COVID-19: Federal Update (4/28)
Senators confirmed yesterday that they will return for legislative business next Monday, May 4, but House lawmakers have reversed course on their decision to return after consulting the attending physician’s office. While the floor and Committee schedules for coming days and weeks have yet to be fully ironed out, leadership officials stated that Congress is likely to consider another round of COVID-19 legislation as they look to stem emerging and existing issues pertaining to the outbreak. Despite their plans to continue distancing from Capitol Hill, House Democrats have indicated that work has already begun on their next response measure and will likely include: (1) more aid for state and local governments; (2) funding for unemployment insurance; (3) additional economic impact payments; and (4) provisions to address certain supply chain issues. However, it remains to be seen whether Senate Republicans coalesce around an aid package that omits their key legislative priorities — namely liability protections for business owners and employees and any actions needed to shore up the Paycheck Protection Program (PPP). The North Texas Commission is closely monitoring any updates to aid packages.
COVID-19: What We’re Hearing
COVID 4.0. House Democrats are using Speaker Nancy Pelosi’s (D-CA) counteroffer to Senate Majority Leader Mitch McConnell’s (R-KY) CARES Act as a starting point for developing the forthcoming COVID Phase IV bill. Bill text on certain provisions could be released by House Democrats as early as this week.
Liability. Leader McConnell emphasized that he will “insist” Congress limit the liabilities of health care workers, business owners, and employees from lawsuits pertaining to the COVID-19 outbreak. Democrats have dismissed this proposal, arguing that it would water down federal consumer protection efforts.
PPP. When asked how long he expects this next tranche of funding for the PPP to last, House Majority Leader Steny Hoyer (D-MD) expressed uncertainty as to how quickly the funding could dry up. He suggested that lawmakers could move on additional PPP funding in the forthcoming Phase IV effort.
State and Local Governments. While additional funding for states and local governments was not included in the Phase 3.5 measure, there is bipartisan agreement that this additional assistance should be included in COVID Phase IV.
A bipartisan group of House lawmakers have introduced legislation that would allocate $250 billion in direct funding for local governments of all sizes. The measure would provide funding for all local governments with fewer than 500,000 people, and would also allow governments to offset lost revenue due to the pandemic.
Infrastructure. President Trump reiterated his call for robust infrastructure provisions in the Phase IV bill in a recent tweet, specifically highlighting surface transportation and broadband infrastructure as areas he’d like to see addressed.
Despite support for infrastructure from Speaker Pelosi and President Trump, it remains to be seen whether both parties can strike an agreement on big-ticket legislative items such as infrastructure, as Republicans on Capitol Hill are pushing back against using COVID-19 legislation as a vehicle to carry unrelated policy priorities.
Surprise Billing. Energy and Commerce Ranking Member Greg Walden (R-OR) expects another push for action on surprise billing in the next round of relief. During the Phase III negotiations, Chairman Frank Pallone (D-NJ) and Senate Health, Education, Labor, and Pensions (HELP) Chairman Lamar Alexander (R-TN) were actively trying to tack their surprise billing legislation onto the package.
Provider Funding. On Apr. 22, the Department of Health and Human Services (HHS) announced new distributions from the $100 billion Provider Relief Fund created by the CARES Act (H.R. 748). TRP’s comprehensive analysis of these distributions can be read here.
The first round of funding included $30 billion for hospitals and providers.
The second round of funding includes an additional $20 billion for providers nationwide, $10 billion for hospitals in highly impacted areas, $10 billion for rural providers, and $400 million for the Indian Health Service. It also establishes a program to fund COVID-19 care for the uninsured.
HHS has published a list of frequently asked questions pertaining to the $50 billion general allocation of the COVID-19 provider relief fund. In addition, providers receiving funds must agree to a set of terms and conditions, including reporting and documentation requirements, charging only in-network rates for COVID-19 care, and certifying that the funds will only be used to prevent, prepare for, and respond to the outbreak. Those that do not agree must contact HHS within 30 days to remit the payment.
Today, HRSA is expected to launch a separate portal allowing providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020 to request claims reimbursement.
HHS also acknowledges cited providers who will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid.
Medicare Accelerated and Advanced Payments. The Centers for Medicare and Medicaid Services (CMS) announced that as of Apr. 27, the agency will not be accepting any new applications for Medicare’s Advance Payment Program (fact sheet). CMS also stated it will be reevaluating all pending and new applications for Accelerated Payments in light of payments made available through the HHS’ Provider Relief Fund.
COVID-19: What’s Happened
Testing. The Trump administration released a blueprint that seeks to bolster state testing plans and rapid response programs.
