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. |
HHS announced that it is broadening the eligibility criteria regarding providers eligible for the new, $20 billion allocation of the Provider Relief Fund, known as “General Distribution Phase 3.” HHS had previously announced that this Fund would be available to providers that bill Medicare and/or Medicaid/CHIP, as well as certain provider types regardless of whether they bill Medicare or Medicaid/CHIP, including behavioral health providers, dentists, and assisted living facilities. HHS is now further expanding the pool of eligible providers by including other providers of patient care services that do not bill Medicare or Medicaid/CHIP, including chiropractors, nursing service providers, hospice providers, laboratories, eye and vision service providers, nursing and custodial care facilities, among others. Notably, HHS does not seem to have yet updated the application instructions to reflect that these providers are eligible; nonetheless, these providers should submit their TINs for validation and submit their applications as soon as possible.
On October 21, HHS posted informational materials on the Provider Relief Fund Phase 3 General Distribution, including a one-page fact sheet, 12-page presentation, and recording of its October 15 informational webinar. Because the eligibility changes were announced on October 22, the latest broadening of eligibility does not yet appear in these materials.
HHS issued new guidance related to the reporting requirements tied to receiving Provider Relief Fund (PRF) payments, walking back the September 19 guidance, which changed “lost revenue” to mean net operating income. Under the October 22 guidance, providers can keep PRF dollars equal to their year-over-year change in revenue from 2019 to 2020. In other words, HHS has scrapped the change in net operating income definition from the September 19 guidance. This also eliminates the part of the guidance that allowed providers with negative 2019 margins to keep provider relief revenue up to a break even in 2020.
As was the case with the September 19 guidance, the provider-level impact will vary.
– Many providers are pleased with the change because they will have a better case for keeping more money by demonstrating lost revenue and not lost profit.
– Others—particularly those with negative 2019 margins—will be in a worse position.
– In either case, there is still a risk that some providers will not be able to retain their full PRF payment. For example, providers that received particularly large payments (e.g., hot spot hospitals and rural providers that received large targeted distributions) are at the greatest risk for needing to return funding.
HHS issued new Provider Relief Fund FAQs regarding Phase 3 of the General Distribution (which is currently open to applicants). HHS indicated that prescription sale revenues may not generally be included as part of patient care revenue submitted to HHS for its determination of payments–with one exception: Patient care revenues should include savings obtained by providers through enrollment in the 340B program.
HHS published updated data regarding providers that have received Provider Relief Fund General Distribution (Phase 1 or Phase 2) and/or Targeted Distribution payments (which includes allocations for high impact areas, safety net hospitals, rural providers, tribal facilities, clinics and urban health centers, and skilled nursing facilities); attested to receiving payment; and agreed to HHS’s terms and conditions as of October 12. As of this cut-off date, 358,598 providers have attested to receiving $90.6 billion in Provider Relief Fund payments.
HHS released the following materials with information for providers interested in applying for Phase 3 of the General Distribution of the Provider Relief Fund: – Application instructions – Sample application form – Provider Relief Fund FAQs (see section regarding Phase 3 of the General Distribution) – Webcast registration information for a webinar to be held October 15 at 3:00 pm
This document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. In the September 30 update, CMS issued an update to the deadline for teaching hospitals to submit Medicare Graduate Medical Education (GME) affiliation agreements that were either originated or amended for FY2020. CMS previously extend the deadline from June 30 to October 1, 2020 and has now extended the deadline to January 1, 2021.
HHS announced a new $20 billion Phase 3 General Distribution of the Provider Relief Fund, which providers may apply for between October 5 and November 6. The Phase 3 General Distribution makes the General Distribution available to additional behavioral health provider types and gives these and other providers the opportunity to receive additional payment–above 2% of net patient revenue–based on HHS’s assessment of applicant providers’ financial losses and changes in operating expenses caused by COVID-19. HHS also will take into consideration providers’ aggregate provider relief fund payments to date.Eligible Providers:
– Providers that previously received, rejected, or accepted a General Distribution payment. Providers that already received General Distribution payment(s) amounting to 2% or more of net patient revenue may submit more information to become eligible for an additional payment
– Behavioral Health providers, including those that previously received funding and providers that HHS determined with SAMHSA did not receive funding (HHS notes that this may include, for example, addiction counseling centers, mental health counselors, and psychiatrists)
– Providers that began practicing between January 1, 2020 and March 31, 2020 (these providers were ineligible for prior General Distribution payments).
This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers
As a follow-up to its September 19 guidance outlining the reporting requirements for Provider Relief Fund (PRF) recipients that received one or more General Distribution or Targeted Distribution payments exceeding $10,000 in the aggregate, HHS announced via its PRF “Reporting Requirements & Auditing” landing page that the PRF reporting system will be made available on January 15. Previously, HHS indicated that it planned to launch the PRF Reporting System on October 1. Providers are expected to submit the first reports regarding 2020 spending by February 15.
