Medicaid Block Grants And Per Capita Caps

The Federal government announced a new program allowing states to apply for block grants or per capita caps in exchange for new flexibility to limit enrollment and benefits.  A new report from the Urban Institute discusses how this policy may place states at risk for the increased costs from recession related increases in enrollment as well as spikes in spending from unforeseen events such as the coronavirus outbreak or the opioid epidemic.

The report can be obtained at https://www.urban.org/sites/default/files/publication/101913/medicaid20block20grants20and20per20capita20caps.pdf.

Update On COVID-19 Testing And Preparedness Guidelines

The Centers for Disease Control and Prevention (CDC) has updated its COVID-19 testing priority guidance, which gives first priority to testing hospitalized patients and symptomatic health care workers. The agency also updated its interim guidelines for collecting, handling, and testing COVID-19 clinical specimens to allow for self- or health care worker-collected nasal or nasal turbinate swabs if nasopharyngeal swab is not possible.

Testing guidance can be obtained at https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html and interim guidelines at https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html.

Congressional Spending Agreement Update

After five days of intense negotiations, a bipartisan agreement has been reached on a $2 trillion, bipartisan stimulus bill, a revised version of the CARES Act introduced a few days ago by Majority Leader McConnell.

The final text is still under review, but the Senate will be back in session at 12pm with a final vote on the bill likely later today. House Speaker Pelosi, indicated yesterday that she plans to bring an eventual Senate passed bill to the House floor by Unanimous Consent or voice vote to ensure that House Members do not need to return to DC to vote on this measure. Speaker Pelosi said today that, “House Democrats will now review the final provisions and legislative text fo the agreement to determine a course of action.”

Minority Leader Schumer circulated a Dear Colleague letter, which can be found below, early this morning highlighting changes Democrats negotiated to the original version of the bill.

The bill includes a five-year reauthorization of the Title VII HRSA health professions workforce programs. The title VII portion of the bill is generally closer to the Senate’s Title VII reauthorization bill (S 2997) in terms of authorized levels than the House’s EMPOWER Act (HR 2781). Many of the Title VII authorized funding lines are identical to those in the Senate bill.

Geriatrics program funding in the CARES agreement is authorized at $40,737,000 for each year FY 2021 through FY 2025. $40,737,000 was the enacted funding levels for both FY 19 and FY 20, and the same as was in the Senate’s Title VII bill. Scholarships for Disadvantaged Students is reauthorized at $51,470,000 for each of fiscal years 2021 through 2025. It is the same funding level as the FY 20 enacted level. Faculty loan repayment is reauthorized at $1,190,000. It is also the same as the FY 20 enacted level.

The bill also includes a clean extension of the Health Profession Opportunity Grant program through November 30, 2020.  This extension ensures that HPOG grantees are able to finish out their grant cycle with full access to the technical assistance and evaluation support. 

Other key components of this compromise bill include the following:

  • Direct stimulus of $1200 per adult and $500 per child for individuals up to $75,000 and $150,000 per couple;

  • $500 billion in loans and loan guarantees for impacted businesses with stronger oversight of loans provided to large employers;

  • Expanded Unemployment Insurance now providing four months (up from three months) of federal pandemic UI at up to $600 per week above the compensation level paid by state unemployment office;  

  • $130 billion for hospitals, health care systems, and community health centers (increased from $75 billion);

  • $150 billion for a state and local coronavirus stabilization relief fund;

  • $30 billion for Education, (an increase of $10 billion);

  • $366 billion for forgivable small-business loans, with $17 billion set aside for businesses in low-income areas and investment companies that provide venture capital to small businesses.

  • $10 billion for SBA Economic Injury Disaster Loans emergency grants of up to $10,000 to provide immediate relief for small business operating costs.

  • $30 billion for a Disaster Relief Fund to provide financial assistance to state, local, tribal, and territorial governments, as well as private nonprofits providing critical and essential services.

House leadership officials have indicated this will not be the last round of pandemic related funding, they expect to have two more rounds of funding in the coming weeks or months, which will both address ongoing needs and economic recovery efforts.   

We will continue to keep you updated on the latest developments in Washington.

Part A of the bill text
Part B of the bill text
Minority Leader Schumer’s Dear Colleague Letter
Senate Appropriations Committee Majority Summary
Senate Appropriations Committee Minority Summary

ASAHP Joins Coalition Letter on Coronavirus Pandemic Sent to the White House and Congressional Leadership

ASAHP was among 15 organizations of the Federation of Associations of Schools of the Health Professions (FASHP) that joined in urging the White House and Congressional leadership to consider the unique needs of the nation’s health professions schools and students, and the associations that represent them, in any federal legislative or stimulus package to address the impacts of the COVID-19 (Coronavirus) pandemic. 

The letter to the White House may be accessed here.

The letter to Congressional leadership may be accessed here.

ASAHP’s coronavirus (COVID-19) resource page may be accessed here

Hospital Readiness For COVID-19

Across the nation, concerns are mounting that the need for hospital beds will overwhelm national capacity as the COVID-19 outbreak expands, placing severe strains on the health care system and limiting patient access to necessary care. A report from the Urban Institute presents estimates of the number of occupied versus unoccupied beds at national, state, and county levels.

The report can be obtained at https://www.urban.org/sites/default/files/publication/101864/hospital-readiness-for-covid-19_2.pdf.

Tool Available For Tracking Coronavirus Policy Actions

A new updated tool from the Kaiser Family Foundation can be used to track coronavirus policy actions, along with data on current cases, deaths, and state-level data on health coverage and provider capacity. 

The tool can be obtained at https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/.

Telehealth Benefits For Medicare Beneficiaries Expanded Due To Coronavirus

The Trump Administration on March 17, 2020 announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare temporarily will pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

A fact sheet can be obtained at https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.

