March 15, 2020
Area(s) of Interest: Public Health
U.S. House Speaker Nancy Pelosi and U.S. Treasury Secretary Steven Mnuchin reached an agreement on Friday on a new far-reaching COVID-19 response package. The U.S. House of Representatives passed the legislative package early Saturday morning with a bipartisan vote of 363-40. It is expected to be voted on in the U.S. Senate as early as Monday.
The legislative package will ensure free COVID-19 testing and expand the safety net to cope with the potentially catastrophic economic impact of the coronavirus outbreak.
Specifically, the bill includes the following:
- Mandates coverage and waives all patient cost-sharing for COVID-19 tests, and associated physician visits for evaluating the need for testing. This mandate applies for patients who are privately insured, uninsured or enrolled in Medicare, Medicaid, SCHIP, TriCare, the Veterans Administration, the Indian Health Services or contract/referral services for Indians.
- Medicare will cover 100% of the payment amount for COVID-19 tests and associated physician visits. The bill also specifies that Medicare COVID-19 testing-related services is a medical visit in any of the following categories of HCPCS evaluation and management (E&M) service codes: office and other outpatient services, and services provided in hospital observation, emergency departments, nursing facilities, rest homes or custodial care, and home health. Outpatient payment includes hospital outpatient, the Medicare physician fee schedule, the prospective payment system and rural health clinic payments. CMS is also mandated to provide a modifier for physicians to include on claims to identify COVID-19 testing-related services.
- Prohibits prior authorization or utilization management requirements for COVID-19 testing and associated physician visits for all patients.
- Provides Medicaid eligibility to the uninsured for purposes of COVID-19 testing. The federal government will pay for 100% of the cost of COVID-19 testing and associated physician visits for these uninsured patients and will not require a state match.
- Increases federal matching funds for the Medicaid program overall by 6.2%
- Increases OSHA protections for health care workers.
- Provides $1 billion in funding for food assistance programs (school lunch, emergency food assistance, aging and disability programs, and the women, infants and children nutrition program)
- Provides up to two weeks of paid sick leave for workers who work for the government or employers with 500 employees or less.
- Provides up to 3 months of paid family and medical leave for government employees and employees who work for employers with less than 500 employees. The paid family and medical leave begins after the first 14 days of sick leave and is not less than two-thirds of the employee's regular payment rate.
- Increases funding for state unemployment funds by $1 billion.
- Provides tax credits to employers to offset the costs of emergency sick leave.
The California Medical Association (CMA) is checking with the American Medical Association CPT and Centers for Medicare and Medicaid Services (CMS) to get clarification on a physician’s ability to bill for telephone codes for new patients and whether patient copays will be waived for telephonic visits.
This package comes on the heels of legislation that Congress enacted last week to provide $8.3 billion in funding to assist with COVID-19 vaccine development and treatment, public health preparedness, low-interest small business loans and financial assistance to help Americans afford the vaccine.
Last week’s legislation also gave broad authority for HHS Secretary Azar to waive Medicare telehealth requirements so that physicians can provide services related to screening, testing and treatment of coronovirus in all settings and geographic regions. Azar is expected to release the details of the telehealth waiver soon. We will provide an update when details are available.
The California Medical Association (CMA) has set up a COVID-19 resource page, where you will find links to the latest news, research and developments on the COVID-19 outbreak for physicians and other health care providers.