Health Law Advisor

As the coronavirus spreads throughout the country, hospitals and other health care providers are finding themselves inundated with patients. Those providers who are in-network with payors have and will likely continue to experience difficulty in complying with certain provisions of their contracts. For instance, as payors are also experiencing an unexpected influx of telephone traffic, the wait time for various approvals, including, but not limited to, pre-authorizations are being delayed.

Providers are often contractually obligated to obtain pre-authorizations for certain procedures and services prior to rendering the care. Due to the increased telephone traffic and increased wait times on the payor end, these providers are now faced with a dilemma. A process that as of two weeks ago only took a matter of ten to fifteen minutes now can take up to an hour or more. This creates a serious dilemma for those providers who need to render care to their patients and comply with their contractual obligations to payors.

The Senate has spoken to this issue via the Families First Act which prohibits cost sharing and imposing prior authorizations for COVID-19 related testing under Medicare, CHIP, and individual and small/large self-funded group plans. See Division F-Health Provisions, § 6001, Coverage of Testing for COVID-19. While some payors have recognized and acknowledged the difficulties posed by COVID-19 and have made exceptions to the standard requirements, those exceptions have been limited. For example, the Blue Cross Blue Shield Association has indicated that its network of 36 BCBS companies will waive prior authorizations for diagnostic tests and covered services that are medically necessary for members diagnosed with COVID-19. Similarly, Wellmark and Anthem, Inc., have waived prior authorizations for covered services related to COVID-19. While these limited pre-authorization waivers are a start, they do not resolve the dilemma faced by those providers treating patients who are not suffering from COVID-19.

We hope that everyone is staying safe during the COVID-19 crisis. State health departments are, of course, doing what they can to facilitate management of transmission of COVID-19 by healthcare providers. Some recent actions by the New York Department of Health (“DOH”) to allow or promote telephonic and telehealth services include:

Telephonic Evaluation - Beginning with dates of service of March 13, Medicaid will reimburse telephonic evaluation and management services for established patients where face-to-face visits may not be recommended and it is medically ...

While the world continues to respond to the growing COVID-19 pandemic, the United States Congress recently passed legislation that provides for more than $8 billion in emergency funding to combat COVID-19. Part of this supplemental funding package, signed into law on March 6, 2020, includes the Telehealth Services During Certain Emergency Periods Act of 2020 (the “Act”),[1] which authorizes the Administration to loosen restrictions on telehealth in order to expand access to COVID-19 related telehealth services for Medicare beneficiaries—many of whom are especially vulnerable to this virus and in the event of future emergencies. On March 17, 2020, the Administration announced the implementation of this waiver with a retroactive effective date of March 6, 2020.

A post on the Management Memo blog will be of interest to many of our readers: "Coronavirus Considerations for Employers with a Unionized Workforce," by attorneys Adam S. Forman, Michael S. Ferrell, Steven M. Swirsky, and Elizabeth "Libby" Martin of Epstein Becker Green.

Following is an excerpt:

As we have discussed in prior Advisories, the 2019 Novel Coronavirus (“Coronavirus” or “COVID-19”) public health emergency is raising important issues for employers addressing rapidly developing disruptions to the workplace and the lives of employees with mass school ...

Recently, the Defense Health Agency (DHA) announced a rewrite of the TRICARE Autism Care Demonstration (ACD) program that encompasses “significant changes to the ACD.” It will move the ACD from the current Applied Behavior Analysis (ABA)-centric model to one focused on the beneficiary and family. Without specific details, the DHA states these comprehensive changes will provide an opportunity to improve support to beneficiaries and their families by:

1. Providing more information about Autism Spectrum Disorder (ASD) and potential services;
2. Linking beneficiaries to the right care at the right time; and
3. Increasing services to eligible family members – especially parents.

Our colleague Nancy Gunzenhauser Popper at Epstein Becker Green has recently published a post on the Workforce Bulletin blog that will be of interest to our readers in the health care industry: “Colorado Mandates 4 Days of Paid Leave for COVID-19 Testing.”

Following is an excerpt:

On March 10, 2020, Colorado Governor Jared Polis issued an executive order directing he Colorado Department of Labor and Employment (“DLE”) to create emergency rules to “ensure workers in food handling, hospitality, child care, health care, and education can get paid sick leave to ...

On March 11, 2020, the World Health Organization declared that the 2019 novel coronavirus (known as “COVID-19”) is now a pandemic. The effects continue to be felt in the United States, which currently has well over 1,000 cases of COVID-19. As of March 12, 2020, 19 states have declared a state of emergency to ensure there are resources to address the coronavirus, and President Trump has announced a ban on travel to and from Europe for 30 days starting on Friday, March 13, 2020, which was extended to the United Kingdom and Ireland on March 15^th. Additionally, on March 13, 2020 President ...

Our colleague Maxine Neuhauser at Epstein Becker Green has recently published a post on the Workforce Bulletin blog that will be of interest to our readers in the health care industry: “NJ Supreme Court Rules That the LAD Protects Registered Medical Cannabis Users.”

Following is an excerpt:

On March 10, 2020 the New Jersey Supreme Court ruled that under the New Jersey Law Against Discrimination (“LAD”), employees who legally use cannabis as permitted by the state’s Compassionate Use of Cannabis of Medical Marijuana Act[i] (“Compassionate Use Act”) may ...

Our colleagues Anthony Argiropoulos and Sheila A. Woolson have a post on the Workforce Bulletin blog that will be of interest to our readers in the health care and life sciences industry: “Coronavirus Emergency Declarations Trigger Anti-Price Gouging Laws.”

Following is an excerpt:

The particulars of the laws vary with each state.  Some states set a percentage above which the merchant cannot increase the price.  Others simply state the price increase cannot be “unconscionable.”  Some laws apply to any party in the distribution chain, whereas others make allowances for ...

Our colleague  Tzvia Feiertag at Epstein Becker Green has recently published a post on the Workforce Bulletin blog that will be of interest to our readers in the health care industry: “IRS Memo Concludes There Is No Statute of Limitations for ACA Employer Mandate Penalties Under Internal Revenue Code § 4980H.”

Following is an excerpt:

The IRS Office of Chief Counsel recently issued a memo which, in a surprise to many, concluded that the filing of the Affordable Care Act (“ACA”) Forms 1094-C and 1095-C (“C Forms”) does not start the statute of limitations on ...