As a follow-up to its August 14 and September 19 guidance outlining the reporting requirements for Provider Relief Fund (PRF) recipients that received one or more General Distribution or Targeted Distribution payments exceeding $10,000 in the aggregate,* HHS released a one-page summary of the reporting deadlines, reporting requirements, and permissible uses of Provider Relief Fund payments. HHS also updated its PRF “Reporting Requirements and Auditing” landing page to include the first FAQ regarding the reporting requirements. The single FAQ currently available on the page does not provide new substantive information about reporting requirements, but providers will want to monitor this page as HHS is expected continue to post FAQs related to the reporting requirements on this page.* Does not apply to the ~$2.5 billion Nursing Home Infection Control distribution.
HHS issued new Provider Relief Fund FAQs clarifying the application deadline for the $18 billion Phase 2 of the Provider Relief Fund General Distribution. As previously announced, providers were to submit a taxpayer identification number (TIN) by September 13 for HHS to validate in its determination of applicants’ eligibility for payment. In the September 17 update to the FAQs, applications must be started by September 21 and submitted by September 28.
HHS announced that assisted living facilities (ALFs) that do not bill Medicare or Medicaid and therefore have not otherwise been eligible for the Provider Relief Fund General Distribution are now eligible for Phase 2 of the General Distribution. To accommodate this eligibility expansion, HHS clarifies in its Provider Relief Fund FAQs that HHS has developed a curated list of assisted living facility TINs from third party sources and HHS datasets. Akin to the process HHS has taken to validate Medicaid/CHIP providers, HHS will work with states and its partners to authenticate assisted living facilities that are not on the curated list. All providers eligible for Phase 2 General Distribution funding–including newly-eligible ALFs–have until September 13, 2020 to begin their application by entering their Tax Identification Number (TIN) for validation. The FAQs also address how ALFs should calculate revenue from patient care.
HHS issued new and modified Provider Relief Fund FAQs, clarifying:The Methodology & Parameters of the $5 Billion Nursing Home Infection Control DistributionAs previously announced, HHS distributed approximately $2.5 billion in upfront funding to nursing homes to support increased testing, staffing, and personal protective equipment (PPE) needs. The FAQs apply new nomenclature to this distribution, deeming it the “Nursing Home Infection Control Distribution.” Unlike other Provider Relief Fund distributions, these payments may only be used for the infection control expenses defined in the Terms and Conditions, which includes costs associated with administering COVID-19 testing for both staff and residents; reporting COVID-19 test results to local, state, or federal governments; hiring staff to provide patient care or administrative support; incurring expenses to improve infection control, including “mentorship” programs with subject matter experts or changes made to physical facilities; and providing additional services to residents, such as technology that permits residents to connect with their families if their families are not able to visit in person. Recipients received a per-facility payment of $10,000 plus a per-bed payment of $1,450. Eligible providers include nursing homes and skilled nursing facilities that are not revoked, have an active CMS certification, and have at least 6 certified beds.Application Processes for Phase 2 of the General DistributionHHS clarified that providers applying for Phase 2 of the General Distribution (for which applications are now being accepted through September 13):
– May submit a new application for Phase 2 even if there is an application still under consideration as part of Phase 1 of the General Distribution.
– If the provider experienced a change in ownership in 2019 or 2020, the provider should report the revenue, along with the proportion of revenue from patient care, for the acquisition or dispositions from the date of sale through the date of application in the Provider Relief Fund Application and Attestation Portal.
Considerations for Providers with Specific Ownership Structures and Financial Relationships
-Parent organizations that received a Provider Relief Fund Targeted Distribution on behalf of a subsidiary should attest to the Terms and Conditions rather than their subsidiary.
– Parent entities submitting applications on behalf of their subsidiaries may enter up to 1,200 subsidiary TINs in the application portal which will initiate the application process for each of their subsidiaries.
HHS’ Office of the Inspector General (OIG) released an updated list of its Active Work Plan Items reflective of OIG’s audits, evaluations, and inspections that are underway or planned in determination of providers’ compliance with temporary authorities during the COVID-19 public health emergency. The newly-announced items include:
– Hospital Recipients of Provider Relief Funds (PRF)—General and Targeted Distributions. OIG will audit a statistical sample of PRF recipients to determine whether providers that received PRF payments complied with federal requirements including “the terms and conditions for reporting and expending federal funds.” OIG expects the report to be issued fiscal year 2021. Although the title of the report title specifies hospitals, the description is unclear about whether the audit will indeed be limited to hospitals or other providers that have received PRF payments.
– Audit of Medicare Payments for Inpatient Discharges Billed by Hospitals for Beneficiaries Diagnosed With COVID-19. OIG will audit whether payments made by Medicare for COVID-19 inpatient discharges billed by hospitals complied with federal requirements. Notably, Section 3710 of the CARES Act directed the Secretary to increase the weighting factor that would otherwise apply to the assigned DRG by 20 percentage points for an individual who is diagnosed with COVID-19 and discharged during the COVID-19 public health emergency.
