Washington News: COVID-19 Special Update – 2nd Edition 03-23-20

March 23, 2020 ~

Each day, we are learning new information about the spread and impact of Coronavirus (COVID-19). As this global health situation evolves, AdvantEdge will be closely monitoring federal and state government updates and legislation to ensure you have the most relevant and up-to-date COVID-19 news and resources.

The articles below from Capitol Associates, Inc. (CAI), a nonpartisan government relations firm specializing in health policy, provide a comprehensive update on the federal response regarding COVID-19 in the United States.

CMS to Provide Temporary Provider Enrollment Flexibilities

Capitol Associates, Inc. (CAI) – Monday, March 23, 2020

Additionally, CMS released an FAQ Document explaining how it will use its authority under Sec. 1135 of the Social Security Act to provide flexibility with its Medicare provider enrollment requirements during the COVID-19 Public Health Emergency (PHE).

Expedited Provider Enrollment

During the PHE, CMS is allowing physicians and non-physician practitioners to temporarily enroll as Medicare providers using a toll-free hotline provided by their MAC. The numbers are included in the CMS FAQ document.

To initiate temporary billing privileges, practitioners will be asked to provide limited information, including, but not limited to, Legal Name, National Provider Identifier (NPI), Social Security Number, a valid in-state or out-of-state license, address information and contact information (telephone number).

MACs should be able to complete the expedited enrollment process over the phone. Enrollments would be effective as early as March 1, 2020.

Providers can enroll their homes as distant site locations for telehealth services using the hotline.

CMS will also temporarily waive the following screening requirements:

• Criminal background checks associated with fingerprint-based criminal background checks (to the extent applicable).
• Site visits.
• Postpone all revalidation actions.

The expedited process does not impact enrollment applications submitted to MACs prior to March 1^st using the regular enrollment process.

State Licensure for Medicare Providers

CMS will also provide individual waivers from the Medicare requirement that a physician or non-physician practitioner must be licensed in the State in which s/he is practicing. Four criteria must be met for the waiver:

1. The physician or non-physician practitioner must be enrolled as such in the Medicare program,
2. The physician or non-physician practitioner must possess a valid license to practice in the State which relates to his or her Medicare enrollment,
3. The physician or non-physician practitioner is furnishing services – whether in person or via telehealth – in a State in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity, and
4. The physician or non-physician practitioner is not affirmatively excluded from practice in the State or any other State that is part of the 1135 emergency area.

However, the state must also waive its licensure requirements. CMS’ waivers do not supersede State or local licensure requirements or any requirement specified by the State or a local government. Those requirements would continue to apply unless waived by the State. Therefore, the State also would have to waive its licensure requirements, either individually or categorically, for the type of practice for which the physician or non-physician practitioner is licensed in his or her home State.

Suspending Revalidation Activities

CMS is temporarily ceasing revalidation efforts for all Medicare providers or suppliers. Upon the lifting of the public health emergency, CMS will resume revalidation activities.

COVID-19 Federal Response Update 

Capitol Associates, Inc. (CAI) – Friday, March 20, 2020

Congress

• The Senate is continuing to negotiate changes to its Phase III stimulus legislation. This draft version of the bill was introduced by Senate Majority Leader Mitch McConnell with the goal of negotiating with Democrats and the White House to produce a final version by as soon as this weekend. A Senate vote could come as early as Monday. A summary of the bill was included in Thursday’s daily update.
• Most Congressional staff are working remotely and they are being flooded with requests from stakeholder organizations to add or change provisions in the bill. It is not immediately clear if Congress can finish negotiations by Monday but there is a strong possibility that the Senate will indeed vote on Monday.
• There is already talk about a fourth major COVID-19 response bill that will follow the Phase III stimulus bill.
• A group of Democratic Senators is asking large commercial health insurance companies to completely cover the costs of treating COVID-19. Most legislative efforts have focused on providing free coverage for testing, not treatment.

