The Centers for Medicare & Medicaid Services (CMS) issued a fact sheet with additional guidance for healthcare providers and patients about the telehealth benefits in the agency’s Medicare program. The fact sheet is part of a broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this disease.
“As we continue to learn about the COVID-19 virus, it’s important for all Americans, and particularly vulnerable populations who are at heightened risk, to be able to access their providers when they feel sick or have questions” said CMS Administrator Seema Verma. “Over the last three years, President Trump’s leadership and historic efforts have made it possible for doctors to bill for their time on the phone or video chat with patients to help triage medical issues. Today, a patient who is not feeling well can call their doctor to decide whether or not they need to go in for a visit, offering solutions and peace of mind immediately.”
CMS’ historic effort made virtual check-ins and other services that use telecommunications possible with new policies implemented in 2019 and 2020. These services are available right now to patients and their physicians, providing a great deal of flexibility and an easy way for patients who are concerned about illness to remain in their home avoiding exposure to others.
With the COVID-19 virus, there is an urgency to expand the use of virtual care to keep the beneficiaries with mild symptoms in their homes while increasing access to their provider’s office.
For the beneficiary, these benefits can be very helpful. For example, a Medicare beneficiary who is looking for advice about symptoms they are experiencing, can call their doctor and receive medical advice about whether he or she needs to see their doctor in person for a physical exam.
If they start to feel more ill, a virtual check-in allows a healthcare provider to offer recommendations about next steps and even take precautions for someone they are concerned may have the COVID-19 virus or flu before they step in the office or hospital putting others at risk. These check-ins are billable services and the Medicare coinsurance and deductible would apply to these services.
Medicare Advantage plans may also provide enrollees access to Medicare Part B services via telehealth in any geographic area and from a variety of places, including beneficiaries’ homes, as part of their benefit packages for a plan year.
Therefore, enrollees in Medicare Advantage plans that include coverage of such services may be available to receive clinically appropriate services for treatment of COVID-19 via telehealth from many sites, including their home.
The U.S. Department of Health and Human Services (HHS) today finalized two transformative rules that will give patients unprecedented safe, secure access to their health data. Interoperability has been pursued by multiple administrations and numerous laws, and today, these rules finally deliver on giving patients true access to their healthcare data to make informed healthcare decisions anPutting patients in charge of their health records is a key piece of giving patients more control in healthcare, and patient control is at the center of the Trump administration’s work toward a value-based healthcare system.d better manage their care.
The two rules, issued by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act (Cures Act) and support President Trump’s MyHealthEData initiative. MyHealthEData is designed to empower patients around a common aim — giving every American access to their medical information so they can make better healthcare decisions.
Together, these final rules mark the most extensive healthcare data sharing policies the federal government has implemented, requiring both public and private entities to share health information between patients and other parties while keeping that information private and secure, a top priority for the Administration.
“President Trump is delivering on his vision for healthcare that is affordable, personalized, and puts patients in control. From the start of our efforts to put patients and value at the center of our healthcare system, we’ve been clear: Patients should have control of their records, period. Now that’s becoming a reality,” said HHS Secretary Alex M. Azar. “These rules are the start of a new chapter in how patients experience American healthcare, opening up countless new opportunities for them to improve their own health, find the providers that meet their needs, and drive quality through greater coordination.”
“Delivering interoperability actually gives patients the ability to manage their healthcare the same way they manage their finances, travel and every other component of their lives. This requires using modern computing standards and APIs that give patients access to their health information and give them the ability to use the tools they want to shop for and coordinate their own care on their smartphones,” said Don Rucker, M.D., national coordinator for health information technology. “A core part of the rule is patients’ control of their electronic health information which will drive a growing patient-facing healthcare IT economy, and allow apps to provide patient-specific price and product transparency.”
“The days of patients being kept in the dark are over,” said CMS Administrator Seema Verma. “In today’s digital age, our health system’s data sharing capacity shouldn’t be mired in the stone age. Unfortunately, data silos continue to fragment care, burden patients, and providers, and drive up costs through repeat tests. Thanks to the leadership of President Trump, these rules begin a new chapter by requiring insurance plans to share health data with their patients in a format suitable for their phones or other device of their choice. We are holding payers to a higher standard while protecting patient privacy through secure access to their health information. Patients can expect improved quality and better outcomes at a lower cost.”
