In response to the COVID-19 pandemic, national provider associations have urged the federal government to take immediate steps to protect healthcare entities and providers from financial losses incurred as a result of the outbreak. Specifically, these associations have called on the government to provide financial assistance to frontline providers and to ensure that the necessary equipment and infrastructure is in place to treat the rapidly increasing number of COVID-19 patients, while also maintaining continuity of care for all other patients.
Request Letters for Provider Relief
On March 17, 2020, the American Hospital Association (AHA) issued a , urging Congress to “quickly pass critically needed direct financial assistance for hospitals and health systems to protect the public health and address the economic turmoil caused by the 2019 novel coronavirus (COVID-19) outbreak.” Notably, the AHA requests the following measures be taken:
Direct Financial Assistance: The AHA urges Congress to provide financial assistance to hospitals making infrastructure investments, as well as for the purchase of necessary equipment and supplies needed to combat COVID-19. The AHA notes that “if tax relief is provided, it is important to provide that assistance through payroll taxes” to ensure that all hospitals benefit from such relief.
Offsetting Costs: The AHA requests that Congress offset the costs of uncompensated care, bad debt and charity care for treating COVID-19 patients through a full payroll tax credit or other applicable measure.
Restoration of Financing Tools: The AHA asks that Congress expand the availability of financing for needed hospital construction during this time, and specifically, the temporary extension and/or permanent restoration of certain financing tools, including:
Restoring the ability for hospitals to advance refund tax-exempt municipal bonds, thereby providing bad debt service savings for taxpayers which could be put into immediate public works projects (H.R. 2772); and
Increasing the bank-qualified borrowing limit from $10 million to $30 million, thereby providing hospitals with access to capital for immediate needs (H.R. 3967).
On March 18, 2020, the Medical Group Management Association (MGMA) issued a similar addressed to Congress, seeking financial assistance for group practices and clinicians during the COVID-19 crisis. MGMA requests that the federal government “provide direct and increased payments to physicians and their practices, without budget neutral offsets, to allow them to maintain the financial viability of their practices.” Particularly, MGMA requests that the federal government enforce the following:
Personal Protective Equipment (PPE): MGMA requests that Congress increase the $500 million in funding for PPE that was provided in the Public Health and Social Services Emergency Fund by the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (H.R. 6074) for the procurement and distribution of PPE to frontline physicians and staff. Further, MGMA requests that immediate and direct federal financial support be provided to physician practices so that they may obtain the necessary PPE.
Telemedicine Services: MGMA requests that Congress require all payors to comply with measures to ensure uniformity in coverage, payment, and billing guidelines for telemedicine.
Medicare Sequestration: MGMA urges the suspension of Medicare sequestration cuts to physicians and hospitals.
Increase National Disaster Relief Funding and Physician Fee Schedule: MGMA requests Congress direct the use of national disaster relief funding to reimburse physicians at 110% of 2020 Medicare rates for uninsured patients’ COVID-19 related care. Additionally, MGMA asks for an increase in the 2020 Medicare Physician Fee Schedule conversion factor to offset increased costs and lost revenue.
Payroll Tax Relief: MGMA asks Congress to institute payroll tax relief, advance tax credits, and make other changes to tax policy directed specifically at physician practices to support practice viability.
CMS Regulatory Authority: MGMA want Congress to allow CMS to make changes to how the Quality Payment Program is implemented during this national emergency.
Expand Leave: Expand paid family, medical, and sick leave with federal funding and ensure physician practices have immediate access to funding or tax relief to offset the costs of such expanded leave.
Medicaid Increase: MGMA requests Congress fund an increase in Medicaid payments to physicians by setting Medicaid reimbursement rates at no less than Medicare rates.
On March 19, 2020, in a to Congress, the AHA, the American Medical Association (AMA), and the American Nurses Association (ANA) (collectively, the “Associations”), urged Congress to allocate $100 billion dollars to frontline healthcare personnel and providers, including physicians, nurses, hospitals and health systems. Additionally, the Associations encouraged Congress to make such funds immediately available so health care providers can afford to take the necessary steps to fight the COVID-19 pandemic. To address growing and ever-changing concerns, the Associations request that Congress consider the following:
Creation of a Stabilization Fund: The Associations urge Congress to supply funding to include covering: loss of revenues due to suspension of elective services not related to COVID-19; providing additional training for frontline health care providers on pandemic preparedness; erecting emergency operation centers; providing housing and care for patients who do not require hospitalization but do not have housing in order to prevent the spread of COVID-19; constructing or retrofitting facilities to provide separate areas to screen for COVID-19; and implementing additional security measures.
Childcare Needs for Healthcare Personnel: The Associations encourage Congress to provide direct funding for frontline healthcare personnel in need to ensure there is quality childcare for such providers.
Surge Capacity: The Associations ask for funding so that outpatient facilities or large structures in close proximity to hospitals can be constructed to provide additional capacity for COVID-19 patients that are mildly or moderately sick. These measures will allow for sicker COVID-19 patients who need more intensive care to be treated in hospitals without creating capacity issues.
Responses to COVID-19 Pandemic and Provider Relief Considerations To-Date
In response to the COVID-19 outbreak, the federal government has taken a three phase approach. Phase One included the introduction of the Coronavirus Preparedness and Response Supplemental Appropriations Act () (the Coronavirus Preparedness Act), that was signed into law on March 6, 2020. The Coronavirus Preparedness Act appropriated $8.3 billion dollars in emergency funding for federal agencies to respond to the COVID-19 outbreak.
Phase Two was completed on March 18, 2020, when President Trump signed the Families First Coronavirus Response Act () (the Families First Act). Generally, the Families First Act responds to the COVID-19 outbreak by providing paid sick leave and free COVID-19 testing, expanding food assistance and unemployment benefits, and requiring employers to provide additional protections for health care workers.
Notably, neither the Coronavirus Preparedness Act nor the Families First Act include specific monetary relief for providers. Phase One allocates an initial $500 million dollars to hospitals for drugs, medical supplies, training and capacity needs. The U.S. Department of Health & Human Services is tasked with distributing those funds and is working with State Health Officers to move forward with awarding this funding. The distribution mandate, however, includes no provision or requirement to pass any payment through to physicians or physician practices. Phase Two includes provisions for employment related matters and reimbursement for COVID-19 testing and related services, but similarly provides no direct financial assistance for physicians or physician practices.
Phase Three of the federal government’s response to the COVID-19 pandemic is currently under negotiation. Until the final bill is ultimately proposed and passed, however, it is unclear if specific financial assistance for providers will be included in this phase.
This situation is rapidly evolving. Please check back for updates on Congressional action.