Summary of CARES Act Supplemental Appropriations / Summary of CARES Act Healthcare Provisions

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Summary of CARES Act Supplemental Appropriations

By Capitol Associates, Inc.

In the late hours of March 25, 2020, the Senate passed its $2 trillion “Phase III” response to the COVID-19 public health emergency (PHE), the CARES Act by a vote of 96-0. The final version of the bill is the product of over a week of negotiations between Republicans and Democrats in Congress and the White House.

The House, which is currently out of session, is scheduled to vote on the bill on Friday at 9:00 a.m. President Trump is expected to sign the bill into law as soon as it reaches his desk.

Below is a summary of the bill’s supplemental appropriations.

Supplemental Appropriations

Below is a summary of the Phase III bill’s supplemental appropriations.

  • The bill provides $117 billion for hospitals and VA hospitals.
    • $100 billion would reimburse hospitals for expenses related to preparation, response and treatment of COVID 19. Some of the funding must be used to pay for building or leasing space to serve as temporary medical facilities. This funding is available until it is expended.
    • To request funding, providers must submit an application to HHS that includes a statement justifying the need for the payment. Eligible health care providers must have a valid tax identification number.
    • The VA healthcare system would receive $14.6 billion to help it prepare for an increased demand in health care services. It also receives $2.1 billion to compensate for an expected increase in demand for community care – specifically emergency and urgent care.
    • The VA would also receive $606 million to develop alternative sites for treating COVID-19 cases and to increase capabilities of existing sites. This funding is available until September 30, 2021.
  • $27 billion for an HHS Public Health and Social Services Emergency Fund to help acquire medical supplies, develop vaccines and countermeasures and improve telehealth infrastructure, among other things. This funding is available until September 30, 2024.
  • $16 billion is allocated for securing personal protective equipment (PPE) for the Strategic National Stockpile.
  • $11 billion for vaccine development and procurement.
  • The NIH would receive $945.5 million for vaccine and treatment research. Congress has already provided $1.78 billion to NIH for this purpose.
  • FEMA would receive $45 billion for its Disaster Relief Fund. This funding is available until it is expended.
  • The CDC would receive $4.3 billion for its efforts to combat the coronavirus.
    • This includes $1.5 billion in State and local Preparedness grants to supplement $2.5 billion Congress has already allocated for state and local governments.
  • The FDA would receive $80 million.
  • $713.6 million for the Department of Defense operations to respond such as deploying Navy hospital ships for civilian use.
  • CMS would receive $200 million for infection health care facility infection control inspections which is expected to be used to increase nursing home inspections.
  • $1.3 billion for Community Health Centers.

Summary of CARES Act Healthcare Provisions

By Capitol Associates, Inc.

In the late hours of March 25, 2020, the Senate passed its $2 trillion “Phase III” response to the COVID-19 public health emergency (PHE), the CARES Act by a vote of 96-0. The final version of the bill is the product of over a week of negotiations between Republicans and Democrats in Congress and the White House.

The House, which is currently out of session, is scheduled to vote on the bill on Friday at 9:00 a.m. President Trump is expected to sign the bill into law as soon as it reaches his desk.

Below is a summary of the bill’s provisions that affect the healthcare system.

Supporting America’s Health Care System

 NOTE – many of these provisions are time limited. Where noted in the law, we have highlighted the expiration date of the benefit/program.

 Coverage for COVID-19 Testing

All Health Plans are currently required to cover FDA approved COVID-19 diagnostic testing. The bill expands the definition for what types of COVID-19 diagnostic tests health plans must cover to include tests for which the developer has submitted or intends to submit an emergency use authorization to the FDA or if the state government where the test was developed notifies HHS that it will review and approve the test. Health plans cannot charge cost sharing for COVID-19 testing. Finally, HHS is authorized to issue guidance that lists tests that health plans must cover.

If health plans do not have an in-network rate for COVID-19 testing with a provider (regardless if the provider is in or out-of-network), the health plan is to pay the provider’s list price for the test. Providers that offer COVID-19 testing are required disclose their list price for COVID-19 testing publicly online. If a provider doesn’t publicize their testing price online, then the health plan and provider can negotiate the price. Providers can be fined up to $300 per day if they do not publicly list their testing price.

Health plans will also be required to cover approved vaccines for the coronavirus. Approved vaccines must either receive an A or B rating from the U.S. Preventive Services Task Force (USPSTF) or receive a recommendation from the CDC’s Advisory Committee on Immunization Practices.

