Thursday Miscellany

Thursday Miscellany

Healthcare Dive helpfully reviews the benefit improvements that large health insurers have made in response to the COVID-19 emergency.

Hospitals say that’s not enough, and are calling on the biggest payers to follow actions taken by Congress and CMS to help resolve cash flow issues, by accelerating payments or opting into releasing interim periodic payments. The American Hospital Association also is urging payers to eliminate administrative burdens such as prior authorizations.

The more things change, the more they stay the same.

Beckers Hospital Review reports that “Peak demand for hospital resources due to COVID-19 is expected by mid-April in the U.S., according to an analysis from the University of Washington’s Institute for Health Metrics and Evaluation in Seattle.” The report provides an expect peak demand date for each State in the Union and DC.

The HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules loosened another Privacy Act provision for the duration of the COVID-19 emergency —

As a matter of enforcement discretion, effective immediately, the HHS Office for Civil Rights (OCR) will exercise its enforcement discretion and will not impose potential penalties for violations of certain provisions of the HIPAA Privacy Rule against covered health care providers or their business associates for uses and disclosures of protected health information by business associates for public health and health oversight activities during the COVID-19 nationwide public health emergency.

Although this is really inside the Beltway, the FEHBlog, as a lawyer, finds it noteworthy to relate that, according to, the Office of Management and Budget “is not directing agencies to extend the amount of time alloted for public feedback on regulation changes during the coronavirus outbreak, despite calls from [House Democrat] lawmakers to do so.”

Finally, the FEHBlog notes that according to the Boston Globe’s Stat News, rumblings about masking the American public continue.

In a draft document obtained by STAT, the CDC recommended that the public use homemade face coverings when in public, reserving higher-grade protective equipment like N95 masks for hospitals and health care workers, who have faced severe shortages in personal protective equipment as the coronavirus pandemic has accelerated through the United States.

Such face coverings, according to the draft guidance, would not be intended to protect the wearer, but rather prevent the wearer from unknowingly spreading the disease when in public. Individuals should wear face coverings in public settings like grocery stores, the guidance said. Children under the age of 2 and people experiencing trouble breathing would be excluded from the mask guidelines.

Friday Stats and More

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

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.

Tuesday Tidbits

Fierce Healthcare reports on how health insurers are communicating with their members and the public about COVID-19. This is a good idea.

The U.S. Preventive Services Task Force has decided to expand its Hepatitis C screening B level recommendation to all asymptomatic people aged 18 to 79. “This recommendation incorporates new evidence and replaces the 2013 USPSTF recommendation, which recommended screening for HCV infection in persons at high risk for infection and 1-time screening in adults born between 1945 and 1965.” The Task Force took this action because among other factors “Since 2013, the prevalence of HCV infection has increased in younger persons aged 20 to 39 years.” “The USPSTF concluded that broadening the age for HCV screening beyond its previous recommendation will identify infected patients at earlier stages of disease who could greatly benefit from effective treatment before developing complications.” The ACA requires health plans to cover the expansion of this service with no patient cost-sharing when provided in-network beginning January 1, 2022. It occurs to the FEHBlog that there may be practical difficulties distinguishing claims from the original and expanded group members.

Forbes reports that Anthem, a Blue Cross licensee, has closed on its acquisition of behavioral health services provider Beacon Health Options.

Beacon manages mental health, substance abuse and other behavioral health services for more than 36 million people across the U.S. Anthem, which owns Blue Cross and Blue Shield plans in 14 states, didn’t disclose a price it is paying Bain Capital Private Equity and Diamond Castle Holdings for Beacon Health, which is privately held. 

The AP informs us that “The Justice Department said Monday [March 2] that pharmaceutical company Sandoz Inc. will pay a $195 million penalty to resolve criminal charges of conspiring to fix prices and rig bids to stifle competition for generic drugs.” “The price-fixing affected more than $500 million in Sandoz’s generic drug sales, the Justice Department said. It involved drugs used to treat a range of chronic problems and pain conditions including arthritis, hypertension, seizures, various skin conditions and blood clots, according to officials.”

The Department of Health and Human Services announced that its Office for Civl Rights has reached a HIPAA Security Rule settlement with an Ogden Utah medical practice.

“All health care providers, large and small, need to take their HIPAA obligations seriously,” said OCR Director Roger Severino. “The failure to implement basic HIPAA requirements, such as an accurate and thorough risk analysis and risk management plan, continues to be an unacceptable and disturbing trend within the health care industry.” 

Monday Musings

The Wall Street Journal reports today that

There have been at least 19 million U.S. cases of the flu this season, 180,000 hospitalizations, and 10,000 deaths, according to preliminary estimates from the CDC. There were 61,000 flu-related deaths in 2017-18 and 34,200 deaths in 2018-19. Public health experts say the levels of hospitalization are similar to recent seasons, but deaths are lower than usual and outpatient reports of influenza-like illness remain elevated.

The article adds that

More than half of the positive influenza test results from public health laboratories this flu season have been in children and adults under the age of 25, according to the Centers for Disease Control and Prevention’s most recent weekly influenza report. That’s a higher portion than in the past few years, when less than half the cases were in kids and young adults. 

The reason: The predominant strain circulating early this season was influenza B, which causes more significant illness in children than in adults. 

It makes one wonder why the Wuhan or novel coronavirus was named as a public health emergency but evidently not the flu. The FEHBlog realizes that the public health emergency declaration was intended to free up funding for an unexpected illness but even more government and press focus should be placed on the flu in the FEHBlog’s opinion.

Recently the FEHBlog mentioned a U.S. District Court for the District of Columbia decision holding that the government mandated “patient rates” applicable to individual requests for their own medical records cannot be applied to requests that direct the records to third parties. HHS’s Office for Civil Rights issued an important notice last week advising compliance with the court’s order. The FEHBlog would not be surprised to see an appellate challenge to the decision.

Last week, the Trump Administration made available to State governments a new Medicaid Healthy Adult Opportunity block grant program. The program reminds the FEHBlog of the block grant approach in the Republican’s 2017 bill to repeal and replace the Affordable Care Act. Healthcare Dive reports

Analysts with Cantor Fitzgerald said they maintain a positive view on the manged care sector following the block grant news last week. “It remains to be seen if/when/how many states will opt into the initiative,” the analysts said in a recent note. “We continue to view Medicaid as a compelling growth area.”

The nation’s health insurance lobby didn’t take a position on the measure, but stressed the importance of having flexibility in the program and the need to cover everyone​.

“We support offering state policymakers flexibility to design their Medicaid programs to best meet the needs of their citizens. At the same time, funding mechanisms for Medicaid should not undermine Americans’ access to the care they need and deserve,” America’s Health Insurance Plans said in a statement Friday.

Even if states were interested in implementing the policy, legal experts told Healthcare Dive the demonstration is unlikely to get off the ground — as a fight in the courts is all but certain.

That’s unfortunate, in the FEHBlog’s opinion.

Our firm is closely monitoring the impacts of COVID-19. Effective 3/16/20, Ermer & Suter has implemented telework for all of our staff to encourage social distancing and help contain the virus. We remain fully operational and are readily available from our telework locations with no change in telephone numbers or email addresses.