“States need to do everything in their power to get COVID-19 patients accurate tests and vital treatment right away – to minimize the potential spread of the virus and avoid severe outcomes,” says Terry Wilcox, executive director of Patients Rising NOW, a national patient advocacy non-profit organization that helps patients overcome access barriers.
To assist in that effort, state Medicaid directors have emergency authority to waive regulations, cut red tape and implement streamlined processes that expedite patient care through what’s known as an 1135 Waiver.
Patients Rising NOW has joined a coalition of two dozen patient non-profit organizations including Aimed Alliance, Chronic Disease Coalition, Global Healthy Living Foundation, Headache and Migraine Policy Forum and the Vasculitis Foundation, to urge states to take full advantage of waivers allowed under President Trump’s national coronavirus emergency declaration. As of March 27, 34 states have requested 1135 waiver from the Centers for Medicare and Medicaid Services.
Here are three ways every state can help flatten the curve, improve patient care, and alleviate the burden on our health care system.
1. Eliminate Prior Authorization Requirements for Testing and Treatment of COVID-19
Prior authorization requirements force patients to get permission from their insurance company or pharmacy benefit manager before insurance will agree to cover a test or treatment. As we’ve learned over the past month, testing delays increase the chance of community spread.
“Waiving prior authorization requirements may reduce delays in testing and treatment for patients with COVID-19,” points out Aimed Alliance, which is leading the coalition of patient organizations urging state Medicaid directors to exercise their authority to eliminate prior authorization requirements.
2. Waive Cost Sharing for COVID-19 Treatment and Supportive Services
For patients living on fixed incomes or struggling to pay the bills, even a small co-pay can cause a patient to second guess getting medical attention. With COVID-19, that delay in seeking care can result in a severe deterioration in the patient’s condition.
“We need to treat patients before they need intensive care or a ventilator,” explains Wilcox of Patients Rising. “By waiving cost sharing requirements for the duration of the public health emergency, it encourages patients to seek care as soon as they need it.”
3. Allow Patients to Visit Out-of-Network Hospitals
Under many insurance plans, patients can be denied full insurance coverage if they obtain medical care from an out-of-network provider. Patients in Texas have a one-in-three chance of receiving a “surprise” medical bill after receiving medical care.
But, it’s not as easy as just visiting the right in-network hospital. Even when staying “in-network,” patients can be hit with a massive surprise medical bill for “out-of-network” charges from doctors and specialists that are out-of-network. An analysis published in the New England Journal of Medicine found that a quarter of in-network emergency room visits resulted in a bill from an out-of-network doctor.
States are required to ensure that Managed Care Organizations, contracted with the state’s Medicaid program, provide adequate and timely service coverage for enrollees at out-of-network settings if the MCO’s provider network is unable to provide them. State Medicaid directors have the power to enforce this provision to ensure that the most vulnerable patients are not burdened with unnecessary costs when they receive testing and treatment for COVID-19 at an out-of-network setting.