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March 27, 2020
In Historic Stimulus Bill, Congress Fixes COVID-19 Coverage Sought by CAP, Lab Groups
The $2 trillion economic stimulus bill that’s soon expected to become law will clarify insurance coverage for all diagnostic tests for COVID-19, suspend scheduled Medicare cuts to clinical laboratory services in 2021, and provide billions of dollars in relief to hospitals and providers preparing for the surge of patients during the current national emergency. The CAP had lobbied for these provisions with other laboratory groups and is pleased that they are included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
The Senate unanimously passed the bill 96-0 during the early morning of March 26. That set up a vote in the House on the CARES Act on March 27. President Donald Trump has said he will sign the legislation into law once it arrives on his desk.
The CAP is outlining provisions in the bill that will be of interest to its members. More information will be reported on the implementation of sections of the CARES Act after it becomes law. Go to CAP.org for more details about the CAP’s response to COVID-19.
Coverage and Payment Provisions
The CARES Act is the third piece of supplemental legislation to be passed by Congress during this crisis. The previous bills were the Coronavirus Preparedness and Response Supplemental Appropriations Act and the Families First Coronavirus Response Act. The CARES Act clarifies an issue identified earlier by the CAP and other groups regarding coverage of testing for COVID-19 by private insurance plans. Once signed into law, all testing must be provided without cost sharing for patients, including those tests without an emergency use authorization by the Food and Drug Administration (FDA) and those developed in, and authorized by, a state. Under the CARES Act, insurers are required to pay either a specified rate in a contract with the provider or, if there is no contract, a cash price posted by the provider.
To provide additional funds to providers caring for Medicare beneficiaries, the CARES Act temporarily lifts a budget sequester on Medicare, which reduces payments by 2%, and includes an add-on payment of 20% to Medicare’s hospital inpatient payment system for COVID-19 patients. The bill also pauses scheduled reductions, as mandated by the Protecting Access to Medicare Act (PAMA), in Medicare payment for clinical laboratory services provided to patients in 2021. Additionally, the CARES Act delays by one year the upcoming PAMA reporting period during which laboratories are required to report private payer data. The new reporting period will be Jan. 1-March 31, 2022.
Public Health Provisions
In the CARES Act, Congress directed roughly $130 billion to hospitals to cope with surge capacity during the COVID-19 pandemic. This includes $100 billion to reimburse expenses accumulated by providers for health care related expenses or lost revenues that are attributable to the coronavirus. In addition, $11 billion is designated for vaccines, therapeutics, diagnostics, and other medical or preparedness needs.
To address any shortage in the blood supply, the bill directs the Department of Health and Human Services (HHS) to carry out an initiative to improve awareness of the importance of safety of blood donation and the continued need for blood donations during the COVID-19 national emergency.
The bill also makes clear that physicians who provide volunteer medical services during the public health emergency related to COVID-19 will have liability protections.
For small businesses, lawmakers have set aside over $300 billion to provide emergency relief during the economic downturn. The CARES Act notes $10 billion for emergency grants of up to $10,000 will be available for immediate relief and $17 billion to cover six months of payment for small businesses with existing Small Business Administration loans. The bill also creates a process for loan forgiveness for certain payroll costs, mortgage, rent, and utility obligations.