On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law, marking the third and largest major legislative initiative to address COVID-19 to date. (The first was the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, signed into law on March 6, followed by the Families First Coronavirus Response Act, signed into law on March 18.) The CARES Act contains a number of health-related provisions focused on the outbreak in the United States, including paid sick leave, insurance coverage of coronavirus testing, nutrition assistance, and other programs and efforts. It also includes support for the global response. Highlights are provided below, followed by summaries of provisions in the tables; not included are provisions that are not closely related to health but which are important aspects of the response to the outbreak, such as those pertaining to support for small businesses and severely stressed sectors of the U.S. economy and childcare.

The understanding and trajectory of the COVID-19 outbreak is changing rapidly, as is the response by Congress and the current administration. Some of the provisions in the CARES Act have already been enhanced by regulatory actions, such as telehealth. Others may be modified by a fourth legislative initiative to address COVID-19, which is now under discussion. Given that, it is important to keep in mind that additional changes may be forthcoming.

The CARES Act is divided into two main parts: Division A, which contains authorizing language for several programs and mandatory spending provisions, and Division B, which contains emergency, discretionary appropriations.

Among the areas addressed under Division A are (in order of appearance in the legislation):

  • Provisions to address issues related to drug, device, equipment, and supply shortages/stockpiles.
  • Amendments to the Food, Drug, and Cosmetic Act to expedite approval, review, and inspections of drugs and devices in limited circumstances and institute new user fees.
  • An amendment to the Families First Coronavirus Response Act to clarify that tests for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 are to be covered without cost-sharing by private insurance and Medicare even if that test has not yet received FDA emergency use authorization and an amendment clarifying that Medicaid must cover such tests regardless of whether they are authorized for emergency use by the FDA. Also provides consumer protections around balance billing for these tests.
  • Provisions to expand coverage of and offer grants to support broader use of telehealth services including in Medicare, private insurance, and through other federally funded providers (e.g., community health centers).
  • Reauthorization of multiple programs including programs to strengthen rural community health, the Healthy Start Program, and Temporary Assistance for Needy Families (TANF).
  • Provisions to address potential workforce issues, increasing flexibility for certain federal employee deployments, increasing training opportunities, and adding reporting requirements on workforce issues.
  • Several changes related to the Medicare program, including: eliminates certain Medicare requirements related to face-to-face encounters, delays certain scheduled payment reductions in the Medicare program, increases certain Medicare payments for the treatment of patients with COVID-19, permits 90-day supply of prescription drugs during the COVID-19 emergency, and requires coverage of any COVID-19 vaccine without cost-sharing.
Division B includes appropriations for several programs and initiatives, including (in order of appearance in the legislation):
  • More than $25 billion for domestic food assistance programs, including the school breakfast and lunch programs, the supplemental nutrition assistance program (SNAP), and the emergency food assistance program.
  • $1 billion for Defense Production Act purchases of personal protective equipment and medical equipment, such as ventilators.
  • $4.9 billion for the Department of Defense’s Defense Health Program, including $415 million for research and development efforts related to vaccines and antiviral pharmaceuticals and for procurement of diagnostic tests.
  • $80 million for a Pandemic Response Accountability Committee to promote transparency and conduct and support oversight of funds.
  • $45 billion for the Disaster Relief Fund, which is used by the Federal Emergency Management Agency (FEMA) to fund federal disaster response and assist nonfederal levels of government that have had their capacity to deal with major disasters and emergencies overwhelmed.
  • More than $1 billion for the Indian Health Service to prevent, prepare for, and respond to coronavirus.
  • $4.3 billion for the Centers for Disease Control and Prevention (CDC) for coronavirus activities.
  • Almost $1 billion for the National Institutes of Health (NIH) to support research, including research on coronavirus and developing countermeasures to prevent and treat COVID-19 disease.
  • $425 million to the Substance Abuse and Mental Health Services Administration (SAMHSA) to address mental health needs.
  • $200 million to the Centers for Medicare and Medicaid Services (CMS) for its coronavirus efforts, of which not less than half must be spent on nursing home inspections with priority given to those in localities with community transmission of COVID-19.
  • More than $127 billion for the Public Health and Social Services Emergency Fund at the Department of Health and Human Services (HHS), including, among other things, $100 billion to reimburse hospitals and other health care entities responding to coronavirus for health care-related expenses or lost revenues attributable to coronavirus. It also includes $275 million for Health Resources and Services Administration (HRSA) coronavirus-related activities through certain programs, including $90 million for the Ryan White HIV/AIDS Program.
  • More than $17 billion for the Veterans Health Administration to support medical care and related services and facilities during the coronavirus response.
  • $678 million to the Department of State, including $350 million to address the needs of vulnerable refugee populations abroad.
  • $363 million to the U.S. Agency for International Development (USAID) to address needs in countries that are underequipped to respond to the pandemic.

Overall, we identified $242.4 billion provided for health or health-related activities under Division B, though this estimate should be treated as a floor. More than half of this funding is directed to HHS.

Table 1: Division A of the Coronavirus Aid, Relief, and Economic Security (CARES) Act – Summary of Key Health and Related Provisions
Part/Subpart –  Name Section #. Name of Provision Summary of Provision
DIVISION A—KEEPING WORKERS PAID AND EMPLOYED, HEALTH CARE SYSTEM ENHANCEMENTS, AND ECONOMIC STABILIZATION
   TITLE III—SUPPORTING AMERICA’S HEALTH CARE SYSTEM IN THE FIGHT AGAINST THE CORONAVIRUS
      Subtitle A – Health Provisions
  Sec. 3001. Short title This may be cited as the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
PART I—ADDRESSING SUPPLY SHORTAGES

SUBPART A—MEDICAL PRODUCT SUPPLIES

 

Sec. 3101. National Academies report on America’s medical product supply chain security. Requires the Secretary of Health and Human Services (HHS) to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine to examine and report on the security of the U.S. medical product supply chain, including assessing and evaluating the dependence of the U.S. on critical drugs and devices sourced or manufactured outside of the U.S., and to provide recommendations.
Sec. 3102. Requiring the strategic national stockpile to include certain types of medical supplies. Requires the Strategic National Stockpile to include personal protective equipment, ancillary medical supplies, and supplies required for administering drugs, vaccines and other biological products, medical devices, and diagnostic tests.
Sec. 3103. Treatment of respiratory protective devices as covered countermeasures. Amends the Public Health Service Act to include a respiratory protective device (e.g., masks, respirators), approved by the National Institute for Occupational Safety and Health and that the Secretary determines to be a priority for use during a public health emergency, to be a covered countermeasure, conferring permanent liability protection for manufacturers.
PART I—ADDRESSING SUPPLY SHORTAGES

SUBPART B—MITIGATING EMERGENCY DRUG SHORTAGES

 

Sec. 3111. Prioritize reviews of drug applications; incentives. Amends the Federal Food, Drug, and Cosmetic Act to require the Secretary of HHS to prioritize expedited review and inspections if there is or is likely to be a shortage of a drug that is life-supporting, life-sustaining, or intended to prevent or treat a debilitating disease or condition.
Sec. 3112. Additional manufacturer reporting requirements in response to drug shortages. Provides for additional reporting requirements when drug manufacturing interruption or discontinuation occurs and is likely to lead to a meaningful disruption when the drug or ingredient is critical to the public health during a public health emergency. Requires: disclosure of reasons for the discontinuation or interruption, and if an active pharmaceutical ingredient is a reason for, or risk factor in, such interruption, the source of the active ingredient and any known alternative sources; whether any associated device is a reason for, or a risk factor in interruption; the expected duration of the interruption; and such other information as the Secretary may require. Manufacturers of drugs, ingredients, or associated devices facing discontinuation or limitation shall develop, maintain, and implement, as appropriate, a redundancy risk management plan that identifies and evaluates risks to the supply of the drug, subject to inspection and copying by the Secretary. Secretary to provide regular reporting on current drug shortage lists. Provides certain exemptions for biological products not necessary to protect the public health. Provisions take effect 180 days after enactment.
PART I—ADDRESSING SUPPLY SHORTAGES

SUBPART C—PREVENTING MEDICAL DEVICE SHORTAGES

Sec. 3121. Discontinuance or interruption in the production of medical devices. Provides that certain manufacturers of devices deemed critical to public health during a public health emergency provide notice of manufacturing discontinuation or interruption impacting supply. Provides that the secretary shall report on such disturbances. Exceptions for reporting if Secretary determines such disclosure would adversely affect the public health (e.g. increasing possibility of unnecessary over purchase). Provides expedited review processes for devices that could help mitigate or prevent such shortages.
PART II—ACCESS TO HEALTH CARE FOR COVID-19 PATIENTS

SUBPART A—COVERAGE OF TESTING AND PREVENTIVE SERVICES

Sec. 3201. Coverage of diagnostic testing for COVID-19. Amends the Families First Coronavirus Response Act to require coverage (without cost-sharing or other cost-containment measures) of a test for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 if: the test has received an Emergency Use Authorization (EUA) from the FDA; the developer has requested or intends to request EUA (until such request is denied or withdrawn); or the test has been developed in and authorized by a State that has notified HHS of its intention to review such test; or other test that the Secretary determines appropriate in guidance.
Sec. 3202. Pricing of diagnostic testing.

Amends requirement under the Families First Coronavirus Response Act (for private plans to cover coronavirus test) to address balance billing.

