Today on the Hill: Special COVID-19 Edition (5/8)

Capitol Hill Update

House lawmakers are currently scheduled to return to Washington next week, yet the lack of a “CARES 2.0” proposal from House Democratic leadership suggests that this date could get pushed to the following week of May 18. House Democrats are still tying up loose ends on their forthcoming stimulus proposal and have cooled on their original timeline of producing legislative text by the end of this week. Intel from senior Democratic leadership sources suggests that the House majority could have a section-by-section outline of the package as soon as this weekend, with legislative text released toward the middle to late part of next week. Meanwhile, the two parties are currently far apart on the next round of relief efforts and will need to navigate deep policy schisms over the size and scope of the next package before a concrete timeline emerges.

COVID-19: What We’re Hearing

• COVID 4.0. As the COVID-19 pandemic ensues, lawmakers are continuing to mull over policy items for another round of economic stimulus relief. TRP has compiled a list and summaries of the major priorities that have been discussed.
  • Supply Chain. Speaker Nancy Pelosi (D-CA) stated that the next round of COVID-19 relief next will include Energy & Commerce Health Subcommittee Chair Anna Eshoo’s (D-CA) bill that calls for an expert committee to assess the U.S. drug supply chain and recommend ways to reduce dependence on foreign drug manufacturing. Click here to read TRP’s comprehensive analysis of the federal actions taken to address pharmaceutical supply chain concerns.
  • PPP. Lawmakers on both sides of the aisle are mulling potential policy options that would bolster and reform the Paycheck Protection Program (PPP). Additional funding to shore up lending, as well as easing loan forgiveness requirements, are two key areas that currently enjoy bipartisan support.
  • State and Local Governments. GOP lawmakers have indicated that they support promoting flexibility for state and local governments to use CARES Act funding to replace lost revenue, but are lukewarm on providing new funding beyond the $150 billion fund established in the “Phase III” bill. A bipartisan group of Senators introduced a measure that would give states these flexibilities to offset losses.
    • House Ways and Means Chairman Richard Neal (D-MA) stated recently that House Democrats will soon detail plans to provide additional financial assistance to state and local governments. In addition to a set amount of money that could reach up to $800 billion, the plan will likely include provisions that seek to boost private activity bonds.
    • A bipartisan group of House lawmakers have introduced legislation that would allocate $250 billion in direct funding for local governments of all sizes. The measure would also allow governments to offset lost revenue due to the pandemic.
  • Postal Service. House Majority Leader Steny Hoyer (D-MD) indicated that Democrats are coalescing behind Oversight and Reform Chairwoman Carolyn Maloney’s (D-NY) proposal that would boost USPS by $25 billion. However, he recognized that the President’s current attitude toward Amazon could impede progress on that front. 
  • Liability. Leader McConnell emphasized that he will “insist” Congress limit the liabilities of health care workers, business owners, and employees from lawsuits pertaining to the COVID-19 outbreak, making it contingent in order for the Senate to consider any additional relief legislation. Democrats have been dismissive of this proposal, arguing that it would water down federal consumer protection efforts.
    • Senate Judiciary Chairman Lindsey Graham (R-SC) stated yesterday that he expects to hold a hearing on liability in the era of COVID-19 next week.
  • Payroll Tax. During a virtual town hall meeting over the weekend, President Donald Trump stated that he will not support another COVID-19 relief bill without a provision that provides payroll tax relief.
  • Infrastructure. President Trump reiterated his call for robust infrastructure provisions in the Phase IV bill during Sunday’s town hall. In a recent tweet, he specifically highlighted surface transportation and broadband infrastructure as areas he’d like to see addressed.
    • Despite support for infrastructure from Speaker Pelosi and President Trump, it remains to be seen whether both parties can strike an agreement on big-ticket legislative items such as infrastructure. Congressional Republicans have remained opposed to tacking on non-COVID related items to future relief packages.
  • Merger Ban. Several Democratic lawmakers have offered support of a plan sponsored by Sen. Elizabeth Warren (D-MA) and Alexandria Ocasio-Cortez (D-NY) that would place a ban on company mergers during the outbreak. However, Democratic leadership appears lukewarm on this suggestion as of now, and it’s unlikely to gain traction in the GOP-controlled Senate.
  • Surprise Billing. Energy and Commerce Ranking Member Greg Walden (R-OR) expects another push for action on surprise billing in the next round of relief. During the Phase III negotiations, Chairman Frank Pallone (D-NJ) and Senate Health, Education, Labor, and Pensions (HELP) Chairman Lamar Alexander (R-TN) were actively trying to tack their surprise billing legislation onto the package.

