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Everything you need to know about BMD and the industry.

CARES Act Offers Additional Funds to Healthcare Providers Offering Care, Diagnoses, or Testing Related to COVID-19

In order to help prevent, prepare for, and respond to the COVID-19 pandemic, a $100 billion fund, run through the Public Health and Social Services Emergency Fund (PHSSEF), has been made available to cover non-reimbursable costs attributable to COVID-19 under the CARES Act. This fund has been designed to get money into the health care system as quickly as possible. As such, applications will be reviewed, and payments will be made, on a rolling basis. HHS has been given significant flexibility in determining how the funds are to be allocated, as opposed to operating under a mandated formula or process for awarding the funds. While the Secretary of HHS has not yet released guidance on the application process, this is expected in the near future. BMD will provide updates as soon as this information becomes available.

Who is eligible under the PHSSEF Fund?

Eligible entities include hospitals, public entities, and Medicare- or Medicaid-enrolled suppliers and providers that provide COVID-19 related diagnosis, care, or testing.

What expenses qualify for funding?

This funding is meant to cover non-reimbursable costs and expenses related to COVID-19. Examples include:

  • Building or retrofitting new ICUs
  • Increased staffing or training
  • Leasing of properties, medical supplies, and equipment, including personal protective equipment and testing supplies
  • Building of temporary structures
  • Forgone revenue from cancelled procedures

It is important to note that expenses reimbursed or obligated to be reimbursed by insurance or other mechanisms are not eligible. The Secretary of HHS has been instructed to establish a reconciliation process under which payments will have to be returned to the fund if other sources provide reimbursement for expenses.  

BMD will continue to educate health care providers as additional information and further guidance on COVID-19 become available. For questions, contact any Member of BMD's Healthcare & Hospital Law group.

Changes to Medicare’s Physician Fee Schedule and Outpatient Prospective Payment System

Come the beginning of 2022, both the Medicare Physician Fee Schedule (“MPFS”) and Outpatient Prospective Payment System (“OPPS”) will look a little different. As a refresher, the MPFS lists the fees associated with reimbursement of services to providers at certain facilities, taking into account geography and costs. By contrast, OPPS sets reimbursement rates for hospitals and community mental health centers for outpatient services, which are determined in advance. A summary of some of the more pertinent changes to each rule will be outlined below.

CMS to Once Again Reprocess Outpatient Clinic Claims

The Hospital Outpatient Prospective Payment System (OPPS) Rule was passed in November 2018, which was intended to prevent the Centers for Medicare and Medicaid Services (CMS) from paying more for services rendered in outpatient settings than what they paid for the same services rendered in physician offices that are simply owned by hospitals or health systems.[1]

New Vaccine Requirement for Select CMS-Participating Facilities

On November 4, 2021, the Centers for Medicare and Medicaid (“CMS”) released a new rule requiring certain healthcare facilities to implement policies requiring employees to be vaccinated against COVID-19. It does not matter if a staff member does not perform patient treatment services, they must still be vaccinated if an employee of an applicable facility.

OSHA COVID-19 EMERGENCY TEMPORARY STANDARD (ETS) Vaccination, Testing, Recordkeeping, and Reporting

The Occupational Safety and Health Administration has issued its long-awaited COVID-19 Emergency Temporary Standard (ETS). Note that the ETS does not apply to employers covered under the Safer Federal Workforce Task Force COVID-19 Workplace Safety: Guidance for Federal Contractors or Subcontractors (see here), or to settings where employees provide healthcare services subject to OSHA’s ETS for the healthcare industry (see here).

Interesting Trends Revealed in 50-State Medicaid Budget Survey

Results of the KFF annual survey of state Medicaid directors reveal some fascinating trends in Medicaid service delivery and benefit coverage. Read on for a summary of the highlights we find most noteworthy. Background As a preliminary matter, many of the trends KFF identifies and that we highlight below are no doubt a result of the Covid-19 pandemic. The pandemic triggered a public health emergency and economic crisis that resulted in increased Medicaid enrollment, service offerings, and flexibility in service delivery, along with a heightened awareness of disparities in access to care and health outcomes.