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|CARES Act 2020|
Click here to sign AANP's email campaign to thank Congress for supporting patients and providers during the COVID-19 pandemic.
On Tuesday, August 11th, CMS announced the creation of the Community Health and Rural Transformation (CHART) model. This model is in response to the President’s Executive Order on telehealth and rural health, released last week, which directed the Secretary of the U.S. Department of Health and Human Services (HHS) to create an advanced payment model focused on rural communities. There are two participation tracks in the CHART model. More details can be found in the published fact sheet.
As of April 30th, CMS issued an interim final rule that permanently implements Section 3708 of the CARES Act, retroactively effective on March 1, 2020. This interim final rule overrides the previous Medicare and Medicaid home health flexibilities issued last month, which were only for the duration of the public health emergency. Section 3708 of the CARES Act permanently authorizes nurse practitioners (NPs) to certify for Medicare and Medicaid home health care services in accordance with state law. It is important to ensure that if there is any conflicting language in state law or regulations that it is amended in accordance with this interim final rule.
On March 27, the Coronavirus Aid, Relief and Economic Security Act (CARES) Act, was signed into law. The CARES Act includes a provision (Section 3708) that authorizes nurse practitioners (NPs) to certify and recertify home health care services to Medicare patients, permanently retiring this federal barrier to NP practice. It also strengthens funding for personal protective equipment (PPE). The American Association of Nurse Practitioners® (AANP) has created a summary of the health provisions contained in the Act.
Additionally, while this section removes the federal barriers for Medicare and Medicaid patients, consistent with longstanding language in the Social Security Act, an NP still must be practicing in accordance with state law to provide these services. The majority of state nurse practice acts authorize NPs to broadly provide services and refer patients; however, we anticipate that some states may require updates, including to Medicaid regulations and state plan amendments, to address any state language that may inhibit NPs in your state from performing these services once they are implemented at the federal level. We will also provide additional resources to NPs to ensure that they are aware of the changes and the subsequent billing and documentation requirements.
AANP Resource: Telehealth Webpage
In an effort to provide members with the best resources available, AANP created a standalone telehealth webpage with general telehealth resources and information specific to the COVID-19 pandemic. This page will be frequently updated with federal and state policy resources, billing and clinical information and feedback from AANP experts on how to implement telehealth in your practice.
Additional Medicaid Waivers
On April 9, 2020, the Centers for Medicare and Medicaid Services (CMS) announced new Medicare waivers pursuant to the COVID-19 public health emergency that have the intent of maximizing the frontline health care workforce. Learn more about the waivers.
Skilled Nursing Facilities (SNFs) — Currently, federal SNF regulations require that physicians perform the initial patient visit and that they alternate performance of the other mandatory monthly and bi-monthly visits. CMS is waiving these requirements to authorize NPs, clinical nurse specialists (CNSs) and physician assistants (PAs) to perform all mandatory SNF visits at the discretion of the facility, if they are not an employee of the facility and if they are performing the visits in accordance with state law.
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) — CMS is waiving the requirement that physicians provide supervision of NPs in RHCs and FQHCs, to the extent permitted under state law.
CARES Act Provider Relief Fund: Initial Distribution
The CARES Act, signed into law on March 27, 2020, provides $100 billion in relief funding for health care providers to cover lost revenue due to COVID-19 and to support health care related expenses. On April 10, the U.S. Department of Health and Human Services announced the initial round of distribution of $30 billion to providers. It is important to note that this money is payment to providers and is separate from any other loan, grant or financial support programs. This initial round of funding prioritizes hospitals and providers enrolled in Medicare. The funding amounts are based on a provider's share of total Medicare Fee for Service reimbursements in 2019. There is still $70 billion in CARES Act relief, which will be allocated through additional rounds of funding. AANP will continue to monitor this and all other programs providing financial support to nurse practitioners (NPs). Learn more about payment processing, distribution and other program details.
AANP COVID-19 Policy and Practice Resources
AANP has put together a webpage that we are updating frequently with federal and state policy information related to COVID-19. Please continue to visit this page throughout the week for the most up-to-date resources. We would like to draw your attention to recent information added to the page:
New Business Resources — On April 3, 2020, the Small Business Administration opened applications for the Paycheck Protection Program and other disaster relief programs. This information and other resources to help your business are being frequently updated on the AANP COVID-19 Policy and Practice Resources page.
Small Business Administration Disaster Assistance — The Small Business Administration has a disaster loan assistance program for small businesses impacted by the COVID-19 pandemic. Learn more.