially in the first quarter of 2020, and are even paying at parity in the short-term with an actual face-to-face office visit.

The impact from job losses also has not yet manifested into enrollment decline for health insurance companies; however, the risk of enrollment losses increases the longer the COVID-related closures persist. AM Best is maintaining a stable market segment outlook on the U.S. health insurance segment, and will continue to monitor enrollment, premium and new business trends as they develop in the second quarter.

Protests Could Cause Infection Surge; Over 4,000 Dead In California

Sacramento teen at protest shot in face with rubber bullet | The ...

Source: The Sacramento Bee, by Vincent Moleski

As massive protests over the death of George Floyd spread across the country, concerns are being raised over possible coronavirus transmission given close contact.

Health experts who spoke with The Associated Press said there is a distinct possibility that asymptomatic people arriving at protests have the potential to infect many others without knowing it.

Although many of the protesters in Sacramento were seen wearing masks ranging from bandannas — which are only somewhat effective — to medical-grade N95 masks, many others were not.

“If you were out protesting last night, you probably need to go get a COVID test this week,” Atlanta Mayor Keisha Lance Bottoms told AP. “There is still a pandemic in America that’s killing black and brown people at higher numbers.”

Given that these protests are highly vocal by nature — demonstrators often rely on chants, rallying cries and even songs to convey their message — the potential for infection is there.

Coronavirus is spread through contact between people within 6 feet of each other, especially through coughing and sneezing that expels respiratory droplets that land in the mouths or noses of people nearby. The CDC says it’s possible to catch the disease COVID-19 by touching something that has the virus on it, and then touching your own face, “but this is not thought to be the main way the virus spreads.”

Symptoms of the virus that causes COVID-19 include fever, cough and shortness of breath, which may occur two days to two weeks after exposure. Most develop only mild symptoms, but some people develop more severe symptoms, including pneumonia, which can be fatal. The disease is especially dangerous to the elderly and others with weaker immune systems.

More than 6.1 million people have been infected with coronavirus around the globe as of Sunday evening, according to Johns Hopkins University. On Saturday, the world surpassed 6 million patients.

The world hit the 5 million mark May 21. On May 9, the global infection total was 4 million. On April 27, it was 3 million. On April 15, the world hit the 2 million mark. On April 2, it was 1 million.

Just under 370,000 people have died of COVID-19, and nearly 2.6 million patients have recovered.

The United States accounts about 30 percent of all coronavirus cases, with nearly 1.8 million. More than 104,000 Americans have been killed by the virus.

Brazil has surpassed half a million cases – far behind the U.S., but well ahead of most European and Asian nations. More than 29,000 people have died of COVID-19 in the South American country.

Russia has also seen a surge in cases that pushed it near the top of the list in infections. More than 405,000 people have been infected and nearly 4,700 people have died.

The United Kingdom has reported more than 38,000 deaths, followed by Italy (over 33,000), Brazil, France (nearly 29,000) and Spain (more than 27,000).

New York state is still the largest center of coronavirus in the United States, with more than 370,000 cases and 29,000 deaths.

California has seen 110,000 cases of coronavirus and just over 4,100 deaths as of Sunday morning. Los Angeles County has been hit the hardest, with 53,000 of its own cases and 2,000 deaths.

Sacramento County health officials have reported 1,415 cases and 56. On Sunday, 15 new cases were added to the total county. On Saturday, 27 new cases were added, marking another day of increased infection rates. On Friday, 24 new cases were added. The last death in the county was reported May 18.

Yolo County reported one case Sunday, bringing the total number of infected people there to 211. There have been 24 people killed by the virus in the county, with another death reported Friday. Of those deaths, 16 have been connected to Stollwood Convalescent Hospital in Woodland.

Placer County reported 215 cases and nine deaths as of Sunday morning, adding one new case. There were 15 new cases added Saturday.

El Dorado County reported 90 cases of the virus Friday, up six from Thursday. The majority of infections have occurred in the Lake Tahoe area, El Dorado Hills and Diamond Springs. No deaths have been reported in the county.

Sutter County reported 46 cases and two deaths as of Sunday, adding three confirmed positive tests. Yuba County added one new case on Saturday, bringing its total to 30, and one death.

In Reopening Restaurants And Hair Salons, L.A. County Tests Whether It Can Prevent Second Wave Of Coronavirus

In reopening restaurants and hair salons, L.A. County tests ...

Source: Los Angeles Times, by By Alex Wigglesworth, Colleen Shalby, Andrea Chang

Despite having the most serious coronavirus outbreak in California, Los Angeles County on Friday was given the go-ahead to reopen restaurants for in-person dining, and resume services at barbershops and hair salons in the biggest test of whether the state can reopen the economy without causing COVID-19 to spread more rapidly.

Gov. Gavin Newsom approved a request by L.A. County leaders to begin the next phase of reopening and businesses could be up and running this weekend.

Many smaller counties across California already allow restaurants to start serving meals again with social distancing and other safety regulations. But those regions have been hit far less hard than Los Angeles County, and health officials said there is a clear risk that L.A. County’s move could fuel more outbreaks if rules are not strictly followed.

Over the past few weeks, California’s first-in-the-nation stay-at-home order has been rapidly loosened as Newsom and others said the coronavirus threat had eased. The order is credited with helping California avoid the huge death tolls of hot spots such as New York and New Jersey but has devastated the economy.

While many have praised the relaxations of the stay-at-home order, there have been growing concerns that it is coming too early for urban areas still vulnerable. Backers of the latest reopening plan believe the potential benefits outweigh the risks.

“This is a fine line that we’re walking in the county of Los Angeles,” County Supervisor Janice Hahn said Friday. “We are threading the needle between keeping the public safe and allowing our economy to reopen.”

L.A. County has recorded more than 2,200 coronavirus deaths. More than half of all COVID-19 fatalities in the state have been in L.A. County, which has been slower to reopen than areas less hard hit by the outbreak. The total number of confirmed infections in L.A. County is more than 50,000 — representing almost half of all California cases.

Just hours after the reopenings were announced, the county reported 50 additional coronavirus-related deaths Friday, bringing California’s total to more than 4,000. The county also confirmed an additional 1,824 new cases, bringing the total to 51,562.

Dr. Christina Ghaly, director of health services for L.A. County, said that although the numbers of local cases are flattening, the county may see a new upward curve as more businesses reopen and chances of transmission increase. But that wouldn’t necessarily mean that the county would have to backtrack.