CMS issued guidance in coordination with its release of the interim final rule with comments (IFC) regarding new/modified Clinical Laboratory Improvement Amendments (CLIA) regulations related to laboratory reporting of COVID-19 test results. The guidance emphasizes that health care facilities using Point of Care COVID-19 testing devices under a CLIA Certificate of Waiver, including nursing homes, pharmacies, or other settings will be required to report test results under the IFC. The guidance also enumerates the mandatory citations and civil monetary penalties that will apply to CLIA-certified laboratories who fail to meet the IFC requirements.
In coordination with its release of its third interim final rule with comments (IFC) related to the COVID-19 public health emergency, CMS issued guidance that builds upon the nursing home COVID-19 testing requirements established in the IFC. The guidance sets out facility requirements for testing resident and staff based on “testing triggers” such as a symptomatic individual being identified, an outbreak (i.e., any new case arises in the facility), or routine testing. The guidance requires that:• Staff and residents with signs/symptoms of COVID-19 are tested;• In the event of an outbreak, all staff and residents that previously tested negative should be retested every 3 to 7 days until there are no new cases for a period of at least 14 days; • Routine testing should be completed for staff, but not residents unless the resident “leaves the facility routinely.” Routine testing for staff should be conducted in accordance with parameters set forth related to the weekly positivity rate in the county in which the facility is located.The guidance also includes: other testing considerations; information about the steps facilities should take to address individuals who refuse testing; information about conducting, documenting, and reporting testing; an updated COVID-19 focused survey for nursing homes; and additional resources.
CMS issued an interim final rule with comments (IFC) related to the COVID-19 public health emergency. The rule includes a focus, in particular, on COVID-19-related testing and reporting requirements for nursing homes and hospitals. It also includes modifications to quality reporting program requirements impacting plans and providers.Key areas addressed by the rule include:
CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) issued a fact sheet describing the applicability of the IFC to individual and small group market health plan issuers. The fact sheet describes the impact of the IFC on Medical Loss Ratio (MLR) reporting and rebate requirements for issuers electing to provide temporary premium reductions.The IFC will become effective upon its pending publication to the Federal Register through the duration of the Public Health Emergency. Public comment will be available for 60 days upon the IFR’s publication to the Federal Register.
HHS announced a new $1.4 billion allocation of the Provider Relief Fund for free-standing children’s hospitals. HHS indicated in its announcement that the distribution is aimed at ensuring “that certain free-standing children’s hospitals, not affiliated with larger hospital systems, also receive the financial relief they urgently need to offset revenue losses,” suggesting that the distribution is meant to provide funding to hospitals that were left out of the prior safety net hospital distribution. These free-standing children’s hospitals—defined as those that are either exempt under the CMS inpatient prospective payment system or are HRSA-defined Children’s Hospital Graduate Medical Education facilities—will receive a payment in the amount of 2.5% of net patient revenue beginning the week of August 17. HHS also published a state/regional-level breakdown of validated children’s hospital distribution; the Department notes that an additional 24 children’s hospitals are being reviewed and the file will be updated once that validation is complete.
HHS announced that it is now accepting applications for the General Distribution: Phase 2 of the Provider Relief Fund–which now includes Medicaid, CHIP, and dental providers that did not bill Medicare in 2019 plus providers who missed out on their 2% of net patient revenue payment in Phase I–and released instructions for eligible providers to apply. The General Distribution is made up of two funding streams: • one for any provider who billed Medicare in 2019 (“Medicare General Distribution” or the “General Distribution: Phase 1”), and • one for Medicaid/CHIP/dental providers who did not bill Medicare in 2019 and therefore were entirely left out of the Medicare General Distribution (“Medicaid, CHIP, and Dental Provider General Distribution” or “General Distribution: Phase 2”). All Medicare, Medicaid, and dental care providers who have not received at least 2% of patient revenue from a General Distribution payment should apply for Phase 2 of the General Distribution by August 28, via the Provider Relief Fund Application and Attestation Portal.
HHS issued new and modified Provider Relief Fund FAQs, including FAQs specifying:- July 31, 2021 as the date by which providers must fully expend Provider Relief Fund dollars;- How Financial Management Services can apply for the Medicaid/CHIP Distribution on behalf of Home & Community Based Services (HCBS) providers, including how to count self-directed providers as full time employees (FTEs); and- Parent organizations may only redistribute General Distribution payments among subsidiaries. Control and use of Targeted Distribution payments must be delegated to/remain with the entity that was eligible for the Targeted Distribution payment.
HHS announced that it is extending the deadline for eligible providers to apply for the Medicare General Distribution and Medicaid, CHIP, and Dental Providers Distribution of the Provider Relief Fund. These announcements impact the following providers:Providers eligible for the Medicaid, CHIP, and Dental Providers Distribution. These providers (Medicaid/CHIP and dental providers that did not bill Medicare fee-for-service in 2019) now have until August 28, 2020 to apply for payment.Providers that billed Medicare fee-for-service in 2019 but did not receive their full 2% of patient revenue payment from the $50 Billion General Distribution. HHS has re-opened the $50 billion Medicare General Distribution–which it had previously closed on June 3, 2020.HHS also indicated that it is “working to address relief payments” for providers that were newly established in 2020 (and therefore are ineligible for both distributions described above) and other providers that have not yet received any payment (such as those that only bill commercial insurance).