White House and Federal Agencies

• During his daily press conference on the emergency, President Trump said that Americans should expect additional federal support if the $1,200 checks they would be issued in the Phase III bill are not enough. He said the White House is talking about “much more than a thousand dollar check.”
• The Federal Emergency Management Agency (FEMA) is now the agency that is coordinating the overall federal response to the COVID-19 public health emergency. However, the Department of Health and Human Services (HHS) will continue to lead the health and medical components of the response.
• Some drug manufacturers are increasing production of a malaria drug called Chloroquine which some, including President Trump, believe can be an effective treatment for COVID-19. U.S. Food and Drug Administration (FDA) Commissioner Stephen Hahn and National Institute of Allergy and Infectious Diseases Director Anthony Fauci both warned that Chloroquine was not intended for treating COVID-19 and they do not know how effective it will be at treating the disease.
• The Centers for Medicare and Medicaid Services (CMS) granted a temporary Medicaid waiver request to Washington State. This is the second Medicaid waiver request CMS has granted. Florida was the first state to receive a waiver.
• The Veterans Health System is preparing to support the civilian healthcare system if the public health emergency worsens. The VA is authorized to assist during major emergency situations and has procedures in place to do so.
• CMS published two toolkits that consolidate CMS telehealth coverage policies into a centralized document. One toolkit is for General Practitioners and the other is for ESRD
• CMS also issued an updated MLN Matters Article to explain its new Medicare and Medicaid telehealth coverage policies.
• The Federal Communications Commission (FCC) is making it easier for rural healthcare providers to receive broadband internet from internet providers at reduced rates.
• CMS could delay the effective date of its recently issued final rules on interoperability and data blocking. The rules were issued as the public health emergency began to increase in severity.

COVID-19 Federal Response Update

Capitol Associates, Inc. (CAI) – Thursday, March 19, 2020

Congress

• Senate Majority Leader released the text of the Phase III stimulus legislation. The bill provides over $1 trillion to help stimulate the economy. This is very much a first draft of Phase III. Senate Minority Leader Chuck Schumer has his own list of priorities. Also, some Senators have disagreements about what is in the package. In summary:

Economic Stimulus

• The bill indeed includes loans to small businesses.
• It authorizes the Treasury Department to payments to American taxpayers equal to $1,200 individual or $2,400 joint tax filers that will be reduced by up to five dollars for every $100 of the taxpayer’s adjusted gross income that exceeds $75,000 (individual) or $150,000 (joint) filers based on 2018 tax filings.
• Under this formula, individuals who earn more than $99,000 will not receive a check.
• The payment also includes $500 for every child.
• Delays the deadline for filing individual tax returns from April 15^th to July 15^th.
• Delays the employer portion of the payroll tax. Employers can pay their 2020 portion in two, 50 percent installments. One would be due by the end of 2021 and the other is due by the end of 2022.
• The bill provides the Secretary of the Treasury with the authority to determine when the payments are made.
• The bill temporarily waives the penalty for early withdrawals from retirement accounts up to $100,000.
• Provides over $208 billion for loans and loan guarantees to business from “distressed” sectors of the economy.
  • $50 billion is reserved for airlines.
  • $8 billion of which can be used for air cargo carriers.
  • $150 billion is available for other types of businesses.
  • Provides federal loans and loan guarantees to the airline industry. The bill authorizes the Department of Transportation to require airlines to maintain scheduled air transportation service as a condition of financial assistance.
• Changes the limit an employer has to pay for FMLA from $200 per day with a $10,000 aggregate cap:
  • To $511 per day with a $5,110 aggregate cap if the employee is self-quarantining due to COVID-19 diagnoses or potential exposure to someone who tested positive.
  • Maintains $200 per day and decreases the aggregate limit to $2,000 for employees who are caregivers for someone who is in self-isolation or if they are home caring for kids because their school was canceled.

