The Headlines
- The federal government and stakeholders continue to respond to the impact of COVID-19.
- CMS announces additional waivers for telehealth, including expanding coverage to OT, PT, SLT, and audiology services.
- House appropriators are moving forward with FY2021 funding bills.
The Details
1. Federal COVID-19 virus updates
The full Senate reconvened this week for the first time since March. The House may return as soon next week (May 11), but the timing will be dependent on whether votes are scheduled on a potential fourth COVID-19 relief and stimulus package. While resuming a more regular schedule, new precautions are being put into place to protect Members and staff. The Office of the Attending Physician, which serves Congress and the U.S. Supreme Court, has warned that pre-COVID-19 normal operations will not be back in place for quite some time.
Duke Health Government Relations continues to connect Duke Health experts and leadership with Members of Congress, including Reps. Mark Walker (R-NC-06) and Ted Budd (R-NC-13), about the financial impacts on the health system and PDC. Our office also provides updates to congressional staff on testing and research underway in the health system. On May 8, staff from the office of Senator Richard Burr (R-NC) and the government relations team at the Association of American Medical Colleges (AAMC) will meet by phone with residents in the Advocacy in Clinical Leadership Track (led by Dr. Dani Zipkin in the Duke University School of Medicine's Department of Medicine, Division of Internal Medicine) about their patient care experience.
This week, House Democrats introduced legislation to provide targeted loan forgiveness to frontline medical professionals and other essential workers with the intent to include it in the next emergency relief bill. Specifically, the bill would establish a federal and private loan forgiveness program for loans acquired to receive medical and professional training held by health care workers who have made significant contributions to COVID-19 patient care, medical research, testing and enhancing the capacity of the health care system to respond to this urgent crisis.
Reps. Ann Kuster (D-NH) and Brian Fitzpatrick (R-PA) introduced legislation that would offer loan forgiveness or credit for future education to essential workers during the COVID-19 crisis, including firefighters, grocery store workers, workers at food and processing facilities, and health care providers.
Senator Chris Coons (D-DE) and Reps. David Price (D-NC) and Doris Matsui (D-CA) introduced legislation that would provide a comprehensive, locally focused, national service strategy to address the COVID-19 pandemic. The bill would create 750,000 AmeriCorps positions and establishes a partnership with the Centers for Disease Control and Prevention (CDC) to manage a quick, federal deployment to crisis regions.
On Wednesday, the House Appropriations Subcommittee on Labor, Health and Human Services, and Education held a hearing on the COVID-19 response and the path forward. The hearing focused on the current state of the public health emergency and how best to curb the novel coronavirus, featuring former CDC Administrator Tom Frieden and Dr. Caitlin Rivers, Senior Scholar at the Johns Hopkins Center for Health Security.
On Thursday, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on new testing for COVID-19. The HELP Committee will hold another hearing next week on returning to work and school from a public health perspective. While National Institute of Allergy and Infectious Diseases Director Anthony Fauci was not permitted to testify this week in the House, he will testify before the Senate HELP Committee on May 12.
Next week, the House Energy and Commerce Committee’s Subcommittee on Health will hold a hearing on “Protecting Scientific Integrity in the COVID-19 Response.” The hearing will feature Dr. Rick A. Bright, former Director of the Biomedical Advanced Research and Development Authority. Duke Health Government Relations will monitor this hearing.
Democratic and Republican leaders remain at odds over the timing and potential scope of a fourth broad stimulus and recovery package. Republicans are pursuing a payroll tax cut and additional liability protections for employers, while Democrats seek more than $500 billion for state and local governments and additional funding for health care providers and essential workers. House Democrats may release a draft of its version of Phase IV bill as soon as this weekend. Meanwhile, stakeholders continue advocating for priorities to be included in the next effort. The AAMC, of which Duke Health is a member, has renewed its call for an additional $26 billion in funding for research.
2. CMS adds additional telehealth waivers
On April 30, the Centers for Medicare and Medicaid Services (CMS) issued a number of new COVID-19 related telehealth services waivers. The changes include:
- Allowing physical therapist, occupational therapists, speech language pathologists, and audiologists to now receive payment for Medicare telehealth services.
- Allowing hospitals to bill the originating site facility fee for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.
- Allowing hospitals to bill for therapy, education and training services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including counseling, psychotherapy, group therapy, and partial hospitalization program services.
- Changing its process during the emergency so that it can add, on a sub-regulatory basis, new services to the list of Medicare services that may be furnished via telehealth.
- Broadening providers’ ability to furnish services via audio-only communication. Specifically:
- Audio-only evaluation and management (E/M) service codes
- Telephonic E/M services and for behavioral health counseling and educational services
- Increasing payments for telephone visits to have parity with similar office and outpatient visits, retroactive to March 1, 2020.
Unless provided otherwise, other services included on the current Medicare telehealth services list must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.
Duke Health Government Relations is working with our partners and internal telehealth experts to advocate for further expansion and permanence of telehealth services that are data-supported to improve patient care and quality of treatment.
3. House moving forward on FY 2021 appropriations
The House Appropriations Committee has reportedly instructed its twelve subcommittees to submit their respective appropriations bills to Committee leadership for review by May 11. Despite persistent delays in regular order due to the ongoing national health emergency, House leaders are hopeful to move the FY 2021 appropriations process along as quickly as possible.
Congressional Appropriators are dealing with the complication of statutory spending caps that would otherwise limit that amount of funding available for both defense and non-defense programs for FY2021. Recognizing that additional flexibilities may be needed for additional response to COVID-19 emergent needs, House Appropriations Labor-HHS-Education Subcommittee leaders agreed on May 6 to consider a plan proposed by former CDC Administrator Tom Frieden that would move federal dollars intended for health threats into a special fund not subject to spending limits. The Health Defense Operations fund would be specific to public health programs and would prioritize spending for public health programs responding to the coronavirus national health emergency.
Duke Health Government Relations continues to advocate for robust federal funding for medical research and key medical education and clinical programs for FY 2021 and will monitor the appropriations process closely for opportunities to engage.