These final rules deliver on the Administration’s promise to put patients at the center of their care by promoting patient access and use of their own health information and spurring the use of and development of new smartphone applications.
Addressing Interoperability and Information Blocking
The ONC Final Rule identifies and finalizes the reasonable and necessary activities that do not constitute information blocking while establishing new rules to prevent “information blocking” practices (e.g., anti-competitive behaviors) by healthcare providers, developers of certified health IT, health information exchanges, and health information networks as required by the Cures Act.
Currently, many EHR contracts contain provisions that either prevent or are perceived to prevent users from sharing information related to the EHRs in use, such as screen shots or video. The ONC final rule updates certification requirements for health IT developers and establishes new provisions to ensure that providers using certified health IT have the ability to communicate about health IT usability, user experience, interoperability, and security including (with limitations) screenshots and video, which are critical forms of visual communication for such issues.
The ONC final rule also requires electronic health records to provide the clinical data necessary, including core data classes and elements, to promote new business models of care. This rule advances common data through the U.S. Core Data for Interoperability (USCDI).
The USCDI is a standardized set of health data classes and data elements that are essential for nationwide, interoperable health information exchange. The USCDI includes “clinical notes,” allergies, and medications among other important clinical data, to help improve the flow of electronic health information and ensure that the information can be effectively understood when it is received. It also includes essential demographic data to support patient matching across care settings.
Unleashing Innovation & Patient Access
ONC’s final rule establishes secure, standards-based application programming interface (API) requirements to support a patient’s access and control of their electronic health information. APIs are the foundation of smartphone applications (apps). As a result of this rule, patients will be able to securely and easily obtain and use their electronic health information from their provider’s medical record for free, using the smartphone app of their choice.
Building on the foundation established by ONC’s final rule, the CMS Interoperability and Patient Access final rule requires health plans in Medicare Advantage, Medicaid, CHIP, and through the federal Exchanges to share claims data electronically with patients.
CMS took the first step towards interoperability by launching Medicare Blue Button 2.0 for Medicare beneficiaries in 2018. Medicare Blue Button 2.0 gives beneficiaries the ability to securely connect their Medicare Part A, Part B and Part D claims and encounter data to apps and other tools developed by innovators. Engagement and partnership with the technology community has involved more than 2,770 developers from over 1,100 organizations working in the Medicare Blue Button 2.0 sandbox to develop innovative apps to benefit Medicare patients.
Currently, 55 organizations have applications in production. Beginning January 1, 2021, Medicare Advantage, Medicaid, CHIP, and, for plan years beginning on or after January 1, 2021, plans on the federal Exchanges will be required to share claims and other health information with patients in a safe, secure, understandable, user-friendly electronic format through the Patient Access API. With more complete data in their hands, patients can be more informed decision makers leading to better informed treatment.
This Patient Access API will allow patients to access their data through any third party application they choose to connect to the API and could also be used to integrate a health plan’s information to a patient’s electronic health record (EHR). By requiring their relevant health information including their claims to be shared with them, patients can take this information with them as they move from plan to plan, and provider to provider throughout the healthcare system.
To further advance the mission of fostering innovation, the CMS final rule establishes a new Condition of Participation (CoP) for all Medicare and Medicaid participating hospitals, requiring them to send electronic notifications to another healthcare facility or community provider or practitioner when a patient is admitted, discharged, or transferred. These notifications can facilitate better care coordination and improve patient outcomes by allowing a receiving provider, facility, or practitioner to reach out to the patient and deliver appropriate follow-up care in a timely manner.
Additionally, CMS is requiring states to send enrollee data daily beginning April 1, 2022 for beneficiaries enrolled in both Medicare and Medicaid, improving the coordination of care for this population. This ensures beneficiaries are getting access to appropriate services and that these services are billed appropriately the first time, eliminating waste and burden. Beneficiaries will get the right services at the right time at the right cost, with no administrative burden to rebill services.
