Health Plan Weekly

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered “medically necessary” diagnostic and antibody tests.

The guidance, released jointly on June 23 by the Department of Health and Human Services, the Department of Labor and the Department of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate, and that providers of tests must publicly post retail prices for those tests.

COVID-19 has disproportionately infected and killed people of color, causing many health care leaders to renew their focus on racism’s role in social determinants of health (SDOH). Since George Floyd was killed by Minneapolis police and Black Lives Matter protests took over America’s streets, the conversation about racism in health care has become even more urgent. Experts and policymakers say payers can help battle racism and SDOH by partnering with organizations rooted in communities of color — and improve insurance business outcomes by doing so.

In a June 22 meeting of the House Committee on Education and Labor about the pandemic’s impact on education, health care and the workforce, Rep. Lauren Underwood (D-Ill.) observed that COVID-19’s brutal impact on Black communities is “glaring, but not surprising.” Underwood is a nurse with a master’s degree in public health who worked on Affordable Care Act (ACA) implementation at HHS and taught at Georgetown University before being elected to Congress.

✦ CMS issued a proposed rule on June 17 aimed at making it easier for state Medicaid programs to enter into outcomes-based contracts with drug manufacturers. Among other policy revisions, the rule would allow manufacturers to report multiple “best prices” for a therapy under the Medicaid Drug Rebate Program if the prices are tied to a value-based payment arrangement. CMS Administrator Seema Verma touted the proposed rule as a way to lower prescription drug costs in general. “CMS’s rules for ensuring that Medicaid receives the lowest price available for prescription drugs have not been updated in thirty years and are blocking the opportunity for markets to create innovative payment models. By modernizing our rules, we are creating opportunities for drug manufacturers to have skin in the game through payment arrangement[s] that challenge them to put their money where their mouth is,” she said in a statement about the new proposal. Read the proposed rule at https://bit.ly/30X06jg.

✦ Despite calls for expanded testing to detect coronavirus cases and ensure Americans can safely return to work, some private health insurers may cover only those deemed medically necessary, Reuters reported. Such policies could limit testing to people who either have symptoms of COVID-19 or have been in close contact with someone who has, the article pointed out. Meanwhile, states including Georgia, North Dakota, Oklahoma, Tennessee and Washington have taken steps to ensure patients are protected from being balance billed for coronavirus tests, such as capping costs or more narrowly defining what insurers should pay for, Politico reported. Read more at https://reut.rs/3d9dFOQ and https://politi.co/2YKYJkM.

The Supreme Court’s June 15 ruling on LGBTQ+ workforce protections in Bostock v. Clayton County, Georgia, could supersede a recently finalized rule by HHS’s Office for Civil Rights (OCR) that stripped gender identity protections from anti-discrimination provisions in the Affordable Care Act (ACA), legal experts say. However, the same experts emphasize that the matter is still an open question and is likely to play out over time in lower courts.

In Bostock, the Court held that Title VII of the Civil Rights Act of 1964 protects employees from discrimination based on sexual orientation or gender identity. The case originated with Gerald Bostock, who sued his employer, Clayton County, when he was fired after mentioning that he was the member of a gay softball league.

Unsurprisingly, COVID-19 was a frequent topic of discussion during the 2020 America’s Health Insurance Plans Institute & Expo — an event held virtually because of the ongoing pandemic. Here’s a selection of what health care executives and thought leaders had to say about the impact of the crisis on their organizations and the industry:

“Mid-January was when we began to prepare, and we assumed it would come when we were seeing what was happening in China….[We] didn’t imagine that it would be in Seattle and that it would spin up in a particular nursing home, nor were we expecting that two of our employees would have close relatives who lived in that nursing home and lost them both. And that brought it home really early on and made it personal.”