KEEPING OUR FAMILIES HEALTHY AND PROTECTING OUR HEALTH CARE WORKERS, LOCAL HOSPITALS AND HEALTH CENTERS

The COVID-19 pandemic has greatly impacted our daily lives.  As we adjust to these changes while trying to keep our families safe and healthy, Congress has enacted a number of laws to ensure that folks have access to the care and testing they need, our health care workers have the protective equipment they require to do their jobs, and our local municipalities can be reimbursed as they respond to this unprecedented crisis.    

Below you will find some helpful information related to the recently enacted CARES Act as well as additional information on the other two COVID-19 stimulus packages that were recently signed into law.  

Help for Patients Impacted by COVID-19

  • Are patients protected from the costs associated with COVID-19 testing? 
    • YES, the Families First Coronavirus Response Act (FFCRA) provided that COVID-19 testing would be free of charge to all Americans, including those in Medicare, Medicaid, and private insurance, as well as the uninsured.  The CARES Act builds on these consumer protections.
  • Are patients protected from the costs associated with the development of a COVID-19 vaccination? 
    • The CARES Act requires that any COVID-19 vaccine developed in the future be provided free of charge to Medicare beneficiaries and individuals with private insurance coverage.  It does not mandate coverage of vaccines in the Medicaid program or for the uninsured. 
  • How does Texas cover testing for uninsured individuals? 
    • The FFCRA provided states with a new option to extend Medicaid coverage for COVID-19 testing to any uninsured individual living in the state for the duration of the COVID-19 public health emergency.  If Texas wants to adopt this option, it will need to submit a state plan amendment and get CMS approval. 

Health Care Workers and Personal Protective Equipment

  • What does the CARES Act do to help our health care workers receive more personal protective equipment (PPE)? 
    • The CARES Act contains many funding streams available to health care entities to purchase additional PPE for their frontline workers.  Funds to cover PPE are included in the Public Health and Social Services Emergency Fund (PHESSF), and the Hospital Preparedness Program.  The Public Health Emergency and Social Services Fund (PHESSF) will be critical in providing much-needed grants to strained hospitals, public and not-for-profit entities cover the costs resulting from this pandemic. 

Reimbursement for Local Entities Responding to COVID-19

  • The Public Health Emergency and Social Services Fund (PHESSF) includes $100 billion to reimburse impacted eligible health care entities.  How much funding is included in PHESSF for assistance to hospitals and health care providers?  Who is eligible for the funding? 
    • Entities eligible for reimbursement include: public entities, Medicare or Medicaid enrolled suppliers and providers, and others that the Secretary of Health and Human Services (HHS) can specify, that provide diagnoses, testing, or care for patients with possible or actual cases of COVID– 19.
  • What can providers be reimbursed for?
    • ?These grants are meant to reimburse health care related expenses or lost revenues that are attributable to COVID-19.   The funds are available for the following: 
      • building or construction of temporary structures
      • leasing of properties
      • medical supplies and equipment including personal protective equipment (PPE) and testing supplies
      • increased workforce and trainings
      • emergency operation centers
      • retrofitting facilities
      • surge capacity 
  • How can providers apply?  Is there one application period? 
    • ?The CARES Act requires that the HHS Secretary receive applications on a rolling basis.  The applicants will have to include a justification for why they need the funds.  HHS will issue specific application guidance in the coming weeks.  
  • How is funding disbursed? 
    • The CARES Act gives discretion to the HHS Secretary to include pre-payment, prospective payment, or retrospective payment but does require that the payment mechanisms take into consideration possible efficient payment systems during the emergency.  HHS will issue specific funding distribution guidance in the coming weeks. 

Expanded Telehealth Services for Patients

  • Can Medicare physicians and practitioners use audio-only phone calls to treat their patients? 
    • Medicare currently pays for “virtual check-ins” for quick audio-only calls with existing patients, regardless of the COVID-19 public health emergency.  With the passage of the CARES Act, Medicare providers across the country can now also treat their patients using e-visits with both video and/or audio calls for the duration of the public health emergency. 
  • Does the physician have to have a pre-existing relationship with the Medicare beneficiary to conduct an e-visit with telehealth in Medicare? 
    • Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released guidance stating it would not enforce a provision of law that requires a pre-existing relationship with a physician or practitioner to use telehealth for expanded telehealth services during the COVID-19 public health emergency.  Additionally, the CARES Act struck the statutory requirement of this pre-existing relationship in order to furnish Medicare telehealth services for the duration of the COVID-19 public health emergency, in order to expand telehealth use.  
  • What about health care facilities that don’t offer telehealth now, but want to expand their capabilities to include this service, especially in rural areas? 
    • The CARES Act reauthorizes Health Resources and Services Administration (HRSA) grant programs that promote the use of telehealth technologies for health care delivery, education, and health information services.  The bill also 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.

Additional Funds for Community Health Centers

  • What does the CARES Act do to help Community Health Centers? 
    • The CARES Act includes $1.3 billion in additional funding for Community Health Centers (CHC) to respond to COVID-19.  This includes providing expanded health care services, purchasing necessary equipment like PPE, or expanding staffing levels.  They can also access the $100 billion funding in the PHESSF.  In addition, the CARES Act extends the CHC Fund through November 30, 2020.  
  • Can Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) bill for telehealth services? 
    • Currently, under Medicare physicians and practitioners enrolled in Medicare who practice at FQHCs and RHCs can bill for telehealth services, but the FQHC and RHC facilities themselves cannot bill for these services.  Under the CARES Act, FQHC and RHC facilities can now bill for telehealth services during the COVID-19 public health emergency.  The FQHCs and RHCs will be paid based on payment rates that are similar to the national average payment rates that Medicare physicians get paid under the Medicare Physician Fee Schedule.