by James C. Sherlock
The Kaiser Family Foundation today reported state COVID-19 policy actions through March 17. Virginia is one of only 18 of 50 states and the District of Columbia to have taken none of the listed policy actions other than an emergency declaration.
The actions not taken include:
- Waive cost sharing for COVIC-19 testing
- Waive cost sharing for COVID-19 treatment
- Free cost vaccine when available
- Waiver of prior authorization requirements
- Early prescription refills
- Marketplace special enrollment period (N/A in Virginia)
- Section 1135 waiver[1]
- Paid sick leave
(To view raw policy action data for each state and the District of Columbia, click here.)
To that list of actions not taken I would personally add two more.
- The Medical Society of Northern Virginia has alerted me to a lack of progress in organizing the appropriate distribution of existing stocks of masks, gowns and other personal protective equipment to independent practitioners charged with treating those affected with the virus. The hospital systems largely have the existing supplies and as big customers their orders take priority with the vendors. It is an issue with which the Health Commissioner can and should deal.
- On my recommendation, the President of the Medical Society of Virginia, Dr. Clifford Deal, has taken up an initiative to organize physicians, nurses and technicians specialist practices whose patient load is declining during COVID-19 into a reserve force to supplement medical personnel on the front lines. The concept is for those practices to arrange their remaining patient loads to enable them to close their offices certain days of each week to free up the entire staff to support the COVID-19 effort on those days. That program would be coordinated among the medical societies, the Virginia Department of Health and local health departments to optimize the flow of the assistance Deal has indicated to me initial frustration with getting support for this initiative from the Northam administration. Waiting until such reserves are needed is not acceptable.
In a state with a big government Democratic Governor who is also a physician, these failures to act seem inexplicable. They may be traceable to inertia in the Department of Health (VDH) and the Department of Medical Assistance Services (DMAS) or at the level above them in the office of the Secretary of Health and Human Resources. Or, perhaps those agencies and the Secretary have made recommendations that have yet to be acted upon by the Governor.
Whatever the cause, action is needed by the administration to take the appropriate steps with some sense of urgency and let us all know what they are doing.
Finally, the General Assembly must mandate an investigation and report of state COVID-19 actions, inactions, lessons learned and recommended legislative corrective actions.
Do not limit the scope to the issues discussed in this essay. There are many others, most prominently the direct link between COPN and the terrible shortages of facilities to treat COVID-19 patients that Virginia now faces.
Such work is appropriately accomplished by the Joint Legislative Audit and Review Commission (JLARC), a Virginia version of the federal Government Accountability Office (GAO). I recommend that JLARC be tasked with record keeping on COVID-19 related administration activities. The leadership of the General Assembly should be able to organize the support of such a step by the members and task the JLARC record keeping now. JLARC, like most of us, is working from home, but they are working.
On January 31, 2020, Secretary of the US Department of Health and Human Services (HHS) declared a public health emergency under the Public Health Service Act. On March 13, the President declared a national emergency under the National Emergencies Act and made an emergency determination under the Stafford Act. These actions permitted the authorization of waivers by the Centers for Medicare/Medicaid Services (CMS) of certain Medicare, Medicaid and Children’s Health Insurance Program requirements as provided by Section 1135 of the Social Security Act. Section 1135 permits states to waive or modify certain Medicare, Medicaid, CHIP, and HIPAA requirements during a national emergency. Some blanket waivers have already been issued by CMS. Others need to be applied for.
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