Health Components of the CARES Act --§§3001 et seq.
The failings of our nation’s health system have been on prominent display: testing, ICU beds, ventilators, masks, shields and personal protective equipment on top of high prices, high out of pocket and high rates of uninsured, particularly among Southern states that did not expand their Medicaid programs under the ACA’s generous federal matching rates. The level of the nation’s unpreparedness is nearly criminal in its scope. While it’s devastating for those who are elderly or with underlying medical conditions, it strikes the healthy young as well with hospitalizations and even death.
The provisions of the CARES Act stanch some of the gaping wounds: $100 billion for hospitals and other medical providers to take care of the sick and vulnerable, $27 billion for public and community health for prevention, $150 billion for state and local governments who must pay for the wreckage of our economy and meet the huge increase in public needs for food, shelter and medical care, greater support for development of the essential vaccines to stop the spread of this virus. During the public health emergency only, there will be greater flexibility to use telehealth services and greater reliance on nurse practitioners, clinical nurse specialists, physician assistants to fill the gaps in patient access to medical care. The CARES Act does not in any way fix the long untended dry rot in the foundations of the American health care system that the raging storms of this pandemic have exposed. It is imperative more than ever that we vote for change in November and devote all the best of ourselves to the essential repairs of our nation’s fabric.
§3101 Study of the Supply Chain for American medical products, including drugs and devices.
§3102 adds “personal protective equipment, testing, and medical supplies” to the Strategic National Stockpile.
3103 adds “respiratory devices” to the covered countermeasures in public health emergencies
3104 requires the Secretary of HHS to prioritize and expedite reviews of drug applications
3112 requires FDA reporting of drug component shortages
3121 requires manufacturers to report disruptions in the supply of life sustaining medical devices. FDA must prioritize review and approval of devices to meet the shortages
3201 adds diagnostic testing for Covid 19 to covered services
3202 health plans must reimburse for Covid 19 testing at negotiated rates or at list prices if no rate is negotiated
3203 vaccines or other recommended and approved preventive services for Covid 19 shall be covered with no patient cost sharing
3211 $1.3 billion in supplemental awards for community health centers to detect Covid 19
3212 $29 million annually for 5 years for development of tele-health networks and centers
3213 $79.5 million annually for rural health care network development
3214 Ready Reserve Corps for US Public Health Service Corps in times of national public health emergencies
3215 volunteer health care professionals serving during the Covid 19 national emergency are not liable for simple negligence (only gross or criminal negligence); state laws to the contrary are preempted
3216 Secretary may reassign National Health Service Corps members during the Covid 19 public health emergency within reasonable distances
3221 improves confidentiality and consent procedures for patients being treated for substance use disorders
3222 allows nutrition services to the elderly to be used for home delivered meals to the elderly practicing social distancing due to Covid 19
3223 allows individuals participating in community service programs to the elderly to extend their community service during the Covid 19 emergency
3224 provisions for sharing patient’s HIPPA protected health info during the Covid 19 Public Health Emergency
3225 Reauthorizes Healthy Start at $125 million annually through 2025
3226 National campaign to improve blood donations during the public health emergency
3301 Removes the cap on OTA (Office of Technology Assessment?) during the public health emergency
3302 Priority and expedited review for testing of Zoonotic Animal Drugs (i.e. diseases that cross over from animals to humans)
3401 Reauthorizes the health professions workforce program and funds it at $51 million, $1 million, and $15 million annually for four years.
3701 Creates an exemption (i.e. they are not subject to the deductible) for tele-health and other remote care services in high deductible plans