  Liability Protection for Volunteer Health Workers

Volunteer health care professionals are protected from liability under Federal or State law for any harm caused by an act or omission in the provision of health care services related to COVID-19 during the public health emergency. Volunteer providers are still required to practice within the scope of their license or certification.

Treatment of Protected Health Information

Within six months, HHS must issue guidance on how to treat Protected Health Information (PHI) with respect to COVID-19.

Health Savings Accounts for Telehealth Services

This section would allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible, increasing access for patients who may have the COVID-19 virus and protecting other patients from potential exposure.

Over-the-Counter Medical Products without Prescription

This section would allow patients to use funds in HSAs and Flexible Spending Accounts for the purchase of over-the-counter medical products, including those needed in quarantine and social distancing, without a prescription from a physician.

Expanding Medicare Telehealth Flexibilities

This section would eliminate the requirement that limits the Medicare telehealth expansion authority during the COVID-19 emergency period to situations where the physician or other professional has treated the patient in the past three years. This would enable beneficiaries to access telehealth, including in their home, from a broader range of providers

Allowing Federally Qualified Health Centers and Rural Health Clinics to Furnish Telehealth in Medicare 

This section would allow, during the COVID-19 emergency period, Federally Qualified Health Centers and Rural Health Clinics to serve as a distant site for telehealth consultations. A distant site is where the practitioner is located during the time of the telehealth service. This section would allow FQHCs and RHCs to furnish telehealth services to beneficiaries in their home.

Expanding Medicare Telehealth for Home Dialysis Patients

This section would eliminate a requirement during the COVID-19 emergency period that a nephrologist conduct some of the required periodic evaluations of a patient on home dialysis face-to-face, allowing these vulnerable beneficiaries to get more care in the safety of their home.

Allowing for the Use of Telehealth during the Hospice Care Recertification Process in Medicare

Under current law, hospice physicians and nurse practitioners cannot conduct recertification encounters using telehealth. This section would allow, during the COVID-19 emergency period, qualified providers to use telehealth technologies in order to fulfill the hospice face-to-face recertification requirement.

Encouraging the Use of Telecommunications Systems for Home Health Services in Medicare

This section would require the Health and Human Services (HHS) to issue clarifying guidance encouraging the use of telecommunications systems, including remote patient monitoring, to furnish home health services consistent with the beneficiary care plan during the COVID-19 emergency period.

Enabling Physician Assistants and Nurse Practitioners to Order Medicare Home Health Services

This section would allow physician assistants, nurse practitioners, and other professionals to order home health services for beneficiaries, reducing delays and increasing beneficiary access to care in the safety of their home.

Increasing Provider Funding through Immediate Medicare Sequester Relief

This section would temporarily lift the Medicare sequester, which reduces payments to providers by 2 percent, from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care. The Medicare sequester would be extended by one-year beyond current law to provide immediate relief without worsening Medicare’s long-term financial outlook.

Medicare Add-on for Inpatient Hospital COVID-19 Patients

This section would increase the payment that would otherwise be made to a hospital for treating a patient admitted with COVID-19 by 20 percent. It would build on the Centers for Disease Control and Prevention (CDC) decision to expedite use of a COVID-19 diagnosis to enable better surveillance as well as trigger appropriate payment for these complex patients. This add-on payment would be available through the duration of the COVID-19 emergency period.

Increasing Medicare Access to Post-Acute Care

This section would provide acute care hospitals flexibility, during the COVID-19 emergency period, to transfer patients out of their facilities and into alternative care settings in order to prioritize resources needed to treat COVID-19 cases. Specifically, this section would waive the Inpatient Rehabilitation Facility (IRF) 3-hour rule, which requires that a beneficiary be expected to participate in at least 3 hours of intensive rehabilitation at least 5 days per week to be admitted to an IRF. It would allow a Long Term Care Hospital (LTCH) to maintain its designation even if more than 50 percent of its cases are less intensive. It would also temporarily pause the current LTCH site-neutral payment methodology.

   Preventing Medicare Durable Medical Equipment Payment Reduction

This section would prevent scheduled reductions in Medicare payments for durable medical equipment, which helps patients transition from hospital to home and remain in their home, through the length of COVID-19 emergency period.

