Coronavirus Hammer Falling Hard on NYC Metro

The nation’s largest city saw its cases soar past the 1,000 mark this week.

I wish that I was writing under better circumstances, but these are difficult times in New York, and across the United States.

As of Tuesday, New York State had more patients identified with COVID-19 than any other state in the U.S. This is not a distinction that anyone here had hoped for.

It was announced Tuesday that 1,374 cases of COVID-19 had been confirmed, including 644 in New York City. There are three patients who have died in New York so far. These numbers are being updated as we speak.

New York Governor Andrew Cuomo has watched world events closely, particularly in Italy, Spain, and China. He has called on the federal government to mobilize the U.S. Army Corps of Engineers to convert existing state-owned facilities, like State University of New York dormitories, into medical facilities. It is true that there are approximately 3,000 ICU beds at hospitals in the state; however, these beds are already 80 percent filled. That means there are only 600 available ICU beds in New York State at any given time.

If New York’s clinical capacity is not increased immediately, Cuomo predicts that New York’s hospitals “will soon be overwhelmed by an oncoming wave of coronavirus patients.”

Faced with this dire reality, Governor Cuomo last week issued an Executive Order (effective through April 11) that suspends certain laws and regulations to allow for expansion of services and temporary facilities for hospitals and other health and human service providers:

• This will allow hospitals to make temporary changes to buildings, bed capacities, and services provided, upon approval of the Commissioner of Health, in response to a surge in patient census;
• It will allow construction applications for temporary hospital locations and extensions to be approved by the Commissioner of Health;
• Providers can establish temporary hospital locations and extensions without following the standard approval processes, and take further measures as may be necessary to expedite departmental reviews for such approval;
• Clinical laboratories may operate temporary collecting stations to collect specimens from individuals suspected of suffering from a COVID-19 infection;
• It will allow screenings to be conducted by telephone, and will permit other types of practitioners to deliver services within their scopes of practice, and to authorize the use of certain technologies for the delivery of healthcare services to established patients;
• New York also will waive or revise eligibility criteria, documentation requirements, or premium contributions; modify covered healthcare services or the scope and level of such services set forth in contracts; increase subsidy payments to approved organizations, including the maximum dollar amount set forth in contracts; and provide extensions for required reports due by approved organizations, in accordance with contracts.

The New York Department of Financial Services announced the removal of barriers to testing and treatment for COVID-19 in a letter issued March 3.

The letter states that insurers should not use preauthorization requirements as a barrier to accessing COVID-19 treatment, and should be prepared to expedite utilization review and appeal processes for services related to COVID-19.

Hospitals are awaiting the release of emergency Department of Financial Services regulations prohibiting health insurers from imposing cost-sharing on in-network provider office visits, urgent care center visits, or emergency room visits when the purpose of the visit is testing for COVID-19. The Hospital Association of New York State is advocating that cost-sharing prohibitions include all copays, deductibles, and other out-of-pocket costs.

In states like New York, where the governor has declared an emergency, Medicare Advantage plans must cover services by out-of-network providers at the in-network cost-sharing rate, and also waive gatekeeper referral requirements.

New York’s Medicaid program will cover services for physicians, clinics, and emergency visits without copays for patients when the purpose of the visit is testing for COVID-19. New York State Medicaid will add HCPCS codes as they become available.

Outside of the state healthcare systems, other serious steps are being taken to curb the spread of the virus. All schools in New York City and many surrounding counties have been closed. Any large gathering or event for which attendance is anticipated to be in excess of 50 is prohibited or postponed. Monday morning, the U.S. Centers for Disease Control and Prevention (CDC) issued similar guidance.

Across the Hudson River in New Jersey,

The New Jersey Hospital Association has announced a restricted visitors’ policy for all New Jersey hospitals, nursing homes, and other post-acute care facilities.

No hospital visitors will be allowed until further notice, with limited exceptions, including:

• Patients in hospice or end-of-life care;
• Maternity patients are allowed one visitor/support person;
• One visitor/support person is allowed for pediatric patients; and
• One visitor/support person is allowed for an individual undergoing same-day surgery or an ambulatory procedure. (Although I understand that all elective surgeries are being cancelled).

Importantly, even visitors who meet these exceptions must be screened for symptoms before being allowed to visit.

In addition, hospitals and other healthcare providers in coronavirus hot spots are being forced to fast-track work-from-home strategies.

These are unique times that we are dealing with. Updates on the virus, its spread, and its impact seem to come faster than we can digest them. We will look for specifics to flesh out the general policies and regulations that have been announced, and we will have to keep up with local state and national events as best as we can until new, effective treatments and a vaccine are developed.