April 10, 2020

Health Care Support in Coronavirus Legislation


KEY TAKEAWAYS

  • Congress has passed and President Trump has signed into law three pieces of legislation to provide funding and other resources to help fight the spread of the coronavirus.
  • These laws ensure patients can have coverage for coronavirus testing, support the development of a vaccine, help the health care workforce by increasing access to medical supplies, and direct resources to providers to enable patient care.
  • This paper describes the key health care provisions Congress has provided to combat the outbreak.

Congress has passed three pieces of legislation in response to the coronavirus outbreak. The laws have included funding and resources to help support the health care industry and patients affected by the coronavirus.

Coronavirus Response Resources for Health Care Provided by Congress

Health Care Resources

Phase I: Coronavirus Preparedness and Response Supplemental Appropriations Act

Funding to Fight Coronavirus. In March, Congress passed and President Trump signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act. The Phase I legislation includes funding for the research and development of vaccines and treatments; for health system preparedness; to support state and local public health departments; and to strengthen the national stockpile of medical supplies. Phase I provides $7.8 billion in discretionary funding:

  • $2.2 billion for the Centers for Disease Control and Prevention. The Infectious Disease Rapid Response Reserve Fund receives $300 million, restoring funding that was initially used to respond to the coronavirus outbreak and ensuring additional funds are available if needed. At least $950 million for state and local public health preparedness grants, with half of that funding being provided to the grantees – states, cities, and tribes – within 30 days after enactment. States receive no less than $4.5 million each to prepare for and respond to COVID-19.

  • $3.4 billion for the Public Health and Social Services Emergency Fund. This funds activities under the Office of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, which includes the Biomedical Advanced Research and Development Authority and Strategic National Stockpile. This flexible funding will assist in procurement of medical supplies for federal and state response efforts; vaccine, therapeutics, and diagnostics research and development; and hospital and health system preparedness. Specifically, $300 million will be available to assist the federal government in purchasing necessary vaccines, therapeutics, and diagnostics to help with the public health response to this virus. It preserves current law with regard to federal programs and assistance to purchase vaccines that help make them affordable without allowing the federal government to set the price. It also maintains incentives for the private market to develop vaccines and therapeutics.  

  • $836 million for the National Institutes of Health. The majority of the funding to NIH, $826 million, goes to the National Institute of Allergy and Infectious Diseases to research necessary vaccines, therapeutics, and diagnostics. The National Institute on Environmental Health Sciences receives $10 million to train health care workers on prevention and reducing exposure to COVID-19. 

  • $1.25 billion to the Department of State and U.S. Agency for International Development to lead the global health response to the coronavirus. The supplemental funding provides $200 million for the Emergency Reserve Fund for USAID to respond to emerging health threats that pose severe risks to human health. It also includes $300 million for humanitarian and health needs in affected areas. Additional funding is provided for State Department consular operations to assist with evacuation expenses and emergency preparedness of our embassies and consulates as well as funding for oversight of the spending.

  • $61 million to the Food and Drug Administration. These funds remain available until expended and will be used to support development and review of countermeasures, therapeutics, and vaccines for the coronavirus. The funds also will be used to monitor and mitigate shortages in medical product supply chains.

Expanding Telehealth. Phase I gives the Centers for Medicare and Medicaid Services the authority to temporarily waive certain Medicare program requirements for telehealth services provided during the emergency period. This expands the ability of Medicare beneficiaries to remain in their homes to receive care and reduce their exposure to the virus.

Phase II: Families First Coronavirus Response Act

COVID-19 Testing. The Phase II legislation, Families First Coronavirus Response Act, which was passed March 18, ensures that people have coverage to receive diagnostic testing for coronavirus authorized or approved by the FDA. The third relief bill, the Coronavirus Aid, Relief, and Economic Security Act, clarifies that all testing for COVID-19 will be covered by private insurance plans even for tests that have been approved or authorized by the FDA, or comply with the agency’s guidance.

Phase II requires private health care plans to provide COVID-19 diagnostic testing and related visits at no cost to consumers. This includes coverage for the cost of a provider, urgent care center, or emergency room visit to receive testing. Multiple insurers have waived copays and cost sharing for all COVID-19 related medical treatments, not just for testing and diagnostic services as directed by Congress. 

The law provides a temporary Medicaid 6.2 percentage point increase to each qualifying state and territory federal medical assistance percentage

Phase III: Coronavirus Aid, Relief, and Economic Security Act

Addressing Supply Shortages. The Phase III legislation, the CARES Act, passed on March 25. It attempts to prevent shortages of medical product supplies, emergency drugs, and medical devices.

  • The legislation provides an additional $16 billion for the Strategic National Stockpile for the purchase of personal protective equipment, ventilators, and other medical supplies to deploy to facilities caring for COVID-19 patients.