During the emergency period, the amendment requires group health plans and issuers to reimburse providers for a test for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19 as follows:

-If the provider participates in the plan network, the plan shall pay the contracted in-network rate

-If the provider is out-of-network, the plan shall either negotiate a price with the provider, or the plan shall reimburse the provider in an amount equal to the cash price that the provider lists on a public internet website

During the emergency period, a provider of such diagnostic testing shall post the cash price for such test on its public website. A civil money penalty of up to $300 can be imposed by the Secretary of HHS for each day a provider is out of compliance with this requirement.
Sec. 3203. Rapid coverage of preventive services and vaccines for coronavirus. Requires group health plans and individual health insurance policies to cover any qualifying coronavirus preventive service, including a vaccine, without cost-sharing no later than 15 days after it is recommended for such coverage by the US Preventive Services Task Force (USPSTF) with an A or B rating or by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention. Under current law, plans have up to 1 year following such recommendations to implement coverage.
PART II—ACCESS TO HEALTH CARE FOR COVID-19 PATIENTS

SUBPART B—SUPPORT FOR HEALTH CARE PROVIDERS

Sec. 3211. Supplemental awards for health centers. Provides supplemental awards of $1.32 billion in FY 2020 for health centers for the detection of SARS-CoV-2 or the prevention, diagnosis, and treatment of COVID-19.
Sec. 3212. Telehealth network and telehealth resource centers grant programs. Amends the Public Health Service Act to authorize to be appropriated $29 million for each of fiscal years 2021 through 2025 for the telehealth network grant program, which awards eligible entities for projects which demonstrate telehealth technologies can be used in rural areas and medically underserved areas. Extends the grant award period from 4 years to 5 years. Eliminates grants for telehealth resource centers. Cuts requirement that the Secretary of HHS establish terms and conditions of grants, maximum amounts of grants, and publish a notice of application requirements. Eliminates the requirement that grantees be non-profits. Removes requirement that states establish a health care provider reciprocity agreement.
Sec. 3213. Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs. Amends the Public Health Service Act to reauthorize grant programs to strengthen rural community health, to authorize to be appropriated $79.5 million for each of fiscal years 2021 through 2025, extending the grant award period from 3 years to 5 years. Removes the requirement that grantees be a rural public or nonprofit and broadens eligibility to include any entity with experience serving (or capacity to serve) rural underserved populations. Grants may be for basic healthcare services rather than limited to essential healthcare services. Adds focus on community engagement during rural healthcare services. Includes activities related to care coordination, chronic disease management, and improving patient health outcomes in requirements for small health care provider quality improvement grants.
Sec. 3214. United States Public Health Service Modernization. Amends the Public Health Service Act to provide for a Ready Reserve Corp in times of public health emergencies, in addition to national emergencies.
Sec. 3215. Limitation on liability for volunteer health care professionals during COVID-19 emergency response. Protects health care professional from liability under Federal or State law for any harm caused by an act or omission in the provision of health care services during the COVID-19 public health emergency so long as health care services in response to the public health emergency are performed in a volunteer capacity and the act or omission occurs in the course of providing health care services within the scope of the license, registration, or certification and in good faith. Protections do not apply if harm was caused by an act or omission of willful or criminal misconduct, gross, negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed or if rendered under the influence of alcohol or an intoxicating drug. Provision takes effect upon enactment of Act and is in effect for the length of the COVD-19 public health emergency.
Sec. 3216. Flexibility for members of National Health Service Corps during emergency period. With their voluntary agreement and consistent with existing statute, the Secretary may assign members of the National Health Service Corp to assist during the COVID-19 public health emergency to provide health services, provided such places are within a reasonable distance of the site to which members were originally assigned, and the total number of hours required are the same as were required prior to the date of enactment of this Act.
PART II—ACCESS TO HEALTH CARE FOR COVID-19 PATIENTS

SUBPART C—MISCELLANEOUS PROVISIONS

Sec. 3221. Confidentiality and disclosure of records relating to substance use disorder. Incorporates certain Health Insurance Portability and Accountability Act (HIPAA) provisions into existing regulations governing confidentiality related to substance use disorder treatment records. Includes provision for patient consent in sharing information and does not require re-consent until initial consent is revoked. Provides for patient protections around breaches of information and introduces penalties in cases where privacy protections are violated. Provides for nondiscrimination protections for individuals in cases where information covered by this section is received by others. The Secretary of HHS to make revisions to regulations as necessary for implementing and enforcing amendments made by this section on or after 12 months after enactment and shall update privacy notices within one year of enactment.
Sec. 3222. Nutrition services. During any portion of the COVID-19 public health emergency, the Secretary of HHS shall allow any state or area agency on aging to transfer no more than 100% of funds to address the needs of the area served, specifically funds for either a) making available comprehensive programs which include a full range of health, education, and supportive services to older citizens, b) special consideration for older citizens with special needs (especially those with the greatest social or economic need) in planning such programs, c) reducing hunger and food insecurity, d) promoting the health and well-being of older individuals by assisting such individuals to gain access to nutrition, other disease prevention, health promotion services.

Provides for a home delivery nutrition services waiver – during the COVID-19 public health emergency, the same meaning will be given to an individual who cannot obtain nutrition because of social distancing during COVID-19, as is currently given to an individual who is unable to leave home due to illness. For the duration of the public health emergency, allows the Assistant Secretary of Aging to waive the dietary guidelines as set forward by the Secretary of HHS and the Secretary of Agriculture.

Sec. 3223. Continuity of service and opportunities for participants in community service activities under title V of the Older Americans Act of 1965. The Secretary of Labor may allow individuals participating in community service activities as established under title V of the Older Americans Act of 1965 to extend their participation in the program past the period established in law if the Secretary determines such extension is appropriate due to the COVID-19 public health emergency. If it is necessary to respond to the additional administrative needs to respond to the COVID–19 public health emergency, the Secretary may also increase the amount available to pay the authorized administrative costs for a project, not to exceed 20% of the grant.
Sec. 3224. Guidance on protected health information. No later than 180 days after the passage of this Act, pursuant to the section 160.103 of title 45 of the Code of Federal Regulations, the Secretary of HHS must issue guidance on the sharing of patients’ protected health information during public health emergencies and national emergencies, respectively declared by HHS and the President. This guidance will include compliance information on the Health Insurance Portability and Accountability Act (HIPAA).
Sec. 3225. Reauthorization of healthy start program. Healthy Start is an initiative that makes grants in an effort to reduce infant mortality rates and improve perinatal outcomes. Amends Section 330H of the Public Health Service Act to reauthorize the program, require the Secretary of HHS to consider social determinants of health, high infant mortality rates, and poor perinatal health outcomes when awarding grants, and authorize to be appropriated $125,500,000 for each of fiscal years 2021 through 2025. Requires the Government Accountability Office (GAO) to conduct an evaluation in 4 years.
Sec. 3226. Importance of the blood supply. Requires the Secretary of HHS to carry out a national campaign on the importance and safety of blood donation during a public health emergency declared by the Secretary under section 319 of the Public Health Service Act.
PART III—INNOVATION Sec. 3301. Removing the cap on OTA during public health emergencies. Removes the cap on Other Transaction Authority (OTA) during a public health emergency to allow the Biomedical Advanced Research and Development Authority (BARDA) to more easily enter into agreements to carry out research and development projects for purposes of a public health emergency.
Sec. 3302. Priority zoonotic animal drugs. Gives expedited review of new animal drugs if such drugs are shown to treat zoonotic diseases (diseases spread between animals and people) that have the potential to cause adverse consequences or life-threatening to human health.
PART IV—HEALTH CARE WORKFORCE Sec. 3401. Reauthorization of health professions workforce programs. Amends Public Health Service Act to authorize to be appropriated funding for each of fiscal years 2021 through 2025 for health professions workforce programs and allows more grant funding to be used for training of healthcare workers in rural and underserved areas, prioritizing the fields of substance use, geriatrics and maternal and child health.
Sec. 3402. Health workforce coordination. Directs Secretary of HHS to lead the development of and reporting for a plan on health care workforce issues that establishes performance measures, identifies gaps in workforce, and recommends strategies for filling gaps.
Sec. 3403. Education and training relating to geriatrics.

Amends the Public Health Service Act to establish education and training programs related to geriatrics.

Geriatrics Workforce Enhancement Program: Directs the Secretary to award grants, contracts, or cooperative agreements to a variety of entities including, health professions schools, schools of nursing, nursing centers, academic health centers, State or local governments, and other appropriate public or private nonprofit entities to establish or operate Geriatrics Workforce Enhancement Programs that meet the following requirements:

– Award supports the training of health professionals in geriatrics, including traineeships or fellowships.

– Activities conducted include clinical training on providing integrated geriatrics and primary care; interprofessional training to practitioners from multiple disciplines including training on the provision of care to older adults; establishing or maintaining training-related community-based programs for older adults and caregivers to improve health outcomes for older adults; providing education on Alzheimer’s disease and related dementias.

– Grant length does not exceed 5 years.

When awarding the grants, Secretary should prioritize certain applicants, such as those with programs or activities that are expected to substantially benefit rural or medically underserved populations of older adults, and give special consideration to those that provide services in areas with a shortage of geriatric workforce professionals.

Geriatrics Academic Career Awards: Directs the Secretary to establish a program to provide geriatric academic career awards to a variety of entities including, health professions schools, schools of nursing, nursing centers, academic health centers, State or local governments, and other appropriate public or private nonprofit entities applying on behalf of eligible individuals to promote the career development of academic geriatricians or other academic geriatrics health professionals.

– The amount of an award shall be at least $75,000 for fiscal year 2021, increasing by CPI for future years.

– The Secretary should not make awards longer than a period of 5 years.

Sec. 3404. Nursing workforce development Reauthorizes and amends Title VIII of the Public Health Service Act on nurse workforce training programs. Alters definitions of eligible entities and programs for nursing workforce grants. Authorizes to be appropriated $137,837,000 for each of fiscal years 2021 through 2025 for grants for nurse education and training programs, nursing workforce diversity, and nurse retention and $117,135,000 for each of fiscal years 2021 through 2025 for student loan funds with schools of nursing. Updates reporting requirements on nurse loan repayment program.
      Subtitle C—Labor Provisions
Sec. 3601. Limitation on paid leave. Clarifies that dollar caps on emergency paid family leave benefits in the Families First Act are per employee. The Families First Act requires employers to provide 12 weeks of emergency family leave paid at two-thirds the employee’s regular pay, up to $200/day and $10,000 in aggregate, when the employee’s child’s school or place of care is closed as a result of coronavirus.
Sec. 3602. Emergency Paid Sick Leave Act Limitation.
Clarifies that the dollar caps on emergency paid sick leave benefits in the Families First Act are per employee. An employer shall not be required to pay more than either:

– $511 per day and $5,110 in the aggregate for each employee, when the employee is taking leave to care for themselves for reasons related to COVID-19.

– $200 per day and $2,000 in the aggregate for each employee, when the employee is taking leave to provide caregiving for an individual impacted by COVID-19.