Healthcare System and Medicare

• Activates the Strategic National Stockpile of medical equipment and transfers it to HHS and DHS.
• Requires a report from the National Academies on U.S. Medical Product Supply Chain Security.
• Authorizes and expedites the process for approving lab-developed tests for COVID-19.
• Requires ACA health plans to:
  • Cover, not charge cost-sharing and not impose prior authorization requirements on COVID-19 testing.
  • Reimburse diagnostic testing services to test for COVID-19 at the provider’s list price if the service is out of network. Providers must publicize that price on the internet.
• Provides $1.3 billion to Community Health Centers.
• Suspends the two percent sequestration payment cuts for Medicare services for the remainder of 2020 beginning on May 1^st. However, it extends the 2029 expiration of the sequestration payments for an additional year, until 2030.
• Allows Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) to serve as a distant site for Medicare telehealth visits.
• Provides a temporary waiver of the Medicare requirement for a face-to-face interaction between home dialysis patients and a physician.
• Increases DRG payments to hospitals for COVID-19-related services by 15 percent for the duration of the emergency.

• Two Members of the House of Representatives tested positive for the Coronavirus and many others are self-quarantining due to exposure to those two Members or to others who tested positive for the virus.
  • Mario Diaz-Balart (R-FL) and Rep. Ben McAdams (D-UT) both tested positive.
  • In the Senate, Senator Cory Gardner (R-CO) is self-quarantining. There is more self-quarantining occurring on the House side with House Majority Whip Steve Scalise (R-LA), Rep Jason Crow (D-CO), Rep. Drew Ferguson (R-GA), Rep. Ann Wagner (R-MS) and Rep. Stephanie Murphy (D-FL) all self-isolating due to contact with someone who was diagnosed with COVID-19.
• Some House Members are asking for a change in the House rules to allow remote voting on legislation. The House currently requires physical presence in the House Chamber for voting.
• Those Members are concerned that having 435 Members in the Chamber is not consistent with guidelines from the CDC and other public health officials to avoid large gatherings. Concerned Members also cite the news that two Members tested positive and others are self-isolating as well as the noted risks of traveling back and forth between their districts and the Capitol.
  • House Leadership is entertaining the idea to the point where it is gauging interest from both House Democrats and Republicans. However, there are questions about how remote voting would disrupt Floor procedures. The workarounds Congress is proposing also could face legal challenges which would jeopardize any legislation passed by Congress using the remote voting system.
  • A solution could be holding votes open for longer and limiting the number of Members who are allowed into the Chamber to vote to a few at a time.

White House and Federal Agencies

• CMS is asking hospitals to indefinitely postpone all elective procedures. CMS is also urging a similar postponement for all non-essential dental procedures. The purpose of this guidance is to preserve supplies of personal protective equipment (PPE) and to maintain availability of hospital beds.
• CMS is encouraging catastrophic health plans to offer COVID-19 related coverage. Those plans normally are not allowed to offer this type of coverage by CMS will issue an exception during this public health emergency.
• President Trump signed an Executive Order authorizing HHS to take control of the U.S. medical supply chain if the Coronavirus situation worsens.
• The U.S. State Department issued a Global Level 4- Do Not Travel This is the highest level travel advisory that the State Department issues.
  • According to the warning: “The Department of State advises U.S. citizens to avoid all international travel due to the global impact of COVID-19.  In countries where commercial departure options remain available, U.S. citizens who live in the United States should arrange for an immediate return to the United States, unless they are prepared to remain abroad for an indefinite period.  U.S. citizens who live abroad should avoid all international travel.”
  • The Transportation Safety Administration (TSA) reported that airport travel declined to below 1 million.
• CMS updated its FAQ to states on available flexibilities for their Medicaid programs.
• The FDA is suspending routine facility inspections.

Articles shared with permission from original source, Capitol Associates, Inc. (CAI).