Pinnacle 2020 Quick Take: Washington Update – The CARES Act 2.0; what the election will mean for EMS
A policy and regulation expert shares insights on the next wave of coronavirus relief funding, and the future of ET3 and telehealth
The response to COVID-19 has generated a number of national initiatives impacting the EMS industry, some at a faster pace and larger dollar amount than Lisa Hawke, a partner in Holland & Knight's Washington, D.C., office has seen in her 30-year career.
Fitch & Associates Senior Associate Todd Sheridan, MBA, led the information-packed Washington Update conversation with Hawke during the Virtual Pinnacle Leadership Summit. Hawke is a member of Holland & Knight's Public Policy & Regulation Group, focusing on federal relations and policy in healthcare, EMS and transportation issues.
Memorable quotes on Washington’s response to COVID-19
Here are some of the key points Hawke made about the administration’s response to COVID-19:
“I don’t think anyone can or wants to put the telehealth genie back in the bottle”
“You’re going to be producing reports and you’re going to be audited, so one of the best practices you can employ is to segregate the funds.”
“The reason the EMS community is confused is because the entire provider community is confused – including hospitals – about how to spend the dollars, what’s allowable, what’s not allowable.”
Top takeaways on COVID-19 relief funding, ET3 and telemedicine
Hawke provided an update on where things like coronavirus relief funding, temporary legislative measures and ET3 stand now, and what impact the election is likely to have on EMS.
Here are 3 takeaways on how events in Washington are impacting EMS.
1. Where COVID-19 relief funding stands now
The CARES Act and a subsequent act provided $175 billion for funding providers, and was passed in about 10 days. According to Hawke, there is about $30-40 billion left, depending on how much is being spent to provide Medicare payments for uninsured individuals with COVID-19, but that funding will soon run dry.
Congress is currently working on the next piece of legislation, commonly referred to as CARES 2.0 or COVID 4.
House Democrats pushed out The HEROES Act, a $3 trillion bill, which included a replenishment of $100 billion for the Provider Relief Fund. Hawke noted the numbers are “astronomical, even by Washington standards,” but the bill did include some “guardrails” which would require providers to apply for funding through The Health Resources and Services Administration (HRSA), which prioritizes higher Medicare and Medicaid providers over commercial entities.
The bill has been passed and sent to the Senate, which after 5 weeks of consideration, put out its proposed approach: a $1 trillion next-round Coronavirus relief package, which includes $25 billion (as opposed to the $100 billion) for the Provider Relief Fund, without changing the parameters for disbursement.
With a large gulf between proposals, the goal is to finalize the legislation before the August 8 scheduled office recess. Speaker Nancy Pelosi has said the House will remain open until it’s done.
Hawke noted the legislators could get the bill passed before the break, or they could play kick the can and choose some of the most critical components to fund immediately and then return in September before the election to readdress.
2. How to manage CARES Act funds
Hawke explained that despite the administration’s efforts to push out this unprecedented funding for providers, we do not have formal regulations in how to use CARES Act funding, but rather what those in the legal world describe as self-regulatory guidance. She offered a few tips to manage CARES Act funding:
- Understand what you’re attesting to every time you sign those documents. “Make sure you know it, make sure you’re reporting it and screenshot everything that you are attesting to,” she said.
- Assume you are going to be audited. The statute states these funds are to be used to prepare for, prevent and respond to coronavirus and revenue losses you have experienced as a result of the pandemic, Hawke noted. The best way to prepare for an eventual audit is to segregate the funds – put them in a separate account – and then leave a clear paper trail for the auditors in terms of how you are spending those dollars, so that it all ties back to COVID-19, your losses and what your expenses have been – the more detailed the better. She recommended going a step further and taking a screenshot of the CARES Act Provider Relief Fund: FAQs on the HHS site. “Print them out so you have a paper trail that this was the guidance you were relying on when you were making allocations, whether it’s purchasing PPE, hiring additional staff … it’s all about documenting,” Hawke said. You want to be able to show 2 years from now, the auditor who shows up at your door, that this was – as of that particular date – what HHS was saying was and wasn’t permissible.”
- Seek legal counsel. Hawke cautioned that her tips were not legal advice, and encouraged attendees to engage their own legal counsel. “There are a whole bunch of law firms, including mine, gearing up for this,” she noted, and “this isn’t one you’re going to want to do on your own.”
3. What the election results will mean for EMS
It is too early in the election cycle to predict what will happen come November, but regardless, Hawke predicts healthcare legislation changes: perhaps not Medicare for all, but a push for coverage for all if Democrats take control, or incremental changes regarding telehealth, surprise billing and coverage for the uninsured during the pandemic if Republicans retain the White House.
She noted the administration has some degree of flexibility during the pandemic, due to waiver authority under the Stafford Act, to make some changes they otherwise wouldn’t be able to make, including making some of the telehealth adoption permanent. About 20 telehealth bills have been filed in the U.S. Congress, House and Senate since May that have potential. “It may not be dealt with at this particular moment in this particular legislation, but over a long period of time, there’s a great opportunity for EMS to really continue and build its role around mobile integrated healthcare utilizing telehealth,” Hawke predicted. “The industry spent so many years building that basic platform, mobile integrated healthcare, and I think the pandemic is really going to open that up so we can build that out further.”
As for ET3’s slow start, while the pandemic forced the administration to focus on the immediate issues at hand, Hawke sees no reason why this administration or a new administration led by Vice President Joe Biden would pull back from the direction undertaken by the proposed reimbursement model.
Hawke recognized the strong legislative efforts that have been undertaken by EMS organizations to lobby for legislative relief for treatment in place reimbursement. “The EMS community, critical organizations, have been leading that effort, so we’re hopeful to be able to see something come out at least with regard to some flexibility during the pandemic for treatment in place,” Hawke said. “Of course that requires quality assurance, medical direction, and all of those good things, so the language matters in terms of what it looks like, but the lobbying community and the organizational community are really hopeful we can get that done.”
Additional resources for EMS COVID-19 funding
Learn more about how to obtain and apply COVID-19 relief funding with these resources:
- CARES Act and grant funding: How it will benefit local fire and EMS response
- CARES Act Payroll Protection Plan can help struggling ambulance services
- You’ve seen the CARES Act stimulus payment, but did you see the strings?
- Beyond federal assistance: State COVID-19 response grants
- A hidden gem in the CARES Act that benefits ambulance services
- Video: Webinar outlines how to apply for FEMA COVID-19 assistance