CMS says the waiver will give state governments more flexibility to respond to the epidemic.
Florida this week became the first state to be approved for a Section 1135 waiver to respond to the COVID-19 national emergency, the Centers for Medicare & Medicaid Services said.
"Florida is acutely focused on eliminating unnecessary barriers on our healthcare providers who are on the front lines serving our communities most impacted by COVID-19," Florida Governor Ron DeSantis said in a media release.
On Friday, President Donald Trump granted CMS emergency powers to waive some requirements in Medicare, Medicaid, and CHIP under Section 1135 authority, to give state governments more flexibility to respond to the epidemic.
The waiver: streamlines provider enrollment processes; allows care to be provided in alternative settings in unlicensed facilities if a licensed facility is evacuated; waives prior authorization requirements; suspends some nursing home screening requirements to provide necessary administrative relief; and extends deadlines for appeals and state fair hearing requests.
While Florida is the first state to receive the 1135 waiver, CMS said it expects to review waiver requests from other states.
"CMS is committed to removing all unnecessary administrative and bureaucratic barriers that may hinder an effective response to this public health emergency, and I have directed my team to expeditiously process these requests," CMS Administrator Seema Verma said.
The U.S. House this is expected to take up an emergency spending bill for the coronavirus, but sequestration relief is not part of the package.
Hospital stakeholders have urged Congress to suspend the upcoming 2% Medicare cuts mandated under the sequestration "for at least the duration of the coronavirus pandemic."
"This action alone will provide immediate, significant relief across-the-board, and will signal continued Congressional support for the hard work that lies ahead for all of us," the American Hospital Association, the Association of American Medical Colleges, and the Federation of American Hospitals said Sunday in a joint letter to Senate Majority Leader Mitch McConnell and House Speaker Nancy Pelosi.
"Suspending the sequester and restoring those payments will provide a much-needed jolt of confidence not just for hospitals, but for physicians, post-acute providers, Medicare Advantage plans and so many others who rely on Medicare as a trusted partner," the letter said.
The U.S. House this is expected to take up an emergency spending bill – estimated at more than $100 billion -- to offset the cost of paid sick leave, family leave, and expanded unemployment benefits. However, sequestration relief is not part of the package.
On Friday, President Donald Trump declared a national emergency and earmarked $50 billion to fight the coronavirus, on top of the $8.3 billion he pledged two weeks ago.
In an analysis issued this month, BDO International noted that many providers in the United States are under financial stress, and that the coronavirus could have a direct and lasting impact in the form of supply chain disruption and financial challenges as many hospitals curtail profitable elective surgeries until the epidemic subsides.
"For example, more than three-fourths (76%) of U.S. providers already have 60 days or less cash on hand, and nearly a quarter (23%) are concerned about government reimbursement risks, according to BDO’s Treating Healthcare Distress. "Variables like instability around the Affordable Care Act and uncertainty around incoming payments because of fluctuating deductibles and patient copays, meanwhile, will persist."
In their letter to Congressional leaders, the hospital stakeholders noted that the Medicare Payment Advisory Commission's semi-annual report this month found that Medicare payments to hospitals "fall far below the cost of care and have been deeply negative for well over a decade."
"The Medicare sequester, which reduces payments for most benefits by 2%, is a major contributor to these underpayments," the stakeholders wrote. "Indeed, MedPAC has argued against the Medicare sequester, "'because it reduces payments for all sectors by 2% without regard to payment adequacy.'"
Instead of the "arbitrary cuts," the stakeholders called for "the flexibility desperately needed to respond to the evolving demands of this pandemic."
AHA and other stakeholders say their "ability to respond to patients must not be prevented by arbitrary directives."
The nation's largest hospital associations are pushing back against a recommendation from U.S. Surgeon General Jerome Adams that providers "consider stopping elective surgeries" until the coronavirus threat subsides.
"Our ability to respond to patients must not be prevented by arbitrary directives," the American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges, and the Children's Hospital Association said in a joint letter to Adams on Sunday.
