Public Health & Health Care Providers
This page will be updated as more information becomes available
UPDATE: COVID-19 Program Information for Vaccinators
The Wisconsin Department of Health Services (DHS) is currently accepting enrollment information for COVID-19 vaccinators. By enrolling in the program, vaccinators will be approved to administer COVID-19 vaccine in Wisconsin, once a safe and effective vaccine is made available.
Click here to learn more about enrolling to become a COVID-19 vaccinator in Wisconsin.
Providers play a critical role in helping build confidence in COVID-19 vaccination. An important part of preparing for a safe and effective COVID-19 vaccine is sharing information about the vaccine with the public. As one of the most trusted sources of information about vaccines, providers can share the resources and information the CDC has developed around COVID-19 vaccine planning, recommendations, and safety monitoring. Providers can also share CDC’s list of 10 things health care professionals need to know about COVID-19 vaccination plans with coworkers and staff.
Congress has passed several rounds of financial assistance and relief in response to the COVID-19 pandemic, including most recently the American Rescue Plan Act of 2021, which was signed into law on March 11, 2021.
The majority of people in this country are still not vaccinated. What does this bill do to increase vaccination rates?
The American Rescue Plan Act of 2021 provides $20 billion in funding for COVID-19 vaccinations. This includes $7.5 billion in funding through the Centers for Disease Control and Prevention (CDC) for vaccine activities which goes beyond supplying the vaccines themselves and includes activities like increased staffing, disseminating information on how to get vaccinated, transportation for people to reach vaccination sites, and mobile vans to reach underserved areas. Some of the other vaccination funding in the American Rescue Plan Act of 2021 includes $1 billion to strengthen vaccine confidence in the United States, $7.5 billion for FEMA vaccination efforts, and $2.2 billion for a vaccine procurement reserve.
How does this bill help combat variants of the virus that causes COVID-19?
In order to detect variants, we need to conduct widespread testing, and then we need to sequence a sample of those tests. The American Rescue Plan Act of 2021 provides $47.8 billion in funding for COVID-19 testing. This includes funding to develop tests, increase laboratory capacity, and improve data collection. Additionally, the American Rescue Plan Act of 2021 provides $1.75 billion in funding for genomic sequencing, which allows the CDC to detect and track variants of the virus. Ultimately, the way to stop the spread of variants is to get as many people vaccinated as we can, and the American Rescue Plan Act of 2021 provides $14 billion in funding for vaccinations. The bill also provides $500 million in funding to FDA to be used in part for the evaluation with respect to emerging variants of the continued performance, safety, and effectiveness of vaccines, therapeutics, and diagnostics.
Does the bill do anything to address COVID-19 globally?
The American Rescue Plan Act of 2021 appropriates $750 million to address COVID-19 globally including efforts for global immunization and global coordination on public health.
What support is included for community health centers?
The American Rescue Plan Act of 2021 provides $7.6 billion for community health centers, Federally Qualified Health Center Look-Alikes, and Native Hawaiian Health Centers. Of this total amount, at least $20 million must be awarded to Native Hawaiian Health Centers. These funds can cover retroactive costs incurred since the beginning of the pandemic and can be used for activities necessary to respond to COVID-19, including testing, vaccine administration, delivery of health care services, infrastructure modifications, and community outreach and education.
Does the bill do anything to address public health or health care workforce shortages?
The American Rescue Plan Act of 2021 provides $7.66 billion for activities related to establishing, expanding, and sustaining a public health workforce, including by making awards to State, local, and territorial health departments. The bill also provides $800 million for scholarships and loan repayment through the National Health Service Corps (NHSC), as well as $200 million for scholarships and loan repayment through the Nurse Corps. These programs incentivize primary care providers and nursing professionals to practice in underserved areas across the country.
What does the bill do to address mental and behavioral health and substance use disorder concerns related to the COVID-19 pandemic?
The American Rescue Plan Act of 2021 provides historic investments to address surging mental and behavioral health and substance use disorder concerns related to the COVID-19 pandemic. The bill funds a total of $3 billion in block grants for prevention and treatment of substance use disorders and community mental health care services. Another $420 million goes toward certified community behavioral health clinics. Relatedly, the bill supports community-based and local substance use disorder and behavioral health care, including $50 million for local behavioral health services, such as telehealth and crisis intervention, and $30 million for harm reduction services.
