Summation of COVID-19 Federal Responses
(updated 4/3/2020)

The College’s Advocacy Council is continuously tracking new developments regarding COVID-19. We will provide regular updates on the federal response to the COVID-19 situation on this page; check back regularly to stay up to date. You may need to check multiple dates to find specific information.

Telephone service added to their list of covered benefits:

CMS will reimburse CPT Codes for phone calls (audio-only).

Alabama
Blue Cross/Blue Shield of Alabama

Illinois
Illinois Governor’s Executive Order includes telephone benefits
Blue Cross/Blue Shield of Illinois
Aetna of Illinois

Louisiana
Louisiana Medicaid

Mississippi
Mississippi

Thursday, April 2, 2020

Beginning Friday, April 3, approved lenders can start processing applications for loans under the Paycheck Protection Program that was created by the CARES Act. Businesses and nonprofits with fewer than 500 employees can request loans for 2.5 times of their average monthly payroll expenses over the last twelve months (capped at $10 million). At least 75% of the loans must be used to pay employee salaries and benefits while the rest can go toward rent, mortgage or utility payments. The loans convert into grants (that do not need to be repaid) if certain conditions are met. Applicants do not need to provide any collateral for the loan. Loan repayments are also deferred for six months.

Both Congress and the Administration are discussing how to provide hazard pay increases to frontline healthcare workers.

Dr. Deborah Birx, one of the top coronavirus response advisors to President Trump and Vice President Pence, is asking colleges and universities to develop a special type of blood test to see if healthcare workers have developed an immunity to COVID-19. The enzyme-linked immunosorbent assay (ELISA) tests can detect antibodies that the body naturally produces. These tests are already used to detect antibodies for other infectious diseases such as HIV. An ELISA test for COVID-19 can help determine if certain healthcare workers are at increased risk for the virus. An ELISA test could also be used for non-healthcare workers, but it would be especially beneficial to frontline healthcare workers who are exposing themselves to the virus every day.

Duke University will begin a $50 million research project to test the efficacy of the malaria drug hydroxychloroquine to treat and prevent COVID-19. However, a French hospital that has been using the drug for this off-label purpose has found that it has limited effectiveness at treating the virus.

Speaker of the House Nancy Pelosi (D-CA) announced the House of Representatives will form a special committee to perform oversight of the Administration’s distribution of the coronavirus relief funds from the CARES Act and other legislation. The Committee will be bipartisan, and it will have subpoena power. Speaker Pelosi did not announce who will be on the Committee except that it will be led by House Majority Whip Jim Clyburn (D-SC).

The Federal Bureau of Investigation seized hundreds of thousands of personal protective equipment (PPE) items from a Brooklyn, NY man who was hoarding the supplies and price gouging buyers. The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) will distribute the seized equipment to healthcare providers. The FBI seized the supplies using authorities granted under the Defense Production Act. HHS will pay the owner fair market value for the equipment. The man was allegedly charging healthcare providers more than 700 percent above market value.

Speaker Pelosi is adding to her list of priorities for the next round of legislation that the House introduces to address the COVID-19 pandemic.  Speaker Pelosi would like to eliminate certain portions of the Tax Cuts and Jobs Act to provide increased tax relief to some taxpayers. Specifically, she proposes eliminating the $10,000 cap on the state and local tax deduction. It is highly unlikely that Republicans will support that proposal.

President Trump issued an Executive Order directing the Administration to use authorities under the Defense Production Act to ensure that manufacturers of important medical supplies such as ventilators and PPE have the materials and supplies they need to manufacture their products.

The HHS Office of Civil Rights (OCR) is providing increased enforcement flexibilities for protected health information (PHI) during the public health emergency. OCR will not take enforcement actions against entities that are acting in “good faith” when they disclose PHI.

The Department of Housing and Urban Development (HUD) will allow single family homeowners with FHA backed mortgages to defer or reduce mortgage payments for up to six months if they are facing financial difficulties due to the public health emergency.

Wednesday, April 1, 2020

Congress

Both President Trump and Speaker Pelosi expressed their desire for Phase IV to include infrastructure spending.

  • President Trump specifically wants to spend $2 trillion on infrastructure.
  • Speaker Pelosi outlined a bill that spends $760 billion on several priorities of which infrastructure is one. Speaker Pelosi also listed community health centers, broadband and education, among other things, as priorities.
  • House and Senate Republican Leadership are open to a Phase IV bill, but they prefer to give the CARES Act more time to take effect before drafting the next bill.
  • Many industries are advocating for assistance in the next bill. For example, hospitals are asking funds to be directly distributed to hospitals at a rate of $25,000 per bed; $30,000 in hot spots.

White House and Federal Agencies

President Trump issued a forceful warning about the danger posed by the coronavirus. His warning stated that anywhere from 100,000 to 240,000 people could die from COVID-19. The White House is trying to prepare the public for more tragic news that is expected throughout April as the number of cases and deaths is expected to increase – perhaps to a peak.

The U.S. Food and Drug Administration (FDA) has created a new Coronavirus Treatment Acceleration Program (CTAP) to expedite reviews and requests related to COVID-19 treatments.

The U.S. Strategic National Stockpile of medical equipment such as ventilators and personal protective equipment (PPE) is almost completely distributed. The CARES Act provided $16 billion to restock the Strategic National Stockpile. To date, the stockpile has distributed 8,000 ventilators and 26 million protective masks.

The Centers for Medicare and Medicaid Services (CMS) will not reopen the federal health insurance exchanges for a special enrollment period to allow people to enroll in health insurance coverage. Some states that operate their own exchanges have created special enrollment periods. The Affordable Care Act (ACA) still allows people to enroll in health coverage through the federal or state exchanges if they experience a qualifying life event such as losing their job.