OIG released two toolkits summarizing lessons learned from OIG reports on emergency preparedness and response published between 2002 and 2004 . The first toolkit addresses state and local actions during emergency events such as infectious disease outbreaks and natural disasters, and the second toolkit focuses on healthcare facility response during such events. While the evaluations referenced in the toolkits took place prior to the COVID-19 pandemic, OIG intends for this information to assist communities and healthcare facilities in responding to the current pandemic.
CMS modified a previously issued waiver regarding the deadline for hospital Wage Index Occupational Mix surveys. The original deadline for 2020 was July 1. On March 30, CMS granted an extension for hospitals nationwide affected by COVID-19 until August 3, 2020. Due to continued COVID related concerns from hospitals about meeting this deadline, CMS is further extending this deadline to September 3, 2020. Hospitals must submit their occupational mix surveys along with complete supporting documentation to their MACs by no later than September 3, 2020. Hospitals may then submit revisions to their occupational mix surveys to their MACs, if needed, by no later than September 10, 2020.
HRSA published updated data regarding providers that have received reimbursement from the Claims Reimbursement for COVID-19 Care of the Uninsured Program and agreed to HHS’s terms and conditions as of July 15. As of this cut-off date, 13,901 providers have received $419.1 million in claims reimbursement.
The Departments of Health & Human Services, Labor, and Treasury (collectively, the “tri-agencies”) published guidance on April 11 in attempt to clarify some of the testing coverage requirements under FFCRA and the CARES Act. However, as calls have increased for more widespread and frequent testing, particularly of at-risk populations such as health care workers, residents and staff of long-term care facilities, and people potentially exposed at protests or rallies, insurers have questioned their responsibility to cover all testing in all circumstances.On June 23, the tri-agencies published new guidance that attempts to answer implementation questions from states, plans, and insurers, including the definition of “medically necessary”, surveillance or workplace related testing, coverage of hospital “facility fees”, and protections against provider balance billing.
HHS issued new Provider Relief Fund FAQs, clarifying:- Parent organizations with multiple billing TINs that each received General Distribution payments may attest and keep the payments (as long as the subsidiaries attest to the Terms and Conditions) and can control and allocate funds to its subsidiaries at its discretion provided that they parent organization attests to receiving the payments and accept HHS’ terms and conditions.- The revenue data used to determine payments for the Medicaid, CHIP, and Dental Providers Distribution will be based on the applicant’s most recent federal income tax return for 2017, 2018 or 2019.
HHS issued a revised Provider Relief Fund FAQs indicating that the application deadline for the Provider Relief Fund Dental Provider Distribution is extended to August 3rd from July 24th.
HHS announced the following Provider Relief Fund updates:• Medicaid providers eligible for the Medicaid Distribution may submit applications through August 3, rather than the original July 20 deadline. HHS indicated that it is “continuing to work with provider organizations, Congressional, state and local leaders to get the word out about this program,” suggesting that application rates have been low.• HHS will begin to distribute the second tranche of Provider Relief Fund payments to hotspot hospitals next week. HHS distributed the first round of funding to 395 hospitals that had at least 100 COVID-19 admissions between January 1 and April 10. This second tranche of funding will go to hospitals that had at least 161 COVID-19 admissions between January 1 and June 10—“taking into account” the amount of funding that hospitals received in the prior distribution. Alongside the press release, HHS published data listing the nearly 1000 hospitals that, between the first and second tranche of hotspot hospital allocations, have received or will receive payment.
On June 9, the U.S. Department of Health and Human Services (HHS) announced the allocation of $15 billion in funding to be distributed to Medicaid/CHIP providers who did not receive a payment from the $50 billion General Distribution. The below table summarizes the funding allocations, eligibility requirements, and the process to apply. Medicaid/CHIP providers must apply no later than August 3, 2020 (this deadline was formerly July 20, which was extended on July 17). We encourage all Medicaid providers that may be eligible to begin the application process as soon as possible by submitting their Tax Identification Number (TIN) through the CARES Act Provider Relief Fund Attestation Portal.
