In response to the COVID-19 pandemic, Congress and the Centers for Medicare & Medicaid Services (CMS) have enacted multiple programs to help health care providers and their patients.
Telehealth services have been significantly expanded. CMS said the reason for the new rule is to not require beneficiaries "to travel to a health care facility and risk exposure to COVID-19."
The reimbursement rates for telehealth services now are comparable to office visits - increasing from a range of $14 to $41 to approximately $46 to $110.
The types of providers eligible to receive payments have expanded. Prior to the new regulations, reimbursement for telehealth primarily was available to doctors, nurse practitioners and physician assistants. Now reimbursement also is available to physical therapists, occupational therapists, and speech and language pathologists.
The types of services covered have expanded to allow billing for services rendered by hospital-based practitioners to Medicare patients registered as outpatients, including when the patient is at home.
Use of technology also has become more flexible. CMS explained: "[S]ome Medicare beneficiaries don’t have access to interactive audio-visual technology…or choose not to use it even if offered by their practitioner." Thus, audio-only telephone services (rather than audio and video) generally are now permissible.
The Families First Coronavirus Response Act covers the cost of diagnostic testing for uninsured individuals regardless of income or assets. (The program does not pay for testing for people already covered by Medicare, the Veterans Administration or private insurance, or cover treatment or vaccines.) Diagnostic tests include tests for the virus as well as serological tests for antibodies.
The Families First Act also authorized a 6.2 percent increase in Medicaid matching funds. The funds are designed to compensate for added services to Medicaid beneficiaries during the COVID-19 emergency. The added funds will stop on expiration of the program or if the Secretary of Health and Human Services declares the emergency to be over.
The Kaiser Family Foundation, a nonpartisan organization that studies health issues, said the increase in the matching funds "leverages Medicaid’s existing financing structure, which allows federal funds to be provided to states more quickly and efficiently than establishing a new program or allocating money from a new funding stream."
Another federal law passed in spring - the Coronavirus Aid, Relief, and Economic Security (CARES) Act - allocated billions of dollars to health care providers. Initially, $100 billion was allocated, and that was followed by another $75 billion. A review by the Kaiser Foundation highlighted the following allocations:
Provider payments through Medicare. $50 billion was paid to providers based on income the providers had received from Medicare and from other sources in 2018. Under the law, the payments could be used for "health care related expenses or lost revenues that are attributable to coronavirus."
High-impact areas. $10 billion was allocated for high-impact areas, particularly hospitals that see a high proportion of low-income patients. New York was the largest beneficiary of this portion of the funds.
Rural providers. $10 billion has been allocated to rural hospitals and health clinics.
Indian Health Services. A minimum of $400 million has been allocated to tribes, tribal organizations and urban Indian health organizations in coordination with Indian Health Services.
A condition of receiving these funds is that providers may not "surprise bill" patients. Payments to providers must be at in-network rates. For example, if a patient goes to an in-network hospital, but receives care from an out-of-network provider, the bill for the out-of-network provider’s services must be at in-network rates.
Congress has allocated at least $5.5 billion for research related to the coronavirus and to treat COVID-19. Funding passes through multiple organizations, including the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Defense Department Health Program.
Congress allocated more than $650 billion for the Paycheck Protection Program (PPP). Physicians’ practices were among the beneficiaries. Under the program, businesses with 500 or fewer employees could apply for loans that would be forgiven if the businesses maintained payrolls for a period of eight weeks.
The amount of the loan could be up to 2.5 times the average monthly payroll for the preceding calendar year, up to a maximum amount of $10 million per loan. For the purpose of calculating the amount of the loan, salaries were capped at $100,000 per employee per year.
Thus, for example, if an office employed 10 physicians earning more than $300,000 each year, only the first $100,000 per physician would count for the purpose of calculating the loan. The full salaries of nurses and office personnel earning less than $100,000 per year would count for the loan and forgiveness program. If a practice employed 10 physicians and five others who earned $60,000 per year, the practice could have received a forgivable loan of $270,833.
An alternative program is a 50 percent tax credit on wages up to $10,000 per year per employee for wages paid from March 13 through December 31, 2020. Cash savings will be up to $5,000 per employee.
To be eligible for the program, the business needs to have suspended or ceased operations due to COVID-19, or gross receipts of the business need to have declined by more than 50 percent compared to the same quarter of the prior year. This program cannot be used if the business already has received a payment through the Paycheck Protection Program.
COVID-19 has imposed extraordinary challenges on health care providers. The actions taken by Congress and CMS have eased some of the burden, but struggles will continue.
Jeff Atkinson is a professor for the Illinois Judicial Conference and has taught health care law at DePaul University College of Law in Chicago.