State Health and Value Strategies (SHVS), in partnership with Manatt Health, Georgetown’s Center on Health Insurance Reforms (CHIR), State Health Access Data Assistance Center (SHADAC), Bailit Health, and GMMB developed this resource page to serve as an accessible “one-stop” source of COVID-19 information for states. This resource is designed to support states seeking to make coverage and essential services available to all of their residents, especially high risk and vulnerable people, during the COVID-19 pandemic. SHVS will update this page frequently with new resources as they become available.
| If you have materials you are willing to share with other states through this page, or if there are topics of particular concern that you would like addressed, please contact SHVS. |
As states face the extraordinary challenges of the COVID-19 crisis, information technology (IT) is an essential tool to support access to health coverage and the safe and effective evaluation, testing, and treatment of patients nationwide. Under the current statutory and regulatory framework, state Medicaid agencies are authorized to receive federal funding for Medicaid IT and associated activities, and much of it at an enhanced federal matching level. This issue brief outlines potential IT investments in responding to COVID-19 and strategies for states to support these investments, as well as secure current and future IT investments that enable Medicaid program operations. The issue brief also highlights the Medicaid authorities and the provisions that may allow states more expeditious access and flexible use of these funds.
On Thursday, May 21, State Health and Value Strategies hosted a webinar that reviewed potential information technology (IT) investments in responding to COVID-19 and strategies for states to support these investments. As states face the extraordinary challenges of the COVID-19 crisis, IT is an essential tool to support access to health coverage and the safe and effective evaluation, testing, and treatment of patients nationwide. The webinar outlined strategies states can employ to secure current and potential IT investments that enable ongoing Medicaid program operations and advance health information exchange.
An analysis by Manatt Health on a CMS Informational Bulletin regarding Medicaid managed care options to mitigate the impact of the COVID-19 pandemic on Medicaid providers. Most notably, the Bulletin highlights how, under certain conditions, states can use existing authority to require plans to make directed payments to providers to help them weather the financial impacts of the pandemic, including COVID-19 expenses and steep revenue declines.
SBA issued an IFR outlining the PPP loan forgiveness process for lenders, the process for borrowers to apply for loan forgiveness, and the types of costs that are eligible for loan forgiveness. SBA issued a separate IFR regarding how SBA may audit PPP loans, including their forgiveness, and the loan forgiveness process for lenders. SBA also announced that PPP has approved over $511 billion across 4.4 million PPP loans through May 23, inclusive of funding authorized through both the CARES and PPPHCE Acts. This leaves approximately $159 billion remaining until the funding authorized by the PPPHCE Act is exhausted.
SBA Loan Review Procedures and Related Borrower/Lender Responsibilities IFR
HHS OIG issued its strategic plan to support the COVID-19 response and recovery.
FEMA announced that government officials can now access the “Community Mitigation Decision Support Tool,” which makes data for each metric in the President’s Guidelines for Opening Up America Again available in one tool.
CMS issued guidance for state and local governments regarding receiving reimbursement from CMS programs (Medicare, Medicaid, CHIP) for care provided at an alternate care site. CMS advises that the easiest path is for an already-enrolled hospital or health system to treat the ACS as a temporary expansion of their “brick-and-mortar” location. In these circumstances, the local hospitals and health systems operate, staff, and bill for care furnished at the ACS. The guidance also describes the ways in which state and local governments that want to develop or build a hospital ACS may be paid by CMS for furnishing covered hospital inpatient and outpatient services.
HHS announced $500 million in Provider Relief Fund awards to Indian Health Service (IHS) and tribal hospitals, clinics, and urban health centers. As part of the announcement, HHS released the methodology for calculating award amounts for HIS and Tribal Hospitals, Clinics and Urban Programs.
HHS announced that providers who have received Provider Relief Fund payments now have an additional 45 days (90 days total) to accept the Terms and Conditions and the payment or return the funds.
HHS submitted its initial report to Congress detailing the national approach to testing and the testing ecosystem. The report includes key components of a state’s testing plan and actual and recommended targets for states’ and territories’ COVID-19 test rates. HHS is required to submit this report to Congress every 90 days until funds are expended.
