Since the beginning of this pandemic, there has been a push to establish a Health Insurance Marketplace Special Enrollment Period (SEP) due to the COVID-19 Emergency Declaration. The Trump administration has decided against reopening the Marketplace to those needing coverage during the coronavirus pandemic. The Special Enrollment Period (SEP) for loss of coverage is still available for individuals losing job-based coverage. Consumers have 60 days from the last day of coverage to sign up for an SEP. In Pennsylvania, Medicaid benefits will not be terminated for consumers as of March 18 until the end of the emergency declarations unless the individual leaves the state or voluntarily terminate their benefits. While county assistance offices remain closed to the public, consumers can still apply online and via the mobile app. Documents needed for verification can be submitted via the COMPASS webpage, mobile app or dropped off at county assistance office locations in the designated mailbox.

We know that the need and demand for personal protective equipment (PPE) continues to far exceed supply.  There are many others who are also aware of that fact and some of them are preying on the desperation for supplies, exhaustion from juggling so many priorities in responding to the COVID-19 pandemic, and strong desire to protect our workers on the front line.  Because there are many unscrupulous players in the market right now, PACHC urges caution in these desperate times when accepting offers.  Here are some initial checks to evaluate offers:

• Large Minimum Order Quantities?  Any provider that is established in this space would be stocking and able to ship case pack quantities. Legitimate providers would not be putting large Minimum Order Quantities (MOQs) out.
• Suspicious Pricing?  Legitimate providers aren’t pricing products significantly above what you could search an item for on the internet or a previous price paid.
• Do They Have a Website?  Not a foolproof check by any means because it’s easy to set up fake sites these days, but an easy rule-out if they don’t have one.
• Do They Have the Appropriate Certifications?  NIOSH, CDC or other?

Can They Send You a Product Sample and/or Product Specification Sheet?  If a distributor is able to do so you have another level of assurance that you are more likely to get what you’re paying for.

The Institute of State and Regional Affairs at Penn State Harrisburg has released a report to help guide strategic planning in response to the COVID-19 outbreak in Pennsylvania. The report compares counties in Pennsylvania based on medical risk factors relating to COVID-19. The institute found that the three Pennsylvania counties with the highest relative risk, Sullivan, Northumberland and Juniata, are not yet showing high rates of infection.

“Efforts to mitigate the spread of COVID-19 in Pennsylvania have been strong and grounded in the best available evidence. This analysis provides new information that may aid strategic efforts to promote the health and safety of communities at greatest risk,” said Institute Director Philip Sirinides.

Rather than mapping current hot spots of COVID-19, this report’s purpose is to highlight areas where the outcomes from COVID-19 may be more severe. To highlight which Pennsylvania counties have the most vulnerable populations, the institute collected data relating to age, prevalence of cardiovascular disease and diabetes, available hospital staff and beds, and nursing home populations, all factors associated with COVID-19 risk identified by the Centers for Disease Control and Prevention.

Click here to read the report on medical risk and COVID-19 in Pennsylvania. 

During the COVID-19 Public Health Emergency, Medicare will cover a medically necessary emergency and non-emergency ground ambulance transportation from any point of origin to a destination that is equipped to treat the condition of the patient consistent with state and local Emergency Medical Services (EMS) protocols where the services will be furnished. On an interim basis, we are expanding the list of destinations that may include but are not limited to:

• Any location that is an alternative site determined to be part of a hospital, Critical Access Hospital (CAH), or Skilled Nursing Facility (SNF)
• Community mental health centers
• Federally Qualified Health Centers (FQHCs)
• Rural health clinics (RHCs)
• Physicians’ offices
• Urgent care facilities
• Ambulatory Surgery Centers (ASCs)
• Any location furnishing dialysis services outside of an End-Stage Renal Disease (ESRD) facility when an ESRD facility is not available
• Beneficiary’s home

CMS expanded the descriptions for these origin and destination claim modifiers to account for the new covered locations:

• Modifier D – Community mental health center, FQHC, RHC, urgent care facility, non-provider-based ASC or freestanding emergency center, location furnishing dialysis services and not affiliated with ESRD facility
• Modifier E – Residential, domiciliary, custodial facility (other than 1819 facility) if the facility is the beneficiary’s home
• Modifier H – Alternative care site for hospital, including CAH, provider-based ASC, or freestanding emergency center
• Modifier N – Alternative care site for SNF
• Modifier P – Physician’s office
• Modifier R – Beneficiary’s home

For the complete list of ambulance origin and destination claim modifiers see Medicare Claims Processing Manual Chapter 15, Section 30 A.

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients.

Guidance

The Families First Coronavirus Response Act waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services. These services are medical visits for the HCPCS evaluation and management categories described below when an outpatient provider, physician, or other providers and suppliers that bill Medicare for Part B services orders or administers COVID-19 lab test U0001, U0002, or 87635.

Cost-sharing does not apply for COVID-19 testing-related services, which are medical visits that: are furnished between March 18, 2020 and the end of the Public Health Emergency (PHE); that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; and are in any of the following categories of HCPCS evaluation and management codes:

• Office and other outpatient services
• Hospital observation services
• Emergency department services
• Nursing facility services
• Domiciliary, rest home, or custodial care services
• Home services
• Online digital evaluation and management services

Cost-sharing does not apply to the above medical visit services for which payment is made to:

• Hospital Outpatient Departments paid under the Outpatient Prospective Payment System
• Physicians and other professionals under the Physician Fee Schedule
• Critical Access Hospitals (CAHs)
• Rural Health Clinics (RHCs)
• Federally Qualified Health Centers (FQHCs)

For services furnished on March 18, 2020, and through the end of the PHE, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under these payment systems should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.

For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment.

For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.

Additional CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Video

By Beth Prusaczyk, PhD, Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri

The rapid spread of COVID-19 across the United States (US) demands a similarly rapid scientific response to mitigate the impact. While the initial scientific discourse about the virus appropriately focused on virology, clinical features, and therapeutics, there is now equal, if not greater, attention on the public health practices that are immediately needed to slow the spread as the response shifts from―containment‖ to―mitigation.

To mitigate the spread of the virus, numerous states have enacted policies that restrict their residents statewide, such as closing all schools, limiting gatherings over a certain amount, or issuing ―shelter in place/stay at home‖ orders for all non-essential activities. These―social or physical distancing‖ practices are seen by many public health experts as the most effective tools currently available to slow the transmission of the virus.

Read more.