Coronavirus Aid, Relief and Economic Security Act Signed

The President signed the Coronavirus Aid, Relief and Economic Security Act (CARES), also referred to as COVID Stimulus 3 or COVID 3, into law today at 3:00 p.m. CT. The various Federal agencies are expected to begin implementation of these new programs and distribution of this new funding immediately.

This legislation is in addition to the regulatory changes already implemented by the Centers for Medicare and Medicaid Services (CMS) related to expanded reimbursement of telehealth services and the extension for 2019 reporting and the possible suspension of 2020 reporting under the Quality Payment Programs and Alternative Payment Models.
For SGO members, there are several programs of interest in this legislation:

• Allowing the use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during emergency period.
  • 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.
• Exemption for telehealth services in high-deductible health plan (HDHP) with a health savings account (HSA).
  • Would allow for coverage of 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 for those plan years beginning on or before December 31, 2021.
• Adjustment of the Medicare Sequestration.
  • Specifically, provision would temporarily lift the Medicare sequester, which reduces payments to providers by 2%, from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health and other care. SGO will monitor CMS transmittals and regulations for an updated 2020 conversion factor and report.
• Extension of the work geographic index floor under the Medicare program.
  • This provision increases 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.
• $100 billion for a new program run through the Public Health and Social Services Emergency Fund (PHSSEF) to provide grants to hospitals, public entities, not-for-profit entities, and Medicare and Medicaid enrolled suppliers and institutional providers.
  • This new fund that will run on a rolling basis to cover unreimbursed health care related expenses or lost revenues attributable to the public health emergency resulting from the coronavirus. HHS is instructed to review applications and make payments on a rolling basis, in order to get money into the health system as quickly as possible. As soon as SGO has the application materials will share them on the COVID-19 Resources page.

For SGO private practice providers: Small business administration paycheck protection program

• Small businesses and 501(c)(3) non-profit organizations, including hospitals, health systems and health care providers, are eligible to apply for the Small Business Administration’s Paycheck Protection Program. They can apply to an SBA-approved lender for a loan of up to 250% of their average monthly payroll costs to cover eight weeks of payroll as well as help with other expenses like rent, mortgage payments and utilities.
  • This loan can be forgiven based on maintaining employee and salary levels. For any portion of the loan that is not forgiven, the terms include a maximum term of 10 years, a maximum interest rate of 4%.
  • Small businesses and organizations will be able to apply if they were harmed by COVID-19 between February 15, 2020, and June 30, 2020.
  • To be eligible, small businesses and 501(c)(3) non-profit organizations must have fewer than 500 employees.
  • This program is retroactive to February 15, 2020, in order to help bring workers who may have already been laid off back onto payrolls. Loans are available through June 30, 2020.
• Limitation on liability for volunteer health care professionals during COVID-19 emergency response.
  • This new law clarifies that health care providers who provide volunteer medical services during the public health emergency related to COVID-19 have liability protections under specified conditions.

For States, the Department of Defense and FEMA regarding new, additional funding in FY 2020 for PPE, medical supplies and medical equipment:

• $1 billion for the Defense Production Act to allow the Department of Defense to invest in manufacturing capabilities that are key to increasing the production rate of personal protective equipment and medical equipment to meet the demand of healthcare workers across the nation.
• $45 billion for FEMA Disaster Relief Fund to provide for the immediate needs of state, local, tribal and territorial governments to protect citizens and help them recovery from the overwhelming effects of COVID-19. Reimbursable activities may include medical response, personal protective equipment, National Guard deployment, coordination of logistics, safety measures and community services nationwide. Note that FEMA sent out a solicitation on March 26, 2020, to purchase more PPE. SGO will continue to track the government’s procurement in this area.
• $1.5 billion to support States, locals, territories and tribes in their efforts to conduct public health activities, including purchase of personal protective equipment; surveillance for coronavirus; laboratory testing to detect positive cases; contact tracing to identify additional cases; infection control and mitigation at the local level to prevent the spread of the virus; and other public health preparedness and response activities.