Phase III Coronavirus Package // Health-Related Provisions

March 26, 2020

What Medicare and health tax provisions are included in the CARES Act?

It Boosts Investment in Hospitals:

  • Temporarily lifts the Medicare sequester— which reduces payments to providers by 2 percent— from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care
  • Pays 20 percent more for inpatient hospital treatment of COVID-19 patients
  • Allows eligible hospitals to get accelerated Medicare payments

It Expands Access to Quality Care:

  • Removes provider restrictions on telehealth, such as a patient’s past relationship with a doctor, connecting folks on home dialysis, hospice and home health with providers and allowing federally qualified health centers and rural health centers to participate for the remainder of the public health emergency.
  • Expands access to nurse practitioners and physicians’ assistants for home health services, which could help relieve our overburdened physicians
  • Supports payments for durable medical equipment, which helps patients transition from hospital to home and remain in their home for the remainder of the public health emergency.
  • Makes it easier for post-acute facilities to be fully utilized during this crisis.
  • Supports our labs

It Removes Limitations Employers and Individuals are Facing on consumer directed health plans and accounts:

  • Allow over-the-counter medicines to be purchased using all tax-favored health care accounts, like HSAs and FSAs, without a prescription starting this year.
  • Give flexibility to allow for a more generous telehealth benefit for 2020 and 2021.

 

 

Does the  CARES  package expand cost-sharing waivers to any other benefit besides testing and testing-related visits?

Only preemptively for a COVID-19 vaccine under Medicare Part B.

 

 

 

Does the CARES package change the Medicare requirement that telehealth visits be conducted in both an audio and visual format?

No.

 

 

Why aren’t phone calls – which are low-tech and easier than video conferencing – eligible for telehealth reimbursement?

We understand that seniors may have issues with video conferencing for telehealth purposes, particularly in areas where there is a lack of broadband, especially rural areas. CARES does include $340 million to invest in rural broadband.

The limitation on telemedicine was originally included as a guardrail by House Democrats in package 2 to ensure unscrupulous providers didn’t start reaching out to beneficiaries they had no relationship with to bill for unneeded or non-provided services. But we all realize how important keeping our vulnerable seniors out of the community setting is during this public health emergency. We can only assume CARES did not include phone calls to be eligible for telehealth reimbursement because doctors already complete many regular calls with seniors that are currently not billable. Without a clear delineation between those standard calls and new COVID authority related telehealth calls, there is not a good way to cover audio-only telehealth without a massive expansion in costs, even without patients receiving new services.

 

 

How will my rural hospital get help?

A hospital located in a rural area would get sequester relief and would qualify for the 20 percent inpatient add-on. Moreover, the expanded accelerated Medicare payments program would help hospitals, especially those facilities in rural and frontier areas, need reliable and stable cash flow to help them maintain an adequate workforce, buy essential supplies, create additional infrastructure, and keep their doors open to care for patients.

 

In addition to IPPS hospitals, the bill expands the current program to children’s hospitals, cancer hospitals and critical access hospitals (CAHs). Specifically, qualified facilities would be able to request up to a six month advanced lump sum or periodic payment. This advanced payment would be based on net reimbursement represented by unbilled discharges or unpaid bills. Most hospital types could elect to receive up to 100 percent of the prior period payments, with Critical Access Hospitals able to receive up to 125 percent. Finally, a qualifying hospital would not be required to start paying down the loan for four months, and would also have at least 12 months to complete repayment without a requirement to pay interest.

 

 

What kind of providers are eligible for grants from the $100 billion Public Health and Social Services Emergency Fund?

The language is very broad and defines “eligible health care providers’’ as public entities, Medicare or Medicaid enrolled suppliers and providers, and such for-profit entities and not-for-profit entities not otherwise described in this proviso as the Secretary may specify, within the United States (including territories), that provide diagnoses, testing, or care for individuals with possible or actual cases of COVID–19. HHS will administer the fund and will set up rules for distribution.

 

What is the process for interested providers to receive funds from the Public Health and Social Services Emergency Fund?

HHS will administer the fund and will set up rules for distribution.  The Secretary has wide digression in how to most effectively utilize these funds, and is still working on determining an allocation process.  We are currently awaiting that guidance from the Administration.

 

How does bill address the PPE and COVID-19 testing shortage?

The bill provides $16 billion explicitly for the National stockpile. This funding can purchase medical supplies, equipment, and medicine to be distributed to states.

 

 

How does the bill help individuals with mental health needs?

  • EXPANDS TELEHEALTH SERVICES: Opens up expanded telehealth services in the Medicare program, allowing seniors across the nation to receive any current telehealth approved service (not just COVID related services), including mental health and substance abuse services. This will allow seniors to receive critically important mental health and substance use disorder services in their homes without having to forgo care or risk infection by entering the community.
  • IMPROVED CARE COORDINATION FOR PATIENTS WITH SUBSTANCE USE DISORDER: Ensures that health care providers can more effectively care for patients with substance use disorders (especially those with comorbid mental illness and other chronic diseases) by better aligning the treatment of substance use disorder medical records subject to 42 CFR Part 2 with HIPAA.
  • REAUTHORIZES THE EXCELLENCE IN MENTAL HEALTH DEMONSTRATION PROGRAM: Reauthorizes and expands Certified Community Behavioral Health Clinics, which provide critical services both in person and via telemedicine to tens of thousands of vulnerable Americans with suffering with mental health or addiction issues.
  • PROVIDES ADDITIONAL FUNDING TO THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA): Provides a total of $425 million for SAMHSA to be used to support grants to address suicide prevention, mental and behavioral health priorities for tribes and tribal organizations, Certified Community Behavioral Health Clinics, and other emergency substance use disorder or mental health needs in local communities. Specifically:

Certified Community Behavioral Health Clinics: $250 million to increase access to mental health care services.

Suicide Prevention: $50 million to provide increased support for those most in need of intervention.

SAMHSA Emergency Response Grants: $100 million in flexible funding to address mental health, substance use disorders, and provide resources and support to youth and the homeless during the pandemic.

 

 

Will emergency service providers be eligible for telehealth provisions?

Emergency service providers are still required to respond to the scene if they are dispatched through a 911 emergency call. However, emergency service providers will be able to use funds from the Public Health and Social Services Emergency Fund in order to authorize treatment in place and alternative destinations of care besides the hospital for ground ambulance responders. These emergency service providers should be able to use telehealth tools and capabilities in order to treat patients on site or determine if they require care at an alternative site. These concepts of treatment in place and alternative destinations of care for emergency responders are found in the Administration’s Emergency Triage, Treat, and Transport (ET3) Model released last year aimed at providing greater flexibility for first responders and patients.

(Updated 4/2)