Annual Report To The Nation On Cancer

Published in the journal Cancer, the Annual Report to the Nation on the Status of Cancer finds that cancer death rates continued to decline from 2001 to 2017 in the United States for all cancer sites combined. These decreases were seen in all major racial and ethnic groups and among men, women, adolescents, young adults, and children. Rates of new cancers (cancer incidence) for all cancers combined leveled off among men and increased slightly for women during 2012 to 2016.

The report can be obtained at https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.32802.

New Student Loan Law Could Ease Student Repayment

An analysis from The Pew Charitable Trusts discusses how the Fostering Undergraduate Talent by Unlocking Resources for Education (FUTURE) Act could benefit more than eight million student loan borrowers, depending on how the 2019 law is implemented. Decision-makers putting the FUTURE Act in place should consider five key issues.

The analysis can be obtained at https://www.pewtrusts.org/en/research-and-analysis/articles/2020/03/02/law-will-ease-access-to-affordable-student-loan-repayment-if-implemented-effectively?utm_campaign=2020-03-11+Rundown&utm_medium=email&utm_source=Pew.

Medicaid And The Coronavirus

A “To The Point” posting by the Commonwealth Fund shows why Medicaid’s design allows it to respond nimbly to a crisis by enrolling additional individuals and covering new services. Medicaid’s flexibility is a strength to streamline the enrollment process, sign up beneficiaries whenever needed, and make eligibility retroactive so providers are not financially punished for furnishing emergency care.

The posting can be obtained at https://www.commonwealthfund.org/blog/2020/medicaid-and-coronavirus-putting-nations-largest-health-care-first-responder-work.

Latest COVID-19 News in Higher Education

Several colleges in California, New York, and Washington have either cancelled classes or online instruction in light of the coronavirus outbreak. The Department of Education has relaxed their rules that institutions must gain permission from accreditors and the Department to move to online courses. Higher ed institutions have also expressed concerns to the Department of Homeland Security on behalf of their international students, who have in-person learning requirements. Many institutions continue to cancel study aboard programs and university-sponsored travel.

Read more here.

Additional COVID-19 Guidance Released for Colleges

The Centers for Disease Control, U.S. Department of Education, and American College Health Association have released guidance for institutions of higher education to prepare for a potential COVID-19 outbreak on campus. The CDC guidance outlines preparation plans for administrators and students to ensure the safety of individuals on campus or studying aboard. The U.S. Department of Education focuses on potential disruption to federal financial aid, while the ACHA details plans for student health centers to have the capacity for increased student demand or a COVID-19 outbreak.

Read more here.

Fiscal Impact Of Trump Administration’s Medicaid Block Grant Initiative

A new Issue Brief from the Commonwealth Fund estimates Medicaid expenditures under current law on a state-by-state basis and compares them to funding available under a block grant. States that take up the block grant would see substantial reductions in Medicaid funding.

The Brief can be obtained at https://www.commonwealthfund.org/sites/default/files/2020-03/Mann_fiscal_impact_Medicaid_block_grants_ib.pdf.

CMS Develops Additional Code For Coronavirus Lab Tests

Today, the Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities, and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19). CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. CMS also released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well. 

Medicare Fact Sheet Highlights can be obtained at https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf.

CDC Provides Interim Guidance on the Coronavirus

The CDC has provided interim guidance for administrators of Institutions of Higher Education to plan, prepare, and respond to the Coronavirus. The CDC provided guidance for IHE that do not have COVID-19 identified in their community as well as guidance for IHE with identified cases of COVID-19 in their community. The CDC also released interim guidance for organizers and staff responsible for planning mass gatherings or large community events.

Interim Guidance for Administrators of US Institutions of Higher Education (IHE) to Plan, Prepare, and Respond to Coronavirus Disease 2019 (COVID-19)

Interim Guidance: Get Your Mass Gatherings or Large Community Events Ready for Coronavirus Disease 2019 (COVID-19)

CDC Coronavirus Information

Department of Education Coronavirus Resources Page

COVID-19 ("Coronavirus") Information and Resources for Schools and School Personnel

Federal Student Aid Guidance

Inside Higher Ed Article

World Health Organization Coronavirus Information

Supreme Court Will Review Individual Mandate Case

The Supreme Court agreed today that in its term beginning in October 2020 it will review a federal appeals court decision that held the Affordable Care Act's individual mandate unconstitutional to determine which of the law's provisions could survive without the mandate. Twenty states and the District of Columbia have petitioned the Supreme Court to review a decision that sent back the case to the district court in Texas.

Ed Secretary DeVos Testifies before House Labor, HHS & Education Subcommittee

The House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies held a hearing on “Fiscal 2021 Budget Request for the Department of Education” in which Department of Education Secretary Betsy DeVos testified. Career and technical education garnered bipartisan support, especially for the nearly $900 million increase in the President’s Budget.

Rep. Moolenaar and Ranking Member Cole were supportive of the Second Chance Pell; Rep. Moolenaar noted that community colleges in his district are interested in participating. Secretary DeVos hopes to make Second Chance Pell a permanent program but believes Congress needs to authorize the program, which is why there was no line item in the budget for it. Republicans would also like to see Federal Work Study programs collaborate with the private sector to allow students to work in their field of study, such as teaching or health professions. Rep. Bustos was particularly concerned about the budget’s proposal to eliminate Public Service Loan Forgiveness.

Secretary DeVos highlighted the College Score Card and myStudentAid app as ways for students to gain a better understanding on how much college may cost, if they will need loans, how they could pay it off, and have FAFSA more accessible. Secretary DeVos discussed the Department’s proposal to cap graduate student loan amounts and cap the amount for parents.

Summary of the hearing is available here.