Coronavirus Aid, Relief, and Economic Security Act - Impact for Healthcare Organizations

This document has been updated based upon additional guidance issued by the Center for Medicare and Medicaid Services (CMS) on March 29 and 30, 2020.

Congress and the Administration have been working on the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) which will be the third coronavirus relief package. The first relief package was $8 billion in emergency spending focused on combatting the spread of the virus at the local, state, national, and international levels. This included provisions to allow Medicare beneficiaries to access telehealth programs.

The second coronavirus package provided paid sick and family leave for workers impacted by the illness, expanded unemployment assistance, nutrition assistance, and increased resources for testing for the coronavirus.

The CARES Act is expected to provide $2 trillion in relief for the COVID‐19 pandemic. Below is an estimate of how the funding breaks down.

• Individuals, $560 billion
• Large Corporations, $500 billion
• Small Businesses, $377 billion
• State and Local Governments, $339.8 billion
• Public Health, $153.5 billion
• Education/Other, $43.7 billion
• Safety Net, $26 billion

There are several sections of the CARES Act that will impact healthcare organizations. This document will focus on how the CARES Act impacts reimbursement, healthcare operations, and patient access. There are other parts of the CARES Act which healthcare organizations may be eligible for that may help meet capital needs of the organization.

Testing and Preventive Services

• Testing for COVID‐19 is to be covered by private insurance plans with no cost to patients, including those tests without an Emergency Use Authorization (EUA) by the It requires insurers to pay either the rate specified in a contract between the provider and the insurer, or, if there is no contract, a cash price posted by the provider. (Sections 3201 and 3202)
• Provides coverage with no cost to the patient within 15 days for a vaccine for COVID‐19 that has in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force, or a recommendation from the Advisory Committee on Immunization Practices (ACIP). (Section 3203)
• Medicare Part B beneficiaries can receive a COVID‐19 vaccine at no cost. (Sections 3713 and 3717)
• Clarifies a section of the Families First Coronavirus Response Act of 2020 (Public Law 116‐127) by ensuring that uninsured individuals can receive a COVID‐19 test and related service at no cost in any state Medicaid program that elects to offer such enrollment option. (Section 3717)

Insurance, Health Saving Accounts and Flexible Spending Accounts

• Allows a high‐deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible. (Section 3701)
• Allows patients to use funds in HSAs and Flexible Spending Accounts for the purchase of over‐the‐counter medical products, including those needed in quarantine and social distancing, without a prescription from a physician. (Section 3702)

Medicare Reimbursement

• Temporarily lifts the Medicare sequester, which reduced payments to providers by 2 percent, from May 1 through December 31, 2020. (Section 3709)
• Increases the payment to a hospital for treating a patient admitted with COVID‐19 by 20% during the COVID‐19 emergency period. (Section 3710)
• Provides acute care hospitals the flexibility to transfer patients out of their facilities and into alternative care settings to prioritize resources to treat COVID‐19 cases during the COVID‐19 emergency This waives the Inpatient Rehabilitation Facility (IRF) 3‐hour rule and allows a Long Term Care Hospital (LTCH) to maintain its designation even if more than 50 percent of its cases are less intensive. It would also temporarily pause the current LTCH site‐neutral payment methodology. (Section 3711)
• Prevents scheduled reductions in Medicare payments for durable medical equipment through the length of COVID‐19 emergency period. (Section 3712)
• Prevents scheduled reductions in Medicare payments for clinical diagnostic laboratory tests furnished to beneficiaries in 2021 and delays by one year the upcoming reporting period during which laboratories are required to report private payer data. (Section 3718)
• Expands an existing Medicare accelerated payment program for qualified hospitals to a broader group of Part A providers and Part B suppliers for the duration of the COVID‐19 emergency. Any Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the requirements would be able to request an advanced lump-sum payment. Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals can request up to 100% of the Medicare payment amount for a six-month period. Critical access hospitals (CAH) can request up to 125% of their payment amount for a six-month period. Each MAC will strive to review and issue payments within seven calendar days of receiving the request. CMS has extended the repayment of the accelerated/advanced payment to begin 120 days after the date of issuance of payment. Hospitals will have up to one year and other Part A providers and Part B supplies will have 210 days from the date of the accelerated/advanced payment to repay the balance. (Section 3719 and CMS Guidance issued March 29, 2020)
• Increases payments for the work component of physician fees in areas where labor cost is determined to be lower than the national average through December 1, 2020. (Section 3801)

Medicaid Reimbursement

• Amends a section of the Families First Coronavirus Response Act of 2020 (Public Law 116‐127) to ensure that states are able to receive the Medicaid 6.2 % Federal Medical Assistance Percentage (FMAP) increase.

