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Last week, $30 billion of the $100 billion emergency funding relief to hospitals was paid. Primarily, adult systems suffering from Medicare lost revenue received the overwhelming support. However, we are anxiously waiting for reports from Health and Human Services (HHS) about the timing of the second tranche of the $100 billion relief designated to children’s hospitals and other providers with a high-volume of Medicaid payments. Reports indicate the funding could be the final $70 billion allotment or come in segments like the first round.

Since the Coronavirus Aid, Relief, and Economic Stability (CARES) Act has been signed into law, children’s hospitals have been aggressively lobbying the administration and Congress to demonstrate the financial harm to children’s hospitals as part of the national response to the COVID-19 crisis and the need for access to and commensurate support from the relief funding. Last week, Nebraska Congressmen Don Bacon (R-CD 2, Omaha) and Jeff Fortenberry (R-CD 1, Lincoln) joined 149 bipartisan House members on a Dear Colleague Letter, urging the inclusion of funding specific to children’s hospitals in the upcoming COVID-19 relief legislation.

Both chambers continue to discuss narrow relief packages that could move through the House and Senate by unanimous consent before Congress returns, expected to focus on Small Business loans. It is widely expected Congress will turn to a more expansive “CARES 2.0” relief package when Congress returns early next month. On April 6, Children’s Hospital Association (CHA) submitted a letter to Hill leaders requesting Congress specifically target $10 billion to support children’s hospitals in upcoming relief legislation, noting the major losses being suffered in responding to COVID-19.

Gating Criteria

Last week, President Donald Trump announced Gating Criteria, or a phasing system, for reopening states ahead of federal stay-at-home guidelines that expire in 10 days.

In order to proceed to a phased comeback, the following criteria must be met at the state or regional level:

  1. SYMPTOMS. It is required that states or regions show a downward trajectory of influenza-like illnesses reported within a 14-day period AND a downward trajectory of COVID-like syndromic cases reported within a 14-day period.
  2. CASES. States must experience a downward trajectory of documented cases within a 14-day period OR a
    downward trajectory of positive tests as percent of total tests within a 14-day period (flat or increasing volume of tests).
  3. HOSPITALS. Hospitals must treat all patients without crisis care AND have a robust testing program in place for all at-risk healthcare workers, including emerging antibody testing.

Phase 1

Among many things, includes the ability to perform outpatient surgery, so long as states are in a comfortable position to begin this process similarly outlined by Governor Ricketts. This is now available for states to take part in.

The benchmark for phase 1 includes a sustained number of cases over a 14-day period, then pre-crisis conditions for outpatient surgery may begin.

Schools remain closed and employees working from home should remain home. However, restaurants, gyms and few other venues may begin strict social distancing protocols while opening to the public.

Vulnerable populations must remain sheltered-in-place.

Phase 2

Allows for inpatient surgical procedures to begin following a successful run with phase 1. States must complete “gating criteria” to move forward, much of which includes demonstrating proven abilities to remain prepared for a surge (supplies, staff, etc.) while maintaining outpatient procedures.

Phase 3

Most restrictions applied by the declared National Emergency are revoked.

Guidance from Center for Medicare and Medicaid Services

On Sunday, the Centers for Medicare and Medicaid Services (CMS) released guidance for hospitals to restart elective surgeries while maintaining their ability to treat COVID-19 patients. States or regions that have passed the Gating Criteria. Flexibility among states is encouraged so long as resources for any COVID-19 surge is on hand and the decisions consistent with the recommendations from the local public health department. Telehealth remains highly encouraged for all compatible modalities.

(Sources: CHA, AHA, Kaiser, CMS, Whitehouse.gov)

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Liz Lyons Director Government Relations
Liz Lyons
Government Relations

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