March 20, 2020 Edition
On Thursday
evening, Governor Gavin Newsom issued Executive Order N-33-20 in response to the ongoing COVID-19 pandemic. The executive
order, which includes an order of the California Department of Public Health
(CDPH) Director and State Public Health Officer Dr. Sonia Angell, requires all
Californians to stay at home or at their place of residence effective
immediately and until further notice to protect the public’s health. The order
exempts a series of critical infrastructure sectors, including healthcare
services, grocery stores, pharmacies, and essential governmental operations.
The order further
directs the healthcare delivery system to prioritize services to the sickest
and prioritize resources, including personal protective equipment (PPE), to
providers delivering direct care to the sickest individuals. The Governor’s
Office of Emergency Services (Cal OES) is also directed to take steps to ensure
compliance with the order.
The Administration
is expected to issue further guidance related to the statewide stay-at-home
order.
The State of
California has also established a new website, www.covid19.ca.gov, to provide Californians up-to-date
information on the ongoing emergency, including a series of public service
announcements (PSAs) from key state officials.
On March 19, the California Department of Health Care Services sent a formal letter to the Centers for Medicare and Medicaid Services (CMS) requesting additional flexibilities to assist in California’s COVID-19 response efforts. DHCS requested the following flexibilities to be granted for fee-for-service Medi-Cal beneficiaries and providers, and various federally approved delivery systems such as Medi-Cal managed care plans, county organized health systems, county mental health plans and the Drug Medi-Cal organized delivery systems and to the state’s Children’s Health Insurance Program:
- Service authorization and utilization controls,
with specific programs listed.
- Eligibility flexibility including allowing
hospital presumptive eligibility to cover more than one period in a 12-month
timeframe.
- Payment and HIPAA flexibility during the
COVID-19 emergency.
- Extensions for administrative activities such as
waiving the two-year claiming limit for federal financial participation, the
12-month timeframe for provider claims, cost report deadlines, and financial
oversight and medical compliance.
- Waiving timing requirements for setting interim
rates and waiving the statewide maximum allowance rate.
In regard to the Section 1115
Waiver, DHCS requested the ability to allow for Medi-Cal claiming for services
provided in jails and prisons for testing, diagnosis and treatment of COVID-19
or ensure care is provided in a safe way without transport to acute care
facilities. DHCS also requested the waiver of the IMD exclusion.
Last night, Senate Majority Leader Mitch McConnell released
the details of a Senate Republican plan for a third round of proposals aimed to
address the COVID-19 crisis. The Coronavirus Aid, Relief, and Economic Security
Act, or CARES Act is a nearly $1 trillion package. Major provisions include:
- $300 billion for loans for impacted small
businesses.
- Direct funding to taxpayers in amounts ranging
from $600-1,200 per taxpayer ($1,200-2,400 joint) with a cap on those income eligible
held at $75,000 for individuals or $150,000 jointly. There are also provisions
extending $500 per child, depending on family income.
- Delay of the IRS tax filing deadline until July
15, 2020.
- Delays in certain tax payments for corporations
and employers.
- $208 billion in emergency relief funding through
loans and loan guarantees for airlines, air cargo carriers, and other eligible
businesses.
- Caps on paid leave and emergency paid sick leave
for employers.
Of interest to local health departments, the CARES Act also
contains a few health-related provisions including:
- Moves responsibility for the Strategic National
Stockpile (SNS) to the Assistant Secretary for Preparedness and Response (ASPR)
and removes the Centers for Disease Control and Prevention.
- Tasks the National Academies with preparing a
report on America’s medical product supply chain focused on critical drugs and
devices sourced or manufactured outside of the US and directs the Academies to
consult with a variety of stakeholders including State and local health
departments.
- Requires the SNS to include certain types of
medical supplies including personal protective equipment, ancillary medical
supplies, and other applicable supplies required for the administration of
drugs, vaccines, and other biological products, medical devices, and diagnostic
tests.
- Allows for the emergency use of lab developed
tests for SARS CoV-2 detection, within prescribed guidelines.
- Requires health insurers to provide diagnostic
testing coverage for COVID-19 enrollees and not impose any cost-sharing provisions.
Also requires health insurers to reimburse providers for diagnostic testing.
