The Centers for Disease Control and Prevention (CDC) provide comprehensive guidelines for local health departments determining who has been diagnosed with an infectious disease and providing support to people (contacts) who may have been infected through exposure to the patient. Read more here.

CMS Announces Final Payment Notice for 2021 Coverage Year

The final Notice of Benefit and Payment Parameters for the 2021 benefit year, also referred to as the 2021 Payment Notice, minimizes the number of significant regulatory changes to provide states and issuers with a more stable and predictable regulatory framework that facilitates a more efficient and competitive market. These changes further the Administration’s goals of lowering premiums, promoting program integrity, stabilizing markets, enhancing the consumer experience, and reducing regulatory burden.

To view the full press release, go to: 2021 Payment Notice Press Release.

To view the final rule, go to: 2021 Payment Notice Final Rule

To view the fact sheet on the final rule, go to: 2021 Payment Notice Fact Sheet

COVID-19 Federal Response

The federal government is taking action to protect the health and safety of our nation’s patients and providers in response to the coronavirus disease 2019 (COVID-19). There are a number of sources of information about actions being taken across the federal government.

• To keep up with the important work the White House Task Force is doing in response to COVID-19, visit White House Task Force.
• For the latest information about COVID-19 prevention, symptoms, and answers to common questions, visit up-to-date COVID-19 information.
• For information on the actions CMS is taking in response to COVID-19, please visit the CMS News Room and Current Emergencies Website.
• For COVID-19 Guidance for private health insurance issuers and group health plans, visit Coronavirus Disease 2019 (COVID-19) FAQs
• Please see the HealthCare.gov webpage for Marketplace-specific information, visit Marketplace-specific relating to COVID-19

The Center for Consumer Information and Insurance Oversight (CCIIO) COVID-19-Related Guidance

The Departments of Labor, Health and Human Services, and the Treasury issued guidance to implement requirements under the Families First Coronavirus Response Act (FFCRA), and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) that generally require private health issuers and employer group health plans to cover COVID-19 testing, the administration of that testing, and certain related items and services. This coverage must be provided for items and services that are furnished on or after March 18, 2020, with no out-of-pocket expenses, prior authorization or medical management requirements for the duration of the applicable emergency period.  Visit FFCRA and CARES Act FAQs for more information.

Prior to the FFCRA and the CARES Act, CMS released guidance that explains that essential health benefits (EHB) generally includes coverage for the diagnosis and treatment of COVID-19. However, the exact coverage details and cost-sharing amounts for individual services may vary by plan, and some plans may require prior authorization before these services are covered. This guidance remains relevant for any treatment related to COVID-19, as well as diagnostic testing received before March 18, 2020. Please visit EHB Coverage for COVID-19 for more information. As noted above, under FFCRA and the CARES Act private health issuers and group health plans must now cover diagnostic services at no cost and with no prior authorization or medical management requirements

In addition, the Departments provided plans and issuers flexibility to reduce or eliminate cost-sharing for telehealth services, even in cases when a consumer may not have met their deductible. For more information, visit telehealth FAQs.

Lastly, CMS released guidance on payment and grace period flexibilities associated with the COVID-19 outbreak. CMS will exercise enforcement discretion to permit issuers of QHPs and stand-alone dental plans (SADPs) to extend payment deadlines for initial binder payments as well as ongoing premium payments during the period of the COVID-19 national emergency. Visit payment and grace period for more information.

New Guidance on Extension of Timeframes for COBRA and Coverage Appeals

On April 28, 2020, a Department of Labor notice, jointly issued with the Department of the Treasury and Internal Revenue Service, extends certain timeframes affecting participants’ rights to healthcare coverage, portability, and continuation of group health plan coverage under COBRA, and extends the time for plan participants to file or perfect benefit claims or appeals of denied claims. These extensions provide participants and beneficiaries of employee benefit plans sponsored by private sector employers additional time to make important health coverage and other decisions affecting their benefits during the coronavirus outbreak.

CMS released a guidance document concurring with the disaster relief specified by the Department of Labor, the Department of the Treasury and Internal Revenue Service and encouraging states, non-federal governmental plans (such as state and local employee health plans) and issuers offering coverage in connection with a group health plan to enforce and operate, respectively, in a manner consistent with this relief.

For a link to the Department of Labor, Treasury and Internal Revenue Service notice, visit COBRA Timeframes. Visit EBSA guidance for other guidance related to group health plans. For CMS guidance, visit the CMS website.

Economic Impact Payments and Unemployment Benefits

The CARES Act calls for the IRS to make economic impact payments of up to $1,200 per taxpayer and $500 for each qualifying child. If consumers get one of these payments, they don’t need to include it in the income they report on their HealthCare.gov application. These payments don’t impact their eligibility for financial assistance for health care coverage through the Marketplace, or their eligibility for Medicaid or the Children’s Health Insurance Program (CHIP). For more information, visit IRS Coronavirus Tax Relief information.

Unemployment benefits, including the additional $600 per week payments in the CARES Act, are taxable income included in modified adjusted gross income (MAGI). The CARES Act exempted the $600 payment increase from income calculations for purposes of eligibility for Medicaid and CHIP, but did not exempt the $600 per week payment increase for purposes of eligibility for subsidies to purchase health insurance coverage through the Marketplace. Please instruct consumers to report all unemployment payments, including the $600 per week payment increase, on their Marketplace application.