HHS announced the following new Provider Relief Fund distributions:- Additional ~$3 Billion for Safety Net Hospitals: On June 9, HHS announced a $10 billion distribution to safety net hospitals that met certain criteria (for more information, see Manatt’s newsletter). In today’s announcement, HHS indicated that it is expanding the criterion related to hospital profitability. To receive the June 9-announced payment, hospitals were required to (among other criteria) have demonstrated profitability of 3% or less on their most recent cost report. The new $3 billion distribution will now include hospitals that meet a profitability threshold of 3% or less over two or more of the last five cost reporting periods. HHS expects to distribute over $3 billion across 215 acute care facilities based on this criterion adjustment, bringing the total distribution to safety net hospitals to $12.8 billion across 959 facilities. – $1 Billion for Certain Rural Providers and Other Providers from Small Metropolitan Areas: In May, HHS announced $10 billion in funding for rural providers (including hospitals, health clinics, and health centers). HHS is expanding that payment formula to include certain special rural Medicare designation hospitals in urban areas, as well as others that provide care in smaller, non-rural communities (which may include some suburban hospitals). Payments will range from $100,000 to $4.5 million. – Allocation for Dentists: An application process is now open for dentists who may not have been eligible to receive funding through the Provider Relief Fund. Eligible dentists will receive 2% of their annual reported patient revenue and have until July 24 to apply for funding via the enhanced portal.
HRSA issued a fact sheet on the $15 billion Provider Relief Fund Medicaid/CHIP Provider distribution, reiterating previous guidance on the eligibility requirements, application process, attestation requirements, and payment methodology for this distribution.
This document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. The June 25 update indicates that CMS has terminated the waiver of 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system. This is the first termination of a COVID-19 related 1135 waiver and in accompanying guidance, CMS justified the termination on the grounds that more than half of facilities continued to report data, and that staffing data is an important component of assessing quality.
This regulatory analysis provides an overview of New Hampshire’s directed payment and the documents used in the New Hampshire approval.
Responses to CMS’ questions regarding NH’s directed payment
Responses to CMS’ questions regarding NH’s directed payment
Letter from CMS to NH notifying the state of approval of their directed payment
New Hampshire directed payment preprint submission to CMS
Memo from Milliman to Henry Lipman, New Hampshire’s Medicaid Director, presenting updated rates for September 1, 2019 through June 30, 2020, certification of their actuarial soundness, and a description of how New Hampshire established and will administer the new provider payment pool for the directed payments.
HHS announced its latest allocations of the $175 billion Provider Relief Fund, including approximately $15 billion for Medicaid providers that do not bill Medicare (predominantly outpatient providers), $10 billion for safety net hospitals as defined by specific HHS criteria and an additional $10 billion for COVID-19 “hot spot” hospitals. HHS indicated that the safety net hospital payments will be distributed “this week.” The timing of the other distributions is not yet known.
HHS’s Office for Civil Rights (OCR) issued guidance clarifying that, generally, HIPAA permits a covered health care provider to use protected health information (PHI) to identify and contact patients who have recovered from COVID-19 to provide them with information about donating blood and plasma that could help other COVID-19 patients.
CMS issued COVID-19 FAQs for non-long term care facilities and intermediate care facilities for individuals with intellectual disabilities. The FAQs clarify existing flexibilities for these organizations and respond to clarifying questions submitted by such providers.
The Center for Consumer Information & Insurance Oversight (CCIIO) issued guidance to sponsors of non-federal governmental plans clarifying the following policies:- Requirement to cover COVID-19 Diagnostic Testing and Certain Related Items and Services without Cost Sharing or Medical Management. T- Temporary Period of Relaxed Enforcement of Certain Timeframes Related to Group Market Requirements under the Public Health Service Act (PHS Act).- Expanding and Promoting Access to Telehealth Options and Prescription Drugs during the COVID-19 Outbreak.
CMS issued guidance for providers in states and regions in Phase II of the White House’s “Opening Up America Again” guidelines that have no evidence of a COVID-19 rebound. The guidance encourages providers in these regions to return to offering non-emergent, non-COVID care in-person when such care cannot be offered virtually, for patients that are not at higher risk for severe COVID-19 illness (as defined by CDC).
HHS, through the Health Resources and Services Administration (HRSA), announced’- a $15 billion allocation of the Provider Relief Fund for Medicaid and CHIP providers that have not received a payment from the Provider Relief Fund General Allocation (roughly 38% of Medicaid/CHIP providers, according to HHS); -$10 billion allocation of the Provider Relief Fund for safety net hospitals; and- a new $10 billion distribution of the Provider Relief Fund, considered a second “high impact” paymen
HHS launched a COVID-19 testing website that collates testing background information, HHS guidance related to the availability of COVID-19 tests (e.g., emergency use authorizations), guidance for providers and public health providers about who should be tested for COVID-19 (issued by CDC), and other guidance.
The White House issued an addendum to its Testing Blueprint, outlining a prioritization approach for COVID-19 diagnostic and surveillance testing. The guidance includes the following “areas of focus”:1) Diagnosing active infection in individuals. 2) Using testing for proactive surveillance. 3) Developing innovative approaches to support the reopening of colleges and universities
In recent months, the Department of Health and Human Services (HHS) has issued ongoing announcements and updates with respect to the Provider Relief Fund. The guidance and updates that HHS has provided to date relate to the $100 billion authorized by the CARES Act; they do not yet contemplate how HHS will distribute the additional $75 billion.This analysis provides:• An overview of the available funds, the resources HHS has made available to providers, and the steps that providers will need to take (or must have already taken) to access these funds. • An overview of the longer-term reporting and documentation requirements that providers will need to satisfy by way of accepting these funds. See page 8.
