Midweek Update

David Ermer–ACA, COVID-19, Telehealth, U.S. Healthcare–
Photo by Manasvita S on Unsplash

The Affordable Care Act regulators (the Departments of Health and Human Services, Labor and Treasury) issued an interim final rule with an opportunity to comment (“IFC”) on coverage of COVID-19 preventive services. This rule focuses on coverage of COVID-19 vaccinations. The fact sheet explains with respect to private plans, including FEHB plans, that

the Departments [have] amend[ed] existing regulations to implement the unique requirements related to rapid coverage of qualifying coronavirus preventive services. This coverage is required to be provided within 15 business days after the date on which the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) makes an applicable recommendation relating to a qualifying coronavirus preventive service.

Specifically, plans and issuers must cover COVID-19 immunizations that have in effect a recommendation of ACIP with respect to the individual involved, even if not listed for routine use on the Immunization Schedules of the CDC. This IFC also provides that during the public health emergency for COVID-19, plans and issuers must cover without cost sharing qualifying coronavirus preventive services, regardless of whether an in-network or out-of-network provider delivers such services. The IFC also affirms that plans and issuers subject to section 2713 of the Public Health Service Act must cover without cost sharing items and services that are integral to the furnishing of recommended preventive services, including the administration of COVID-19 immunizations.

In related news, Route Fifty reports that

When the coronavirus vaccine arrives on the market, demand will far exceed supply. During those first few months, state and county public health officials will face tough questions about who should be first in line to get one of the limited vaccine doses. The Vaccine Allocation Planner for Covid-19, a new tool released Wednesday, aims to help make those decisions with data.

Jointly developed by Ariadne Labs, a project run out of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, and the Surgo Foundation, a nonprofit at the intersection of behavioral and data science, the tool allows policymakers to look at region-specific data. They can estimate the size of high-risk populations, consider factors like particular community’s vulnerabilities, and run scenarios based on an estimated number of vaccine doses available.

The New York Times maintains a COVID-19 vaccine tracker here

In other healthcare news —

Anthem beat Wall Street’s third-quarter expectations on earnings and reported revenue of $31.2 billion, up 16.8% from the year prior, in results released Wednesday morning. Expenses, however, were up more than 22% year over year, leaving profit to plummet roughly 80%.
Total medical membership jumped 4%, attributed to increases in Medicare and Medicaid rolls. Anthem CEO Gail Boudreaux said on the earnings call the overall membership trends are outpacing internal expectations.
The payer also reported a $594 million payment in Q3 toward a federal antitrust settlement reached with Blue Cross Blue Shield plans that is still awaiting approval by a judge. Other terms include nixing the “best efforts” rule that required member plans to generate at least two-thirds of their annual revenue from Blues brands and allowing employers to request a second bid from a non-local Blues plan, Boudreaux said, adding “we don’t see this changing our strategy.”

There is a clear overlap between specialties that are using telemedicine the most, and those specialties that manage chronic illnesses, such as endocrinology and rheumatology. Treating long-term chronic conditions like diabetes and arthritis require frequent patient visits, but they don’t always need to be in-person. For patients that require long-term care, telemedicine tools can reduce taxing trips to hospitals or clinics.

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Screening for colorectal cancer (CRC) should begin at age 45 for all average-risk adults in the United States, the U.S. Preventive Services Task Force (USPSTF) recommends in a guideline draft. Screening should continue at recommended intervals until age 75, the draft states. For patients ages 76 to 85, the decision to continue screening should be based on an individualized assessment of the benefits and harms associated with screening.

Currently FEHB plans are required to cover CRC screening with no member cost sharing for members beginning at age 50. If this guideline is finalized in 2020, the no cost sharing coverage requirement would drop to age 45 on January 1, 2022 pursuant to the Affordable Care Act’s requirements.

Here is a list of all of the USPSTF Grade A and B preventive service for adults recommendations which are eligible for cost free coverage starting in the plan year that begins on or after exactly one year from the issue date. FEHB plan years follow the calendar year, but not all health plans do.