By 斯泰西周，校长，快乐宝彩票app和 玛丽·齐默尔曼医疗补助转型与融资副总裁 詹妮弗·瑞恩执行副总裁
随着COVID-19的传播继续展开, 将有限的资源最大化是至关重要的, 尤其是州医疗补助计划. The Secretary of Health 和 Human Services has the opportunity to utilize its emergency powers to the maximum extent possible to help state Medicaid programs in this time of crisis. This includes the Secretary’s special powers under section 1135 of the Social Security Act which went into effect upon the President’s declaration of a national emergency on March 13, 2020.
根据 最近的指导 来自医疗保险中心 & 医疗补助服务(CMS), the Secretary is permitting several “blanket” 1135 waivers for 医疗保险 in response to COVID-19. 该指南还提供了一些对医疗补助的有限豁免的例子. 3月17日, 佛罗里达 became the first state to receive an 1135 waiver approval of certain Medicaid flexibilities, 包括暂时暂停之前的授权规则, 简化供应商注册的更改, 在其他环境(包括无证设施)提供的护理的覆盖范围, 放弃安老院检查规定, 延长州公平听证请求和上诉的截止日期. 其他一些州，包括 华盛顿 和 加州 -正在效仿.
虽然1135项豁免条款提供的最初灵活性是积极的, 他们很可能不足以满足州医疗补助计划的需求, 和, 更重要的是, 奋战在COVID-19第一线的医护人员. States need further flexibility in their Medicaid programs to ensure access to care is maintained 和 that our health care system is nimble enough to respond to the expected surge of patients needing inpatient care. CMS为各州提供了额外的有用信息 COVID-19资源页面 医疗补助和儿童健康保险计划.
确保为未来几个月做好准备, CMS should work with states 和 providers to use the broadest application of 1135 authority to facilitate 和 maximize access to Medicaid services 和 reimbursement. CMS’ guidance points to the State Plan Amendment process to make changes in conjunction with 1135; however, CMS could also offer expedited 1115 waivers to help states meet the immediate needs of affected enrollees, 类似于它使用的过程 卡特里娜飓风 确保撤离人员获得足够的医疗保健服务.
Other flexibilities states should consider requesting under the Secretary’s emergency powers for the Medicaid program include:
- 提供方利用远程医疗的最大灵活性. CMS should give state Medicaid programs maximum flexibility to use telemedicine for COVID-19, 为医疗保险受益人提供的 CMS的指导 3月17日. 而各州有相当大的权力来决定如何覆盖远程医疗, CMS需要明确地说明灵活性. CMS should offer states a quick path to approval of strategies like a temporary suspension of face-to-face requirements for certain types of providers, 允许医疗补助计划报销“电子访问”和电话访问, 和 interprofessional consultations through e-consults by clinic providers for new 和 established clinic patients. CMS should also provide flexibility to quickly exp和 telemedicine coverage to other services 和 provider types, such as behavioral health treatment 和 counseling if these services are not currently eligible for telemedicine coverage in certain states.
- 延迟或暂停医疗补助资格的续签和终止. The Medicaid statute requires enrollees to periodically renew their eligibility for coverage. 然而，各州在如何管理更新过程方面有灵活性. 为应对COVID-19, states can provide enrollees with more time for people to respond to renewal information requests, 接受收入自我证明, 暂时放弃某些验证要求, or allow for post-eligibility verification to allow coverage to continue while people respond. 这些例外情况在一个 医疗补助和芯片灵活性工具包 并于2018年在近期发表了一套 常见问题(FAQs) 专注于应对COVID. 然而, CMS could also offer states the opportunity to temporarily suspend eligibility renewals to ensure Medicaid coverage continues for people with COVID-19 和 for others at risk of acquiring the virus without having to document exceptions on a case-by-case basis. This will help prevent people from not seeking care due to concerns about the status of their health coverage. It will also help ensure the provider system receives reimbursement for services delivered to patients impacted by this crisis.
- 扩大推定资格的使用. 推定资格是允许合格实体的一个重要工具, 比如医院和有联邦资格的医疗中心, 为可能符合医疗补助条件的个人提供临时医疗补助. States could seek a waiver to exp和 the list of qualified entities to include off-site locations in non-traditional settings that may be established in response to COVID-19. States could also request that CMS allow an expedited 和/or abbreviated patient application process for Medicaid to allow sufficient time for qualified entities to file records of presumptive eligibility with state agencies.
- 放弃对印度医疗服务(IHS)和部落供应商的“四墙”要求. 有部落民族的国家应寻求放弃42 C项下的“四墙”规则.F.R. §440.90, which requires tribal providers to furnish services within the four walls of a clinic setting to be eligible for Medicaid reimbursement. 在这次危机, this rule could serve as a harmful barrier for tribal providers rendering screening 和 treatment to tribal residents impacted by COVID-19.
- 为州公平听证和上诉留出额外的时间. Flexibility for state fair hearings 和 appeals is an important element to ensure due process rights are met in a time of crisis. 就像 佛罗里达, other states should consider seeking authority to extend deadlines for hearings 和 appeals 和 the power to suspend adverse coverage actions for individuals for whom the state has completed a determination, 但该州认为可能没有收到适当的通知.
几个州也在医疗补助制度之外采取进一步行动, such as seeking additional authority to help support the health care system 和 the people in need of care during COVID-19, 如:
- Prohibiting cost-sharing 和 prior authorization by insurance companies for people tested 和/or treated for COVID-19;
- Requiring insurance companies to cover an additional one-time early refill of prescriptions to ensure access to medications;
- Requiring insurance companies to cover the cost of vaccinations for COVID-19 once they become available; 和
- Requiring insurance companies to pay fair rates to all in-network providers who utilize telemedicine for COVID-19 efforts without limitations on audio-only modalities or requirements for live video technologies.