March 4: Congress passes $8.3 billion appropriations bill for COVID-19

The Coronavirus Preparedness and Response Supplemental Appropriations Act provides emergency funding to fight the virus. The Act loosened telehealth restrictions for Medicare recipients. The bill is broken down into funding for:

• $2.2 billion for the CDC
• $3 billion across different agencies for research and development of COVID-19 treatment materials
• $1 billion for pharmaceuticals and medical supplies

March 5: CMS provides guidance on COVID-19 cost-sharing for Medicare, Medicaid, and small group plans

CMS releases guidance on cost-sharing mechanisms for the coverage of COVID-19. CMS advises plans to limit cost-sharing for COVID-19 treatment and testing.

March 9: CMS emphasizes telehealth benefits for Medicare through press release

CMS encourages Medicare beneficiaries to utilize telehealth for screening and treatment of COVID-19. Current regulatory measures are relaxed to increase telehealth treatment and monitoring capabilities.

March 10: CMS releases guidance on Medicare Advantage organizations and Part D plans

CMS allows payment flexibilities for preventing the spread of COVID-19. CMS waives cost-sharing for COVID-19 tests and treatment.

March 13: President Trump declares COVID-19 a national emergency

Under the Stafford Act, the federal government is able to designate more resources towards a crisis. More funding is funneled towards the federal COVID-19 response.

March 14: House passes the Families First Coronavirus Response Act

The bills includes:

• 6.2 percentage point increase in state FMAP
• Protections for paid sick leave
• Funding for COVID-19 testing
• Reimbursement for costs associated with testing uninsured people

March 16: CMS releases fact sheet about regulatory and licensing requirement

CMS expands regulatory and licensing requirements to include:

• Waive requirement that out-of-state providers can only practice in the state where they are licensed
• Suspend Medicare enrollment requirements
• Grant state Medicaid agencies wider flexibilities with section 1135 waivers

March 17: CMS expands telehealth enforcement guidance

States are no longer required to submit a state plan amendment (SPA) for telehealth services. Services must meet the same requirements as face-to-face settings.

March 18: Presentation for members on COVID-19 federal response

On March 18th, NCHC held a COVID-19 policy meeting for members. Members weighed in on current efforts to combat the pandemic. Also, members helped shape a letter to Congress with policy recommendations.

March 19: Letter to Congress with policy recommendations for COVID-19

The National Coalition on Health Care (NCHC) sends a letter to Congress on March 19^th underscoring the Coalition’s policy priorities amidst the COVID-19 pandemic. The Coalition urges Congressional leadership to:

• Provide financial assistance to frontline medical workers and CHCs
• Provide additional CDC funding
• Eliminate cost-sharing for COVID-19 treatment and testing
• Pass protections for the most vulnerable populations.

The Coalition also discussed policy solutions to address Medicare and Medicaid financing.

March 23: House releases Take Responsibility for Workers and Families Act

House Democrats release new stimulus package proposition that provides economic relief across a variety of sectors. Additional funding would also be provided to social service programs. However, the bill is missing key policy provisions:

• Patients with Health Savings Accounts and high-deductible plans cannot use telehealth services
• The bill waives cost-sharing but does not explicitly ban surprise billing

March 25: Memo on CARES Act

NCHC distributes a memorandum highlighting key health provisions in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The memo reviews:

• COVID-19 testing access and affordability
• Medicare and Medicaid payment and regulatory changes

The Coalition also located vital policy provisions not addressed in the CARES Act, such as:

• Drug pricing reform
• Surprise billing
• Financial assistance to non-hospital based, primary care physicians (PCPs)

March 27: President Trump signs CARES Act into law

President Trump signs the third federal response package into law.

March 27: CMS releases telehealth toolkit for nursing home facilities

As telehealth benefits expand and improve, CMS releases toolkit on effective telehealth methodologies. The toolkit provides information on:

• Selecting telemedicine equipment and vendors
• Monitoring patients remotely for continuous care
• Documenting telehealth procedures

April 2: Presentation for members on COVID-19 policy

On April 2^nd, NCHC held a COVID-19 policy update and discussion for members. Health policy experts from NCHC and Healthsperien guided a discussion on legislative and regulatory actions in response to COVID-19. The presentation covered COVID-19’s impact on:

• Utilization rates
• Medical loss ratios (MLRs)
• Telehealth

Health policy experts analyzed key changes in Medicare and Medicaid reimbursement rates and the CARES Act’s impact on commercial health insurance. Health policy experts reiterated that drug pricing and surprise billing are key policy considerations for the Coalition.

