HRSA’s Bureau of Primary Health Care (BPHC) and Office of Federal Assistance Management (OFAM) will host a question and answer session for the recipients of Look-Alikes: Expanding Capacity for Coronavirus Testing (LAL ECT) funding. This session is an opportunity for LALs to receive clarification on key fiscal and grants management requirements and hear strategies to ensure compliance and properly manage the LAL ECT award. Join the webcast the day of the session; Wednesday, Aug. 12 from 2:00-3:00 pm. Call-in: 888-972-9343; Passcode: 2324051. If you have questions to submit ahead of time, send them to OFAMFTA@hrsa.gov. You are also encouraged to watch the BPHC/OFAM Fiscal and Grants Management Orientation webinar held last month.

On July 20, 2020, the U.S. Department of Labor (DOL) issued guidance on return-to-work issues under the Families First Coronavirus Response Act (FFCRA). Enacted on March 18, 2020, the FFCRA provides emergency paid sick leave, fully paid for by the federal government by way of refundable tax credits and paid family leave under the Family and Medical Leave Act (FMLA) for certain qualifying employees affected by the COVID-19 pandemic. The following three areas were updated in this recently issued additional guidance:

• Paid Leave Clarifications: DOL clarifies that the period an employee was furloughed cannot count against their FFCRA or FMLA leave entitlement.
• Return-to-Work Positions: Provides direction to employers who have staff returning to work after caring for a family member exposed to COVID-19.
• No Retaliation: Makes it clear that employers may not discriminate against an employee for the use of FFCRA or influence any employment decisions based on the possible future use of FFCRA leave when returning staff to the workplace.

The DOL previously issued guidance in late June which clarified worker’s rights to FFCRA leave for school, camp or other child care closures affecting them during the summer months. The FFCRA’s leave provisions are currently scheduled to expire on Dec. 31, 2020.

Health Insurance Marketplace enrollment has increased due to millions losing employer sponsored coverage and employment across the nation. This enrollment spike nationwide may draw other insurers to state-based exchanges, reducing the per-person costs for insurers with the addition of healthy people looking for coverage. An increase in Medicaid rolls nationwide is partially due to states pausing eligibility redeterminations during the public health crisis as required under the Families First Coronavirus Response Act. To date, Medicaid enrollment has increased 1.3 percent in Pennsylvania.

On August 3, President Trump signed an Executive Order on Improving Rural Health and Telehealth Access, aiming to expand rural health access and many of the telehealth policies put into place during the COVID-19 pandemic. It is important to be aware, however, that Congressional action is needed to extend telehealth services for FQHCs beyond the public health emergency declaration, a fact emphasized in the annual Medicare Physician Fee Schedule proposed rule issued shortly after the executive order. There are a number of efforts in Congress to address the need for an extension of Medicare telehealth services for FQHCs; an overview of NACHC supported bills can be found here. The proposed rule does include a provision to add Principal Care Management services for FQHCs and RHCs and to rebase the Medicare FQHC market basket.

Hospitals must start paying back the millions in federal loans that were provided at the beginning of the pandemic, but experts are worried that these payments, which will be docked from regular Medicare payments until they are completely paid off, will cause rural hospitals to struggle. Chip Kahn, President of the American Federation of Hospitals, expressed concerns that hospitals are in the middle of these COVID-19 surges and that being forced to repay these loans is “going to kill them.” NRHA is advocating for MAAP loan relief for rural hospitals in the upcoming COVID-19 relief package. However, thus far, Republicans and Democrats have failed to agree on what to include and how much to spend on the relief package.

Missouri Congressman Jason Smith introduced the Saving Rural Hospitals from Closure Act. The bill would require HHS to forgive all Medicare Advance and Accelerated Payments (MAAP) for rural hospitals that are experiencing severe financial hardship. Additionally, it would extend the timeline for rural hospitals’ repayment or lower the interest rate of their payments. The legislation stipulates that HHS must make a decision within 30 days of receiving a request from a struggling hospital. In the months since April, Congressman Smith has implored both the White House and Congressional leaders to explore cost saving opportunities to rural hospitals.