Title III - Supporting America's Health Care System in the Fight Against the Coronavirus
- CARES Act Resources
- Title I - Keeping American Workers Paid and Employed Act
- Title II - Assistance for American Workers, Families and Businesses
- Title III - Supporting America's Health Care System in the Fight Against the Coronavirus
- Title VIII: Agency Appropriations
Subtitle B - Support for Healthcare Providers
Subtitle C - Labor Provisions
Subtitle D - Finance Committee
Subtitle E - Health And Human Services Extenders
Subtitle B - Support for Healthcare Providers
This section expands the types of entities that may apply for grants to develop and implement telehealth technology, including grants available outside the context of COVID-19 needs. Notable changes to the program are:
- Substance use disorder treatment centers are now included as entities eligible for telehealth grants;
- Requires that at least 50 percent of funds awarded are for projects in rural areas;
- Changes the maximum grant funding period from 4 years to 5 years; and
- Establishes funding of $29 million for each fiscal year from 2021 through 2025.
Although additional funding will be administered through the existing grant processes in place for telehealth development, providers will likely need to await guidance and, possibly, additional regulations specific to applying for and utilizing these funds.
This section expands the types of entities that may participate in developing, implementing, and maintaining health care services in rural areas. These programs are to be available outside the context of COVID-19 needs. Notable provisions for rural health outreach and development are:
- Participating entities are no longer required to be rural public or not-for-profit entities. Now, entities may participate if they can show they are experienced in serving, or have the capacity to serve, rural populations;
- Changes the maximum grant funding period from 3 years to 5 years;
- Supports development of integrated networks and community participation; and
- Increases available funding from $45 million to $79.5 million for each fiscal year from 2021 through 2025.
Although additional funding will be administered through the existing grant processes in place for rural outreach and development, providers will likely need to await guidance and, possibly, additional regulations specific to applying for and utilizing these funds.
Currently, the law permits Public Health Service personnel to be deployed for service “in time of national emergency.” This section expands possible deployment to include “in time of a public health or national emergency.”
Specifics for deployment of Public Health Service personnel are broadly described in Section 3216, described below.
This section limits potential state and federal liability for volunteer health care professionals—who provide services without compensation or other thing of value—for harm caused to patients relating to the diagnosis, prevention, or treatment of COVID-19. This provision expressly preempts more restrictive state or local law, and sunsets at the end of the COVID-19 public health emergency.
This section places the following limitations on deployment of Public Health Service personnel during times of public health or national emergency.
Public Health Service personnel must:
- voluntarily agree to provide health care services during the emergency;
- provide services at places the Secretary of Health and Human Services deems appropriate, and for the number of hours assigned, provided that:
- the places are a reasonable distance from the members’ original assignment; and
- the total hours required are the same as required of the member prior to the date of enactment of the applicable emergency.
Subtitle C - Labor Provisions
Health Centers are entities that provide services to underserved populations and in medically underserved areas. Section 3211 of the CARES Act augments existing programs for grant funding available to Health Centers by adding $1.32 billion in funding. The additional funds are to be used to develop programs for the detection of SARS-CoV-2 and the prevention, diagnosis, and treatment of COVID-19.
Although additional funding will be administered through the existing grant processes in place for Health Centers, providers will likely need to await guidance and, possibly, additional regulations specific to applying for and utilizing these funds.
De-identified health information, as contemplated by 45 CFR 164.514(b), concerning substance use disorder patients may be disclosed to public health authorities. Health care providers must revise their notice of privacy practices within one year to reflect the permissibility of such disclosures. While patients in substance use disorder treatment may still request restrictions on otherwise permissible disclosures for health care operations, they will not be able to request such restrictions with respect to reporting de-identified COVID-19 testing information to public health authorities.
Providers treating drug use disorders will need to acquaint themselves with HIPAA’s de-identification requirements. Such providers must be prepared to provide de-identified COVID-19 testing information to local, state, and federal public health authorities.
State agencies or contracted private organizations operating as area agencies on aging may transfer federal funds received for specified uses to other uses deemed appropriate by the agency. Persons in isolation who are unable to obtain nutrition, but would not otherwise qualify for meal delivery, will qualify for delivery services during the pendency of the national emergency.
