April 1st Newsletter - Sachs Policy Group

State Updates

Governor Cuomo Announces New Projections and Preventive Measures, Discusses FY 2021 Budget

Today (April 1^st), Governor Cuomo announced in his daily COVID-19 conference (available here) that updated McKinsey projections predict a slightly lower and later apex for the COVID-19 outbreak, estimated to be at the end of April. For the first time, these included two versions of the projections, with low and high effects from social distancing measures:

Low compliance: 110,000 hospital beds, 37,000 ventilators
High compliance: 75,000 hospital beds, 25,000 ventilators

The Governor also announced that companies have offered New York large volumes of new testing kits (more than one million in total) at no cost or at a reduced price. Addressing new preventive measures, the Governor stated that the State has decided to close all New York City playgrounds due to lack of social distancing compliance, but would leave open spaces in parks available for use.

The Governor acknowledged that the State budget is due today and indicated that he, the House, and the Assembly have come to a “conceptual agreement.” Final discussions on the agreement are now being conducted among legislative leaders, and the budget is expected to be passed shortly. The New York State Budget Director, Robert Mujica, also stated that due to the extended deadline for tax filing to July 15^th and associated lack of revenue, the State will need to use reserves and temporary short-term borrowing to bridge the gap between expenditures and revenue. Options under discussion include the issuance of up to $8 billion in short-term bonds and establishing a State line of credit of up to $3 billion. As previously floated by the Governor, the Budget Director would have the ability to adjust disbursements on a periodic basis based on actual tax receipts.

Updated Guidance Documents

Yesterday (March 31^st), the New York State Department of Health (DOH) released a COVID-19 Telehealth FAQ (available here) that provides comprehensive answers to questions across a range of topics, including billing guidelines, patient and provider locations, practitioner types, documentation requirements, and children’s services. Questions are arranged by topic area and provider type. A number of important issues are clarified, including:

Article 28 clinics may bill for telemedicine (audio-video) services provided by their employed practitioners who are at home.
Details about the types of staff who may bill for patient assessment and management have been clarified (including FQHC social workers, home care aides, therapists, and so on).
For dual eligibles, NYS Medicaid will continue only to cover services that are covered by Medicare, and it will reimburse applicable Medicare coinsurance or deductibles for such services. In particular, services such as psychotherapy (which Medicaid will reimburse when provided telephonically for non-dual eligibles) will not be reimbursed if provided telephonically to dual eligibles. The FAQ does not yet address the new CMS rules released Monday evening that create Medicare reimbursement for telephonic visits through CPT codes 98966-98968 and 99441-99443.

Additional new/updated guidance documents from the City and State are listed below.

Other Updates

FAIR Health Releases Projection of COVID-19 Hospital Expenses

On March 25^th, FAIR Health released a report estimating an average in-network commercial cost of $38,221 per hospitalized COVID-19 patient, with substantially lower Medicare and Medicaid costs per patient. Based on projections of between 4.9 million and 19.8 million Americans requiring hospitalization during the pandemic, total projected costs to treat hospitalized COVID-19 patients range from $139 billion and $558 billion, in direct treatment in-network allowed amounts. Costs reflect contractually allowed amounts prior to legislative and regulatory changes such as the 20% increase in Medicare fee for service reimbursement for COVID-19 services, and do not count losses of revenue for hospitals from the postponement or cancellation of elective procedures. These losses are under investigation as the topic of a subsequent report. The report can be found here.

Innovative Solutions to Urgent Problems

SPG continually explores innovative telehealth and digital health solutions to the problems facing the health care industry. In light of the ongoing COVID-19 pandemic, we thought it would be helpful to start a series in which we present startups and tech companies that seek to provide solutions to the urgent needs many of our clients are facing (some of which are free of charge):

Vesta Healthcare (fka Hometeam) offers a 24/7 care and condition reporting platform via its mobile app to support high-risk patients, allowing care teams (care managers, nurses, physicians) to better monitor, communicate, and care for patients remotely. It supports COVID-19 management by providing education, clinical escalation and intervention pathways for COVID-19 and other complex chronic conditions, telehealth access, and more.
Netsmart offers a standalone telehealth platform that can support providers in offering remote services to patients during the COVID-19 outbreak. Netsmart also offers a fully functional electronic health record system for human service agencies and post-acute care providers. Netsmart’s products incorporate COVID-19 screeners and capture all remote encounters so organizations can track and bill for services (many that may not have clear codes) delivered during this time.
OhMD gives practices the ability to communicate with patients through two-way texting, with the ability to immediately transition to a patient video visit. No new app is required—consumers receive a text message with a link. OhMD is making its SMS texting features available in a “COVID-19 Plan” to any practice at no cost for the next two months.
K Health provides an app that allows consumers to have a conversation with an AI-enabled tool to share their symptoms, which can be triaged to a text-based conversation with a board-certified doctor. This service is free during the COVID-19 outbreak.
Talkspace provides therapy via a subscription-based online platform. Users can choose from a range of plans, which include messaging-only options and live video sessions. In response to COVID-19, Talkspace is providing a free month of therapy for impacted health care workers, as well as a $100 discount and free resources for other consumers.