To support the mental and behavioral health workforce, the American Rescue Plan Act of 2021 provides $100 million to support the recruitment, education and clinical training of mental and behavioral health providers. The bill also provides $140 million to support the mental health of essential health care workers. This includes $80 million for mental health and substance use disorder training for health care professionals, paraprofessionals, and public safety officers, $20 million for a national education and awareness campaign to encourage healthy work conditions, and $40 million to promote the mental health of the health professional workforce. For children and adolescents, the American Rescue Plan Act of 2021 allocates $80 million for pediatric mental health care grants, $30 million for Project AWARE, which is a federal program that supports mental and behavioral health among school-aged children, and $20 million for youth suicide prevention.
Vaccines and testing are essential to slow the spread of COVID-19. The American Rescue Plan Act of 2021 contains billions in funding to get vaccines into Americans’ arms more quickly and provide crucial supplies, testing, and staffing to stop the spread of COVID-19. The bill includes:
- $50 billion for testing, genomic sequencing of variants, and contact tracing efforts, as well as manufacturing and procurement of PPE
- $20 billion for improving vaccine administration and distribution
- $10 billion for the Defense Production Act to procure essential PPE and other medical equipment
- $8 billion for public health workforce development
Between March and September 2020, as many as 3 million Americans lost their employer-sponsored health insurance. Americans must have affordable health insurance and access to care during and after this unprecedented public health crisis.
The American Rescue Plan Act of 2021 will ensure access to health coverage by:
- Lowering or eliminating health insurance premiums for millions of Americans who buy insurance through the marketplaces through increased tax credits, reducing premiums by potentially thousands of dollars each year
- Providing incentives for states to expand Medicaid by increasing federal supports, which could provide health insurance coverage to nearly 4 million Americans, including 640,000 frontline or essential workers, if expanded nationwide
- Subsidizing 100% of premiums for COBRA continuation coverage to help people who experienced job loss maintain their health coverage
- Providing $8.5 billion in provider relief to help struggling rural health care providers and ensure access to care in rural areas
The American Rescue Plan Act of 2021 will work to address systemic inequities through a $25.2 billion investment in underserved communities and communities of color, including:
- $7.6 billion for community health centers, Federally Qualified Health Center Look-Alikes, and Native Hawaiian Health Centers
- $3.3 billion for the Indian Health Service
- $1 billion for emergency assistance for children, families, and workers through the Temporary Assistance for Needy Families program
- $500 million for nursing home strike teams to manage COVID-19 outbreaks and another $200 million for infection control in nursing homes
- $276 million to protect the elderly and fight elder abuse
- $150 million for the Maternal, Infant, and Early Childhood Home Visiting Program
- $50 million for the Title X Family Planning Program
- Allowing states to provide Medicaid coverage for one year postpartum to address the maternal health crisis disproportionately affecting communities of color
- Increased federal support through Medicaid for home- and community-based services
The COVID-19 pandemic has taken a toll on the mental health of many Americans, further straining mental and behavioral health and substance use disorder services that have been historically underfunded. The American Rescue Plan Act of 2021 aims to increase access to mental health and substance use disorder services, treatment, and prevention with $4 billion in funding, including:
- $3 billion for the Substance Abuse Prevention and Treatment and Community Mental Health Block Grants
- $420 million for Certified Community Behavioral Health Clinics
- $420 million to the Indian Health Service for behavioral health services
- $140 million to develop a program to support providers’ mental health and decrease burnout of providers and public safety officers
- $100 million to the Behavioral Health Workforce Education and Training Program to train behavioral health paraprofessionals, such as peer support specialists
- $80 million in new grants for community-based and behavioral health organizations
- $80 million for the Pediatric Mental Health Care Access Program and an additional $50 million to support youth suicide prevention
- $10 million for the National Childhood Traumatic Stress Network
Payment for Ambulance Services
The American Rescue Plan Act of 2021 provides authority for the secretary of the Department of Health and Human Services to let Medicare pay for ambulance services provided to individuals who are treated in place instead of transported to a hospital or other location.
