Congress Passes and the President Signs into Law Third COVID-19 Package

  

Today, the U.S. Congress passed and the President signed into law, the Coronavirus Aid, Relief, and Economic Security (CARES) Act. It includes more than $2 trillion in spending and tax breaks to help the economy and health care providers respond to the pandemic.

ANA has been aggressively pushing Congress and the Administration to do something about the lack of personal protective equipment (PPE). Thankfully, the legislation provides $1.5 billion to States for the equipment, contact tracing to identify additional cases, and other public health preparedness and response activities. Additionally, it provides $16 billion for the Strategic National Stockpile (SNS) for critical medical supplies, including more PPE, and life-saving medicine.

Additional details of the agreement include:

  • $150 billion for hospitals and health providers
  • $1,200 checks for middle class Americans
  • $150 billion for states and local governments
  • $500 billion for loan guarantees for businesses
  • $350 billion for small businesses to maintain payroll
  • Reauthorizes Title VIII Nursing Workforce Development Programs
  • Authorizes NPs and CNS’ to certify home health care for their patients
  • Includes United States Public Health Service Modernization – Ready Reserve Corps to respond to public health and national emergencies.

Congressional leaders have indicated there will be additional supplemental packages to come in the following weeks. ANA will continue to be engaged with Congress and the Administration about priorities for nurses in the upcoming packages. Some areas that need to be addressed are:

  • Prioritize treatment of nurses, and other frontline health care providers who contract COVID-19, so those individuals can go back to work as soon as possible.
  • Instruct all manufacturers of respirators providing equal or higher protection as N95s, such as N99 or N100 filtering facepieces, reusable elastomeric respirators with appropriate filters or cartridges, or powered air purifying respirators, to sell their supply to health care facilities at fair market value.
  • Retrofit or repurpose closed or currently running manufacturing plants and put individuals back to work by manufacturing more PPE in the United States.
  • Require the Centers for Disease Control and Prevention to provide science-based information on the transmission of the virus so that nurses can make the best decision on the appropriate level of protection.
  • Require the Department of Health and Human Services to develop reporting requirements to better track shortages of PPE.

As we continue to move forward, ANA will continue to provide updates on what Congress is doing to address COVID-19.

COVID-19: Legislative and Regulatory Update

  

The American Nurses Association’s Policy and Government Affairs Department is committed to providing nurses with the most comprehensive and up-to-date information regarding the current legislative and regulatory developments related to addressing the Coronavirus Disease 2019 (COVID-19) global pandemic. This information is current as of Wednesday, March 18, 2020.

Topline Summary

  • On Wednesday, March 18, President Trump announced he would invoke the Defense Production Act (DPA) in response to the coronavirus pandemic, which gives the federal government broad powers to enlist private companies to help with national crises. The President mentioned masks, respirators and ventilators amongst the supplies for which DPA will be used to accelerate development.
  • On Friday, March 13, the administration declared a national emergency and the CDC published guidance to limit gatherings to 10 or fewer people and to avoid public places like bars and restaurants; several cities have implemented shelter in place orders.
  • The Centers for Medicare & Medicaid Services issued guidance to expand Medicare telehealth services for beneficiaries through providers including NPs and CRNAs; Medicaid approved the first emergency Medicaid waiver (Florida) to simplify access and coverage.
  • The U.S. House of Representatives passed the second piece of supplemental legislation on Saturday, March 14; the U.S. Senate passed the second supplemental measure on Wednesday, March 18. The House and Senate are now negotiating the third supplemental package and ANA continues to monitor developments and engage with stakeholders.

General Update

On Friday, March 13, President Trump declared a national emergency under the Stafford Act in response to the ongoing COVID-19 pandemic. As of this writing, the United States has reported a total of 7,047 confirmed cases of COVID-19 and 121 total deaths (a mortality rate of 1.72 percent among reported cases).

The latest guidance from the administration is to limit any gatherings to 10 or fewer people, and to avoid going out to public places like restaurants and bars.

  • As of March 16, 2020, 29 states have closed schools for at least two weeks.
  • Many other states have closed restaurants, bars, gyms, and other social gathering places.
  • San Francisco and the greater Bay Area has issued a shelter in place which restricts movement outside the home to only essential needs including the grocery store, pharmacy, and police.

Below are some of the legislative and regulatory actions that the administration and Congress have taken to respond to the COVID-19 pandemic:

Legislative

On Saturday, March 14, the U.S. House of Representatives passed H.R. 6201, the second supplemental legislation to address the impacts of the COVID-19 pandemic; the Senate passed this legislation on Wednesday, March 18. The House and Senate are currently negotiating a third supplemental economic relief measure. ANA is monitoring the negotiations and continuing its outreach on Capitol Hill.

