NPAIHB COVID-19 Legislative & Policy Update
Tuesday, March 24, 2020
NPAIHB has developed this COVID-19 legislative and policy update to keep you apprised of national and state actions in response to the novel coronavirus 2019. These updates will be posted to the NPAIHB COVID-19 website located here:  

In response to the 2019 novel coronavirus (COVID-19), Congress passed two supplemental funding packages H.R. 6074 and H.R. 6201, both are detailed below. A third supplemental funding package is anticipated to be passed this week. It is considered an economic stimulus package and includes increases to several federal agencies related to COVID-19, including the Indian Health Service. There may also be other beneficial health provisions for the Indian health system, including an extension of the Special Diabetes Program for Indians which expires on May 22, 2020. More detail will be provided as we learn more about what is in the final package. 
HHS announces upcoming action to provide funding to tribes for COVID-19 response
Published 3/20/20
Announces $80 million in funding provided by the Centers for Disease Control and Prevention (CDC) to tribes, tribal organizations, and urban Indian organizations for resources in response to the COVID-19. CDC funding includes supplemental funding to an existing CDC Cooperative Agreement for resources to the nine regionally designated tribal organizations; funding to the National Indian Health Board for communication activities; funding to the National Council of Urban Indian Health to make sub-awards to 41 urban Indian health centers; and issuance of a new non-competitive grant Notice of Funding Opportunity to reachch all Title I and Title V tribes. Additional funding for COVID-19 testing will be made available through the Families First Coronavirus Response Act.

Families First Coronavirus Response Act (H.R. 6201) (2nd supplemental funding package)
Signed by President 3/18/20
Contains extension of supplemental nutrition programs,  unemployment provisions, and funding for coronavirus treatment and testing, including at  the IHS (which will receive $64 million for COVID-19 testing, and  which will be distributed by the IHS director). Also creates two new types of paid leave: emergency FMLA-style leave for parents who must care for children when schools close or whose childcare become unavailable due to COVID-19, and a two-week Paid Sick Leave program for several COVID-19 and related conditions. The law is ambiguous as to whether it applies to tribes, but it generally applies to all employers with 500 or fewer employees. 
Tribal advocates are seeking to address the sick leave reimbursement issues,
repayment or tax credits for payroll taxes paid by tribes, and favorable language for tribes  who may suffer multiple unemployment benefit claims following layoffs or furlough.

HHS Office of Civil Rights (OCR) notification of enforcement discretion for telehealth remote communications during COVID-19 public health emergency
Released 3/17/20
Effective immediately, HHS OCR will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency. This exercise of discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19. 

President Trump expands telehealth benefits for Medicare beneficiaries during COVID-19 outbreak
Published 3/17/20
Expands Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, CMS will temporarily pay clinicians to provide Telehealth services for beneficiaries residing across the entire country.  CMS is expanding Medicare's telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act.  Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings.

CDC to award over $560 million to state and local jurisdictions in support of COVID-19 response 
Released 3/11/20
Provides resources to state and local jurisdictions in response to the coronavirus disease (COVID-19).  On Friday, March 6, the President signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. The supplemental contains $8.3 billion, with resources directed for grants or cooperative agreements to states, localities, territories, and tribes to accelerate planning and operational readiness for COVID-19 preparedness and response. Idaho received $4,567,500.00; Oregon received $7,798,826.30; and Washington has received $14,230,798.70.

Coronavirus preparedness and response supplemental appropriations act, 2020 (H.R. 6074) (1st supplemental funding package)
Signed by President 3/6/20
Provides $8.3 billion in emergency funding for HHS, the State Department, and the Small Business Administration  to respond to the coronavirus outbreak. Funding is provided to address issues such as the following: developing, manufacturing, and procuring vaccines and medical supplies; grants for state, local, and tribal public health agencies; loans for affected small businesses; evacuations and emergency preparedness activities at U.S. embassies and other State Department facilities; and humanitarian assistance and support for health systems in the affected countries. 
Allows HHS to temporarily waive certain Medicare restrictions and requirements regarding telehealth services during the coronavirus public health emergency.