The coronavirus pandemic of 2020 has created a seemingly paradoxical scenario for the finances of health care providers. While states were rushing to build field hospitals to prepare for a surge of COVID-19 patients, traditional revenue streams for providers completely dried up: elective procedures were suspended and social distancing protocols limited the number of patients in office settings. A public health crisis became a health care crisis, as COVID-19 revealed the faults in the way necessary and critical health care services are paid for in America.
HHS Assistant Secretary for Preparedness and Response (ASPR) announced $250 M in Hospital Preparedness Program (HPP) awards to aid health care systems responding to the COVID-19 pandemic as authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. HPP funds support hospitals and other health care entities to train workforces, expand telemedicine and the use of virtual healthcare, procure supplies and equipment, and coordinate effectively across regional, state and jurisdictional, and local health care facilities to respond to COVID-19.
A blog post from the Urban Institute analyzing how HHS has distributed Provider Relief Fund payments to date. As of June 10, 2020, 35 percent of the aid remains unallocated.
CMS approved COVID-19 Section 1135 waiver requests for Arizona which includes a new 1135 waiver authority regarding Medicaid home health and medical equipment. Specifically, the state may delay the required “face-to-face encounter” for up to one year from the date of service (normally, the encounter must occur before the initiation of medical equipment, or within 30 days after the start of home health services).
SBA and the Treasury Department are setting aside $10 billion of the $321 billion authorized by the PPPHCE Act for the PPP exclusively for CDFI lenders. As of May 23, CDFIs had approved $3.2 billion of PPHCEA-authorized PPP funds, leaving $6.8 billion to be fulfilled as part of the new set-aside.
HRSA awarded $15 million to 52 Tribes, Tribal organizations, urban Indian health organizations, and other health services providers to Tribes across 20 states. HRSA made these CARES Act awards in response to applications submitted through the Rural Tribal COVID-19 Response (RTCR) program. Applicants could request up to $300,000 in funding and were assessed based on their needs and capacity to implement COVID-19 related activities in their rural communities
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.
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 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.
New York’s Department of Health issued a directive determining that COVID-19 testing of nursing home and adult care facility personnel is medically necessary and twice weekly testing is essential. The health directive was accompanied by a concurrent New York Department of Financial Services directive to insurers requiring coverage of twice weekly testing of all nursing home and adult facility personnel without cost sharing.
An analysis by the Commonwealth Fund on the impact of COVID-19 on outpatient visits. Although visits to ambulatory care practices have rebounded since ealry April after a decline of nearly 60 percent, visits are still a third lower than they were before the pandemic.
This Health Affairs blog post highlights states’ policy responses to the COVID-19 pandemic, as well as their proactive approaches to addressing a wide range of health concerns.
New York’s Department of Financial Services released a directive to insurers requiring coverage of twice weekly testing of all nursing home and adult facility personnel without cost sharing. The directive applies broadly to insuers, including Medicaid and Marketplace plans. The insurance directive was accompanied by a concurrent New York’s Department of Health directive determining that COVID-19 testing of nursing home and adult care facility personnel is medically necessary and twice weekly testing is essential.
On Thursday, April 9 at 2:00 p.m. ET, State Health and Value Strategies hosted a webinar during which experts from Manatt Health walked through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization. As the COVID-19 pandemic continues to progress, providers across the continuum of care are experiencing significant changes in utilization resulting in declining revenue and jeopardizing access to care. The federal government has acknowledged the financial challenges facing providers through supplemental funding included in the three federal stimulus bills enacted to date and several states have submitted Section 1115 waivers requesting CMS approval to establish “disaster relief funds,” paid for with Medicaid dollars, to further assist providers. States are increasingly seeking innovative strategies to leverage Medicaid authorities to support the essential and vulnerable providers on the frontlines of the pandemic.
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.
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.
As the COVID-19 pandemic continues to progress, providers across the continuum of care are experiencing significant changes in utilization resulting in declining revenue and jeopardizing access to care. The federal government has acknowledged the financial challenges facing providers through supplemental funding included in the three federal stimulus bills enacted to date. In addition, several states have submitted Section 1115 waivers requesting CMS approval to establish “disaster relief funds,” paid for with Medicaid dollars, to further assist providers. While it will take some time for waiver requests to be reviewed and for the new federal funds to be released, more immediately available tools can help ensure payments continue flowing to providers despite substantial utilization changes. This Q&A provides a moment-in-time update in response to questions SHVS has received regarding the April 9 Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis Webinar and corresponding Toolkit.
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.
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.
Price Transparency: Requirements for Providers to Make Public Cash Prices for COVID-19 Diagnostic Testing
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 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.
