Federal Support of COVID Care for the Uninsured

There is little good news about the coronavirus pandemic in the United States; however, there are new federal government programs to reimburse healthcare providers for coronavirus testing, counseling associated with testing, and treatment of individuals not covered under any other health insurance policy. The current Coronavirus Aid, Relief, and Economic Security Act (CARES) states that “Every health care provider who has provided for COVID-related treatment of uninsured patients on or after February 4, 2020, may request claims reimbursement and will be reimbursed at Medicare rates, subject to available funding. https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html

Several U.S. Department of Health and Human Services (DHHS) agencies are involved including Health Resources & Services Administration (HRSA) and Centers for Medicare & Medicaid Services (CMS). DHHS has contracted some of the administration of these programs to private sector partners including Optum Services and United Health Care. Since all of these programs have been created in the past few months, information on how to enroll and how to bill for services is still evolving. I have attempted to summarize what I can find online. Some of the websites I cite below have telephone support lines to assist providers and their staff. Primary care providers can apply (subject to eligibility criteria) but must complete the enrollment process by November 6, 2020 11:59pm ET. https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#how-to-apply

Once enrolled, providers can submit claims for up to 365 days after the service was rendered. If either the patient or some other party has partially or totally reimbursed the provider, those funds would have to be returned to the payers prior to accepting Federal funds. https://coviduninsuredclaim.linkhealth.com/

Clinicians can bill for visits to the office, emergency room, urgent care, or telemedicine to evaluate patients to determine whether they should be referred for laboratory testing. In-office or point-of-care testing for Coronavirus SARS2 antigens or antibodies using products approved by the US Food and Drug Administration (FDA) under the Emergency Use Authorization (EUA) is also reimbursable. Click here for FAQs.

Counseling associated with COVID testing will be reimbursed provided it includes the following: “Discuss the need for immediate isolation, even before results of the test are available; Advise patients to inform their immediate household/contacts that they may wish to be tested and quarantine as well. Review locations and people they have been in contact with in the past two weeks; Review the signs and symptoms of COVID-19; Inform patients that if positive, they will likely be contacted by a public health worker and asked to provide a list of the people they’ve been with for contact tracing, encourage them to ‘answer the call’; Discuss services that might help the patient successfully isolate and quarantine at home.” https://www.cms.gov/newsroom/press-releases/cms-and-cdc-announce-provider-reimbursement-available-counseling-patients-self-isolate-time-covid-19

In our primary care practice, we have not applied for any federal funding because we have no infrastructure for billing third-party payers. I will share with you our experience with COVID care and testing of the uninsured because you may have some of these options available in your community as well. Culmore Clinic, where I volunteer as medical director, is an interfaith-based free clinic which prior to the pandemic received no support from federal, state, or county funds and is supported entirely by voluntary contributions from religious congregations, businesses, and individuals in our surrounding community. We provide primary care to adults with no eligibility for other health insurance, with household incomes less than 200% of federal poverty guidelines, and who reside in our county. Most of our patients live in one neighborhood (Culmore) and are immigrants from Central and South America.  Most who are employed perform tasks where their physical presence is essential and are often unable to physically distance either at work or at home. Many live-in apartments shared by large families or multiple roommates.

Before the pandemic, we held clinic three days a week in the basement of the First Christian Church of Falls Church. After the county schools and the church closed in early March, we have conducted all patient care by telephone, except for outdoor coronavirus testing and medication/supply distribution. Most of our patients do not have cellular or home internet access to support video telemedicine. During the “first wave”, the Culmore area zip codes had a disproportionately higher incidence of COVID than the rest of Fairfax County. Our community and clinic in the suburbs of Washington, DC got both local and national media attention. https://www.culmoreclinic.org/covid19

We have been able to partner with a federally qualified health center (FQHC), Neighborhood Health, for free coronavirus testing of our patients because the FQHC is able to get HHS reimbursement as described above. They provide us PPE, and we arrange drive-through nasopharyngeal sampling at our site. The sampling has been done by volunteer nurses assigned by the Virginia Medical Reserve Corps. The FQHC submits the samples to a commercial laboratory for PCR viral testing, and we get results in about 48 hours. I report positive testing and clinically diagnosed COVID to the Virginia Department of Health, and the Fairfax County Health Department contacts the patients for contact tracing. Ironically, because the only medical therapy of COVID in the primary care setting is supportive care and symptomatic treatment, we have been able to provide a quality of care comparable to that available to insured patients in our community. With the support of individual donors and neighborhood businesses, we have supplied our symptomatic COVID patients’ thermometers, pulse oximeters, and daily phone calls from our nursing staff. Family members and friends delivered to them some cooked meals, groceries, and homemade masks donated by Dar Al Hijrah Islamic Center, one of our partner religious congregations. We have received PPE donations for our on-site services. INOVA Fairfax Hospital has provided emergency and inpatient care to those of our patients who have required it. Again, we have been blessed to have a partnership offering state of the art intensive care including extracorporeal membrane oxygenation (ECMO) for one of our patients. So far, we have not had any deaths from COVID, but both we and our patients have great concern for the future.

Charles A. Sneiderman, MD, PhD, DABFM
Medical Director, Culmore Clinic
Bailey’s Crossroads, VA

Published on 11/3/2020