| Mar 25, 2020

Commercial Health Insurance Coverage and Access

e.g., eligibility and enrollment (including appeals), benefits and cost-sharing (prior authorization, refills), individual market coverage, Employee Retirement Income Security Act (ERISA) flexibilities

If you have materials you are willing to share with other states through this page, or if there are topics of particular concern that you would like addressed, please contact SHVS.

STATE HEALTH AND VALUE STRATEGIES RESOURCES

SHVS/Manatt Health/Georgetown CHIR/Levitis Strategies.   Grace Periods: A Good Start But Not Sufficient  An expert perspective about state actions to extend grace periods, during which insurance coverage cannot be cancelled for non-payment of premiums, in the individual market in response to the COVID-19 pandemic. This piece highlights the risks to consumers of extending traditional grace periods, when not paired with additional protections, and suggests a range of options for addressing the limitations of grace periods. It also provides a primer on this important issue and describes a couple of wrinkles under the Affordable Care Act (ACA).

SHVS/Manatt Health/Georgetown CHIR.  Implications of Health Care Provisions for States in the Second COVID Stimulus Bill  Webinar slides and recording that explores the key health care provisions in the second COVID-19 stimulus bill.

SHVS/Manatt Health Responding to COVID-19: State Strategies for Medicaid and Commercial Health Insurance Oversight  Webinar recording and slide deck from webinar hosted on March 18, 2020.

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OTHER RESOURCES

STATE TEMPLATES AND TOOLKITS

CMS.  Coronavirus (COVID-19) Partner Toolkit  CMS’ toolkit includes CMS and HHS materials on COVID-19.

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FEDERAL STATUTE AND GUIDANCE

CMS. The Center for Consumer Information & Insurance Oversight Fact Sheets & Frequently Asked Questions (FAQs) Compilation of COVID-19 FAQs on private insurance issues

Internal Revenue Service (IRS). Cornonavirus Tax Relief  Information on federal tax provisions, guidance, and operational changes responding to COVID-19.

CMS.  FAQ on Essential Health Benefit Coverage and the Coronavirus (COVID-19)  Details existing federal rules governing health coverage provided through the individual and small group insurance markets that applies to the diagnosis and treatment of COVID-19

CMS. COVID-19 Resources for States Compilation of resources for state on Medicare, Medicaid, and CHIP, including transcripts and recordings of all-state calls.

CMS. Podcasts and Transcripts: COVID-19 Stakeholder Calls Recordings and transcripts of CMS calls on COVID-19 with states and other stakeholders.

Internal Revenue Service (IRS). High-deductible health plans can cover coronavirus costs

CMS. FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019  CCIIO FAQs on telehealth coverage.

CMS.  FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)  CCIIO guidance on COVID-19 coverage and catastrophic plans.

CMS. FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets  CCIIO guidance on Rx coverage and COVID-19.

CMSPayment and Grace Period Flexibilities Associated with the COVID-19 National Emergency  CCIIO guidance on grace periods.

Internal Revenue Service (IRS).  HIGH DEDUCTIBLE HEALTH PLANS AND EXPENSES RELATED TO COVID-19  IRS Notice allowing HDHPs to waive cost-sharing for COVID-19 testing & treatment.

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ANALYSIS

Manatt Health. Summary of Healthcare Provisions of COVID-19 Stimulus Package #3 (CARES Act)

Manatt Health.  Summary of Key Healthcare Provisions in the Second COVID-19 Stimulus Bill

The Commonwealth Fund/Georgetown’s Center on Health Insurance Reforms (CHIR). What Are State Officials Doing to Make Private Health Insurance Work Better for Consumers During the Coronavirus Public Health Crisis?  A state-by-state compendium of actions related to COVID-19 coverage.

National Committee for Quality Assurance (NCQA).  COVID19: HEDIS Reporting and NCQA Accreditation Changes  NCQA has made modifications to HEDIS and accreditation requirements for Medicaid and Commercial plans related to COVID19.

National Association of Insurance Companies (NAIC). NAIC Insurance Brief: Covid-19 and Insurance

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STATE EXAMPLES AND MODELS

The Commonwealth Fund/Georgetown’s Center on Health Insurance Reforms (CHIR). State Action Related to COVID-19 Coverage of Critical Services by Private Insurers  Interactive 50-state map on state DOI actions re: COVID-19

Alaska Insurance Coverage for Telehealth AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

California.  DHCS COVID‑19 Response  CA developed a robust, centralized COVID-19 resource page that provides guidance related to providers, HCBS, and federal requests/waivers.

Massachusetts.  March 15 2020 Telehealth Order  In MA, through executive order, Governor Baker expanded access to telehealth services in all commercial insurers and MassHealth programs, waived all cost-sharing for any medically necessary treatment delivered via telehealth related to COVID-19 at in-network providers, waived any prior authorization barriers needed to obtain medically necessary telehealth services, and established a 24-hour process to allow medical professionals to receive a license to practice in Massachusetts

Minnesota. CHAPTER 70–S.F.No. 4334 AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

New Jersey. Governor Murphy Signs Legislation to Expand Telehealth Access and Expedite Licensure of Out-of-State Professionals AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

New York. Department of Financial Services Adopts New Emergency Regulation Requiring Insurance Companies to Waive Cost Sharing for In-Network Telehealth Visits NY waived cost-sharing for telehealth visits with in-network providers.

New York.  Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency  NY allowed out-of-state providers and providers in New York that are not currently registered to provide telehealth services. 

Vermont. Vermont House Passes Telehealth Bill Amid Coronavirus Concerns  AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

West Virginia.  House Bill 4003 AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.