American Society of Addiction Medicine: COVID-19 Legislation – Summary of Provisions for Addiction Medicine

CHEVY CHASE, Maryland, March 27 -- The American Society of Addiction Medicine issued the following news release:

To date, Congress has passed, and the President has signed, two stimulus bills in response to the COVID-19 pandemic. A third is expected to be enacted in the coming days. Summaries of each highlighting sections most relevant to the addiction prevention and treatment community are below.

*This page will be updated as events progress and additional details emerge.*

1. The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020/i (P.L. 116-123), signed into law on March 6, 2020, provides $8.3 billion in emergency funding for federal agencies to respond to the coronavirus outbreak.

Most of the funding ($6.2b) was directed to the Department of Health and Human Services (HHS) for the Office of the Secretary - Public Health and Social Services Emergency Fund to develop vaccines, therapeutics and diagnostics; for the Centers for Disease Control and Prevention (CDC) to support state and local response efforts; for the National Institute of Allergy and Infectious Diseases (NIAID) to research vaccines, therapeutics and diagnostics; and to the Food and Drug Administration (FDA) to review vaccines, therapeutics and medical devices and address potential supply chain interruptions.

The bill also included a waiver removing restrictions on Medicare providers allowing them to offer telehealth services to beneficiaries regardless of whether the beneficiary is in a rural community.

2. The Families First Coronavirus Response Act/ii (P.L. 116-127) was signed into law on March 18, 2020. It includes nearly $3.5 billion in total funding along with federal nutrition program waivers; the Emergency Family and Medical Leave Expansion Act; the Emergency Paid Sick Leave Act; and health provisions regarding coverage of SARS-CoV-2 testing.

The funding is designated for food and nutrition programs run by the U.S. Department of Agriculture; unemployment insurance grants to states; and detection of SARS-CoV-2 or diagnosis of the virus that causes COVID-19 within the Defense Health Program (TRICARE), the Indian Health Service, the Veterans Health Administration (VA), and the National Disaster Medical System.

The health provisions require private insurers (group and individual plans, including grandfathered plans, Medicare, Medicaid and CHIP, TRICARE, the VA, the Indian Health Service, and plans covering federal employees to cover detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19 and the associated visit without cost-sharing, without needing to meet a deductible, and without prior authorization or other utilization management.

3. The Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748) passed the Senate 96-0 on March 25, 2020. The House is expected to take it up on Friday, March 27 with bipartisan support. ASAM joined other physician associations on a letter calling on Congressional leadership to ensure this legislation supports and sustains physicians and their practices during this unprecedented national emergency through tax relief, no-interest loans, direct payments, payment for virtual visits including phone calls, and other measures. Several provisions, summarized below, of the current bill address the financial hardship that healthcare practices are experiencing and change policies to expand access to virtual visits. The bill includes $2.2 trillion in stimulus funding and several healthcare-related policy changes, including:

Nearly $350 billion in federally guaranteed loans to provide eight weeks of cash-flow assistance to small businesses, including non-profits, who maintain their payroll during this emergency. If employers maintain their payroll, the loans would be forgiven.

$100 billion for a new program to provide grants to hospitals, public entities, not-for-profit entities, and Medicare and Medicaid enrolled suppliers and institutional providers to cover unreimbursed health care related expenses or lost revenues attributable to the public health emergency resulting from the coronavirus.

$425 million for SAMHSA to increase access to mental health services through Community Behavioral Health Clinics ($250m), suicide prevention programs ($50m), and emergency response grants ($100m) that can target support where it is most needed, such as outreach to those experiencing homelessness.

$275 million for the Health Resources and Services Administration (HRSA), including $90 million for Ryan White HIV/AIDS programs and $185 to support rural critical access hospitals, rural tribal health and telehealth programs, and poison control centers

Substantial changes to 42 CFR Part 2 that allow the contents of substance use disorder (SUD) patient records to be used or disclosed by a covered entity, business associate, or Part 2 program for treatment, payment or healthcare operations as permitted by the Health Insurance Portability and Accountability Act (HIPAA), after prior written patient consent has been obtained. Any information so disclosed may then be redisclosed in accordance with the HIPAA regulations. A patient's prior written consent to be given once for all such future uses or disclosures for purposes of treatment, payment, and health care operations, until such time as the patient revokes such consent in writing.

Expansion of Medicare telehealth authority to remove a restriction that limits telehealth coverage during the COVID-19 emergency period to situations where the physician or other professional has treated the patient in the past three years. This will enable beneficiaries to access telehealth, including in their home, from a broader range of providers, reducing COVID-19 exposure. The bill also allows for Federally Qualified Health Centers and Rural Health Clinics to serve as a distant site (where the clinician is located) for telehealth consultations for Medicare beneficiaries.

Extension of the Medicaid Community Mental Health Services demonstration that provides coordinated care to patients with mental health and substance use disorders, through November 30, 2020. It would also expand the demonstration to two additional states.

ASAM continues to advocate on behalf of its members and the addiction treatment community to ensure patients can access needed care during this national crisis, and to ensure addiction specialist clinicians and their teams have the resources and policy flexibility they need to provide that care.

Footnotes:

i/. For a more detailed breakdown of the funding allocation, see https://www.kff.org/global-health-policy/issue-brief/the-u-s-response-to-coronavirus-summary-of-the-coronavirus-preparedness-and-response-supplemental-appropriations-act-2020/

ii/. For more information, see https://www.kff.org/global-health-policy/issue-brief/the-families-first-coronavirus-response-act-summary-of-key-provisions/