Rural Health Clinic Relevant Provisions in the CARES Act

Legislation Provides Access to Liquidity for Small Businesses



The Coronavirus Aid, Relief, and Economic Security Act or CARES Act passed the Senate by a vote of 96-0 on Wednesday, March 25th and is expected to be passed by the House and signed into law by President Trump on Friday March 27th. This historic legislation is one of the largest spending bills ever passed by Congress, but lawmakers have already signaled that a fourth round of COVID-19 related legislation is necessary and work will begin on that legislation immediately.  

In addition to the telehealth provisions for RHCs, the phase 3 coronavirus legislation includes several other sections of note for the RHC community. We have highlighted a few of these sections below.

Temporary Suspension of Medicare Sequestration
From May 1, 2020 through December 31, 2020, Medicare will no longer have an across the board 2% reduction on reimbursement. This means that RHCs will receive 80% of their AIR instead of 78.4% of their AIR during this period. 

Small Business Loans
The Small Business Administration’s 7(a) loan program is expanded more than tenfold. The legislation authorizes $349 billion in lending from February 15th to June 30th for businesses with fewer than 500 employees. Recipients could receive up to $10 million of 250% of their monthly payroll costs and would be expected to use the funds to retain workers, maintain payroll, and continue to pay monthly expenses. 

Recipients of these loans could also apply for loan forgiveness that would forgive an amount up to eight weeks of payroll and other fixed expenses such as rent and utilities. 

Accelerated Payment Program for Hospitals
The existing Medicare accelerated payment program is expanded to include additional hospitals such as Critical Access Hospitals. 

Critical Access Hospitals would be able to request up to 125% of Medicare payments for a 6-month period. After 120 days, Medicare begins to offset payments to recoup the accelerated payment back from the hospital. 

Physician Assistants and Nurse Practitioners Permanently Authorized to Order Home Healthcare Services for Medicare Patients
Congress included the Home Health Care Planning Improvement Act in this legislation which permanently authorizes PAs, NPs, clinical nurse specialists, and certified nurse-midwifes to order home healthcare services for Medicare patients in accordance with state law. 

Previously, only physicians were able to order home health services for Medicare patients. 

Funding for Several Programs Extended Through November 30th
The legislation funds several healthcare programs which were set to expire on May 22nd through November 30th. These programs include: Disproportionate Share Hospital (or DSH) funding, National Health Service Corps funding, and community health center funding. 

The extension sets up a legislative vehicle during the Congressional lame duck that could include surprise medical billing legislation, drug pricing legislation, and rural health legislation such as the Rural Health Clinic Modernization Act. Policymakers were working on many of these issues before the COVID-19 health crisis.  

COVID-19 Vaccine Coverage
Once a vaccine is approved, all private insurance must cover the vaccine without patient cost sharing. Furthermore, Medicare and Medicare Advantage plans will cover any approved COVID-19 Vaccine without any patient cost sharing. 

Medicare Add-on for Inpatient Hospital COVID-19 Patients
This section increases the payment that would otherwise be made to a hospital for treating a patient admitted with COVID-19 by 20 percent. It would build on the Centers for Disease Control and Prevention (CDC) decision to expedite use of a COVID-19 diagnosis to enable better surveillance as well as trigger appropriate payment for these complex patients. This add-on payment would be available through the duration of the COVID-19 emergency period.