Congress remains at a stalemate over approving additional COVID-19 aid after Senate Democrats and Republicans blocked each other proposals last Thursday. However, pressure is mounting for Congress to act, as funding for Paycheck Protection Program (PPP) loans for small businesses dwindles and the unemployment rate climbs. According to Treasury Secretary Steven Mnuchin, $90 billion in PPP loan applications have been approved and another $100 billion are being processed, leaving a balance of about $160 billion.
Senate Majority Leader Mitch McConnell (R-KY) is seeking a “clean PPP funding increase” of $250 billion, while House Speaker Nancy Pelosi (D-CA) and Senate Minority Leader Chuck Schumer (D-NY) are calling for a more expansive interim emergency coronavirus package – including, $250 billion in small business assistance (as well as PPP changes), $100 billion for the Provider Relief Fund, $150 billion for state and local governments via the Coronavirus Relief Fund, and a 15 percent increase to the maximum SNAP benefit. Democratic leaders are also demanding additional funding for production and distribution of national rapid testing and personal protective equipment (PPE), as well as public reporting of demographic information of patients with COVID-19. Senate Democrats are focused on negotiating with Secretary Mnuchin in hopes that securing President Trump’s endorsement will pressure Sente Republicans to support the more expansive package.
Leader McConnell has said that he is “in favor of even more funding for hospitals and providers down the line” but “need[s] to see the existing funding begin to work before we can know what additional resources may be needed.”
Last Friday, the Department of Health and Human Services (HHS) released details on how the first $30 billion of the $100 billion Provider Relief Fund, created by Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748), will be allocated and disseminated. Facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for the rapid distribution.
While the Trump administration’s plan for the remaining $70 billion is not yet available, HHS noted it is working to develop targeted distributions that will focus on: (1) providers in areas particularly impacted by the COVID-19 outbreak; (2) rural providers; (3) providers who deliver services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population; and (4) providers requesting reimbursement for the treatment of uninsured Americans. HHS reiterated the administration’s position that a portion of the $100 billion will be used to reimburse health care providers, at Medicare rates, for COVID-related treatment of the uninsured. Of note, providers must abstain from balance billing any patient for COVID-19 related treatment as a condition of receiving funds from the Provider Relief Fund.
On a related note, Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and House Energy and Commerce (E&C) Committee Ranking Member Greg Walden (R-OR) are calling for the next COVID-19 relief package to contain a measure to protect patients from surprise medical bills, including bills unrelated to COVID-19. Along with E&C Committee Chairman Frank Pallone, Jr. (D-NJ), they support resolving payment disputes using benchmark payments set at the median contracted rate and allowing independent dispute resolution (i.e., arbitration) for services for which the median contracted rate is greater than $750 in 2022. Democrats have not yet indicated whether they support including surprise medical billing provisions in a COVID-19 package or prefer to address the issue in an end-of-year package reauthorizing health care extenders, which expire on November 30, 2020.
As for the timing of more comprehensive legislation on COVID-19, floor action remains unclear and complicated. Lawmakers are scheduled to return to Washington next week, but the House Rules Committee is pursuing alternatives to in-person voting, such as remote voting or proxy voting – both of which would require a rule change. While the House and Senate are out of session, legislation can only be passed by a voice vote or unanimous consent.