Very few businesses today use fax machines, yet more than 9 billion faxes are still sent every year in healthcare, according to DirectTrust. Eighty percent of all serious medical mistakes result from poor communication, which includes fax. Simply put, every industry decreased or eliminated its reliance on the fax machine over the past decade – except healthcare. Beyond fax, healthcare’s dependence on manual communications is costly, inefficient and brings serious security risks.
According to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, there is no place left for the antiquated fax machine. In 2018, she issued a bold vision to transform patient care by improving communication and data exchange. She challenged the industry to make doctors’ offices “a fax-free zone” by 2020.
Why not push healthcare to go beyond that? Let’s look at all the ways inefficiencies and “doing things the way they’ve always been done” are holding healthcare back with manual processes, repetitive tasks and increasing frustration.
To replace fax, we must look at why it’s still being used. Fax is easy. Fax numbers are already programmed and shared. Faxes (usually) go directly to the recipient. But, the costs associated with faxing keep growing. The process isn’t efficient and it’s not at all secure in today’s HIPAA-compliant environment.
Yet, reports say nearly 90% of hospitals still rely on fax. Change is a challenge. Fax machines must become a thing of the past in order to bring healthcare fully into the 21st century. As those machines are eliminated, healthcare providers still need a way to exchange information and transfer documents. The need to exchange documents isn’t going to change but the way that is done – to ensure efficiency and security – has to change.
Are providers of all sizes ready for the end of an era? Understanding the true value and efficiency of eliminating fax is critical, but it has to be replaced with a solution that actually makes it easier.
Benefits Beyond Cost Savings
While physicians and staff are familiar and comfortable with using traditional faxing, this old school approach is an inefficient and costly part of both independent practices and health systems alike. Redundant work processes, like inputting information from faxes into electronic health record (EHR) systems, severely hampers productivity and profitability.
On average, providers spend upwards of 55 hours per month manually faxing based on a customer engagement survey by Updox. And for every 5,000 fax pages sent or received, a practice spends about $155 in supplies, including paper, toner, phone lines and shredding costs.
Plus, there are patient privacy and security concerns when using faxes. In recent years, researchers have discovered security flaws that can leave entire networks vulnerable from malicious faxes. Manual errors, too, result in protected patient information getting sent to the wrong number, which could lead to HIPAA violations and fines costing hundreds of thousands of dollars.
By Rob Wiley, head of marketing and product strategy, Formstack.
Rob Wiley
If you’re in healthcare, it’s likely because you have a passion for helping others and solving problems. Those on the IT side of the industry are no exception. Healthcare IT has seen a significant shift from navigating health records in a paper-based system to the digitization of health data—and for good reason.
There are many benefits to digital transformation in the health industry. For one, administrative costs alone in healthcare account for nearly $266 billion per year. By transferring records like medical forms and insurance verification paperwork to a secure electronic platform, healthcare providers can save on administrative spending and put those funds into more impactful areas. Additionally, the digitization of health data streamlines communication between all levels of the healthcare process: from physicians to patients and insurance companies.
But the digitization of health data also comes with challenges that healthcare IT professionals must solve—most notably around the implications of Health Insurance Portability and Accountability Act (HIPAA) compliance, patient engagement and employee empowerment.
HIPAA Compliance
Rules and regulations in healthcare are ever-changing, and health providers and practices are expected to stay up-to-date and comply. Ensuring your company maintains compliance and data stays secure begins with your healthcare IT team. Not only does compliance protect your company from stiff penalties and violations, it also safeguards the protected health information (PHI) of customers and partners.
Consider this: A patient is asked to share interest in an elective surgery and decides to opt out. If this document confirming their disinterest in the surgery is stored insecurely using a paper file, this puts the patient’s trust at risk of being breached, and in turn, the decision to opt out of the procedure at risk of being dishonored. Meanwhile, storing this information in a secure, electronic file would reduce the risk associated with data breaches and the file being lost or misread. With a strong IT team following HIPAA guidelines, your practice can stay safe from violations and accidental exposure of sensitive records in the digital world of healthcare.