Eliminating Medicare Part B Cost-Sharing for the COVID-19 Vaccine

This section would enable beneficiaries to receive a COVID-19 vaccine in Medicare Part B with no cost-sharing.

Allowing Up to 3-Month Fills and Refills of Covered Medicare Part D Drugs

This section would require that Medicare Part D plans provide up to a 90-day supply of a prescription medication if requested by a beneficiary during the COVID-19 emergency period.

Providing Home and Community-based Support Services during Hospital Stays

This section would allow state Medicaid programs to pay for direct support professionals, caregivers trained to help with activities of daily living, to assist disabled individuals in the hospital to reduce length of stay and free up beds.

Clarification Regarding Uninsured Individuals

This section would clarify a section of the Families First Coronavirus Response Act of 2020 by ensuring that uninsured individuals can receive a COVID-19 test and related service with no cost-sharing in any state Medicaid program that elects to offer such enrollment option.

Clarification Regarding Coverage of Tests 

This section would clarify a section of the Families First Coronavirus Response Act of 2020 by ensuring that beneficiaries can receive all tests for COVID-19 in Medicare Part B with no cost-sharing.

Preventing Medicare Clinical Laboratory Test Payment Reduction

This section would prevent scheduled reductions in Medicare payments for clinical diagnostic laboratory tests furnished to beneficiaries in 2021. It would also delay by one year the upcoming reporting period during which laboratories are required to report private payer data.

Providing Hospitals Medicare Advance Payments

This section would expand, for the duration of the COVID-19 emergency period, an existing Medicare accelerated payment program. Hospitals, especially those facilities in rural and frontier areas, need reliable and stable cash flow to help them maintain an adequate workforce, buy essential supplies, create additional infrastructure, and keep their doors open to care for patients.

Specifically, qualified facilities would be able to request up to a six month advanced lump sum or periodic payment. This advanced payment would be based on net reimbursement represented by unbilled discharges or unpaid bills. Most hospital types could elect to receive up to 100 percent of the prior period payments, with Critical Access Hospitals able to receive up to 125 percent. Finally, a qualifying hospital would not be required to start paying down the loan for four months, and would also have at least 12 months to complete repayment without a requirement to pay interest.

Providing State Access to Enhanced Medicaid FMAP  

This section would ensure that states are able to receive the previously approved Medicaid 6.2 percent FMAP increase.

Extension of Physician Work Geographic Index Floor

This section would extend increased payments for the work component of physician fees in areas where labor cost is determined to be lower than the national average through December 1, 2020.

Extension of Funding Outreach and Assistance for Low-Income Programs 

This section would extend funding for beneficiary outreach and counseling related to low income programs through November 30, 2020.

Extension of Money Follows the Person Demonstration Program

This section would extend the Medicaid Money Follows the Person demonstration that helps patients transition from the nursing home to the home setting through November 30, 2020.

Extension of Spousal Impoverishment Protections

This section would extend the Medicaid spousal impoverishment protections program through November 30, 2020 to help a spouse of an individual who qualifies for nursing home care to live at home in the community.

Delay of Disproportionate Share Hospital Reductions

The section would delay scheduled reductions in Medicaid disproportionate share hospital payments through November 30, 2020.

Extension and Expansion of Community Mental Health Services Demonstration 

This section would extend the Medicaid Community Mental Health Services demonstration that provides coordinated care to patients with mental health and substance use disorders, through November 30, 2020. It would also expand the demonstration to two additional states.

Extension of Sexual Risk Avoidance Education

This section extends the Sexual Risk Avoidance Education (SRAE) program through November 30, 2020 at current funding levels. This program provides funds to states to provide education exclusively focused on sexual risk avoidance (meaning voluntarily refraining from sexual activity).

Extension of Personal Responsibility Education

This section extends the Personal Responsibility Education Program (PREP) through November 30, 2020 at current funding levels. PREP provides states, community groups, tribes, and tribal organizations with grants to implement evidence-based, or evidence-informed, innovative strategies for teen pregnancy and HIV/STD prevention, youth development, and adulthood preparation for young people.

Extension of Demonstration Projects to Address Health Professions Workforce Needs

This section extends the Health Professions Opportunity Grants (HPOG) program through November 30, 2020 at current funding levels. This program provides funding to help low-income individuals obtain education and training in high-demand, well-paid, health care jobs.

Extension of the Temporary Assistance for Needy Families Program and Related Programs

This section extends TANF and related programs through November 30, 2020.

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