Monday Musings

Congress

Monday Musings

David Ermer–Congress, COVID-19, OPM, SCOTUS–

Becker’s Hospital Review provides a helpful update of today’s top seven COVID-19 news items.

Healthleaders Media interviews “Karen Murphy, PhD, RN, executive vice president and chief innovation officer at Geisinger, and founding director of the Steele Institute” for Health Innovation about COVID-19 and lessons for the future.

HL: Is telehealth among the initiatives that should be expanded? What else?

Murphy: Virtual care is one thing that I think will transform the healthcare industry. And, we’re looking at what we need in terms of infection control. How do we change our practices?

Federal News Network reports on legislative ideas coming from the majority leadership of the House Oversight and Reform Committee. With regard to the FEHBP, the leaders

recommended allowing federal employees to change or opt into new insurance plans during a health emergency like the current pandemic.

Currently, FEHB participants have one chance a year, usually a four-week “open season,” to make changes to their health insurance plan.

In addition, the chairmen suggested allowing employees to extend eligibility for their federal health, dental and vision benefits to qualifying dependents for an additional year. Some children, for example, may age out of their family’s current health plans during the coronavirus pandemic, they said.

The FEHBlog recalls that approximately 15% of FEHBP eligible employees decline FEHBP coverage in favor of taking coverage under his or her spouse’s employer sponsored coverage. We the rapid employment loss due to the great hunkering down, it would make sense for OPM to remind federal employees that losing other health coverage is a qualifying life event that allows them to rejoin the FEHBP for themselves and their eligible family members. OPM prominently notes that “Generally, if you choose to make a change to your enrollment, you must make the change within 60 days of the event.”

Today, the U.S. Supreme Court, which had cancelled its March and April oral arguments, rescheduled ten of those cases for telephonic oral argument in May. “The Court anticipates providing a live audio feed of these arguments to news media.” Normally the press desiring live feeds would have listen to the oral argument in person at the Court. Transcripts of the oral argument come later.

Weekend Update

David Ermer–Congress, COVID-19–

Congress is on a State / district work period at least until April 20 as a form of social distancing. Congress nevertheless can take action by unanimous consent measures from afar. The Wall Street Journal reports on bumpy bi-partisan efforts to craft a fourth COVID-19 relief bill.

The Affordable Care Act regulators have issued FAQ 42 on concerning “implementation of the Families First Coronavirus Response Act (the FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and other health coverage issues related to Coronavirus Disease 2019 (COVID-19).” The FAQs cover COVID-19 coverage issues for group and individual health plans as well as employee assistance plan and telehealth issues.

The Wall Street Journal helpfully wrote about how to obtain healthcare for issues other than COVID-19 during this emergency.

Don’t assume doctors are too busy for you. Doctors are converting their practices to telemedicine quickly to address more ailments, so there is no need to suffer in silence. Call your doctor and together make a plan that addresses both your medical need and your concern for protection from the coronavirus.

“Doctors have switched their business model on the fly,” says Fred Feuerbach, a cardiologist and assistant attending physician and clinical instructor of medicine at NewYork-Presbyterian/Weill Cornell Medical Center, who is monitoring some patients through daily phone calls and FaceTime visits. “Patients should know doctors are available,” he says.

According to the article, the same approach applies to seeking dental care. The article also discusses women’s health care, vision care, orthopedics, and allergy and vision care during the great hunkering down. The across the board advice is to avoid emergency rooms now.

The Wall Street Journal reports on the expansion of serological / blood testing for COVID-19 antibodies.

“To date, we have had no clue how many people have been infected,” said Eran Bendavid, an infectious-disease physician at Stanford University. “This could be an extraordinarily important piece of how we’re going to get over this epidemic.”

In the U.S., the Food and Drug Administration granted the first emergency authorization for one of the blood tests last week, and the Centers for Disease Control and Prevention said it has started using its own test. The U.S. could have a “rather large number of tests” available within a week, provided extra checks show them to be accurate, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN.

Reason Magazine discusses a serological test study conducted in a German hot spot.

Over the last two weeks, German virologists tested nearly 80 percent of the population of Gangelt for antibodies that indicate whether they’d been infected by the coronavirus. Around 15 percent had been infected, allowing them to calculate a COVID-19 infection fatality rate of about 0.37 percent. The researchers also concluded that people who recover from the infection are immune to reinfection, at least for a while.

This preliminary study illustrates the promise of these serological tests in gauging the lifting of the great hunkering.