Patient Engagement
The digital transformation of healthcare doesn’t just impact the backend of business; it also affects patient experience and how practices are represented to future customers and partners. Healthcare IT professionals have to consider how digitization impacts the user experience and the ease of electronic communication between patient and practitioner. Here are seven important questions healthcare IT teams should ask themselves when evaluating their current digital network and any future improvements:
What systems are patients interacting with when preparing for or during the visit?
How easy is it for patients to provide information to their health provider?
How long does it take for the patient to fill out the intake documentation?
Are patients required to enter duplicate information anywhere?
Is the process convenient for the patient? Are they able to complete the information when and where they would like?
Is there an option to sign electronically and securely?
Does the patient receive copies of their documents for their own record keeping?
Healthcare IT professionals should consider the answers to these questions to determine the top changes they need to make to their digital system in order to improve patient experience and, ultimately, increase the number of patients they serve.
Rimidi, a cloud-based software platform, announced the launch of its patient-reported outcomes survey app to help limit the spread of COVID-19 in healthcare settings. Currently, the app is in expedited beta testing by select U.S. health systems operating in the regions at the greatest risk of Coronavirus outbreak. Rimidi anticipates general availability of the app before the end of March 2020.
Ide
“One of the greatest challenges in China and across other countries that faced early COVID-19 outbreaks has been hospital-based transmission,” said Lucienne Ide, MD, PhD, founder of Rimidi. “With the app, we can help keep potentially infectious individuals from exposing other patients or staff in the healthcare system in waiting rooms, emergency rooms, or triage before they are identified and separated.”
Combatting Coronavirus Spread via Advanced EHR-integrated Technology
Along with their text message appointment reminder, patients are sent a brief COVID-19 screening survey inquiring about current symptoms and recent travel. Integrated within the electronic health record (EHR), patient responses are easily captured and analyzed by clinical teams. The survey respondents demonstrating potential risk of COVID-19 exposure, in accordance with the latest CDC guidelines, are immediately notified with the appropriate next steps of care and treatment options, while the healthcare system is confidentially made aware of the at-risk patient.
Ultimately, the simplicity and accessibility of Rimidi’s screening app will help minimize the spread and impact of COVID-19 in healthcare settings by reducing the number of undiagnosed patients interacting with patients seeking standard care. It will also limit exposure of healthcare staff to potentially infectious patients in settings that are not adequately prepared.
Dr. Ide added, “The need for such a screening app was advocated for in a JAMA article following the Ebola outbreak in 2014. Today, the potential COVID-19 public health emergency reinforces the healthcare industry’s need for interoperability and stronger data-sharing rules to ease the flow of information, which enables rapid deployment of a single application across multiple EHR platforms.”
Rimidi remains in close coordination with the Centers for Disease Control and Prevention and will incorporate new evidence and its evolving guidance into the screening app as it emerges. This may include ongoing remote monitoring and self-reporting by patients in quarantine, among other features.
For more information and to be notified when the app is widely available for healthcare systems, please visit rimidi.com/covid19.
The past decade of healthcare delivery has been dominated by the electronic health record (EHR), which has consumed vast hospital budgets and executive mindshare.
However, 35 percent of hospital executives say if they could go back in time, they would choose a different EHR vendor, and 56 percent say they seek out other health IT vendors to fulfill their needs rather than wait for their EMR to provide a tool.
These findings emerge in the Hospital Technology Forecast 2020, a new market report from Sage Growth Partners (SGP), a Baltimore-based healthcare research, strategy, and marketing firm.
Based on a survey of 100 hospital C-suite leaders conducted to gauge hospitals’ top health IT needs, challenges, and priorities, key findings from the market survey include:
Pessimism about EHR capabilities are pervasive; EHR loyalty is weak:
More than a quarter (27 percent) of respondents believe their EHR will fail to meet their future needs. COOs are the most pessimistic (67 percent) followed by CEOs (37 percent), and CFOs (34 percent).
If an organization’s EHR does not provide a tool they need, the majority (56 percent) of respondents say they seek out another vendor. Only 30 percent wait for the capability to be added to the EHR, and 14 percent say they create their own in-house solution.