The Department of Health and Human Services issued an open letter that approves the use of ventilators on two patients at once as a last resort if all other options have been exhausted.

Ventilators are not the only equipment in short supply. The drugs patients are given, when they are placed on ventilators, are also running low.

The Federal Communications Commission (FCC) officially announced a $200 million telehealth program to support healthcare providers responding to the ongoing pandemic. Congress appropriated the funds as part of the CARES Act. This program will allow the FCC to help health care providers purchase telecommunications, broadband connectivity, and devices necessary for providing telehealth services.

Tuesday, March 31, 2020

Congress

The House Energy and Commerce (E&C) Committee hopes to include its bill to address unexpected out-of-network (OON) “surprise” medical bills in the next big COVID-19 relief bill.  

  • The E&C bill, which was introduced in the Senate by the Senate Health, Education, Labor and Pensions Committee, is one of three major proposals to address this issue. The House Ways and Means (W&M) Committee and the House Education and Labor (E&L) Committee both have proposals as well.
  • Congress was originally trying to decide on a bill that can advance in time to include surprise billing legislation in a package of expiring temporary Medicare and Medicaid provisions that needed to be extended by May 22. The CARES Act extended those provisions, which means Congress needs to find a new legislative vehicle for surprise billing legislation.

Speaker of the House Nancy Pelosi (D-CA) is already working on a “Phase IV” bill. Her goal is to have a bill ready when Congress returns to the Capitol on April 20.

The Joint Committee on Taxation (JCT) estimates the CARES Act “recovery rebates” will cost the Government $591 billion. The recovery rebates are the $1,200 checks to individuals ($2,400 to families) that are adjusted based on income and number of children.

Speaker Pelosi is in favor of holding a vote by mail election in November instead of requiring voters to vote in person at their polling location unless they receive an absentee ballot.

White House and Federal Agencies

The Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (IRF) that expands many Medicare regulatory flexibilities. It also codifies certain waivers CMS previously announced.

  • The IRF changes certain Medicare billing requirements. Of particular note, Medicare telehealth claims should not use the telehealth POS 02. Telehealth claims should use the POS as if the service was provided face-to-face and should use modifier 95 to indicate it was a telehealth service. The purpose of this change is to provide a higher facility payment than telehealth claims with POS 02 would pay.
  • CMS also added 80 services to its covered telehealth services list.
  • The IRF also adds new telehealth codes that can be furnished by telephone (without a visual connection).
  • CMS will also allow services that require direct supervision to occur over real-time, interactive telecommunications technology.
  • CMS will pay hospitals for inpatient services that are provided outside of the hospital (e.g. ambulatory surgical centers or hotels). This is intended to reserve hospital capacity for COVID-19 patients.
  • It also gives ambulance providers the discretion to transport patients to non-hospital settings that may be more appropriate for the patient.

CMS’ announcement of the interim final rule includes many important details, but not all were included in its factsheets and FAQs on its wavier actions. CMS’ fact sheets include:

Read the interim final rule for more details.

The White House today announced the start date for the newly created Paycheck Protection Loan Program. This program was authorized under the recently passed Coronavirus Aid, Relief, and Economic Security (CARES) Act. The Paycheck Protection Loan Assistance program expands and modifies an existing Small Business Administration (SBA) Loan program. The purpose is to help ANY business that is struggling financially due to the COVID-19 pandemic.

The U.S. Food and Drug Administration issued a new final guidance that updates what qualifies as personal protective equipment (PPE) such as surgical gowns, gloves and masks. The purpose of the guidance is to help manufacturers (either traditional or non-traditional manufacturers) produce more equipment.

The FDA also issued guidance about sterilizers, disinfectant devices and air purifiers.

Both guidance documents apply for the duration of the public health emergency.

Monday, March 30, 2020

Congress

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 FDA also issued an emergency use authorization for a testing device developed by Abbot Laboratories that can perform on-site COVID-19 tests and receive results within 15 minutes.

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.

Friday, March 27, 2020

Congress

The House of Representatives passed the “Phase III” CARES Act this afternoon by a voice vote. Rep. Thomas Massie (R-KY) tried to force a roll call vote on the bill but his effort failed. 

President Trump signed the bill into law after he received it.

The bill provides more than $2 trillion in assistance that will be used to help small businesses and specific industries, provides extra funding for the healthcare system and increases the federal government’s response.

Various federal agencies are responsible for implementing the law. For example, the Treasury Department will determine how to provide the “Recovery Dividend” payments. Those payments are available to individual and joint-filing taxpayers based on their 2018 adjusted gross income.

Now that the bill is passed, members of Congress have left Washington and are not expected to return until April 20 unless any pressing business arises.

Behind the scenes, Congressional staff will begin working on an expected “Phase IV” bill. This update will continue to share information about the Phase IV efforts. However, those details might be scarce at times.

Going forward, the Congressional portion of this update will provide deeper dives into important sections of the Phase III bill.

White House and Federal Agencies

National Institutes of Allergy and Infections Diseases (NIAID) Director Dr. Anthony Fauci announced that a potential COVID-19 vaccine will go into production while safety and efficacy testing is still occurring. It is rare for a vaccine product to go into production before it has passed those important tests.

CMS published a new online telehealth toolkit for long-term care nursing homes. Most of the information is directed toward providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.

CMS approved six additional state Medicaid Section 1135 waiver requests. This brings the total number of approved Medicaid Section 1135 waivers to 29.

CMS also issued Guidance to labs about flexibilities CMS will take under the Clinical Laboratory Improvement Amendments (CLIA) statute on an emergency basis. This includes flexibilities regarding temporary and remote testing sites, use of alternate specimen collection devices, and implementation of laboratory developed tests. 

The Health IT Advisory Committee (HITAC) created a coronavirus task force to help advise HHS on privacy and interoperability issues.

