In the United States, mental health (“MH”) and substance use disorder (“SUD”) (collectively “MH/SUD”) have continued to represent areas of intense concern. During the COVID-19 pandemic, the MH struggles of essential workers and health care professionals were pushed to the forefront. However, issues related to MH/SUD have continued to escalate.
On Friday February 26, 2021, several agencies including The Departments of Labor, health, and Humans Services (HHS) published FAQs regarding health insurance issuers’ obligations under the FFCRA and CARES Act for governing diagnosing testing for COVID-19 and related items and serves during the public health emergency. This new guidance is helpful for plans, providers, and individuals alike and provides clarity on the nuances of coverage for COVID-19 tests and vaccines.
There is a trend in healthcare toward customer-centrism—placing the interests of the consumer before all other considerations. The trend may be slow in its growth, but for those healthcare organizations that embrace the idea and obsess over improving the consumer’s experience throughout their healthcare journey, there can be a payoff. But improving consumer experience in healthcare takes a commitment and courage to venture outside of traditional comfort zones.
For years, the polarized debate over healthcare policy has included advocacy for a more consumer-directed healthcare system. The argument in favor says consumers and providers alike must have more skin in the game—financial responsibility—and better information with which to make more consumer-like decisions. For providers, the “skin” means risk-based contracts. For consumers, it means higher deductibles and other out-of-pocket cost exposure. There has been significant movement in this direction.
On June 9, 2016, the Texas Medical Board proposed for comment new rules regarding physician call coverage. The proposed new rule originated from the Board’s Telemedicine Committee and changes the current telemedicine call coverage rule. The rule would apply to all physician call coverage relationships, not just telemedicine.
During the meetings last week, the Board’s Executive Director stated that the proposed rule was created at the request of the Texas Medical Association and leadership from Children’s Medical Center of Dallas with input from the Texas e-Health Alliance. An earlier draft was withdrawn during the Board’s March 2016 meeting. The current draft was reviewed and discussed during a recent meeting of the Board’s telemedicine stakeholder group.
The out-of-network (OON) business model faces challenges as the result of changes to health and benefit plan OON coverage, but a ruling by Judge Hoyt of the U.S. District Court for the Southern District of Texas suggests that health plans should be careful in refusing payment based on perceived OON high charges, questions about OON co-insurance collection, or provider financial arrangements.