Over $100 billion of aid is targeted towards the healthcare system and includes something for nearly all types of providers
The Coronavirus Aid, Relief, and Economic Security (CARES) Act (or “the Act”) takes major steps toward supporting the nation’s health care system as it responds to this unprecedented health and financial crisis. The Act includes provisions to:
- Expand access to diagnostic testing and telehealth;
- Bolster the stockpile of personal protective equipment and other needed supplies;
- Mitigate drug and device shortages; and
- Provide financial support and flexibilities for providers to respond to the outbreak.
- Reimburse hospitals and other providers for expenditures and lost revenues related to COVID-19, among billions of dollars in other supplemental funding for HHS agencies.
Health Care Workforce and Provider Relief
The Act includes provisions meant to support and enhance the health industry workforce like a reauthorization of several workforce programs designed to support clinician training and education, including training for practitioners in family medicine, general internal medicine, pediatrics and other specialties. These programs are administered by the Health Resources and Services Administration (HRSA).
Improved Access and Provider Flexibility - Telehealth Expansion
The Act contains various Medicare provisions that aim to expand the use of telehealth services during the public health emergency, including the redaction of prior regulations which requires providers to have treated a patient within the last three years in order to furnish telehealth services to that person during the emergency period.
Federally qualified health centers (FQHCs) and rural health clinics (RHCs) will be permitted to serve as distant sites and provide telehealth services to patients during the public health emergency at reimbursement rates “similar” to the national average rates for comparable telehealth services under the Medicare physician fee schedule, with some exceptions.
Improved Access and Provider Flexibility - Sequestration
The Act temporarily suspends sequestration-mandated reductions to Medicare claims from May 1, 2020, through December 31, 2020, which will have the effect of increasing Medicare payments to providers. In addition, the legislation creates a new 20 percent add-on to the Hospital Inpatient Prospective Payment System (IPPS) rate for patients with COVID-19 under the Medicare hospital inpatient prospective payment system.
Improved Access and Provider Flexibility - Post-Acute Care Access, DME and Clinical Labs
The Act aims to increase access to post-acute care during the emergency period through additional flexibilities for post-acute care providers including waivers on requirements regarding hours of therapy and modifications to selected IPPS rates. The Act also allows or provides for:
- Nurse practitioners and physician assistants to order home health services during the six months following enactment.
- Permitting state Medicaid programs to pay for direct support professionals.
- Different blended payment rates to increase Medicare reimbursement for durable medical equipment (DME) suppliers
- Delays in scheduled payment reductions to clinical laboratories and postpones the upcoming reporting period during which clinical labs are required to report private payer information.
Improved Access and Provider Flexibility - Community Health Centers
The Act sets aside an additional $1.32 billion for supplemental awards for the treatment, detection and diagnosis of COVID-19 in community health centers. It also reauthorizes HRSA’s Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement grant programs, as well as the Telehealth Network and Telehealth Resource Center grant programs.
The Act directs HHS to issue guidance on restrictions on protected health information, which the agency has already taken steps towards loosening.
Coverage and Access to Care
According to the Act, should a health plan or issuer have a negotiated rate with respect to COVID-19 testing, the rates in the contract must be adhered to. However, if there is no existing contract, the plan or insurance issuer is required to reimburse the provider in the amount specified (“cash price”) as listed by the provider online or the plan or issuer may negotiate a lower price with the provider.
Social Support Programs
The Act includes language to address problems that have arisen with respect to social programs put in place to support the elderly. This includes provisions allowing individuals who are practicing social distancing in order to avoid infection by the coronavirus to receive home-delivered nutrition services It also reauthorizes the Healthy Start Program to provide resources for the improvement of birth outcomes for infants and their mothers.
The Act provides funding through November 30, 2020, for community health centers, the National Health Service Corps, the Teaching Health Center Graduate Medical Education (THCGME) program, the Special Diabetes Program and the Special Diabetes Program for Indians.
The Act also delays scheduled Medicaid disproportionate share hospital (DSH) payment reductions until December 1, 2020 and provides funding through November 30 for Medicare quality measure endorsement, input and selection, and for outreach and assistance for Medicare low-income programs.
HHS Supplemental Appropriations
The Act provides $127 billion for medical response efforts including $100 billion for the Public Health and Social Services Emergency Fund to reimburse, through grants or other mechanisms, providers for coronavirus-related expenses or lost revenues attributable to the outbreak.
Eligible providers include public entities, Medicare or Medicaid enrolled providers and suppliers, and other for-profit and not-for-profit entities that provide diagnoses, testing or care for individuals with COVID-19. Other supplemental appropriations:
- Funding for building or construction of temporary structures, leasing of properties, medical supplies and equipment, increased workforce and training costs, emergency operation centers, repurposing facilities and surge capacity.
- $3.5 billion for the development and purchasing of vaccines and therapeutics for COVID-19
- $16 billion for the Strategic National Stockpile to procure personal protective equipment and other supplies.
- $4.3 billion in funding for the CDC, including $1.5 billion for grants or cooperative agreements with states, localities, territories and tribes to carry out public health activities
- $945 million for the National Institutes of Health (NIH) for research activities related to COVID-19
- $955 million for the Administration for Community Living to support nutrition programs, home and community-based services, family caregivers and other programs for seniors and individuals with disabilities.
- $1.03 billion for the Indian Health Service to respond to the outbreak.
Assistance and Guidance from Freed Maxick
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If you wish additional guidance, we are available to discuss your issues and concerns. Connect with us here or call Freed Maxick at 716.847.2651.
Please keep in mind that due to the quickly-changing nature of the COVID-19 pandemic, you should always discuss changes with your Freed Maxick advisor or legal counsel.