Trump Declares COVID-19 Emergency, Asks Hospitals to Activate Emergency Plans

On March 16, 2020, President Donald Trump asked hospitals to activate their emergency preparedness plans and declared the COVID-19 outbreak a national emergency, which will allow HHS to give providers more flexibility.  “I’m also asking every hospital in this country to activate its emergency preparedness plan so that they can meet the needs of Americans everywhere,” Trump said.

Ambassador Debbie Birx, the Trump administration’s coronavirus response coordinator, said that hospital emergency preparedness plans could include delaying elective procedures to ensure availability of hospital beds.

The emergency declaration, in conjunction with the administration’s prior designation of COVID-19 as a public health emergency on January 31, frees up to $50 billion in federal disaster relief funding, Trump said, and provides the HHS secretary with more authority to waive some Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements.

Trump highlighted that the HHS secretary will have authority to waive several requirements hospitals had voiced concerns about, including the 3-day hospital stay requirement for skilled nursing facility coverage; limits on numbers of beds and length of stay in Critical Access Hospitals; requirements that providers have a license in the state in which they are providing services if they have an equivalent license in another state; HIPAA requirements that could be an obstacle to telemedicine accessibility; and easing restrictions on where certain patients can be treated within a hospital.

“We’ll remove or eliminate every obstacle necessary to deliver our people the care that they need, and that they’re entitled to. No resource will be spared, none whatsoever,” Trump said.

It is unclear precisely how much money would be available for which purposes, but the government has wide discretion in how federal emergency funds are spent, said Georgetown University adjunct law professor and Avalere consultant Nick Diamond.

“The law affords a lot of flexibility for funds to be used in concert with some of the waivers, so there is a possibility for reimbursement for services provided by providers in some of their response efforts,” Diamond said.

The American Hospital Association, American Medical Association and American Nurses Association on Thursday wrote a letter to Vice President Mike Pence, who heads the White House coronavirus response effort, asking for an emergency declaration.

“Physicians, nurses, first responders, and other healthcare professionals across the country are on the front lines in this effort, and streamlining critical processes is vitally important to prevent the further spread of COVID-19,” AMA President Dr. Patrice Harris said in a statement.

Trump also said the administration is in discussions with pharmacies and retailers to set up drive-through testing sites in locations determined by public health officials.

Sen. Rick Scott (R-Fla.), a former Florida governor and health system executive, said he told President Donald Trump on a phone call Thursday that Scott wanted an emergency declaration to provide funding for mobile COVID-19 testing sites to minimize exposure for healthcare workers in primary care and hospital settings who may not have sufficient personal protective equipment.

“I have talked to a lot of hospitals inside and outside the state, and their main concern is how do we make sure they don’t lose their workers?” Scott said.CMS Administrator Seema Verma said Friday that the agency will issue guidance instructing nursing homes to restrict all visitors and non-essential personnel, with exceptions including end-of-life situations.

Senate Democrats had also called upon the administration to declare a national emergency under the Stafford Act.

“Calling for a national emergency under the Stafford Act would free up lots of FEMA’s resources to help states and localities. Why he hasn’t done it is a mystery. We need him to do it, and do it now,” Senate Minority Leader Chuck Schumer (D-N.Y.) said on the Senate floor on Thursday.

Additional guidance on what types of waivers the Trump administration will allow is expected soon. Similar authorities to those outlined by Trump were invoked in the 2009 H1N1 pandemic.