The COVID-19 pandemic continues to evolve and bring about significant–and rapidly occurring–changes in care delivery. As a result, states are examining their Medicaid managed care incentive arrangements to evaluate the impact of COVID-19 on their health care quality and cost performance requirements. This expert perspective identifies actions federal and state policymakers have taken to address the impact of COVID-19 on their managed care performance incentive programs, and 2020 quality and total cost of care performance. The examples detailed in the expert perspective can be used to inform state decisions on whether and how to modify Medicaid managed care reporting and performance incentives as a result of COVID-19.
This analysis by Manatt Health summarizes key provisions from the “Health and Economic Recovery Omnibus Emergency Solutions” (HEROES) Act introduced by House Democrats on May 12. The fifth COVID-19 stimulus bill includes numerous provisions with a significant price tag (a Congressional Budget Office score is not yet available).
HHS announced nearly $4.9 billion in awards for over 13,000 skilled nursing facilities (SNFs) in a new targeted allocation of the $175 billion Provider Relief Fund, made available through the CARES and PPPHCE Acts. Skilled Nursing Facilities (SNFs) with six or more certified beds are eligible for payments and may use the payments for critical needs such as labor, scaling up testing capacity, acquiring personal protective equipment and a range of other expenses directly linked to the pandemic. Each SNF will receive a fixed distribution of $50,000, plus a distribution of $2,500 per bed. Recipients must attest that they will only use Provider Relief Fund payments for permissible purposes, as set forth in the Terms and Conditions, and agree to comply with future government audit and reporting requirements.
HHS issued updated FAQs for the $50 billion general allocation of the Provider Relief Fund, clarifying and expanding upon previous guidance, including:- Providers who received their payments by check have 60 days (rather than 45) to accept the terms and conditions and accept or reject the payment.- Providers cannot elect to have their data omitted from the provider-level data set detailing the Provider Relief Fund payment allocations that is publicly available on the CDC website.- various scenarios under which parent entities and their subsidiaries are eligible–or ineligible–for General Allocation Provider Relief Fund payments. Additional information is provided on how parent entities should submit revenue information for their subsidiaries and scenarios under which they may transfer HHS payments to their subsidiaries.
HHS issued a clarification for providers who are eligible for, but have not yet received, a second payment from the $20 billion tranche of the $50 billion Provider Relief Fund General Allocation. These providers must accept HHS’s Terms & Conditions and submit revenue information via tax forms or financial statements to HHS by June 3 in order to remain eligible for the additional payment. HHS also issued updated FAQs
This analysis examines the interplay between the Provider Relief Funds and its impact on balance/surprise billing.
HHS released several updates related to the Provider Relief Fund, including an extension of the deadline for providers to attest to terms and conditions and accept funds, new provider-level data on distribution of the $50 billion general fund allocation, and additional detail on the payment methodology used to distribute $10 billion to rural providers.
The Treasury issued additional guidance to Tribal governments regarding required information that must be submitted to inform the second payment of their Tribal allocations of the Coronavirus Relief Fund. While the first 60% of their $8 billion allocation was based on population size of eligible tribes, the remaining 40% will be based on Tribes’ submissions regarding the number of employees of the Tribal government or its subsidiaries; governmental expenditures; and the amount of federal financial assistance for FY2019. An electronic form will become available early the week of May 17.
The Treasury announced final award amounts from the $150 billion Coronavirus Relief Fund authorized by the CARES Act, that were available to states, tribal governments, and local governments with populations of 500,000 or more.
HHS released several updates related to the Provider Relief Fund, including an extension of the deadline for providers to attest to terms and conditions and accept funds, new provider-level data on distribution of the $50 billion general fund allocation, and additional detail on the payment methodology used to distribute $10 billion to rural providers.
HHS released provider-level data regarding the distribution of the $12 billion COVID-19 High-Impact Allocation from the Provider Relief Fund, of which $2 billion was based on hospitals’ Medicare disproportionate share and uncompensated care payments. These funds were distributed by HRSA to 395 hospitals that accounted for 71 percent of COVID-19 inpatient admissions reported to HHS from nearly 6,000 hospitals around the country.
HHS released several updates related to the Provider Relief Fund, including an extension of the deadline for providers to attest to terms and conditions and accept funds, new provider-level data on distribution of the $50 billion general fund allocation, and additional detail on the payment methodology used to distribute $10 billion to rural providers.
CARES Act Provider Relief Fund General Distribution FAQs
HHS issued new terms and conditions for recipients of the Provider Relief Fund allocations for high-impact hospitals and rural hospitals/health clinics. These are the terms and conditions for high-impact hospitals.