Substantial appropriations are authorized for the Healthy Start meal program and other programs addressing high rates of infant mortality, poor birth outcomes, and unfavorable social determinants of newborn and infant health.
In addition to reauthorizing the Health Start program, $125 million is appropriated in each of the next four years for other programs devoted to improving neonatal, perinatal, and infant health.
The Secretary of the Department of Health and Human Services (DHHS) is directed to conduct a campaign promoting awareness of the importance of our national blood supply during the pendency of the public health emergency. The Secretary will report to Congress in two years concerning the campaign’s success.
The Emergency Family and Medical Leave Expansion Act (effective April 1, 2020) provides up to 12 weeks of paid emergency FMLA leave for employees who have worked at least 30 calendar days for an employer of fewer than 500 employees when the employee is unable to work or telework because they need to care for a child when that child’s school or child care facility is closed or unavailable. Under this leave, the eligible employee would be entitled to 10 weeks of paid leave—after a two week waiting period—at two-thirds of their daily rate of pay up to $200 per day or $10,000 in total.
The CARES Act revises the Emergency Family and Medical Leave Expansion Act of March 18, 2020, to clarify that no employer would be required to pay more than $200 per day and $10,000 in aggregate for any employee who takes paid emergency FMLA.
Finally, if an individual was laid off on or after March 1, 2020, was employed by a covered employer (500 or fewer employees) for at least 30 of the last 60 calendar days, and was rehired by the employer, they become eligible for the emergency paid FMLA benefit.
The Emergency Paid Sick Leave Act (effective April 1, 2020) provides that employees who are unable to work or telework may take paid sick leave under six enumerated circumstances.
The CARES Act clarifies that the employers will not be required to pay more than $511 per day or $5,110 in aggregate for an employee taking leave (1) under a government quarantine or isolation order, (2) because he/she has been advised by a health care provider to self-quarantine, or (3) because he/she is experiencing symptoms of COVID-19 and seeking medical attention.
Further, employers will not be required to pay more than $200 per day or $2,000 in aggregate for an employee taking leave (4) to care for an individual with COVID-19 or experiencing symptoms of COVID-19, (5) to care for a child whose school or child care facilities are closed due to COVID-19, or (6) because the employee is experiencing other substantially similar conditions specified by the Secretary of Health and Human Services.
The CARES Act directs states to ensure that applications for unemployment compensation and assistance with the process is accessible, to the extent possible, in at least two of the following manners: in person, by phone, or online.
Employers sponsoring single-employer defined benefit pension plans may delay contributions otherwise due in 2020 until January 1, 2021, and may elect to use the plan’s funding status as of the plan year ending in 2019 to determine whether the plan is subject to funding-based restrictions on lump-sum benefits and amendments increasing benefits for plan years that include the 2020 calendar year.
Subject to availability of funds, federal agencies are permitted to modify the terms of a federal contractor who cannot perform work at a federal site due to COVID-19 related closures or restrictions and who cannot telework, to provide up to 40 hours per week of leave compensation so that the contractor can keep its employees or subcontractors in a ready state, including to protect the life and safety of government and contractor personnel, through September 30, 2020. These amounts may be reduced by tax credits available to the contractor.
 Under these circumstances, the employee would likely be entitled to use the Emergency Paid Sick Leave for the first two weeks of leave, or they can use prior accrued, unused paid leave through their employer.
Subtitle D - Finance Committee
The Internal Revenue Code is amended to permit deductibles and coverage of telehealth services by Health Savings Account (HSA) high-deductible plans.
Health insurers offering HSAs do not currently offer plans recognizing deductible amounts for telehealth. Given that open enrollment for 2021 has passed, insurers will need to consider whether existing HSA offerings might be adjusted mid-year and provision made for special enrollment periods.
Over the counter menstrual care products purchased after December 31, 2019 now qualify as “qualified medical care expenses” that may be reimbursed under Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs), Health Flexible Spending Accounts (FSAs) and other reimbursement arrangements.