- Requires each provider of a COVID-19 diagnostic
test to make public the cash price for the test on their public website.
- Requires health insurers to cover any qualifying
coronavirus preventive service including an item, service, or immunization
intended to prevent or mitigate coronavirus 2019.
- Provides $1.3 billion in supplemental funding to
Health Centers for the detection of SARS CoV-2, and for the prevention,
diagnosis, and treatment of COVID-19.
Negotiations continue between Senate Republicans and Senate
Democrats today and will likely extend into Saturday. Democrats have been
critical of the cash assistance limitations, particularly that it would provide
no relief for the poorest of Americans (those earning less than $2,500 of
qualified income). Democrats are also pushing for increased funding for
hospitals and an increase in Medicaid FMAP, they have raised concerns about
limitations on paid leave the Republicans are offering, and they have been very
critical of the size of corporate loans. Moreover, talks are complicated by
requests from the White House to include additional funding for response
activities. It is Senator McConnell’s stated intent to have the bill up for consideration
on the Senate Floor starting on Sunday, March 22.
For more information on the previous COVID-19 related packages passed by Congress, please see our memo released on Wednesday, March 18.
In response to the extraordinary circumstances facing local health departments as they respond to the COVID-19 crisis, the Public Health Accreditation Board (PHAB) announced a 90-day extension for all local health departments who are currently engaged in the initial accreditation process and those seeking reaccreditation. More information on the extension can be found here.
Today, Covered
California Executive Director Peter Lee, along with Department of Health Care
Services (DHCS) Director Dr. Bradley Gilbert and State Medicaid Director Jacey Cooper,
announced a special enrollment period for health insurance coverage amid the
ongoing COVID-19 pandemic. Effective today, Friday, March 20, Californians who
meet eligibility requirements and are without health insurance are able to sign
up for coverage through June 30, 2020.
This enrollment
period is similar to those in place during the annual open enrollment period,
and those who sign up for health coverage would receive coverage beginning on
the first of the following month. Consumers who sign up for coverage through
Covered California may also find out if they are eligible for no-cost or
low-cost coverage through Medi-Cal; those eligible for Medi-Cal can enroll
online and have coverage that is effective immediately. Expanded state
subsidies will also be offered to income-eligible applicants.
In announcing
the special enrollment period, DHCS Director Dr. Bradley Gilbert indicated,
“The extraordinary challenges posed by COVID-19 demand an equally extraordinary
response, and the Medi-Cal and Covered California systems are stepping up to
meet the need for health coverage and ease access to services.”
The full
special enrollment period announcement is available here.
In a move that has not occurred in almost 160 years, the
California Legislature voted Monday night to recess their respective bodies
until Monday, April 13, 2020, due to COVID-19. Acknowledging the seriousness of
the crisis, President pro Tempore Toni Atkins said “…even though we may not
physically be in the Capitol, we will continue working in our districts to
serve our constituents. We’re committed to protecting the health of all
Californians.” ACR
179/Rendon and Waldron also includes provisions that allow the Pro Tem
and the Speaker to jointly recall their respective houses back into session as
well as extend the joint recess if necessary.
This week’s CHEAC Weekly Bill Chart is available
here. New updates will resume upon the Legislature’s return.
Earlier this week, the Senate Rules Committee convened to
review the appointment of Marko Mijic, for his role as Deputy Secretary,
Program and Fiscal Affairs, for the California Health and Human Services
Agency. Mr. Mijic in his opening remarks noted that he came to the United
States 22 years earlier as a refugee with his family, speaking no English, and
how his commitment to public service is “rooted in the idea that government can
and must look to build an equitable, just, and tolerant society.”
Members of the committee questioned Mr. Mijic on subjects
such as foster care, impacts of the public charge rule, budget proposals
relating to homelessness, and they were also very interested in hearing from
him about California’s response to Coronavirus. Mr. Mijic briefly walked them
through the Health and Human Services Agency’s activities including working
with their local partners in counties and cities, health care providers, and
schools and universities, and he noted that though it was an evolving situation,
he felt California was prepared and ready to respond to the novel virus.
The Senate Rules Committee voted unanimously to confirm Mr.
Mijic. His confirmation now goes before the full Senate for consideration.