HHS issued new terms and conditions for recipients of the Provider Relief Fund allocations for high-impact hospitals and rural hospitals/health clinics. These are the terms and conditions for rural hospitals.
This resource reviews HHS’s approach for the recent distribution of $22 billion to hot spot and rural providers and what we know about the first $100 billion of the Provider Relief Fund. This resource also discusses next steps for remaining Provider Relief Fund dollars.
The FCC issued an updated notice of awards for the COVID-19 Telehealth Program, providing $16.9 million to 50 providers in this tranche. As of May 20, the FCC has awarded a total of $50 million to 132 health care providers in 33 states plus the District of Columbia.
Through May 16, the SBA has approved over $513 billion across 4.3 million PPP loans, inclusive of funding authorized through both the CARES and PPPHCEA Acts. As of this cut-off date, PPP has approximately $156 billion remaining until the funding authorized by the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) is exhausted.
SBA released the PPP Loan Forgiveness Application, along with detailed instructions, for small business borrowers seeking forgiveness at the conclusion of the eight week covered period that begins with the disbursement of their PPP loans. The form indicates that the SBA will allow payers to align their covered periods with regular payroll cycles and the flexibility to include payroll and non-payroll expenses paid or incurred during the eight-week period.
CDC issued a compilation of guidance on its COVID-19 surveillance activities and a framework of indicators for state and local jurisdictions to assess the feasibility of re-opening
IHS announced its allocations of the $750 million Public Health and Social Services Emergency Fund for Tribal Organizations authorized through the Paycheck Protection Program and Health Care Enhancement Act.
On May 18, the CDC announced $10.25 billion in awards for states, localities, and territories to spend on: the development, purchase, administration, processing, and analysis of COVID-19 tests; surveillance; contact tracing; and related activities. States are required to submit COVID-19 testing projections for May and June 2020 to the CDC by May 30, 2020 and projections for July through December 2020 by June 15, 2020
HHS issued guidance regarding the distribution of the remaining $70 billion in the CARES Act Provider Relief Fund, including to providers in COVID-19 “hot spots”.
CDC issued a set of health considerations for states, tribes, localities, and territories as they begin phased re-openings of summer camps, schools, youth sports organizations, institutes of higher education, restaurants, and bars. Considerations are framed as strategies to assist leaders with promoting healthy behaviors, environments, and operations as well as mitigation strategies in the event of incident COVID-19 cases.
The guidance document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. Recent updates include: – Revising the existing “”physical environment”” waivers for hospitals to support activities related to both surge capacity and appropriate quarantining and to clarify that it does not modify hospitals’ obligations under the Americans with Disabilities Act (ADA), to “avoid subjecting persons with disabilities to unjustified institutionalization or segregation
HHS announced that the Indian Health Service (IHS) will administer the $750 million allocation for Tribal organizations of the $11 billion authorized by the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) for Public Health and Social Services Emergency Fund for COVID-19 testing and tracing. HHS conveyed that a more detailed announcement for this funding opportunity is expected in the coming days.The remaining $10.25 billion will be administered by the CDC as part of the Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement for states, localities, and territories to spend on COVID-19 testing and tracing.
HHS OIG issued updated FAQs regarding application of OIG’s administrative enforcement authorities to arrangements directly connected to COVID-19. OIG is accepting inquiries from the health care community regarding the application of OIG’s administrative enforcement authorities.Healthcare providers and personnel are encouraged to submit questions to OIGComplianceSuggestions@oig.hhs.gov.
CMCS issued an informational bulletin (CIB) to provide states with guidance about temporarily modifying provider payment methodologies and capitation rates under their Medicaid managed care contracts to address the impacts of the public health emergency. The guidance enumerates several options states could choose to adopt and details example state proposals in an appendix. States may effectuate these actions through managed care contract amendments, rate amendments, and state directed payment preprints and CMS noted it is continuing to prioritize and expedite reviews of these COVID-19 related managed care actions.
SBA released two interim final rules (IFRs) and an FAQ for the PPP with the following updates:
• SBA will allow lenders to increase existing PPP loans to certain classes of borrowers, specifically to partnerships and seasonal employers, to take into account new guidance on how these borrowers should calculate maximum loan amounts.
• SBA extended a “Safe Harbor” related deadline for borrowers that are repaying their PPP loans from May 14 to May 18.