The FEHBlog noted recently about a new rapid COVID-19 test development by Abbott Labs. According to this Wall Street Journal article, the federal government bought a boatload of the machines and distributed them among the States and other U.S. jurisdictions. However, Abbott has experienced a backlog in manufacturing the test cartridges to be read on the machines, notwithstanding producing 50,000 cartridges daily. On the bright side,

Detroit, was able to buy and deploy a large number of Abbott’s rapid tests shortly after the company got approval from the FDA on March 27. The quick results helped reshape the city’s response to the virus.

Since the start of the month, Detroit has administered more than 1,000 tests, initially focusing on first responders and bus drivers who had been in quarantine, said John Roach, a spokesman for the mayor. The city has already purchased 4,000 additional tests from Abbott and recently said that rapid tests would be used at nursing homes and homeless shelters.

Well done, Detroit.

Weekend update

David Ermer–ACA, CDC, Congress, COVID-19–

Congress is on a State / district work period this week. The Health Affairs blog discusses the health coverage provisions in the CARES ACT. In addition to broadening coverage of COVID-19 testing [Section 3201] and any future FDA-approved vaccine [Section 3203] , the new law permits high deductible health plans with health savings account to pay for telehealth care before the deductible [Section 3701] and repeals the Affordable Care Act provision requiring a doctor’s prescription for over the counter medicines as a prerequisite to reimbursement from a health savings account or a healthcare flexible spending account [Section 3702].

The high deductible health plan telehealth provision took effect last Friday and the over the counter drug coverage change was made retroactively effective January 1, 2020.

Health Affairs blog adds that

Under [Section 3202 of] the CARES Act, all comprehensive private health insurance plans would reimburse a test provider based on the rate negotiated between the plan and the provider (i.e., the in-network rate) that was put in place prior to this emergency. If there is no negotiated rate between the plan and provider (i.e., the provider is out-of-network), the plan would fully reimburse the provider based on the provider’s own “cash price” (or a lower price if the plan can negotiate one). This “cash price” must be publicly available (listed on a public website) while there is a declared public health emergency. Providers that fail to make their price public could face a civil monetary penalty of up to $300/day. This provision essentially allows out-of-network labs to set their own price and expect full reimbursement from the plan, potentially leading to dramatic price increases for testing.

Fierce Healthcare reports that that healthcare actuarial consulting firm TowersWillisWatson has released a projection of healthcare spending associated with the COVID-19 emergency.

On the low end of the spectrum, should the outbreak infect just 10% of the population and prove to have low morbidity, costs will increase by under 1%. However, if the virus infected 50% of the population with high morbidity, costs could increase by 6.8%, the study found. The scenario with the highest cost increases is if the virus 30% of people with high morbidity—a combination that could lead to 7.2% in cost increases, Willis Towers Watson found.

A major federal agency and two other health plan accrediting bodies have centralized their COVID-19 emergency guidance:

Apple in partnership with the Centers for Disease Control has posted a COVID-19 screening tool for consumers.

Friday Stats and More

David Ermer–CDC, Congress, COVID-19, HIPAA Privacy and Security Rules–

Here are the week by week COVID-19 case statistics for this month from the Centers for Disease Control:

3-6-203-13-203-20-203-27-20
Travel36138290712
Person to Person181293101326
Cause under invest.1101362984283,318
Total Cases164162910,44285,356
Total Deaths1501246
Deaths over cases1.44%1.46%

Quite a spike. In the FEHBlog’s view, it will be interesting to see whether there is any leveling off in the case count increase.

The CDC’s latest Fluline reports “that [according to CDC estimates] so far this season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 deaths from flu.” That represents a deaths over cases percentage of .06%.

With regard to COVID related guidance from that is relevant to FEHBP carriers and others

  • The Department of Health and Human Services Office for Human Rights has gathered together all of its COVID-19 emergency guidance on the HIPAA Privacy and Security Rules in one website.
  • The Department of Labor and the IRS have issued additional guidance on the Families First Coronavirus Response Act’s paid sick leave mandate and expanded FMLA leave.
  • The National Committee for Quality Assurance has assembled its COVID-19 emergency guidance here.

As previously mentioned the Office of Personnel Management has taken the same consolidated approach with its online COVID-19 emergency guidance which generally is directed at federal agencies.

CARES Act Passes Congress

David Ermer–Congress, COVID-19–

The FEHBlog just watched on C-SPAN the House of Representatives join the Senate in adopting the CARES Act (H.R. 748) so the $2 trillion COVID-19 emergency relief bill heads to the President for his expected signature later today.

