The Paycheck Protection Program and Health Care Enhancement Act: Summary of Key Health Provisions

On April 24, 2020, the Paycheck Protection Program and Health Care Enhancement Act was signed into law, marking the fourth major legislative initiative to address COVID-19. The three earlier initiatives include:

• the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, which was signed on March 6 and provided emergency funding relief for domestic and global efforts;
• the Families First Coronavirus Response Act, which was signed on March 18 and provided emergency funding relief for domestic efforts; and
• the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which was signed into law on March 27 and provided emergency funding relief for domestic and global efforts.

The Paycheck Protection Program and Health Care Enhancement Act includes a number of health provisions to address the domestic outbreak, which are summarized in the table below. This summary does not include other aspects of the domestic response addressed by the Act, such as additional funding provided for the paycheck protection program under the Small Business Administration.

Among the areas addressed is $100 billion for the Public Health and Social Services Emergency Fund at the Department of Health and Human Services (HHS), including $75 billion for additional funding to reimburse hospitals and other health care entities for health care related-expenses or lost revenues attributable to coronavirus (referred to as the CARES Act Provider Relief Fund, which now totals $175 billion overall) and $25 billion for necessary expenses related to COVID-19 testing. The testing funding includes:

• Not less than $11 billion for states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes, of which:
  • Not less than $750 million shall be allocated to tribes and tribal organizations, and
  • Not less than $4.25 billion shall be allocated to States, localities, and territories according to a formula based on the relative number of COVID-19 cases;

  Table 1: Division B of the Paycheck Protection Program and Health Care Enhancement Act – Summary of Key Health and Related Provisions
  Department	Operating Division/ Office	Key Provisions	Fund/ Account	Funding Available	Period
  DIVISION B–ADDITIONAL EMERGENCY APPROPRIATIONS FOR CORONAVIRUS RESPONSE
  Title I
  DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)

  Office of the Secretary

  Reimbursement for Hospitals and Other Eligible Health Care Providers for Coronavirus-Related Expenses or Lost Revenues: 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, through grants or other mechanisms, hospitals and other eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus (this pool of funding is known now as the “CARES Act Provider Relief Fund”).

  Of the funds provided:

  • 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 HHS Secretary determines are needed to ensure compliance with conditions that are imposed for such payments.
  • Here “eligible health care providers” means public entities, Medicare or Medicaid enrolled suppliers and providers, and such for-profit entities and not-for-profit entities as the HHS 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 HHS Secretary shall, on a rolling basis, review applications and make payments.
  • That funds 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.
  • Here the term “payment” means a pre-payment, prospective payment, or retrospective payment, as determined appropriate by the HHS Secretary.
  • Payments shall be made in consideration of the most efficient payment systems practicable to provide emergency payment.
  • To be eligible for a payment, an eligible health care provider shall submit to the HHS Secretary 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, the Office of HHS Inspector General shall transmit a final report on audit findings with respect to this program to the Committees on Appropriations of the House of Representatives and the Senate.
  • Not later than 60 days after the date of enactment of this Act, the HHS Secretary shall provide a report to the Committees on Appropriations of the House of Representatives and the Senate 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 to such Committees every 60 days until funds are expended.

  (including transfer of funds)

  Of the funds provided:

  • States, Localities, Territories, and Certain Others:Not less than $11,000,000,000 shall be for States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes for necessary expenses to develop, purchase, administer, process, and analyze COVID-19 tests, including support for workforce, epidemiology, use by employers or in other settings, scale up of testing by public health, academic, commercial, and hospital laboratories, and community-based testing sites, health care facilities, and other entities engaged in COVID-19 testing, conduct surveillance, trace contacts, and other related activities related to COVID-19 testing.
    • Of this:
      • not less than $2,000,000,000 shall be allocated to States, localities, and territories according to the formula that applied to the Public Health Emergency Preparedness cooperative agreement in fiscal year 2019,
      • not less than $4,250,000,000 shall be allocated to States, localities, and territories according to a formula methodology that is based on relative number of cases of COVID-19, and
      • not less than $750,000,000 shall be allocated in coordination with the Director of the Indian Health Service, to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.
      • (1) the number of tests needed, month-by-month, to include diagnostic, serological, and other tests, as appropriate;
      • (2) month-by-month estimates of laboratory and testing capacity, including related to workforce, equipment and supplies, and available tests; and
      • (3) a description of how the State, locality, territory, tribe, or tribal organization will use its resources for testing, including as it relates to easing any COVID-19 community mitigation policies.
      • grants for the rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve preparedness and response capability at the State and local level for diagnostic, serologic, or other COVID-19 tests, or related supplies.
      • construction, alteration, renovation, or equipping of non-federally owned facilities for the production of diagnostic, serologic, or other COVID-19 tests, or related supplies, where the HHS Secretary determines that such a contract is necessary to secure, or for the production of, sufficient amounts of such tests or related supplies.
      • purchase of medical supplies and equipment, including personal protective equipment and testing supplies to be used for administering tests, increased workforce and trainings, emergency operation centers, and surge capacity for diagnostic, serologic, or other COVID-19 tests, or related supplies.
      • Certain requirements regarding consideration of applications providing care to those medically underserved in rural vs. urban areas and distribution of grants under the Public Health Service Act shall not apply to these funds.
      • Such funds shall be distributed using the procedures developed for the CARES Act Provider Relief Fund; may be distributed using contracts or agreements established for such program; and shall be subject to the process requirements applicable to such program.
      • The HHS Secretary may specify a minimum amount for each eligible entity accepting such assistance.
      • include data on demographic characteristics, including, in a de-identified and disaggregated manner, race, ethnicity, age, sex, geographic region and other relevant factors of individuals tested for or diagnosed with COVID-19, to the extent such information is available.
      • include information on the number and rates of cases, hospitalizations, and deaths as a result of COVID-19.
      • be submitted to the Committees on Appropriations of the House and Senate, and the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate, and updated and resubmitted to such Committees, as necessary, every 30 days until the end of the COVID-19 public health emergency first declared by the HHS Secretary on January 31, 2020.
      • assist States, localities, territories, tribes, tribal organizations, and urban Indian health organizations, in understanding COVID-19 testing for both active infection and prior exposure, including hospital-based testing, high-complexity laboratory testing, point-of-care testing, mobile-testing units, testing for employers and other settings, and other tests as necessary.
      • include estimates of testing production that account for new and emerging technologies, as well as guidelines for testing.
      • address how the HHS Secretary will increase domestic testing capacity, including testing supplies; and address disparities in all communities.
      • outline Federal resources that are available to support the testing plans of each State, locality, territory, tribe, tribal organization, and urban Indian health organization.
      • be updated every 90 days until funds are expended.

      (including transfer of funds)