SBA released two interim final rules (IFRs) and an FAQ for the PPP with the following updates:
• SBA will allow lenders to increase existing PPP loans to certain classes of borrowers, specifically to partnerships and seasonal employers, to take into account new guidance on how these borrowers should calculate maximum loan amounts.
• SBA extended a “Safe Harbor” related deadline for borrowers that are repaying their PPP loans from May 14 to May 18.
On May 13, HRSA awarded $15 million to 159 organizations across five health workforce programs to increase telehealth capabilities in response to the COVID-19 pandemic. The funding will go towards training students, physicians, nurses, physician assistants, allied health and other high-demand professionals in telehealth.
FCC issued an updated notice of awards for the COVID-19 Telehealth Program. As of May 13, FCC has awarded a total of $33.26 million to 82 health care providers in 30 states. The CARES Act appropriated $200 million for FCC to award to healthcare providers to purchase and adopt telecommunication technologies to support telehealth services for patients. FCC announces awards on a weekly basis.
A rececent piece in Kaiser Health News highlights the fact that providers who predominately serve Medicaid beneficiaries have received very little, if any, federal funding meant provide financial relief.
HUD announced allocations for $1 billion in funding to Community Development Block Grant (CDBG) grantees, including all states and insular areas. This allocation is the second CDBG allocation from the CARES Act, with $3 billion of the total $5 billion awarded to date, and was based on: public health needs, risk of transmission of coronavirus, number of coronavirus cases compared to the national average, economic and housing market disruptions, and other factors.
SAMHSA announced a $40 million funding opportunity to leverage CARES Act funding for COVID-19 Suicide Prevention Programs available to various entities including but not limited to state/territorial governments, social service providers, emergency departments, public health agencies, emergency departments, and tribal organizations. . SAMHSA anticipates making 50 awards up to $800,000 each. Applications are due May 22, 2020.
HRSA announced $225 million in awards to 4,549 Rural Health Clinics (RHCs) for COVID-19 testing, as authorized through the Paycheck Protection Program and Health Care Enhancement Act. Each RHC received a flat amount of just under $50,000, which may be used for a wide range COVID-19 testing and related expenses.
ACF notified Community Services Block Grant (CSBG) stakeholders that the agency is preparing to release the $1 billion in funding provided by the CARES Act to states, territories and tribes. The Office of Community Services (OCS) provided projected award amounts and additional instructions. Final amounts, including allocations for tribes, will be provided in subsequent guidance.
SBA issued a revised “Paycheck Protection Program Frequently Asked Questions” (FAQ) that provides clarification regarding borrowers’ required certification on their application that economic uncertainty made the PPP loan request necessary to support ongoing operations.
CMS updated its Medicaid managed care “state directed payments” page on Medicaid.gov to include COVID-19 delivery system and provider payment initiatives and post 2 example 42 CFR 438.6(c) pre-prints. The update supplements a May 14 informational bulletin in which CMS described Medicaid managed care options to mitigate the impact of the COVID-19 pandemic on Medicaid providers.
FEMA released Coronavirus guidance on medical care costs eligible for FEMA public assistance. This guidance provides information on topics including: • Primary Medical Care Facilities• Temporary and Expanded Medical Facilities
HHS provided additional detail on which providers were eligible for the Provider Relief Funding for rural hospitals and rural health clinics (RHCs) based on their geographical location and the methodology used to develop provider-specific allocations.
See “10 Billion Allocation for Rural Hospitals and Providers” section:
This document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. The May 11 update includes several new flexibilities, including, for example:• Relaxed requirements for hospitals to offer “swing-bed” services to patients who qualify for SNF-level care, subject to certain restrictions;• Reduced training requirements for paid feeding assistants in LTC facilities; and,• Expanded the list of clinicians who may perform home health initial and comprehensive assessments (prior waiver added OTs, new waiver adds PTs and speech language pathologists).
CMS issued an interim final rule with comment period (IFC) that provides additional flexibilities for Medicare, Medicaid, and Exchange coverage programs as a result of COVID-19 and also implements regulations in response to recently enacted stimulus legislation.
Tri-agency guidance extending COBRA, SEP, and other group plan timelines due to COVID-19
HHS issued a clarification for providers who are eligible for, but have not yet received, a second payment from the $20 billion tranche of the $50 billion Provider Relief Fund General Allocation. These providers must accept HHS’s Terms & Conditions and submit revenue information via tax forms or financial statements to HHS by June 3 in order to remain eligible for the additional payment. HHS also issued updated FAQs
HHS opened the CARES Act Provider Relief Fund Payment Attestation Portal for the initial $30 billion in funding. Providers must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 30 days of payment (on or around May 10 for most providers).