Newsom and others acknowledged that while the death toll in L.A. County remains a major concern, other metrics show it’s safe to reopen the economy more. They point to reduced hospitalizations, infection rates and increased testing capacity.

Hahn said officials have been working with the county’s Economic Resiliency Task Force, which includes experts from a variety of sectors, including the restaurant industry, to develop a detailed safety plan for in-restaurant dining. The plan includes diagrams showing how to separate tables six feet apart and proposes putting physical barriers between tables where such distancing isn’t possible, Hahn said.

As those plans suggest, things won’t immediately return to business as usual for the newly reopened establishments.

County public health officials are expected to announce restrictions on operations, including a 60% capacity limit for restaurants.

“Many of them will have to find creative ways to do that by utilizing their parking lots and the streets in front of their restaurants,” Hahn said.

Some communities, including the cities of Los Angeles and Long Beach, are preparing to close streets to traffic and expedite permit variances so restaurants can put more tables and chairs outside.

Both restaurants and salons are expected to be required to keep detailed records of customers, including contact numbers, so public health officials can quickly follow up with patrons in the event of an outbreak.

Environmental health inspectors will be out inspecting and providing guidance to newly reopened establishments, but the businesses are not required to undergo an inspection before they resume services, Barbara Ferrer, the county health director, said Friday.

“As we enter the weekend and we are out of our homes and visiting many of the reopened establishments because we’re all really hungering for some return to normalcy, I want to just note that the new normal that you’re going to see reflected in the businesses reflects the fact that COVID-19 is still very active in our communities and there’s a great deal at stake in the reopening,” she said.

Ferrer added that it continues to be crucial for people to practice physical distancing, wear a cloth face covering and stay home if they’re feeling sick.

“We do again want to note that the actions we take now are essential to making sure that people don’t become seriously ill, we don’t overwhelm our hospitals and we save people’s lives,” she said.

“It’s never been more important for businesses, individuals and institutions to use the tools that we have available to take care of each other and to continue to slow the spread of COVID-19.”

The state is developing a dashboard for counties to track statewide metrics related to improvements and pitfalls as modifications continue.

“If in fact the state determines that there’s a cause of concern, what they really are doing is offering technical support,” Ferrer said. The state wouldn’t necessarily inform a county to rescind its eased restrictions but would instead try to understand what is driving an increase in numbers to properly assist.

Restaurateurs and other business owners expressed relief and some concern about the move.

“I don’t think we’re going to scramble to open,” said Jon Yao, chef-owner of Kato in West L.A. “I think our timeline is going to be more in line with how we combat the disease instead of what the city says is OK.”

Some establishments expressed concern with the pace of the reopening.

“Personally I think it’s all a disaster,” said Josiah Citrin, chef-owner of Charcoal, Dear John’s, Citrin and Melisse. “It all went too fast; nothing’s been smartly done.”

Citrin said he plans to reopen Charcoal, his steakhouse in Marina del Rey, on Thursday. But things will look remarkably different: Instead of as many as 110 diners spread across booths, a communal table and the bar, he’s limiting capacity to 40 diners at a time, all at their own tables.

He has removed the bottles of steak sauce, chimichurri and barbecue sauce that used to remain on tables all day. No walk-ins will be allowed. Instead of 56 employees, he’ll have about 35.

The rush to reopen Charcoal, he said, is because the money he received from the federal PPP loan “is almost out.”

“I followed the rules, and I have almost no money,” he said. “I have a couple weeks left.”

He figures going to a restaurant is safer than shopping at a crowded grocery store and believes diners will return after being cooped up for so long.

“If cases start spiking and it gets really bad, then maybe people won’t go out,” he said. “But for now, what else can you do? You can’t go to a movie, you can’t go to a concert, you can’t go to a sporting game, so restaurants will be in pretty high demand.”

Still, with only 40 diners max at a time, he’s bracing for a significant revenue hit.

“It’s going to really hurt my bottom line. From now until this is over, it’s not about making money, it’s about surviving. It’s about finding ways to see another day.”

Johnny Ciccone, 42, owns Headbetter, a hair salon in Sherman Oaks that had eight chairs, four worked by employees and four worked by stylists who rented their space. It has been closed for the past 2½ months.

“We’ve just been decimated by this,” he said.

Even with the plans for reopening, Ciccone fears that as many as half of the city’s hair salons are still destined to fail.

“The only reason I’m still able to hang out at my salon is because there has been a moratorium on evictions. I did receive PPP funding but that was six weeks in and I haven’t been able to pay anyone or bring them back to work,” he said.

“For a lot of salons, it’s going to depend on the landlords. Are they willing to make deals? Maybe my landlord will make a deal with me, maybe not.”

Ciccone was told to close March 15. Prepandemic, Headbetter would see 25 to 30 customers a day. Ciccone estimates he will be able to serve about half that number under the new guidelines. Even as he talked about the reopening, workers were removing four of his eight chairs, in order to comply with the new spacing requirements. Ciccone added that it wasn’t as if he could just reopen and conduct business as usual — he must provide everyone with hand sanitizer, screen people for fevers before they enter and require both employees and clients to wear masks.

“One of the biggest changes is that there are not going to be any walk-in services,” he said. “Customers are going to have to wait outside until we are ready for them.”

He said he’s purchased thousands of masks and gloves and gallons of disinfectant and rubbing alcohol, as well as new point-of-sale card readers.

Even signage will require another outlay of money, Ciccone said. “The city has released sample signs, requiring social distancing, hand washing and other requirements, how we are going to be operating safely,” he said. “We have to have all that posted, so I’ll be dealing with that this weekend.

“For a small business like mine, we have spent a few thousand dollars getting ready for the reopening, changing chair layouts, other things.”

In spite of all this, Ciccone said, “I don’t think we are going to pass this on to our clients, especially if they have faced unemployment. They are going to have wait longer to get appointments. These are people I have a close relationship with. They have been going through the same tough times I’ve gone through.”

Anre Anduha, 35, who owns Brotherhood Barbershop in Sherman Oaks, said he’s also taken on a lot of debt.

“I’m $15,000 in debt now when I consider rent, my $400 to $500 DWP bills, cable bills and that’s not even counting the lost income,” he said. “When I open back up, I’m only going to be using four chairs.”

