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HOSPITALS & HEALTH CARE PROVIDERS

Our hospitals, health centers, nursing homes, and their workers are on the front lines of fighting COVID-19.  I have been deeply focused on getting the necessary supplies these professionals need to treat patients and keep themselves safe.  The CARES Act, which was enacted on March 25, included:

  • $100 billion for our health care providers, in order to cover non-reimbursable expenses attributable to COVID-19;
  • $150 billion for a Coronavirus Relief Fund to help states shoulder the unexpected burden of battling the pandemic.  This provision will provide $1.25 billion to Rhode Island to help meet financial obligations as it cares for Rhode Islanders and combats this pandemic;
  • $1.32 billion in supplemental funding for community health centers (CHCs);
  • $16 billion to replenish the Strategic National Stockpile supplies of pharmaceuticals, personal protective equipment (PPE), and other medical supplies, which are distributed to state and local health agencies, hospitals, and other health care entities facing shortages; and
  • $1 billion for the Defense Production Act to bolster domestic supply chains, enabling industry to quickly ramp up production of PPE, ventilators, and other urgently needed medical supplies.

On April 23, Congress also passed the Paycheck Protection Program and Health Care Enhancement Act.  This interim legislative package sets aside an additional $75 billion in funding for health care providers, includes $25 billion to increase national testing and contract tracing capabilities, and requires that the Administration create a national testing strategy.  Under this provision, Rhode Island will receive $17.5 million to boost its COVID-19 testing capacity.

I am a health care worker and my facility is running low on PPE.  How do we get more?

The RI state government has the lead role on PPE, but if you are a health care provider and need assistance getting in touch with the Rhode Island Department of Health (RIDOH) regarding PPE requests, please contact my office.

Additionally, RIDOH has issued guidance to health care providers on conserving PPE, which you can view HERE.

How can hospitals, health systems, and health care providers receive funding to cover expenses attributable to COVID-19?

One of the primary ways the CARES Act supports our health system is through the creation of a $100 billion fund to cover non-reimbursable expenses attributable to COVID-19.  All health care entities that provide health care, diagnoses, or testing are eligible for funding.  With the recent passage of interim COVID-19 legislation, that funding now totals $175 billion.

The fund is designed to be immediately responsive to needs.  The Department of Health and Human Services (HHS) is instructed to review applications and make payments on a rolling basis, in order to get money into the health system as quickly and flexibly as possible.  As such, HHS is given significant flexibility in determining how the funds are allocated, as opposed to a more traditional approach of requiring the use of a mandated formula or competitive grant process for awarding the funds.

Rhode Island has received $90.5 million to date, and I will continue to work with the Administration to ensure that the funding and application process work as we intended.

What expenses qualify for funding?

All non-reimbursable expenses attributable to COVID-19 qualify for funding.  Examples include building or retrofitting new ICUs, increased staffing or training, PPE, the building of temporary structures, and more.  Forgone revenue from canceled procedures, which has put significant strain on the health care system, is also a qualified expense.

This fund can only be used for non-reimbursable expenses.  Any expenses reimbursed or obligated to be reimbursed by insurance or other mechanisms are not eligible.  The law instructs the HHS Secretary to establish a reconciliation process under which payments will have to be returned to the fund, if other sources provide reimbursement for expenses (for example, if a canceled procedure is completed later in the year).

Congress created a dedicated fund for health care providers.  Can health care entities access these funds, if they are also eligible for funding from another government program?

Yes.  Health care providers may apply for funding from the Public Health and Social Services Emergency Fund (PHSSEF) while simultaneously applying for funding from other government sources.  If the health care provider then receives reimbursement of an expense from both the PHSSEF and another source, it would be obligated to repay the funding received from the PHSSEF.  This same principal also applies to the new SBA7(a) loans, Paycheck Protection Program (PPP) forgivable loans, the SBA’s Economic Injury Disaster Loan (EIDL) Program, and the new EIDL Emergency Grant Program.

What support is included for community health centers?

The CARES Act provides $1.32 billion in supplemental funding for community health centers (CHCs), which are on the front lines in addressing COVID-19 in underserved communities across the country.  This funding is in addition to the $100 million distributed by the Health Resources and Services Administration (HRSA) to CHCs on March 24, the $600 million provided by the interim COVID-19 legislation, and the health care provider fund that CHCs can also access.

Rhode Island’s CHCs have already benefited from two rounds of funding from the Coronavirus Emergency Supplemental and the CARES Act.

Hospitals are facing cash flow challenges due to canceling elective services.  What has Congress done to help hospitals stay afloat, even temporarily?

Hospitals need reliable and stable cash flow to help them maintain and support their workforce, buy essential supplies, create additional infrastructure, and keep their doors open to care for patients.  Under the CARES Act, acute care hospitals, critical access hospitals (CAHs), children’s hospitals, and prospective payment system-exempt cancer hospitals will be able to request accelerated Medicare payments for inpatient hospital services.  This is an expanded set of hospitals compared to the existing accelerated payment program.

Rather than waiting until claims have been processed to issue payment, Medicare will work with qualified and interested hospitals to estimate their upcoming payments and give that money to the hospitals in advance.  Qualified facilities can request a lump sum or periodic payment reflecting up to six months of Medicare services.  Accelerated payments must be repaid to Medicare, beginning four months after receiving the first payment.  Hospitals would have at least 12 months to complete repayment without paying interest.

Hospitals interested in receiving accelerated payments should contact their Medicare Administrative Contractor (MAC).  To learn which MAC to contact, please look HERE.

Additionally, Congress has temporarily increased the federal Medicaid matching rate (FMAP) by 6.2 percent for the duration of the COVID-19 crisis.  As a result, RI is expected to get a $150 million boost in federal funds for Medicaid services this year.

Does the law give additional flexibility for hospice providers?

Yes.  In order for a qualified beneficiary to receive hospice benefits, a hospice physician or nurse practitioner must certify their eligibility.  Typically, a recertification must be done in person.  The CARES Act allows hospice physicians and nurse practitioners to conduct these visits via telehealth for the duration of the public health emergency.

What is the federal government doing to get more PPE?

As the outbreak has spread further, I have continued pressing for increased production of PPE and more supplies for Rhode Island.  I cosigned letters to the Administration first urging it to invoke the Defense Protection Act (DPA) to spur domestic PPE production, and followed up when the Administration inadequately and indefensibly failed to use this power quickly.  I also sent several letters to the Administration concerning the status and procurement of supplies, such as a March 21 letter to the President and Vice President requesting answers on the current supply of PPE and other critical medical equipment, as well as on plans to further augment their production.  I expressed similar needs during a one-on-one call with Vice President Pence.

To date, Congress has enacted several pieces of legislation to address the COVID-19 pandemic and provide relief to our health care system and its workforce.  The Coronavirus Emergency Supplemental, which passed on March 5, included approximately $500 million for procurement of pharmaceuticals, masks, PPE, and other medical supplies for distribution to state and local health agencies in areas with a shortage of medical supplies.  The Coronavirus Aid, Relief, and Economic Security (CARES) Act built substantially on this investment, allocating $16 billion to replenish the Strategic National Stockpile, and providing $1 billion for the DPA to help ramp up domestic production of medical supplies.  It also created the $100 billion health care providers relief fund to aid providers in their COVID-19 response, for uses including the purchase of PPE.  The $1.25 billion Rhode Island receives from the Coronavirus Relief Fund may also be used for PPE.

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