Post-Acute Care for Medicare
The Coronavirus Aid, Relief, and Economic Security (CARES) Act provides acute care hospitals flexibilities during the coronavirus emergency period in order to transfer patients out of their facilities and into alternative care settings, and to open up existing beds in post-acute care settings. For the duration of the public health emergency, the bill:
- Waives the Inpatient Rehabilitation Facility (IRF) 3-hour rule, which requires a beneficiary to be expected to participate in at least 3 hours of intensive rehabilitation at least 5 days per week to be admitted to an IRF.
- Allows Long Term Care Hospitals (LTCHs) to maintain their designation even if more than 50 percent of their cases are less intensive.
- Pauses the LTCH site-neutral payment methodology.
Medicare Home Health
The CARES Act permanently allows physician assistants, nurse practitioners, and clinical nurse specialists to order home health services for beneficiaries, which will reduce delays and increase beneficiary access to care in the safety of their homes. Before this provision, only physicians were able to certify the need for home health services. This provision goes into effect no later than 6 months after March 27, 2020.
The CARES Act also directs the secretary of health and human services to encourage the use of telecommunications systems, including remote patient monitoring, to deliver home health services consistent with the beneficiary care plan during the COVID-19 emergency period. This allows patients to receive certain home health services without a provider entering their home.
In order for a qualified beneficiary to receive hospice benefits, a hospice physician or nurse practitioner must certify their eligibility. Typically, a recertification must be done in person. The CARES Act allows hospice physicians and nurse practitioners to conduct these visits via telehealth for the duration of the public health emergency.
Requirements for Medicare Quality Reporting Programs
The Centers for Medicare & Medicaid Services (CMS) has granted exceptions from reporting requirements and extensions for providers participating in Medicare quality reporting programs for upcoming measure reporting and data submission. More information is available at this link.
Medicare Blanket Waivers and New Rules
CMS has used its existing waiver authority under a public health emergency to issue blanket waivers for Medicare and an interim final rule with many new payment rules and policies to respond to the pandemic. These temporary policies are meant to expand hospital capacity, expand the health care workforce, reduce paperwork requirements, and further promote telehealth. For information on the waivers and guidance, and the interim final rule, please go to the CMS COVID-19 flexibilities webpage. This webpage also includes provider-specific fact sheets and FAQs. A fact sheet on blanket waivers is also available here and a summary is available here.
Medicaid Home and Community-Based Support
Under the CARES Act, if patients have COVID-19 and are admitted to a hospital, state Medicaid programs now have the ability to allow direct support professionals to continue to provide care and services in the hospital for patients they are supporting, including seniors and individuals with disabilities.
CMS has approved a section 1135 waiver request for Med-QUEST to waive authorities under Medicaid and Hawaii’s request to amend the 1915(c) Home and Community-Based Services waiver. The section 1135 waiver approval is available here.
Liability Protections for Volunteer Health Care Professionals
The CARES Act specifies that health care providers who provide volunteer medical services during the coronavirus public health emergency have liability protections under certain conditions for any harm caused by an act or omission of the provider while providing health care services.
- The provider must be providing health care services within the scope of their license, registration, or certification.
- The provider must be a volunteer who does not receive compensation or any other thing of value in lieu of compensation.
- Liability protections do not apply if the harm was caused by willful or criminal misconduct, gross negligence, reckless misconduct, or conscious flagrant indifference to an individual’s rights or safety or if the volunteer rendered the health care services under the influence of alcohol or an intoxicating drug.
- These protections preempt state laws unless state laws provider greater liability protections.
Sharing of Patient Health Information
The CARES Act requires HHS to issue guidance clarifying what patient information may be shared during the COVID-19 public health emergency.
Other Information from CMS
Additional guidance and information from CMS is available here.
The Food and Drug Administration (FDA) issued emergency use authorizations for vaccines to prevent COVID-19, and more are under development. These vaccines have been found to be safe and effective, but their availability is limited at this time. The vaccines are free for all individuals.