Health insurers offering HSAs and MSAs do not currently recognize deductible amounts for menstrual care products. FSAs similarly do not provide coverage. Given that open enrollment for 2021 has passed, insurers will need to consider whether existing offerings might be adjusted mid-year or provision made for special enrollment periods.
Medicare Part B (physician) coverage during the emergency period is extended to telehealth services provided by Federally Qualified Health Centers (FQHCs) and rural clinics that are not co-located with the covered individual. Payment rates will be enhanced to match national average payment rates under the physician fee schedule. Telehealth costs, however, will not be figured into payments under the prospective payment system for FQHCs or the methodology for all-inclusive rates for rural health centers.
During the emergency period, face-to-face clinical assessment for the recertification of end stage renal care may be conducted via telehealth technology.
Expanded Medicare and Medicaid Home Health Services by certified nurse practitioners, nurse specialists, nurse midwives, and physician assistants, practicing within the scope of their licenses under state law, is authorized. This authorization includes clinical assessments required for certification of eligibility for services. Further regulation for such certification by the Secretary of DHHS is required within the six months following enactment of the CARES Act.
These changes are not limited to the duration of the emergency and therefore open the door to new staffing strategies and solutions.
Beginning May 1, 2020, Medicare is exempt from sequestration. Spending reductions required by past budget legislation are also suspended for an additional year, until 2030.
During the emergency period, payments for inpatient Medicare hospital services under the Prospective Payment System will be increased for discharged COVID-19 patients. The weighting factor used for calculation of discharge Diagnostic Related Groups for such patients will be enhanced by 20%.
During the emergency period, reimbursement for inpatient rehabilitation facility patients will not require the patient to receive 15 hours of therapy per week. Similarly, requirements of long-term care hospitals concerning a minimum 50% discharge payment percentage and site neutral discharge payment rates will be waived.
Medicare transition rules in 42 CFR 414.210(g)(9) for reimbursement of durable medical equipment (DME) expenses in rural and noncontiguous areas are extended during the emergency period, or through December 31, 2020, whichever is longer. The transition rules for reimbursement of DME in other areas are changed for the duration of the emergency period beginning March 6, 2020, and thereafter will be 75% of adjusted payments and 25% of the unadjusted fee amount.
Effective upon approval of a COVID-19 vaccine under federal law, cost-sharing deductibles under Part B (physician services) will not be imposed for a COVID-19 vaccine or its administration. Similarly, Medicare Advantage plans will not require cost-sharing for a COVID-19 vaccine or its administration.
During the emergency period, Medicare Part D and Medicare Advantage drug plans must allow refills of covered drugs for up to 90 days, save those prescriptions with a safety edit.
Medicaid coverage for home and community based care in acute care settings, including personal assistance and attendant services, is authorized in specified circumstances.
Technical amendments implement the provisions of the Families First Coronavirus Response Act, passed on March 11, 2020, to permit Medicaid coverage, and to require coverage under the Children’s Health Insurance Program, for uninsured COVID-19 testing and related visits without cost-sharing during the public health emergency.
During the emergency period, the Medicare hospital accelerated payment program is expanded to include additional hospitals: those whose inpatients are predominantly individuals under 18 years of age, cancer centers, clinical cancer research centers, and critical access hospitals. Reimbursement for such hospitals also may be increased by the Secretary upon request. The Secretary is required to permit an additional grace time of 120 days before recouping accelerated payments and not less than 12 months from the date of the first accelerated payment before recovery in full.
Subtitle E - Health And Human Services Extenders
Payments to physicians under the Medicare program are calculated using a complex formula that considers the physician’s expertise, efforts, time, location, and other factors. This CARES Act section ensures that one of those factors, the Work Geographic Index Floor, remains at its current level until December 1, 2020. The level was previously scheduled to change on May 23, 2020.
This section amends the Social Security Act to increase the amount allotted for development and implementation of quality measure related activities (which are part of value-based payment and other quality initiatives) for this fiscal year ending on October 1, 2020, from $4.83 million to $20 million, and for the period beginning on October 1, 2020, and ending on November 30, 2020, in an amount equal to the pro rata portion of $20 million.
This section increases existing funding for certain low-income programs.
