Congressional leaders and the Trump administration are closing in on an approximately $470 billion interim package to provide additional COVID-19 relief to small businesses, health care providers, and hospitals. Congress is likely to vote on a package this week. House Republicans have indicated they will demand a recorded vote, requiring a majority of the chamber to return to Capitol Hill.
Specifically, the package adds $310 billion to the Paycheck Protection Program (PPP) and $60 billion to the Economic Injury Disaster Loan (EIDL) Program – both programs overseen by the Small Business Administration (SBA) that have run out of funding. Democrats managed to carve out $60 billion of the new PPP funding for community-based lenders to ensure loans for minority and underserved areas. The agreement would also include additional health provider relief, though less than what Democrats had demanded – $75 billion (instead of $100 billion) for the Provider Relief Fund and $25 billion (instead of $30 billion) for COVID-19 testing.
Senate Majority Leader Mitch McConnell (R-KY) said the interim package would not include the additional $150 billion for coronavirus relief for state and local governments, nor the 15 percent SNAP benefit increase sought by Democrats.
Lawmakers may include bipartisan policy fixes in this new package that would affect implementation of the CARES Act (116-36). First, the new package may include a provision creating an exception to allow government-owned hospitals – which includes a large chuck of rural hospitals and rural health clinics – to participate in the Paycheck Protection Program. The package may also include language waiving or reducing the 10.25 percent rate for Medicare’s accelerated and advance payments.
On the regulatory front, CMS is expected to soon release an additional array of waiver flexibilities to aid the COVID-19 response. A new interim final rule – the same rulemaking vehicle CMS used in its first set of waivers – arrived at OMB for review on April 14th. The rule would effectuate “additional policy and regulatory revisions” for providers responding to the COVID-19 pandemic, and could include specific flexibilities around telehealth, providers’ scopes of practice, and reporting requirements.
Such changes will add to the growing pool of temporary flexibilities that CMS is reportedly considering extending beyond the emergency period. While no details are yet confirmed, CMS Administrator Seema Verma remarked last week that the agency is eyeing the telehealth flexibilities in particular as potential changes to maintain after the pandemic’s conclusion.
As for the dispersal of the Provider Relief Fund, HHS Secretary Alex Azar informed lawmakers last week that HHS needs up to a week-and-a-half to finalize formulas and timelines for the next tranche of funding, despite Administrator Verma hinting that funding would be distributed by the end of last week. The second wave of funding will likely be aimed at more specific provider groups in need of additional support.
Last week, Senate Finance Democrats urged HHS to consider the following factors for future distribution of funds: (1) providers excluded by the methodology applied to the first tranche of funds (i.e., facilities and providers did not receive Medicare fee-for-service reimbursements in 2019), such as Medicaid-dependent safety net providers, and those with variable payer mix, including Medicare Advantage; (2) impact of lost revenues as a result of a moratorium on elective care; (3) burden on community-based organizations providing essential care to help keep patients at home; and (4) severity of the outbreak in a geographic area.