Analysis of CARES Act Provider Relief Fund distribution to hospitals, including the implications of distributing funds based on net patient revenue. The analysis found that the formula used to allocate the $50 billion in funding favored hospitals with the highest share of private insurance revenue as a percent of total net patient revenue.
This analysis provides updated overview of guidance from the Treasury Department about the $150 billion “Coronavirus Relief Fund,” which obligates the Secretary of the Treasury to make payments for COVID-19 response efforts to states, territories, tribal governments, and certain local government.
On April 22, the federal government published guidance and FAQs on permissible uses for the $150 billion CARES Act Coronavirus Relief Fund for states, local governments, and tribal entities.
The Treasury issued guidance on its methodology for allocating Coronavirus Relief Fund awards to Tribal governments. Treasury will distribute 60 percent of the $8 billion reserved for Tribal governments immediately, based on the population size of eligible Tribes. Treasury will distribute the remaining 40 percent based on data from Tribes and tribally-owned entities on employment levels and and increased expenditures due to the public health emergency.
Treasury issued a notice that the Alaska Native regional and village corporations are eligible to receive payments from the Coronavirus Relief Fund. In determining the appropriate allocation of payments to Tribal governments, Treasury intends to take steps to account for overlaps between Alaskan Native village membership and Alaska Native corporation shareholders or other beneficiaries.
This analysis provides a deep dive into HHS’ approach to distributing the remaining $70 billion in the Provider Relief Fund, including by disbursing an additional $20 billion based on 2019 net patient revenue from all payers, earmarking payments for providers in hot spot regions and rural areas.
Treasury issued a revised FAQ document with more guidance on parameters for use of the Coronavirus Relief Fund, including use of the funds for state unemployment insurance, workers’ compensation for essential workers, contact tracing, assistance with enrolling in government benefit programs, eviction prevention, and other expenses.
HHS announced it has begun the distribution of an additional $20 billion of the $50 billion “General Allocation” of the Provider Relief Fund. Providers eligible for the general distribution must submit required revenue information for verification, and must attest to the terms and conditions.
CDC published in the Federal Register a proposed data collection, “Emerging Infections Program (EIP) Tracking of SARS-CoV-2 Infections among Healthcare Personnel.This program would determine the extent of COVID among health care workers, describe the characteristics of health care workers infected with COVID and compare exposures and other characteristics of workers who do not become infected. Public comments will be accepted on or before July 14.
CMS issued an interim final rule with comment period (IFC) that provides additional flexibilities for Medicare, Medicaid, Basic Health Program, and Exchange coverage programs as a result of COVID-19 and also implements regulations in response to recently enacted stimulus legislation. The IFC is scheduled to be published in the Federal Register on May 8. Public comments will be accepted for 60 days following posting to the Federal Register.
Federal Emergency Management Agency (FEMA) issued guidance clarifying that its award recipients and subrecipients may generally repurpose funds under FEMA programs not originally for COVID-19 response for the purchase of medical equipment or other resources to support the COVID-19 response, with prior approval from the FEMA program office.
CMS issued a memo regarding new COVID-19 infection control and reporting rules for nursing homes in the recent interim final rule. The memo indicates CMS will be publicly posting facility-level data from the CDC National Healthcare Safety Network.
HHS announced that it has begun the distribution of $12 billion to facilities admitting large numbers of COVID-19 patients (more than 100 inpatients) and $10 billion to providers in rural areas.
SBA issued a new interim final rule for the Paycheck Protection Program (PPP), confirming the applicability of non-discrimination standards for PPP loans and providing guidance on religious employer exemption and other PPP loan eligibility criteria
The Emergency Food and Shelter Program (EFSP) National Board announced the allocations of CARES Act ($200 million) and annual FY 2019 appropriations ($120 million) distributed to Local EFSP Boards throughout the country. Local Boards will begin accepting applications from local organizations that can provide emergency food and shelter services. Local Boards’ plans for the funding are due to the National Board by 5/29/20. Organizations seeking to apply should contact their jurisdiction’s Local Board for more details.
This updated document outlines COVID-19 emergency declaration 1135 “blanket waivers” for healthcare providers and is regularly updated by CMS. The April 30 updates add new telehealth-related flexibilities, relax physical environment requirements for providers, and make changes to a number of policies related to Community Mental Health Centers and long term care providers.
