Emergency COVID-19 Stimulus Package

The Senate unanimously passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748), which provides more than $130 billion for the healthcare system to respond to the COVID-19 outbreak. While the process remains fluid, the House is expected to approve the package under unanimous consent, with the President signing it in short order. Congressional leaders and the White House are already signaling that there will be a fourth, and perhaps fifth, emergency COVID-19 stimulus package.

Below are highlights of the provisions of the CARES Act that most directly impact our membership:

• $100 billion for a new program through the Assistant Secretary for Preparedness and Response (ASPR) to provide grants to hospitals, public entities, not-for profit entities, and Medicare and Medicaid enrolled suppliers and institutional providers to cover unreimbursed healthcare related expenses or lost revenues attributable to the public health emergency resulting from the coronavirus.
• Expands an existing Medicare accelerated payment program to provide a stable cash flow for hospitals, including to help offset lost revenue directly attributable to the public health emergency resulting from coronavirus.
• Qualified facilities can request up to a six-month advanced lump sum or periodic payment 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.
• 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.
• Delays the Medicare provider sequestration cuts through December 31, 2020 and then extends the cuts an additional year at the back end from 2029 to 2030.
• Provides at least $250 million for hospital preparedness to improve the capacity of healthcare facilities to respond to medical events.
• Extends expiring Medicare & Medicaid extenders by:
• Delaying Medicaid DSH cuts delayed through November 30, 2020;
• Extending the Medicare Work Geographic Index Floor through December 1, 2020;
• Extending the Medicaid Money Follows the Person program through November 30, 2020;
• Extending Community Health Center funding through November 30, 2020
• Funding Teaching Health Centers that operate graduate medical education (GME) programs through November 30, 2020
• Extending health professions workforce programs through November 30, 2020 at current funding levels.
• Provides a Medicare inpatient add-on payment of 20 percent for COVID-19 patients.
• Broadly expands telemedicine and telehealth, through funding and new regulatory flexibilities. This includes:
• Increasing Medicare telehealth flexibilities services during the emergency period
• Grants for telehealth network and telehealth resource centers
• Enhancing Medicare telehealth services for federally qualified health centers, rural health clinics, home dialysis patients, home health services and hospice care
• Allowing high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible
• Provides enhanced federal Medical Assistance Percentages (FMAP) to states during the emergency period.
• Includes provisions from the Mitigating Emergency Drug Shortages or “MEDS” Act (S. 2723), a Premier-championed bill, which provides additional authority to the Food and Drug Administration (FDA) to proactively address drug shortages and develops market-based incentives for the manufacturing of these critical drugs, including on-shore manufacturing. The bill also requires suppliers to have plans to address discontinuity and supply interruptions.
• Contains Premier’s recommendations to prevent medical device shortages, including by:
• Requiring medical device manufacturers to submit information about a potential shortage of critical devices or device components to the FDA in advance or during an emergency;
• Prioritizing and expediting the review of critical devices to mitigate shortages; and
• Requiring the National Academies to send recommendations to Congress to promote supply chain redundancy and domestic manufacturing for critical drugs and devices.
• Provides $1.6 billion for the Strategic National Stockpile (SNS), clarifies that the SNS can stockpile personal protective equipment, ancillary medical supplies, and other applicable supplies and requires procurement of respiratory protective devices as covered countermeasures.
• Includes an additional $80 million in supplemental appropriations for the FDA, including for the development of necessary medical countermeasures and vaccines, advanced manufacturing for medical products, the monitoring of medical product supply chains, and related activities.
• Removes the data stranglehold on healthcare providers’ ability to diagnose, treat and prevent addiction and other opioid-related disorders, provisions by aligning 42CFR Part 2 with HIPPA. These provisions are contained in the Protecting Jessica Grubb’s Legacy Act (S. 3374) and Overdose Prevention and Patient Safety Act (H.R. 2062), legislation Premier has championed.
• Provides acute care hospitals flexibility to transfer patients out of their facilities and into alternative care settings in order to prioritize resources needed to treat COVID-19 cases.
• Allows 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.
• Reauthorizes Health Resource and Services Administration (HRSA) grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services.
• Provides cost-sharing protection for individuals, including by:
• Requiring health plans to cover diagnostic tests, preventive services and vaccinations for COVID-19;
• Ensuring 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; and
• Eliminating Medicare Part B Cost-Sharing for the COVID-19 Vaccine.
• Prevents scheduled reductions in Medicare payments for clinical diagnostic laboratory tests furnished to beneficiaries in 2021.
• Provides an additional $1.032 billion for the Indian Health Services the tribal health system during the pandemic.
• Provides $4.3 billion for the Centers for Disease Control and Prevention (CDC) to support federal, state, and local public health agencies to prevent, prepare for, and respond to the coronavirus.
• Allocates $945 million to NIH funding to support research and expand on prior research plans.

Among the many non-healthcare related items, the CARES Act would provide cash payments of $1,200 to taxpayers, a large temporary expansion of unemployment benefits, extend the tax filing deadline, liberalize net operating loss rules, modify interest expense limitations for businesses, and implement other tax code changes to assist individuals and businesses.

Resources

• Section-by-section summary of the CARES Act
• Summary and legislative text of supplemental appropriations sections