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Costs for testing are being waived as diagnostic tests proceed.

EDITOR’S NOTE: The World Health Organization (WHO) has declared that the coronavirus is now a pandemic.

With the novel coronavirus (COVID-19) outbreak intensifying across the country and large-scale public gatherings of all types being postponed or canceled en masse, federal officials and insurers are scrambling to eliminate financial barriers to testing and care, marking part of a broader effort to ensure that the nation’s healthcare infrastructure does not become overwhelmed.

The Centers for Medicare & Medicaid Services (CMS) announced Tuesday that many leading insurance companies and their industry associations are now indicating that they will be treating COVID-19 diagnostic tests as covered benefits, and will be waiving cost-sharing that would otherwise. The agency also pledged to provide more flexibility to Medicare Advantage and Part D plans, “to ensure they have the tools they need to provide seniors with the best coverage.” 

As part of a flurry of related activity, CMS published a memorandum to Medicare Advantage (MA) and Part D health and prescription drug plans, informing them of the flexibilities they have to provide healthcare coverage to Medicare beneficiaries for COVID-19 testing, treatments, and prevention.

More than 1,000 people have now tested positive for the virus in more than 30 states, with pockets of infection reflecting substantial ease of spread.

“The President directed CMS to make sure Medicare Advantage beneficiaries have access to the healthcare services they need during this time,” CMS Administrator Seema Verma said in a statement. “Today we announced guidance to Medicare Advantage and Part D plans to remove barriers that could prevent or delay beneficiaries from receiving care. Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19, and CMS will continue doing everything in our power to protect them.”

In the aforementioned memorandum, CMS outlined the flexibilities MA and Part D plans have to waive certain requirements to help prevent the spread of the virus; specifically, the relief involves:

  • Waiving cost-sharing for COVID-19 tests
  • Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms, and services delivered via telehealth
  • Removing prior authorization requirements
  • Waiving prescription refill limits
  • Relaxing restrictions on home or mail delivery of prescription drugs
  • Expanding access to certain telehealth services

The changes mark part of a broader effort on the part of the newly created White House Coronavirus Task Force, which has publicly announced an intention to ensure that all Americans – particularly those at high risk of complications from the COVID-19 virus – have access to benefits while helping to contain the spread of disease. 

To view CMS’s memorandum for MA and Part D plans, go online to  https://www.cms.gov/files/document/hpms-memo-covid-information-plans.pdf

CMS has announced changes in policy to address the coronavirus outbreak several times per week recently, including half a dozen times since the start of the month alone:

On March 9, CMS delivered guidance on the screening, treatment, and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19 in a hospice setting. CMS also issued additional guidance specific to nursing homes to help control and prevent the spread of the virus: https://www.cms.gov/newsroom/press-releases/cms-issues-clear-actionable-guidance-providers-about-covid-19-virus

Also on March 9, CMS issued a press release highlighting the telehealth benefits in the agency’s Medicare program for use by patients and providers: https://www.cms.gov/newsroom/press-releases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak

Additionally, on March 9, CMS published guidance to hospitals with emergency departments (EDs) on patient screening, treatment, and transfer requirements to prevent the spread of infectious disease and illness, including COVID-19, ordering that Medicare-participating hospitals follow both Centers for Disease Control and Prevention (CDC) guidance for infection control and Emergency Medical Treatment and Labor Act (EMTALA) requirements: https://www.cms.gov/newsroom/press-releases/cms-issues-call-action-hospital-emergency-departments-screen-patients-coronavirus

On March 6, CMS issued frequently asked questions and answers (FAQs) for healthcare providers regarding Medicare payment for laboratory test and other services related to the outbreak: https://www.cms.gov/newsroom/press-releases/covid-19-response-news-alert-cms-issues-frequently-asked-questions-assist-medicare-providers

On March 5, CMS issued a second Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs: https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests

On March 4, CMS issued a call to action to healthcare providers nationwide and offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare: https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus


Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.

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