This list details recipients of SAMHSA’s COVID-19 funding to date. SAMHSA has awarded $374 million in grants and supplements to address mental health and substance use disorders, support Certified Community Behavioral Health Clinics, and supplement funding for tribal behavioral health services.
HUD announced allocations for $685 million in funding to public housing agencies (PHA) through the Public Housing Operating Fund and can be used for a wide range of preparation, prevention and response actions.
The Office of Minority Health (OMH) and Office of the Assistant Secretary for Health announced a $40 million funding opportunity for the development and coordination of a strategic network of national, state, territorial, tribal and local organizations to deliver important COVID-19-related information to racial and ethnic minority, rural and socially vulnerable communities hardest hit by the pandemic. Applications are due by Monday, May 11 at 6 pm ET.
The Federal Reserve announced that it is establishing a “Main Street Lending Program,” which will provide additional credit to small and medium-sized businesses to help maintain their operations and payroll during the COVID-19 pandemic. Main Street consists of three programs: 1) Main Street New Loan Facility, 2) Main Street Expanded Loan Facility and 3) Main Street Priority Loan Facility. All three facilities use the same eligible lender and borrower criteria, and have many of the same features, including the same maturity, interest rate, deferral of principal and interest for one year, and ability of the borrower to prepay without penalty. The loan types also differ in how they interact with the Eligible Borrower’s existing outstanding debt, including with respect to the level of pre-crisis indebtedness a borrower may have incurred.
The Federal Reserve issued FAQs on the Main Street Lending Program for small and medium-sized businesses during the COVID-19 pandemic. The FAQs outline loan eligibilitiy, application process, and terms. The Program has not yet launched.
HRSA awarded nearly $583 million to 1,385 HRSA-funded health centers in all 50 states, the District of Columbia, and eight U.S. territories to expand COVID-19 testing.
The Administration for Community Living (ACL) released an FAQ on $85 million distributed to Centers for Independent Living to address needs of individuals with disabilities and allow them to remain safely in their communities. The FAQ covers funding allocation methodologies, allowable uses of funding, and reporting requirements.
The White House issued guidelines for easing stay-at home restrictions for states and employers. State responsibilities included development and implementation of testing and contract tracing, healthcare system capacity support, and planning with various industries and public leaders.
HRSA opened its program portal and issued FAQs for providers to receive reimbursement for COVID-19 testing and treatment for uninsured patients. Providers must register with HRSA and may start submitting claims electronically on May 6th, with reimbursement beginning in mid-May. The reimbursement is supported through the $1 billion through the Families First Act and an additional yet-to-be-specified amount under the CARES Act Provider Relief Fund.
HRSA announced a funding opportunity for $15 million to tribal organizations. Applications are due May 6, 2020.
CMS provided additional information on the $100 million in CARES Act supplemental funding for survey and certification efforts of nursing homes, noting it intends to make $81 million of the $100 million available to states through September 30, 2023.
FCC approved its fourth set of COVID-19 Telehealth Program applications, distributing an additional $4.2 million. FCC has awarded $13.7 million to date under the program, which allows for up to $200 million in funding, and continues to approve applications on a rolling basis.
CMS approved parts of the state of Washington’s COVID-19 section 1115 waiver request that aligned with CMS’ COVID-19 Section 1115 demonstration opportunity guidance and checklist template. CMS is still reviewing several aspects of the request (e.g., the establishment of a disaster relief fund to pay providers for uncompensated care related to COVID-19) and denied its request to establish a temporary eligibility group for individuals with incomes at or below 200% of the FPL. In deferring approval, CMS noted that a number of Washington’s requests may be approvable under a Medicaid Disaster state plan amendment (SPA) or Appendix K for 1915(c) waivers. This is the first approval of 1115 waiver authority related to the COVID-19 response.
ACF announced intent to award $45 million to states, territories, and tribes to support the child welfare needs of families during the crisis and to help keep families together, as authorized by the CARES Act.
Manatt Health’s analysis of CMS’ guidance for states about new increased Medicaid and CHIP matching rate.
In response to the COVID-19 pandemic, the federal government is moving rapidly to help states and health care providers respond to mounting needs for new sources of funding and flexibility. Congress has passed three COVID-19 stimulus bills, and the U.S. Department of Health and Human Services has issued guidance outlining new flexibilities available to states and providers, and is working to approve additional requests from states, to award funds appropriated by Congress, and to issue more guidance about such funding. This Q&A provides a moment-in-time update in response to questions SHVS has received about the federal government’s response.