"We are concerned about recent comments by government officials that could be interpreted as recommending that hospitals immediately stop performing “elective” surgeries without clear agreement on how we classify various levels of necessary care," the letter said.
The hospital lobby was responding to a tweet from Adams on Saturday that read: "Hospital & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve!"
Adams, in turn, was responding torecommendations from the American College of Surgeons, which on Friday advised its members to "thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs."
In their letter to Adams, the hospital lobby acknowledged that the coronavirus crisis "may require the curtailment of the least critical or time-sensitive hospital services, but any curtailment must be nuanced to meet the needs of all severely ill patients."
"Our patients will be best served by carefully evaluating and prioritizing gradients of "elective" care to ensure that the most time-sensitive medically necessary care can be delivered by physicians and hospitals," the letter read.
Some health systems are already cancelling elective procedures until the coronavirus threat subsides.
Northwell Health announced on Monday that it will cancel elective surgeries and procedures in its hospitals, but added that the guidelines will not apply to emergency surgeries
"With appropriate screening of patients and when deemed clinically necessary, some planned cases will continue to be performed," Northwell CMO David Battinelli, MD, said in a media release. "Patient care that may appear routine could, if canceled, result in significant negative impact on our patients' health."
On Sunday, Atlanta-based Emory Healthcare announced that it would postpone all inpatient and outpatient elective surgeries for the next two weeks, or longer if needed.
"We are currently contacting all patients and their physicians to alert them of this decision and to offer our support during this time when their cases are being postponed,"the health system said in a post on its website.
"While we adhere to the most stringent protocols to ensure infection prevention, we are taking this step to protect our patients and are working to support and preserve supplies, equipment and staffing for the most urgent and time-sensitive patient needs."
Dearborn, Michigan-based Beaumont Health announced Sunday that it "will begin limiting or reducing non-essential surgeries later this week, as the U.S. Surgeon General advised."
"As of right now, Beaumont will not require surgeons to cancel elective procedures on Monday, March 16. However, depending on the circumstances, we could start canceling non-essential surgeries beginning Tuesday, March 17," the health system said on its website.
Hazen and other senior leaders at Nashville-based HCA were handsomely rewarded for the company's strong financial performance in 2019.
HCA Healthcare CEO Samuel N. Hazen received $26.7 million in total compensation in his first year at the helm of the nation's largest for-profit hospital system.
Hazen and other senior leaders at Nashville-based HCA were handsomely rewarded for the company's strong financial performance in 2019, which saw total revenues of nearly $12.3 billion, a 6.2% increase year-over-year.
Hazen's compensation came in the form of $1.4 million in salary, $5.9 million in stock, $5.6 million in SAR awards, $4 million in non-equity incentives, $9.5 million in pension value and deferred earnings, and $126,000 in "all other compensation."
William Rutherford, HCA's CFO, received total compensation of $6.3 million; Jon M. Foster, president of HCA's American Group, received $7.7 million; Charles J. Hall, president of HCA's National Group, received $6.5 million; Jonathan B. Perlin, MD, CMO, received $5.9 million; and former CEO R. Milton Johnson received $4.3 million.
HCA ended 2019 with total revenues of more than $46.7 billion, up from $43.6 billion in 2018, and a net income of $3.8 billion, well exceeding its $2.2 billion during the prior year.
A whistleblower complaint alleged that Millennium Physicians Association PLLC billed Medicare for sleep studies conducted by uncredentialed technicians.
A Houston area physician group will pay $1.2 million to settle whistleblower allegations that it improperly billed Medicare for sleep studies,the Department of Justice said.
A whistleblower complaint alleged that, from January 2015 through March 2019, Millennium Physicians Association PLLC, operating as Millennium Respiratory & Sleep Disorder Specialists, and based in The Woodlands, conducted sleep studies at two clinics without properly credentialed technicians, and improperly billed Medicare for the services.