For most private insurance plans, the CARES Act requires coverage for COVID-19 vaccines without cost-sharing. Specifically, this coverage is required to begin fifteen days after a favorable rating or recommendation from the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices. In addition, private health insurance plans are required to cover all the costs of a COVID-19 vaccine even if an out-of-network provider administers it.
Typically, the Affordable Care Act requires that preventive services and vaccines be covered by private insurance starting on the first day of the plan year beginning after a favorable rating or recommendation, so the CARES Act requires this coverage to begin sooner.
The CARES Act requires a vaccine that the FDA has authorized or approved and its administration to be free to beneficiaries with Medicare Part B and those with Medicare Advantage who receive the vaccine from an in-network provider.
Medicaid and CHIP must cover recommended vaccines for children without cost-sharing. For adults in Hawaii, Medicaid must cover vaccinations without cost sharing. Please contact Med-QUEST for more information on vaccine coverage.
Testing for COVID-19
The Families First Coronavirus Response Act requires health insurers to cover the COVID-19 diagnostic test at no cost to individuals. This includes private health plans, Medicare, Medicare Advantage, Medicaid, CHIP, TRICARE, veterans’ plans, federal workers’ health plans, and the Indian Health Service.
- Plans may not use tools like prior authorization to limit access to the test.
- Insurers must also cover the cost, without cost-sharing, of a patient’s visit to a provider, urgent care center, or emergency room to receive this testing.
- This means that individuals are not responsible for deductibles, coinsurance, or co-pays for a medically necessary COVID-19 test or the visit associated with receiving that test.
Pricing of Diagnostic Testing
For COVID-19 testing, the CARES Act requires insurers to pay either the rate specified in a contract between the provider and the insurer, or, if there is no contract, a cash price posted by the provider. Insurers may negotiate a lower price than cash price.
Prescription Drug Coverage for Medicare Beneficiaries
During the COVID-19 public health emergency, Medicare Part D plans may permit seniors on Medicare to receive up to 90 days of a prescription if that is what their doctor prescribed, as long as there are no safety concerns. Medicare drug plans may also allow beneficiaries to fill prescription early for refills up to 90 days, depending on the prescription.
Over-the-Counter Medical Products
The CARES Act allows patients to use funds in Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), and Health Reimbursement Arrangement (HRAs) for the purchase of over-the-counter medical products, such as non-prescription pain relievers and cold/flu medications, without a prescription from a physician. In addition, menstrual care products have been added to the list of qualified health care expenses under FSAs, HSAs, and HRAs.
The CARES Act provides new options to use telehealth, and allows for high-deductible health plans with a health savings account to cover telehealth services prior to a patient reaching their deductible.
HHS will not take enforcement action against any health insurance issuer that amends its catastrophic plans to provide pre-deductible coverage for services associated with the diagnosis and/or treatment of COVID-19.
CMS has posted several guidance documents and other information at this link. Of particular note are the following:
- FAQs on diagnostic testing.
- Medicaid and CHIP - Coverage and Benefits Related to COVID-19
- Individual and Small Group Market Insurance Coverage – Information Related to COVID-19
- Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019
- FAQs on Prescription Drugs and the Coronavirus Disease 2019 for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019
- FAQs on Essential Health Benefit Coverage and the Coronavirus
- Information for Medicare Advantage Organizations, Part D Sponsors, and Medicare-Medicaid Plans
Provider Relief Fund – Health Care Provider Grant Program
The American Rescue Plan Act of 2021 includes $8.5 billion for rural health providers. In addition, the Coronavirus Aid, Relief, and Economic Security (CARES) Act provides $100 billion, the Paycheck Protection Program and Health Care Enhancement Act provides $75 billion, and the Coronavirus Response and Relief Supplemental Appropriations Act of 2021 provides $3 billion in grants to health care providers to reimburse for health care related expenses or lost revenues that are attributable to the coronavirus. The Department of Health and Human Services (HHS) is distributing these grants through the Provider Relief Fund (PRF).
The Coronavirus Response and Relief Supplemental Appropriations Act of 2021 also requires that PRF payments made prior to September 19, 2020, must be calculated using the Frequently Asked Question guidance released by HHS on June 19, 2020. This ensures that the definition of lost revenue is based on any revenue that a provider lost due to coronavirus. The legislation also clarifies that PRF payments can be used for staffing and allows health systems to move targeted PRF distributions within their system.