CMS issues guidance on flexibilities to allow certain freestanding emergency departments to participate in Medicare and Medicaid to increase hospital capacity.
New toolkit and resource guide to help state and local decision-makers address health care workforce challenges in their communities.
HRSA announced nearly $165 million in awards to rural communities, including to support 1,779 small rural hospitals, and 14 HRSA-funded Telehealth Resource Centers (TRCs) providing technical assistance on telehealth in rural and underserved areas.
Webinar recording and slide deck from webinar hosted on March 18, 2020.
ACL announced that it is awarding $905 million in CARES Act funding for older adults and people with disabilities.
SAMHSA released a list of Certified Community Behavioral Health Clinic (CCBHC) awardees for grants to increase access to and improve the quality of community mental health and substance use disorder (SUD) treatment. Funding includes $200 million in annually appropriated funding and $250 million in emergency COVID-19 funding.
HRSA announced an upcoming funding opportunity to make $15 million in awards available to tribal organizations. The funding opportunity announcement is expected on 4/21/2020 and the estimated application due date is 5/12/2020.
DHS and FEMA announced an additional $100 million in supplemental Emergency Management Performance Grant Program funds; application submissions are required by April 28.
ACL announced $955 million in CARES Act grants for support of older adults and people with disabilities. These grants will fund services such as home-delivered meals, care services in the home, and respite care; the majority of these funds are being awarded to states, territories, and tribes for subsequent allocation to local service providers.
ACF announced distribution of $3.5 billion in additional Child Care Development and Block Grant funds to support families, health care workers, other first responders, and child care providers during the public health crisis.
CMS issued recommendations for healthcare facilities in areas that have low or stable incidence of COVID-19 to begin to restart care that has been postponed in response to the COVID-19 outbreak.
CCIIO issued an FAQ for commercial health insurance issuers on flexibilities related to utilization management and prior authorization.
Guidance from CMS increasing nursing home transparency related to COVID-19, including through reporting cases to the CDC, and notifying residents and families of confirmed cases.
SBA issued an interim final rule on the Paycheck Protection Program, to provide economic relief to small businesses-including small healthcare providers and community-based organizations adversely impacted by the COVID-19 public health emergency. Public comment is open through May 15, 2020.
On Thursday, April 16 State Health and Value Strategies hosted a webinar, Implications of Health Care Provisions for States in the CARES Act, on the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law on March 27. The CARES Act contains a number of health care related provisions and federal funding sources to support states as they continue to work tirelessly to respond to the COVID-19 outbreak. During the webinar experts from Manatt Health and Georgetown’s Center on Health Insurance Reforms highlighted funding opportunities and conducted a deep dive on key provisions relevant to states included in the CARES Act.
Section 3221 of the CARES Act changes federal law regarding the confidentiality of substance use disorder (SUD) records, including surrounding sharing of written consent with HIPAA covered entities.
Webinar slides and recording that explores the key health care provisions in the second COVID-19 stimulus bill.
ACL recently opened a competitive funding opportunity for states with Aging and Disability Resource Centers (ADRCs) to support immediate response to urgent needs resulting from COVID-19. $50 million available through this opportunitity and applications are due by April 27.
CMS’ website is now updated with a list of submitted and approved Medicaid Disaster State Plan Amendments (SPAs)
HRSA announces $1.3 billion in awards to 1,387 health centers across the United States with funding provided by the Coronavirus Aid, Relief and Economic Security (CARES) Act. This interactive map provides a summary of the CARES Act funding awarded to health centers in each state and US territory.
Federal Guidance on the Families First and CARES Act Legislation
Providers must accept the terms and conditions outlined by HHS in this document prior to receiving funds from the CARES Act.
A state-by-state breakdown of how the first $30 billion of the CARES Act funding will be distributed to US states and territories
CMCS issued new Medicaid FAQs regarding the new optional COVID-19 testing Medicaid eligibility group, benefits and cost-sharing for COVID-19-related testing and diagnostic services, the increased FMAP available under Section 6008 of the FFCRA, and other FAQs
This expert perspective, written by experts at Manatt Health, discusses strategies state Medicaid and CHIP agencies can pursue as part of their response to COVID-19.