SAMHSA. The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded grant funding to increase access and improve the quality of community mental and substance use disorder (SUD) treatment services through the expansion of Certified Community Behavioral Health Clinics (CCBHC).
FCC. The Federal Communications Commission (FCC) and the Department of Education announced efforts to promote the use of $16 billion in funding for the CARES Act’s Education Stabilization Fund for remote learning.
In a move aimed at expanding access to Wi-Fi throughout the country, the FCC voted to adopt a report and order that would make 1,200 megahertz of spectrum in the 6 GHz band available for unlicensed use.
Legislative Response. TRP has published several in-depth policy memos that analyzes actions that Congress and the federal government have taken to address the COVID-19 outbreak. Click here for the full list of memos.
President Donald Trump signed the $483.4 billion “COVID-19 Phase 3.5” bill into law last week. TRP’s comprehensive analysis of the Phase 3.5 legislation can be read here.
TRP has published a memo explores the “health extenders” that the CARES Act reauthorized through Nov. 2020, what’s on the table for these programs in the fall, and the questions that will shape the conversation. Click here to read the memo.
TRP has published a memo that looks at the substance use and mental health policies contained in the CARES Act. This includes new funding for SAMHSA, new funding for Certified Community Behavioral Health Centers, relaxed disclosure requirements for SUD-related health records, and more. Click here to read the memo.
TRP has published an analysis of the medical device-related provisions in the CARES Act, including new reporting requirements, a study on the security of the medical device supply chain, and storage requirements. Click here to read the memo.
The Fed. The Federal Reserve expanded the scope and duration of its Municipal Liquidity Facility to offer up to $500 billion in lending to states and municipalities during the pandemic.
The Federal Reserve stated that the central bank plans to disclose “substantial amounts of information” regarding borrowers from its emergency lending facilities.
The Federal Reserve issued a statement saying that it is working to expand access to the PPP Liquidity Facility for qualified lenders as soon as possible.
The Federal Reserve announced a series of emergency actions that would provide more than $2 trillion in COVID-19 loans to businesses, state, and local governments.
The Federal Reserve announced the creation of a lending facility that will provide liquidity for lenders for the purposes of funding up to $349 billion authorized by the CARES Act. The interim final rule can be read here.
The Federal Reserve announced on Mar. 23 a series of emergency moves aimed at stemming the economic impact of the outbreak. These actions include three new emergency lending facilities, as well as a new program that will support lending to eligible small-and medium-sized
SBA. Following the enactment of the COVID Phase 3.5 legislation, the Small Business Administration’s (SBA) Paycheck Protection Program (PPP) resumed lending yesterday.
SBA published a list of all lenders participating in the PPP.
The SBA and Treasury Department updated their list of frequently asked questions on the PPP.
SBA published a detailed breakdown of the PPP funding that has been distributed thus far.
SBA issued an interim final rule clarifying the process of applying for PPP loans for individuals who report self-employed income on a 1040 Schedule C
SBA issued an interim final rule outlining additional guidance for the PPP. TRP’s comprehensive analysis of the small business provisions contained in COVID-19 response bills can be read here. The loan application form can be accessed here.
CMS. CMS approved a first-of-its-kind section 1115(a) demonstration that will permit the state of Washington to utilize waiver and expenditure authorities aimed at boosting access to care for Medicaid beneficiaries during the pandemic.
CMS has updated its information related to COVID-19 guidance document for Medicare Advantage, Part D, and Medicare-Medicaid plans.
CMS has issued additional blanket waivers to promote flexibility for Long-Term Care Hospitals (LTCH), Rural Health Clinics (RHC), Federally Qualified Health Centers (FQHC), and Intermediate Care Facilities.
CMS announced regulatory requirements that mandate nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC).
CMS issued recommendations that outline how certain health care systems can resume non-essential surgeries and medical procedures in areas with low incidence of COVID-19.
CMS has proposed to permanently codify a change to its inpatient rehabilitation facility (IRF) policy that dispenses with the requirement that IRFs provide and document a post-admission physician evaluation within 24 hours of admission.
CMS is preparing to issue another interim final rule that will address additional policy and regulatory revisions in response to the COVID-19 public health emergency. The rule is expected to include narrow and technical changes to Medicare and Medicaid policies, and will be effective upon publication.
CMS announced that they would nearly double Medicare payment for lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases.
CMS has issued a series of regulatory changes that seek to provide flexibility and bolster the health care system to address the COVID-19 outbreak. TRP’s analysis of the rule can be read here. A list of new frequently asked questions can be read here.