Monday Musings

David Ermer–ACA, Congress, COVID-19–

Today is the tenth anniversary of President Obama signing the Patient Protection and Affordable Care Act into law. The FEHBlog is tempted to muse on the law but since he has been writing in this space since 2006, he concluded no need exists for another such musing.

Be sure to check out at least the transcript for this week’s Econtalk interview with Dr. Azra Raza, a veteran oncologist who wrote a book on the human cost of cancer treatment. She explained that the benefit of early detection of cancer lies in the fact that at that point the body has fewer cancer cells that must be killed. She also touted tobacco cessation. She further explained that the new fangled CAR-T drug therapy has a weakness. CAR-T activates the body’s T cells which wind up killing healthy and cancerous tissue in a particular organ. Consequently CAR-T therapy is not used for example on liver cancer because the cure would kill the liver. Cancer is a very complicated disease.

On the COVID-19 front —

  • The Hill reports on continuing Senate negotiations over the third COVID-19 emergency relief bill. The American Hospital Association helpfully lists the healthcare provisions in the draft legislation which includes adjustments to the Families First relief bill’s COVID-19 testing coverage mandate and allow high deductible health plans with health savings accounts to waive their deductible for telehealth services.
  • “Today the U.S. Treasury Department, Internal Revenue Service and the U.S. Department of Labor announced that small and midsize employers [under 500 employees] can begin taking advantage of two new refundable payroll tax credits, designed to immediately and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirus-related leave to their employees.”
  • The Wall Street Journal offers an illuminating story about its investigation into the COVID-19 deaths at a Washington State nursing home. On February 26 the nursing home order closure of its dining rooms and an institutional scrub down due to a high number of respiratory illnesses among patients. Nevertheless the staff went ahead with a schedule party for patients, their family members and staff and ka-boom. This is why the social distancing guidance is so important right.

Friday’s Stats and more

David Ermer–Congress, COVID-19, OPM–
COVID-19 CasesMarch 6March 13March 20
Travel36138290
Person to Person18239310
Cause of Infection
Under Investigation		1103629,842
Total Cases164162910,442
Total Deaths150

These statistics are drawn from Centers for Disease Control’s COVID-19 Situation Summary in the U.S. website. The CDC indicates that there statistics may be understated. The FEHBlog is using the CDC’s website in the interest of consistency and reliability.

The COVID-19 virus is present in all 50 states with the highest concentration of case in New York State, California, and Washington State.

From the CDC’s latest Fluline (March 14),

  • Nationally, the percent of specimens testing positive for influenza at clinical laboratories continued to decrease while ILI activity increased for the second week in a row after declining for three weeks. Due to the ongoing COVID-19 pandemic, more people may be seeking care for respiratory illness than usual at this time.
  • Laboratory confirmed influenza-associated hospitalization rates for the U.S. population overall remain moderate compared to recent seasons, but rates for children 0-4 years and adults 18-49 years are now the highest CDC has on record for these age groups, surpassing rates reported during the 2009 H1N1 pandemic. Hospitalization rates for school-aged children (5-17 years) are higher than any recent regular season but remain lower than rates experienced by this age group during the pandemic.
  • Pneumonia and influenza mortality levels have been low, but 149 influenza-associated deaths in children have been reported so far this season. This number is higher than recorded at the same time in every season since reporting began in 2004-05, except for the 2009 pandemic.
  • CDC estimates that so far this season there have been at least 38 million flu illnesses, 390,000 hospitalizations and 23,000 deaths from flu.

In other news,

  • SHRM offers more details on the Family and Medical Leave Act and new COVID-19 related paid leave created by this week’s Families First Coronavirus Response Act.
  • Govexec.com reports on OPM’s latest guidance regarding COVID-19 related telework for federal employees. “OPM on Thursday wrote that agencies can more quickly implement mass telework by formally evacuating employees’ worksites in connection with a pandemic. By using evacuation pay authority, agencies can mandate that federal employees use telework, regardless of whether they already have a telework agreement.”
  • FCW informs us about an interview with OMB Deputy Director Margaret Weichert about the government’s COVID-19 communications strategy for its agencies and workforce.
  • The IRS has moved this year’s tax day from April 15 to July 15 due to the COVID-19 emergency. Check with your tax advisor generally and on whether your state is following the IRS’s lead.
  • Healthcare Dive reports that telehealth companies are scrambling to add doctors to their platforms. That’s a good sign. Mhealthintelligence.com adds that “The national network of 36 independent BCBS companies announced Thursday that it would boost connected health coverage for the next 90 days, in response to the Coronavirus (COVID-19) pandemic. This will include waiving cost-sharing for telehealth services for fully-insured members, and it applies to all in-network providers and clinically appropriate services.”