Guidance on Marketplace Coverage and Coronavirus

For more information on topics relating to Marketplace coverage and COVID-19, please visit Marketplace coverage for COVID-19. This page provides information on the following situations:

• If I lost my job or experienced a reduction in hours due to COVID-19
• Coverage start dates with a Special Enrollment Period due to loss in coverage
• If I can’t pay my premiums because of a hardship due to COVID-19
• If I’m enrolled in a Marketplace plan and my income has changed
• If I previously qualified for a Special Enrollment Period, but missed the deadline because I was impacted by the COVID-19 national emergency
• If I want to change my current Marketplace plan or enroll for the first time
• If my child is now living with me after their college sent them home early
• If I get a direct deposit or check from the IRS that is called an economic impact payment

 COVID-19 Partner Toolkit

CMS has developed a toolkit to help you stay informed on CMS and HHS materials available on the COVID-19. Please share these materials, bookmark the page, and check back often for the most up-to-date information.  To listen to the audio files and read the transcripts for the COVID-19 Stakeholder calls, visit the Podcast and Transcripts page. The link to the toolkit and more resources is available at Coronavirus Partner Tool Kit page.

Guidance on Medicaid and CHIP Coverage and Benefits Related to COVID-19

Medicaid and CHIP programs cover a broad range of benefits, which may vary by state. Some benefits are mandatory which means states are required to provide them while other benefits are optional for states to provide.  Visit benefits related to COVID-19 for more information. Specific questions regarding covered benefits should be directed to the respective state Medicaid and CHIP agency. More information is available by contacting your state.

CMS revised MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) to clarify when you must use modifier CR (catastrophe/disaster related) and/or condition code DR (disaster related) when submitting claims to Medicare. The update includes a chart of blanket waivers and flexibilities that require the modifier or condition code.

As the United States reports over 100,000 deaths from the COVID-19 pandemic, some people-especially people of color, families with low incomes, and other marginalized communities-are suffering disproportionately. They are also the communities whose health could be hardest hit if states rush to reopen without a robust, fair plan.

If your state and local leaders are weighing how best to reopen and recover from the COVID-19 pandemic, consider five principles that we believe should be embedded in those decisions.

Read: 5 Principles to Help Communities Recover from COVID-19  >

By Natalie Krebs

Studies have found the rates of mental illness and suicide are higher for farmers. They work long hours, have limited social contact and are at the mercy of factors such as weather. Now the COVID-19 pandemic is creating even greater challenges to their livelihood—and mental health.

Read more

By Zoya Teirstein

Keeping wildland firefighting crews safe this year will require a significant shift in the way the country fights wildfires. So far, the changes haven’t materialized.

Read more

By Leah Douglas and Tim Marema

A one-of-a-kind data set shows the statistical relationship between meatpacking and the spread of Covid-19 in rural America. Information compiled by the Food & Environment Reporting Network shows how meatpacking counties have some of the highest infection rates in the United States.

Read more

On May 27, 2020, CMS issued updated FAQs.  Among other topics, CMS noted that the RHC productivity limits may be waived during the COVID period at the discretion of the MACs (page 31).  Based on this FAQ, if an RHC expects to have difficulty meeting the productivity guideline because of COVID, they should proactively consult with their MAC.

Another FAQ notes the treatment of telehealth costs on the cost reports (page 32).  This FAQ response is consistent with current cost reporting instructions – as non-reimbursable costs excluded from the all-inclusive rate calculation.  Other RHC FAQs are on pages 31-33.

The FAQs are attached and available at the following link.

www.cms.gov/files/document/…

The FAQs in this document supplement the previously released FAQs: 1135 Waiver FAQs, available at https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/MedicareFFS-EmergencyQsAs1135Waiver.pdf.

Acting Assistant Secretary Dana Gartzke and External Affairs Director Joel Frushone, of the Economic Development Agency (EDA) briefed ARC, the Delta Regional Authority and the Northern Border Regional Commission on the EDA CARES Act Recovery Assistance program, a new grant program developed via the Coronavirus Aid, Relief, and Economic Security (CARES) Act and is being administered under the authority of the bureau’s Economic Adjustment Assistance (EAA) program. This $1.5 billion initiative provides a wide-range of financial assistance to communities and regions as they respond to and recover from the impacts of COVID-19. While mostly available via a competitive process, support may also be available to LDDs, universities, revolving loan funds and other entities on a non-competitive basis.

“COVID-19 has accelerated economic changes. Just as you see it in the aftermath of natural disasters, rural, urban, small and large business, local government, all of us have been impacted by this virus and are still being impacted,” said Phil Paradice, Regional Director, EDA Atlanta Regional Office.

In order to be more responsive to businesses that are impacted by COVID-19, EDA leadership added staff in order to ensure applicants receive an initial response within 30 days after submitting a full application. The EDA has also taken steps to waive certain restrictions such as no interest loans, or waiving various leverage requirements, so revolving loan funding can drive needed and necessary capital into small businesses to help them survive.

For more information and resources please visit, www.EDA.gov/coronavirus.

As part of the National Institute for Occupational Safety and Health’s (NIOSH) efforts to keep stakeholders up to date on the CDC and NIOSH COVID-19 response, below is a summary of new information posted this week.

General Resources 

Resuming Business Toolkit
CDC has developed a toolkit to guide employers as they seek to resume normal or phased business operations. The toolkit is based on CDC’s Interim Guidance for Businesses and Employers Responding to COVID-19 and is designed to assist employers as they implement that guidance in their workplaces. These tools will help employers in planning, preparing, and responding to COVID-19.

Industry Specific Resources

Fact Sheet for Working in Office Buildings 
CDC published a new fact sheet for office building employers, building owners and managers, and building operations specialists. The fact sheet provides detailed steps to create a safe and healthy workplace and protect workers and clients from COVID-19 exposure.

For More Information

For more information, please visit the COVID-19 webpage. To stay up to date on new developments, sign up for the COVID-19 newsletter.