3702 Includes expenses for menstrual products as medical care under Health Savings Accounts, MSA’s etc.
3703 Telehealth services can be reimbursed by Medicare during the Covid 19 public health emergency
3704 FQHC’s and RHCs shall be paid by Medicare for telehealth services at distant sites at rates comparable to other telehealth services provided by MDs during the Covid 19 emergency
3705 Waiver of face to face visits between MDs and dialysis patients during the emergency
3706 Telehealth can be used for hospice care recertification during the emergency
3707 Telehealth can be encouraged for monitoring of home health patients during the emergency
3708 adds nurse practitioners, clinical nurse specialists, physician assistants to the list of health professions who can oversee the delivery of home health services to Medicare and Medicaid patients
3709 suspends the sequestration reductions in Medicare for one year
3710 adds on a 20% bump in the hospital reimbursements for treating Covid 19 patients
3711 suspends the 15 hours a week of therapy requirements for patients in inpatient rehabilitation facilities during the emergency and waives the site neutral payment provisions for long term care hospitals during the emergency
3712 revises the Medicare payment schedules for durable medical equipment during the emergency
3713 specifies that the as yet undeveloped Covid 19 vaccine shall be covered through Medicare with no cost sharing
3714 requires Medicare plans to allow three months fills and refills of prescription drugs during the emergency
3715 allows acute care hospitals to deliver home and community based services to their patients
3716 clarifies that the uninsured are eligible for Covid 19 testing at state option with 100% FFP even in states that have not expanded their Medicaid programs.
3717 clarifies which Covid 19 tests are covered under Medicaid
3718 delays reporting of private sector payment rates for clinical lab diagnostic rates for one year.
3719 expands the Medicare accelerated payment program to critical access, sole providers and other hospitals during the emergency
3720 delays the requirements that a state end its Medicaid premium requirements in order to qualify for the enhanced FMAP of the Coronavirus Response Act
3801 delays the work geographic index from May to December 2020
3802 extends funding for quality measures from May to December 2020 and increases funding from $5 million to $20 million
3803 extends and increases funding ($13 million) for outreach and assistance for low income programs and for area agencies on aging ($7 million) and for aging and disabled resource centers ($5 million) and for National Center on Outreach Enrollment ($12 million)
3811 extends the Money Follows the Person Rebalancing Program and authorizes $337 million for it
3812 extends the spousal impoverishment protections that apply when one spouse is in a nursing home and the other is living independently at home until November 20, 2020
3813 delays hospitals’ DSH reductions by 6 months to December 2020
3814 extends and expands (2 more states) the community mental health services demonstration project ‘til November 30, 2020
3821 extends the sexual risk adjustment education program ‘til November 30, 2020
3822 extends the personal responsibility education program ‘til November 30, 2020
3823 extends the health profession workforce needs projects ‘til November 30, 2020
3824 extends TANF (Temporary Assistance to Needy Families) until November 30, 2020
3831 extends and expands ($4 billion) Community Health Center’s Teaching Programs, National Health Service Corps ($310 million)
3832 Diabetes programs ($97 million) and Native Americans ($96 million)
CORONA VIRUS RELIEF FUND
§601 $150 billion for state and local governments and Indian Tribes. State government funding is distributed based on population and there is a minimum of $1.25 billion for small states. The funds can only be used for expenditures due to Covid 19 between March and December of 2020 and were not accounted for as part of the state’s most recent approved budget. Local governments with populations over 500,000 are eligible; others are not.
§6001 the USPS receives a $10 billion loan for mail deliveries during the emergency; it must prioritize delivery of medical supplies.
HHS Covid 19 Augmentations
Indian Health Services augmented by $1 billion through September 30, 2021
CDC augmented by $4 billion
NIH, Heart, Lung augmented by $103 million
National Institute of Infectious Diseases augmented by $706 million
LIHEAP augmented by $900 million
Child Care and Development Block Grant augmented by $3.5 billion
Aging and Disability Community Living Programs augmented by $1 billion
Public Health and Social Services Emergency Fund augmented by $27 billion for vaccine development
$100 billion for hospitals and other medical providers for unreimbursed (no double dipping) care and treatment to uninsured Corona virus patients and construction of temporary facilities, increased medical supplies and equipment due to Covid 19
Department of Education
$30 billion augmentation for Covid 19
LEAs, higher Ed, etc. receiving such funds must continue to employ their workforces
States must maintain their levels of effort
Veterans Affairs
$14 billion augmentation of VA Health Administration for Covid 19 costs of treatment of Veterans
Prepared by: Lucien Wulsin
Dated: 4/5/20