Thursday Miscellany

David Ermer–Congress, COVID-19, OPM–

On the COVID-19 front —

  • The President signed the Families First Coronavirus Response bill (H.R. 6021) into law last night. The Society for Human Resource Management discusses the HR aspects of the new law.
  • The FEHBlog ran across this Worldometer COVID-19 monitor. The FEHBlog finds it easier to decipher than the Johns Hopkins dashboard.
  • A company called Everlywell will start selling an at home COVID-19 tests on Monday. The testing floodgates finally may be opening.
  • Currently telehealth doctors must be licensed in the state where the patient resides. MHealthIntelligence reports that the federal government is about to override this state law requirement. That action would give quite a boost to telehealth and would help staffing hospitals in cities with adjoining states like New York City and Washington DC.

Finally, here’s a link to the Politico article that broke the story about Dale Cabaniss’s resignation as OPM Director on Tuesday. The FEHBlog is disturbed that a federal agency director would resign over personal differences with White House officials in the midst of a national emergency. Can’t we all get along?

Midweek update

David Ermer–AHRQ, Congress, COVID-19, Medicare, OPM–

On the COVID-19 front —

  • The Senate this afternoon approved H.R. 6021, the Families First Coronavirus Response bill. HR Dive explains the paid leave revisions that the House made to the bill first passed last Saturday before sending the bill to the Senate. Three attempts in the Senate to further amend the bill were rejected. The President has indicated that he will sign the bill.
  • H.R 6021 will mandate all types of health plans, including FEHB plans, cover FDA approved COVID-19 testing without cost sharing or medical management by the health plan. OPM already has required this for FEHB plans. However, the no cost sharing aspect of this coverage does not extend to treatment of the COVID-19 disease. A recent survey “of nearly 600 individual and family health insurance enrollees released today by eHealth, Inc. more than two thirds (69%) feel they lack a basic understanding of how testing and treatment of coronavirus (COVID-19) would be covered by their health insurance plan.” A word to the wise, etc.
  • Federal News Network reports “Federal agencies have 48 hours [until tomorrow] to review, modify and start implementing policies and procedures that will realign critical resources to slow the spread of the coronavirus. This includes offering “maximum telework flexibilities” for the federal workforce and may even include mandatory telework orders, the Office of Management and Budget said Tuesday night.”
  • The Wall Street Journal’s Journal podcast offers an interesting 20 minute long take on the race for a cure to the COVID-19 disease. One of the drugs discussed on the podcast is a Regeneron arthritis drug Kevazara that acts to calm the body’s immune system. Severe cases of COVID-19 cause lung inflammation. The FEHBlog read in the Great Influenza that the flu pandemic caused a spike in the death rate for healthy young adults. This flu struck deep in the lungs where the alveoli tissues transfer oxygen to the blood stream. The body’s immune system took great umbrage with this type of attack and threw everything at the disease. The body’s immune system attack often was the cause of death in young adults who have the strongest immune systems. The modern treatment is to try to calm the immune system and use a ventilator, options that didn’t exist in 1918.
  • Verily Health, the Google / Alphabet affiliate, issued an update on its development of a COVID-19 testing platform for patients. The Washington Post reports on COVID-19 testing sites in the DC metropolitan area.
  • Medicare has expanded the availability of telehealth for traditional Medicare beneficiaries during the COVID-19 emergency. HHS has issued guidance to health care providers on how to maintain HIPAA Privacy and Security rule compliance in the brave new world of telehealth.

In other news–

  • The Labor Department’s Employee Benefits Security Administration has released its latest report to Congress on improving health plan compliance with the federal mental health parity law and its report and an appendix on EBSA enforcement of that law in 2019.
  • Healthcare Dive reports that “The Trump administration is considering pushing back the timeline for payers, providers and health IT vendors to come into compliance with its two sweeping rules to promote interoperability as the healthcare system struggles with the novel coronavirus outbreak.” It would make sense to slow down the effort to ensure that it is done correctly, in the FEHBlog’s opinion.
  • AHRQ wisely points out the need to rethink the role of primary care in reducing hospital readmissions. Check it out.
  • Fierce Healthcare reports that

Aetna is linking Unite Us, a social care coordination platform, with its Guardian Angel program for members who have suffered an opioid overdose. The insurer, owned by CVS Health, will roll out the joint effort first in North Carolina, it announced this week. Using the Unite Us platform, care managers will be able to more effectively link members with social supports and other nonclinical options to aid in recovery, such as housing and healthy food.

Bravo.