less than meets the eye?

On April 4, CMS announced the coverage of Over the Counter (OTC) COVID-19 tests by Medicare, and released a fact sheet along with guidance for providers on the coverage and billing requirements and guidance for beneficiaries on how to obtain cost-free tests. According to these documents, coverage for these tests began April 4 and will continue through the duration of the COVID-19 Public Health Emergency (PHE). The COVID-19 PHE was last renewed on January 14, which would extend the PHE through April 16, 2022. However, on January 21, 2021, Acting Secretary of HHS Norris Cochran sent a letter to State Governors indicating that:

… when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.

To date (April 11, 2022), it does not appear that any notification of the termination of the PHE has been issued by the Secretary, but neither has the PHE been renewed. (UPDATE: The PHE was renewed on April 12, posted to the DHHS website on April 13, and again renewed on July 15. The PHE will presumably, after this most recent renewal, expire on October 16 unless again renewed.)

Despite all of this busyness a fair amount remains uncertain. Beneficiaries are right to be confused—as am I. Will the PHE expire on April 16? Or will the Department renew the PHE in the next 5 days? Or will it continue until such time as the Department notifies the states that it has made a decision to terminate the declaration? If so, then why has the Department renewed the PHE three times since the letter to the Governors was sent—on April 15, July 19, October 15, 2021, and again on January 14, 2022?

If the PHE does expire on April 16, 2022, then the “coverage” of COVID-19 tests is more sound than substance. So presumably a renewal of the PHE is forthcoming … but why the needless confusion?

Somewhere, if only in my mind, Max Weber is weeping.

On another note, the guidance given to providers indicates that Medicare will pay the lesser of $12 per test or the amount charged by the participating pharmacy or provider—$24 is the retail price for a package of 2 Binax tests at Walgreens.


mandates, incentives, and personal responsibility

We have met the enemy and he is us.
—Pogo (Walt Kelly), 1972

Joe Biden is not responsible for the current surge of COVID-19Δ, and will not be responsible for the coming surge of COVID-19Ο. Nor is COVID-19 in either its delta or omicron mutation responsible. Who is? Those who won’t do the very least they can do, all on their own, to prevent transmission of COVID-19 to themselves (by vaccination) or others (by wearing a mask). The COVID-19 pandemic has revealed a longer-standing and more virulent pandemic: a pandemic of malignant individualism and selfishness masquerading as a defense of freedom.

The reactionary right waxes hysterical about mandates, has tantrums about masks, is sent into a frenzy by school policies that will protect their own children, and goes on and on (and on and on) about tyrannical assaults on their freedom. At this point we know that mandates may be counterproductive when directed at people who haven’t the faintest understanding of what freedom entails. That would be personal responsibility. Something else that the reactionary right goes on and on (and on and on and on) about when it concerns the responsibilities of other people.

So … if not mandates, then what?

How about incentives? Pro-market conservatives like incentives. They prefer them. They maintain that incentives are always superior to mandates and regulations as a tool of public policy. So, let’s think about how that would work. It would be fairly simple: if you aren’t vaccinated you have to pay for your own care when you contract COVID-19. All of your care: the testing, the emergency room care; the hospital care; the physician visits; the drugs you need; the follow-up care. And you will be put at the end of the queue for resources that are in short supply: ICU beds, ventilators, monoclonal anti-body treatment, the latest drugs. If you won’t do the very least to take care of yourself and others, then the rest of us shouldn’t have to foot the bill for your selfishness (not to mention your foolishness).

Should there be exceptions? Only if the physicians in the hospital where you are seeking care concur that vaccination was clinically contraindicated. No religious exception: you should appeal to your co-religionists to pay for your care or be a martyr to your sacred principles. No exception based on political principle: “Live Free or Die” implies “Live Free and Die”. No exception for financial hardship given the extraordinary actions that have been taken to make the vaccine freely available. And those efforts should and will and do continue.

The very least the unvaccinated can do is: get vaccinated. The next-to-least thing they can do is: wear a mask when around others. This also applies to the vaccinated—but many of us do continue to wear masks out of consideration for the health of others. It’s time for the unvaccinated to use the freedom with which they are endowed to take some personal responsibility. Which is what freedom is about.

federal register • 28 december 2020

CMS has published in the federal register:

  • A Final Rule and Interim Final Rule for the Medicare Program:
    1. CY 2021 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies;
    2. Medicare Shared Savings Program Requirements;
    3. Medicaid Promoting Interoperability Program Requirements for Eligible Professionals;
    4. Quality Payment Program;
    5. Coverage of Opioid Use Disorder Services Furnished by Opioid Treatment Programs;
    6. Medicare Enrollment of Opioid Treatment Programs;
    7. Electronic Prescribing for Controlled Substances for a Covered Part D Drug;
    8. Payment for Office/Outpatient Evaluation and Management Services;
    9. Hospital IQR Program;
    10. Establish New Code Categories;
    11. Medicare Diabetes Prevention Program (MDPP) Expanded Model Emergency Policy;
    12. Coding and Payment for Virtual Check-in Services Interim Final Rule Policy;
    13. Coding and Payment for Personal Protective Equipment (PPE) Interim Final Rule Policy;
    14. Regulatory Revisions in Response to the Public Health Emergency (PHE) for COVID-19; and
    15. Finalization of Certain Provisions from the March 31st, May 8th and September 2nd Interim Final Rules in Response to the PHE for COVID-19

federal register • 04 november 2020

CMS has published in the federal register:

  • A Final Rule for the Medicare and Medicaid Programs: CY 2021 Home Health Prospective Payment System Rate Update, Home Health Quality Reporting Program Requirements, and Home Infusion Therapy Services and Supplier Enrollment Requirements; and Home Health Value-Based Purchasing Model Data Submission Requirements
  • A Proposed Rule for the Medicare Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Policy Issues and Level II of the Healthcare Common Procedure Coding System
  • A Notice of Agency Information Collection Activities: CLIA Collection of Information Requirements Related to SARS-CoV-2 Test Results Reporting
  • A Notice of Agency Information Collection Activities: Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program—Contracting Forms
  • A Notice for the Medicare and Medicaid Programs: Quarterly Listing of Program Issuances; July through September 2020

DHHS has published in the federal register:

  • An Interim Final Rule: Information Blocking and the ONC Health IT Certification Program: Extension of Compliance Dates and Timeframes in Response to the COVID-19 Public Health Emergency

federal register • 08 may 2020

CMS has published in the federal register:

  • An Interim Final Rule with comment period for the Medicare and Medicaid Programs, Basic Health Program, and Exchanges: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program