More information about how HHS is distributing this funding is available on the HHS website.Use of Provider Relief Funds
Funds may be used for all non-reimbursable expenses attributable to coronavirus. These funds may not be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Even if qualified expenses are eligible for reimbursement from another mechanism, an entity may still apply for funding from this fund while simultaneously applying for funding from other sources. However, should an entity subsequently receive reimbursement for expenses from any other source after receiving funding for the same expenses from this fund, the entity will be required to re-pay the funding it received from this fund. The funds may be used for building or construction of temporary structures, leasing of properties, medical supplies and equipment (including PPE and testing supplies), increased workforce and trainings, emergency operation centers, retrofitting facilities, and surge capacity.
Community Health Centers
The American Rescue Plan Act of 2021 includes $7.6 billion for community health centers for the prevention, diagnosis, and treatment of coronavirus. In addition, the CARES Act provided $1.32 billion and the Coronavirus Preparedness and Response Supplemental Appropriations Act provided $100 million to community health centers. Community health centers are also eligible for grants described above.
Increased Medicare Payments
The CARES Act and the COVID relief law increase Medicare payments in the following ways:
- Under the Medicare Inpatient Prospective Payment System, for any discharges of an individual diagnosed with COVID-19 occurring during the coronavirus public health emergency, the weighting factor that would otherwise apply to the diagnosis-related group (DRG) is increased by 20 percent.
- The CARES Act exempts Medicare payments from the two percent payment reduction under sequestration from May 1, 2020 to December 31, 2020, and the COVID relief law extended this relief until March 31, 2021.
- The CARES Act delays reductions in Medicare payments for durable medical equipment and clinical diagnostic laboratory tests.
- The COVID relief law increases payments for all services under the Medicare Physician Schedule by 3.75 percent for 2021.
Medicare Accelerated/Advance Payment Program
The CARES Act expanded the existing Medicare Accelerated/Advance payment program to ensure a reliable and stable cash flow for hospitals and other providers. Qualified facilities— acute care hospitals, critical access hospitals (CAHs), children’s hospitals, and prospective payment system-exempt cancer hospitals—were able to request accelerated Medicare payments for inpatient hospital services. Rather than waiting until claims have been processed to issue payment, Medicare worked with qualified hospitals to estimate their upcoming payments and give that money to the hospital in advance.
On April 26, 2020, CMS announced the pause of the Accelerated Payments Program and the suspension of the Advance Payments Program, although CMS continued to accept applications from providers as they related to the COVID-19 PHE. As of October 8, 2020 CMS is no longer accepting applications for accelerated or advance payments as they relate to the COVID-19 PHE.
The Continuing Appropriations Act, 2021 and Other Extensions Act amended the repayment terms for all providers and suppliers who requested and received accelerated and advance payments during the PHE.
- Providers were originally required to make payments starting in August of this year, but repayment is now delayed until one year after payment was issued.
- After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months.
- At the end of the eleven-month period, recoupment will increase to 50 percent for another six months.
- If the provider or supplier is unable to repay the total amount during this time-period, CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.
Mortgages for Health Care Facilities
The Coronavirus Response and Relief Supplemental Appropriations Act of 2021 authorizes the Department of Housing and Urban Development to insure mortgages under the Section 223(d) Operating Loss Loan Program to cover the operating losses of health care facilities that are already insured under the Section 232 and 242 mortgage insurance programs and that were financially sound immediately prior to the COVID-19 pandemic.
What financial assistance is available for hospitals, health systems and health care providers in the bill?
One of the primary ways the bill supports our health system is a $100 billion fund, run through the Public Health and Social Services Emergency Fund (PHSSEF), to cover non-reimbursable expenses attributable to COVID-19. All health care entities that provide health care, diagnoses or testing are eligible for funding. Additional funding mechanisms, such as Medicare payment boosts, support for community health centers and additional appropriated funding, are discussed in more detail below.
What is the process and criteria for hospitals, health systems and health care providers to receive the PHSSEF funding?