- The amount allocated for state health insurance programs is $13 million for this fiscal year. For the period beginning on October 1, 2020, and ending on November 30, 2020, the amount available will be equal to the pro rata portion of $13 million.
- The amount allocated for area agencies on aging will be $7.5 million for the fiscal year of 2020. For the period beginning on October 1, 2020, and ending on November 30, 2020, the amount available will be equal to the pro rata portion of $7.5 million.
- The amount allocated for aging and disability resource centers will be $5 million for fiscal year 2020. For the period beginning on October 1, 2020, and ending on November 30, 2020, the amount available will be equal to the pro rata portion of $5 million.
- The amount allocated for grants or contracts with national centers for benefits and outreach enrollment is now $12 million for the 2020 fiscal year ending on October 1, 2020. For the period beginning on October 1, 2020, and ending on November 30, 2020, the amount available will be equal to the pro rata portion of $12 million.
The Money Follows the Person (MFP) project supports state efforts so that individuals have a choice of where they live and receive services. Specifically, the program encourages states to “rebalance” long-term care services so that individuals can move out of nursing homes and into less intensive, but equally supportive, environments, including assisted living centers, senior housing, or an individual’s home. This section increases funding for this project to $337.5 million for the period beginning on January 1, 2020, and ending on September 30, 2020. For the period beginning on October 1, 2020, and ending on November 30, 2020, the amount available will be equal to the pro rata portion of $337.5 million.
The expense of nursing home care can rapidly deplete the lifetime savings of elderly couples. In 1988, Congress enacted provisions to prevent what has come to be called “spousal impoverishment,” leaving the spouse who is still living at home in the community with little or no income or resources. These spousal impoverishment provisions help ensure that this situation will not occur and that community spouses are able to live out their lives with independence and dignity.
Under the Medicaid spousal impoverishment provisions, a certain amount of a couple’s combined resources is protected for the spouse living in the community. Depending on how much of his or her own income the community spouse actually has, a certain amount of income belonging to the spouse in the institution can also be set aside for the community spouse’s use.
This section extends these provisions through November 30, 2020, and allows the state to disregard the income of a spouse and conduct an analysis solely on an individual’s eligibility for medical assistance based on reduction in the individual’s income.
The U.S. government provides funding to hospitals that treat indigent patients through the Disproportionate Share Hospital (DSH) programs, under which facilities are able to receive at least partial compensation for treating individuals who cannot pay for their care. This section of the CARES Act removes the $4 billion DSH reductions for federal fiscal year 2020 and delays the cuts from taking effect until December 1, 2020.
Eight states are currently participating in two-year demonstration programs to improve community behavioral health. Throughout these states, certified community behavioral health clinics (CCBHCs) and their designated collaborating organizations (DCOs) are now offering whole-person care, with the integration of physical and behavioral care serving the “whole person” rather than simply one disconnected aspect of the individual, regardless of their place of residence or ability to pay.
This CARES Act section expands that project. According to this section, not later than six months after the date of enactment, the Secretary must select two states, in addition to the eight states already chosen, to participate in two-year demonstration programs that meet the requirements of this subsection.
This section increases the amounts allocated for these programs as follows:
- For Community Health Centers, funding is increased to $4 billion for fiscal year 2020 and $668,493,151 for the period beginning on October 1, 2020, and ending on November 30, 2020.
- For the National Health Service Corps, funding is now $310 million for fiscal year 2020 and $51,808,219 for the period beginning on October 1, 2020, and ending in November 30, 2020.
- For teaching health centers that operate graduate medical education programs, funding now extends through fiscal year 2020 and $21,141,096 is allocated for the period beginning on October 1, 2020, and ending on November 30, 2020.
This section increases funding for diabetes treatment programs as follows:
- The amount allocated for Type I diabetes will extend through the fiscal year of 2020, and $25,068,493 will be allocated for the period beginning on October 1, 2020, and ending on November 30, 2020.
- The amount allocated for Native American diabetes programs will extend through the 2020 fiscal year, and $25,068,493 will be allocated for the period beginning on October 1, 2020, and ending on November 30, 2020.
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