April 22nd Newsletter - Sachs Policy Group

Federal Updates

HHS Announces Further Details on Allocation of $100 Billion CARES Act Provider Funding

Today, the Department of Health and Human Services (HHS) announced new information on how the $100 billion provider relief funding included in the CARES Act will be distributed. Of this pool, $30 billion has already been distributed, proportional to providers’ share of Medicare fee-for-service (FFS) reimbursement in 2019. HHS now states that an additional $20 billion will be distributed beginning this Friday, April 24^th, with the goal of making the combined distribution of $50 billion proportional to providers’ 2018 net patient revenue. The first tranche of this funding will be distributed based on already-submitted data from CMS cost reports, where available. Providers without such data on file will need to submit data through a portal, which will be made available this week, to receive funding. Eventually, all providers will need to verify their revenue data, even if they receive their funds automatically.

Next, $10 billion will be targeted to hospitals in areas particularly impacted by the COVID-19 outbreak, including New York. Such hospitals must, by midnight on Thursday, April 23^rd, submit their TIN, NPI, total number of ICU beds as of April 10^th, and total number of admissions with a COVID-19-positive diagnosis between January 1^st and April 10^th. HHS has not published a formula for how these funds will be distributed. A further $10 billion will be distributed to rural hospitals, proportional to their operating expenses. Additional allocations of the remaining $30 billion are planned for providers treating the uninsured and specific types of providers, including skilled nursing facilities (SNFs), dentists, and providers who solely accept Medicaid.

For funding allocated to reimburse providers for treatment of uninsured COVID-19 patients, services where the primary diagnosis is COVID-19 and the service would be covered by Medicare Parts A and B will be reimbursable (e.g., office visits, outpatient services, inpatient services, nursing home services, home health, etc.), except for hospice services and outpatient prescription drugs covered under Part D. Reimbursement will be made through a claims process, administered by the Health Resources Services Administration (HRSA), with signup beginning April 27^th. Providers would be able to submit claims starting May 6^th. Since HHS has not provided a specific funding allocation, and reimbursement is subject to funding availability, providers should submit claims quickly.

In general, HHS now states that the prohibition on balance billing for providers accepting these funds will apply to any services provided to “a presumptive or actual COVID-19 patient.” Providers must accept the in-network rate as payment in full. In the case of reimbursement for treatment of the uninsured, providers must accept that amount as payment in full.

HHS’s website on this funding can be accessed here. HRSA website on payments for treatment to the uninsured is here. As a reminder, the House is expected to vote tomorrow to approve an additional $75 billion in provider relief program funds.

CMS Releases Additional Blanket Waivers for New Provider Types

On April 21^st, the Centers for Medicare and Medicaid Services (CMS) released new blanket waivers pertaining to Long-Term Care Hospitals (LTCHs), Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs),Intermediate Care Facilities (ICFs) for individuals with intellectual disabilities, and the limit for substitute billing arrangements. The new waivers have been added directly to CMS’s list of blanket waivers (available here). Waived requirements include:

Certain site-neutral payment rate provisions for LTCHs;
Provisions that limit FQHCs and RHCs from establishing temporary expansion locations without approval;
The requirement that patients in an inpatient rehabilitation facility receive 15 hours of therapy per week;
The LTCH 25-day average length of stay requirement (already waived, but now expanded to facilities that are seeking to become LTCHs);
Staffing regulations, community outings requirements, mandatory training requirements, and rules around active treatment for ICFs; and
The 60-day limit that a physician or physical therapist may use a single substitute (extended to the length of the COVID-19 emergency plus 60 days).

CMS also issued further guidance and examples related to the blanket waiver for the physician self-referral (Stark) law. The explanatory guidance is available here.

State Updates

Governor Cuomo Announces New Federal Support and Contact Tracing/Testing Efforts

At today’s press conference (April 22^nd), Governor Cuomo discussed his April 21^st meeting with President Trump at the White House and the consequent plan for a federal and state partnership to address the COVID-19 pandemic moving forward. According to the Governor, the State will set a goal of doubling current testing capacity (to 40,000 tests per day) over the next few weeks. The State will continue to administer and oversee the testing program, but the federal government would take responsibility for increasing output of the testing supply chain. Regarding federal funding support, the Governor said that the federal government agreed to:

Provide $1.3 billion in funding that will help support contact tracing efforts;
Work to include state funding in the next piece of COVID-19 legislation, and
Waive the 25 percent state match for Federal Emergency Management Agency (FEMA) costs related to the COVID-19 emergency.

The Governor announced that former Mayor Michael Bloomberg has volunteered to develop a testing/tracing/isolation program in partnership with the Johns Hopkins Bloomberg School of Public Health and Vital Strategies, a global health organization based in New York. Mayor Bloomberg will be contributing financially to the program and will be responsible for coordinating the program in collaboration with his partners and the State, including recruiting and training contact tracers and designing the programmatic, operational, and technological aspects of the program. The Governor also discussed efforts, in collaboration with New Jersey and Connecticut, to build a tri-state contact tracing “army.” New York State will build upon the current contact tracing workforce and partner with SUNY and CUNY to draw from 35,000 students in medical fields who can work as contact tracers.

DFS Emergency Amendments to Health Insurance Law

As per Governor Cuomo’s Executive Order 202.14 (available here), the Department of Financial Services (DFS) released an Emergency Rule (available here on pp. 17-21) that amends health insurance regulations to implement the following provisions of the Order:

Extend the period for premium payments to either the expiration of the contractual grace period or June 1^st, whichever is later, for any comprehensive health insurance policyholder or contract holder who is facing financial hardship as a result of COVID-19.
Require insurers or health maintenance organizations to be responsible for payment of claims during the premium payment extension period and prohibit insurers from retroactively terminating an insurance policy or contract for non-payment during this period.

Updated Guidance Documents

Recently released or revised New York State and City guidance documents are available below: