Healthcare Roundup: Skyrocketing Costs of COVID-19 Test Kits, Nursing Home Workers Strike and More

Coronavirus Tests Cash Cows for Some Providers:

Some hospitals have been charging as much as $650 for a basic molecular COVID-19 test that costs them less than $50 to do, according to analysis of Medicare claims by Hospital Pricing Specialists. Some free-standing ERs have been charging over $1,000 for such tests. And with 400 million coronavirus tests having already been administered, they’ve provided a steady stream of cash for such providers.

The steep test prices aren’t being paid by patients but by their insurance companies.

“Patients themselves do not face any costs” said Cara Martinez, a spokesperson for Cedars-Sinai Medical Center in Los Angeles, which charges $480 for a basic PCR COVID-19 test. “The amounts we charge [insurers] for medical care are set to cover our operating costs” and other expenses.

Ge Bai, an associate professor at Johns Hopkins Bloomberg School of Public Health, said insurers “have no bargaining power in this game,” because in some cases there’s no cap on the price of the tests.

One of those cases is when a test is performed by an out-of-network hospital or clinic, so negotiated in-network prices don’t apply. Unlike with out-of-network vaccine charges, which are required by federal regulations to be “reasonable,” insurers have to pay a provider’s posted coronavirus test price, whatever the amount. Many hospitals and other test providers adhere to the Medicare reimbursement rate, which is $100 for high-volume tests that provide results within two days, but not all providers do.

“There’s a problem with the federal law,” said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms. “The CARES Act requires insurers to pay the full billed charge to the provider. Unless they’ve negotiated, their hands are tied.” (KAISER HEALTH NEWS)

Will IN’s COVID-19 Immunity Shield Allow Nursing Home Neglect?

Indiana enacted legislation this year (SB 1) providing individuals, businesses and other entities civil immunity from COVID-19-related lawsuits. Some worry the new law, which was supported by the nursing home industry, will allow nursing homes to shirk their responsibility for neglect and substandard treatment unrelated to the pandemic.

The bill’s sponsor, Sen. Mark Messmer (R), described it as being “very carefully balanced between the concerns of the medical community and protections for patients to make sure nothing outside of COVID-related issues are covered.”

One of the new law’s patient protections is that it doesn’t bar COVID-19 lawsuits due to “gross negligence or willful or wanton misconduct.” Trial lawyers, however, say it’s very hard to prove either of those things.

Jody Madeira, a professor at Indiana University Bloomington’s Maurer School of Law, meanwhile, said she was concerned that the law’s liability protections applied to healthcare providers’ allocation of staff.

“As soon as you go into staffing, which nursing homes have problems within the best of times, then it opens up the door to just about anything,” she said. (INSURANCE JOURNAL)

CA Weighs Extending Health Coverage to Dependent Parents:

A bill introduced in California (AB 570) would make the state the first in the nation to require state-regulated private health insurance plans to cover policyholders’ dependent parents. The Affordable Care Act already allows policyholders nationwide to extend coverage to their dependent children up to age 26.

The bill is opposed by business groups, which fear having to cover older, sicker individuals will raise their insurance premiums. But the measure also has strong support from health advocacy and immigrants’ rights groups, with immigrants comprising a large share of the state’s uninsured population.

“This is groundbreaking and, quite frankly, a shift in the paradigm about the way we think about people getting health care,” said Assembly member Miguel Santiago (D), the bill’s author. “The bottom line is we want everybody to get health care, and we will fight every angle to ensure that people get adequate health care.” (KAISER HEALTH NEWS, STATE NET)

MO Poised to Restrict Local Health Orders, Ban Vaccine Passports:

Missouri lawmakers passed a bill (HB 271) that would impose limits on local public health orders and ban vaccine passports. The bill now goes to Gov. Mike Parson (R), who has expressed support for both of those measures. (MISSOURI INDEPENDENT, STATE NET)

PA Lawmaker Wants to Be Able to Fine Rule-Breaking Addiction Treatment Centers:

Pennsylvania Rep. Mark Gillen is seeking support from fellow lawmakers for legislation to authorize the state’s Department of Drug and Alcohol Programs to fine licensed addiction treatment facilities for violations of state rules. Gillen’s proposal has not been formally introduced and there is currently no time frame for doing so. (PHILADELPHIA INQUIRER)

CT Makes Nursing Home Workers $280M ‘Final’ Offer to Avoid Strike:

The administration of Connecticut Gov. Ned Lamont (D) proposed a $280 million package of wage and staff increases to leaders of the New England Health Care Employees Union to avert a strike over nursing home pay and staffing levels. Top advisers to the governor called the proposal the state’s “best and final offer,” and Lamont has mobilized the National Guard to help ensure the safety of nursing home residents, including by moving them to other facilities if necessary. (HARTFORD COURANT)

-- Compiled by KOREY CLARK