Medicare requires sleep centers to be accredited or certified by the America Academy of Sleep Medicine, Joint Commission or Accreditation Commission for Health Care Inc.
Millennium self-reported that from 2011 through 2019, two of its sleep centers were unaccredited.
"Providers using improperly credentialed technicians are cheating the taxpayers and may put beneficiaries at risk," said Joseph Martin, Acting Special Agent In Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.
The whistleblower will receive $187,000 from the settlement.
MA, Part D plans given option to waive cost-sharing and prior authorizations.
Medicare Advantage and Part D plans have been given the option to waive prior authorization, cost-sharing, and other potential barriers that could delay testing and treatment for the COVID-19 virus, the Centers for Medicare & Medicaid Services said.
"Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19 and CMS will continue doing everything in our power to protect them," CMS Administrator Seema Verma said in a media release.
Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth;
Removing prior authorizations requirements;
Waiving prescription refill limits;
Relaxing restrictions on home or mail delivery of prescription drugs;
Expanding access to certain telehealth services.
Verma said the waivers allow plans to work with pharmacies and providers to treat patients without burdensome requirements limiting their options during this outbreak.
ACP says its decision to cancel its conference next month was based on "rapidly escalating concerns about the Coronavirus Disease 2019."
The American College of Physicians on Tuesday cancelled its annual Internal Medicine Meeting 2020 next month in Los Angeles over concerns about the spread of the coronavirus.
Philadelphia-based ACP said the decision was "based on recent reports from the World Health Organization and the Centers for Disease Control and Prevention of rapidly escalating concerns about the Coronavirus Disease 2019 (COVID-19), and in recognition of the vital role of internal medicine physicians in diagnosing, managing and caring for their patients and communities on the front lines."
"ACP also recognizes its professional responsibility to consider the safety of its meeting participants by modeling social distancing and not contributing to the spread of the virus through a large public gathering such as its annual scientific meeting," ACP said in a media release.
ACP, the nation's largest specialty organization, with 159,000 members in more than 145 countries, was scheduled to meet on April 23-25 in Los Angeles. The cancellation joins a growing list of associations opting out of conferences because of fears of the coronavirus.
Last week, the Healthcare Information and Management Systems Society, American College of Healthcare Executives, America's Health Insurance Plans, and the American Organization for Nurse Leadership all cancelled upcoming meetings for later this month.
The actions follow that of HIMSS, which last week issued a last-minute cancellation of this week's annual conference in Florida.
The American College of Healthcare Executives, America's Health Insurance Plans, and the American Organization for Nursing Leadership have cancelled upcoming annual conferences this month amid concerns about the coronavirus.
The actions follow those of Healthcare Information and Management Systems Society, which last week issued a last-minute cancellation of this week's annual conference in Orlando, at which 45,000 people from across the globe were expected to attend.
ACHE's board of governors issued a statement saying it cancelled its 2020 Congress on Healthcare Leadership, scheduled for March 23-26, 2020 in Chicago, because many of the 4,200 executives who were expected to attend "are actively managing the response to coronavirus (COVID-19) in their communities."
"We understand and support our members and other leaders—and the need to respond effectively to patient and community concerns," ACHE said."The decision to cancel this event was not made lightly. Out of respect for our attendees and faculty, we wanted to announce this news as soon as the decision was made and prior to our cancellation deadline."
AHIP's board of directors said it cancelled its National Health Policy Conference and National Conference on the Individual and Small Group Market in Washington, D.C., scheduled for March 18-20, "to help prevent the spread of this disease, to ensure that people have coverage for and access to needed testing, and to help patients who are infected receive the care and treatment they need."
"As our country prepares for the possibility of widespread infections and takes action to mitigate the impact, our priority is the health and well-being of the people we serve," AHIP said in a media release. "There are three critical areas health insurance providers are proactively addressing right now: Prevention, testing, and treatment."
As of now, AHIP's Institute & Expo on June 17-18 in Miami remains scheduled.
