House Speaker Nancy Pelosi (D-CA) has indeed confirmed that the House is already discussing its next major piece of legislation to help the country respond to the coronavirus public health emergency (PHE). Speaker Pelosi and other legislators from both the House and Senate are already describing what they hope to include in the “Phase IV” bill.
Speaker Pelosi intends to strengthen Occupational Safety and Health Administration (OSHA) workplace protections for healthcare workers. These protections are in response to shortages of personal protective equipment (PPE) that have forced healthcare workers to use makeshift protective equipment such as trash bags and bandanas. The “Phase III” Cares Act did include some federal funding for OSHA and the Department of Labor for this purpose, but Speaker Pelosi and other House Democrats believe more funding is needed. House Democrats included new OSHA protections for healthcare workers in their version of Phase III legislation. The Democratic version never received a vote.
Congress is out of session until April 20th. The U.S. Capitol Building and its adjacent House and Senate Office Buildings are closed to the public until May 1. Members and their Staff can still access the building for official business, but many offices are teleworking.
White House and Federal Agencies
President Trump extended his guidance for social distancing until at least April 30. He previously advised that the social distancing guidance would continue until April 15.
The Centers for Medicare and Medicaid Services (CMS) is allowing Medicare providers to request accelerated and advance payments for Medicare services. The purpose of this program is to help providers manage short-term cash flow issues.
- CMS regularly uses this policy in natural disasters. It is expanding the policy nationally during the public health emergency.
- Under the program, Medicare providers can receive payment for up to three months of Medicare payments. Providers can still bill for their services and will be paid as normal in addition to the advance payments.
- Providers will repay the advance payments 120 days later. At the end of the 120-day period, the automatic recoupment process will begin, and every claim submitted by the provider/supplier will be offset from the new claims to repay the accelerated/advance payment. Instead of receiving payment for newly submitted claims, the provider’s/supplier’s outstanding accelerated/advance payment balance is reduced by the claim payment amount.
CMS is issuing an unprecedented number of temporary regulatory waivers and new rules, which will become effective immediately across the U.S. health care system and will continue for the duration of the COVID-19 pandemic.
- CMS will now pay physicians at the higher non-facility rate for E/M visits performed via telehealth.
- CMS will reimburse CPT Codes for phone calls (audio-only). Note: The reimbursement for telephone calls is much less than E/M visits.
- CMS is waiving requirements (also outlined in USP 797 – Sterile Compounding) at 42 CFR §482.25(b)(1) and §485.635(a)(3) in order to allow used face masks to be removed and retained in the compounding area to be re-donned and reused during the same work shift in the compounding area only. This will conserve scarce face mask supplies. CMS will not review the use and storage of face masks under these requirements.
CMS is asking hospitals to submit data on COVID-19 testing to HHS on a daily basis. Specifically, the Trump Administration is requesting that hospitals report COVID-19 testing data to the U.S. Department of Health and Human Services (HHS), in addition to daily reporting regarding bed capacity and supplies to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) COVID-19 Patient Impact and Hospital Capacity Module.
The U.S. Food and Drug Administration (FDA) issued an emergency use authorization for hydroxychloroquine and chloroquine to treat COVID-19. Those drugs are intended to treat malaria, but some studies have shown they can positively treat COVID-19. Additional studies to prove their efficacy in treating COVID-19 are ongoing. Manufacturers are beginning to donate doses to the Strategic National Stockpile, which will distribute the drugs to health systems across the country. Sandoz donated 30 million doses and Bayer donated 1 million doses.
The full list of FDA COVID-19 Emergency Use Authorizations (EUA) is available here. There are EUAs for ventilators, personal protective equipment, and testing/diagnostic devices.
The HHS Office of Civil Rights (OCR) issued a bulletin reminding healthcare providers about non-discrimination requirements when treating patients for COVID-19.