Many COVID-19 cost-sharing waivers set to expire by October

• Most private payers offered financial relief for COVID-19 treatment, but many of those cost-sharing waivers are set to expire in the next few months, even as the pandemic shows no signs of slowing, a new Kaiser Family Foundation analysis found.
• Nearly nine in ten people enrolled in the individual and fully insured group markets are in plans that have limited out-of-pocket costs for COVID-19 treatment. However, 20% of such waivers in the U.S. have already expired, and another 16% are scheduled to time out by the end of September, meaning just over half of enrollees in the plans will still be free from COVID-19 cost-sharing by October.
• Many insurers have extended the waivers, and others could take that step before theirs expire. But the report raises concerns more privately insured individuals could be exposed to steep medical costs at a time of deep economic and public health instability, even as payers report record profits amid the pandemic.

The coronavirus has swept through the country largely unchecked, leading to 5.6 million confirmed infections and 176,000 deaths to date. It’s also sparked a coverage crisis, as tens of millions of Americans lose their jobs and, correspondingly, their health insurance at a time of great medical need.

In the early days of the pandemic, insurers took steps to lessen the financial impact of the coronavirus on their members, waiving coinsurance, copayments and deductibles for COVID-19 treatment and offering premium relief, along with easing access to telehealth.

However, KFF found much of this aid could soon expire even though the need for it hasn’t gone away, and could even intensify. The pandemic is gaining steam in many regions of the U.S. and could commingle with a bad flu season this fall, piling up more burden on the country’s already stressed healthcare system, public health experts warn.

Congress has attempted some health cost relief: Two major pieces of COVID-19 relief legislation passed in March made COVID-19 testing free for most people, though questions remain about who exactly pays. Some patients have been hit with massive bills for the service, despite the laws.

Congress didn’t limit out-of-pocket costs for COVID-19 treatment. Only five states — Massachusetts, New Mexico, Idaho, Michigan and Minnesota — and Washington, D.C., require insurers waive cost-sharing for COVID-19 treatment for fully insured beneficiaries.

KFF previously estimated an inpatient admission for COVID-19 treatment could generate more than $1,300 in out-of-pocket costs for a patient in a large employer-sponsored plan. Costs could be significantly higher for severely sick patients, or for enrollees in individual and small group market plans, which typically have higher deductibles.

A little less than a third of beneficiaries in the individual and fully insured group markets are covered by plans that waived COVID-19 treatment cost-sharing through the end of 2020. Another 15% are in plans that have an unspecified expiration date on the cost-sharing, KFF found.

Only about one in four enrollees in individual and fully insured group market plans are getting some sort of premium relief, KFF estimates, including premium credits or reductions, payment grace periods or expedited medical loss ratio rebates.

If insurers don’t spend enough on patient care — including waivers and premium relief — they could be on the hook for steep MLR rebates next year under the Affordable Care Act. Payers reported massive profits due to patients delaying care in the first half of 2020, sparking a House committee investigation.

KFF’s analysis of payer lobby America’s Health Insurance Plans’ and enrollment data did not include the 61% of group market enrollees in self-insured plans through their job, as comprehensive data wasn’t available for that cohort. Employers in self-insured plans can opt out of extending cost-sharing and other forms of financial relief for their employees.

https://www.healthcaredive.com/news/many-covid-19-cost-sharing-waivers-set-to-expire-by-october-study/583938/

Hospitals hit ‘disturbing’ Covid data reporting rule threatening Medicare funds

• CMS is now requiring hospitals to report COVID-19 data such as number of confirmed and suspected COVID-19 positive patients, ICU beds occupied and availability of supplies including ventilators and personal protective equipment. Previously, the submissions were voluntary, the agency said Tuesday.
• The penalty for not reporting the data or correcting deficiencies is withdrawal from the Medicare and Medicaid programs, which are huge sources of funding that hospitals rely on for survival, according to the interim final rule.
• The American Hospital Association quickly slammed the regulation, calling it “heavy-handed” and requesting it be reversed immediately. “It’s beyond perplexing why CMS would use a regulatory sledgehammer — threatening Medicare participation — to the very organizations that are on the frontlines in the fight against COVID-19,” the group said in a statement.

