Providers set to get billions from COVID-19 relief package
PROVIDER GROUPS GOT MOST of what they wanted in Congress’ historic $2 trillion COVID-19 economic stimulus deal that includes billions of dollars to bolster the healthcare system, and more funds may still be on the way.
The centerpiece for healthcare is a $100 billion fund to reimburse providers for COVID-19 related expenses and lost revenue. Providers sounded the alarm that they needed funding in this package to support operations, expand surge capacity and buy protective equipment. Senate Minority Leader Chuck Schumer (D-N.Y.) pushed for increased funding for hospitals in negotiations with Trump administration officials. It is the third major economic stimulus passed this month to address the pandemic.
The American Hospital Association, American Medical Association and American Nurses Association asked for $100 billion to support operations, while the Federation of American Hospitals lobbied for $225 billion. Shawn Martin, senior vice president of the American Academy of Family Physicians, said he also hopes that smaller primary-care practices can get some of the funds to maintain cash flow as non-essential office visits are canceled or conducted remotely, though it is unclear how the provider funds will be allocated.
The law suspends the Medicare sequester from May 1 to Dec. 31, 2020, to boost provider payments. The sequester reduced spending for most benefits by 2% starting in 2013. However, the sequestration is extended an additional year past its original end date in 2029. The suspension was a top priority for provider groups.
Hospitals will also get a 20% add-on payment for inpatient care for COVID-19 patients. A GOP Senate Finance Committee aide said it is difficult to determine how much money will be funneled to providers overall because these payments are tied to treating an unknown number of COVID-19 cases.
Cuts to Medicaid disproportionate-share hospital payments are delayed through November, though hospitals had aimed for two years. The package eliminates $4 billion in fiscal 2020 cuts and reduces 2021 cuts from $8 billion to $4 billion. Community health centers will get $1.3 billion in emergency funding, but their main funding stream was only extended until Nov. 30, not the several years sought by the National Association of Community Health Centers.
More hospitals, including critical-access hospitals and cancer centers, will also be allowed to request advance Medicare payments based on prior years’ payments and pay back any overages over at least 12 months. Group purchasing organization Premier, which pushed for the change, said the upfront payments could help with hospitals’ cash-flow issues as elective surgeries are delayed.
There’s a chance that some healthcare providers with fewer than 500 employees could have access to nearly $350 billion in small business loans to help with cash flow, said AHA’s senior vice president of public policy, Ashley Thompson. The funds are sorely needed. J. Scott Graham, CEO of Three Rivers and North Valley rural hospitals in Brewster and Tonasket, Wash., respectively, said he fears having to close if he can’t make payroll or pay for protective equipment.
“In terms of planning, we know we need to ramp up, but we are concerned that we will not be able to be around by the time the surge hits,” Graham told reporters.
Senate Appropriations health subcommittee Chair Roy Blunt (R-Mo.) said he was satisfied with the package, but added that Congress still needs to take “another step” on coronavirus relief.
Providers had also requested funding to purchase personal protective equipment that’s in short supply. Congress set aside $16 billion for buying medical supplies for the Strategic National Stockpile and $1 billion for purchases under the Defense Production Act, which the Trump administration has resisted using so far despite calls from hospitals, doctors and governors.
Congress also wants the HHS secretary to develop and implement a new payment rule for federally qualified health centers and rural health clinics that provide telehealth services to eligible patients. Rates will be based on payment that currently applies to comparable telehealth services under the physician fee schedule. HHS has to issue guidance on using telehealth for home health services. Medicare beneficiaries will be allowed to use telehealth services regardless of whether they had
“In terms of planning, we know we need to ramp up, but we are concerned that we will not be able to be around by the time the surge hits.” J. Scott Graham, CEO of Three Rivers and North Valley hospitals
seen the provider in-person in the preceding three years.
The deal extends Medicare and Medicaid programs including the Money Follows the Person demonstration and the Certified Community Behavioral Health Clinics Demonstration Program, among others, that were set to expire on May 22 until Nov. 30, setting up a potential vehicle for legislation to ban surprise medical bills and address prescription drug prices after the 2020 election.
The White House had pushed for a surprise billing ban and price transparency language that was ultimately left out. The Greater New York Hospital Association, a powerful force in Schumer’s state, told members that the group “advocated strongly against” the policies.
The package also mandates more reporting requirements about where drugmakers source their materials and allows the U.S. Food and Drug Administration to prioritize drug applications that could help address a shortage.
FDA policy is amended so that laboratory-developed tests and diagnostic kits could be used and covered by private insurance plans before they receive an emergency use authorization.
Insurers are required to pay either a negotiated price with a provider or a cash price posted by the provider for the test. Vaccines that meet certain effectiveness standards will have to be covered with no cost-sharing.
Lawmakers are already shifting their focus to the next COVID-19 relief bill, though the Senate does not expect to hold votes again until April 20. Healthcare industry groups including insurers, hospitals, physicians and clinical labs say they may need more funds in the next package. ●