Recycle Intelligence reports that House of Representatives members are returning to Capitol Hill to vote on the fourth (3.5?) COVID-19 relief bill (H.R. 266) tomorrow morning.

Today, the Health and Human Services Department (“HHS”)announced how it plans to divvy up the remaining $70 billion in funding allocated to hospitals and other healthcare providers in the third relief law known as the CARES Act. The last paragraph of the announcement states that

as a condition to receiving general funds, providers must agree not to seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.

If the FEHBlog’s recollection serves him correctly, the earlier version of this statement flatly prohibited surprise billing. This version permits the provider to collect in-network cost sharing from the patient. How will the provider know the amount of in-network cost sharing?, and how will the member and the patient be made aware that the provider is subject to this obligation? In any event, the government has to provide much more guidance on this well meaning initiative.

Speaking of guidance, the Centers for Medicare and Medicaid Services did provide guidance to health plans yesterday concerning limits on medical management of COVID-19 testing coverage mandated by the Families First Coronavirus Response Act as amended by the CARES Act. Check it out.

In an interesting development, the day after HHS delayed enforcement of its new electronic health record interoperability rule, the HHS Office of Inspector General proposed a rule to apply civil monetary penalties to electronic health information blocking violations.

The White House and Congressional leaders continue to negotiate over the bill that would expand funding for the Small Business Administration relief programs and provide more grants for health care providers and testing. According to the Wall Street Journal, the parties are close to a deal, and a Senate vote is expected tomorrow.

Healthcare Dive explains the precarious financial position in which many primary care practices find themselves as the great hunkering drags on.

Most providers have turned to telehealth in a bid to recoup patient volume, but reimbursement for virtual care is often lower than an in-office visit — if it’s reimbursed at all. A majority [of 2600 primary care providers surveyed by the Primary Care Collaborative (“PCC”)] are unsure whether they’ll be reimbursed for telehealth services, and full-scale use of virtual care is slight — 34% of practices rely mostly on video to conduct appointments, 15% on e-visits and 19% on a patient portal, compared to 48% of doctors conducting the majority of visits by phone, PCC found.

The article adds that “65% of clinicians in the PCC survey reporting they have patients who can’t use telehealth because they don’t have a computer or internet access. Congress allocated $200 million in CARES funding to the Federal Communications Commission ​to support providers’ telehealth infrastructure. FCC rolled out the first wave of grants on Friday.” Health plans can’t do much about the FCC issue, but they can provide temporary improvements on the telehealth payment issue.

Fierce Healthcare reports that the Centers for Medicare and Medicare Services announced late Sunday new guidelines on resuming “non-essential” surgical procedures such as joint replacements. “The lack of revenue from such surgeries, in addition to low patient volume overall, has sparked a cash crisis for U.S. hospitals. Some major healthcare systems such as Tenet, Trinity Health and Detroit Medical Center have had to furlough workers due to the lack of cash.” The aforementioned Healthcare Dive article indicates that resumption of non-essential surgeries will aid medical practices too. But the ramp up understandably will be slow.

Congress remains on a District / State work period at least until May 4. In the meantime, Congress can enact legislation by unanimous consent / voice vote and the Wall Street Journal reports this evening that White House and Congressional negotiators are close to agreement on a law that would expand funding for underfunded small business programs and provide $75 billion in hospital funding and $25 billion in COVID-19 testing funding, among other things.

Speaking of testing, CVS Health, Walgreen’s and Verily Health all have expanded the scope of their drive in COVID-19 testing programs. Verily Health, a subsidiary fo Alphabet / Google, is now operating its testing service outside California:

• CVS Health (which just added drive in testing at the FEHBlog’s place of birth New Haven CT)
• Walgreen’s
• Verily Health

GoodRx helpfully offers a more complete list of drive up COVID testing sites here.

In the Wall Street Journal, Dr. Scott Gottlieb, the former FDA commissioner, and Dr. Stephen Ostroff offer suggestions for businesses on how to prepare for reopening following the great hunkering.

NPR Shots discusses the Administration’s efforts to put a stop on surprise billing for patients receiving COVID-19 care.

Last week, as HHS released an initial draft of its terms and conditions for the emergency funds allocated by Congress in the CARES Act, the Trump administration startled many in health care by declaring that providers would have to agree not to send surprise bills to COVID-19 patients for treatment. A White House spokesperson declined to comment. HHS did not immediately comment.

But the blanket assertion by health officials that “every patient” is considered a COVID-19 patient, offered without further clarification, seems to go beyond the administration’s announcement and open the door to lawsuits over whether HHS intended to ban balance billing entirely.

The FEHBlog expects further guidance from HHS.

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.

The President signed the CARES Act (H.R. 748) into law yesterday. Here’s a link to the new law. It’s helpful that professionals have the weekend to unpack the law.

The FEHBlog finished reading John Barry’s The Great Influenza this morning. The New Yorker interviewed Mr. Barry on the current emergency. Check both out.