CMS published a list of frequently asked questions on the enhanced Medicaid Federal Medical Assistance Percentage (FMAP). A list of FAQs for state Medicaid and CHIP agencies regarding COVID-19 response efforts can be read here. A list of FAQs for state Medicaid and Children’s Health Insurance Program (CHIP) agencies can be read here.
CMS posted a transcript of its Mar. 31 national stakeholder call. A full list of CMS call transcripts and recordings can be found here.
CMS issued guidance for health care providers regarding the expansion of the accelerated and advance payments program for providers and suppliers during COVID-19 emergency.
CMS approved Medicaid Section 1135 Waivers for states in response to the COVID-19 outbreak. A full list of the 1135 waiver approval letters can be accessed here.
Telehealth. CMS has released a telehealth toolkit aimed at accelerating the use of broader telehealth coverage policies in state Medicaid and CHIP programs. TRP’s analysis of COVID-19 telehealth policies can be read here.
The Federal Communications Commission (FCC) launched its COVID-19 Telehealth Program application portal. Click here for details.
Ed. The Department of Education announced the availability of more than $13 billion in emergency funds aimed at helping students K-12 whose schools were closed due to the outbreak.
The Department of Education announced the availability of $3 billion in emergency education relief funding for states to allocate in support of institutions that have been adversely impacted by the outbreak. A breakdown of the funding allocations can be read here.
HHS. HHS announced a contract with General Electric and Ford under the Defense Production Act (DPA) that would allow for production of 50,000 ventilators by Jul. 13.
HHS announced that it will not penalize HIPAA-covered business associates for sharing patient information intended to assist the government combat COVID-19.
HHS issued an emergency use authorization declaration stating that circumstances exist to justify the authorization of emergency use of drugs and biological products during the COVID-19 outbreak.
Treasury. Treasury Secretary Steven Mnuchin issued guidance and frequently asked questions that provide examples of eligible and ineligible expenditures of the state, local, and tribal Coronavirus Relief Fund.
NIH. The National Institutes of Health issued its first guidance on COVID-19 treatment options that are currently under review.
NIH and the Foundation for the NIH (FNIH) announced that they will launch a new public-private partnership with more than a dozen biopharmaceutical companies aimed at speeding COVID-19 vaccine and treatment options.
FDA. The Food and Drug Administration (FDA) issued guidance that will temporarily allow hospitals to compound certain sedatives used for COVID-19 patients during the public health emergency. Additional details on this policy from the FDA can be read here.
FDA has authorized the first at-home COVID-19 testing kit that will allow patients to self-collect samples.
FDA issued an update on steps the agency is taking to help mitigate supply interruptions of food and medical products.
FDA announced actions to increase U.S. supplies to support COVID-19 response efforts by providing instructions to manufacturers importing personal protective equipment (PPE) and other devices.
FDA has provided new guidance on patient access to certain Risk Evaluation and Mitigation Strategy (REMS)-requited drugs during the COVID-19 public health emergency.
FDA issued guidance allowing manufacturers of certain non-invasive, FDA-cleared devices to expand their use so that health care providers can use them to monitor patients remotely.
USDA. The U.S. Department of Agriculture (USDA) and Department of Homeland Security (DHS) issued a temporary final rule allowing for flexibilities on certain agricultural-related employment regulations.
DOT. The Department of Transportation (DOT) awarded $10 billion in grant funding for airports to certain operating expenses during the COVID-19 pandemic. A breakdown of the disbursements can be read here. A list of frequently asked questions on this funding can be read here.
DOT issued a final order on service obligations for air carriers receiving financial relief through the CARES Act.
DOT and the Federal Transit Administration (FTA) announced a total of $25 billion in federal funding allocations to help the public transit systems respond to the COVID-29 outbreak.
DOL. The Department of Labor issued a temporary rule implementing the paid family and medical leave provisions of the Families First Coronavirus Response Act. TRP’s analysis of the rule can be read here.
The Trump administration offered a broad definition of “health care providers” that may be excluded from paid sick and family leave, as well as broad exceptions to family leave for companies with fewer than 50 workers in the rule. This led some Members of Congress to say that the rule veers away from what Congress intended when it passed the law.
HUD. The Department of Housing and Urban Affairs (HUD) has begun allocating $3 billion in funding for communities through the Community Development Block Grant, Emergency Solutions Grant, and Housing Opportunities for Persons With AIDS programs to address COVID-19 issues.
CFPB. The Consumer Financial Protection Bureau (CFBP) issued guidance urging lenders to provide information to credit reporting agencies about the work they are doing to provide relief to consumers during the COVID-19 emergency.