President signs $2 Trillion Coronavirus Aid, Relief, and Economic Security Act (CARES Act)
President Trump signed the third legislative package (Phase 3) H.R. 748 the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) on March 27, 2020 in response to COVID-19 aimed at mitigating the economic effects of the pandemic. Unfortunately, this legislation does not include language on payment for pharmacist services. AACP will continue to work with a pharmacy stakeholder coalition to include language that recognizes pharmacists and their services under Medicare Part B in future coronavirus legislation.
The measure, negotiated between the Senate and administration, includes:
- $500 billion for loans and assistance to companies and state and local governments, including $29 billion for loans to U.S. airlines and related businesses. Stock buybacks and executive compensation would be restricted. Additional funds would be provided to aviation workers.
- $349 billion in low-interest small business loans that could be partially forgiven.
- Payments of as much as $1,200 for individual taxpayers, and $500 per child, phased out when incomes exceed $75,000 for individuals and $150,000 for couples filing jointly.
- An additional $600 per week for those receiving unemployment benefits.
- $150 billion for aid to state, local, and tribal governments.
- $4.3 billion to the Centers for Disease Control and Prevention, including a minimum of $1.5 billion in grants to state and local governments and tribes to purchase protective equipment, carry out surveillance and laboratory testing, infection control and other activities.
- $706 million to the National Institute of Allergy and Infectious Diseases, including a minimum of $156 million dedicated to research, construction, and equipment for vaccine and infectious disease facilities.
- $103 million for the National Heart, Lung, and Blood Institute.
- $1 billion to the Indian Health Service to support tribal health care system.
- $27 billion is set aside for the Biomedical Advanced Research and Development Authority for research and development of vaccines and therapeutics to fight the virus and other medical needs. A suspension of Medicare sequestration through the end of the year and the extension of several health programs until December.
- Employer student loan repayment assistance paid after the bill’s enactment and before Jan. 1, 2021, would be excluded from employees’ income tax. Repaid amounts would count toward a $5,250 limit on other forms of employer-provided education assistance, such as tuition and related expenses, that can be excluded from income.
- The measure would provide an additional $1.32 billion for fiscal 2020 for supplemental awards to community health centers to prevent and treat COVID-19. Funding would be subject to Hyde amendment restrictions that prevent the use of federal funds for abortions, except in cases of rape or incest or if the mother’s life is in danger.
Pharmacists can administer coronavirus vaccine or vaccines when available, either under current Medicare rules categorized as “suppliers,” when Part B compensates pharmacists as mass immunizers, or both.
Below you will find a comprehensive summary of relevant provisions as it relates to the members of AACP. Please reach out to Associate Director of Strategic Engagement, Jasey Cárdenas at jcardenas@aacp.org with any specific questions.
Full Bill Text (PDF)
Section By Section (PDF)
Health Records: The measure would allow patient records related to substance use disorders to be disclosed to health-care providers and other entities in accordance with the Health Insurance Portability and Accountability Act (HIPPA) after a patient gives initial consent. Substance use records are currently governed under stricter privacy regulations than HIPAA.
Public Health Programs: Funding for community health centers serving vulnerable and underserved populations would be extended at the fiscal 2019 level of $4 billion annually through fiscal 2020, and $668.5 million would be appropriated for the two-month period of Oct. 1 through Nov. 30.
The measure would extend funding for a number of other public health programs through Nov. 30 at their fiscal 2019 levels, including:
- National Health Service Corps (NHSC).
- Teaching Health Center Graduate Medical Education (THCGME) Program.
- Special Diabetes Program.
- Special Diabetes Program for Indians.
- Sexual Risk Avoidance Education Program.
- Personal Responsibility Education Program.
Medicare & Medicaid
Sequestration: The measure would suspend automatic Medicare payment cuts to hospitals and doctors, known as sequestration, from May 1 through Dec. 31.
Medicare Payments: Hospitals would receive a 20% increase in their Medicare payments for treating a patient with COVID-19 during the coronavirus emergency.
Telehealth: The measure would remove a requirement from the first coronavirus response measure (Public Law 116-123) that a doctor had to have treated a patient within the last three years to use expanded telehealth authorities under Medicare.
