Coronavirus Update for Friday, February 26

The following is the latest COVID-19 information from the federal government as of 2:30 on Friday, February 26.

Congress

The House Budget Committee has passed a COVID-19 relief bill.  The following is a summary of the bill’s major spending, how it differs from the previous proposals submitted to the Budget Committee by other House committees, and what the bill does not do.

Major Spending Categories

The bill, which calls for $1.9 trillion in federal spending and tax credits, proposes:

  • $350 billion for emergency aid to states, local, and tribal governments.
  • $195 billion for state governments, with most of it distributed based on states’ share of unemployed workers.
  • $130 billion for local governments.

Proposed Health Care-Related COVID-19 Response Spending

The bill proposes:

  • $46 billion for a national strategy for COVID-19 testing, mitigation, and surveillance.
  • $10 billion for producing emergency medical equipment and supplies, including testing materials, personal protective equipment, and drugs and devices.
  • $7.6 billion for a public health workforce that includes epidemiologists, investigators, and contract-tracers.
  • $7.6 billion for community health centers.
  • $17 billion for the Department of Veterans Affairs.
  • $6.1 billion for the Indian Health Service.
  • $7.5 billion for the promoting, distributing, administering, and tracking COVID-19 vaccines.
  • $5.2 billion for COVID-19 vaccine research, manufacturing, and purchase and for the purchase of therapeutics and other products needed to treat COVID-19 and its variants.
  • $1.75 billion for community mental health block grants.
  • $1.75 billion for substance abuse prevention and treatment block grants.

Medicaid Provisions

The House bill includes several specific Medicaid provisions, including:

  • An increase of the federal medical assistance percentage – FMAP, the rate at which the federal government matches state Medicaid spending – to 95 percent for Medicaid expansion states.
  • A 100 percent federal match for Medicaid’s COVID-19 vaccine costs.
  • An increase of FMAP to 85 percent for Medicaid programs that employ community-based mobile crisis intervention services.
  • Extension of the 100 percent FMAP for two years for Medicaid services provided by urban Native American health organizations and native Hawaiian health care systems.
  • A requirement that Medicaid cover COVID-19 vaccines and treatment without cost-sharing until one year has passed after the end of the public health emergency.
  • Inclusion of outpatient drugs used to treat COVID-19 patients in Medicaid’s drug rebate program.

Changes From Previous Draft Legislation

The House bill includes several changes from legislation proposed last week:

  • The original draft legislation proposed giving states an option for five years to expand Medicaid eligibility to pregnant women postpartum for 12 months.  The length of time of this option has been extended to seven years.
  • A provision that would have made prison inmates eligible for Medicaid 30 days prior to their release was eliminated.
  • A proposed $1.8 billion for testing, contact-tracing, and monitoring of COVID-19 in congregate living settings has been eliminated.

Key Issues Not Addressed in the House Bill

The House bill does not:

  • Add any money to the Provider Relief Fund.
  • Extend the current moratorium on Medicare sequestration.
  • Address forgiveness for money provided to hospitals under the Medicare Accelerated and Advance Payment Program.

What’s Next?

The House is expected to begin deliberating on this bill this afternoon and to vote on it late tonight.  It is expected to pass with no Republican votes, after which it will go to the Senate.

The bill is not expected to survive in its current form in the Senate, where it will surely be modified.  The bill the House passes will include an increase of the minimum wage to $15 an hour but the Senate parliamentarian has already advised that such a measure is inappropriate in reconciliation, so that provision will be removed in the Senate.  It is not yet clear when the Senate might vote on the bill, what changes it might make, or what its prospects ultimately are in that chamber.  We should have a better idea about that next week.

Provider Relief Fund

  • HHS has made four additions and modifications in its Provider Relief Fund FAQ.  New questions on rural health clinics and Medicare cost reporting can be found on pp. 14 and 16 and a modified question on Medicare cost reporting can be found on page 17; all are marked “2/24/2021.”

A fourth change, a new question also marked 2/24/2021, can be found on page 16 and addresses Medicaid DSH payments and Provider Relief Fund money.

Question:

Are there any restrictions on how hospitals that receive Medicaid disproportionate share hospital (DSH) payments can use Provider Relief Fund General and Targeted Distribution payments?

Answer:

Yes. Providers may not use PRF payments to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Therefore, if a hospital has received Medicaid DSH payments for the uncompensated costs of furnishing inpatient and/or outpatient hospital services to Medicaid beneficiaries and to individuals with no source of third party coverage for the services, these expenses would be considered reimbursed by the Medicaid program and would not be eligible to be covered by money received from a General or Targeted Distribution payment. For more information on the calculation of the Medicaid hospital-specific DSH limit, see https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf.

Department of Health and Human Services

HHS and CMS COVID-19 Stakeholder Calls

HHS Clinical Rounds Peer-to-Peer Virtual Communities of Practice

HHS’s Office of the Assistant Secretary for Preparedness and Response sponsors COVID-19 Clinical Rounds Peer-to-Peer Virtual Communities of Practice that are interactive virtual learning sessions that seek to create a peer-to-peer learning network in which clinicians from the U.S. and abroad who have experience treating patients with COVID-19 share their challenges and successes.  These webinar topics are covered every week:

  • EMS:  Patient Care and Operations (Mondays, 12:00-1:00 PM eastern)
  • Critical Care:  Lifesaving Treatment and Clinical Operations (Tuesdays, 12:00-1:00 PM eastern)
  • Emergency Department:  Patient Care and Clinical Operations (Thursdays, 12:00-1:00 PM eastern)

Go here for information about signing up to participate in the sessions and go here for access to materials and video recordings of past sessions.

CMS Stakeholder Calls

CMS hosts recurring stakeholder engagement sessions to share information about the agency’s response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer participants an opportunity to ask questions of CMS and other subject matter experts.

CMS COVID-19 Office Hours Calls

Tuesday, March 16 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:833-614-0820; Access Passcode:  4177586

Audio Webcast link:  go here

Tuesday, April 6 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:833-614-0820; Access Passcode:  2769397

Audio Webcast link:  go here

Centers for Disease Control and Prevention

Food and Drug Administration

  • The FDA announced that it is permitting undiluted frozen vials of the Pfizer-BioNTech COVID-19 vaccine to be transported and stored at conventional temperatures commonly found in pharmaceutical freezers for a period of up to two weeks.  This reflects an alternative to the preferred storage of the undiluted vials in an ultra-low temperature freezer between -80ºC to -60ºC (-112ºF to -76ºF).  Learn more from the FDA’s announcement of this new guidance and from its revised fact sheet for providers.