The COVID-19 pandemic is causing dramatic changes in utilization that threaten the financial stability of providers and may jeopardize access to care during and after the national emergency. With elective cases generally cancelled, hospitals have sharply lower utilization and revenue. Some hospitals in hotspots are seeing a surge in COVID-19 related usage, which may offset some or all of the revenue decline and in some cases increase their costs. In addition, many other providers that rely on face-to-face visits—including primary care, behavioral health, and providers of long-term services and supports—are seeing large utilization declines due to social distancing requirements. Federal and state governments have acknowledged and responded to the financial challenges facing providers in several different ways. While it will take some time for waiver requests to be reviewed and for the new federal funds to be released, this toolkit identifies more immediately available tools that can help ensure payments continue flowing to providers despite substantial utilization changes.
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.
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 released a new toolkit for states to help accelerate adoption of broader telehealth coverage policies in the Medicaid and CHIP during the COVID-19 public health emergency.
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.
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.
Certificate of Need (CON) laws are state regulatory mechanisms for establishing or expanding health care facilities and services in a given area of a state. In states that have CON programs, a state health planning agency must approve major capital expenditures for certain health care facilities. This piece highlights how several states are re-evaluating and adjusting the policies for their CON programs.
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.
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.
Medicaid program guidance allowing telemedicine to be provided and billed for payment when delivered via the school-based services program for counseling and occupational, physical and speech therapy.
Oregon policy to redirect CCO quality funds to support critical needs related to COVID-19.
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.
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.
This FAQ answers common provider questions regarding the provision of methadone and buprenorphin, including through the use of telehealth, for the treatment of opioid disorder during the COVID-19 crisis.
North Carolina website cataloging guidance on telehealth expansion during COVID-19, including recent policies related to enhanced behavioral health services, optometry services, postpartum care visits, and even self-measured blood pressure monitoring.
Medicaid memo to providers summarizing changes to program requirements, including expansion of telehealth coverage, provider licensure, and prior authorization for services, during the COVID-19 crisis. Content on behavioral health was updated in a subsequent memo.
This guidance temporarily allows DEA-registered practitioners to distribute controlled substances with fewer limitations, to meet the increasing demand as a result of the public health emergency.
New joint guidance from the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury that addresses questions on the Families First and CARES Acts requirements on coverage of COVID-19 related testing services, including, for example, the requirement to cover (without cost sharing) diagnostic tests to rule out other conditions such as influenza.
This guidance provides DEA-registered hospitals/clinics with the flexibility to use alternate satellite locations and allow these satellite locations to receive shipments of controlled substances expeditiously.
The FCC has established two new programs: 1) The COVID-19 Telehealth Program under which the FCC will distribute $200 million in CARES Act funding to help health care providers offer connected care services to patients at their homes or mobile locations, and 2) the Connected Care Pilot Program, which will also support connected care services to consumers, particularly for low-income Americans and veterans, with up to $100 million over three years.
This memo clarifies a section of the earlier Medicaid provider memo on flexibilities offered to providers of behavioral health and addiction and recovery treatment.
Guidance from New York State Office of Mental Health on adult Continuing Day Treatment (CDT) program expectations, changes in documentation requirements during the disaster emergency period, and reduction or elimination of minimum billing requirements.
CMS issues guidance for long-term care facilities transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status (i.e., positive, negative, unknown/under observation).
WA policies related to Integrated managed care behavioral health provider support during the COVID-19 pandemic
CMS released guidance for intermediate care facilites for individuals with intellectual disabilities, and for psychiatric residental treatment facilities, to address infection control and prevention practices.
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.
Guidance from New York State Office of Mental Health on Assertive Communty Treatment (ACT) program expectations, changes in documentation requirements during the disaster emergency period, and the reduction or elimination of minimum billing requirements.
Guidance from New York State Department of Heatlh on the provision of community based long-term services and supports covered by Medicaid.
CMS, in collaboration with medical societies and associations, updated recommendations to postpone and limit non-essential surgeries and other procedures, including non-emergent, elective treatment, and preventive medical services.
A state-by-state breakdown of how the first $30 billion of the CARES Act funding will be distributed to US states and territories
New York has made significant changes to increase the flexibility and timeliness of its CON program. Under new guidance, providers in New York are only required to notify the Department of Health about the new project–but do not need to wait for approval prior to moving forward with these requests.
FAQs include HRSA’s guidance for health centers related to COVID-19, which is updated on an ongoing basis. 4/7 updates to FAQs include guidance on infection control/prevention for health centers, health center obligations for paid sick leave/other benefits for staff, liability protections for volunteer providers, permissible adjustments to operating hours, telehealth, and scope of practice.
New guidance from CMS outlines a host of blanket waivers and flexibilities that the Administration is affording to healthcare providers. The release communicates 1135 blanket waivers issued in previous weeks as well as new waivers announced on 4/9/2020, including new flexibilities such as allowing doctors to care for patients across state lines via telehealth.
CMS releases an FAQ in support of communicating key changes outlined in the Medicare Interim Final Rule issued on 3/31/2020. Topics in the FAQ include payment for specimen collection, hospital services, ambulance services, RHCs, FQHCs, telehealth, and physician services.