Other Medicare Benefits

• Medicare Part D plans are to provide a 90‐day supply of a prescription medication if requested by a beneficiary during the COVID‐19 emergency period. (Section 3714)

Other Medicaid Benefits

• Allows state Medicaid programs to pay for direct support professionals, caregivers trained to help with activities of daily living, to assist disabled individuals in the hospital to reduce length of stay and free ups bed. (Section 3715)

Telehealth

• CMS expanded the telehealth services providers may provide to Medicare beneficiaries to include Emergency Department visits; Hospital visits; Nursing Facility visits; Critical Care Services; Domiciliary, Rest Home, or Custodial Care services; Home Visits; Inpatient Neonatal and Pediatric Critical Care and Radiation Treatment Management. A complete list of all Medicare telehealth services can be found here. (CMS Guidance Issued March 30, 2020)
• CMS expanded the expanded the check-in services to both new and established patients and e-visits provided by licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists. (CMS Guidance Issued March 30, 2020)
• CMS expanded remote patient monitoring services to new and established patients for acute and chronic problems and can now be provided for patients with only one disease. (CMS Guidance Issued March 30, 2020)
• CMS removed the frequency limitations on telehealth visits for subsequent inpatient visits, subsequent skilled nursing facility visits and critical care consult codes. (CMS Guidance Issued March 30, 2020)
• Reauthorizes the Health Resources and Services Administration (HRSA) grant programs promoting the use of telehealth technologies for health care delivery, education, and health information services. (Section 3212)
• Eliminates the requirement in Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (Public Law 116‐123) limiting the Medicare telehealth expansion authority during the COVID‐19 emergency period to situations where the physician or other professional has treated the patient in the past three years. (Section 3703)
• During the COVID‐19 emergency period, Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) can serve as a distant site for telehealth Medicare would reimburse for these telehealth services based on the Medicare Physician Fee Schedule, and costs associated with these services would be excluded from both the FQHC prospective payment system and the RHC all‐inclusive rate calculation. (Section 3704)
• Allows Nephrologists to conduct required periodic evaluations of a patient on home dialysis to be performed via telehealth. (Section 3705)
• Hospice face‐to‐face recertification requirements can be performed using telehealth during the COVID‐19 emergency period. (Section 3706)
• Requires Department of Health and Human Services (HHS) to issue clarifying guidance encouraging the use of telecommunications systems, including remote patient monitoring, to furnish home health services consistent with the beneficiary care plan during the COVID‐ 19 emergency period. (Section 3707)
• Allows physician assistants, nurse practitioners, and other professionals to order home health services for beneficiaries, reducing delays and increasing beneficiary access to care in the safety of their home.

HIPPA

• Allows for additional care coordination by aligning the 42 CFR Part 2 regulations, which govern the confidentiality and sharing of substance use disorder treatment records, with the Health Insurance Portability and Accountability Act (HIPAA), with initial patient consent. (Section 3221)
• Requires the HHS to issue guidance on what patient health information is allowed to be shared during the public health emergency related to COVID‐19. (Section 3224)

Programs

• Waives nutrition requirements for Older Americans Act (OAA) meal programs during the COVID‐19 emergency period to ensure seniors can get meals if other food options are not available. (Section 3222)
• Reauthorizes Healthy Start for women and their families who may need additional support during the COVID‐19 emergency period. (Section 3225)
• Reauthorizes and updates Title VII of the Public Health Service Act (PHSA) pertaining to programs to support clinician training and faculty development, including the training of practitioners in family medicine, general internal medicine, geriatrics, pediatrics, and other medical specialties. (Section 3403)
• Extends Medicare funding for beneficiary outreach and counseling related to low‐income programs through November 30, (Section 3803)

Other

• Reauthorizes HRSA grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services. (Section 3213)
• Provides liability protections to physicians who volunteer medical services during the COVID‐19 emergency period. (Section 3215)
• Provides funding for HHS to contract with a consensus‐based entity, e.g, the National Quality Forum (NQF), to carry out duties related to quality measurement and performance improvement through November 30, 2020. (Section 3803)
• CMS relaxed Medicare Physician Supervision rules to allow for real-time audio/video technology. (CMS Guidance Issued March 30, 2020)

We can help

If you have questions about how the CARES Act impacts healthcare providers, contact Ira Bedenbaugh, Consulting Principal, at 864.552.4715 or ira.bedenbaugh@elliottdavis.com or fill out the form below.

For more helpful tax updates and business continuity resources to navigate COVID-19, visit the Elliott Davis COVID-19 Resource Center

The information provided in this communication is of a general nature and should not be considered professional advice. You should not act upon the information provided without obtaining specific professional advice. The information above is subject to change.