The top three reasons executives look outside the EHR for an IT solution are: patient safety is jeopardized (No. 1), an outside solution promises greater ROI (No. 2), and an outside solution promises greater quality (No. 3).
Investment outside the EHR is already widespread, especially in non-clinical areas:
The top areas where hospitals have already invested in an IT solution outside of their EHR include data/analytics (73 percent), cybersecurity (70 percent), revenue cycle management (48 percent) and patient engagement (43 percent).
Of the health IT segments that hospitals have invested in, the areas of greatest return on investment include revenue cycle management and data/analytics (tied at No. 1), cybersecurity (No. 2), and operational efficiency (No. 3).
Over the next one to two years, hospitals’ top areas of health IT investment will include data/analytics (No. 1), operational efficiency (No. 2), patient engagement (No. 3), and revenue cycle (No. 4).
When asked to select the top digital health priority for their organization, most respondents (36 percent) selected patient self-scheduling. Just over a quarter (28 percent) selected care coordination; fewer selected patient access to clinical and financial records (15 percent), remote patient monitoring (12 percent), or disease management (nine percent).
With limited budget and attention, hospital leaders may choose the path of least resistance:
Sixty percent of C-suite leaders said only up to three percent of net patient revenue will be budgeted for new IT investments. Only four percent of C-suite leaders said more than five percent of net revenue will go toward new IT investments.
More than a quarter (28 percent) of survey respondents reported that vendors reach out to them daily, and another thirty percent field weekly inquiries.
A quarter of survey respondents said their EHR vendor offers rebates and incentives for adopting tools within the EHR. Of those respondents, 70 percent said this increases the likelihood that they would choose the EHR solution over a best-of-breed solution outside the EHR.
But executives expect any solution provider to keep up with interoperability requirements:
When asked how the recent CMS and ONC proposed rules on interoperability have affected IT investment plans, 48 percent said they simply expect their current vendors to provide solutions that meet the new rule requirements.
About one in five (22 percent) plan to hold off on investment decisions until they know more about the new rules, and 16 percent plan to accelerate investment. Only 13 percent reported already being in compliance with the new rules.
“The movement for new, better, and more appropriate digital solutions is underway,” says Dan D’Orazio, SGP’s CEO. “This is driven by fatigue and frustration around EHRs, as well as the many striking studies that show poorly performing EHRs can negatively impact patient safety. While hospitals were willing to put up with poor workflows in the EHR, they aren’t willing to compromise on safety, quality, or ROI. Healthcare is about to enter a new decade of digital innovation, and we will continue to see IT vendors and outside players like Amazon, Walmart, and CVS, disrupt EMRs and traditional care models.”
Connected Nation (CN), through its state program Connected Nation Michigan (CN Michigan), released a study that examines the use and perceptions of telehealth in rural areas with a focus on Michigan counties.
Researchers found, among other things, the highest ratios in the country of patients per doctor, a lower-than-average life expectancy, and a higher-than-average number of preventable hospital stays in rural states with restrictive telehealth policies.
Ferree
“This study demonstrates why connecting rural America is critical,” said Tom Ferree, chairman & CEO, CN. “Connected Nation has worked for nearly two decades to identify innovative solutions for connecting every community, and in that time, we’ve seen firsthand that having access to high-speed internet impacts everything from the economy to educating our children. Now we have real data that shows it can also impact healthcare—and even life expectancies—among families and individuals in our rural communities and small towns through telehealth applications and programs.”
The more than six-month-long study was done in partnership with AARP and the Michigan Health Endowment Fund. Find the full report at http://bit.ly/2ThWBPX. The study looks at the opportunities and reasons for expanding telehealth as well as the obstacles for rural areas.
“Many older adults in Michigan, especially those who live in rural areas, do not have access to high-speed internet, and that’s a quality-of-life issue for them,” said Paula D. Cunningham, State Director of AARP Michigan. “That means they can’t take advantage of advances in telemedicine that at the very least could save them long trips to the doctor, and at the most could be lifesaving.”