Several federal agencies, including the FDA, NIH, VA and DOD are collaborating to 3D print parts for manufacturing ventilators.

The Federal Communications Commission (FCC) is extending a deadline for rural health care providers to apply for assistance in paying for broadband internet and other telecommunication services. The new deadline is June 30. One of the purposes of the main program is to increase broadband capabilities for the delivery of telehealth services.

Thursday, March 26, 2020

Congress

In the late hours of March 25, 2020, the Senate passed its $2 trillion “Phase III” response to the COVID-19 public health emergency (PHE), the CARES Act by a vote of 96-0. The final version of the bill is the product of more than a week of negotiations between Republicans and Democrats in Congress and the White House.

The House, which is currently out of session, is scheduled to vote on the bill on Friday.

President Trump is expected to sign the bill into law as soon as it reaches his desk.

After the House votes, Congress is expected to leave Washington for their districts until at least April 20th. House and Senate Leadership put their Members on notice that they could be called back with 24 hours’ notice if there is pressing business. The Capitol complex is expected to be mostly closed during this time period. Congressional staff will work remotely.

Congress is already beginning to talk about a “Phase IV” bill. House Speaker Nancy Pelosi (D-CA) described the CARES Act as “emergency mitigation.” She said Phase IV will focus on recovery. She indicated her priorities for Phase IV include continuing to fund social benefit programs such as food assistance and unemployment and providing more funding to state and local governments. Work on Phase IV will probably intensify after Congress returns on April 20th.

Rep. Ben McAdams (R-UT), who was recently diagnosed with COVID-19, published an OpEd describing his experience with the virus.

White House and Federal Agencies

The Centers for Medicare and Medicaid Services is expected to issue a revised version of its telehealth coverage flexibilities guidance to clarify that providers do not need to enroll their homes as practice locations for providing telehealth services.

The U.S. Food and Drug Administration (FDA) is trying to quickly increase the number of ventilators available to treat COVID-19 patients.

  • New FDA guidance allows manufacturers to modify devices into ventilators.
  • The FDA also issued guidance on how certain ventilator products can be modified to support two patients at once.

Federal Reserve Chair Jerome Powell appeared on the Today Show this morning. He believes we are currently in a recession, but he expressed optimism that it will be a short recession because the economy is fundamentally strong.

The U.S. Army Corps of Engineers issued a draft request for proposals for contracts that can convert hotels, convention centers and other large spaces, into temporary healthcare facilities should a need arise.

CMS granted 12 new state Medicaid waivers. CMS has now granted Medicaid waivers to 29 states.

CMS also published new guidance on how it will implement federal Medicaid matching increases for COVID-19 as required by the the Families First Coronavirus Response Act:

Wednesday, March 25, 2020

Congress

Early this morning, Congressional and White House negotiators reached a deal to finalize the “Phase III” stimulus legislation. The final version of the bill is the product of more than a week of negotiations between Republicans and Democrats in Congress and the White House. Congress has yet to release the official legislative text.

The bill could exceed $2 trillion in cost. It is intended to provide emergency federal funding to the U.S. healthcare system, small business, and certain industries that are the most affected, such as the airline industry.

The Senate Appropriations Committee published a summary of the federal spending provisions of the bill.

  • The summary indicates increases to the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to combat the coronavirus.
  • The bill also provides $117 billion to hospitals and veterans’ health centers.

The bill still includes $1,200 payments to individuals ($2,400 to joint tax filers and $500 per qualified child). The payments will phase down above certain income thresholds based on 2018 tax filings.

The Senate, which is still in session, is expected to pass the bill this afternoon (3/25). The House is currently out of session and it is not yet clear when or how the House will vote on the bill. The fastest and easiest way for the House to vote is by gathering as many Members as they can in the Chamber for a unanimous consent (UC) vote. However, if one present and voting Member objects, the bill cannot be passed by UC.

The House is trying to build the necessary support for a UC vote. If that option is not available, the House would have to call its Members back to Washington to vote in person. Special measures will need to be taken to make sure the in-person voting complies with social distancing and other preventive guidelines.

White House and Federal Agencies

The Centers for Medicare and Medicaid Services (CMS) is giving Affordable Care Act (ACA) plans increased flexibilities to:

  • Delay premium payment deadlines.
  • Delay cancellation of coverage for late premium payments.
  • Allow early prescription refills and allow refills beyond a 90-day supply.
  • Expand coverage of telehealth services.

Some states that operate their own exchanges created Special Enrollment Periods to allow people to enroll in health plans.

The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) issued guidance to clarify how HIPAA privacy protections apply to COVID-19 patients.

The HHS Office of Inspector General (OIG) is responding to complaints of fraudulent activity while also providing flexibilities and clarifications about anti-kickback statute provisions.

  • OIG created a portal for all information and announcements related to COVID-19. The portal can be accessed from OIG’s main website or directly at oig.hhs.gov/coronavirus.
  • OIG also created an email address for questions about the anti-kickback statute:  OIGComplianceSuggestions@oig.hhs.gov

Seven more states received emergency Medicaid waivers from CMS.

HHS issued a request for information (RFI) asking for companies to respond if they can contribute to manufacturing ventilators. HHS appears willing to pay for 100,000 new ventilators.

Tuesday, March 24, 2020

Congress

Congress and the White House are still in negotiations on the bipartisan Phase III stimulus bill, but a deal appears close. Senate Minority Leader Chuck Schumer (D-NY) said negotiations were on the “two-yard line” this afternoon. Senate Democrats were holding out for additional funding for hospitals and more restrictions on the corporate financial assistance.

The cost has supposedly increased to $1.8 trillion.

