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On July 20, 2020, The U.S. Department of Health and Human Services (HHS) notified providers that if they received $10,000 or more in funds from the general or targeted Provider Relief Fund (PRF) established under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, reports on how those funds were used will be required. HHS expects to release (through the Health Resources and Services Administration [HRSA] website) detailed instructions on reporting requirements by August 17, 2020. Specifically, reports will be required of any provider who received one or more payments exceeding $10,000 in the aggregate from:

Dentist

On July 10, 2020, the U.S. Department of Health and Human Services (HHS) announced dentists and other dental providers are eligible to apply for relief from the Provider Relief Fund. The Provider Relief Fund General Distribution FAQs outlined the eligibility requirements and payment methodology for calculating distribution amounts. The deadline for applying is July 24, 2020.

In July of 2016, through 2013 Wisconsin Act 236 (Act 236), many of the regulatory provisions of Wis. Admin. Code DHS 124, Wisconsin’s long-standing hospital regulations, were sunset and replaced with the Medicare Conditions of Participation for hospitals (CoPs) as the minimum standards, enforceable by the Department of Health Services (the Department). However, the administrative provisions detailing the approval and plan review processes, fees, waivers and variances, requirements relating to Critical Access Hospitals (CAHs) were retained. Moreover, the Department retained the ability to promulgate additional rules, if necessary,Th to provide safe and adequate care and treatment of hospital patients and to protect the health and safety of the patients and employees.

Executive Order GA-40

Texas: On July 9 Governor Abbott issued a Proclamation (the Proclamation) amending Executive Order GA-27. The Proclamation expands the number of counties required to postpone all non-essential surgeries and procedures indefinitely to preserve hospital capacity for COVID-19 patients to include:

Coronavirus Covid-19 State of Emergency on a white background large graphic design.

On Monday, June 30, 2020, HHS spokesman Michael Caputo tweeted that HHS intends to extend the COVID-19 public health emergency before it expires on July 25, 2020. Once extended, the public health emergency will be effective for an additional 90 days. Extending the emergency declaration will allow providers to continue to use waivers and flexibilities issued to assist them in responding to the COVID-19 pandemic.

PHI Covid19 population-based activities

On June 12, 2020, the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), issued guidance confirming HIPAA permits a covered healthcare provider (Provider) to use protected health information (PHI) to identify and contact recovered COVID-19 patients to inform them of how they can donate their blood and plasma.  As background, HIPAA…

Executive Order GA-40

On June 19, 2020, the Texas Department of Insurance adopted final rules specifying patient notice and election requirements in order for out-of-network providers to balance bill. The final rules replace similar emergency rules that were adopted on December 18, 2019.

Under the new rules, which are meant to implement legislation passed in 2019 by the Texas Legislature, out-of-network providers are prohibited from Balance Billing for nonemergency services unless a patient elects, in writing, to obtain the service from the out-of-network provider. The patient’s election is only effective if the provider satisfies the following notice and disclosure requirements: (1) the patient is provided with a “meaningful choice between an in-network provider and an out-of-network provider,” (2) the patient is not “coerced” into choosing the out-of-network provider, and (3) the patient is provided with a written notice and disclosure. The notice and disclosure statement must be signed by the patient at least 10 business days before receiving any care.[1]

CARES Act Reporting

Under new guidance from the U.S. Department of Health and Human Services (HHS), hospices and other providers who received CARES Act Provider Relief Fund payments can hold off on filing their first quarterly compliance report, slated to be due on July 10, 2020.[1] Instead, HHS states that it will develop its own report and this report itself will contain “all information necessary for recipients of Provider Relief Fund payments to comply with” the quarterly reporting requirements under the Relief Fund Terms and Conditions.

On June 9 the Department of Health and Human Services announced that it will distribute $15 billion to Medicaid and Children’s Health Insurance Program (“CHIP”) providers. HHS spokesman Eric Hargan noted that this distribution will be focused on the approximately 275,000 providers who care for Medicaid and CHIP recipients but who did not receive funds in HHS’ April distribution of $50 billion. Mr. Hargan specifically mentioned providers such as dentists, pediatricians, assisted living facilities and behavioral health provider such as opioid treatment programs. Medicaid/CHIP providers can apply for the funds through the enhanced Provider Relief Portal by providing data that will determine their payments, including information concerning their payer mix to inform future distributions to providers who serve a large portion of Medicaid patients or provide a large amount of uncompensated care.