Before COVID-19 struck, Brotherhood Barbershop was always busy with appointments and walk-ins, averaging between 75 to 100 customers a day. It’s been closed since March 19.

Anduha also faces additional expenses, such as capes, “for every single client that comes in, instead of many switching capes two or three times in a day.”

Also, by contrast, hair salons do not typically rely on walk-ins for a significant slice of their business. That’s not the case with barbershops, which do rely on them. Anduha said that half of his business were people who just walked in, hoping to quickly find an empty chair and willing to sit around inside the shop to wait, which will not be allowed now.

“It’s supposed to be appointment only now,” said Anduha, who was already thinking about workarounds, depending on the peace of mind of the particular barber, especially if dealing with strangers. “Barbers may want to take a client’s temperature, ask whether they have been traveling. For the majority of those, we’d probably just write down their information, ask them to wait outside in case a chair opens up. You can’t just say ‘come on in, sit in a chair’ like we used to.”

In spite of being in debt, he was just as reluctant as Ciccone to raise prices as substantially as circumstances might warrant, noting that his customers have also suffered from issues such as lost work and income.

“Do I think I will survive? I really don’t have another option. I’ll have to. But we were already at a decent price level at $40 a cut,” Anduha said. “We might go to $45, but I’m not going to raise prices a lot right away.”

McConnell And Pelosi’s Next Battle: How To Help The 40 Million Unemployed

McConnell and Pelosi's next battle: How to help the 40 million ...

Source: Politico, by Marianne Levine and Sarah Ferris

The debate over whether Congress will approve a new round of pandemic aid is over. Now it’s just a question of what’s in the package.

After brushing off Democrats’ demands for more relief, Senate Republicans now say the next major coronavirus package is likely to move in the coming weeks. And a key conflict ahead will be over how to help the 40 million Americans out of work.

The shift comes as the state of the economy grows worse and more GOP senators call for action. But Senate Majority Leader Mitch McConnell (R-Ky.) is already making clear Republicans will not support an extension of the extra unemployment benefits Congress passed in March. GOP lawmakers say the additional aid — which expires at the end of July — provides a disincentive to return to work and some are now proposing alternatives they can rally behind.

Democrats counter that Congress must extend benefits for the millions struggling to pay bills as the U.S. faces its most uncertain economic climate in generations. Regular unemployment insurance, they note, covers just half of workers’ pay on average.

In fact, some top Democrats want to go further. Senate Minority Leader Chuck Schumer (D-N.Y.) is eyeing a push to automatically tie unemployment benefits to the condition of the economy, according to a Senate aide — a move that has not been previously reported. Supporters of the automatic stabilizer idea, which Speaker Nancy Pelosi has also publicly endorsed, say it would avoid the political wrangling that could otherwise threaten to hold up much-needed aid.

The divide over jobless benefits is likely to surface as one of the biggest flashpoints for McConnell and Pelosi as they lead their parties in talks on the next major aid bill. The outcome will determine not just how much help goes to the roughly 1-in-4 unemployed Americans but how the parties can position themselves in a fierce campaign in which Congress and the White House are up for grabs.

McConnell said in Louisville over the Senate’s Memorial Day recess that he is “still in favor of unemployment insurance,” but he strongly criticized the additional $600 each week unemployed workers get under the CARES Act, which he said hampered certain industries’ abilities to bring back workers as the economy reopens.

“What I thought was a mistake was the bonus we added that small businesses all over the country are saying make it more lucrative to not work than to work. That’s exactly the opposite of what we want to do,” McConnell said. The GOP leader also vowed to end enhanced unemployment benefits on a recent call with House Republicans.

Democrats, however, have been adamant that Congress can’t cut off that economic lifeline.

“They’ve said that they don’t want workers to get this money that they need to pay rent and groceries,” Sen. Ron Wyden (D-Ore.), who negotiated the unemployment provisions in the March package, argued in an interview. “It expires July 31. And we’ll see if they want all those workers hurting all summer long.”

The debate over the government’s role in supporting unemployed workers comes amid the worst economy since the Great Depression and as each state has begun to gradually reopen its economy.

Some businesses — particularly in industries like food service — are struggling to bring back workers whose prepandemic salaries don’t match their current unemployment benefits. Other workers have complained that their previous pay isn’t enough to justify the risk of working as a virus that has killed more than 100,000 Americans continues to spread.

The enhanced unemployment benefits nearly tripped up the $2 trillion coronavirus relief package just hours before it was passed by the Senate in March. Several Republicans, led by Sen. Ben Sasse (R-Neb.), threatened to hold up the bill because of the provision, which Schumer called “unemployment insurance on steroids.”

Now, even Republicans who were initially open to the boost in benefits are showing little interest in extending them.

“Future coronavirus relief legislation must provide a better system to help make people whole, but not receive more through unemployment compensation than they were previously earning,” Sen. Susan Collins (R-Maine) said in a statement.

Collins was one of only two Senate Republicans alongside Cory Gardner of Colorado to oppose a Sasse amendment to cap benefits at workers’ previous salary. The Maine Republican, referring to her state’s Department of Labor, said that at the time she was “informed by both the Treasury Department and the Maine DOL that the only way to quickly begin administering expanded benefits was through a flat rate increase.“ But now, she said, “states have had sufficient time to adjust“ their unemployment insurance systems.

In a sign that lawmakers are now eager to spur an economic recovery rather than just extend a lifeline, members of both parties have introduced legislation recently to boost employment with “return to work” proposals.

Sen. Josh Hawley (R-Mo.) is pushing to have the federal government subsidize business’ payrolls during the pandemic. Sen. Rob Portman (R-Ohio) has a proposal that would provide workers with an additional $450 a week bonus on top of their current wages as an incentive to go back to work — an idea that has caught the attention of the White House.

“We need policies that encourage those individuals that can to return to the workplace to help get our economy going again,” Portman said in a statement. Top White House economic advisor Larry Kudlow said recently on Fox News that Portman’s plan is “a good idea” and “something we’re looking at very carefully.”

Even as Democrats back an extension of the benefits for those out of work, many also advocate for more aggressive plans to save jobs.

Sen. Mark Warner (D-Va.) has a proposal supported by moderates and liberals in the Democratic caucus — as well as Schumer — to dramatically expand the employee retention tax credit. A similar provision, from Rep. Stephanie Murphy (D-Fla.), was backed by the House.