House Democrats released their own version of Phase III stimulus legislation - Take Responsibility for Workers and Families Act, H.R. 6379. That bill could exceed $2.5 trillion. The Democratic bill is not expected to receive any Republican support if it ever comes up for a vote.

  • A summary of H.R. 6379 is here.

House Majority Leader Rep. Steny Hoyer (D-MD) said he expects the House will consider at least two more bills after the Phase III bill is passed.

A group of Senate Democrats introduced legislation that would federalize the domestic medical supply chain during the public health emergency. The purpose of that drastic action would be to prevent hoarding and prevent state governments and healthcare systems from bidding against each other for the supplies.

White House and Federal Agencies

President Trump issued an Executive Order directing the federal government to prevent companies from hoarding and price gouging medical supplies. The Department of Health and Human Services (HHS) will designate a list of essential products. It appears that the Department of Justice (DOJ) will enforce the order with prosecutions. Attorney General William Barr reassured Americans that their efforts will be focused on businesses, not families.

During a televised townhall from the White House, President Trump expressed optimism that the economy will be much improved by Easter and that we can begin winding down social distancing soon.

President Trump is delaying the October 1 deadline for all Americans to have Real IDs. Obtaining a Real ID requires an in-person visit to DMV office. Delaying the deadline will help people maintain social distancing. Americans will need a Real ID to enter federal buildings and board flights after the deadline. President Trump did not announce a new deadline.

The Centers for Disease Control and Prevention (CDC) created an online COVID-19 Self-Checker chatbox. The purpose of the Self-Checker is to help people make decisions about seeking appropriate medical care. This system is not intended for the diagnosis or treatment of disease or other conditions, including COVID-19.

The Federal Emergency Management Agency (FEMA) is distributing 8 million N-95 masks and 13.3 million surgical masks. New York City and Washington State are receiving the bulk of the distributions.

The CDC issued guidelines for when healthcare workers who test positive for COVID-19 can return to work. Under the guidelines, healthcare workers must test negative twice before they can return to work.

The Centers for Medicare and Medicaid Services (CMS) announced that it has granted Medicaid waivers to 11 more states. The waivers should allow states more flexibilities during the public health emergency.

CMS is increasing its infection control inspections of nursing homes due to the prevalence of COVID-19 cases. CMS believes 147 nursing homes across 27 states have at least one confirmed case.

Monday, March 23, 2020

Congress

Congress is still in negotiations on the Phase III stimulus bill. The Senate held procedural votes to advance the bill on Sunday and Monday, but both votes failed.

Democrats are still seeking higher funding levels for hospitals and additional restrictions on corporate financial assistance, among other things.

Though it failed to advance, the Phase III bill was revised over the weekend.

  • The total cost of the bill is now expected to eclipse $1.6 trillion. The cost of the original version was $1.3 billion. 
  • Extensions for the Medicare and Medicaid Extenders provisions are set to expire on May 23 – without Congressional Action.
  • Some news reports indicated that the House Energy and Commerce Committee and Senate Health, Education, Labor and Pensions Committee were trying to add their “surprise” medical bill legislation to Phase III. That legislation is not included in the most current Phase III bill.

Senator Rand Paul (R-KY) tested positive for COVID-19. This has prompted some of his Senate colleagues to begin a 14-day self-quarantine for coming into contact with Senator Paul. Several Members of the House of Representatives have already tested positive. Additionally, Senator Amy Klobuchar announced that her husband is currently hospitalized with the virus.  

Both the House and Senate are deciding how to conduct business with many legislators diagnosed with the virus or in self-quarantine for precautionary reasons. Many legislators also want to avoid the constant travelling between their districts and Washington, D.C.

  • There are some discussions about shifting to remote voting but there are serious concerns with that process.
  • Another alternative could be to approve bills under unanimous consent of those who can make it to the Chamber in person. This could mean the $1.6 trillion Phase III stimulus bill could be passed without a recorded vote of who is voting and which way they vote.
  • Congress is also considering holding votes open for days at a time to allow Members to travel to D.C. and avoid congregating as a large group in the Chamber at one time.

White House and Federal Agencies

Dr. Anthony Fauci, who leads the National Institute of Allergy and Infection Disease (NIAID) said Americans should anticipate practicing social distancing for more than the next two weeks.

On Sunday, the Centers for Medicare and Medicaid Services (CMS) announced it is creating an expedited process for Medicare provider enrollments and suspending certain provider enrollment requirements during the public health emergency (PHE).

  • Providers can call a hotline provided by their Medicare Administrative Contractor (MAC) for expedited provider enrollments. For example, this process can help providers register their home as a distant site for telehealth services. 
  • CMS will also temporarily suspend all Medicare revalidations during the PHE.
  • CMS also announced it is granting exceptions from reporting requirements and extensions for providers participating in Medicare quality reporting programs – including MIPS – with respect to upcoming measure reporting and data submission.

President Trump clarified that the federal government will not compete against states for in-demand medical supplies. States were concerned that they were competing against the federal government for the same supplies, as all governments prepare for an increase in cases. President Trump said if states inform the Federal government about a conflict, the federal government will drop its order for the supplies.

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is warning the public about certain fraud schemes related to COVID-19.

The U.S. Food and Drug Administration (FDA) is suspending certain premarket notification requirements to expedite the development of ventilators.

The FDA approved a COVID-19 test that can provide results within 45 minutes at the point of care.

FDA also issued guidance that it will suspend some requirements for in-person patient lab tests or imaging for certain prescription drugs.

The National Institutes of Health is suspending “non-mission critical” research so that it can dedicate its resources to the COVID-19 PHE.