- Secretary of Health and Human Services (HHS) has the authority to consider waiving all Medicare telehealth restrictions to treat COVID-19 in the future, such as restrictions on pharmacists offering these services or offering telepharmacy services.
Medicare Coverage: Medicare Part B, which provides general medical insurance, would fully cover a COVID-19 vaccine without any cost-sharing. Drug plans would have to allow Part D prescription drug beneficiaries to receive a 90-day supply of medication during the public health emergency.
- Allow state Medicaid programs to cover home and community-based services that are provided in acute-care hospitals.
- Delay by 30 days a requirement in the second coronavirus response package that a state maintain premiums to receive the 6.2 percentage point increase in Medicaid funding.
Medical Supplies: The bill would expand the Strategic National Stockpile to include personal protective equipment and supplies such as swabs used for COVID-19 testing.
- It would also make permanent a provision in the second coronavirus response package extending liability immunity to manufacturers of respiratory protective devices, such as masks and ventilators, that HHS designates for use during a declared public health emergency.
Drug & Device Shortages: Manufacturers of drugs that are critical to public health during an emergency would have to notify the FDA of supply chain interruptions for active pharmaceutical ingredients. Device manufacturers would have to make similar disclosures.
Makers of covered drugs, active ingredients, and related devices would have to maintain risk management plans for facilities to evaluate supply risks.
The FDA would have to:
- Prioritize application reviews and inspections for drugs and devices that could mitigate shortages.
- Publish a list of device shortages, though it could withhold such information to prevent hoarding.
Testing: Health insurers would have to reimburse providers for all coronavirus testing and related visits based on the cash price that the provider lists online, unless they have a previously negotiated rate or negotiate a new rate that’s less than the cash price. Testing providers that don’t list their prices online during the emergency could be penalized a maximum of $300 per day.
Over-the-Counter Drugs: The measure would modify the FDA’s regulatory framework for nonprescription drugs and establish user fees to support the new process. The user fees would be authorized from fiscal 2021 through 2025 and include facility fees and fees for administrative order requests.
Vaccines: Health insurers would have to cover vaccines and other services intended to prevent COVID-19 without any cost-sharing. The requirement would take effect 15 business days after a recommendation from the U.S. Preventive Services Task Force or CDC Advisory Committee on Immunization Practices.
Financial Aid
The measure would allow the Education Department to waive requirements related to institutions’ eligibility for and allotment of federal financial aid, as well as certain reporting requirements.
The package would direct the department to waive requirements that higher education institutions match a portion of federal student aid for two school years. When calculating eligibility against lifetime usage limits, the department couldn’t count a student’s enrollment in subsidized loan or Pell Grant programs during any semester the student didn’t complete because of the emergency.
The department would waive repayment of grants and loans by students who received support and were forced to withdraw from school.
The department could allow institutions to keep unused grant or loan assistance if students were unable to use the funding due to the emergency. It could modify the required and allowable uses of funds provided to institutions, as well as non-federal matching requirements, upon the request of an institution or other grant recipient.
The measure would allow institutions to:
- Roll over unused funds from the previous five years for use during the next five-year period.
- Make work-study payments to participating students who were unable to fulfill their work requirements due to closed workplaces.
- Treat any unspent work-study funds as grants to support the ability of low-income students to access and complete higher education.
- Use supplemental educational opportunity grants to provide emergency aid to students facing unexpected expenses and unmet needs.
- Provide students with leaves of absence that don’t require them to pick up where they left off if they return the same semester.
- Exclude credits for classes a student began but didn’t finish due to the emergency when determining the student’s academic progress for financial aid eligibility purposes.
HBCU Capital Loans: The measure would appropriate $62 million for the department to defer and cover the principal and interest on capital loans to historically black colleges and universities due during the emergency. After the original loan is repaid, the institutions would have to repay any amounts covered by the department.
AmeriCorps Service: The Corporation for National and Community Service would have to allow AmeriCorps participants who are eligible for educational awards and whose service has been limited due to COVID-19 to perform other activities to accrue necessary service hours. The corporation could provide the full value of an educational award for service to participants forced to suspend or limit their involvement or exit the program early as a result of the coronavirus emergency.