Health Plan Weekly

Facing mounting criticism for deciding not to allow a special enrollment period (SEP) on the federal health insurance exchange amid the COVID-19 crisis, the Trump administration offered up a different strategy to help the uninsured get the care they need if stricken by the disease caused by the new coronavirus. In short, the administration will funnel a portion of the $100 billion in funding earmarked for U.S. hospitals in the latest emergency stimulus bill “to cover providers’ costs of delivering COVID-19 care for the uninsured,” HHS Secretary Alex Azar explained during an April 3 White House press briefing.

Ten years after the launch of a mobile outpatient cardiac telemetry device from medtech company BioTelemetry, Inc., insurer Health Care Service Corp. (HCSC) has included it in its medical coverage policy. Pennsylvania-based manufacturer BioTelemetry revealed the coverage decision in a February earnings call, saying that the move was the result of a non-stop effort to flip a small holdout of insurers. BioTelemetry says about 95% of payers cover the diagnostic device, and many without step therapy requirements that mandate patients try other devices first.

The mobile outpatient cardiac telemetry (MOCT) device is perhaps one of the most recent medical developments used for diagnosing heart rhythm and rate abnormalities. These problems — the heart pumping too slow or too fast — can cause sudden cardiac arrest, stroke and/or death.

An earlier version of this story incorrectly stated that a Wakely study of COVID-19-related risk to insurers only examined the risk to commercial carriers. While the study did not estimate risk to traditional Medicare or Medicaid, it did include risk to Medicaid managed care and Medicare Advantage plans. This version of the story has been corrected.

In a series of open letters dated April 1, the American Hospital Association (AHA) asked payers to consider moving temporarily to an advance or scheduled payments model because hospitals’ cash flow is strained by the COVID-19 pandemic. Experts say the need for liquidity is very real, but what hospitals are requesting may not be feasible.

✦ During the 2020 open enrollment period for the Affordable Care Act (ACA) marketplaces, approximately 11.4 million people selected or were automatically reenrolled in plans across all 50 states and the District of Columbia, according to new data CMS released on April 1. That means signups held steady compared with 2019, when 11.4 million enrolled, and 2018, when 11.8 million signed up. Average premiums in the 38 states that use HealthCare.gov, meanwhile, dropped 3% from $612 in 2019 to $595 in 2020. Read more at https://go.cms.gov/3bOxGKu.

✦ On March 30, CMS unveiled several significant regulatory changes in response to the COVID-19 pandemic, including easing the conversion of outpatient facilities to hospital use. Other new or changed policies included rules allowing community COVID-19 screening sites, encouraging a move of non-COVID-19 hospital procedures to outpatient sites, allowing ambulances to transport patients to non-hospital facilities, and establishing special dialysis facilities for those stricken with COVID-19. The agency also suspended scheduled audits of Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid plans and Programs of All-Inclusive Care for the Elderly organizations until further notice, and will focus instead on more pressing oversight priorities. Read more at https://go.cms.gov/2JvxMKR.

by Jinghong Chen NOTES: Data includes adults ages 18 and older, but excludes adults living in nursing homes and other institutional settings. Hospital-bed data includes staffed beds/rooms for community hospitals, which represent 85% of all hospitals. SOURCES: Kaiser Family Foundation, “State Data and Policy Actions to Address Coronavirus,” as of April 1, 2020. Visit https://bit.ly/2UZMEqe. AIS’s Directory of Health Plans. Visit https://aishealthdata.com. Click here for a pdf of the full issue