Sec. 3603. Unemployment insurance. Addresses ways in which applications and assistance for unemployment should be accessible, ensuring that at least two methods are available, to the extent practicable (in-person, phone, or online).
Sec. 3604. OMB waiver of paid family and paid sick leave. Amends the Families First Act to allow OMB to exclude for good cause certain federal employees in the Executive Branch from eligibility for emergency paid family and sick leave benefits.
Sec. 3605. Paid leave for rehired employees. Provides that an employee laid off March 1, 2020, or later, and having been employed by that employer for at least 30 of the last 60 calendar days and then rehired is eligible for emergency paid family leave as provided in the Families First Act.
Sec. 3606. Advance refunding of credits. Provides that tax credits for employers providing emergency paid sick and/or family leave, as provided in the Families First Act, are advanceable. Adds that the Secretary of the Treasury shall make regulations that permit advancement of tax credits.
Sec. 3607. Expansion of DOL Authority to postpone certain deadlines. Amends ERISA to expand the circumstances under which the Secretary of the DOL may postpone certain ERISA filing deadlines to include a public health emergency, as declared by the Secretary of HHS.
Sec. 3608. Single-employer plan funding rules. Delays payment of minimum required contributions, plus interest, for single-employer plans to Jan. 1, 2021, and allows the plan sponsor to use the plan’s adjusted funding target attainment percentage as of Dec. 31, 2019, through 2020.
Sec. 3609. Application of cooperative and small employer charity pension plan rules to certain charitable employers whose primary exempt purpose is providing services with respect to mothers and children. Amends ERISA and the Internal Revenue Code to include in its definition of a cooperative and small employer charity pension plans that as of Jan. 1, 2020, were a 501(c)(3), were in existence since 1938, that conduct medical research through grant making, and whose primary exempt purpose is to provide services with respect to mothers and children. Amendments apply to plan years beginning after Dec. 31, 2018.
Sec. 3610. Federal contractor authority. Pending availability of appropriations, reimburses any paid leave a government contractor provides to its employees or subcontractors who are unable to work or telework due to coronavirus-related closures, through Sept. 30, 2020.
Sec. 3611. Technical corrections. Makes minor technical corrections to grammar, etc., that do not change substance of paid leave provided under the Families First Act.
      Subtitle D—Finance Committee
Sec. 3701. Exemption for telehealth services. For plan years beginning on or before Dec. 31, 2021, allows high-deductible health plans with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible.
Sec. 3702. Inclusion of certain over-the-counter medical products as qualified medical expenses. Includes in definition of qualified medical expenses menstrual care products (such as tampons, pads, liners, cups, sponges and similar products). Such expenses can be reimbursed with funds from tax-favored health savings accounts (HSAs and Archer MSAs), health reimbursement accounts (HRAs), or health flexible spending arrangements (FSAs). Removes requirement that drugs/medicines be prescribed in order to be eligible for reimbursement. This change is effective for amounts paid after Dec. 31, 2019.
Sec. 3703. Increasing Medicare telehealth flexibilities during emergency period. Gives the Secretary authority to waive provisions with regard to payment for telehealth services and, for telehealth services provided during the COVID-19 emergency period, removes the requirement that providers of telehealth services have treated the Medicare beneficiary receiving telehealth services in the last three years.
Sec. 3704. Enhancing Medicare telehealth services for Federally qualified health centers and rural health clinics during emergency period. Allows FQHCs and rural health clinics to provide telehealth services to Medicare beneficiaries during the COVID-19 emergency period.
Sec. 3705. Temporary waiver of requirement for face-to-face visits between home dialysis patients and physicians. Eliminates the requirement that Medicare beneficiaries with end-stage renal disease receiving home dialysis have a face-to-face clinical assessment at least once every 3 months during the COVID-19 emergency period.
Sec. 3706. Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during emergency period. Allows Medicare beneficiaries receiving hospice care to have a face-to-face encounter via telehealth with a hospice physician or nurse practitioner to recertify continued eligibility for hospice care during the COVID-19 emergency period.
Sec. 3707. Encouraging use of telecommunications systems for home health services furnished during emergency period. Requires the Secretary of HHS to issue clarifying guidance regarding the use of telecommunications systems for home health services, including remote patient monitoring, during the COVID-19 emergency period.
Sec. 3708. Improving care planning for Medicare home health services. Adds nurse practitioners, clinical nurse specialists, and physician assistants to the types of providers who can order home health services for Medicare beneficiaries. Amendments made by this provision also apply to Medicaid.
Sec. 3709. Adjustment of sequestration. Temporarily suspends the 2% reduction in Medicare payments to providers from May 1, 2020 through Dec. 31, 2020, and extends the Medicare sequester one year beyond current law (from 2029 to 2030).
Sec. 3710. Medicare hospital inpatient prospective payment system add-on payment for COVID–19 patients during emergency period. Increases payments to hospitals for the treatment of patients diagnosed with COVID-19 by 20%.
Sec. 3711. Increasing access to post-acute care during emergency period.

Waives the requirement that patients of an Inpatient Rehabilitation Facility (IRF) receive at least 15 hours of therapy a week (3 hours of therapy per day, 5 days per week)

For inpatient services furnished at a long-term care hospital (LTCH) during the emergency period:

– Waives the rule that limits payments for all hospital discharges to the site neutral payment rate if a hospital fails to meet the applicable LTCH discharge threshold of 50%

– Waives site-neutral IPPS payment rate for a discharge at a LTCH, if the admission occurs during the public health emergency and is in response to the public health emergency

Sec. 3712. Revising payment rates for durable medical equipment under the Medicare program through duration of emergency period.
Adjusts transition rules for payment reductions for durable medical equipment

– Maintains current Medicare payment rates for durable medical equipment for rural and non-contiguous areas until Dec. 31, 2020 or for the duration of the public health emergency, if longer. (Payment rates are based on the fee schedule amount for the area that is equal to 50% of the adjusted payment amount and 50% of the unadjusted fee schedule amount).

– For areas other than rural or non-contiguous areas, Medicare payment rates for durable medical equipment will be based on the fee schedule amount for the area that is equal to 75% of the adjusted payment amount and 25% of the unadjusted fee schedule amount through the duration of the public health emergency. (Current law is based on the fee schedule amount for the area that is equal to 100% of the adjusted payment amount).

Sec. 3713. Coverage of the COVID-19 vaccine under part B of the Medicare program without any cost-sharing. Medicare, including traditional Medicare and Medicare Advantage plans, will cover any COVID-19 vaccine (that is licensed under section 351 of the Public Health Service Act) and its administration under Medicare Part B. Medicare beneficiaries will not pay cost sharing for the vaccine or its administration (typically many services under Part B are subject to a deductible and 20% coinsurance).
Sec. 3714. Requiring Medicare prescription drug plans and MA–PD plans to allow during the COVID-19 emergency period for fills and refills of covered part D drugs for up to a 3-month supply. Requires Medicare prescription drug plans and Medicare Advantage drug plans to permit Part D plan enrollees to obtain a 90-day supply of a covered Part D drug (even if the drug is subject to cost and utilization management, medication therapy management, or other such programs) during the COVID-19 emergency period.
Sec. 3715. Providing home and community-based services in acute care hospitals. Clarifies that Medicaid home and community-based services can be provided in an acute care hospital if they are identified in an individual’s service plan, meet individual needs that are unmet by hospital services, do not substitute for services that the hospital is obligated to provide, and are designed to ensure smooth transitions between acute care and home and community-based settings and preserve functional abilities. Applies to Section 1915 (c) and (d) waivers, Section 1915 (j) self-directed personal assistance, the Section 1915 (i) home and community-based services state plan option, Section 1915 (k) Community First Choice attendant services, and Section 1115 waivers.
Sec. 3716. Clarification regarding uninsured individuals. Clarifies the definition of “uninsured individuals” who are eligible for Medicaid-covered COVID-19 testing and testing-related services with 100% federal matching funds in the new optional pathway created by the Families First Coronavirus Response Act. Specifically, the bill clarifies that adults in non-expansion states who would be eligible for the ACA Medicaid expansion if the expansion was adopted by their state do qualify as “uninsured individuals” eligible in the new pathway. Also provides that “uninsured individuals” eligible in the new pathway include those eligible for Medicaid in pathways for TB-infection, breast or cervical cancer, optional family planning services, medically needy/spend down (only if they receive a limited benefit package that is less than minimum essential coverage), and pregnant women who receive only pregnancy-related services.
Sec. 3717. Clarification regarding coverage of COVID-19 testing products. The Families First Coronavirus Response Act added COVID-19 testing products to the mandatory Medicaid lab services benefit and also exempts these tests from cost-sharing. This bill removes the requirement that these testing products be FDA-approved to be covered and exempt from cost-sharing in Medicaid.
Sec. 3718. Amendments relating to reporting requirements with respect to clinical diagnostic laboratory tests. Prevents reductions in Medicare payments for clinical laboratory diagnostic tests that were scheduled to occur in 2021 and delays the requirement for laboratories to report to Medicare the private payer rates for tests.
Sec. 3719. Expansion of the Medicare hospital accelerated payment program during the COVID-19 public health emergency.

Expands the type of hospitals eligible for the Medicare hospital accelerated payment program during the COVID-19 emergency. Eligible hospitals will now include: hospitals whose inpatients are predominantly individuals under 18 years of age; certain hospitals involved extensively in treatment for or research on cancer; and critical access hospitals.

Upon the request of the hospital, the Secretary of HHS may:

– Make accelerated payments to eligible hospitals on a periodic or lump sum basis

– Increase the amount of payment that would otherwise be made to hospitals under the program up to 100% (or, in the case of critical access hospitals, up to 125%)

– Extend the period that accelerated payments cover so that it covers up to a 6-month period.