The $100 billion PHSSEF fund is designed to be immediately responsive to needs. The U.S. Department of Health and Human Services (HHS) is instructed to review applications and make payments on a rolling basis, in order to get money into the health system as quickly as possible. This is in contrast to a more traditional competitive grant process, under which HHS would solicit applications by a certain deadline and review all applications together – a process that would take considerably more time. HHS will instead release the funds to health care entities on a rolling basis as qualified applications are received. As such, HHS is given significant flexibility in determining how the funds are allocated, as opposed to operating under a mandated formula or process for awarding the funds. This is to ensure that the funding is nimble enough to meet all needs and that the fund disperses money fast enough to help struggling entities. The HHS Secretary is expected to release guidance on the application process shortly, and Congress will continue to work with the Administration to ensure that the funding and application process works as intended.
What expenses qualify for funding?
All non-reimbursable expenses attributable to COVID-19 qualify for funding. Examples include building or retrofitting new ICUs, increased staffing or training, personal protective equipment, the building of temporary structures and more. Forgone revenue from cancelled procedures, which has put significant strain on the health care system, is also a qualified expense. It is important to note that this fund can only be used for non-reimbursable expenses. Any expenses reimbursed or obligated to be reimbursed by insurance or other mechanisms are not eligible. The bill instructs the HHS Secretary to establish a reconciliation process under which payments will have to be returned to the fund if other sources provide reimbursement for expenses.
Can health care entities access funds under the PHSSEF if they are also eligible for funding from another government program?
Yes. The language states that the funds may not be used for expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Even if qualified expenses are eligible for reimbursement from another mechanism, an entity may still apply for funding from the PHSSEF fund while simultaneously applying for funding from other sources. However, should the entity subsequently receive reimbursement for expenses from any other source after receiving funding for the same expenses from the PHSSEF fund, the entity will be required to re-pay the funding it received from the PHSSEF fund. This same principal also applies to the new SBA7(a) loans Paycheck Protection Program forgivable loans, the SBA’s Economic Injury Disaster Loan (EIDL) Program, and the new EIDL Emergency Grant Program. Read more about these SBA loan and grant programs here.
What is the process for hospitals, health systems and health care providers to apply for and receive funding under the 7(a) SBA Paycheck Protection Program (PPP)?
Small businesses and 501(c)(3) non-profit organizations, including hospitals, health systems, and health care providers, are eligible to apply for the Small Business Administration’s Paycheck Protection Program (PPP). Through this program, a small business or organization can apply to an SBA-approved lender for a loan of up to 250% of your average monthly payroll costs to cover eight weeks of payroll as well as help with other expenses like rent, mortgage payments, and utilities. This loan can be forgiven based on maintaining employee and salary levels. For any portion of the loan that is not forgiven, the terms include a maximum term of 10 years, a maximum interest rate of 4 percent. Small businesses and organizations will be able to apply if they were harmed by COVID-19 between February 15, 2020 and June 30, 2020. To be eligible, small businesses and 501(c)(3) non-profit organizations must have fewer than 500 employees, or more if SBA’s size standards for the non-profit allows. This program is retroactive to February 15, 2020, in order to help bring workers who may have already been laid off back onto payrolls. Loans are available through June 30, 2020. Read more about the PPP program here.
What support is included for community health centers?
The CARES Act provides $1.32 billion in supplemental funding for community health centers (CHCS), which are on the front lines in addressing COVID-19 in underserved communities across the country. This funding is in addition to the $100 million distributed by the Health Resources and Services Administration (HRSA) to CHCs on March 24th. Community Health Centers can also access the PHSEFF fund.
How much will Medicare patients have to pay for the COVID-19 test?
Medicare Part B (Medical Insurance) will cover the cost of a COVID-19 test. This test is covered when your doctor or other health care provider orders it.
For more information on how to get tested in the state of Wisconsin, please visit the Wisconsin Department of Health Services’ website.
How much will Medicare patients have to pay for treatment of COVID-19?
Medicare covers all lab tests for COVID-19 without any out-of-pocket costs. Medicare also covers all medically necessary hospitalizations. This includes if you're diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine. If you have a Medicare Advantage (MA) Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many MA plans offer additional telehealth benefits, so check your plan about your coverage and costs.