Governor Little rolls out latest actions to further prepare Idaho for coronavirus, ease burdens on citizens
Released 3/23
Implements  two proclamations - one lifting restrictions in 125 administrative rules to increase healthcare provider capacity and reduce barriers to healthcare access and another extending the state income tax filing and payment deadline to June 15, 2020. The waivers broaden the use of telehealth and remove barriers on out-of-state providers treating Idaho patients through telehealth technology. They streamline the licensure of nurses and physicians, allowing inactive or retired providers to come back into the profession more quickly and easily. They also remove restrictions so that physician assistants can be fully engaged as part of the medical team. The waivers also enhance the care for Idaho patients by ensuring each Idahoan can access their chronic medications by allowing emergency refill of up to 90 days for existing medications. 

Idaho Medicaid Division requests CMS Section 1135 waiver flexibilities related to novel coronavirus disease public health emergency
Submitted 3/23/20
Responds to the March 13, 2020, Idaho's Governor Brad Little declaration of a state of emergency due to the 2019 Novel Coronavirus Disease (COVID-19). The Idaho Department of Health and Welfare, Division of Medicaid, writes to CMS to request approval for detailed flexibilities under Section 1135 of the Social Security Act. The request proposes flexibilities for the provider workforce; implementation of waivers to streamline service authorization and utilization; as well as removal of cost-sharing and other requirements to support continued access to services.


Governor Kate Brown tightens social distancing measures, tells Oregonians to "stay home, save lives"
Issued 3/23/20
Directs everyone in Oregon to stay at home to the maximum extent possible and adding to the list of businesses that will be temporarily closed to stem the spread of COVID-19 in Oregon. The order is effective immediately, and remains in effect until ended by the Governor. While many businesses and organizations that are heavily dependent on foot traffic and in-person interactions have already closed or will close under the expanded order, other businesses that make robust plans to meet social distancing requirements-and enforce those requirements-may remain in operation, preserving jobs while ensuring health. 

Governor Kate Brown announces new order to preserve surgical masks, gowns, and gloves
Issued 3/18/20
Directs all Oregon hospitals, outpatient clinics, and health care providers, including veterinarians and dentists, to cease all non-emergency procedures, in order to preserve personal protective equipment (PPE), such as surgical masks, gowns, and gloves, for health care workers treating COVID-19 patients. The order also limits visitation in hospitals to protect health care workers and at-risk patients from the spread of COVID-19. 


Inslee annonces "stay home, stay healthy" order
Issued 3/23/20
Announces a  statewide order that requires everyone in the state to stay home. The order will last for two weeks and could be extended. This  order is similar to orders that other governors, in places such as California and New York, issued last week.  This proclamation will: r equire every Washingtonian to stay home unless they need to pursue an essential activity; ba n all gatherings for social, spiritual and recreational purposes; and c lose all businesses except essential businesses.

President Trump approves Washington disaster declaration
Issued 3/22/20
Declares that a major disaster exists in the state of Washington and ordered Federal assistance to supplement State, Tribal, and local recovery efforts in the areas affected by the coronavirus disease pandemic beginning January 2020 and continuing.  The President's action makes Federal funding available for Crisis Counseling for affected individuals in all areas in the State of Washington.   Federal funding is also available to State, tribal, and eligible local governments and certain private nonprofit organizations for emergency protective measures, including direct Federal assistance, for all areas in the State of Washington impacted by COVID-19.
President Trump's Declaration Approval

Department of Health releases personal protective equipment distribution guidelines
Released 3/21/20
Publishes guidelines on how personal protective equipment (PPE) will be allocated to counties with the greatest number of confirmed COVID-19 cases. This DOH guidance will help counties determine how to distribute PPE to their facilities. The guidelines include prioritization tiers and the following considerations: methodology for how much protective equipment to allocate, based on the size of the facility, number of health care workers, the number of confirmed or suspected cases, or number of patients in need of assessment. The prioritization of N95 respirators are only distributed to facilities in the first tier. 

CMS approves Washington State's request for 1135 Medicaid Waivers
Includes flexibilities that enable the state to focus its resources on combatting the outbreak and provide the best possible care to Medicaid beneficiaries in their state.  CMS provides guidance to states on how to apply for Section 1135 waivers through the Medicaid Disaster Response Tool Kit. Section 1135 waivers ensure that CMS is providing state partners with maximum flexibility they need to care for Medicaid beneficiaries during the public health emergency. Washington is the second state to receive approval for 1135 Medicaid waiver authority.
For more information
  Laura Platero, Executive Director
Sarah Sullivan, Health Policy Analyst
(503) 228-4185