• Provider Funding. On Apr. 22, the Department of Health and Human Services (HHS) announced new distributions from the $100 billion Provider Relief Fund created by the CARES Act (H.R. 748). On May 1, HHS began distributing $12 billion to 395 hospitals who provided inpatient care for 100 or more COVID-19 patients through April 10, 2020. HHS also provided additional detail on the $10 billion rural health care provider distribution. TRP’s comprehensive analysis of these distributions can be read here.
  • The first round of funding included $30 billion for Medicare hospitals and providers. 
  • The second round of funding includes an additional $20 billion for Medicare providers nationwide, $10 billion for hospitals in highly impacted areas, $10 billion for rural providers, and $400 million for the Indian Health Service. It also establishes a program to fund COVID-19 care for the uninsured.
  • HHS has published a list of frequently asked questions pertaining to the $50 billion general allocation of the COVID-19 provider relief fund. In addition, providers receiving funds must agree to a set of terms and conditions, including reporting and documentation requirements, charging only in-network rates for COVID-19 care, and certifying that the funds will only be used to prevent, prepare for, and respond to the outbreak. HHS announced yesterday that it has extended the deadline for providers to attest to the receipt of payments and accept the terms and conditions from 30 days to 45 days.
  • HRSA launched a separate portal allowing providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020 to request reimbursement.
  • HHS also cited providers who will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid.

• Medicare Accelerated and Advanced Payments. The Centers for Medicare and Medicaid Services (CMS) announced that as of Apr. 27, the agency will not be accepting any new applications for Medicare’s Advance Payment Program (fact sheet). CMS also stated it will be reevaluating all pending and new applications for Accelerated Payments in light of payments made available through the HHS’ Provider Relief Fund.

COVID-19: What’s Happened

• Legislative Response. TRP has published several in-depth policy memos that analyze actions that Congress and the federal government have taken to address the COVID-19 outbreak. Click here for the full list of memos.
  • Since the beginning of the COVID-19 outbreak, Congress and the Trump administration have issued a number of policies and waivers designed to lower restrictions on and encourage telehealth services. Click here to read TRP’s memo on these telehealth policies.
  • President Donald Trump signed the $483.4 billion “COVID-19 Phase 3.5” bill into law. TRP’s comprehensive analysis of the Phase 3.5 legislation can be read here.
  • TRP’s has published a memo explores the “health extenders” that the CARES Act reauthorized through Nov. 2020, what’s on the table for these programs in the fall, and the questions that will shape the conversation. Click here to read the memo.

• SBA. The Small Business Administration (SBA) and Treasury Department updated their list of frequently asked questions on the PPP.
  • SBA provided an update on its PPP loan data.
  • SBA announced yesterday that agricultural businesses are now eligible for SBA’s Economic Injury Disaster Loan (EIDL) and EIDL Advance programs. 
  • SBA issued guidance on how to calculate PPP loans by business type.
  • SBA is temporarily restricting incoming applications for PPP loans to only those submitted by the country’s smallest lenders.
  • SBA published a list of all lenders participating in the PPP.
  • SBA issued a interim final rule clarifying the process of applying for PPP loans for individuals who report self-employed income on a 1040 Schedule C
  • SBA issued an interim final rule outlining additional guidance for the PPP. TRP’s comprehensive analysis of the small business provisions contained in COVID-19 response bills can be read here. The loan application form can be accessed here.

• FDA. The Food and Drug Administration (FDA) published guidance on reporting requirements for medical device shortages.
  • FDA issued an emergency use authorization for the antiviral remdesivir.
  • FDA issued guidance outlining an exemption and exclusion from certain requirements of the Drug Supply Chain Security Act during the public health emergency.
  • FDA issued guidance that will temporarily allow hospitals to compound certain sedatives used for COVID-19 patients during the public health emergency. Additional details on this policy from the FDA can be read here.
  • FDA has authorized the first at-home COVID-19 testing kit that will allow patients to self-collect samples.
  • FDA issued an update on steps the agency is taking to help mitigate supply interruptions of food and medical products.
  • FDA announced actions to increase U.S. supplies to support COVID-19 response efforts by providing instructions to manufacturers importing personal protective equipment (PPE) and other devices.

