Policy Updates

Legislative and Regulatory Responses

As health department responses to community outbreaks of COVID-19 continue to expand and evolve rapidly, federal and state policies are being updated to maximize the impact of disease containment and mitigation strategies.

Emergency Funding

Congress passed an emergency funding bill that was signed into law on March 6, providing $8.3 billion for COVID-19 response activities, including investments public health response activities, research (including vaccine and treatment development), testing capabilities, and medical supply medication procurement. The $800,000 that had been reprogrammed from NCHHSTP last month was returned in this bill.

The President signed Families First Coronavirus Response Act into law on March 18. The package provides free COVID-19 testing through commercial insurers, Medicare Part B, Medicare Advantage, Medicaid and CHIP, as well as funding for tests for people who are uninsured. The Federal Medical Assistance Percentage for Medicaid was temporarily raised by 6.2 percent. While businesses with over 500 employees are exempt from providing paid leave, it does include provisions for small businesses to provide 12 weeks of paid leave through an expansion of FMLA and 10 paid sick days for full time employees and less for part-time employees. Small businesses will receive tax credits for reimbursement of this expansion. It also includes funding for unemployment assistance and nutrition benefits. On March 27, H.R. 748, the CARES Act, the third piece of major COVID-19 relief legislation, was signed into law. The package, which passed unanimously in the Senate and by voice vote in the House, provides $340 billion dollars in emergency appropriations, including an additional $4.3 billion to the Centers for Disease Control and Prevention (CDC), $65 million for HOPWA, $90 million for the Ryan White HIV/AIDS Program (RWHAP). It also includes direct cash payments to people, an expansion of unemployment insurance, and aid to large and small businesses. The section by section outline of health provisions can be found here and the appropriations provisions can be found here.

  • The RWHAP funding (discussed above) will supplement existing grants for Parts A, B, C, and D for the COVID-19 response. The funding will modify existing grants and cooperative agreements and will “be awarded using a data driven methodology determined by the Secretary.” On April 15, HHS awarded the funding to 581 recipients across the Ryan White HIV/AIDS Program.
  • The HOPWA funding is for additional housing and may be used for COVID-19 related isolation for family members not living with HIV. At least $50 million of the HOPWA funding will be awarded via formula. More information on the HOPWA CARES funding for grantees can be found here.
  • The CDC funding is for public health preparedness and response, which includes funding to state and local public health agencies. In addition, there is funding for surveillance and public health data infrastructure. NASTAD is working with national and federal partners to ensure coordination of broader COVID-19 CDC funding with HIV and hepatitis programs.

On April 24, the House and Senate passed H.R. 266, Paycheck Protection Program and Health Care Enhancement Act. The package provides supplemental funding for the Paycheck Protection Program and new funding for various health programs, including:

  • $75 billion for hospitals and health care providers for health care related expenses or lost revenues attributable to COVID-19
  • $25 billion for COVID-19 testing:
  • $11 billion for states, localities, territories, and tribes
  • $1 billion for “Centers for Disease Control and Prevention-Wide Activities and Program Support for surveillance, epidemiology, laboratory capacity expansion, contact tracing, public health data surveillance and analytics infrastructure modernization, disseminating information about testing, and workforce support necessary to expand and improve COVID-19 testing”
  • $600 million for Community Health Centers to support COVID-19 testing
  • $225 million for Rural Health Clinics to support COVID-19 testing

On May 12, the House of Representatives introduced The HEROES Act, which funds their priorities for the next iteration of supplemental COVID-19 funding. The HEROES Act includes funding for state, local, and tribal governments, as well as an investment in COVID-19 testing and contact tracing. The bill also includes an additional $15 million for the Housing Opportunities for Persons with AIDS (HOPWA) program and $10 million for the Ryan White Program. The House plans to vote on the bill on May 15. It is unclear if and when the Senate will take up the bill.

Federal Public and Private Insurance Coverage Actions

The Families First Coronavirus Response Act (FFCRA) and the CARES act – two majors pieces of federal legislation responding the public health and economic crises wrought by COVID-19 – contain a number of provisions expanding access to services:

  • Allows states to receive an increased federal Medicaid match (6.2%) as long as they meet the law’s maintenance of effort requirements, including maintaining eligibility standards and covering COVID-19 related testing, treatment, and vaccines for the duration of the public health emergency.
  • Requires Medicaid, Medicare, and private insurance (individual and small group market) to cover COVID-19 related testing free to the consumer.
  • Gives states the option to expand Medicaid to cover COVID-19 testing to uninsured individuals for the duration of the public health emergency via a State Plan Amendment.
  • Requires Medicare Part D plans to provide 90-day prescriptions for beneficiaries.

Justice in Aging provides a comprehensive summary of healthcare provisions in the CARES act and Kaiser Family Foundation provides a summary of the FFCRA provisions. In addition, CMS has published the following Frequently Asked Questions detailing consumer protections and requirements for enhanced Medicaid matching.

CMS has released a number of fact sheets and guidance to instruct Medicaid, Medicare, and individual and small group coverage with regard to provision of a range of services associated with the COVID-19 outbreak. This includes information to healthcare facilities regarding increased and focused inspections, resources for billing for diagnostic testing (including release of new billing codes), guidance on new telehealth flexibilities, including HIPAA enforcement discretion to facilitate scale up of telehealth capabilities), recommendations for elective surgeries and procedures, and fact sheets and information regarding coverage and cost-sharing requirements for preventive services. Because a national emergency has been declared, CMS is also accepting applications for Medicaid 1135 waivers that allow states greater flexibility with regard to provider requirements, prior authorization requirements, and other eligibility rules. More information on federal actions below:

State Insurance Regulatory Actions

Several states departments of insurance have issued regulations and orders to ensure that individuals have access to COVID-19 testing and easy access to necessary medications should there be more aggressive containment measures in jurisdictions that prevent travel to pharmacies. These measures – adopted in California, Washington, and New York, as well as a growing list of additional states – include consumer protections like waiving cost sharing associated with COVID-19 testing; allowing early refills for prescriptions; suspending prior authorization for testing or treatment for COVID-19; providing easier access to telehealth medical advice and treatment; and allowing individuals to seek COVID-19 related services outside of their provider network. Additionally, many major commercial insurance plans have put in place similar policies that apply in states even without regulatory action.