AONL said it decided to cancel its 2020 Conference, scheduled for March 18-21 in Nashville, "in light of the latest COVID-19 developments and the unprecedented and still growing demand for nursing leadership at this time," AONL announced on its webpage. "Our nursing leaders must remain on site in their roles. We are confident this is not only in the best interest of our attendees and exhibitors but also the patients and families they serve."
(Correction: In an earlier report HealthLeaders incorrectly reported that AHIP had cancelled its June conference in Miami.)
AHIP says its members are committed to keeping out-of-pocket expenses low so that cost is not a barrier for people seeking treatment for COVID-19.
The nation's health insurance companies pledged this week to coordinate and intensify prevention, testing and treatment efforts to mitigate the spread of the coronavirus, including waiving patient copays for physician-ordered tests and treatments.
"We are taking decisive action to help prevent the spread of this disease, to ensure that people have coverage for and access to needed testing, and to help patients who are infected receive the care and treatment they need," America's Health Insurance Plans announced on Thursday.
AHIP says its members are committed to keeping out-of-pocket expenses low so that cost is not a barrier for people seeking treatment for COVID-19. That will include payers covering the costs for physician-ordered testing, and reducing red tape around provider networks, referrals and prior authorization, and waiving patient cost-sharing.
The payers said they would share data with clinicians and coordinate care management to ensure providers have the tools to quickly diagnose and treat infections, and that patients have access to effective treatment. This includes encouraging the use of telehealth and other technology-enabled remote health options to expand access and avoid infection risks.
The payers also pledged to work with the Centers for Disease Control and Prevention and other government agencies to coordinate efforts, share information, mitigate health risks, and keep the public informed. That includes identifying people who are most at-risk of acquiring the infection, such as seniors and people with chronic diseases.
Centers for Medicare & Medicaid Services Administrator Seema Verma applauded the stepped-up response from payers, saying it meshes with the Trump administration's "whole-of-America approach, including working with our private partners, so that our entire healthcare system and our communities are activated and coordinated in our efforts to protect the American people."
Separately, Cigna announced that it would waive all copays and cost-shares for coronavirus testing and treatment prescribed by providers.
"During this time of heightened concern, Cigna's role is clear," CEO David M. Cordani said in a media release. "We will do everything we can to help contain this virus, remove barriers to testing and treatment, especially for seniors and people who are chronically ill, and give peace of mind to those we serve."
CMS also ordered state regulators and accrediting organizations to immediately inspect thousands of Medicare-participating healthcare facilities and focus on infection control.
The Centers for Medicare & Medicaid Services has ordered hospitals and nursing homes to ensure that infection control procedures are in place to address the spread of the Coronavirus.
In a series of three memoranda issued Wednesday, CMS also ordered state regulators and accrediting organizations to immediately inspect thousands of Medicare-participating healthcare facilities and focus exclusively on infection control and other serious health and safety threats, such as patient abuse.
Healthcare facilities participating in Medicare and Medicaid already are already required by statute to ensure they have in place infection control procedures. Nonetheless, CMS Administrator Seema Verma said the memoranda issued this week "represent a call to action across the healthcare system."
"All healthcare providers must immediately review their procedures to ensure compliance with CMS' infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention ," she said.
"We sincerely appreciate the proactive efforts of the nursing home and hospital associations that have already galvanized to provide up-to-the-minute information to their members. We must continue working together to keep American patients and residents safe and healthy and prevent the spread of COVID-19."
Under the inspection memorandum, state survey agencies will look for:
All immediate jeopardy complaints (a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect;
Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses;
Statutorily required recertification surveys (Nursing Home, Home Health, Hospice, and ICF/IID facilities);
Any re-visits necessary to resolve current enforcement actions;
Initial certifications;
Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years;
Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy.
The memorandum also includes protocols providers must take when COVID-19 is identified or suspected that include working with CMS and CDC.
The other two memoranda answer procedural questions that nursing homes and hospitalsmay have, such as how to screen patients and staff for the virus, and how to transfer patients diagnosed with the virus between nursing homes and hospitals.
