Senate Republicans on Monday proposed $25 billion in new grant funds for healthcare providers, a liability shield for healthcare facilities and workers, and relaxed terms for Medicare loans in their opening bid in the latest round of COVID-19 relief negotiations.
The Senate GOP's Health, Economic Assistance, Liability Protection and Schools (HEALS) Act is a partisan bill, and Republicans now have just days to negotiate with Democrats before more generous federal unemployment benefits expire Friday. House Speaker Nancy Pelosi (D-Calif.) said Sunday that she wants to reach a larger deal instead of adopting a piecemeal approach, as House Democrats passed their own $3 trillion proposal in May.
Lawmakers have currently appropriated $175 billion to the Provider Relief Fund, and HHS has yet to send out roughly $53 billion of that total, according to the most recent data available. Senate Republicans proposed a $25 billion refill, and Democrats had proposed $100 billion for the Provider Relief Fund with more strings attached.
Senate Appropriations health subcommittee chair Roy Blunt (R-Mo.) said GOP senators had a "vigorous discussion" with the Trump administration to ensure existing Provider Relief Fund grants are distributed, and proposed reevaluating after all money has been sent out.
Healthcare provider groups lobbied for strong federal liability protections, and the bill proposed by Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. John Cornyn (R-Texas) delivers on their demands. The medical liability shield would last at least nearly five years, and protects healthcare facilities, including hospitals and nursing homes, and workers from lawsuits except in cases of gross negligence or intentional misconduct. The heightened standard would apply to care provided for COVID-19 patients, or any medical care directly affected by the coronavirus. The bill also allows stronger state laws to stay in place.
Senate Minority Whip Dick Durbin (D-Ill.) said last week that there's no proof that healthcare providers will face the wave of litigation that McConnell has warned of.
"There is no tsunami, there is no flood," Durbin said.
Another big hospital request was loosening loan terms for Medicare accelerated and advance payments, which was included in the HEALS Act. Hospitals and other providers would have to begin to repay loans on January 1, 2021, and hospitals would have a six-month extension to repay the loans in full. However, the eventual interest rate on the loans was unchanged in the Senate GOP proposal.
The Senate's tweaks to the accelerated and advance payment program are less generous than those proposed in the House, but are still less stringent than the terms providers currently face. Acute-care and critical-access hospitals received more than 80% of the $100 billion in Medicare loans CMS sent to providers to help with their cash flow.
The new GOP bill also extends telehealth flexibilities through the end of 2021 or the end of the COVID-19 public health emergency, whichever is longer. Medicare payment expansions for Rural Health Clinics and Federally Qualified Health Centers would also be extended for five years beyond the end of the public health emergency. Employers got a win on telehealth, as the bill would allow them to offer telehealth as an excepted benefit to employees that are part-time or don't qualify for employer coverage.
"We ensure that Medicare telehealth options don't expire before Congress can determine what should be made permanent," Senate Finance Chair Chuck Grassley (R-Iowa) said Monday.
The HEALS Act includes $16 billion to support state COVID-19 testing and contact tracing efforts, including in nursing homes. Senate GOP lawmakers also proposed earmarking $26 billion for vaccine development and distribution, freezing Medicare Part B premiums and deductibles at 2020 levels, and setting aside $7.6 to support community health centers.
Businesses with fewer than 300 employees would also be able to apply for a second round of forgivable Paycheck Protection Program loans if they can prove a 50% reduction in gross receipts compared with last year under Senate Republicans' new plan.
The new Senate bill spurns healthcare industry priorities that Democrats pushed, including subsidies to help people who lose their jobs keep their employer healthcare plans, funding to help state and local governments and increased federal Medicaid matching funds.