“Our nonprofit has long been focused on connecting more families and communities to high-speed internet,” said Eric Frederick, executive director, CN Michigan. “In recent years, we’ve seen more talk about the ways telehealth could help fill the void in rural areas where there may not be hospitals or doctors for hundreds of miles. But, as we looked around for more detailed information on telehealth in Michigan, we soon learned there were a lot of unanswered questions at the intersection of telehealth and the digital divide that we decided to set out and answer—from how state policies impact the use of technology to whether people or providers even understand the many ways it can be used.”
CN Michigan’s researchers took a three-pronged approach to examine those issues. First, they reviewed the current telehealth policies in all 50 states to identify counties ripe for leveraging the benefits of telehealth. As part of this analysis, CN Michigan compared each county’s access to primary care physicians and health outcomes to determine how big of a role telehealth policies and the Digital Divide play in these metrics.
Second, the team conducted telephone surveys of 2,001 adult heads of households in five rural Michigan counties: Gladwin, Sanilac, Roscommon, Osceola, and Dickinson.
“We chose these five counties because they represent a cross-section of rural portions of the state,” said Chris McGovern, Director, Research Development, Connected Nation (CN). “They were selected due to their differences and representative nature in terms of geography, employment, and the prominence of non-related healthcare provision networks in each county. We focused our questions on current telehealth usage, savings experienced from accessing online healthcare, interest in future use of telehealth services, and barriers that prevent individuals from using the technology.”
The third facet of this study focused on healthcare providers. CN Michigan conducted extended interviews and focus groups with healthcare networks, including doctors, nurses, medical assistants, and others within the five counties identified for telephone surveys. Healthcare networks in these groups ranged from just beginning to experiment with telehealth to those with established and award-winning telehealth programs.
“Although our focus was primarily on the impact in rural Michigan, this data can help inform the development of telehealth services elsewhere and provide a starting point for additional studies in regions across the United States,” said Frederick. “Our hope is to build upon what we’ve learned in this study and help more people in both rural and urban areas save time and money through telehealth applications and expanding broadband access. Most importantly, we hope it will lead to innovations that can improve the quality of life for all Americans—no matter where they live.”
The Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).
CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases.
In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well.
“CMS continues to leverage every tool at our disposal in responding to COVID-19,” said CMS Administrator Seema Verma. “Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them. At the same time, we are providing critical information to our 130 million beneficiaries, many of whom are understandably wondering what will be covered when it comes to this virus. CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe.”
HCPCS is a standardized coding system that Medicare and other health insurers use to submit claims for services provided to patients. Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus.
This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) announced today allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.
The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates.
Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.
To ensure the public has clear information on coverage and benefits under CMS programs, the agency also released three fact sheets that cover diagnostic laboratory tests, immunizations and vaccines, telemedicine, drugs, and cost-sharing policies.
Medicare Fact Sheet Highlights: In addition to the diagnostic tests described above, Medicare covers all medically necessary hospitalizations, as well as brief “virtual check-ins,” which allows patients and their doctors to connect by phone or video chat.
Medicaid and Children’s Health Insurance Program (CHIP) Fact Sheet Highlights: Testing and diagnostic services are commonly covered services, and laboratory and x-ray services are a mandatory benefit covered and reimbursed in all states. States are required to provide both inpatient and outpatient hospital services to beneficiaries. All states provide coverage of hospital care for children and pregnant women enrolled in CHIP. Specific questions on covered benefits should be directed to the respective state Medicaid and CHIP agency.
Individual and Small Group Market Insurance Coverage: Existing federal rules governing health insurance coverage, including with respect to viral infections, apply to the diagnosis and treatment of with Coronavirus (COVID-19). This includes plans purchased through HealthCare.gov. Patients should contact their insurer to determine specific benefits and coverage policies. Benefit and coverage details may vary by state and by plan. States may choose to work with plans and issuers to determine the coverage and cost-sharing parameters for COVID-19 related diagnoses, treatments, equipment, telehealth and home health services, and other related costs.
Summary of CMS Public Health Action on COVID-19 to date:
On Mar. 4, 2020, CMS issued a call to action to healthcare providers nationwide to ensure they are implementing longstanding infection control procedures and issued important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare facilities to focus exclusively on issues related to infection control and other serious health and safety threats. For more information on CMS actions to prepare for and respond to COVID-19, visit: https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus
The Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).