March 30, 2020

President Trump on Friday signed into law a $2 trillion economic stimulus bill that provides more than $150 billion to help hospitals and medical workers respond to the United States' coronavirus epidemic, and his administration on Sunday called on hospitals to report additional information about the epidemic daily.

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US reports about 50K new COVID-19 cases over the weekend

The moves come as officials in the United States reported about 50,000 new cases of COVID-19, the disease caused by the new coronavirus, over the weekend, and as the number of reported deaths linked to the virus in the United States nearly doubled. As of Monday morning, state and federal officials had reported 141,995 cases of COVID-19 in the country—up from 85,381 as of Friday morning. Officials as of Monday morning also have reported 2,486 U.S. deaths linked to the virus, up from 1,271 as of Friday morning.

Trump signs stimulus bill with $150B+ for providers

Trump on Friday signed into law a $2 trillion legislative package aimed at stimulating the United States' economy and protecting workers from income and job losses related to the country's COVID-19 epidemic. The package is unprecedented in size and scope, and includes funding for health care providers and initiatives, businesses, and payments that would go directly to Americans.

Specifically, the legislative package includes a total of $150 billion to help support hospitals' and medical workers' efforts to treat COVID-19 patients. For example, the bill would allocate $100 billion to the Public Health and Social Services Emergency Fund, which would be available to eligible health care providers for expenses or lost revenue associated with the epidemic. Eligible providers include: suppliers or providers enrolled in Medicare or Medicaid, public entities, for-profit entities, and nonprofit entities in the United States that provide testing, diagnoses, or care for individuals with possible or confirmed cases of COVID-19.

In addition, the package would provide $1.32 billion in supplemental funding for community health centers for prevention, diagnostic, and treatment efforts related to COVID-19; create a 20% add-on payment for hospitals treating inpatients with COVID-19; and allow the HHS secretary to create and implement a new payment regulation for rural and federally qualified health centers that provide telehealth services to certain patients.

Further, the proposal would suspend Medicare sequester cuts from May 1 to Dec. 31, though it calls for extending the sequester cuts for a year past their current end date. The measure also would extend through Nov. 30 funding for certain Medicare programs that are set to expire on May 22 and delay through Nov. 30 cuts to Medicaid disproportionate-share hospital payments that are scheduled to take effect May 22.

The proposal also includes provisions to:

  • Bolster the United States' stockpiles of medical supplies and personal protective equipment;
  • Encourage the development of new vaccines and treatments for the disease;
  • Increase the health care workforce;
  • Loosen certain telehealth restrictions;
  • Prevent drug and medical device shortages; and
  • Require that insurers cover testing, treatment, and potential vaccines for COVID-19.

While stakeholders and experts have largely praised the package's goals, some have raised concerns that it might not provide enough funding to help the United States weather the impact the epidemic will have on the country's economy and health care system.

In light of those concerns, policymakers already are working on an additional emergency spending package, the Wall Street Journal reports. Stephen Moore, a fellow at the conservative Heritage Foundation who serves as an outside economic consultant to some congressional Republicans and the Trump administration, told the Journal, "There's talk of a multi-trillion-dollar program, given the size of the shutdown."

House Speaker Nancy Pelosi (D-Calif.) on Thursday said, "Next, we'll go from emergency mitigation to recovery … to grow the economy and create more jobs."

But House Minority Leader Kevin McCarthy (R-Calif.) on Friday said, "I would hope anybody that's talking about a phase four would pause right now." He continued, "Let's make sure this is actually working in the process and be smart, get the data back of where—if—we do need more help."

Trump extends social distancing guidelines after Fauci predicts US could see up to 200K deaths

After signing the economic stimulus bill on Friday, Trump's administration took additional steps intended to curb the new coronavirus' spread and support the country's response to COVID-19.

For example, Trump on Friday invoked his powers under the Defense Production Act to direct General Motors (GM) to produce ventilators needed to care for patients with COVID-19. Trump also said his administration is working with approximately 10 companies to increase ventilator manufacturing, and he expects the United States "will make or get" more than 100,000 ventilators over the next 100 days.

In addition, Trump on Friday appointed Peter Navarro, the White House's director of trade and manufacturing policy, to oversee federal efforts to procure and distribute emergency medical supplies.

On Saturday, CDC issued an advisory urging residents of Connecticut, New Jersey, and New York to halt non-essential domestic travel for 14 days, as the numbers of reported cases of COVID-19 in those states continued to grow at a swift pace.

On Sunday, Trump announced that his administration is extending through April 30 its social distancing guidelines, which originally were scheduled to end on March 30. The guidelines recommend that Americans halt nonessential travel and avoid gatherings with more than 10 people. The guidance also suggests that Americans keep children home from school, stay home from work if able, and avoid bars, food courts, and restaurants. Further, the guidance notes that, if a person tests positive for COVID-19, everyone in that person's household should self-quarantine for 14 days.

Trump last week had said he was hoping to ease the guidelines and reopen U.S. businesses, at least in parts of the country, by April 12. However, Trump on Sunday said those hopes were only "aspirational," and noted that public health experts predict COVID-19 could kill hundreds of thousands of Americans even with the social distancing measures currently in place. For instance, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, on Sunday said, based on his interpretation of various predictive models, the United States could see "millions of cases" of COVID-19 and between 100,000 to 200,000 deaths tied to the new coronavirus.

Trump said "it's very important that [Americans] strongly follow the guidelines," adding, "The better you do, the faster this whole nightmare will end." He said he might have to extend the guidelines again at the end of April, but he believes the United States "should be well on our way to recovery" by June 1.

Further, CMS on Sunday sent a letter to U.S. hospitals on behalf of Vice President Pence urging facilities to report in-house testing data on COVID-19 to HHS daily.

The letter states that "[a]cademic, university, and hospital 'in-house' labs are performing thousands of COVID-19 tests each day, but unlike private laboratories, the full results are not shared with government agencies working to track and analyze the virus." It acknowledged that hospitals might already be reporting COVID-19 testing data to state officials, but noted that HHS also needs the data "to support states and localities in addressing and responding to the virus."

The letter requested that affected hospitals report the testing data to HHS by 5:00 PM EST each day (Fabian/Sink, Bloomberg, 3/27; Modern Healthcare, 3/29; Smith et al., New York Times, 3/30; Schlesinger/Jamerson, Wall Street Journal, 3/29; Cole et al., CNN, 3/30; Miller/Colvin, Associated Press, 3/30; Shear, New York Times, 3/30; Allyn, NPR, 3/29; New York Times, 3/30; Bade, Politico, 3/27; Muller, Axios, 3/28).

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