Corona Virus and the Uninsured — the CARES Act
The Families First Act and the CARES Act specify that the uninsured should not be charged for testing and their care and treatment should be reimbursed by the US Department of Health and Human Services. https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html Over $175 billion was authorized for these purposes and to reimburse for the extra costs of creating surge capacity to treat Covid 19 patients. Kaiser Family Foundation projected the costs of care and treatment of the uninsured would range from $14 to $40 billion. Some facilities had extraordinary costs in building brand new facilities or redirecting whole wards for the crush of Covid 19 patients — the repurposing of the shuttered Saint Vincent’s Hospital to serve as the Los Angeles Surge Hospital is a typical example. Some experienced incredible price increases in the frantic search for ventilators, masks, and PPE (Personal Protective Equipment).
HHS has just opened its portal for providers to secure reimbursement for care to uninsured Covid patients. https://www.hrsa.gov/coviduninsuredclaim Reimbursements are set at Medicare rates, and providers cannot balance bill their patients.
Separate and apart from that, HHS has already sent an additional $30 billion to Medicare hospitals and doctors. Those funds are distributed pro rata to their Medicare billings. https://www.hhs.gov/sites/default/files/state-by-state-breakdown-delivery-of-initial-30-billion-cares-act.pdf HHS is about to send an additional $20 billion to hospitals and doctors who qualified for the first distribution. This funding will be distributed pro rata based on their over all patient revenues. If you have ever looked at this data, you will notice that neither the hospitals’ overall patient revenues nor their Medicare patient revenues bear any relationship at all to the facility’s care to the uninsured. Certain hospitals see lots of uninsured patients and others do not depending on their location and their overall mission.
This $50 billion being distributed from HHS is unrelated to providers’ care and treatment of uninsured Covid 19 patients or to provider’s care to any Covid 19 patients at all. While some providers are completely overwhelmed with Covid 19 patients – e.g. Covid 19 hot spots like New York City, Louisiana, Detroit, South Dakota, Gallup New Mexico, or Albany, Georgia — others are simply not. While those physicians working in hospital ER’s and ICUs are overwhelmed with seriously ill Covid 19 patients, other doctors are seeing none at all and may have closed their offices during the pandemic. So providers are in very different degrees of pain — some are experiencing lost revenues as elective procedures are cancelled and their offices are closed; others are overwhelmed by demand for a particular set of very costly services for very sick patients in the most costly settings. Distributing this funding pro rata based on either total Medicare patient revenues or total patient revenues is entirely inconsistent with the Congressional authorization in the CARES Act. It makes no sense whatsoever, other than as an expeditious way to get the money out the door to the greatest numbers of hospitals and doctors. A distribution based on a provider’s share of Medicaid revenues would make better sense and more appropriately target these funds to the facilities treating the most vulnerable patients with the lowest reimbursement rates. This would also better help long term care facilities treating the frailest elderly and disabled where Covid 19 has been rampant. Better still, this CARES Act funding could be distributed based on a facility’s treatment of Covid 19 patients; however that data is not so readily and timely available to HHS and hospitals will receive a 20% bump in their Medicare reimbursements for treating Medicare Covid 19 patients.
Oversight is urgently needed and being thoroughly blocked by the Trump Administration.
Prepared by: Lucien Wulsin
Dated: 5/1/20