Mixed Federal Messaging on COVID

Original story posted on: September 23, 2020

Congress appears to be closer on a COVID-19 relief package.

U.S. Supreme Court Associate Justice Ruth Bader Ginsburg passed away on Friday. Ginsburg was the second woman appointed to the Supreme Court, serving there for 27 years. We mourn her loss, and as a country, we are grateful for her service.   

Although we are likely to hear nothing out of Washington for the next week except about the Supreme Court, Congress is actually closer than it has been in weeks to agreeing on another COVID-19 relief package. A bipartisan group of 50 U.S. House of Representatives lawmakers released a $1.5 trillion stimulus plan last Tuesday. That $1.5 trillion splits the difference between the White House and the Democrats’ proposed funding numbers. At the same time, House Speaker Nancy Pelosi says that the House is going to stay in town, and not take an October recess until a deal gets done.

In other federal news, agencies and government officials continue to send different signals on COVID-19 testing.

On the one hand, elements of the federal government are urging widespread testing as a way of gaining more knowledge about the spread of the pandemic.

For instance, the FDA (Food and Drug Administration) has so far authorized nearly 250 different COVID tests, and the White House has ordered and received 150 million rapid COVID-19 tests  in order to “get Americans back to work, and kids back to school.” The U.S. Department of Health and Human Services (HHS) sent those tests to 12,000 different sites this past Friday, including assisted living communities, skilled nursing facilities, and schools.

On the other hand, recent guidance appears to be dissuading people from testing unless it is deemed medically necessary.

Earlier this month, we reported that the Centers for Disease Control and Prevention (CDC) modified its COVID-19 testing guidance so that it recommended people not take a test unless they have symptoms.

This past Friday, however, the CDC revised the guidance back to stating that people who may have been exposed to someone with COVID-19 need to take the test – even if they do not have symptoms.

In the meantime, CMS guidance does not give financial support for testing that is not medically necessary. Much to the chagrin of Democrat lawmakers, CMS guidance has interpreted the Coronavirus Aid, Relief, and Economic Security (CARES) Act to say that insurers are required to cover and waive cost sharing only on COVID-19 tests that are ordered by a clinician. That is, an individual may have to pay out of pocket for testing that is requested or required by employers, schools, or universities, or for travel, or because an individual may think it is necessary. That’s not to say that an insurer will not cover these other circumstances of testing, but CMS guidance says that these non-medical circumstances are excluded from the CARES Act mandate that individuals not pay for tests. Note also that Medicare beneficiaries can only get one test that is not ordered by a physician reimbursed by Medicare.

In other testing news, for the first time, the FDA has published a comparative list of the performance of about 60 COVID-19 tests; the list compares the sensitivity or ability of the different tests to accurately detect the virus.

As of last week, over 95 million tests have been given in the United States – nearly 14 million in California alone – with a national total of nearly 7 million positive results.

Programming Note: Matthew Albright is a permanent panelist on Monitor Mondays. Listen to his legislative update sponsored by Zelis, Mondays at 10 a.m. EST.

Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

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