In response to the COVID-19 pandemic, the Centers for Disease Control issued guidance on the use of personal protective equipment (PPE) in health care delivery. This guidance included implementing universal use of PPE, including increased use of masks, gloves, and eye protection, by the patient and provider to reduce the risk of COVID-19 transmission.
Increased demand for PPE led to global supply chains being overwhelmed since the COVID-19 pandemic began. This resulted in shortages and price increases of PPE.
For the duration of the state of emergency related to COVID-19, a health carrier must reimburse a health care provider who bills for PPE as a separate expense, using the American Medical Association's current procedural terminology code 99072 or as subsequently amended, $6.57 for each individual patient encounter. This applies retroactively to claims associated with health care services delivered on or after January 1, 2021.
Enrollee cost sharing is limited to the covered service according to the terms and conditions of the health benefit plan and does not apply to an expense for PPE.
This act expires upon the termination of the state emergency related to COVID-19.
PRO: Providers have not been compensated for additional PPE that they have had to purchase during the pandemic and some supplies have gone up in cost 1000 percent. Physicians can not access free supplies and cannot pass the extra cost on to patients. Provider payments are designed to pay for the average cost of supplies, but this is not covering the current costs.
OTHER: Carriers could support the bill without the retroactivity provision and clarification on what type of services would be eligible for the reimbursement. Reimbursement should only apply for in person encounters when a provider actually needs and uses the PPE. Medicaid behavioral health providers would like to be able to bill for this reimbursement but cannot under the current language. These providers did not receive additional funding from the state or federal government during the COVID-19 emergency.