CMS issued new resources to help states request Medicaid waivers to expand Medicaid access and coverage in response to the PHE. This includes:

Friday, March 20, 2020

Congress

The Senate is continuing to negotiate changes to its Phase III stimulus legislation. This draft version of the bill was introduced by Senate Majority Leader Mitch McConnell with the goal of negotiating with Democrats and the White House to produce a final version by as soon as this weekend. A Senate vote could come as early as Monday. A summary of the bill was included in Thursday’s daily update.

Most Congressional staff are working remotely, and they are being flooded with requests from stakeholder organizations to add or change provisions in the bill. It is not immediately clear if Congress can finish negotiations by Monday, but there is a strong possibility that the Senate will indeed vote on Monday.

There is already talk about a fourth major COVID-19 response bill that will follow the Phase III stimulus bill.

A group of Democratic Senators is asking large commercial health insurance companies to completely cover the costs of treating COVID-19. Most legislative efforts have focused on providing free coverage for testing, not treatment.

White House and Federal Agencies

During his daily press conference on the emergency, President Trump said that Americans should expect additional federal support if the $1,200 checks they would be issued in the Phase III bill are not enough. He said the White House is talking about “much more than a thousand-dollar check.”

The Federal Emergency Management Agency (FEMA) is now the agency that is coordinating the overall federal response to the COVID-19 public health emergency. However, the Department of Health and Human Services (HHS) will continue to lead the health and medical components of the response. 

Some drug manufacturers are increasing production of a malaria drug called Chloroquine which some, including President Trump, believe can be an effective treatment for COVID-19. U.S. Food and Drug Administration (FDA) Commissioner Stephen Hahn and National Institute of Allergy and Infectious Diseases Director Anthony Fauci both warned that Chloroquine was not intended for treating COVID-19 and they do not know how effective it will be at treating the disease.

The Centers for Medicare and Medicaid Services (CMS) granted a temporary Medicaid waiver request to Washington State. This is the second Medicaid waiver request CMS has granted. Florida was the first state to receive a waiver.

The Veterans Health System is preparing to support the civilian healthcare system if the public health emergency worsens. The VA is authorized to assist during major emergency situations and has procedures in place to do so.

CMS published two toolkits that consolidates CMS telehealth coverage policies into a centralized document. One toolkit is for General Practitioners and the other is for ESRD providers. 

CMS also issued an updated MLN Matters Article to explain its new Medicare and Medicaid telehealth coverage policies.

The Federal Communications Commission (FCC) is making it easier for rural healthcare providers to receive broadband internet from internet providers at reduced rates.

CMS could delay the effective date of its recently issued final rules on interoperability and data blocking. The rules were issued as the public health emergency began to increase in severity.

Thursday, March 19, 2020

Congress

Senate Majority Leader released the text of the Phase III stimulus legislation. The bill provides more than $1 trillion to help stimulate the economy. This is very much a first draft of Phase III. Senate Minority Leader Chuck Schumer has his own list of priorities. Also, some Senators have disagreements about what is in the package. In summary:

Economic Stimulus

  • The bill indeed includes loans to small businesses.
  • It authorizes the Treasury Department to make payments to American taxpayers equal to $1,200 individual or $2,400 joint tax filers that will be reduced by up to five dollars for every $100 of the taxpayer’s adjusted gross income that exceeds $75,000 (individual) or $150,000 (joint) filers based on 2018 tax filings.
  • Under this formula, individuals who earn more than $99,000 will not receive a check.
  • The payment also includes $500 for every child.
  • Delays the deadline for filing individual tax returns from April 15th to July 15th.
  • Delays the employer portion of the payroll tax. Employers can pay their 2020 portion in two installments of 50% each. One would be due by the end of 2021 and the other is due by the end of 2022.
  • The bill provides the Secretary of the Treasury with the authority to determine when the payments are made.
  • The bill temporarily waives the penalty for early withdrawals from retirement accounts up to $100,000.
  • Provides over $208 billion for loans and loan guarantees to business from “distressed” sectors of the economy.
    • $50 billion is reserved for airlines.
    • $8 billion of which can be used for air cargo carriers.
    • $150 billion is available for other types of businesses.
    • Provides federal loans and loan guarantees to the airline industry. The bill authorizes the Department of Transportation to require airlines to maintain scheduled air transportation service as a condition of the financial assistance.
  • Changes the limit an employer must pay for FMLA from $200 per day with a $10,000 aggregate cap:
    • Raises limit to $511 per day with a $5,110 aggregate cap if the employee is self-quarantining due to COVID-19 diagnoses or potential exposure to someone who tested positive.
    • Maintains $200 per day and decreases the aggregate limit to $2,000 for employees who are caregivers for someone who is in self-isolation or if they are home caring for children because their school was canceled.

Healthcare System and Medicare

  • Activates the Strategic National Stockpile of medical equipment and transfers it to HHS and DHS.
  • Requires a report from the National Academies on U.S. Medical Product Supply Chain Security.
  • Authorizes and expedites the process for approving lab developed tests for COVID-19.
  • Requires ACA health plans to:
    • Cover - not charge cost-sharing and not impose prior authorization requirements on COVID-19 testing.
    • Reimburse diagnostic testing services to test for COVID-19 at the provider’s list price if the service is out of network. Providers must publicize that price on the internet.
  • Provides $1.3 billion to Community Health Centers.
  • Suspends the two percent sequestration payment cuts for Medicare services for the remainder of 2020 beginning on May 1st. However, it extends the 2029 expiration of the sequestration payments for an additional year, until 2030.
  • Allows Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) to serve as a distant site for Medicare telehealth visits.
  • Provides a temporary waiver of the Medicare requirement for a face-to-face interaction between home dialysis patients and a physician.
  • Increases diagnostic related grouping (DRG) payments to hospitals for COVID-19-related services by 15% for the duration of the emergency.


Two Members of the House of Representatives tested positive for the Coronavirus and many others are self-quarantining due to exposure to those two Members or to others who tested positive for the virus.