Warner said in an interview there could be “some collaboration” between his proposal and Portman’s, in a sign that some consensus could be found when bipartisan talks begin in earnest.

“A lot of what we’re focused on is those employees who at this point have been furloughed, how you reconnect them, but recognizing there may be some additional time before business generates enough to bring the employee back,” he said.

Meanwhile, the Labor Department is strongly encouraging state unemployment agencies to ask employers whether recipients of unemployment insurance benefits refuse to return to work. Under federal rules, once workers accept unemployment benefits, they must take any suitable job offer or will become ineligible, although states have some flexibility in implementing work search requirements.

Most Democrats in the House and Senate have argued that the additional jobless benefits should last beyond the summer. A bill approved by House Democrats earlier this month would extend the extra $600 in assistance through January of next year.

“We are just seeing record-breaking unemployment rates and so many people signing up for it, it breaks your heart. But we have the unemployment insurance that will be renewed in this legislation,” Pelosi said of the House’s recently passed Heroes Act.

Democrats have also argued that lower-income Americans are often hit harder by the economic fallout. Nearly 40 percent of people with a household income below $40,000 lost their job in March, according to a Federal Reserve survey last month.

That compares to just 13 percent of people who made over $100,000 who lost their job over the same period.

Still there are a small number of moderate Democrats — particularly from areas of the country that appear to be suffering more from the recession than from the virus itself — that have privately opposed calls to extend enhanced unemployment benefits. Those Democrats say they’ve heard from employers in their districts that are struggling to bring workers back who earn more on unemployment.

“This is an example of where there are two truths,” said Rep. Dean Phillips (D-Minn.), who supports renewing the aid and has closely studied the effects on small businesses.

“One truth is that yes, the $600 amplification is going to complicate things for many businesses to reattract their employees. That is a fair assessment,” he said. “But the other truth is that we have a problem in our country with people struggling to put food on their tables and a roof over their head.”

White House Bids For ‘Surprise’ Billing Fix Ahead Of Next Rescue Package

White House bids for 'surprise' billing fix ahead of next rescue ...

Source: Politico, by Susannah Luthi and Rachel Roubein

The White House is renewing a push to end “surprise” medical bills — possibly as part of the next coronavirus rescue package — in a bid to deliver on protecting insured patients from sometimes staggering costs of emergency or out-of-network care.

Trump administration officials are floating a plan that would outlaw health care providers from putting patients on the hook for thousands of dollars in expenses — but without mandating how doctors and hospitals would recover their costs from insurers, according to administration officials, Capitol Hill aides and industry lobbyists familiar with discussions. Billing disputes would have to be worked out on a case-by-case basis.

Surprise billing was supposed to be last year’s easy health policy fix. Industry lobbyists, consumer advocates and lawmakers all agreed insured patients shouldn’t receive high bills when they’re taken to the emergency room or inadvertently treated out of network.

But the issue became the object of months of fierce lobbying and rivalries between congressional health committees, though the matter has receded during the pandemic. Congress agreed to cover the cost of Covid-19 testing in an earlier rescue package, and the Trump administration blocked providers that accept any part of a $175 billion industry bailout fund from sending unexpected bills to coronavirus patients.

House Speaker Nancy Pelosi included that prohibition in the lower chamber’s latest rescue proposal. Administration officials now want to pass a blanket prohibition on all hospitals and physicians and deliver a pocketbook health issue for President Donald Trump to tout on the campaign trail.

A White House representative wouldn’t comment on the proposal.

So-called balance billing can hit insured patients with staggering unanticipated medical bills if they inadvertently get treated at an out-of-network facility, such as in an emergency situation. Even people who go to an in-network facility may later discover one of the physicians wasn’t part of the network.

But despite mounting public concern and a flurry of legislative activity, Congress over the past year couldn’t resolve a standoff involving hospitals, physicians, employers and insurers that mired bipartisan proposals and pitted powerful health committees against each other. Efforts to help hospitals and physicians during the pandemic have left the outlook murky.

The prospect of the White House plan raising health care costs could yet douse enthusiasm on Capitol Hill. Though congressional scorekeepers haven’t issued a formal estimate, a congressional aide said the Congressional Budget Office has advised through informal guidance that the plan would raise premiums by driving up provider rates.

“As far as protecting Covid patients from being surprise billed, we’re kind of thinking, if this is all that can happen, we want this issue taken care of,” said one insurance lobbyist who requested anonymity to discuss industry deliberations. “But we have major concerns about impact on costs and patients if the entire issue isn’t addressed in a more comprehensive way.”

Sen. Patty Murray of Washington, the top Democrat on the Senate HELP Committee who developed surprise billing legislation with Chairman Lamar Alexander (R-Tenn.) last year, signaled cost concerns could scuttle the latest White House bid.

“Senator Murray has been clear throughout negotiations on surprise billing that any solution needs to prioritize patients — in particular by making sure costs aren’t passed onto them in the form of higher premiums or out-of-pocket costs,” said an aide to Murray. “She doesn’t believe this proposal meets that principle, and is concerned it would increase patients’ costs.”

A straight-up ban on surprise billing falls in line with a solution the American Hospital Association, Washington’s biggest hospital lobbyhas pushed in the past. The trade group declined to discuss whether it would support including it in the next coronavirus relief package.

Powerful doctors groups have been wary of a policy that only bans the practice and doesn’t include a way to resolve payment disputes. The American Medical Association contends the approach would leave health insurers with too much leverage.

“With physicians working on the front lines of this public health crisis and desperately trying to keep their doors open, Congress is unlikely to find a rationale for strengthening the hand of insurers,” said AMA President Patrice Harris in a statement to POLITICO. “As there is no balance billing for Covid testing and treatment under most types of insurance, there is no need to rush these significant policy changes as part of the next Covid relief package.”

Meanwhile, insurers and employers say that without a formula to resolve payment disputes, they could face costly litigation if hospitals or doctors want higher rates. Their fear is a patchwork of possibly conflicting formulas judges could impose to decide payouts, or that a decision that sides with doctors or hospitals could make high rates the precedent.

“We do want our employees to be protected,” said a lobbyist for an employer group, who also spoke on condition of anonymity. “But with no payment mechanism, it is possible this could give rise to lawsuits, and you could end up with different rules in different jurisdictions.