The Secretary should also provide up to 4 months before claims are offset to recoup the accelerated payment and allow no less than 12 months from the date of the first accelerated payment before requiring that the outstanding balance be paid in full.
Sec. 3720. Delaying requirements for enhanced FMAP to enable state legislation necessary for compliance. The Families First Coronavirus Response Act provides a 6.2 percentage point increase in federal matching funds for Medicaid enrollees (other than ACA expansion adults) during the 1135 emergency period, provided that states meet certain conditions. One of these conditions is that states may not impose premiums higher than those in effect on 1/1/20. This bill provides a limited exception, allowing states to receive the enhanced federal matching funds during the 30-day period after the CARES Act becomes law, even if the state has a premium higher than what was in effect on 1/1/20, provided that the higher premium was in effect on the date that the CARES Act became law.
      Subtitle E—Health and Human Services Extenders
PART I—MEDICARE PROVISIONS

 

Sec. 3801. Extension of the work geographic index floor under the Medicare Program Extends the work geographic index floor from May 23, 2020 to Dec. 1, 2020; the work geographic index is an index which reflects 1/4 of the difference between the relative value of physicians’ work effort in each of the different Medicare fee schedule areas and the national average of such work effort, and the index floor is set at 1.00 for any locality where the index is less than 1.00.
Sec. 3802. Extension of funding for quality measure endorsement, input, and selection. Extends funding for health care quality measurement and performance improvement activities conducted by a consensus-based entity (e.g., the National Quality Forum) under contract with HHS through Nov. 30, 2020, by appropriating $20,000,000 for FY 2020, and a pro-rata portion of the FY 2020 total from Oct. 1, 2020 through Nov. 30, 2020.
Sec. 3803. Extension of funding outreach and assistance for low-income programs. Extends funding for State Health Insurance Programs, Area Agencies on Aging, Aging Disability and Resource Centers, and the National Center for Benefits and Outreach Enrollment through Nov. 30, 2020, by appropriating $13,000,000 for FY 2020 for State Health Insurance Programs, $7,500,000 for FY 2020 for Area Agencies on Aging, $5,000,000 for FY 2020 for Aging Disability and Resource Centers, and $12,000,000 for the National Center for Benefits and Outreach Enrollment, and a pro-rata portion of the FY 2020 total for each program from Oct. 1, 2020 through Nov. 30, 2020.
PART II—MEDICAID PROVISIONS

 

Sec. 3811. Extension of the Money Follows the Person rebalancing demonstration program. Extends Medicaid Money Follows the Person (MFP) demonstration through Nov. 30, 2020, by authorizing to be appropriated $337,500,000 for Jan. 1, 2020 through Sept. 30, 2020, and a pro rata portion of the FY 2020 amount for Oct. 1, 2020 through Nov. 30, 2020. Funds are available to states with approved MFP programs as of Dec. 31, 2018.
Sec. 3812. Extension of spousal impoverishment protections. Extends ACA Section 2404, which requires states to apply the Medicaid spousal impoverishment rules for those receiving institutional long-term care to those receiving home and community-based services, from May 22, 2020 (the current expiration date) through Nov. 30, 2020.
Sec. 3813. Delay of DSH reductions. Delays the effective date of reductions in state Medicaid disproportionate share hospital allotments. The $4 billion reduction provided in current law for May 23, 2020 through Sept. 30, 2020 would instead take effect from Dec. 1, 2020 through Sept. 30, 2021. The $8 billion reduction provided in current law for each fiscal year from 2021 through 2025 would instead take effect in FY 2022 through FY 2025.
Sec. 3814. Extension and expansion of Community Mental Health Services demonstration program. Extends Medicaid Community Mental Health Services demonstrations from May 22, 2020 (the current expiration date) through Nov. 30, 2020. Also directs the Secretary of HHS to select 2 more states for 2-year demonstrations from among the states that received planning grants and applied but were not selected for the original demonstrations, within 6 months of enactment. Selections will be based on states’ original applications, and states do not have to submit any additional application. Prior to delivering services, the new states must submit a monitoring plan for certified community behavioral health centers, commit to data collection, and obtain Secretary approval for any changes in their prospective payment system methodology. Also limits the enhanced federal matching funds available for mental health services provided to enrollees (other than ACA expansion adults) under these demonstrations to 8 fiscal quarters. For states with demonstrations as of Jan. 1, 2020, the 8 quarters begin on that date. Also requires a GAO study and report on the demonstrations within 18 months of enactment to include state experiences, federal evaluation efforts, and recommendations for improvements.
PART III—HUMAN SERVICES AND OTHER HEALTH PROGRAMS

 

Sec. 3821. Extension of sexual risk avoidance education program. Extends the Sexual Risk Avoidance Education Program, an abstinence education grant program, through Nov. 30, 2020.
Sec. 3822. Extension of personal responsibility education program. Extends the Personal Responsibility Education Program, a teen pregnancy and HIV/STI prevention education grant program, through Nov. 30, 2020.
Sec. 3823. Extension of demonstration projects to address health professions workforce needs. Extends ‘Demonstration Project to Provide Low-Income Individuals with Opportunities for Education, Training, and Career Advancement to Address Health Professions Workforce Needs’ grant program through Nov. 30, 2020, at current funding levels.
Sec. 3824. Extension of the temporary assistance for needy families program and related programs. Extends Temporary Assistance for Needy Families (TANF) and related programs until Nov. 30, 2020, at current funding levels.
PART IV—PUBLIC HEALTH PROVISIONS

 

Sec. 3831. Extension for community health centers, the National Health Service Corps, and teaching health centers that operate GME programs. Extends funding for community health centers, the National Health Service Corps, and teaching health centers that operate graduate medical education programs at current levels until Nov. 30, 2020.
Sec. 3832. Diabetes programs. Extends funding for the special diabetes programs for type I diabetes and for the special diabetes programs for Indians at current levels until Nov. 30, 2020.
PART V—MISCELLANEOUS PROVISIONS Sec. 3841. Prevention of duplicate appropriations for fiscal year 2020. Prevents duplicate appropriations for FY 2020 in providing that expenditures made under any provision of law amended in this title for FY 2020 be charged to the applicable appropriation or authorization.
      Subtitle F—Over-the-Counter Drugs
PART I—OTC DRUG REVIEW

 

Sec. 3851. Regulation of certain nonprescription drugs that are marketed without an approved drug application. Amends the FD&C Act by adding a section to change current regulations, permitting FDA to reform the approval process for certain nonprescription (i.e., over-the-counter or OTC) drugs deemed “to be generally recognized as safe and effective” (GRASE) by implementing an administrative (rather than full rulemaking) approval process. OTC drugs not considered to be GRASE or with unacceptable indications (i.e. category II drugs) are deemed new and require a new drug application. Also includes an exclusivity provision for innovative drugs meeting certain conditions and a future GAO study on impact of exclusivity provisions.
Sec. 3852. Misbranding. Provides that nonprescription drugs not subject to a new drugs application are out of compliance if they do not conform to requirements in this act and if required user fees are not paid.
Sec. 3853. Drugs excluded from the over-the-counter drug review. States that nothing in this Act applies to nonprescription drugs previously excluded from Over-the-Counter Drug Review by the FDA in accordance with existing regulations pertaining to procedures for classification of OTC drugs.
Sec. 3854. Treatment of Sunscreen Innovation Act. Provides that a sponsor of a nonprescription sunscreen ingredient may elect an administrative review as described for OTC drugs above with a similar exclusivity provision.
Sec. 3855. Annual update to Congress on appropriate pediatric indication for certain OTC cough and cold drugs. Provides that the HHS Secretary submit an annual letter to congress evaluating the cough and cold OTC monograph (i.e., the drug “recipe” including ingredients, dosing, formulation, and labeling) for children under age 6.
Sec. 3856. Technical corrections. Provides for technical corrections to the Food, Drug, and Cosmetic Act and the FDA Reauthorization Act of 2017.
PART II—USER FEES

 

Sec. 3861. Finding. Establishes that fees authorized by the amendments made in this part will be dedicated to OTC monograph drug (i.e. OTC drugs without a new drug application as provided for above) activities.
Sec. 3862. Fees relating to over-the-counter drugs.
Establishes two fee types related to OTC monograph drugs beginning in FY 2021:

1) Each person that owns an OTC monograph drug facility shall be assessed an annual fee that amount of which is to be published in the Federal Registrar by the second Monday in May 2020. The amount of the fee for a contract manufacturer is 2/3 of the amount for a non-contract manufacturing facility.

2) Each person that submits an OTC monograph request shall be subject to a fee:

A) For a Tier 1 OTC monograph order request: $500,000, adjusted for inflation

B) For a Tier 2 OTC monograph order request: $100,000, adjusted for inflation

   OTHER TITLES
TITLE II—ASSISTANCE FOR AMERICAN WORKERS, FAMILIES, AND BUSINESSES

Subtitle A—Unemployment Insurance Provisions

Sec. 2104. Emergency increase in unemployment compensation benefits. Provides that the monthly amount of federal pandemic unemployment compensation will be disregarded from income when determining Medicaid and CHIP eligibility. Note this funding is counted in modified adjusted gross income (MAGI) for purposes of determining eligibility for Marketplace subsidies.
TITLE II—ASSISTANCE FOR AMERICAN WORKERS, FAMILIES, AND BUSINESSES
Subtitle B—Rebates and Other Individual Provisions
Sec. 2201. 2020 recovery rebates for individuals. Eligible individuals will receive a Recovery Rebate for the 2020 tax year in an amount equal to $1,200 for an individual return ($2,400 for joint return) with an additional $500 per qualified dependent child. Recovery Rebates are limited based on adjusted gross income. No adjustment applied for single returns with adjusted gross income (AGI) up to $75,000 ($112,500 for head of household; $150,000 for join returns). Above these thresholds, the Rebate amount is reduced by $5 for each $100 that a taxpayer’s income exceeds the phase-out threshold. The amount is completely phased-out for single filers with incomes exceeding $99,000, $146,500 for head of household filers with one child, and $198,000 for joint filers with no children.

The Recovery Rebate for individuals is a refundable federal tax credit; as such it is not counted as income in determining eligibility for income-based programs, including Medicaid, CHIP, and Marketplace subsidies.

Sec. 2204. Allowance of partial above the line deduction for charitable contributions. Taxpayers who do not itemize deductions can nonetheless deduct up to $300 in charitable cash donations for the 2020 tax year.  This above-the-line deduction reduces adjusted gross income, and therefore may slightly affect eligibility for marketplace subsidies which are based on modified adjusted gross income.
TITLE V—CORONAVIRUS RELIEF FUNDS Sec. 5001. Coronavirus Relief Fund.

Provides $150 billion for making payments to states, territories and tribes. Funds are available for amounts spent in response to COVID-19 crisis between March 1, 2020 and Dec. 31, 2020 that were not already budgeted in state/territory’s most recent budget approved as of date of enactment. Jurisdictions apply for funds and certify expenditures on application. Inspector General appointed to oversee program.

Of the funds provided:

– $3 billion is reserved for making payments to DC and territories (amount divided by each jurisdiction’s share of the total combined population of DC and the 5 territories).

– $8 billion reserved for making payments to tribal governments.

– $139 billion for making payments to the 50 states. States each receive a minimum payment of $1.25 billion. Remaining $76.5 billion allocated proportionately based on a state’s share of the total U.S. population (minus population of DC and territories).

– Local governments (for jurisdiction with population > 500,000) can apply for direct payment; amount comes out of that state’s allocation.

TITLE VI—MISCELLANEOUS PROVISIONS Sec. 6001. COVID–19 borrowing authority for the United States Postal Service. Provides borrowing authority not to exceed $10 billion if the Postal Service determines that, due to the COVID–19 emergency, the Postal Service will not be able to fund operating expenses without borrowing money.

Requires the Postal Service to prioritize delivery of postal products for medical purposes and allows it to establish temporary delivery points, in such form and manner as the Postal Service determines necessary, to protect employees of the Postal Service and individuals receiving deliveries from the Postal Service.