  • Rep. Mario Diaz-Balart (R-FL) and Rep. Ben McAdams (D-UT) both tested positive.
  • In the Senate, Senator Cory Gardner (R-CO) is self-quarantining. There is more self-quarantining occurring on the House side with House Majority Whip Steve Scalise (R-LA), Rep Jason Crow (D-CO), Rep. Drew Ferguson (R-GA), Rep. Ann Wagner (R-MS) and Rep. Stephanie Murphy (D-FL) all self-isolating due to contact with someone who was diagnosed with COVID-19.

Some House Members are asking for a change in the House rules to allow remote voting on legislation. The House currently requires physical presence in the House Chamber for voting.

Those Members are concerned that having 435 Members in the Chamber is not consistent with guidelines from the Centers for Disease Control (CDC) and other public health officials to avoid large gatherings. Concerned Members also cite the news that two Members tested positive and others are self-isolating as well as the noted risks of travelling back and forth between their districts and the Capitol.

  • House Leadership is entertaining the idea to the point where it is gauging interest from both House Democrats and Republicans. However, there are questions about how remote voting would disrupt Floor procedures. The work-arounds Congress is proposing also could face legal challenges which would jeopardize any legislation passed by Congress using the remote voting system.
  • A solution could be holding votes open for longer and limiting the number of Members who are allowed into the Chamber to vote to a few at a time.

White House and Federal Agencies

The Centers for Medicare and Medicaid Services (CMS) is asking hospitals to indefinitely postpone all elective procedures. CMS is also urging a similar postponement for all non-essential dental procedures. The purpose of this guidance is to preserve supplies of personal protective equipment (PPE) and to maintain an availability of hospital beds.

CMS is encouraging catastrophic health plans to offer COVID-19 related coverage. Those plans normally are not allowed to offer this type of coverage, but CMS will issue an exception during this public health emergency.

President Trump signed an Executive Order authorizing HHS to take control of the U.S. medical supply chain if the Coronavirus situation worsens.

The U.S. State Department issued a Global Level 4- Do Not Travel warning. This is the highest-level travel advisory that the State Department issues.

  • According to the warning: “The Department of State advises U.S. citizens to avoid all international travel due to the global impact of COVID-19.  In countries where commercial departure options remain available, U.S. citizens who live in the United States should arrange for immediate return to the United States, unless they are prepared to remain abroad for an indefinite period.  U.S. citizens who live abroad should avoid all international travel.”
  • The Transportation Safety Administration (TSA) reported that airport travel declined to below 1 million.

CMS updated its FAQ to states on available flexibilities for their Medicaid programs.

The FDA is suspending routine facility inspections.

Wednesday, March 18, 2020

White House and Federal Agencies

President Trump and the White House Coronavirus Task Force held a press conference that announced more sweeping federal actions.

  • Perhaps most notably, President Trump announced he will invoke his powers under the Defense Production Act which will encourage medical product suppliers to increase their production of emergency supplies.
  • Vice President Mike Pence announced that the Department of Health and Human Services (HHS) will issue a regulation that will allow medical professionals to practice in states where they are not licensed.
  • The Centers for Medicare and Medicaid Services (CMS) will recommend that hospitals reduce elective procedures in anticipation of more COVID-19 patients requiring hospitalization. VA hospitals are also canceling elective surgeries in case they need to take on COVID-19 patients as well.
  • The Department of Housing and Urban Development (HUD) is suspending its foreclosures and evictions through the end of April.
  • The U.S. is closing its Canadian border.
  • President Trump will hold another press conference either today or tomorrow with the U.S. Food and Drug Administration (FDA) to discuss testing.

An official HHS response plan dated March 13 outlines the full scope of the threat the virus poses. The report warns the pandemic could last 18 months and consist of multiple waves.

U.S. Surgeon General Jerome Adams is warning to expect more than 15 days of social isolation to bend the infection rate curve.

The Drug Enforcement Agency (DEA) is suspending certain requirements to allow e-prescribing of controlled substances (e.g. opioids) that aren’t predicated with an in-person medical evaluation. According to the DEA: For as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice.
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
  • The practitioner is acting in accordance with applicable Federal and State law.

The Department of Defense (DOD) is preparing to increase its response to the COVID-19 situation. Defense Secretary Mark Esper said the DOD will:

  • Provide around 5 million protective masks and 2,000 ventilators to health systems in need.
  • The DOD has the capability to open 16 labs for COVID-19 testing.
  • Prepare to call up additional members of the National Guard and Reserve forces.
  • The DOD is preparing two military hospital ships to help deal with a surge in patients that exceed hospital capacity. Each ship has the capacity to treat 1,000 patients. The ships would most likely be used to take on non-COVID-19 patients to free up beds in hospitals for COVID-19 patients. The medical personnel on board the ships would be civilian medical staff, not naval medical staff. 

Congress

The Senate passed the “Phase II” bill, H.R.6201, the Families First Coronavirus Response Act with broad bipartisan support. The bill is summarized in detail in our March 16 daily update and here by the House Appropriations Committee.

“Phase I” was the $8.3 billion supplemental appropriations bill Congress passed earlier in March.

Congress is already moving on to a “Phase III” bill which is projected to exceed $1.3 trillion. Phase III is intended to primarily focus on stimulating the U.S. economy.