Still, health care experts and economists think the administration plan could erase huge financial uncertainties for patients without driving up health care costs.

“I view the simple ban on balance billing as pretty close to an ideal solution,” said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, who has advised Congress on its various proposals.

Adler thinks the blanket ban may keep health prices and insurance premiums in check and said the limited data suggests that the policy would lower premiums more than past proposals in Congress.

Even if the policy triggers more litigation, with doctors suing insurers or employers for higher rates, some experts predict courts could be skeptical about ruling for excessive charges.

“I think increasingly courts are getting it right, and maybe that’s because surprise billing is now part of our lexicon,” said Duke University law professor Barak Richman.

California AG Seeks More Power To Battle Merger-Hungry Health Care Chains

California AG Seeks More Power To Battle Merger-Hungry Health Care ...Source: California Healthline, by Rachel Bluth

California’s health care industry has a consolidation problem.

Independent physician practices, outpatient clinics and hospitals are merging or getting gobbled up by private equity firms or large health care systems. A single company can dominate an entire community, and in some cases, vast swaths of the state.

Such dominance can inflate prices, and consumers end up facing higher insurance premiums, more expensive outpatient services and bigger out-of-pocket costs to see specialists.

Now that COVID-19 has slammed the health care industry, especially the small practices that are barely seeing patients, the trend is likely to accelerate.

“I don’t see anything that’s going to stop this wave of consolidations amongst docs,” said Glenn Melnick, a health care economist at the University of Southern California.

“If this thing goes on a long time,” he said of the coronavirus, “then it becomes a tsunami.”

California Attorney General Xavier Becerra has made battling health care consolidation a signature issue since he took office in 2017. With the additional pressure that COVID-19 is putting on vulnerable practices and facilities, Becerra is now pressing the state legislature to expand his authority to slow health care mergers.

“We find that in these times of crisis, economic and health crisis, that the smaller health care players and stakeholders are oftentimes most at risk of being swallowed up by the big fish,” Becerra told California Healthline.

His success would fundamentally change how the health care industry merges and grows in California.

When a health care system, private equity firm or hedge fund plans to merge with or acquire another practice or facility — whether that means buying a small practice or joining a multistate hospital chain — Becerra wants to know about it. He wants written notice, and the ability to deny any sale that doesn’t deliver better access, cost or quality health care to Californians.

Becerra already can regulate mergers among nonprofit health care facilities. Under SB-977, a collaboration between Becerra’s office and the legislature, he would get the ability to regulate the for-profit sector as well.

“Certainly it would put California where it’s accustomed to being,” Becerra said. “At the head of the pack.”

The bill has support from organized labor and consumer advocacy groups. Gov. Gavin Newsom has come out against health care consolidation in the past but hasn’t taken an official stance on the bill.

Yet Becerra isn’t convinced passage will be smooth.

“The biggest concern I have is the legislation will be killed by the industry,” he said. “We’ll end up seeing over-consolidation because decent practices that got on the edge could not swim with sharks.”

Indeed, health care industry players are already lining up against the bill. Alex Hawthorne, a lobbyist for the California Hospital Association, said that hospitals are stretched thin because of the pandemic, and that now isn’t the time for Becerra to be meddling in routine agreements between practices.

“It bestows absolute and arbitrary discretion on the office of the attorney general,” Hawthorne said at a budget hearing in May.

In 2010, about 25% of California physicians worked in a practice owned by a hospital. By 2016, more than 40% of doctors worked in hospital-owned practices, according to research published in the journal Health Affairs in 2018.

There’s evidence that consolidation can hurt consumers. A separate 2018 study found that the cost of medical procedures in highly consolidated Northern California was 20% to 30% higher than in Southern California.

Since 2018, California’s attorney general has had the authority to regulate mergers among nonprofit health care systems, which Becerra exercised the same year when considering a merger between two health care giants: Dignity Health and Catholic Health Initiatives. He said he would approve the deal only if the systems agreed to certain requirements, such as starting a homelessness program.

Later that year, Becerra joined a suit against Sutter Health for using its market power to drive up health care costs in Northern California.

The lawsuit alleged that Sutter, which has 24 hospitals and 34 surgery centers, had spent years buying up practices and facilities, giving insurers little choice but to include them in their networks and agree to higher rates for services.

In October 2019, Becerra secured a $575 million settlement against Sutter, which has yet to be finalized or paid out, that requires Sutter to change how it charges insurance companies and give patients more information about prices.

Sutter Health opposes SB-977, which was introduced in February by state Sen. Bill Monning (D-Carmel). The measure is intended to address some of the challenges Becerra encountered with the Sutter case, Becerra said.

“The best way to prevent problems from occurring in a merger is just to prevent the merger altogether,” said Jaime King, associate dean at UC Hastings College of the Law in San Francisco. “It’s really hard to unwind a merger after you’ve already done it.”

Under the measure, the attorney general must be notified before a system, hedge fund or private equity firm attempts to enter into a merger, acquisition or another kind of affiliation change with another practice or facility. The bill defines a health care system as one with two or more hospitals in multiple counties, or three or more hospitals within one county.

That would trigger a public review process allowing supporters and opponents to make their cases to a review board. The board would assess the transaction, using criteria to determine whether it would improve access, quality and price.

The bill also would make it illegal for systems to act anti-competitively and give the attorney general the power to bring a civil suit against monopolistic systems.

The Senate Health Committee approved the bill, which is expected to be heard in another committee this week.

“Maybe it does mean consolidation should occur, but only because we’ve done the oversight to make sure it’s because of quality and access,” Becerra said. “Not because a big fish wants to make bigger profit.”

The measure includes waivers for rural practices and a fast-track review process for transactions under $500,000.

The California Chamber of Commerce opposes the bill, as does the California Medical Association, which represents doctors. While the California Medical Association is concerned about the survival of small physician practices, it believes the bill is too broad and should focus more tightly on hospital consolidation, said spokesperson Anthony York.

“This approach will only further force smaller providers out of business,” especially as the health systems respond to the COVID-19 emergency, the group’s legislative advocate, Amy Durbin, wrote in a letter of opposition.

For many independent practices struggling for survival, the debate over Becerra’s powers is academic.

Dr. Sarah Azad, who owns a women’s health practice in Mountain View, California, said at least three independent practices in her area have started the process to merge or sell since March because of dramatically lower patient volume.

