The United States Congress has thus far compiled, debated and passed several major legislative packages to address the coronavirus pandemic and the medical and economic implications of the crisis.
On March 6, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 was signed into law (Public Law No: 116-123) to provide $8.3 billion in emergency funding for federal agencies to respond to the coronavirus outbreak. This included approximately $6.2 billion for HHS agencies.
Most notably, the Biomedical Advanced Research and Development Authority (BARDA) will receive $2 billion for research into diagnostics, therapeutics and vaccine development — BARDA is currently soliciting proposals specific to the coronavirus. The Food and Drug Administration (FDA) received $61 million to support review and development of necessary medical countermeasures and vaccines, advanced manufacturing for medical products, supply chain monitoring, and related activities. In addition, $2.2 billion is directed to the Centers for Disease Control and Prevention for coronavirus prevention, preparation and response, and the SBA will receive $20 million for administrative expenses to carry out its disaster loan program. Significant funding was designated for international response efforts.
Beyond the emergency funding for agencies, certain restrictions on Medicare providers of telehealth services were waived during the emergency period (see CMS fact sheet).
Building upon H.R. 6074, the Families First Coronavirus Response Act was signed into law (Public Law No: 116-127) on March 18 to provide enhanced sick leave, require payer coverage for no-cost coronavirus testing, expand various food assistance and nutrition programs, and provide enhanced unemployment benefits and related state grants.
- House Appropriations Committee section-by-section summary
- House Appropriations Committee Paid Leave Provisions Summary
- Full text
The law requires the Occupational Safety and Health Administration to issue an emergency temporary standard that requires certain employers to develop and implement a comprehensive infectious disease exposure control plan to protect health care workers. Private and public payers are required to provide no-cost/no-prior authorization detection and diagnostic coverage during the emergency period for diagnostics that have received the relevant Emergency Use Authorization (EUA) from the FDA. It also requires personal respiratory protective devices to be treated as covered countermeasures that are eligible for certain liability protections.
The third Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed into law on March 27 (Public Law No: 116-136) and provided funding and relief to address various drug and supply issues, the economy, access to care by COVID-19 patients, workforce needs, Medicare/Medicaid issues and other coronavirus-related issues. No surprise billing-related provisions were included in the legislation.
The CARES Act included several provisions of relevance to employers and providers, including, but not limited to:
- A temporary suspension of Medicare sequestration through 2020 (while extending it an additional year);
- A "Paycheck Protection Program" expansion of the Small Business Association (SBA) 7(a) program to provide loans to a wider variety of businesses and organizations, increase the maximum loan amount, allow the loans to be used for expanded uses including payroll support, and a process for loan forgiveness for certain payroll-related costs;
- A public health and social services emergency fund to support eligible health care providers, suppliers, and others that may be specified by the Department of Health and Human Services (HHS) that provide diagnoses, testing, or care for COVID-19 patients with resources for property leasing, supplies and equipment, workforce, increased capacity, and more — an application process will be implemented by HHS;
- A fund for loans, loan guarantees and other investments for companies experiencing hardship, with certain requirements in effect for two years on raises and severance packages for employees making more than $425,000 in 2019;
- Various medical supply- and national stockpile-related provisions, including expansions of previously provided funding from H.R. 6074;
- Telehealth-related grant programs and further reduction of telehealth restrictions; and
- A mandate for HHS to issue guidance on protected health information data-sharing during the emergency period.
The fourth legislative package, the Paycheck Protection Program and Health Care Enhancement Act, was signed into law on April 24 (Public Law No: 116-139) and provided additional funding for federal programs. Supplemental appropriations were provided for the SBA’s Paycheck Protection Program ($321 billion) and Economic Injury Disaster Loan program ($50 billion), HHS’ Public Health and Social Services Emergency Fund ($100 billion), and multiple agencies’ COVID-19 testing programs ($25 billion).
The Paycheck Protection Program Flexibility Act (H.R. 7010) was signed into law on June 5 and made several key reforms to the framework of the SBA’s Paycheck Protection Program, including:
- A change to SBA’s controversial limitation on loan forgiveness amounts by reducing SBA’s minimum payroll usage requirement from 75 percent to 60 percent of the forgiven amount.
- An extension of the covered period during which recipients can use the funds while remaining eligible for loan forgiveness.
- An extension of the minimum maturity of the loan to 5 years.
- An extension of the period of time in which businesses can rehire or eliminate a reduction in employment/salary/wages that would otherwise reduce the loan forgiveness amount.
- A change to the deferral period for loan payments to 10 months after the program expires.
- Elimination of a provision that previously made recipients with forgiven amounts ineligible to defer payroll tax payments.
More information on H.R. 7010:
The application deadline for small businesses interested in Paycheck Protection Program loans was extended through August 8, 2020 by S.4116, signed into law on July 4.
Moving forward, the Executive Branch will continue to implement the programs and assorted mandates from these legislative packages. As implementation proceeds, the American College of Radiology® will continue to provide educational information and resources on pertinent subtopics.