SOURCES: KFF analysis of CARES Act (P.L. 116-136) and Senate Appropriations Committee summary materials.
Table 2: Division B of the Coronavirus Aid, Relief, and Economic Security (CARES) Act – Summary of Key Health and Related Provisions
Department Operating Division/
Office
Key Provisions Fund/
Account
Funding
Available
Period
DIVISION B—EMERGENCY APPROPRIATIONS FOR CORONAVIRUS HEALTH RESPONSE AND AGENCY OPERATIONS
   TITLE I
Department of Agriculture Rural Utilities Service For an additional amount for “Distance Learning, Telemedicine, and Broadband Program” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for telemedicine and distance learning services in rural areas. Distance Learning, Telemedicine, and Broadband Program $25,000,000 To remain available until expended
Food and Nutrition Service

 

For an additional amount for ‘‘Child Nutrition Programs’’ (such as the federal school breakfast and lunch programs) to prevent, prepare for, and respond to coronavirus, domestically or internationally. Child Nutrition Programs $8,800,000,000 To remain available until Sept. 30, 2021
For an additional amount for the “Supplemental Nutrition Assistance Program” (SNAP) to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided:

– $15,510,000,000 shall be placed in a contingency reserve to be allocated as the Secretary of Agriculture deems necessary to support participation should cost or participation exceed budget estimates to prevent, prepare for, and respond to coronavirus.

– $100,000,000 for the food distribution program on Indian reservations program to prevent, prepare for, and respond to coronavirus, of which $50,000,000 for facility improvements and equipment upgrades and $50,000,000 for costs relating to additional food purchases.

– $200,000,000 for the Secretary of Agriculture to provide grants to the Commonwealth of the Northern Mariana Islands, Puerto Rico, and American Samoa for nutrition assistance to prevent, prepare for, and respond to coronavirus, domestically or internationally.

SNAP $15,810,000,000 To remain available until Sept. 30, 2021
For an additional amount for the ‘‘Commodity Assistance Program’’ for The Emergency Food Assistance Program (TEFAP) to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided, the Secretary of Agriculture may use up to $150,000,000 for costs associated with the distribution of commodities.

Commodity Assistance Program $450,000,000 To remain available until Sept. 30, 2021
Foreign Agricultural Service For an additional amount for ‘‘Salaries and Expenses’’ to prevent, prepare for, and respond to coronavirus, domestically or internationally, including necessary expenses to relocate employees and their dependents back from overseas posts: Salaries and Expenses $4,000,000 To remain available until Sept. 30, 2021
Department of Health and Human Services (HHS) Food and Drug Administration (FDA) For an additional amount for “Salaries and Expenses” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including funds for the development of necessary medical countermeasures and vaccines, advanced manufacturing for medical products, the monitoring of medical product supply chains, and related administrative activities. Salaries & Expenses $80,000,000 To remain available until expended
   TITLE II
Department of Commerce National Institute of Standards and Technology For an additional amount for “Scientific and Technical Research and Services to prevent, prepare for, and respond to coronavirus, domestically or internationally, by supporting continuity of operations, including measurement science to support viral testing and bio-manufacturing. Scientific and Technical Research and Services $6,000,000 To remain available until Sept. 30, 2021
Part of an additional amount for “Industrial Technology Services” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for the National Network for Manufacturing Innovation (specifically, the National Institute for Innovation in Manufacturing Biopharmaceuticals) to prevent, prepare for, and respond to coronavirus, including to support development and manufacturing of medical countermeasures and biomedical equipment and supplies. Industrial Technology Services $10,000,000 To remain available until Sept. 30, 2021
Department of Justice Federal Bureau of Prisons
For an additional amount for “Federal Prison System, Salaries and Expenses” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including the impact of coronavirus on the work of the Department of Justice, for Correctional Officer overtime, personal protective equipment and supplies related to coronavirus, clean work and living environments, and inmate medical care and supplies related to coronavirus.
Federal Prison System, Salaries and Expenses $100,000,000 FY 2020
Section 12003. Findings of Congress with regard to supply of personal protective equipment and test kits to the Bureau of Prisons and directs the HHS Secretary to appropriately consider, relative to other priorities of HHS for high-risk and high-need populations, the distribution of infectious disease personal protective equipment and COVID-19 test kits to the Bureau for use by inmates and personnel of the Bureau.

Allows the Director of the Bureau, during the covered emergency period, if the Attorney General finds that emergency conditions will materially affect the functioning of the Bureau, to lengthen the maximum amount of time for which the Director is authorized to place a prisoner in home confinement.

National Science Foundation For an additional amount for “Research and Related Activities” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including to fund research grants and other necessary expenses. Research and Related Activities $75,000,000 To remain available until Sept. 30, 2021
   TITLE III
Department of Defense Defense Production Act Purchases For an additional amount for ‘‘Defense Production Act Purchases’’ to prevent, prepare for, and respond to coronavirus, domestically or internationally. Procurement $1,000,000,000 To remain available until expended
Defense Health Program For an additional amount for the Defense Health Program to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of which, $3,390,600,000 shall be for operation and maintenance (O&M), and $415,000,000 shall be for research, development, test and evaluation (RDT&E) to prevent, prepare for, and respond to coronavirus.

O&M, RDT&E $3,805,600,000 O&M: To remain available until Sept. 30, 2020

RDT&E: To remain available until Sept. 30, 2021

Section 13002. For an additional amount for the Defense Health Program, which shall be for operation and maintenance (O&M).

Of which, $1,095,500,000 may be available for contracts entered into under the TRICARE program.

O&M (TRICARE) $1,095,500,000 To remain available until Sept. 30, 2020
   TITLE V
Federal Communications Commission For and additional amount for “Salaries and Expenses” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including to support efforts of health care providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services during an emergency period. Salaries and Expenses $200,000,000 To remain available until expended
Council of the Inspectors General Pandemic Response Accountability Committee For an additional amount for “Pandemic Response Accountability Committee” to promote transparency and support oversight of funds provided in this Act to prevent, prepare for, and respond to coronavirus, domestically or internationally. Pandemic Response Accountability Committee $80,000,000 To remain available until expended
Section 15010. Establishes, within the Council of the Inspectors General, the Pandemic Response Accountability Committee to promote transparency and conduct and support oversight of funds provided in this Act, the Coronavirus Preparedness and Response Supplemental Appropriations Act 2020, and Families First Coronavirus Response Act, or any other Act primarily making appropriations for the coronavirus response and the coronavirus response to:

– prevent and detect fraud, waste, abuse, and mismanagement; and

– mitigate major risks that cut across program and agency boundaries.

“Coronavirus response” here means the federal government’s response to the nationwide public health emergency declared by the HHS Secretary, retroactive to Jan. 27, 2020, as a result of confirmed cases of the novel coronavirus – COVID-19 – in the U.S.

Outlines the members of the Committee and the selection of the Chairperson.

States there shall be an Executive Director and Deputy Executive Director of the Committee who shall be appointed by the Chairperson not later than 30 days and the Deputy Executive Director not later than 90 days after the date of enactment of this Act, in consultation with certain congressional leaders, and outlines their experience and duties.

Outlines the Committee’s functions and requires it to submit to the President and Congress management alerts on potential mismanagement, risk, and funding problems that require immediate attention, as well as other reports and periodic updates on its work to Congress as it considers appropriate and a biannual report to the President and Congress. Also describes the public availability of these reports and allowable redaction of them.

Requires the Committee to make recommendations to agencies on related measures and for the agency to respond with a report.

States the Committee may conduct its own independent investigations, audits, and reviews relating to covered funds or the coronavirus response and have certain authorities provided under the Inspector General Act of 1978, issue subpoenas to compel the testimony of persons who are not federal officers or employees, and enforce such subpoenas in the event of a refusal to obey. The Committee may hold public hearings, and Committee personnel may conduct necessary inquiries.

Not later than 30 days after the date of enactment of this Act, the Committee shall establish and maintain a user-friendly, public-facing website. The website shall include a plan from each federal agency for using covered funds.

Authorizes to be appropriated such sums as necessary to carry out the duties and functions of the Committee.

The Committee shall terminate on Sept. 30, 2025.

General Provisions Reporting on Use of Funds Section 15011. Outlines the reporting requirements for funds provided in this Act, the Coronavirus Preparedness and Response Supplemental Appropriations Act 2020, and Families First Coronavirus Response Act, or any other Act primarily making appropriations for the coronavirus response, including that not later than 90 days after the enactment of this Act, each agency shall submit to the Pandemic Response Accountability Committee a plan describing how the agency will use covered funds.
   TITLE VI
Department of Homeland Security Federal Emergency Management Agency (FEMA) For an additional amount for “Disaster Relief Fund,” which is used by FEMA to fund federal disaster response and assist nonfederal levels of government that have had their capacity to deal with major disasters and emergencies overwhelmed. It can support a range of eligible efforts, including medical response.

Of the funds provided:

– $25,000,000 for major disasters declared pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act.

– $15,000,000 for all purposes authorized under the Stafford Act and may be used in addition to amounts designated by the Congress as being for disaster relief.

– $3,000,000 for oversight of activities supported by these funds.

Disaster Relief Fund $45,000,000,000 To remain available until expended
Part of an additional amount for “Federal Assistance” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for the Emergency Food and Shelter Program (EFSP), which supports local social service organizations to provide shelter, food and supportive services to individuals and families. Federal Assistance $200,000,000 To remain available until Sept. 30, 2021
General Provisions Section 16005. Certain health care professionals working for the Department of Homeland Security can practice their health profession(s) at any location in any state, the District of Columbia, or Commonwealth, territory, or possession of the U.S., or any location designated by the Secretary of Homeland Security, regardless of where such health care professional or the patient is located, so long as the practice is within the scope of the authorized federal duties of such health care professional. This applies during the COVID-19 emergency declared by the President on March 13, 2020, pursuant to the Stafford Act, and during any subsequent major declaration under Section 401 of that Act that supersedes such emergency declaration.
   TITLE VII
Department of the Interior Bureau of Indian Affairs For an additional amount for “Operation of Indian Programs” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including, but not limited to, funds for public safety and justice programs (including for coronavirus containment in detention facilities), executive direction to carry out deep cleaning of facilities, purchase of personal protective equipment, purchase of information technology to improve teleworking capability, welfare assistance and social services programs (including assistance to individuals), and assistance to tribal governments, including tribal governments who participate in the ‘‘Small and Needy’’ program.

Of the funds provided, not less than $400,000,000 shall be made available to meet the direct needs of tribes.