Her practice is fine for now, despite the fact that her patient volume was only about 30% of normal in March and 60% of normal in April. Azad received a loan from the federal Paycheck Protection Program for small businesses so she could pay her five doctors in May.

“If you catch me on a bad month, I feel like we’re one disaster away from bankruptcy,” Azad said.

Newsom’s Nearly $1 Billion Mask Deal Misses Safety Review

Trouble for Gavin Newsom's $1 billion mask deal: Feds reject ...Source: San Francisco Chronicle, by Dustin Gardiner

Gov. Gavin Newsom’s medical mask deal with a Chinese manufacturer could be canceled after the company failed to obtain a federal safety certification.

Sunday was the deadline for supplier BYD to secure safety certification for its N95 particulate-filtering respirators. But it did not meet that deadline, which had been extended after federal officials denied the company’s previous application.

Katie Shahan, a spokeswoman for the National Institute for Occupational Safety and Health, the agency that inspects masks, said Monday there has been no change in BYD’s certification status.

“There are no additional updates at this time,” she wrote in an email.

California’s contract with BYD, or Build Your Dreams, states that the deal is void and the company must forfeit all $495 million that the state prepaid for the N95 masks if it failed to obtain federal certification by the deadline.

Newsom’s administration was silent on the contract’s fate Monday — a deal he cheered less than two months ago as the state scrambled to buy personal protective equipment for medical workers on the front lines of the coronavirus pandemic.

The Governor’s Office of Emergency Services did not respond to requests for comment about the fate of the deal Monday.

Newsom said Friday that federal officials were “very close” to a certification decision. Then, he downplayed the financial risk to the state.

“We have not spent one penny on anything we haven’t received,” Newsom said.

California wired $495 million to BYD in early April, half the cost of a larger, $990 million contract that also included surgical masks. The company was supposed to provide the state with 300 million of the N95 masks.

But the deal quickly hit trouble: BYD refunded half of the state’s prepayment for the N95 masks last month after it failed to obtain safety certification by the original April 30 deadline. California extended the deadline to May 31.

At the time, Newsom said certification had merely been delayed. The National Institute for Occupational Safety and Health contradicted him, saying it had denied BYD’s safety certification because of “a number of factors.”

Officials with the federal agency won’t say why certification was denied because government rules prohibit the agency from disclosing such details. However, the agency said a “review of the documentation provided to NIOSH for the design, manufacturing and quality inspection of the device was concerning.”

BYD spokesman Frank Girardot declined to comment Monday. He has said the federal agency had denied safety certification for the N95 masks because of a “documentation control” issue.

The company said its masks have already passed quality tests, including inhale and exhale tests.

BYD is also sending 100 million lower-grade surgical masks to California as part of the deal. The federal government does not need to certify those masks, and Newsom said it has delivered more than 50 million so far.

But the company faces a swift fiscal penalty for not meeting the N95 certification deadline.

Under its contract with California, BYD has until June 5 to refund the state’s remaining $247.5 million prepayment. California officials could decide to extend the deadline again.

“If they do not get the certification that’s required in the contract, we won’t be out a dollar and we’ll find other ways of procuring those masks,” Newsom said last week.

BYD mainly manufactured electric buses until the coronavirus pandemic struck. It then branched into personal protective equipment for medical workers.

Will Insurance Cover It? COVID-19 Testing Confusion Continues

Will insurance cover it? COVID-19 testing confusion continues ...

Source: BenefitsPRO, by Blake Farmer

Hospitals around the country are afraid to send out hundreds of thousands of bills related to COVID-19 testing. That’s because Congress mandated there would be no copays and no out-of-pocket costs for patients. But many employers with self-funded health plans seem to believe they’re exempt from the rules.

When testing kits were still scarce, Vanderbilt University Medical Center in Nashville, Tennessee, fired up its clinical labs. It almost single-handedly took over testing in much of Tennessee. Other health systems didn’t even try to compete, although the tests were supposed to be covered by insurance.

In late March, Congress passed two laws, the Families First Coronavirus Response Act and the CARES Act, that essentially stated that not only does testing have to be covered, but patients shouldn’t have to pay a dime. Yet VUMC has found that’s frequently not the case.

“As many as half of those patients potentially have some out-of-pocket [cost], either for the tests or for companion services with the test,” VUMC Chief Financial Officer Cecelia Moore said.

VUMC is holding back bills for these patients, Moore said, rather than face a backlash of anger at surprise billing during the pandemic.

The issue comes down to an interpretation of whether the new federal legislation applies to health plans offered by larger employers. Those companies, which usually have at least a few hundred employees, often use their own money to pay claims as a way to drive down costs. A survey by the Kaiser Family Foundation finds a majority of Americans with health coverage are in this type of plan. (Kaiser Health News is an editorially independent program of the foundation.)

So BlueCross BlueShield of Tennessee may be on an employee’s insurance card, but the insurer is just managing the payments. The employer’s money pays the claims; these plans are often called self-funded or self-insured, and it may not be clear to employees that they are in such a plan.

According to multiple sources, many of the companies with those plans are operating as if they’re exempt from the new federal rules.

“In this case, it appears that the law may have left self-insured employers out of certain elements,” said Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions.

The National Alliance represents employers with self-funded health plans. He said some are not waiving copays and other bills. Most are, he said, though sometimes only bills for the COVID-19 test itself and not for the doctor’s visit or the test to rule out the flu.

“Many of them have opted to cover on a first-dollar basis, but in different ways. They may or may not have included the related treatment elements,” Thompson said. He acknowledges the distinction would be lost on patients. “I get why it’s causing confusion.”

Other associations representing employer-funded health plans, including the Business Group on Health, said their members are generally following the spirit of the law.

Health policy experts don’t see any room for interpretation.

“It doesn’t matter if it’s a self-funded plan or a fully insured plan, if you get it from a small employer or a large employer, if you buy it on your own in the marketplace,” said Karen Pollitz, a senior fellow with KFF. “All private insurance has to cover 100% of the cost of COVID-19 testing.”

Pollitz said she is miffed that employers are trying to argue otherwise.

Still, it’s happening, and not only in Tennessee.

Duke Health in North Carolina confirms it’s not billing claims related to COVID testing or treatment, citing a lack of clarity in what the patient is responsible for paying. In California, UCSF Medical Center is also holding off on billing, and UCLA Medical Center is pressing health plans to pay their part.