• CMS. CMS published a new tranche of frequently asked questions for state Medicaid and CHIP programs regarding COVID-19 response efforts. These FAQs cover a variety of topics, including: (1) emergency preparedness and response; (2) eligibility and enrollment flexibilities; (3) benefit flexibilities; (4) cost-sharing and financing flexibilities; (5) managed care flexibilities; and (6) information technology and data reporting.
  • CMS issued an interim final rule with comment period and blanket waivers under Section 1135 of the Social Security Act. These new flexibilities provide for Medicare coverage of serology tests, new coverage for services provided by pharmacists, and a waiver of the limitation on the types of practitioner that may furnish Medicare telehealth services.
  • CMS also gave hospitals and other inpatient facilities new flexibilities that are intended to increase acute care hospitals’ capacity during the pandemic, as well as permitting off-campus hospital outpatient departments to apply to temporarily receive reimbursement under Medicare’s hospital outpatient prospective payment system, rather than under the physician fee schedule. TRP’s memo on the new flexibilities is available here.
  • CMS announced a new independent commission that will assess safety and quality in nursing homes.
  • CMS has updated its information related to COVID-19 guidance document for for Medicare Advantage, Part D, and Medicare-Medicaid plans.
  • CMS has issued additional blanket waivers to promote flexibility for Long-Term Care Hospitals (LTCH), Rural Health Clinics (RHC), Federally Qualified Health Centers (FQHC), and Intermediate Care Facilities.
  • CMS issued recommendations that outline how certain health care systems can resume non-essential surgeries and medical procedures in areas with low incidence of COVID-19.
  • CMS has proposed to permanently codify a change to its inpatient rehabilitation facility (IRF) policy that dispenses with the requirement that IRFs provide and document a post-admission physician evaluation within 24 hours of admission.
  • A full list of the 1135 waiver approval letters can be accessed here.

• Treasury. The Treasury Department has released a list of frequently asked questions pertaining to the Employee Retention Credit.
  • Treasury Secretary Steven Mnuchin issued guidance and frequently asked questions that provide examples of eligible and ineligible expenditures of the state, local, and tribal Coronavirus Relief Fund.

• The Fed. The Federal Reserve and other bank regulatory agencies published an interim final rule that modifies the Liquidity Coverage Ratio to support banking organizations’ participation in the Money Market Mutual Fund Liquidity Facility and the PPP Liquidity Facility.
  • The Federal Reserve expanded access to its PPP Liquidity Facility for for additional lenders, and also broadened the criteria for collateral that can be pledged.
  • The Federal Reserve will expand the scope and eligibility for the Main Street Lending Program.
  • The Federal Reserve expanded the scope and duration of its Municipal Liquidity Facility to offer up to $500 billion in lending to states and municipalities during the pandemic.
  • The Federal Reserve announced a series of emergency actions that would provide more than $2 trillion in COVID-19 loans to businesses, state, and local governments.

• IRS. The Internal Revenue Service (IRS) published a list of frequently asked questions on COVID-related relief for retirement plans and IRAs.

• FEMA. The Federal Emergency Management Agency (FEMA) published a fact sheet on how the agency will coordinate and distribute two shipments of PPE to 15,000 nursing homes across the country.

• DOT. The Department of Transportation (DOT) announced more than $1 billion in grants to 439 airports across all 50 states.
  • DOT issued a final order on service obligations for air carriers receiving financial relief through the CARES Act.
  • DOT and the Federal Transit Administration (FTA) announced a total of $25 billion in federal funding allocations to help the public transit systems respond to the COVID-29 outbreak.

• Testing. The Trump administration released a blueprint that seeks to bolster state testing plans and rapid response programs.

• SAMHSA. The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded grant funding to increase access and improve the quality of community mental and substance use disorder (SUD) treatment services through the expansion of Certified Community Behavioral Health Clinics (CCBHC). 

• FCC. The Federal Communications Commission (FCC) and the Department of Education announced efforts to promote the use of $16 billion in funding for the CARES Act’s Education Stabilization Fund for remote learning.
  • In a move aimed at expanding access to Wi-Fi throughout the country, the FCC voted to adopt a report and order that would make 1,200 megahertz of spectrum in the 6 GHz band available for unlicensed use.

• NIH. The National Institutes of Health issued its first guidance on COVID-19 treatment options that are currently under review.
  • NIH and the Foundation for the NIH (FNIH) announced that they will launch a new public-private partnership with more than a dozen biopharmaceutical companies aimed at speeding COVID-19 vaccine and treatment options.

• USDA. The U.S. Department of Agriculture (USDA) and Department of Homeland Security (DHS) issued a temporary final rule allowing for flexibilities on certain agricultural-related employment regulations.

• HUD. The Department of Housing and Urban Affairs (HUD) has begun allocating $3 billion in funding for communities through the Community Development Block Grant, Emergency Solutions Grant, and Housing Opportunities for Persons With AIDS programs to address COVID-19 issues.