New fact sheet from HHS detailing the specifics of how the first $30 billion of CARES Act funding will be distributed to providers. Funds will be distributed immediately proportionate to providers’ share of Medicare fee-for-service reimbursements in 2019. The fact sheet notes that HHS is working to develop targeted distributions to hospitals and providers that will focus on providers in hotspot COVID areas, rural providers, and providers with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population.
State-by-state tracker of 1135 waiver requests and approvals.
CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs.
Summary of changes to the the Physician Self-Referral Law, also known as the Stark Law, in light of COVID-19 emergency
This analysis describes flexibilities given to providers under Section 1135 waivers, such as enabling providers to deliver care in alternate care settings and expand workforce capacity.
This page includes guidance and templates for the Medicaid State Plan Disaster Relief SPA and CHIP Disaster Relief SPA.
This page includes federal background information on Section 1135 waivers and a CMS-developed template for states and territories.
Arizona was the first state to have its Disaster SPA approved by CMS on 4/1/2020. The SPA includes several provisions including waiving copays, premiums and deductibles for all members and provision of continuous eligibility for children under the age of 19.
CMS issued a revised FAQ for state Medicaid and CHIP agencies, initially issued on March 12. The May 5-issued FAQ provides additional guidance on available waiver and state plan amendment authorities during the COVID-19 public health emergency, the Basic Health Plan program, presumptive eligibility categories for Medicaid plans, member enrollment flexibilities during the public health emergency, terms for states receiving the previously announced 6.2 percentage point FMAP increase, and other topics.
CMS released an interim final rule with comment period that proposes several changes to the Medicaid and Medicare programs. For the Medicaid program, the rule amends health home regulations by allowing other licensed practitioners to order home health services, without physician sign-off.
This guidance allows practitioners further flexibility in prescribing and dispensing buprenorphine to new and existing patients with opioid use disorder via telephone without examination in person or via telemedicine.
In light of the growing number and diversity of approved 1135 waivers, this Q&A document provides a general primer on Section 1135 to help healthcare stakeholders understand the scope of what HHS and CMS can and cannot do under this emergency authority.
Information on federal tax provisions, guidance, and operational changes responding to COVID-19.
IRS Notice allowing HDHPs to waive cost-sharing for COVID-19 testing & treatment.
Plain-Language Information about Coverage Options, Eligibility, and COVID-Related Benefits
CCIIO guidance on COVID-19 coverage and catastrophic plans
CCIIO FAQs on telehealth coverage
CCIIO guidance on Rx coverage and COVID-19.
CCIIO guidance on grace periods.
Compilation of COVID-19 FAQs on private insurance issues.
CMS expands Accelerated and Advance Payments to all Medicare FFS providers and suppliers.
Recordings and transcripts of CMS calls on COVID-19 with states and other stakeholders
Compilation of resources for state on Medicare, Medicaid, and CHIP, including transcripts and recordings of all-state calls
This broad-sweeping guidance outlines a host of blanket waivers and flexibilities that the Administration is affording to health care providers.
This letter requests that hospitals report testing data to HHS and bed capacity and supplies to CDC’s National Healthcare Safety Network on a daily basis.
Resources on waivers and flexibilities available to states and providers
The governor of theis state sent a letter to HHS and CMS requesting a SEP to allow for uninsured and underinsured residents to enroll in health coverage through healthcare.gov.
The governor of theis state sent a letter to HHS and CMS requesting a SEP to allow for uninsured and underinsured residents to enroll in health coverage through healthcare.gov.
Reinforces plans’ obligations under existing state authority to cover all medically necessary treatment, including for COVID-19, without prior authorization.
Second COVID-19 response / stimulus bill.
A new infographic detailing the U.S. Department of Health and Human Services (HHS) agencies allotted funds in the first COVID-19 bill, Preparedness and Response Supplemental Appropriations Act, 2020—including the Public Health and Social Services Emergency Fund, the National Institutes of Health (NIH) , the Health Resources and Services Administration (HRSA) and the Centers for Disease Control (CDC)—as well as the amounts of the funding, the uses and the recipients.
Summary of Key Healthcare Provisions in the Second COVID-19 Stimulus Bill.
This page catalogs CMS’s approved COVID-19 State Section 1135 waivers.
This page includes 1915(c) Waiver Appendix K templates, instructions, and CMS ‘s approved COVID-19 State Appendix K documents.
This page includes guidance and a template for COVID-19 1115 waiver demonstrations.