April 2: CMS allows Medicaid telehealth flexibilities for rural health and substance use disorders

Telehealth flexibilities are granted to Medicaid plans, especially plans with members in rural areas and members with substance use disorders.

April 6: Letter to Congress with policy recommendations for Phase 4 Proposal

The letter sent to Congress on April 6^th addresses NCHC policy recommendations for the fourth federal response to COVID-19. The letter advocated for:

• A ban on surprise billing for treatment of COVID-19
• Additional financial assistance for PCPs and CHCs
• Improved public health infrastructure
• Funding for social services organizations and mental health services
• Reforming Medicare and Medicaid reimbursement rates
• Reducing drug prices for the treatment of COVID-19
• Reinstatement of 100% Medicaid FMAP for states that expand Medicaid

April 10: HHS releases monetary breakdown of CARES Act

HHS allocates the CARES Act funding into the following categories:

• $30 billion for facilities that receive Medicare fee-for-service (FFS) reimbursement
• $70 billion for targeted providers, such as rural providers, providers with lower Medicare reimbursement rates, and providers who serve Medicaid populations

April 16: White House eases social distancing guidelines

The White House develops new social distancing guidelines that allow individual states to open in three distinct phases. Each state is able to reopen when they meet certain benchmarks.

April 21: Senate passes COVID-19 interim spending package

Senate passes the Paycheck Protection Program and Health Care Enhancement Act which provides an additional $484 billion to COVID-19 relief.

• $75 billion goes towards hospitals and providers
• $25 billion goes to research and development of additional COVID-19 tests

April 23: CMS releases telehealth toolkit for nursing home facilities

As telehealth benefits expand and improve, CMS releases toolkit on effective telehealth methodologies. The toolkit provides information on:

• Eligibility for telehealth services
• Reimbursement policies for telehealth services
• Technology requirements
• How telehealth impacts pediatric services

April 24: President Trump signs Payment Protection Program and Health Care Enhancement Act into law

President Trump signs the Payment Protection Program and Health Care Enhancement Act into law which provides additional economic relief.

May 7: Memo on Phase 4 Proposal

NCHC distributes a memorandum highlighting anticipated key health provisions in the fourth federal response to COVID-19. The fourth federal response may address:

• Medicaid reimbursement rates
• A prolonged SEP for those uninsured
• A federal reinsurance program for COVID-19 expenses
• Cost-sharing will be waived for COVID-19 treatment
• Insurance subsidies for those who have been laid off or furloughed

NCHC also provides recommendations for the next COVID-19 bill, including:

• Banning surprise billing for COVID-19 testing and treatment
• Increase financial assistance for PCPs
• Enhancing Medicaid FMAP, and waiving cost-sharing for COVID-19 treatment

May 12: House releases the fourth coronavirus relief package

The House unveils the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, which aims to

• Provide financial relief to state and local governments
• Fund increased testing
• Provide unemployment insurance and national stimulus payments

May 12: Memo on HEROES Act

Once the House releases the HEROES Act, NCHC categorized key provisions related to the Coalition’s policy goals. The HEROES Act hopes to:

• Increase FMAP
• Eliminate cost-sharing for COVID-19 treatment
• Cover the uninsured for COVID-19 treatment
• Treat incarcerated people with COVID-19 using Medicaid funding
• Addresses Medicare coverage under Part A and Part B for COVID-19 treatment
• Eliminates cost-sharing for Prescription Drug Plans (PDPs) and Medicare Advantage-Prescription Drug plans (MA-PDPs)
• Create SEP for Medicare and private insurance through the federal exchange
• Eliminates cost-sharing for COVID-19 treatment provides subsidies for those who have been laid off or furloughed
• Improves the medical and drug supply chain and increases public health funding for varying initiatives

May 12: HHS releases telehealth website

HHS releases a telehealth website with information on telehealth services.

May 19: Presentation for members on COVID-19’s impact on primary care

On May 19^th, NCHC held a COVID-19 policy discussion focused on primary care during the pandemic. Varying stakeholders and members communicated that PCPs are at risk for closing because of low Medicaid reimbursement rates. NCHC supports increased funding for PCPs and advocates for an integrated, value-based payment model for primary health services. During the presentation, stakeholders and members discussed current and future repercussions for primary care services amidst the pandemic.