H.R. 6201 (passed by both the House and Senate) seeks to:

  • Expand paid leave, food assistance and unemployment insurance and deliver additional Medicaid funding. The measure would provide tax credits to employers to offset the costs of providing emergency sick leave. It also would require insurers, Medicare, Medicaid, and other federal health programs to fully cover testing without prior authorization and related services for the virus.
  • Provide emergency funding for several nutrition programs, including the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), as well as various federal health programs. The funds provided under the measure would be designated as emergency requirements and wouldn’t count against the discretionary spending cap for FY 2020.
  • Make personal respiratory protective devices a covered countermeasure under the Public Readiness and Emergency Preparedness Act (Public Law 109-148). The law allows HHS to provide liability protections for certain emergency response products.

Additionally, earlier in March, Congress passed, and the President signed into law, the first supplemental legislation to address COVID-19. Included in that legislation is $3 billion to the development of treatments and coronavirus vaccine and $300 million to ensure individuals will have access to the vaccine regardless of their ability to pay.

To protect public health, the legislation allows Medicare providers to extend telemedicine services to beneficiaries regardless of where they live. The use of telehealth technologies to provide care can help reduce exposures and preserve personal protective equipment (PPE) and other facility resources during this emergency.

Regulatory

Through the president’s declaration of a national emergency, the U.S. Centers for Medicare & Medicaid Services (CMS) has issued guidance and taken actions to ensure that Medicare and Medicaid beneficiaries – which cover some of the nation’s most vulnerable populations – are able to receive care the care that they need in the safest manner possible.

The administration yesterday also announced expanded Medicare telehealth coverage through Section 1135 waiver authority that will enable beneficiaries to receive a wider range of healthcare services from their clinician without having to travel to a healthcare facility. A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a clinician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

Beginning on March 6, 2020, Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country. Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

The president’s national emergency declaration also allows CMS to approve Section 1135 waivers for state Medicaid programs. These waivers provide state and territorial Medicaid agencies a wider range of flexibilities to remove administrative burdens and expand access to needed services. CMS yesterday approved the first 1135 Medicaid waiver request (submitted by and approved for the State of Florida).

ANA Activity and Next Steps

ANA has prioritized the national response to the COVID-19 pandemic and is devoting significant resources to address it. ANA continues to work with other healthcare stakeholders, provider groups, the administration, and Congress, to ensure that the nation’s registered nurses and other healthcare providers on the front lines have access to adequate personal protective equipment (PPE) that meets OSHA safety standards. ANA also continues to work with these partners to ensure that the U.S. healthcare system maintains the capacity to treat anyone experiencing serious, severe, or extreme symptoms of COVID-19, particularly those in at-risk populations.

How You Can Engage In The Election and The State of the Race

  

We are hitting a frenetic stretch in the presidential primary campaign with ‘Super Tuesday’ this week.  This day officially begins the onslaught of state elections, continuing debates and campaign ads flooding the airwaves. It can be quite easy for nurses to feel overwhelmed with the daily presidential election coverage.

Senator Bernie Sanders has emerged as the Democratic frontrunner with victories in Iowa, New Hampshire and Nevada. Vice President Joe Biden hopes to gain momentum following his victory in South Carolina and a second-place result in Nevada. Mayor Mike Bloomberg is a wild card ahead of ‘Super Tuesday’ and has been spending hundreds of millions of dollars on paid advertising since entering the race.

Senator Bernie Sanders spoke about nurses in last week’s debate in South Carolina. Sanders referenced nurses when speaking about his debt forgiveness proposals, an issue that continues to plague young nurses across the country.

We will know more about the race following Tuesday’s results, though we expect they won’t be fully reported for a few days. It is still somewhat early in the primary race, but after ‘Super Tuesday,’ it will no longer be early, and we can expect some candidates to suspend their campaigns.

To that end, nearly six months ago the American Nurses Association (ANA) launched nursesvote.org to cut through the noise and ensure nurses and nurse advocates had the information they needed to cast their vote and make their voices heard in 2020.

Nursesvote.org is a one-stop shop on everything nurse advocates need surrounding the presidential election. Our “How to Get Involved” toolkit is a comprehensive guide on everything from phone banking to information on volunteering at your local polling precinct. We encourage all visitors to download the toolkit regardless of which candidate they might support. As the Democratic field continues to shrink, we encourage you to check back with our candidate page so you can learn where every candidate stands on issues impacting nurses, their patients and the nursing profession. Our voting ‘Action Center’ will also enable you to check if your voter registration is up-to-date, find the location of your polling place and even how you can vote early in certain states.

Some of the latest developments on nursesvote.org include the development of a “#NursesVote Social Media Corner.” Here we celebrate and highlight nurse advocates engaging in elections by posting their pictures and sharing them on our RNAction Facebook and Twitter. The fastest way to get featured here is to post a picture of yourself engaging in #NurseAdvocacy while using the #NursesVote hashtag. If you wish to inquire about our popular ‘Registered Nurse, Registered Voter’ buttons, please feel free to email us at rnaction@ana.org.

Now is the time, more than ever, that nurses need to engage, have a seat at the table and make their voices heard, regardless of where they are from or who they support.