Controversy has swirled around COVID-19 data reporting, which experts agree is vital for understanding the scope of outbreaks and how medical facilities in hotspots are able to handle them.

In July, HHS suddenly switched the reporting protocols and instructed hospitals to send the information straight to the department instead of using a long-established program from the Centers for Disease Control and Prevention.

Public health groups protested the change, saying it would likely hamstring the pandemic response. Leaders of the House Committee on Energy and Commerce requested the Government Accountability Office review the decision and its impact, writing of concerns about transparency and burden on hospitals.

In its argument against the latestrequirement, AHA said 94% of hospitals are reporting information to the federal government currently. The group also pushed back on the lack of opportunity to comment before the final rule was rolled out.

“This disturbing move, announced in final form without consultation, or the opportunity to provide feedback through appropriate administrative procedures prior to it becoming effective, could jeopardize access to care and leave patients and communities without vital health services from their local hospital during a pandemic,” AHA said.

CMS said the regulation is necessary “in order to ensure a more complete picture in the nationwide surveillance of COVID-19, as well as a more efficient allocation of PPE and other vital supplies.”

It defended the lack of a usual notice and comment period by citing the urgency of the public health emergency and said the information will help public health officials detect outbreaks and save lives.

CMS estimates the new reporting requirement will take a total of more than 3 million hours across all hospitals and cost them $212.2 million annually — $38,488 per hospital assuming one and a half hours per day at a daily wage rate (including overhead and fringe benefits) of $70.48.

The new rule also has requirements for nursing homes and labs, as well as revising a policy that had stated Medicare beneficiaries needed a practitioner order for covering any COVID-19 tests. Now, members may receive one test without an order. “This change helps ensure that beneficiaries receive appropriate medical attention if they need multiple tests,” CMS said. “It is also designed to stop fraudsters from performing or billing for unnecessary tests.”

Also, CMS will cover tests ordered by a pharmacist or other healthcare professional authorized by state law.

Nursing homes are now required to offer tests to residents who show symptoms or when there is an outbreak at a facility. Those that don’t comply could face civil monetary fines.

The rule also implements a requirement from the Coronavirus Aid, Relief, and Economic Security Act that all laboratories conducting COVID-19 testing report results to HHS daily after a one-time three week grace period. Labs that don’t comply will be fined $1,000 for the first day and $500 for each day after.

CMS estimates the requirement could cost labs as much as $4.2 billion annually and between $145 million and $176 million in one-time costs.

https://www.healthcaredive.com/news/hospitals-slam-disturbing-covid-19-data-reporting-requirement-threatens-Medicare/584166/

COVID-19 insurance crisis may not be as drastic as initially feared

• A slew of competing research has attempted to estimate the number of Americans that lost job-based insurance due to the economic effects of the coronavirus, varying in projections from the millions to multiple tens of millions. But the losses may not be as drastic as initially thought, according to a new report from the Urban Institute.
• Researchers performed a comparative analysis on four studies on COVID-19’s effects on job-based insurance coverage published between early May and mid-July, and found they differ wildly in methodology, assumptions and completeness. Smaller household surveys conducted during the pandemic have found little immediate change in insurance status, suggesting studies estimating more modest long-term changes in the number of uninsured people as a result of COVID-19 may be more accurate than others.
• Despite the importance of waiting for definitive data next year, the models are still valuable for informing policymakers on the scope of the insurance crisis spurred by COVID-19. And researchers are continuing to pursue the question: New research released by the Economic Policy Institute on Wednesday found it’s likely 12 million people have lost employer-sponsored insurance since February.

Despite the Trump administration touting a rebounding economy, more than 1 million Americans applied for unemployment benefits last week, according to data released Thursday by the Department of Labor. The number of jobless claims has topped 1 million every week but one since late March.

Since the majority of Americans get coverage through their job, ongoing unemployment has given rise to concerns about an insurance crisis stemming from the pandemic and the threadbare U.S. safety net.

