Agencies Clarify COVID-19 Testing, Telehealth Benefits
A new Frequently Asked Questions (FAQs) document issued by the Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Department of the Treasury (collectively, the Departments) tackles an array of insurance coverage issues stemming from the COVID-19 pandemic. Most notably, the FAQs narrow the federal mandate on group health plans and health insurance issuers to cover diagnostic testing for COVID-19 at no cost-sharing by specifically stating that testing for surveillance or employment purposes is not required to be covered. Absent a reversal of this interpretation by Congress, the clarification largely leaves the question of whether and how to implement and finance a public health surveillance system that could leverage antibody testing to decision makers in states, localities, and employers, including schools. The FAQs also allow plans and issuers to scale back on previously provided expanded coverage for COVID-19-related benefits (e.g., telehealth, pharmacy early refill) provided certain enrollee notifications are made in a reasonable timeframe in advance of the changes. Another FAQ allows employers to offer standalone telehealth and “remote care services” benefits to employees who are not eligible for comprehensive group health plan coverage without treating such arrangements as ERISA-covered group health plans.
Articles & Resources
Link to Tri-Department FAQ Part 43
Judge Dismisses Hospital Price Transparency Rule Challenge
In sharp contrast to a court loss last week over prescription drug price transparency, the Administration was handed a victory at the district court level to dismiss a challenge to a Medicare rule requiring hospitals to publish payer negotiated charges—a significant step further than a prior rule which required only chargemaster list price transparency. Hospitals consider negotiated charges proprietary and challenged the rule on the grounds that the Centers for Medicare and Medicaid Services exceeded its authority, acted arbitrarily and capriciously, and that the provision violated First Amendment protections against compelled speech. The Trump-appointed Judge Carl Nichols found that the agency’s decision to construct the term “standard charges” into multiple categories that would impact the largest group of patients was not unreasonable given the lack of either a definition in the statute or consensus on the term in the industry. The plaintiffs in the case announced plans to seek expedited review of the case immediately after the decision.
Articles & Resources
Link to AHA, et al. v. Azar opinion
ACA Improvement Bill Awaits House Vote
On Wednesday, the House Rules Committee passed a large health care package aimed at strengthening the insurance coverage provisions in the Affordable Care Act. H.R. 1425, the State Health Care Premium Reduction Act or the Patient Protection and Affordable Care Enhancement Act, specifically would, among other features: expand the availability of premium tax credits to eligible individuals whose income is above 400 percent of the federal poverty level, clarify that an offer of “affordable” job-based coverage for an employee does not bar that employee’s family from being eligible for premium tax credits (i.e., fix the so-called “family glitch”), and provide states with $200 million in federal grant funding to newly establish state-based marketplaces. The passage within the Rules Committee allows H.R. 1425 to be brought to the House floor for a vote. From there, the legislation is most likely to be stalled within the Senate, given the Majority Leader’s priorities and the difficulty of moving health care legislation forward during an election year.
While Congress has an opportunity to move health care legislation during the lame-duck session after the November election, this opportunity will likely be focused on prescription drug pricing reform and surprise billing legislation.
Articles & Resources
Link to H.R 1425 text
Federal COVID-19 Response in Oversight Spotlight |
On Thursday, the U.S. Government Accountability Office (GAO) released a report titled, “COVID-19 Opportunities to Improve Federal Response and Recovery Efforts,” detailing how federal agencies are spending the $2.6 trillion in emergency assistance for people, businesses, the health care system, and state and local governments. Among other topics, health policy issues in the report include the following:
Congress continued oversight of the COVID-19 response, holding a number of hearings this week--highlighted by a House Energy and Commerce hearing featuring Dr. Anthony Fauci, Director at the National Institute of Allergy and Infectious Diseases (NIAID) and other top administration officials. The hearing lasted over six hours but largely focused on the “disturbing surge” of infections in a number of states, including Arizona, Florida, and Oklahoma. Dr. Fauci broke from recent comments from President Trump, stating that the administration and states are going to increase testing of COVID-19. Furthermore, Dr. Fauci is “cautiously optimistic” that a COVID-19 vaccine will be ready by the end of the year and that at least one vaccine is poised to go into Phase 3 trials by July. NIAID is preparing to begin large clinical trials of a vaccine that it’s co-developing with U.S.-based biotechnology firm Moderna next month.
Congress will continue to hold a number of hearings next week regarding oversight of COVID-19 related activity to presage a possible Phase 4 COVID-19 legislative package. Articles & ResourcesLink to GAO Report
Link to House E&C Committee Hearing Page |
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