Operation of Indian Programs $453,000,000 To remain available until Sept. 30, 2021
Office of Insular Affairs For an additional amount for “Assistance to Territories” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for general technical assistance to U.S. territories and freely associated states with needs related to prevention and mitigation of the coronavirus outbreak, including medical supplies and equipment, healthcare services, and facilities. Assistance to Territories $55,000,000 To remain available until Sept. 30, 2021
Environmental Protection Agency Part of an additional amount for “Science and Technology” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for research on methods to reduce the risks from environmental transmission of coronavirus via contaminated surfaces or materials. Science and Technology $1,500,000 To remain available until Sept. 30, 2021
Part of an additional amount for “Environmental Programs and Management” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for expediting registration and other actions related to pesticides to address coronavirus. Environmental Programs and Management $1,500,000 To remain available until Sept. 30, 2021
Department of Agriculture U.S. Forest Service For an additional amount for “National Forest System” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for cleaning and disinfecting of public recreation amenities and for personal protective equipment and baseline health testing for first responders to be allocated at the discretion of the Chief of the Forest Service. National Forest System $34,000,000 To remain available until Sept. 30, 2021
For an additional amount for “Wildland Fire Management” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for personal protective equipment and baseline health testing for first responders to be allocated at the discretion of the Chief of the Forest Service. Wildland Fire Management $7,000,000 To remain available until Sept. 30, 2021
Department of Health & Human Services (HHS) Indian Health Service (IHS) For an additional amount for “Indian Health Services” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for public health support, electronic health record modernization, telehealth and other information technology upgrades, Purchased/Referred Care, Catastrophic Health Emergency Fund, Urban Indian Organizations, Tribal Epidemiology Centers, Community Health Representatives, and other activities to protect the safety of patients and staff.

Of the funds provided:

– Up to $65,000,000 for electronic health record stabilization and support, including for planning and tribal consultation.

– Not less than $450,000,000 distributed through IHS directly operated programs and to tribes and tribal organizations and through contracts or grants with urban Indian organizations.

– Amounts not allocated above to be allocated at the discretion of the IHS Director.

– Up to $125,000,000 may be transferred to and merged with the ‘‘Indian Health Service, Indian Health Facilities’’ appropriation at the discretion of the Director for the purposes specified in this Act.

Indian Health Services $1,032,000,000 To remain available until Sept. 30, 2021
Agency for Toxic Substances and Disease Registry (ATSDR) For an additional amount for “Toxic Substances and Environmental Public Health” to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided:

– $7,500,000 for necessary expenses of the Geospatial Research, Analysis and Services Program to support spatial analysis and Geographic Information System mapping of infectious disease hot spots, including cruise ships.

– $5,000,000 for necessary expenses for awards to Pediatric Environmental Health Specialty Units and state health departments to provide guidance and outreach on safe practices for disinfection for home, school, and daycare facilities.

Toxic Substances and Environmental Public Health $12,500,000 To remain available until Sept. 30, 2021
   TITLE VIII
Department of Health & Human Services (HHS) Centers for Disease Control and Prevention (CDC) For an additional amount for “CDC-Wide Activities and Program Support” to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided:

– Not less than $1,500,000,000 for grants to or cooperative agreements with states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes, including to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.

– Every grantee that received a Public Health Emergency Preparedness grant for FY 2019 shall receive not less than 100 percent of that grant level from these funds.

– Of which, not less than $125,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.

– Not less than $500,000,000 for global disease detection and emergency response.

– Not less than $500,000,000 for public health data surveillance and analytics infrastructure modernization.

-CDC shall report to the House and Senate Committees on Appropriations on the development of a public health surveillance and data collection system for coronavirus within 30 days of enactment of this Act.

– $300,000,000 to be transferred to and merged with amounts in the Infectious Disease Rapid Response Reserve Fund.

– Funds may be used for grants for the rent, lease, purchase, acquisition, construction, alteration, or renovation of non-federally owned facilities to improve preparedness and response capability at the state and local level.

CDC-Wide Activities and Program Support $4,300,000,000 To remain available until Sept. 30, 2024
National Institutes of Health (NIH)

 

For an additional amount for “National Heart, Lung, and Blood Institute” to prevent, prepare for, and respond to coronavirus, domestically or internationally. National Heart, Lung, and Blood Institute $103,400,000 To remain available until Sept. 30, 2024
For an additional amount for “National Institute of Allergy and Infectious Diseases” to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided:

– Not less than $156,000,000 for the study of, construction of, demolition of, renovation of, and acquisition of equipment for, vaccine and infectious diseases research facilities of or used by NIH, including the acquisition of real property.

National Institute of Allergy and Infectious Diseases (NIAID) $706,000,000 To remain available until Sept. 30, 2024
For an additional amount for “National Institute of Biomedical Imaging and Bioengineering” to prevent, prepare for, and respond to coronavirus, domestically or internationally” National Institute of Biomedical Imaging and Bioengineering $60,000,000 To remain available until Sept. 30, 2024
For an additional amount for “National Library of Medicine” to prevent, prepare for, and respond to coronavirus, domestically or internationally. National Library of Medicine $10,000,000 To remain available until Sept. 30, 2024
For an additional amount for “National Center for Advancing Translational Science” to prevent, prepare for, and respond to coronavirus, domestically or internationally. National Center for Advancing Translational Sciences $36,000,000 To remain available until Sept. 30, 2024
For an additional amount for “Office of the Director” to prevent, prepare for, and respond to coronavirus, domestically or internationally; these funds shall be available for the Common Fund (according to NIH, “Common Fund programs address emerging scientific opportunities and pressing challenges in biomedical research that no single NIH Institute or Center … can address on its own, but are of high priority for the NIH as a whole.1) Office of the Director (Common Fund) $30,000,000 To remain available until Sept. 30, 2024
Substance Abuse and Mental Health Services Administration (SAMHSA) For an additional amount for “Health Surveillance and Program Support” to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided:

– Not less than $250,000,000 for the Certified Community Behavioral Health Clinic Expansion Grant program.

– Not less than $50,000,000 for suicide prevention programs.

– Not less than $100,000,000 for noncompetitive grants, contracts or cooperative agreements to public entities to enable such entities to address emergency substance abuse or mental health needs in local communities.

– Not less than $15,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers to tribes.

Health Surveillance and Program Support $425,000,000 To remain available through Sept. 30, 2021
Centers for Medicare & Medicaid Services (CMS) For an additional amount for “Program Management” to prevent, prepare for, and respond to coronavirus, domestically and internationally.

Of the funds provided:

– Not less than $100,000,000 for necessary expenses of the survey and certification program, prioritizing nursing home facilities in localities with community transmission of coronavirus.

Program Management $200,000,000 To remain available until Sept. 30, 2023
Administration for Children and Families Part of an additional amount for “Children and Families Services Programs” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for the National Domestic Violence Hotline. Children and Families Services Programs $2,000,000 To remain available through Sept. 30, 2021
Part of an additional amount for “Children and Families Services Programs”  to prevent, prepare for, and respond to coronavirus, domestically or internationally, for Family Violence Prevention and Services formula grants, allowing the Secretary to make such funds available for providing temporary housing and assistance to victims of family, domestic, and dating violence. Children and Families Services Programs $45,000,000 To remain available through Sept. 30, 2021
Administration for Community Living For an additional amount for “Aging and Disability Services Programs” to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided:

– $820,000,000 for activities authorized under the Older Americans Act of 1965, including $200,000,000 for certain supportive services, $480,000,000 for certain nutrition services, $20,000,000 for certain nutrition services, $100,000,000 for support services for family caregivers, and $20,000,000 for elder rights protection activities.

– $50,000,000 for certain aging and disability resource centers to prevent, prepare for, and respond to coronavirus.

– $85,000,000 for centers for independent living that have received certain grants.

Aging and Disability Services Program $955,000,000 To remain available until Sept. 30, 2021
Office of the Secretary

 

For an additional amount for “Public Health and Social Services Emergency Fund” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including the development of necessary countermeasures and vaccines, prioritizing platform-based technologies with U.S.-based manufacturing capabilities, the purchase of vaccines, therapeutics, diagnostics, necessary medical supplies, as well as medical surge capacity, addressing blood supply chain, workforce modernization, telehealth access and infrastructure, initial advanced manufacturing, novel dispensing, enhancements to the U.S. Commissioned Corps, and other preparedness and response activities.

Of the funds provided:

– Funds may be used to develop and demonstrate innovations and enhancements to manufacturing platforms to support above capabilities.

– The HHS Secretary shall purchase vaccines developed using these funds to respond to an outbreak or pandemic related to coronavirus in quantities determined by the Secretary to be adequate to address the public health need.

– Products purchased by the federal government with these funds, including vaccines, therapeutics, and diagnostics, shall be purchased in accordance with Federal Acquisition Regulation guidance on fair and reasonable pricing.

– The Secretary may take such measures authorized under current law to ensure that vaccines, therapeutics, and diagnostics developed from these funds will be affordable in the commercial market and shall not take actions that delay the development of such products.

– Products purchased with these funds may, at the discretion of the HHS Secretary, be deposited in the Strategic National Stockpile.

– Not more than $16,000,000,000 of these funds is for the Strategic National Stockpile.

– Not less than $250,000,000 for grants to or cooperative agreements with entities that are either grantees or sub-grantees of the Hospital Preparedness Program or that meet such other criteria as the HHS Secretary may prescribe.

– Not less than $3,500,000,000 to the Biomedical Advanced Research and Development Authority (BARDA) for necessary expenses of manufacturing, production, and purchase, at the discretion of the HHS Secretary, of vaccines, therapeutics, diagnostics, and small molecule active pharmaceutical ingredients, including the development, translation, and demonstration at scale of innovations in manufacturing platforms.

– These funds may be used for the construction or renovation of U.S.-based next generation manufacturing facilities, other than facilities owned by the United States Government.

– $1,500,000 for the HHS Secretary to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine not later than 60 days after the date of enactment of this Act to examine, and, in a manner that does not compromise national security, report on, the security of the United States medical product supply chain.

Other Provisions:

– These funds may be used to reimburse the Department of Veterans Affairs for expenses incurred by the Veterans Health Administration.

– Not more than $289,000,000 may be transferred as necessary to other federal agencies for necessary expenses related to medical care that are incurred to prevent, prepare for, and respond to coronavirus for persons eligible for treatment pursuant to section 322 of the Public Health Service Act (persons detained in accordance with quarantine laws, or, at the request of the Immigration and Naturalization Service).