But recent household surveys suggest net changes in insurance coverage so far have been relatively minimal, Urban Institute pointed out in its brief. The surveys, conducted by groups like the Census Bureau and the Commonwealth Fund, are more timely but more limited than federal surveys with larger sample sizes. But none have found large increases in uninsurance at this point in the recession.

For example, the Coronavirus Tracking Survey conducted mid-May by Urban Institute and the Robert Wood Johnson Foundation found no change in employer-sponsored insurance, or in the number of uninsured people, for the overall sample. However, for those in families losing jobs, employer-based coverage dipped by 4.9 percentage points. That drop, though, was offset by a 3.5 percentage point increase in private non-group coverage.

More longitudinal estimates, like the four analyzed by the Urban Institute, are much more severe in their projections, but vary widely. They don’t all address the same exact questions, act on different methodology and assumptions and generally differ in completeness, Urban said.

Two earlier estimates from the Urban Institute pegged the number of people losing employer-based coverage over 2020 as 10.1 million workers and dependents, or between 17.7 million and 30 million workers and dependents over several months to a year.Both studies tried to incorporate projections of how many people would gain access to coverage through a family member, or through subsidized Medicaid or individual marketplace coverage.

One study from the Kaiser Family Foundation estimated 27 million workers and dependents were losing employer-based coverage over the remainder of 2020. However, the KFF study did not quantify the number of people who would become uninsured due to job loss.

Another from Families USA, looking at losses already occurred, estimated 5.4 million workers lost job-based insurance, but didn’t factor in family members and dependents who would also lose coverage as a result of the policyholder being let go.

The data is still shifting, and it’s important to wait for more definitive data points next year to get a fuller understanding of the pandemic’s effects on insurance coverage, Urban Institute said, though the projections are important for informing the nation’s public health response.

https://www.healthcaredive.com/news/covid-19-insurance-crisis-may-not-be-as-drastic-as-initially-feared-study/584336/

Teladoc offers free virtual visits to those impacted by Hurricane Laura, wildfires

Teladoc Health recently announced it is providing free, 24/7 telehealth visits to residents and first responders affected by the wildfires in the Western region of the U.S. as well as those impacted by Hurricane Laura across Texas and the Louisiana coasts.

The free visits will cover general medical conditions including sinus problems, respiratory infections and cold and flu symptoms and are available to individuals who have been displaced or cannot receive medical care due to the wildfires in California, Oregon and Colorado.

The same type of services are being offered to those impacted by Hurricane Laura, and any individuals who think they may have been exposed to COVID-19 or that they have symptoms of the virus can be screened and triaged for care as needed.

https://www.beckershospitalreview.com/telehealth/teladoc-offers-free-virtual-visits-to-individuals-impacted-by-hurricane-laura-western-wildfires.html

Out-of-network providers price gouging COVID-19 tests, AHIP says

Out-of-network providers are inflating the price of COVID-19 diagnostic and antibody tests, according to a report from America’s Health Insurance Plans.

AHIP conducted a survey of its member plans in the commercial market and received 22 responses, which represented 67 percent of commercial enrollment of member plans. Responses were weighted based on plans’ enrollment.

Under the Coronavirus Aid, Relief and Economic Security Act, health insurers have to pay the listed cash price for COVID-19 tests to out-of-network providers. AHIP said this has resulted in price gouging, as payers and providers can’t negotiate test prices.

COVID-19 tests usually cost $130. AHIP says out-of-network providers charge more than $185 for 39 percent of diagnostic tests and 25 percent of antibody tests, with 1 in 10 out-of-network providers charging more than $390.

https://www.beckershospitalreview.com/payer-issues/out-of-network-providers-price-gouging-covid-19-tests-ahip-says.html

Rapid testing propels airlines, cruise lines

The S&P closed above 3,500 for the first time and is on its way to the best August performance since 1986, with a 6.6% gain as of Friday’s close.

