Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


CMS Suspends Advance Payment Program

The Centers for Medicare and Medicaid Services (CMS) announced its decision on Sunday to reevaluate the amounts that will be paid under the Accelerated Payment Program and to suspend its Advance Payment Program to Part B suppliers. The agency has already paid over $100 billion to health care providers and suppliers since these programs were expanded on March 28, 2020. CMS will not be accepting any new applications for the Advance Payment Program, and will be reviewing all pending and new applications for the Accelerated Payment Program in light of the direct payments being made available through the U.S. Department of Health and Human Services’ (HHS) Provider Relief Fund.

HHS Opens CARES Provider Relief Fund Payment Portal

Last week, the Department of Health and Human Services (HHS) announced additional plans for distributing funds from the CARES Act Provider Relief Fund. As part of that announcement, HHS stated that $50 billion would be a “General Distribution” based proportionately on the provider’s 2018 net patient revenue. HHS would like the “General Distribution” to replace a percentage of a provider’s annual gross receipts, sales, or program service revenue. HHS has also noted that it will apportion relief funds to US healthcare providers with the intention of optimizing the beneficial impact of the funds.

Of that $50 billion, $30 billion has already been distributed to providers, and approximately $10 billion was scheduled to be released on April 24 to providers who have already shared key data with HHS.

For those that received funds from the initial $30 billion, the provider must sign into the General Distribution Portal to provide revenue data if the provider would like to receive additional funds. Providers must attest to each payment associated with their billing Taxpayer Identification Number(s), if they have not already done so. Per the newly released FAQs, providers will also need to attest to the Terms and Conditions for the first $30 billion, if not done already. At this time, this portal is only for organizations which have already received payments through the CARES Act Provider Relief Fund.

HHS has released a user guide to assist with this data submission process. One key element of the cost reporting is information from your tax returns as outlined in the Appendix A below. In addition, you will need your W-9 and Medicare or Medicaid ID number.

HHS will use this data to calculate your proportional 2018 net revenue and provide such funds via electronic deposit, with the goal of such deposit within 10 business days of the submission. Payments will go out weekly, on a rolling basis, as information is validated. HHS has stated that they will be processing applications in batches every Wednesday at 12:00 noon EST. Funds will NOT be disbursed on a first-come-first-served basis, which is to say, an applicant will be given equal consideration regardless of when they apply.

Our understanding is that the total funds being provided in this round will take into account any funds the provider previously received as part of the $30 billion distribution. Subsequent to the funds being deposited, within 30 days of receipt of the funds, a provider is requested to log onto the CARES Act Provider Relief Fund attestation portal to confirm receipt and agree to the Terms and Conditions. (Note: These Terms and Conditions are NOT identical to those for the $30 billion distribution.)

If a provider meets certain Terms and Conditions, the payments received do not need to be repaid at a later date. These Terms and Conditions can be found here.

According to HHS, if you receive a payment from funds appropriated in the Public Health and Social Services Emergency Fund for provider relief (“Relief Fund”) and retain that payment for at least 30 days without contacting HHS regarding remittance of those funds, you are deemed to have accepted the Terms and Conditions.

For more information, please visit hhs.gov/providerrelief or call the CARES Provider Relief line at (866) 569-3522.

Appendix A: Federal Tax Classification Matrix

PPP Replenished with Passage of COVID 3.5

President Trump signed into law a $484 billion relief package to replenish the depleted Paycheck Protection Program (PPP) on Friday. The Paycheck Protection Program and Health Care Enhancement Act (H.R.266) also includes an additional $75 billion for health care providers and $25 billion to increase coronavirus testing. The bill provides $321 billion for the PPP, with $60 billion for community banks and smaller lenders, plus an additional $60 billion in economic disaster loans for small businesses.

The bill was the culmination of two weeks of negotiations between party leaders and the White House about the scope and recipients of the emergency funding. The Senate passed it by voice vote on Tuesday. Republicans in the House of Representatives forced a recorded vote, requiring lawmakers to return to Washington for House passage on Thursday. Members voted according to alphabetical order and in nine separate groups to allow for social distancing. The legislation passed the House by a vote of 388 - 5, with 1 voting present.

There is general agreement that a fourth, more comprehensive economic rescue package – dubbed CARES 2 – will still be needed, following up on last month’s Coronavirus Aid, Relief, and Economic Security (CARES) Act. The House is expected to act first on the next bill, and Democrats are pushing for the inclusion of at least $500 billion for state and local governments. Senate Majority Leader Mitch McConnell (R-Ky.), however, has indicated that Republicans may want to slow the pace of new deficit spending. There is also disagreement about the timing of the next round of aid – with Democrats insisting that work to draft legislation begin immediately and Republicans countering that they will not agree to any additional legislation for at least another couple of weeks. Congress is scheduled to return on May 4, though negotiations on CARES 2 are expected to continue in the interim.

Members of the centrist New Democrat Coalition are requesting that House leadership include a National Recovery Strategy that prioritizes the continued mitigation and containment of COVID-19 alongside efforts to reopen the economy in future legislative packages. Their letter includes proposals on testing, surveillance, and contact tracing to help ensure states have the capacity to prevent future outbreaks of COVID-19 when communities begin to reopen.

Lawmakers Consider Committee Meetings, Proxy Voting

The House of Representatives had planned to consider a rules change to permit proxy voting last week, but the issue was tabled due to opposition by some Republicans. Instead, House leadership announced the creation of a bipartisan committee to review the use of remote voting by proxy. House Speaker Nancy Pelosi (D-Calif.) told Democrats that the House may try to schedule committee meetings as early as this week. While it is unclear which panels might meet, the Appropriations Committee is likely to be one of them. House Energy and Commerce Health Subcommittee Chair Anna Eshoo (D-Calif.) announced plans to call former Biomedical Advanced Research and Development Authority (BARDA) Director Rick Bright to testify before her panel as soon as is feasible. Bright asserts he was removed from his position after arguing that the administration should more rigorously vet hydroxychloroquine and chloroquine as treatments for COVID-19. He has requested a probe by the Office of the Inspector General into his reassignment to the National Institutes of Health (NIH). Eshoo says she also wishes to hear testimony from U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Assistant Secretary for Preparedness and Response (ASPR) Robert Kadlec.

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