– This funding may be used for grants for the construction, alteration, or renovation of non-federally owned facilities to improve preparedness and response capability at the state and local level and for the production of vaccines, therapeutics, and diagnostics where the HHS Secretary determines that such a contract is necessary to secure sufficient amounts of such supplies.

Public Health and Social Services Emergency Fund (with transfer authority to Covered Countermeasure Process Fund) $27,014,500,000 To remain available until Sept. 30, 2024

For an additional amount for the “Public Health and Social Services Emergency Fund” to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Of the funds provided:

– $90,000,000 to be transferred to the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program.
-Funding to be provided through modifications or supplements to existing contracts, grants, and cooperative agreements under Program parts A, B, C, and D, and to AIDS Education and Training Centers by a methodology determined by the Secretary. Traditional requirements related to spending share dedicated to core medical services in Parts A, B, and C do not apply.

– $5,000,000 to be transferred to HRSA/Health Care Systems to improve the capacity of poison control centers to respond to increased calls.

– $180,000,000 to be transferred to HRSA/Rural Health to carry out telehealth and rural health activities, of which no less than $15,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.

Public Health and Social Services Emergency Fund (with transfer authority to HRSA/Ryan White HIV/AIDS Program, Health Care Systems, and Rural Health) $275,000,000 To remain available until Sept. 30, 2022

For an additional amount for “Public Health and Social Services Emergency Fund” to prevent, prepare for, and respond to coronavirus, domestically or internationally, for necessary expenses to reimburse hospitals and other eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus. Conditions on this funding include:

– These funds may not be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.

-Recipients of payments shall submit reports and maintain documentation as the Secretary of Health and Human Services determines are needed to ensure compliance with conditions imposed for such payments.

– “Eligible health care providers’’ here means public entities, Medicare or Medicaid enrolled suppliers and providers, and such for-profit entities and not-for-profit entities not otherwise described in this proviso as the Secretary may specify, within the United States (including territories), that provide diagnoses, testing, or care for individuals with possible or actual cases of COVID–19.

– The Secretary of Health and Human Services shall, on a rolling basis, review applications and make payments for this portion of the Act.

– This funding shall be available for building or construction of temporary structures, leasing of properties, medical supplies and equipment including personal protective equipment and testing supplies, increased workforce and trainings, emergency operation centers, retrofitting facilities, and surge capacity.

– “Payment” here means a pre-payment, prospective payment, or retrospective payment, as determined appropriate by the Secretary of Health and Human Services.

– Payments shall be made in consideration of the most efficient payment systems practicable to provide emergency payment.

– To be eligible for a payment under this funding, an eligible health care provider shall submit to the Secretary of Health and Human Services an application that includes a statement justifying the need of the provider for the payment and the eligible health care provider shall have a valid tax identification number.

– Not later than 3 years after final payments are made from this funding, the Office of the HHS Inspector General shall transmit a final report on audit findings with respect to this program to the House and Senate Committees on Appropriation; nothing in this section limits the authority of the Inspector General or the Comptroller General to conduct audits of interim payments at an earlier date.

– Not later than 60 days after the date of enactment of this Act, the Secretary of Health and Human Services shall provide a report to the House and Senate Committees on Appropriations on obligation of funds, including obligations to such eligible health care providers summarized by state of the payment receipt; such reports shall be updated and submitted every 60 days until funds are expended.

– Section 18113. Up to $4,000,000 to be transferred to, and merged with, funds made available under the heading “Office of the Secretary, Office of the Inspector General” for oversight of activities supported with funds appropriated to the HHS Department to prevent, prepare for, and respond to coronavirus, domestically or internationally.

Public Health and Social Services Emergency Fund $100,000,000,000 To remain available until expended
General Provisions Section 18108. Allows the HHS Secretary to appoint candidates needed for positions to perform critical work relating to coronavirus.
Section 18109. Allows funds under this title to be used to enter into contracts with individuals for the provision of personal services to prevent, prepare for, and respond to coronavirus, within the United States and abroad; such individuals may not be deemed U.S. employees.
Section 18111. Funds provided under this title to the heading “Department of Health and Human Services” may be transferred to, and merged with, other appropriation accounts under the headings “Centers for Disease Control and Prevention,” “Public Health and Social Services Emergency Fund,” “Administration for Children and Families,” “Administration for Community Living,” and “National Institutes of Health” to prevent, prepare for, and respond to coronavirus following consultation with the Office of Management and Budget (providing congressional notification 10 days in advance of any such transfer).
Section 18112. Not later than 30 days after the date of enactment of this Act, the HHS Secretary is required to provide a detailed spend plan to the House and Senate Appropriations Committees of the anticipated uses of funds made available to the HHS Department in this Act, and such plans shall be updated and submitted to such Committees every 60 days until Sept. 30, 2024.
Section 18115. Every laboratory that performs or analyzes a test that is intended to detect SARS-CoV-2 or to diagnose a possible case of COVID-19 is required to report the results from each such test to the HHS Secretary in such form and manner, and at such timing and frequency, as the Secretary may prescribe until the end of the Secretary’s public health emergency declaration with respect to COVID-19 or any extension of such declaration. Repeals Section 1702 of Division A of the Families First Coronavirus Response Act, which requires that “states and local governments receiving funds or assistance pursuant to this division shall ensure the respective State Emergency Operations Center receives regular and real-time reporting on aggregated data on testing and results from State and local public health departments, as determined by the Director of the Centers for Disease Control and Prevention, and that such data is transmitted to the Centers for Disease Control and Prevention.”
   TITLE IX
House of Representatives/
Senate
Office of the Attending Physician For an additional amount for ‘‘Office of the Attending Physician’’ to prevent, prepare for, and respond to coronavirus, domestically or internationally. Office of the Attending Physician $400,000 To remain available until expended
Government Accountability Office (GAO)   Part of an additional amount for ‘‘Salaries and Expenses’’ to prevent, prepare for, and respond to coronavirus, domestically or internationally, for audits and investigations. Salaries and Expenses $19,400,000 To remain available until expended
Oversight and Audit Authority Section 19010. The Comptroller General shall conduct monitoring and oversight of the exercise of authorities, or the receipt, disbursement, and use of funds made available, under this Act or any other Act to prepare for, respond to, and recover from the Coronavirus 2019 pandemic and the effect of the pandemic on the health, economy, and public and private institutions of the United States, including public health and homeland security efforts by the federal government and the use of selected funds under this or any other Act related to the Coronavirus 2019 pandemic and a comprehensive audit and review of charges made to federal contracts pursuant to authorities provided in the Coronavirus Aid, Relief, and Economic Security Act. Describes frequency of briefings and reports to be provided as well as access to information.
   TITLE X
Department of Veterans Affairs Veterans Health Administration For an additional amount for “Medical Services” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including related impacts on health care delivery, and for support to veterans who are homeless or at risk of becoming homeless. Medical Services $14,432,000,000 To remain available until Sept. 30, 2021
For an additional amount for “Medical Community Care” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including related impacts on health care delivery. Medical Community Care $2,100,000,000 To remain available until Sept. 30, 2021
For an additional amount for “Medical Support and Compliance” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including related impacts on health care delivery. Medical Support and Compliance $100,000,000 To remain available until Sept. 30, 2021
For an additional amount for “Medical Facilities” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including related impacts on health care delivery. Medical Facilities $606,000,000 To remain available until Sept. 30, 2021
Departmental Administration For an additional amount for “Information Technology Systems” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including related impacts on health care delivery. Information Technology Systems $2,150,000,000 To remain available until Sept. 30, 2021
For an additional amount for “Grants for Construction of State Extended Care Facilities” to prevent, prepare for, and respond to coronavirus, domestically or internationally, including to modify or alter existing hospital, nursing home, and domiciliary facilities in state homes. Grants for Construction of State Extended Care Facilities $150,000,000 To remain available until Sept. 30, 2021
Armed Forces Retirement Home For an additional amount for the “Armed Forces Retirement Home Trust Fund” to prevent, prepare for, and respond to coronavirus by supporting increased healthcare, security, and food services personnel expenses, including the personal protective equipment they need, as well as necessary supplies and equipment at the Armed Forces Retirement Homes in Washington, D.C. and Gulfport, Mississippi, which will help minimize the spread of coronavirus among residents. Armed Forces Retirement Home Trust Fund $2,800,000 To remain available until Sept. 30, 2021
General Provisions Section 20004. Short-Term Agreements or Contracts with Telecommunications Providers to Expand Telemental Health Services for Isolated Veterans During a Public Health Emergency: Allows the Secretary of Veterans Affairs to enter into short-term agreements or contracts with telecommunications companies to provide temporary, complimentary or subsidized, fixed and mobile broadband services for the purposes of providing expanded mental health services to isolated veterans through telehealth or VA Video Connect during a public health emergency. Prioritizes veterans who are in unserved and underserved areas, veterans that reside in rural and highly rural areas, low-income veterans, and any other veterans that the Secretary considers to be at a higher risk for suicide and mental health concerns during isolation periods due to a public health emergency.
Section 20005. Treatment of State Homes During Public Health Emergency: Among other things, allows the Secretary of Veteran Affairs to provide medicines, personal protective equipment, medical supplies, and any other equipment, supplies, and assistance available to the Department of Veterans Affairs to state homes. Personal protective equipment may be provided through the All Hazards Emergency Cache of the Department of Veterans Affairs or any other source available to the department.
Section 20006. Modifications to Veteran Direct Care Program of Department of Veterans Affairs: Allows new and six-month renewals for the program to be conducted via telephone or telehealth modality; suspends the dis-enrollment of suspension of veterans or veteran caregiver, waives paperwork requirement to confirm enrollment or renewal.
Section 20007. Provision of Prosthetic Appliances Through Non-Department Providers During Public Health Emergency: Ensures that veterans receiving or eligible to receive a prosthetic appliance are able to do so through a non-Department of Veterans Affairs provider.
Section 20009. Provision of Personal Protective Equipment for Home Health Workers: The Secretary of Veterans Affairs shall provide employees and contractors with personal protective equipment necessary to provide home care to veterans.
Section 20011. Availability of Telehealth For Case Managers and Homeless Veterans: The Secretary of Veterans Affairs shall ensure telehealth capabilities are available for case managers of, and homeless veterans participating in, the Department of House and Urban Development-Department of Veterans Affairs Supportive Housing program.
   TITLE XI
Department of State Administration of Foreign Affairs For an additional amount for “Diplomatic Programs” to prevent, prepare for, and respond to coronavirus, including for necessary expenses to maintain consular operations and to provide for evacuation expenses and emergency preparedness. Diplomatic Programs $324,000,000 To remain available until Sept. 30, 2022
Bilateral Economic Assistance/Department of State For an additional amount for “Migration and Refugee Assistance” to prevent, prepare for, and respond to coronavirus  for the Department of State to contribute to pending appeals from the UN High Commissioner for Refugees, International Committee of the Red Cross, and other partners to prepare for, and respond to, coronavirus among vulnerable refugee populations abroad. Migration and Refugee Assistance $350,000,000 To remain available until expended
General Provisions Section 21005. For an additional amount for the FY 2020 appropriations amount for “Emergencies in the Diplomatic and Consular Services from $1,000,000 to $5,000,000 under the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2020. Emergencies in the Diplomatic and Consular Services $4,000,000 To remain available until expended
Section 21008. States the Secretary of State may exercise certain authorities to provide medical services or related support for private U.S. citizens, nationals, and permanent resident aliens abroad, or third country nationals connected to such persons or to the diplomatic or development missions of the U.S. abroad, who are unable to obtain such services or support otherwise; such assistance shall be provided on a reimbursable basis to the extent feasible. Prioritizes providing such services to individuals eligible for the health program of the Foreign Service Act of 1980. Authority expires on Sept. 30, 2022.
U.S. Agency for International Development (USAID) Funds Appropriated to the President For an additional amount for “Operating Expenses” to prevent, prepare for, and respond to coronavirus for operational needs of USAID, including support for evacuations and ordered departures of overseas staff, surge support, increased technical support for remote functions, and other needs. Operating Expenses $95,000,000 To remain available until Sept. 30, 2022
Bilateral Economic Assistance/Funds Appropriated to the President For an additional amount for “International Disaster Assistance” to prevent, prepare for, and respond to coronavirus for USAID to respond to the extraordinary needs in other countries that are underequipped to respond to the pandemic. The funding will prioritize populations affected by ongoing humanitarian crises, particularly displaced people, because of their heightened vulnerability, the elevated risk of severe outbreaks in camps and informal settlements, and anticipated disproportionate mortality in these populations. International Disaster Assistance $258,000,000 To remain available until expended
General Provisions Section 21004. For an additional amount for the FY 2020 appropriations amount to hire and employ individuals in the United States and overseas on a limited appointment basis from $100,000,000 to $110,000,000 under the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2020. Assistance for Europe, Eurasia and Central Asia $10,000,000 FY 2020-FY 2021
General Provisions Department of State and USAID Section 21003. Requires the Secretary of State and the USAID Administrator to jointly submit a report on the proposed uses of funds appropriated by this title on a country and project bases to the House and Senate Committees on Appropriations and that such report be updated and submitted to these Committees periodically until all funds have been expended; the report shall include information detailing how estimates and assumptions contained in previous reports have changed, including obligations and expenditures on a country and project basis.
Section 21007. Gives the Secretary of State and the USAID Administrator authority to provide additional paid leave to address employee hardships resulting from coronavirus (applies to leave taken since Jan. 29, 2020). Authority expires on Sept. 30, 2022.
Section 21010. Authorizes the Department of State and USAID to enter into contracts with individuals for the provision of personal services to prevent, prepare for, and respond to coronavirus, within the United States and abroad; such individuals may not be deemed U.S. employees. Requires the Secretary of State provide a report to certain committees on the overall staffing needs for the Office of Medical Services not later than 15 days after utilizing this authority. Authority expires on Sept. 30, 2022.
Peace Corps For an additional amount for “Peace Corps” to prevent, prepare for, and respond to coronavirus to support evacuations of all overseas volunteers, relocation of U.S. direct hires on authorized or ordered departure, and certain benefits for returned volunteers, including health care. Peace Corps $88,000,000 To remain available until Sept. 30, 2022
Millennium Challenge Corporation General Provisions Section 21006. For an additional amount for “Millennium Challenge Corporation: increasing from $105,000,000 to $107,000,000 under the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2020, to increase the amount it can spend to cover additional costs due to staff evacuations. Millennium Challenge Corporation $2,000,000 To remain available until expended
World Bank Group International Development Association (IDA) Section 21012. For the purposes of strengthening the ability of foreign countries to prevent, prepare for, and respond to coronavirus and to the adverse economic impacts of coronavirus, in a manner that would protect the United States from the spread of coronavirus and mitigate an international economic crisis resulting from coronavirus that may pose a significant risk to the economy of the United States, authorizes $3,004,200,000 to be appropriated for a U.S. contribution to the 19th replenishment of resources for IDA, without fiscal year limitation.
International Finance Corporation (IFC) Section 21012. For the purposes of strengthening the ability of foreign countries to prevent, prepare for, and respond to coronavirus and to the adverse economic impacts of coronavirus, in a manner that would protect the United States from the spread of coronavirus and mitigate an international economic crisis resulting from coronavirus that may pose a significant risk to the economy of the United States, authorizes the U.S. Governor of the Corporation to vote to approve the capital increase and amendment to the Articles of Agreement of the IFC.
African Development Group African Development Bank Section 21012. For the purposes of strengthening the ability of foreign countries to prevent, prepare for, and respond to coronavirus and to the adverse economic impacts of coronavirus, in a manner that would protect the United States from the spread of coronavirus and mitigate an international economic crisis resulting from coronavirus that may pose a significant risk to the economy of the United States, authorizes the U.S. Governor of the Bank to vote to approve the 7th capital increase of the African Development Bank.
African Development Fund Section 21012. For the purposes of strengthening the ability of foreign countries to prevent, prepare for, and respond to coronavirus and to the adverse economic impacts of coronavirus, in a manner that would protect the United States from the spread of coronavirus and mitigate an international economic crisis resulting from coronavirus that may pose a significant risk to the economy of the United States, authorizes $513,900,000 to be appropriated for the U.S. contribution to the 15th replenishment of the African Development Fund, without fiscal year limitation.
International Monetary Fund (IMF) Section 21012. For the purposes of strengthening the ability of foreign countries to prevent, prepare for, and respond to coronavirus and to the adverse economic impacts of coronavirus, in a manner that would protect the United States from the spread of coronavirus and mitigate an international economic crisis resulting from coronavirus that may pose a significant risk to the economy of the United States, authorizes the vote to expand the New Arrangements to Borrow (NAB) commitment and extend the NAB until the expiration date of Dec. 31, 2025.
   TITLE XII
Department of Housing and Urban Development (HUD) Office of Native American Programs Part of an additional amount for “Native American Programs” for grants to Indian tribes under the Indian Community Development Block Grant program to prevent, prepare for, and respond to coronavirus, for emergencies that constitute imminent threats to health and safety. Indian Community Development Block Grant Program Up to $100,000,000 To remain available until Sept. 30, 2024
Office of Community Planning & Development For an additional amount for carrying out the ‘‘Housing Opportunities for Persons with AIDS’’ (HOPWA) program to provide additional funds to maintain operations and for rental assistance, supportive services, and other necessary actions, in order to prevent, prepare for, and respond to coronavirus.