Many states with Certificate of Need (CON) programs, which typically require state approval of major capital expenditures for health care facilities, are creating emergency CON procedures to allow for expedited approval during the COVID-19 crisis.Vermont has established emergency CON procedures that allow applicants to apply for and receive approval for new health care projects within 24 hours, and without notice or opportunity for public hearing.
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
Guidance from Massachusetts related to the provision of early intervention services during the COVID-19 crisis.
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.
In response to the COVID-19 pandemic, Washington State is offering a limited number of free Zoom videoconferencing licenses to providers to help providers continue seeing patients using telehealth technology.
This page includes guidance and templates for the Medicaid State Plan Disaster Relief SPA and CHIP Disaster Relief SPA.
This resource provides guidance for health care providers on the provision and billing of services telehealth, including telephone and video conferencing
This resource provides guidance for health care providers on the provision and billing of services telehealth, including telephone and video conferencing
CMS issues guidance for clinicians on flexibilities related to accelerated/advance payments, telehealth services, COVID-19 testing, and claims process modifications during the COVID-19 public health emergency.
California guidance to providers to prevent discrimination related to screening and treatment for COVID-19
Infographic detailing funding to key health agencies and programs in the second COVID-19 bill, Families First Coronavirus Response Act—including the Public Health and Social Services Emergency Fund, Centers for Medicare & Medicaid Services (CMS), Administration for Community Living, the Indian Health Service and Department of Veterans Affairs—as well as the amounts of the funding, the uses and the recipients
This page includes federal background information on Section 1135 waivers and a CMS-developed template for states and territories.
CMS has expanded their Medicare Accelerated and Advance Payment Program to a broad group of Medicare providers and suppliers for the duration of the public health emergency. CMS’ FAQs for States (see E.13) addresses how Medicaid agencies may implement similar approaches.
Infographic describing diversion scenarios for COVID-19 screening under the Emergency Medical Treatment & Labor Act (EMTALA).
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 comprehensive resource page on COVID-19 guidance includes multiple funding opportunities to support telehealth for behavioral health services, naloxone distribution, and Opioid Treatment Program facilities.
This letter to behavioral health managed care plans outlines efforts from NC DHHS to provide flexible funding to stabilize providers and respond to the changing needs of consumers.
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.
This guidance allows OTPs to make “door stop” deliveries for medications for opioid use disorder in a lock-box for patients under quarantine.
This guidance allows OTPs to make “door stop” deliveries for medications for opioid use disorder in a lock-box for patients under quarantine.
This guidance allows prescribers and practitoners to issue time limited prescriptions of schedule II drugs via oral communication (e.g., telephone) under limited circumstances.
This guidance allows practitioners to dispense schedule II-IV drugs (including methadone, buprenorphine and opioids) not only in their home states but also in states with which their home stateshave reciprocity.
This guidance advises that Opioid Treatment Programs on providing medications to patients who are quarantined with COVID-19.
This guidance details infection control and social distancing recommendations for state psychiatric hospitals.
This guidance advises outpatient providers to utilize telehealth, whenever possible, reschedule non-urgent appointments, reach out to high risk patients for COVID-19, eliminate cancellation/no show fees.
This guidance clarifies that medical emergency exception to Part 2 applies during COVID-19.
This FAQ addresses general questions associated with award and management of SAMHSA discretionary grants that may arise in relation to COVID-19.
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
This order allows pharmacists and pharmacy interns to administer methadone and buprenorphine for the treatment of opioid use disorder.
This memo provides interim guidance to assist Opioid Treatment Programs with providing medications to patients, aligning state policy with federal take home exceptions of 14 and 28 days.
This FAQ provides guidance to narcotic treatment programs, including information on services that may be provided by telehealth.
MA developed an All Provider Bulletin that summarizes the State’s Hospital-Determined Presumptive Eligibility process.
MA developed a managed care plan bulletin that outlines requirement’s for coverage and billing related to COVID-19.
This FAQ includes guidance for behavioral health providers, partners, and the greater community to develop coordinated prevention and response plans for COVID-19.
NY established telehealth reimbursement parity in Medicaid programs during the state of emergency.
MS Mississippi State Board of Medical Licensure has waived state licensure restrictions to allow out-of-state physicians who already have a pre-existing doctor-patient relationship to treat patients in Mississippi through telemedicine.
This page catalogs CMS’s approved COVID-19 State Section 1135 waivers.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
Information for PACE Organizations Regarding Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19)
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
In MA, through executive order, Governor Baker expanded access to telehealth services in all commercial insurers and MassHealth programs, waived all cost-sharing for any medically necessary treatment delivered via telehealth related to COVID-19 at in-network providers, waived any prior authorization barriers needed to obtain medically necessary telehealth services, and established a 24-hour process to allow medical professionals to receive a license to practice in Massachusetts
This page includes guidance and a template for COVID-19 1115 waiver demonstrations.