The White House is also deeply involved in the Phase III negotiations. According to a proposal from the Treasury Department outlining key details, the White House is requesting:

  • $500 billion of that total would be allocated to give most Americans a check from the government for somewhere in the neighborhood of $1,000 in April and May. Specifically, Congress would issue the checks on April 6 and May 18.
  • The White House is requesting Congress make $250 billion available for these payments for each of the two months.
  • Details of the checks are still being worked out. The amount will probably vary based on family size and income level. Both checks would be the same amount.
  • To help stimulate the economy, the bill would provide:
    • $50 billion in U.S. Government loans to airline companies.
    • $150 billion in for federal loans and loan guarantees to other sectors of the U.S. economy experiencing server financial distress.
    • $300 billion for a newly created small business interruption loan program. It appears the government would provide the funding to U.S. financial institutions who will facilitate the lending.
      • The government would fully guarantee these loans.
      • Employers with 500 employees or less could qualify for the loans.
      • The loans would provide 100 percent of six weeks of payroll capped at $1,540 per week per employee (equivalent to $80,000 annually).
      • Employers must continue to compensate their employees for eight continuous weeks after the loan is distributed.
      • The program would include a streamlined underwriting process based on the previous 6-week payroll amount.
      • The Treasury Department would issue a regulation that establishes the interest rate, loan maturity and other important loan terms.

Senate Democratic Leader Chuck Schumer (D-NY) has his own $750 billion proposal. At some point, Republicans and Democrats in Congress will need to negotiate with each other and with the White House on a final version of the bill. There is optimism that these negotiations will not result in the type of partisan fights that are typical with large bills.

Phase III could be passed into law as early as next week.

Tuesday, March 17, 2020

CMS Suspends Certain Telehealth Coverage Requirements for COVID-19 Public Health Emergency

On March 17, the Centers for Medicare and Medicaid Services issued guidance that explains its new temporary Telehealth Coverage Policies to help address the COVID-19 emergency.

CMS is using its 1135 waiver authority to expand telehealth benefits, effective March 6, 2020 until the end of the COVID-19 Public Health Emergency.

CMS is making changes to certain types of Medicare telehealth services for the duration of the COVID-19 Public Health Emergency. The Fact Sheet and FAQ documents released today are intended to describe the changes as well as provide a broad overview of the existing Medicare telehealth requirements in anticipation of many providers billing for telehealth services for the first time as a result of the changes.

There are three types of virtual services physicians and other professionals can provide to Medicare beneficiaries: Medicare Telehealth Visits, Virtual Check-Ins and E-Visits. CMS telehealth coverage changes apply differently to each of the three.

Most of the telehealth coverage changes apply to Medicare Telehealth Visits. The descriptions for Virtual Check-Ins and E-Visits are mostly informational. CMS is not proposing major changes to those programs.

Below is a summary that clearly describes how the new CMS telehealth coverage policies affect the different types of Medicare telehealth services.

1. Medicare Telehealth Visits

**A Telehealth Visit is not a colloquialism for telehealth services. It is a specific type of Medicare-covered telehealth service with a specific set of Medicare requirements**

Telehealth Visits are for a service that would typically have been provided in person. CMS maintains a list of services that are normally furnished in person that may be furnished via Medicare telehealth. These services are described by HCPCS codes and paid under the Physician Fee Schedule.

Suspending Originating Site Requirement

Normally, Telehealth Visits include an originating site and a distant site. CMS is waiving the requirement that the patient travel to an originating site for a telehealth service. Patients can receive telehealth services at their home.

Suspending Rural Requirement

Telehealth visits are normally limited to patients in rural areas. CMS is removing that requirement.

Preexisting Relationship with a Qualified Telehealth Provider

CMS is not changing the list of distant site practitioners (subject to state law) which can include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals. 

Some states require that telehealth services must be furnished by a provider with whom the patient has a “prior relationship,” meaning the patient has received a Medicare service from that provider (defined at the TIN level) within the last three years. During the Public Health Emergency, CMS will not enforce the prior-relationship requirement for Telehealth Visits.

Communication Methods

Most telehealth services must continue to use an audio and visual communication method. The HHS Office of Civil Rights (OCR) is relaxing the restrictions on the type of audio-visual connection to allow Telehealth Visits using everyday communications technologies, such as FaceTime or Skype, regardless if those methods are HIPAA-compliant.

Telehealth Billing and Payment

CMS is not changing its telehealth billing requirements. Medicare telehealth services are generally billed as if the service had been furnished in person. For Medicare telehealth services, the claim should reflect the designated Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.

Medicare pays the same amount for telehealth services as it would if the service were furnished in person. For services that have different rates in the office versus the facility (the site of service payment differential), Medicare uses the facility payment rate when services are furnished via telehealth.

CMS is not requiring additional or different modifiers associated with telehealth services furnished under these waivers. However, consistent with current rules, there are three scenarios where modifiers are required on Medicare telehealth claims. In cases when a telehealth service is furnished via asynchronous (store and forward) technology as part of a federal telemedicine demonstration project in Alaska and Hawaii, the GQ modifier is required. When a telehealth service is billed under CAH Method II, the GT modifier is required. Finally, when telehealth service is furnished for purposes of diagnosis and treatment of an acute stroke, the G0 modifier is required.

Cost-sharing Waivers

In response to concerns that providers have to charge cost sharing for telehealth visits due to anti-kickback rules, the HHS Office of Inspector General will not enforce this anti-kickback rule for any services paid by Medicare, Medicaid or CHIP. Providers can reduce or waive cost-sharing for Telehealth Visits without penalty but they are also not required to do so.

2. Virtual Check-In

A Virtual Check-In is a brief (5-10 minutes) communication initiated by the patient with a practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. Virtual Check-In’s can occur regardless of if the patient is in a rural area.

Patients can communicate with their practitioner using a broad set of communication methods regardless of audio-visual capabilities, including telephone or other communication technologies. The practitioner can respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal. 

Virtual Check-In’s require an established patient relationship. CMS is not waiving this requirement for Virtual Check-In’s during the Public Health Emergency.

These virtual check-ins cannot be related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available).

There are two Virtual Check-In codes:

  • HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
  • HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.

