Relief and Benefits to Providers Under The Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)

For more information about this blog post, please contact Khaled J. KleleRyan M. Magee, or Labinot Alexander Berlajolli.

Although a lot of attention has been focused on the Small Business Administration (“SBA”) loan programs under the CARES Act, there are many other provisions favorable to health care providers to alleviate the financial distress caused by COVID-19.  The below identifies some of those provisions.

Accelerated and Advance Payment Program:  Pursuant to Section 3719 of the CARES Act, CMS is expanding its accelerated and advance payment program for Medicare participating health care providers to lessen the financial hardships that providers are experiencing because of COVID-19.   Accelerated and advance payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims, usually when dealing with natural disasters.  CMS, however, is expanding the program for COVID-19.  The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers.  

Physician practices can request an advanced payment of up to 100% of the Medicare payment amount based on a three-month lookback period, while hospitals can request up to 100%, or 125% for critical access hospitals, based on a six-month lookback period.   To qualify for accelerated or advance payments, the provider or supplier must:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form;
  • Not be in bankruptcy;
  • Not be under active medical review or program integrity investigation, and
  • Not have any outstanding delinquent Medicare overpayments.

CMS issued a guidance document regarding the process.   A provider must submit their application to their local Medicare Administrative Contractor, which you can locate here.  If approved, CMS anticipates that payments will be issued within seven days of the provider’s request.   Most non-hospital providers will have to start repaying the amount after 120 days by offsetting amounts from new claims.  Most hospitals will have up to one year.

Cost for Testing and Preventive Service:   Section 3202 of the CARES Act requires a health plan to pay a provider for COVID-19 services pursuant to any rate specified in any in-network contract.  However, if there is no existing contract, the plan is required to reimburse the provider in the amount specified (“cash price”) as listed by the provider online, or the plan or issuer may negotiate a lower price with the provider. Furthermore, under Section 3203 of the Act, health plans are required to cover “any qualifying coronavirus preventive service” without cost-sharing.  The phrase “any qualifying coronavirus preventive service” includes any item or service used to prevent or mitigate COVID-19.

HIPAA and Substance Abuse Disorders: Section 3221 loosens the restrictions on sharing 42 C.F.R. Part 2, which is a separate HIPAA regulation that specifically applies to substance abuse disorders, with regard to treatment, payment and health care operations.  It also requires an additional privacy notice.

Limitation of Liability:   As many providers are volunteering their time in assisting hospitals and other providers treat patients with COVID-19, Section 3215 eliminates the liability of such volunteer providers for any harm caused by an act or omission of the professional in the provision of health care services with respect to COVID-19 as long as, among other things, the services are within the scope of the license, registration, or certification of the volunteer, and the volunteer did not receive compensation.

Additional Provisions:  Sections 3701-3718 provide a host of additional benefits for providers and patients as follows:

Section 3701:  Allows high deductible health plans to cover telehealth services before a patient has reached their annual deductible.

Section 3702:  Health savings accounts, Archer medical savings accounts, flexible spending arrangements and health reimbursement arrangements can be used to pay for certain items that were previously ineligible, including over-the-counter medications (without a prescription) and menstrual care products retroactive to the beginning of 2020.

Section 3703-07:  This expands telemedicine in several respects:  (1) they eliminate a provision from the recently passed HR 6074, Coronavirus Preparedness and Response Supplemental Appropriations Act, which requires providers to have treated a patient within the last three years in order to furnish telehealth services to that person during the emergency period;  (2) they allow federally qualified health centers and rural health clinics to serve as distant sites and provide telehealth services to patients during the public health emergency; (3) HHS is waiving certain face-to-face requirements for home dialysis and hospice care; and (4) allows the use of remote patient monitoring and other telehealth services in home health.

3708:  Nurse practitioners and physician assistants can order home health services during the six months following the enactment of the CARES Act.

3709-10:  Temporarily suspends sequestration-mandated reductions to Medicare claims from May 1, 2020 through December 31, 2020.  This should increase Medicare payments to providers since the sequester reduced most Medicare payments by two percent starting in 2013.  These sections also provide 20% add-on payments to the diagnosis-related group rate for patients with COVID-19 and the add-on applies to patients treated at hospitals reimbursed through the inpatient prospective payment system (“IPPS”).

Section 3711:    Provides flexibilities for post-acute care providers to increase access to post-acute care during the emergency period by waiving the requirement that inpatient rehabilitation facilities patients attend three hours of therapy per day or 15 hours per week. It also waives the requirement that long-term care hospitals have no more than 50 percent of Medicare cases paid at the “site-neutral” or IPPS rate.

Sections 3712-14:  The Act provides different blended payment rates to increase Medicare reimbursement for durable medical equipment suppliers in both rural and non-rural areas.  When a vaccine is developed, it will be covered under Medicare Part B without any beneficiary cost-sharing. In addition, Part D beneficiaries can receive up to a 90-day supply of a covered prescription drug during the public health emergency.

Section 3715:   To free up hospital beds, this section permits state Medicaid programs to pay for direct support professionals to transition hospitalized individuals to home care  and community-based care.

Section 3716-17:   These sections provide that uninsured individuals may be covered for COVID-19 testing costs with no cost sharing under the state Medicaid program, if the state chooses to provide this benefit.  These sections also broaden the tests that are covered.  

Section 3718:   The Act delays the reduction in payments to clinical laboratories and delays their reporting dates. 

Medicaid Disproportionate Share Hospital Rule:  The CARES Act delays this rule until December 1, 2020.