Stocks tied to resurgent economic activity soared on anticipation that consumers would feel more comfortable in pre-lockdown activities after the FDA approved a cheap, rapid COVID test. Abbott Labs is conducting trials to see if the test could be used on asymptomatic people. 

Cruise lines rebounded sharply, with Carnival (NYSE:CCL) the third-biggest gainer in XLY, up 10%. Norwegian (NYSE:NCLH) rose 8.2% and Royal Caribbean (NYSE:RCL) added 7%.

Carnival got an extra boost Friday after its German unit AIDA Cruises said it would resume voyages in fall and winter. 

https://seekingalpha.com/news/3609941-weekly-wrap-rapid-testing-propels-airlines-cruise-lines

LSU study explains multipronged SARS-CoV-2 attack, widespread COVID-19 infection

A study of a gateway receptor for SARS-CoV-2 led by Walter J. Lukiw, PhD, Professor of Neuroscience, Neurology and Ophthalmology at LSU Health New Orleans’ Neuroscience Center of Excellence and School of Medicine, may help explain the wide variety of symptoms and organs involved with SARS-CoV-2 infection and COVID-19. The results suggest that a multi-organ infection with SARS-CoV-2 may be via the angiotensin-converting enzyme 2 (ACE2) receptor, which is found almost everywhere throughout the body. The findings are published in the journal Cellular and Molecular Neurobiology, available here.

To better understand the mechanism and pathways of SARS-CoV-2 infection and susceptibility to specific cell and tissue types as well as organ systems, the research team analyzed 85 human tissues for the presence of ACE2 receptors. ACE2 is a protein that is found on the surface of many immune and nonimmune cell types. An enzyme, it is part of the system that regulates blood pressure and fluid and electrolyte balance. It may also help regulate cardiovascular, neurovascular and renal function, as well as fertility. ACE2 receptors act like locks on cells, and the SARS-CoV-2 spike proteins act like keys that open the locks letting the virus enter cells to rapidly multiply. As well as controls, tissues tested included lung, digestive, renal-excretory, reproductive, eye tissues, and 21 different regions of the brain.

“Besides strong ACE2 expression in respiratory, digestive, renal-excretory and reproductive cells, high ACE2 expression was also found in the amygdala, cerebral cortex and brainstem,” reports Dr. Lukiw. “This may help explain cognitive deficits associated with SARS-CoV-2 infection. Some of the highest ACE2 expression levels were found in the pons and medulla oblongata in the human brainstem, an anatomical region of the brain containing the medullary respiratory centers, and this may in part explain the susceptibility of many CoV-19 patients to severe respiratory distress.”

The team further noted that ACE2 receptor activity was also easily detected in the eye, suggesting that the visual system may provide an additional entry point for SARS-CoV-2 invasion and that under certain conditions, eyeglasses or face shields may be as important as face masks in reducing SARS-CoV-2 transmission and infection.

“Several important research gaps remain,” Lukiw concludes. “A real danger of SARS-CoV-2 infection is not only its highly transmissible and contagious nature and lethality, but also its simultaneous and multipronged attack on many human cell and tissue types involving vital and critical respiratory, immunological, vascular, renal-excretory and neural systems as well as an unprecedented coordinated disruption of the complex neurophysiology, neurochemistry, neurobiology and neurology of the cells of the brain and central nervous system (CNS) that normally regulate these multiple physiological systems.”

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The authors credit the late Dr. James M. Hill (formerly a Professor in the Departments of Microbiology, Ophthalmology and Pharmacology at LSU Health New Orleans School of Medicine) with whom they had a longstanding research collaboration on the expression of the ACE2 receptors, including those found in the Alzheimer’s disease brain. Aileen Pogue, from Alchem Biotech Research in Toronto, also participated in the research data tabulation, bioinformatics and statistical analysis.

The research was supported by grants from Research to Prevent Blindness (RPB); the Louisiana Biotechnology Research Network (LBRN); and NIH grants NEI EY006311, NIA AG18031 and NIA AG038834.

https://www.eurekalert.org/pub_releases/2020-08/lsuh-lhs082820.php