  • In addition to the funding Phase I legislation provides to NIH, the CARES Act includes an additional $900 million for the NIH to continue to research the virus, as well as therapies and vaccines to combat the pandemic and future outbreaks.

  • The CARES Act establishes new requirements for medical device manufacturers to identify shortages in their supply chains. Medical devices that are vital to public health are required to be reported to the FDA if the device is no longer available or if there is a disruption in the supply chain. The FDA is also required to create and maintain a publicly available device shortage list. Additionally, the National Academies of Sciences, Engineering, and Medicine will evaluate the security of the drug and medical device supply chain.

Support for Health Care Providers. The Phase III legislation also provides support for health care workers combatting the spread of coronavirus. It provides unprecedented funding and support, ensuring health care workers on the front lines of the outbreak have the assistance they need.

  • $100 billion in new funding through the Public Health and Social Services Emergency Fund goes to health care providers, including hospitals on the front lines of the COVID-19 pandemic. These payments, made on a rolling basis, will cover COVID-related revenue loss as well as expenses such as personal protective equipment and testing supplies, assembling temporary structures, emergency operation centers, training, and preparing for patient surges. 

  • The law temporarily suspends Medicare sequestration, which equates to a 2% add-on for all payments from May 1 to the end of the calendar year.

  • Provides an Inpatient Prospective Payment System add-on payment for the duration of the emergency, so hospitals receive a 20% rate increase to their Medicare reimbursement for patients with a COVID-19 diagnosis who receive inpatient care.

  • Medicare’s hospital accelerated and advanced payment program is expanded for the duration of the emergency to include most Medicare providers, including critical access hospitals, children’s, and cancer hospitals. Payment requests could cover up to six months of payments, based on a prior, more stable period, in an advanced lump sum or in payments made on a scheduled basis. Most hospitals could receive up to 100% of the prior period payments and critical access hospitals can receive up to 125% of such payments. Eligible hospitals would not have to start paying back the loan for four months and would have at least 12 months to pay back the loan with no interest requirement. Medicare has expanded the program to allow providers in addition to hospitals to receive advance payments through the duration of the emergency, with the non-hospital portion of the program having some different parameters. 

  • Provides $1.3 billion in additional grant funding to community health centers. The funding will help CHC response efforts as they provide COVID-19 testing and treatment services and help to alleviate the impact on providers and hospitals that are seeing an increase of patients. 

  • Delays scheduled reductions in Medicaid disproportion share hospital payments to December 1.

  • Delays certain scheduled reductions in Medicare payments to clinical laboratories and durable medical equipment suppliers.

  • Creates a Ready Reserve Corps to ensure there is an adequate number of trained doctors and nurses available to respond to public health emergencies like the coronavirus.

  • Protects volunteer health care providers from liability for treatment of COVID-19 during the emergency.

  • Permits the HHS secretary to reassign relocate National Health Service Corps members, with the member’s consent, to sites near their original assignment location to help respond to the public health emergency.

Coverage for Patient Care and Testing. The CARES Act makes clear all COVID-19 diagnostic testing is to be covered by private insurance plans without patient cost sharing. This includes for tests that detect antibodies, that have been approved or authorized by the FDA, or that comply with the agency’s guidance.

  • Allows Medicare Part B and Medicare Advantage beneficiaries to receive COVID-19 vaccination with no cost sharing.

  • Requires Medicare Part D plans to provide beneficiaries by request up to a 90-day supply of their prescription drugs during the emergency period.

Increased Access to Telehealth. The CARES Act waives Medicare telehealth requirements during the public health emergency to help patients remain in their homes and contain the spread of the virus. The legislation waives in-person care requirements for home dialysis patients and the requirement that Medicare patients have a pre-existing relationship with a health care provider to receive care through telehealth. Other telehealth provisions in CARES include: 

  • The legislation allows for increased ability for federally qualified health centers and rural health clinics to serve as distant sites to provide Medicare patients care through telehealth.

  • Hospice recertifications will be allowed to be completed through telehealth rather than in person.

  • Home health agencies can deliver more care through telehealth, including remote patient monitoring, as CMS is directed to allow broader use of telecommunications consistent with the beneficiary’s care plan. 

  • High-deductible health plans with a health savings account will be able cover telehealth services prior to patients reaching their deducible. Patients also will be able to use their HSA funds and flexible spending accounts to buy over-the-counter medical products without a prescription from their doctor.

  • The Federal Communications Commission is provided $200 million to facilitate telehealth services.

The CARES Act extends community health centers, the National Health Services Corps, and teaching centers operation graduate medical education programs at current funding levels through November 30.

Issue Tags: Health Care, COVID-19