Please note: Scammers may use the coronavirus national emergency to take advantage of Medicare patients. As always, guard your Medicare card like a credit card, check Medicare claims summary forms for errors, and if someone calls asking for your Medicare Number, hang up!
How much will Medicare patients have to pay for the COVID-19 vaccine once it becomes available?
The CARES Act ensures that the vaccine itself and its administration is free to beneficiaries with Medicare Part B and those with Medicare Advantage who receive the vaccine from an in- network provider.
Additionally, the Families First Coronavirus Act required that all private insurance plans cover coronavirus testing without deductibles, coinsurance, or co-pays. That bill also prohibited plans from using tools like prior authorization to limit access to testing. The CARES Act makes a technical correction to ensure that the policy covers all tests that meet the appropriate standards. Insurers also have to cover fees for visits to the ER, an urgent care center, or a doctor’s office associated with getting a test without cost sharing.
The Affordable Care Act required that preventive services and vaccines be covered by private insurance without cost-sharing. Normally, these services and vaccines are covered starting on the first day of the plan year beginning after they get a favorable rating or recommendation from the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices. This section requires that coverage without cost sharing begin fifteen days after getting a favorable rating or recommendation.
How does this bill increase access to telehealth services for seniors and other Medicare beneficiaries?
The CARES Act gives the Secretary of Health and Human Services (HHS) broad authority to allow more health care providers to provide telehealth services to Medicare beneficiaries, including in the beneficiaries’ homes to avoid potential exposure to COVID-19, and provide more flexibility in terms of how those telehealth services can be provided. Once enacted into law, the HHS Secretary must put out guidance explaining how this expanded waiver authority will be used to increase access to telehealth services for seniors and other Medicare beneficiaries.
I’ve heard from Federally Qualified Health Centers (FQHCs) (including Community Health Centers (CHCs)) and Rural Health Clinics (RHCs) that the Administration won’t allow them to use telehealth and get paid. Does this bill help those providers deliver care via telehealth?
Yes. The CARES Act requires the HHS Secretary to provide Medicare payment to FQHCs (including CHCs) and RHCs for telehealth services provided to seniors and other Medicare beneficiaries, including in the beneficiaries’ homes to avoid potential exposure to COVID-19, during the COVID-19 public health emergency. Medicare would be required to pay the FQHC or RHC at rates similar to those for telehealth services provided from a doctor’s office. Costs associated with those telehealth services would not affect the prospective payment system for FQHCs or the all-inclusive rates for RHCs.
How does this bill help clinical laboratories when it comes to Medicare?
The CARES Act prevents scheduled Medicare payment cuts for clinical diagnostic laboratory tests furnished to Medicare beneficiaries in 2021. It also delays by one year—until 2022—the upcoming reporting period during which laboratories are required to report private payer data.
How will seniors access the medications they need while also being told it’s better to stay at home? In the past, Medicare drug plans only let beneficiaries receive a 30 day supply of their prescription.
Under the CARES Act, during the COVID-19 Public Health Emergency (PHE) a senior on Medicare can get up to 90 days of a prescription if that is what the doctor prescribed, as long as there are no safety concerns. Medicare drug plans will also allow beneficiaries to fill prescription early for refills up to 90 days, depending on the prescription.
Hospitals are facing cash flow challenges due to canceling elective services. Is there anything in this bill to help hospitals stay afloat, even temporarily?
The COVID-19 emergency has created significant cash flow concerns for many hospitals. Hospitals need reliable and stable cash flow to help them maintain and support their workforce, buy essential supplies, create additional infrastructure, and keep their doors open to care for patients. During the COVID-19 public health emergency (PHE), the CARES Act creates the opportunity for hospitals to receive accelerated payments. Specifically, acute care hospitals, critical access hospitals (CAHs), children’s hospitals, and prospective payment system-exempt cancer hospitals (PCHs) will be able to request accelerated Medicare payments for inpatient hospital services. This is an expanded set of hospitals compared with the existing accelerated payment program.