Of the funds provided:

– Not less than $50,000,000 to be allocated pursuant to the formula in statute, using data from FY 2020.

– Up to $10,000,000 to provide an additional, one-time award to current formula funded grantees administering contracts for permanent supportive housing.

– Awards shall be made proportionally to their existing grants, do not have to be spent on permanent supportive housing, and can assist with housing payment assistance for rent, mortgage, or utilities payments, which may be provided for a period of up to 24 months.

– To protect persons with HIV/AIDS, funding may be used to self-isolate, quarantine, or to provide other coronavirus infection control services for household members not living with HIV/AIDS.

– May be used to provide relocation services, including to provide lodging at hotels, motels, or other locations, for persons living with HIV/AIDS and household members not living with HIV/AIDS.

– Grantees with such funding provided outside of formula may use up to 6% of award for administrative purposes (vs. 3% typically allowed), and a project sponsor 10% percent of its sub award under this Act for administrative purposes.

– Funding may be used on costs consistent with these purposes incurred by a grantee or project sponsor regardless of the date on which such costs were incurred.

– HUD Secretary issued regulatory waivers may be deemed to be effective as of the date a grantee began preparing for coronavirus.

– At the discretion of the HUD Secretary, these activities and authorities may also apply to funding provided under FY 2020 appropriations.

– Up to 2% of funding may be used, without competition, to increase prior awards made to existing technical assistance providers.

HOPWA $65,000,000 Formula-driven allocations are to remain available until Sept. 30, 2021, while non-formula allocations to remain available until Sept. 30, 2022
For an additional amount for “Community Development Fund” to prevent, prepare for, and respond to coronavirus to enable nearly sates, counties, and cities to rapidly respond to COVID-19 and the economic and housing impacts caused by it, including the expansion of community health facilities, child care centers, food banks, and senior services. Community Development Block Grant Program $5,000,000,000 To remain available until Sept. 30, 2022
Office of Special Needs Assistance Programs

For an additional amount for ‘‘Homeless Assistance Grants’’ to prevent, prepare for, and respond to coronavirus, among individuals and families who are homeless or receiving homeless assistance and to support additional homeless assistance and homelessness prevention activities to mitigate the impacts created by coronavirus under the Emergency Solutions Grants program.

Of the funds provided:

– Funding may be used for training on infectious disease prevention and mitigation and to provide hazard pay, including for time worked prior to the date of enactment of this Act, for staff working directly to prevent, prepare for, and respond to coronavirus among persons who are homeless or at risk of homelessness.

-That up to 1 percent of this funding may be used to make new awards or increase prior awards made to existing technical assistance providers with experience in providing health care services to homeless populations, without competition, to provide an immediate increase in capacity building and technical assistance available to recipients of amounts for the Emergency Solutions Grants program.

– None of these funds may be used to require people experiencing homelessness to receive treatment or perform any other prerequisite activities as a condition for receiving shelter, housing, or other services.

Homeless Assistance Grants $4,000,000,000 To remain available until Sept. 30, 2022
NOTES: DoD and others may receive additional funding within this Act for health response purposes that are not specifically identifiable at this point. Funding for personal protective equipment and sanitizing materials is not included unless otherwise noted for other health purposes. In addition to health-specific amounts/provisions, funding for food assistance and housing related to certain populations particularly vulnerable to severe disease due to COVID-19 or housing conditions linked to spread of COVID-19 are included.
SOURCES: KFF analysis of CARES Act (P.L. 116-136) and Senate Appropriations Committee summary materials.
Endnotes
  1. NIH, “About the NIH Common Fund,” webpage, https://commonfund.nih.gov/about, accessed March 27, 2020.

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