“UCLA Health does not bill COVID-19 patients for testing even if their health plan erroneously does not pay,” spokesperson Enrique Rivero said in a written statement. “Our practice is to notify insurers of their error and request that they reprocess claims consistent with CARES Act guidelines.”

NYU Langone Health and Cleveland Clinic said they won’t bill patients any cost sharing for testing, even if that means they have to bear the cost.

The issue extends beyond academic medical centers. Envision Health, a Nashville-based firm that staffs and operates hundreds of emergency rooms around the country, is holding back 200,000 bills related to COVID-19 testing because of confusion about coverage of cost sharing.

So, many would-be surprise medical bills are still waiting to be sent out. At Vanderbilt alone, the medical center has held back more than $6 million in billing since mid-March.

“I know I’m supposed to be shaking everybody down, but we’re not right now,” said Heather Dunn, VUMC’s vice president of revenue cycle services.

Given the growing disdain for surprise medical bills, she expects a backlash from vulnerable patients.

“My greatest fear is [for] patients who are already suffering from the COVID virus or issues after or have lost their job. I’m hesitant to also say, ‘Your insurance company has passed along this $50 copay,’” she said.

Sometimes, the patient is also left with a large deductible to pay, in the hundreds of dollars.

Dunn said that she can’t delay billing forever and that just because the tests are supposed to be free to patients doesn’t mean they have no cost.

As Residents Perish, Nursing Homes Fight For Protection From Lawsuits

As residents perish, nursing homes fight for protection from lawsuits

Source: Politico, by Maggie Severns and Rachel Roubein

As an unprecedented catastrophe unfolds in which more than 28,000 people have died of Covid-19 in care facilities, the nursing home industry is responding with an unprecedented action of its own: Using its multi-million dollar lobbying machine to secure protections from liability in lawsuits.

At least 20 states have swiftly taken action within the last two and a half months to limit the legal exposure of the politically powerful nursing home industry, which risks huge losses if families of coronavirus victims successfully sue facilities hit by the pandemic. Now, the industry is turning its energies to obtaining nationwide protections from Congress in the upcoming coronavirus relief bill.

The nursing home industry is one of the lobbying world’s quiet powerhouses. The state actions to protect the industry came after it spent tens of millions of dollars in lobbying and other advocacy per year, according to a POLITICO review of state and federal records. At the federal level, the industry has spent more than $4 million on lobbying over the past year, employing more than a dozen full-time lobbyists and drawing on an army of contractors including Brian Ballard, former lobbyist for President Donald Trump, and ex-Mississippi Gov. Haley Barbour, a former Republican National Committee chairman.

In early April, nursing home giant Life Care Centers of America — the multi-state chain whose facility in Kirkland, Washington, was the nation’s first epicenter of coronavirus — hired a team of four former aides to ex-Sen. Bob Corker (R-Tenn.), who was close with Senate leadership, to lobby on Covid-19 issues.

Industry advocates, including the American Health Care Association, which represents nursing homes, argue it would be disastrous for care facilities to be held liable for the deaths of elderly residents, who are far more vulnerable to coronavirus than the rest of the population. They also contend nursing homes have been forced to fight the virus while facing shortages of critical protective gear and testing capabilities because of flawed federal policies over which they have no control. They are also adapting to new federal regulations on the fly.

But lawyers and victims’ advocates point to reports of horrifying neglect and egregious misjudgments by nursing homes across the country thatthey allegecontributed to the deaths of residents, and said that, in many states with weak regulations, the threat of a lawsuit represents a crucial protection for the most vulnerable people.

“The stuff that we’re seeing, it’s pretty awful,” said Brian Lee, a former ombudsman and executive director of Families for Better Care, an advocacy group focusing on long-term care. “The ask from the industry is sweeping. This is about the owners protecting their business and their profits.”

Lee contends some homes have been negligent in failing to protect elderly people from infection.

“They’re supposed to have emergency plans in place,” he said. “It’s supposed to include how to work through a pandemic. They were supposed to be ready for this, they’re not.”

Advocates for the elderly note that nursing homes already have significant legal protections under law – which were further strengthened when the Trump administration watered down Obama-era policies that had blocked homes from forcing residents to forego their right to sue in favor of arbitrationThe many homes with documented poor safety records shouldn’t be protected if they, say, fail to send symptomatic residents to the hospital or neglect to set up proper hygiene protocols, advocates claim.

“Knowing the public regulatory system is pretty weak, they want to stop any other place where they would be held accountable — and that would be litigation,” said Toby Edelman, an attorney with the Center for Medicare Advocacy.

Edelman noted that residents of nursing homes are especially vulnerable to fraud and abuse during times like these when relatives are barred from making visits, where they might witness and report any neglectful practices.

“To me, that’s a frightening combination,” said Edelman, referring to the protection against lawsuits and the lack of a real-time checks on standards of care.

A broader debate over whether to shield corporations from coronavirus-related lawsuits has divided Congress along party lines, with Democrats arguing sick and vulnerable people need to maintain their right to sue, and Republicans arguing businesses will not be able to survive the onslaught of legal action that’s to come without extra protections. But there is far less of a partisan divide among states, where the push for changes in liability for nursing homes has been bipartisan, from Mississippi to Connecticut. In several states, Democratic governors have taken the lead via executive order.

Indemnifying nursing homes is “incredibly unfair, incredibly unjust and leaves an already vulnerable population exposed,” said Justin Varughese, A New York trial attorney who is planning to sue nursing homes in the state, which recently imposed new limits on their liability, signed by Democratic Gov. Andrew Cuomo. “We really need [lawmakers] to amend the breadth of the law to protect the vulnerable here.”

Varughese pointed to cases in which, for example, a nursing home left a dozen or more residents in a room with no personal protective equipment and no consideration for social distancing – situations that he said encourage the spread of Covid-19, and should be grounds for lawsuits. But the law recently enacted in New York requires that he must be able to show “gross negligence,” a difficult-to-prove legal standard that involves a reckless disregard for safety.

Cuomo signed both the new law expanding liability protection for nursing homes and an additional executive order that relaxes recordkeeping laws for nursing homes and hospitals, which lawyers and victims’ advocates say could further handicap their work.

“If they don’t document what they did and didn’t do, how can they be held accountable for what they did and didn’t do?” said Varughese.

