The below is by no means an exhaustive list of all the provisions in the relief package, but it highlights certain provisions that we believe are of interest to most healthcare providers.
Some of the critical healthcare provisions in the relief package are as follows:
includes additional funding through the Public Health and Social Services Emergency Fund (PHSSEF) of $23 billion to prevent, prepare for, and respond to the coronavirus. The bill will also require HHS to distribute 85 percent of the grants through an application process that prioritizes such items as financial losses. (further details to follow as they become available). In addition, the relief package includes another $22.4 billion in the PHSSEF for testing, contact tracing, surveillance, containment, and mitigation to monitor and suppress COVID-19.
The CAA also clarifies that for any reimbursement to a subsidiary of a parent organization, the parent organization may allocate (through transfers or otherwise) all or any portion of such reimbursement among the subsidiary of the parent organization, including reimbursements referred to by the Secretary of Health & Human Services (HHS) as “Targeted Distribution” payments. This, we believe to be very beneficial to many large health systems.
Lawmakers included a provision changing how providers can calculate revenue for its provider relief grants. The new and very relevant language related to the Provider Relief Fund lost revenue calculation states:
“That, for any reimbursement from the Provider Relief Fund to an eligible healthcare provider for healthcare-related expenses or lost revenues that are attributable to coronavirus (including reimbursements made before the date of the enactment of this Act), such provider may calculate lost revenues using the Frequently Asked Questions guidance released by HHS in June 2020, including the difference between such provider’s budgeted and actual revenue budget if such budget had been established and approved prior to March 27, 2020.”
This provision in and of itself will create an additional option for eligible healthcare providers to calculate their lost revenues due to the coronavirus and hopefully, assist in the prevention of having to return funds.
The No Surprises Act requires health plans to hold patients harmless from surprise medical bills for emergency and scheduled care. In a win for providers, the deal bans arbiters from considering Medicare and Medicaid rates when negotiations between insurers and providers stall and they need to decide payment rates through arbitration. The measure also forbids arbiters from considering providers’ billed charges, which are usually much higher than insurers or patients end up paying. It states that patients are only required to pay the in-network cost-sharing, i.e., copayment, coinsurance, and deductibles, amount for out-of-network emergency care for certain ancillary services provided by out-of-network providers at in-network facilities, and for out-of-network care provided at in-network facilities without the patient’s informed consent. In addition, the relief package goes on to list out provider requirements for surprise medical billing.
Overall, the bipartisan relief package is very comprehensive and proposes additional funding and requirements to many programs and policies, and the details surrounding these changes will continue to evolve in the upcoming days, weeks, and months.