Bipartisan talks in the Senate continue this week after the chamber failed to clear a procedural threshold to move forward on H.R. 748, the legislative vehicle for Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Meanwhile, House Democrats are expected to unveil legislative text for their own proposal as soon as today after a breakdown in negotiations with Senate Republicans over the weekend.
Notably, the revised version of the CARES Act includes the health care extenders, provisions reauthorizing various Medicare, Medicaid, and public health programs, that stand to expire on May 22. As made clear by Senate Finance Committee Chairman Chuck Grassley (R-IA), their inclusion would complicate matters to reach a deal on surprise medical billing and prescription drug pricing by taking important pay-fors off the table.
Despite concessions from Senate Republicans in the updated text released yesterday, Democrats still found the legislation to be problematic and inadequate. Senate Minority Leader Chuck Schumer (D-NY) called for changes to financial assistance for corporations, as well as for more funding for hospitals. Other points of concern with the GOP package among Senate Democrats include its lack of funding to help cover the costs of COVID-19 treatment for the uninsured and its lack of occupational protections for health care workers.
Senate Democrats are pushing for the inclusion of provisions that would require the Occupational Safety and Health Administration (OSHA) to promulgate an Emergency Temporary Standard (ETS) within one month after enactment to require employers to develop and implement a comprehensive infectious disease exposure control plan designed to protect health care workers from COVID-19. The health care worker protection measures were included in the initial version of the Families First Coronavirus Response Act (H.R. 6201) but left out of the final version of the bill signed into law by President Trump last week.
In a role reversal, the Trump administration is considering opening a special enrollment period for uninsured individuals to sign up for ACA coverage on the federal exchange. So far, nine states have reopened exchanges due to COVID-19 – Colorado, Connecticut, Maryland, Massachusetts, Nevada, New York, Rhode Island, and Washington.
Additional COVID-19 measures being taken at the state, local, and tribal levels follow.
Yesterday (March 22), the Centers for Medicare and Medicaid Services (CMS) released new checklists and tools to support state Medicaid and CHIP programs during the COVID-19 outbreak. The following flexibilities became available when President Trump declared COVID-19 a national emergency:
- An 1115 waivers opportunity and application checklist to assist states in enrolling and covering Medicaid beneficiaries;
- An 1135 waiver checklist to address Medicare/Medicaid provider enrollment-related issues and flexibilities;
- A 1915(c) Appendix K template to make changes to home and community-based services waivers; and
- A Medicaid disaster state plan amendment template, which would allow states to submit one combined request for temporary changes, such as temporarily expanding coverage to optional eligibility groups and increasing provider reimbursement.
American Indian Tribes –
Last Friday (March 20), the Department of Health and Human Services (HHS) announced that the Centers for Disease Control and Prevention (CDC) would provide $80 million in funding to tribes, tribal organizations, and Urban Indian Organizations for the COVID-19 response. In addition, the CDC will issue a new non-competitive grant Notice of Funding Opportunity that will be available to eligible tribes.