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.

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Author: Gregory Craig

Analyst in the Health Policy Office of the American Nurses Association.

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