Rather than waiting until claims have been processed to issue payment, Medicare will work with qualified and interested hospitals to estimate their upcoming payments and give that money to the hospital in advance. Qualified facilities can request a lump sum or periodic payment reflecting up to six months of Medicare services. Accelerated payments must be repaid to Medicare, however a qualifying hospital would not be required to start paying Medicare back for four months after receiving the first payment. Hospitals would have at least 12 months to complete repayment without paying interest.
Hospitals interested in receiving accelerated payments should contact their Medicare Administrative Contractor (MAC). To learn which MAC to contact, please look here.
Does the bill give additional flexibility for hospice providers?
Yes. In order for a qualified beneficiary to receive hospice benefits, a hospice physician or nurse practitioner must certify their eligibility. Typically, a recertification must be done in person.
The CARES Act allows hospice physicians and nurse practitioners to conduct these visits via telehealth for the duration of the PHE.
Many hospitals are concerned that there aren’t enough ICU beds to take care of those with COVID-19, and inpatient rehabilitation hospitals (IRF) and long-term care hospitals (LTCH) are trying to help build capacity. However, current rules and regulations won’t allow them to take certain patients. What does The CARES Act do to help?
The CARES Act makes changes to both IRFs and LTCHs to provide hospitals with more flexibility when discharging patients in order to maximize bed capacity. It also opens up existing beds at IRFs and LTCHs to increase the availability of post-acute services.
Currently, in order to be admitted to an IRF, Medicare patients must be expected to participate in at least three hours of intensive rehabilitation at least five days per week (also known as the “three-hour rule”). The CARES Act waives this requirement so that IRFs have the ability to accept more patients who may otherwise be sent to other post-acute facilities, such as nursing homes.
Patients who are admitted to LTCHs usually must meet certain clinical criteria for an LTCH to receive a higher Medicare payment. If less than half of an LTCH’s patients meet these criteria, they are no longer eligible to receive any LTCH payments. The CARES Act waives both of these policies for the duration of the PHE so that LTCHs may accept as many patients as necessary at their LTCH rate, without regard to the clinical criteria. By waiving these criteria, an LTCH will be able to take more patients from an acute care hospital and still get paid.
With more patients needing to stay at home, and a growing concern over health care workforce shortages due to COVID-19, how does the CARES Act help those who depend on the home health benefit?
Under current law, only physicians are able to certify the need for home health services. The CARES Act makes a permanent, statutory change to allow physician assistants, nurse practitioners, and clinical nurse specialists to order home health services for beneficiaries, reducing delays and increasing beneficiary access to care in the safety of their home.
The CARES Act also directs the Secretary of Health and Human Services (HHS) to encourage the use of telecommunications systems, including remote patient monitoring, to deliver home health services consistent with the beneficiary care plan during the COVID-19 emergency period. This allows patients to receive certain home health services without a provider entering their home.
Treating patients with COVID-19 is very resource intensive for hospitals. How will Medicare ensure that hospitals are adequately reimbursed for treating COVID-19 patients?
The CARES Act increases Medicare reimbursement to care for a COVID-19 patient by 20 percent (specifically, the Act increases the weighting factor of DRGs for inpatients diagnosed with COVID-19 by 20 percent). This add-on payment for inpatient hospital services recognizes the increased costs incurred by providers and will be applied for the duration of the COVID-19 emergency.
If a hospital has not treated any cases of COVID-19, are there other ways it can benefit from the Medicare policies in the bill?
Yes. The CARES Act temporarily lifts the Medicare sequester, effectively adding an additional two percent for services provided from May 1 through December 31, 2020. This will boost payments for hospital, physician, nursing home, home health, and other care, giving prompt economic assistance to health care providers that treat Medicare patients.
If a patient has COVID-19 and has to enter the hospital, can their regular personal care attendant, who they depend on at home, still help while the patient is in the hospital?
Under the CARES Act, state Medicaid programs now have the ability, should they choose to pick up the option, to allow direct support professionals to continue to provide care and services for patients they are supporting in the hospital, including seniors and individuals with disabilities.
Additional Information and Resources
For general information and resources about coronavirus for Wisconsinites, please click here.
For more information about the American Rescue Plan Act of 2021, please click here.
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