Like many other governors and state lawmakers, Cuomo insists that the industry requires greater legal protection in handling a massive emergency.

“The state was using every type of facility: hospitals, nursing homes, adult care facilities, hospices, ambulatory care facilities, surgery centers, all as possible diagnostic and treatment centers for Covid as we were preparing to face the surge,” said Cuomo spokesperson Dani Lever, explaining the decision to relax record-keeping rules and shield owners from some types of liability. “Under the law, health care professionals and facilities [still] must act in good faith, and no one is shielded from liability for gross negligence, or intentional criminal conduct.”

In New York, a powerful lobbying group called the Greater New York Hospital Association, which represents hospitals that in some cases own nursing homes, drafted the legislation that expanded protections for the industries. The association spent nearly $3 million lobbying the New York state assembly in 2019 alone, state records show.

The law specifically states that short-staffing doesn’t qualify as “gross negligence” or other grounds on which a nursing home can be sued.

But some state lawmakers say they weren’t given proper notice about the liability protections, which were passed as a part of the state’s budget bill — and now they have regrets.

“I’m very much opposed to what we enacted, and also not happy with how we did it. It was inserted in the budget as an amendment from the governor in the last hours, or day, or so of our work on the budget,” said New York state Assemblymember Richard Gottfried (D-New York City), chair of the state assembly’s health committee. Gottfried said he’d like the legislation repealed, but expects a “very uphill fight.”

“People can look at this as a technical legal issue, but if your loved one is being mistreated in a nursing home or is the victim of mistreatment or negligence, or if a hospital or nursing home is guilty of health and safety violations, you want something done,” Gottfried said.

Lever, the Cuomo spokesperson, responded that “elected officials cannot be blindsided by language in a bill, unless they don’t read it.”

In California, a coalition of nursing homes and provider groups wrote to Democratic Gov. Gavin Newsom in early April asking for unusually broad protections from liability. The groups, which collectively spent $1.1 million lobbying the state government in the last year, suggested an executive order that would shield them form “any administrative sanction or criminal or civil liability of claim,” unless there is “clear and convincing evidence of willful misconduct,” according to a letter obtained by POLITICO.

Advocates for nursing home patients in California expect Newsom to sign an executive order at some point in the coming days. Newsom’s office did not respond to a request for comment.

And a separate letter to lawmakers sent by nursing home and hospice associations in Connecticut used track changes to amend language suggested by other health care lobbyists so it would mimic nursing homes’ preferred language on legal liability.

In early April, Democratic Gov. Ned Lamont signed an executive order giving civil liability coverage to nursing homes and other health care providers. It did not use the exact language suggested by the associations but gave them a similar level of legal protection.

Other states passing new laws and issuing executive orders providing some level of protection for nursing homes ranged from deep red Alabama and Arkansas to Democratic-led Illinois and Michigan. In Pennsylvania, Democratic Gov. Tom Wolf signed an executive order granting immunity to health care practitioners — but the industry is pushing for broader protections.

“The last thing these providers and those on the front lines should have to be concerned with is the threat of an impending lawsuit,” Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, said in a statement.

But the nursing home industry has consistently received criticism for failing to meet federal standards for measures like proper handwashing and isolating sick residents. The vast majority of nursing homes were cited for deficiencies in infection prevention and control between 2013 and 2017, according to a new federal watchdog report, which noted “many of these practices can be critical to preventing the spread of infectious diseases, including Covid-19.”

“You’ve got facilities full of really sick patients that are cycling in and out of the hospital. It’s going to be a challenge for any lawyer to prove that the specific breach on the nursing home’s part is what caused that person to contract Covid,” said Michael Brevda, a partner at Senior Justice Law Firm, which is pursuing at least eight lawsuits related to coronavirus in nursing homes in New York, Florida and Pennsylvania.

The back-and-forth on Capitol Hill over whether to enact a national liability protection for nursing homes and other industries is proving more complicated.

While Senate Majority Leader Mitch McConnell (R-Ky.) and House Minority Leader Kevin McCarthy (R-Calif.) have already said broad immunity protections for businesses are “absolutely essential” for Republicans to sign off on another coronavirus relief bill, most Democrats are vehemently proposed.

Senate Republicans have not released any public proposals for expanding liability protections. One lobbyist who had seen multiple proposals from the nursing home industry said that, similar to some state laws, the industry had advocated for a high bar for liability, such as cases of gross negligence.

McConnell, along with a top ally, Sen. John Cornyn (R-Texas), is working to craft the legislation, which they say won’t protect bad actors.

“We should not put our health care workers in an impossible situation where we ask them to do everything they can to help and then we punish them by subjecting them to litigation when somebody claims that they could or should have done better,” Cornyn said on the Senate floor last week.

Mark Parkinson, president and CEO of the American Health Care Association, said in a statement to POLITICO, “We encourage states and the federal government to take action to extend immunity provisions to the long term care providers and other health care sectors associated with care provided during the COVID-19 pandemic.”

“Long term care workers and centers are on the frontline of this pandemic response and it is critical that states provide the necessary liability protection staff and providers need to provide care during this difficult time without fear of reprisal,” Parkinson said.

CMS Finalizes Plan To Allow Medicare Advantage Plans To Expand Telehealth Benefits

Trump administration finalizes MA telehealth benefit policy ...

Source: FierceHealthcare, by Paige Minemyer

The Trump administration has finalized several changes in Medicare Advantage (MA) and Part D in anticipation of bid submissions on June 1.

The Centers for Medicare & Medicaid Services (CMS) released a final rule (PDF) Friday that includes technical changes mandated by the 21st Century Cures Act and the 2018 Bipartisan Budget Act, notably targeting telehealth.

CMS will offer MA plans greater flexibility to offer and discount telehealth for specialty care, which will allow them to grow their benefits while meeting network adequacy standards.

“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma in a statement. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

Earlier this year, CMS finalized a rate increase for MA and Part D of about 4% for the 2021 plan year, up from about 4% the year prior.

In the new rule, the agency also finalized changes to MA and Part D Star Rating methodology to incorporate member feedback to a greater degree.

“One of the best indicators of a plan’s quality is how its enrollees feel about their coverage experience,” CMS said in a release. “This decision reflects CMS’s commitment to put patients first and improves incentives for plans to focus on what patients value and feel is important.”

CMS estimates the changes will save the government $3.65 billion.

Last Updated 06/03/2020

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