Legislative & Practice Updates/Financial Assistance

---- Legislative Updates: Full Scope of Practice ----

CMS continues to update its approved waivers pursuant to the National Emergency Declaration related to COVID-19. Review a list of CMS COVID-19 Blanket Waivers. Recent updates include: Responsibilities of Physicians in Critical Access Hospitals (CAHs). 42 CFR § 485.631(b)(2). CMS is waiving the CAH requirement that a physician be physically present. CMS is retaining the regulatory language that a physician be available "through direct radio or telephone communication, or electronic communication, for consultation, assistance with medical emergencies or patient referral." According to CMS, this allows CAHs to use NPs and physician assistants to the fullest extent possible.

--------------------------------- Legislative Updates: Financial --------------------------------

Paycheck Protection Program Extended

On April 21, the U.S. Senate passed H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act. In the legislation, the Paycheck Protection Program (PPP) for small businesses would be replenished. The IRS guidance applies to eligible, self-employed individuals who filed or will file a Form 1040 Schedule C in 2019. Partners in partnerships may not submit separate applications, and one application must be submitted for all partners due to program efficiency requirements. The program is available until June 30, 2020. The highlights of the legislation include:

• $310 billion in additional lending authority for the PPP;
• $60 billion for separate disaster loans to small businesses;
• $75 billion for hospitals through the Public Health and Social Services Emergency fund (funds could be used to reimburse providers for coronavirus related expenses);  
• $25 billion for COVID-19 testing, including for active infections and previous exposure, through the Public Health and Social Services Emergency Fund (funds can be used for manufacturing and distributing tests, getting personal protective equipment, and conducting surveillance and contact tracing). 

 PPP FAQs.
 Questions — Contact Your Local SBA Field Office.
 Interim Final Rule.

Provider Relief Fund

CARES Act Provider Relief Fund: 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 it 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.

Learn more about payment processing, distribution and other program details. Providers who have received funding must confirm their receipt of funding by signing an attestation form.  Access information about that process, including the form.

Free Frontline NP Hotel Rooms

Teaming Up to Provide Free Hotel Rooms to NPs - Rest, recharge and help keep your loved ones safe as you care for those impacted by COVID-19. American Express, Hilton and AANP have partnered to donate up to one million free hotel nights to AANP members and other front-line medical professionals. Thank you for your dedication to your patients and your bravery during this pandemic. AANP members: Log in to your MyAANP account to learn more about the Hilton Frontline Medical Professionals Room Program.

--------------- Practice Policy and Resources for COVID-19--------------

(Updated Daily)

AANP has put together a webpage that is frequently updated with federal and state policy information related to COVID-19.

 SARS-Co-V-2 in Hospital Settings

Researchers in Wuhan measured SARS-CoV-2 RNA concentrations in aerosol samples taken from 30 sites inside two hospitals dedicated to treating COVID-19, as well as from several public areas. Among the findings:

• Patient areas: Viral RNA concentrations generally were very low or undetectable in patient areas (e.g., ICUs, coronary care unit), except in a patient mobile toilet room, which was not ventilated.
• Medical staff areas: Some sites — including rooms where personal protective equipment was removed — had high SARS-CoV-2 RNA levels; these levels became undetectable after better sanitization procedures were implemented.
• Public areas: Two areas that got a lot of foot traffic — the entrance to a department store and a site next to one of the hospitals — had high viral RNA concentrations.

Conclusions: SARS-CoV-2 may have the potential to be transmitted via aerosols. Our results indicate that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols."