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March 6, 2020

US coronavirus cases surpass 200, as states and insurers look to limit testing costs

Daily Briefing

    The number of reported cases of the new coronavirus in the United States rose to more than 200 as of Friday morning, as states and health insurers announced efforts to limit patients' out-of-pocket costs for being tested for the virus.

    About the coronavirus epidemic

    Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China. As of Friday, officials reported more than 100,600 cases of the virus globally. Officials said as of Friday there had been at least 3,404 deaths linked to the virus, and all but 362 occurred in mainland China.

    The number of newly reported cases in China has been slowing. For instance, Chinese officials on Friday reported no new cases of the virus in the Hubei province outside of Wuhan, marking a first since the outbreak began. But the number of newly reported infections from the new coronavirus, which are referred to as COVID-19 cases, has been surging in other countries.

    For example, in the United States, state and federal officials as of Friday morning reported at least 231 confirmed or presumed positive cases of COVID-19 across 22 states and 14 deaths linked to the virus.

    CDC as of Thursday said 49 of the cases involved Americans who contracted the virus elsewhere and then repatriated to the United States, 30 cases involved patients who had contracted the virus while traveling abroad and were diagnosed after returning to the United States, and 20 cases involved patients who contracted the virus via human-to-human transmission in the United States. CDC said 49 cases were under investigation.

    According to the New York Times, the "pace of diagnosis" in the United States "has grown rapidly in recent days." The federal government this week lifted restrictions on testing patients for the virus, meaning all patients who receive a clinician's order for a COVID-19 test can receive one. In addition, Vice President Pence on Wednesday said HHS designated a lab test for the new coronavirus as an essential health benefit, meaning the test will be covered by private health plans in accordance with the Affordable Care Act (ACA), as well as Medicare and Medicaid. CMS on Thursday announced that it has created another Healthcare Common Procedure Coding System code that laboratories can use to bill for certain coronavirus tests and "new fact sheets that explain Medicare, Medicaid, [CHIP], and Individual and Small Group Market Private Insurance coverage for services" related to COVID-19.

    Major health insurers say they will limit patient cost-sharing for coronavirus tests

    One day after Pence's announcement, America's Health Insurance Plans (AHIP) in a statement said members of the industry group will cover coronavirus screening tests ordered by doctors and "will take action to ease network, referral, and prior authorization requirements and/or waive patient cost sharing."

    Members of AHIP include major health insurers Anthem, Cigna, and Humana, Reuters reports.

    Cigna on Thursday announced that it will cover coronavirus tests ordered by clinicians and waive all copayment, cost-sharing, and deductible requirements related to the tests for individuals enrolled in its employer-sponsored health plans, Medicare Advantage plans, Medicaid plans, and plans sold on the ACA's exchanges. Cigna said it will give organizations with the company's Administrative Services Only plans the option of whether to cover coronavirus testing as a preventive benefit, meaning it would not be subject to cost-sharing requirements.

    But despite the insurers' announcements, some observers warned that patients enrolled in private health plans still could have to meet certain cost-sharing requirements for the test—which could present barriers to screening patients for COVID-19.

    In response, several states—including California, Missouri, New York, and Washington—have ordered health insurers to cover the tests without cost-sharing requirements for members in the states. Other states are eyeing similar moves, the Wall Street Journal reports.

    CMS Administrator Seema Verma on Thursday also noted that tests for the coronavirus are available at no cost to patients at public health departments.

    Will insurers', states' efforts protect patients from high costs?

    Still, some observers said those moves might not go far enough to help patients avoid high costs related to COVID-19.

    For instance, the Associated Press reports that it is "unlikely that a patient will receive only one test for coronavirus," as "[a] doctor also might order a chest X-ray or tests for bacterial pneumonia or the flu," as well as "respiratory diseases, depending on the patient's symptoms."

    In addition, the actions by insurers and states do not address costs patients could face for medical visits related to coronavirus screening or treatments related to COVID-19. Further, Axios' "Vitals" reports that states typically don't regulate self-insured plans, meaning the 61% of American workers covered by such plans might not benefit from policymakers' orders on coronavirus testing.

    Sabrina Corlette, a research professor at Georgetown University, said, "We have a patchwork quilt that's full of holes that's our health care system and it is not well-designed for dealing with a public health crisis like this one."

    Trump signs emergency funding bill

    President Trump on Friday signed a bill (HR 6074) that Congress approved this week to provide $8.3 billion in emergency funding to help federal, state, and local governments respond to the coronavirus.

    Sen. Roy Blunt (R-Mo.) on Tuesday said the bill gives states the flexibility to move some funding they receive to hospitals. "The state government, whenever they get some block grants, which they'll get under this, they'll have to develop in many cases their own allocation formula, both to their hospitals and deciding which hospitals to include," he said.

    But a spokesperson for the House Appropriations Committee told The Hill that the bill doesn't include language addressing paying for care related to the virus for Americans who are underinsured or uninsured.

    According to The Hill, federal lawmakers might look to address the issue in future legislation, such as by creating a specific payment mechanism for hospitals caring for uninsured patients with COVID-19 (Smith et al., New York Times, 3/6; Alonso-Zaldivar/Murphy, Associated Press, 3/5; Lai et al., New York Times, 3/6; Galbraith/Zhang, Reuters, 3/5; CDC website, 3/5; CMS release, 3/5; Beasley, Reuters, 3/5; Wilde Mathews, Wall Street Journal, 3/5; Owens, "Vitals," Axios, 3/6; Hellmann, The Hill, 3/5; Minemyer, FierceHealthcare, 3/5; Ballhaus, Wall Street Journal, 3/6; Cohrs, Modern Healthcare, 3/4).

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