3. E-Visits

Broadly speaking, E-Visits are virtual evaluation and management (EM) services. They are similar to Virtual Check-Ins in that the patient must initiate the E-Visit, an established relationship is required, and the patient does not have to be located in a rural area. E-Visits can also occur in the patient’s home.

E-Visits are different than Telehealth Visits because they must occur through an online patient portal.

Medicare pays for E-visits to practitioners who may independently bill Medicare for evaluation and management visits (for example, physicians and nurse practitioners) under the following codes (cumulatively):

  • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
  • 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
  • 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

Clinicians who may not independently bill for evaluation and management visits (e.g., physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes (cumulatively):

  • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  •  G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
  • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

 

Medicaid and States

This policy applies specifically to Medicare’s coverage of telehealth. CMS did issue additional guidance to states recommending how Medicaid programs can align with Medicare’s policies. Many commercial payers are voluntarily taking action to expand the availability of these services but those decisions are up to states and individual payers.

Monday, March 16, 2020

On Friday, March 13, President Trump declared a National Emergency under the Stafford Act for the COVID-19 pandemic. The declaration immediately makes available about $40-$50 billion in federal funds to address the situation.

  • President Trump also asked hospitals to activate their emergency preparedness plans which could result in hospitals delaying elective procedures to make sure they have enough beds to handle an influx of COVID-19 patients.
  • The declaration also waives the Medicare Part A three-day inpatient requirement for Skilled Nursing Facility (SNF) Coverage.
  • CMS can ease parts of the Medicare provider enrollment process such as suspending application fees, criminal background checks, and site visit requirements.
  • Under the emergency declaration, CMS will pay for Medicare telehealth services in situations where a state authorizes telehealth services to be provided across state lines.

President Trump recommended that people avoid social gatherings of more than 10 people for the next 15 days.

Agency Action

The Centers for Medicare and Medicaid Services (CMS) is providing information about the authorities it now has from the Emergency Declaration.

  • CMS created a new CPT code for Coronavirus testing.
  • The Centers for Disease Control and Prevention’s (CDC) dedicated COVID-19 web page is the best place to find information about the situation and resources for what you can do (as a provider or individual) in response to the situation.
  • The CDC continues to recommend social distancing as the most effective means of preventing the spread of COVID-19. The CDC issued a new guidance recommending against public gatherings of more than 50 people for the next eight weeks.
  • The U.S. Food and Drug Administration (FDA) is allowing more labs to provide COVID-19 testing services.
  • The CDC maintains a list of labs that are offering COVID-19 testing.
  • On Sunday, the Federal Reserve announced it would take actions to help stimulate the economy. The Fed will reduce interest rates to almost 0 and will increase its purchase of U.S. Government bonds and mortgage backed securities.

Congressional Action

On Friday, March 13, the House of Representatives passed legislation to help empower federal agencies to respond to the situation. The House needs to make technical corrections but will soon send the bill to the Senate which is expected to also pass the bill. President Trump announced he will sign the bill into law if it reaches his desk. 

The bill, H.R.6201, Families First Coronavirus Response Act:

  • Requires private sector employers with fewer than 500 workers to offer 12 weeks of job-protected leave under the Family and Medical Leave Act (FMLA) to employees who are quarantining as a result of exposure to or the presentation of symptoms or a confirmed diagnosis. The leave would also apply to employees who are providing care to a family member who is quarantining for those reasons and for employees who must care for their children (under age 18) whose school or daycare closed due to the COVID-19 situation.
    • The first 14 days of leave can be unpaid, however for the following 14 day period of leave, employers would have to pay employees at least two-thirds of their normal pay rate.
    • The Department of Labor (DOL) is authorized to issue exceptions to small businesses with fewer than 50 employees from these requirements. The DOL is also authorized to exclude healthcare providers and emergency responders from these requirements.
  • Separate from FMLA, the bill would require private sector employers with fewer than 500 workers to provide their full-time employees with 80 hours of paid emergency sick leave if they self-quarantine, receive a COVID-19 diagnosis, care for a family member who is quarantined or diagnosed, or have a child whose school or daycare is closed due to the virus. Part-time workers would get paid sick leave that is equivalent to how many hours they typically work over a two-week period.
    • Employers cannot require workers to find a replacement to cover their work while they are on leave. Employers also cannot fire employees who request paid sick leave for situations related to the virus.
  • Provides tax credits to employers to help compensate for the cost of providing emergency sick leave to their employees.
  • Requires all health insurers to make testing free.
    • Requires CMS to designate a modifier code to identify claims where cost sharing should not be charged to the patient.
    • Provides $1 billion to the National Disaster Medical System to reimburse providers for the costs of testing for uninsured individuals.  
  • Provides 100% federal match rate to states that cover tests for uninsured residents under their Medicaid programs. Increases the federal Medicaid match rate by 6.2 percent for states to provide free testing to its Medicaid population.
  • Bolsters funding for public benefit programs such as SNAP benefits and unemployment in anticipation of an increased utilization of those programs.

Congress already passed a supplemental appropriations bill that provides $8.3 billion in new and redirected funding to help federal agencies and state and local governments respond to the virus.

  • The Supplemental Appropriations Bill gives CMS the authority to waive certain Medicare telehealth billing requirements including:
    • Suspending the requirement that telehealth services can only be provided in rural areas.
    • Suspending the originating site requirement which will allow patients to receive telehealth services from their home instead of in a doctor’s office.
    • CMS gave Medicare Advantage and Medicare Part D plans increased flexibilities for telehealth coverage
  • States already have significant flexibility to cover telehealth services under Medicaid. On March 12, CMS issued an FAQ that reinforces these flexibilities.

Congress is already beginning to work on a new piece of legislation to help address the virus and strengthen industries that are most affected.