Reimbursement portal opens for providers that test, treat uninsured COVID-19 patients

Dive Brief:

  • The Trump administration on Monday launched an online portal where hospitals can apply for reimbursement for COVID-19 testing and treatment for the roughly 30 million uninsured patients in the U.S.
  • Providers that tested or treated uninsured patients for the disease starting Feb. 4 could begin signing up on Monday, and can submit patient information and claims for reimbursement beginning May 6. Claims will generally be paid out based on current Medicare rates, and providers will begin receiving reimbursements in mid-May, HHS said, as long as funding is available.
  • To participate, hospitals and doctor’s offices must ensure the patient is uninsured and agree not to balance bill the patient for any part of his or her medical treatment.

Dive Insight:

In the past five weeks, almost 27 million Americans have filed unemployment claims, according to the Department of Labor. The majority of Americans get health insurance through their jobs, so skyrocketing unemployment means soaring numbers of the uninsured as the coronavirus pandemic continues to ravage the United States, infecting roughly 985,000 people in the U.S. and killing 56,000 as of late Monday.

Lawmakers have taken a number of steps to protect patients without insurance. The Families First Coronavirus Response Act passed March 18 allocated $1 billion to reimburse providers to treat uninsured patients with COVID-19. The Coronavirus Aid, Relief, and Economic Security (CARES) Act passed nine days later earmarked $100 billion in relief funds for providers, with the stipulation that a portion of that funding be used to pay for the expenses of uninsured COVID-19 patients.

An HHS spokesperson declined to say how much CARES funding was earmarked for the uninsured. But congressional and White House efforts may not be enough: the Kaiser Family Foundation estimates COVID-19 hospital costs for the uninsured could reach as high as $42 billion — roughly two-fifths of the provider relief pot alone — and CMS has already sent roughly $50 billion of CARES funding out the door to hospitals and doctors.

President Donald Trump has also said he’s mulling expanding Medicaid to a larger swath of low-income Americans, despite previous efforts from his administration to chip away at the safety net program. HHS has also declined to reopen enrollment for the Affordable Care Act’s insurance markets, although losing one’s job is a qualifying life event and would allow someone to apply for individual market coverage.

Public health experts worry a lack of insurance may stop COVID-19 patients from seeking care. But in the new program announced April 22, HHS will reimburse COVID-19 testing for the uninsured, and the following services for uninsured individuals who test positive for the disease:

  • Specimen collection, diagnostic and antibody testing
  • COVID-19 testing or treatment-related visits conducted in an office, urgent care, ER or telehealth setting
  • Durable medical equipment use, including oxygen or ventilator
  • Emergency ambulance transport and patient transfers via ambulance
  • Skilled nursing facility, long-term acute care, acute inpatient rehab or home health services
  • FDA-approved drugs administered during an inpatient stay, as they become available
  • An eventual FDA-approved vaccine

Inpatient claims must be dated on or after Feb. 4. Any services not covered by traditional Medicare will also not be covered under the program, and hospice services and outpatient prescription drugs are also excluded, meaning once an uninsured patient leaves the hospital, the cost of followup medications would revert back to them.

The program is being run by UnitedHealth Group, which owns the largest private payer in the U.S., through a contract with HHS’ Health Resources and Services Administration. HHS first partnered UnitedHealth in March, using hospitals’ and doctors’ information on the behemoth healthcare company’s file to shell out relief funding electronically.

A commercial payer being involved in sending congressional payments to providers raised some eyebrows across the industry, but the process doesn’t involve credentialing, contracting or any gatekeeping on the part of UnitedHealth, according to HHS.

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