An enormous $2 trillion economic stimulus package includes major requirements for insurers to cover diagnostics and services associated with COVID-19 and gives some flexibility to hospitals.
A major part of the legislation, which passed the Senate in the early hours of Thursday morning and is set to get through Congress by the end of this week, is $100 billion to hospitals to help them meet the COVID-19 pandemic.
But the bill, which includes massive unemployment assistance and help to businesses, includes several other healthcare provisions.
- Requiring Medicare Part D and Medicare Advantage plans to allow for refills and fills for up to three months. The provision does give exceptions for cost and utilization management like step therapy or prior authorization and medication therapy management.
- Extending healthcare programs through November. The bill includes a raft of extensions for healthcare programs that were expected to run out of money on May 23. For instance, the bill would extend a delay of reductions in payments to disproportionate share hospitals until Dec. 1. The legislation also extends funding to community health centers through Nov. 30. Funding for the series of programs was extended at the end of last year through May 22. The goal was to give Congress more time to address drug prices and surprise medical bills. But Congress has been blindsided by responding to the COVID-19 pandemic, so work on those bills is likely delayed.
- Waiving site-neutral payment cuts, 50% rule for long-term care hospitals. For the duration of the emergency period, the bill would waive the 50% rule, which cuts payments for long-term care hospitals where fewer than 50% of their Medicare patients get a standard payment. It also waives the site-neutral payment cuts installed this year for long-term care facilities for the duration of the emergency.
- Eliminating Medicare sequester and boosting Medicare payments for COVID-19 payments. This provision was in the original legislation released by Senate Republicans. It would pause for the rest of the year the 2% cut for Medicare under sequestration. It would also boost payments to providers by 20% for COVID-19 related cases.
- Requiring payers to cover hospital-made tests. Major insurers have largely agreed to waive co-pays for COVID-19 tests, but the bill also requires insurers to cover tests developed by hospitals. Major hospital groups and academic medical centers have been working on developing their own tests in-house to get results much faster. The provision ensures that those tests will also be covered.
- Publishing the cash price for diagnostic testing. During the emergency period, each provider of a diagnostic test must put the cash price for a COVID-19 diagnostic test online. The Department of Health and Human Services could fine the diagnostic test provider if they aren’t in compliant by as much as $300 per day that the violation occurs.
- Requiring group and individual health plans to cover preventive services. The bill defines preventive services as immunization or any other item or service intended to “prevent or mitigate coronavirus disease.”