The CARES Act: Key Provisions Related to Rural Health and the Healthcare Workforce

March 30, 2020

Update (Jan. 13, 2021): Certain of the provisions discussed below were further extended in a massive year-end spending bill. To review more about the massive spending bill, our Jan. 13 alert summarizes 15 key healthcare provisions included in H.R. 133.

On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). This is alert is part of a series of alerts discussing the CARES Act provisions that are most important to healthcare providers.

The CARES Act, which provides more than $2 trillion in stimulus benefit for the economy, includes specific provisions to support rural healthcare providers and to improve the American healthcare workforce, in addition to addressing drug and equipment shortages, COVID-19 testing coverage, telehealth, home health/hospice and other issues facing hospitals. Additional highlights of the law include sick leave and family leave benefits, expanded unemployment benefits, tax provisions offering support to employers, loans for small businesses, and significant financial appropriations for specific industries.

1. Maintains Medicare reimbursement for rural providers. Medicare reimbursement for physicians and other providers includes three geographic adjustments, including one based on the relative work geographic practice cost index (GPCI) of the region where the service is provided. The CARES Act extends a “floor” for such adjustment at 1.0 that was slated to expire on May 23, 2020 but will now extend until Dec. 1, 2020. This adjustment should help ensure rural providers do not see a decrease in their reimbursement during the COVID-19 pandemic.

2. Funds HRSA rural programs and Indian Health Services. The CARES Act includes $180 million to support rural critical access hospitals, rural tribal health and telehealth programs. The funding will be provided to the Health Resources Service Administration (HRSA) within the Department of Health and Human Services (HHS), and remain available through Sept. 30, 2022. HRSA is directed to spend at least $15 million of this amount on Indian tribes and organizations, and an additional $5 million to support poison control centers. Note that the CARES Act also provides $1 billion for the Indian Health Service to remain available until Sept. 30, 2021, among other expenditures to Indian tribes and organizations.

3. Protects volunteer healthcare professionals from liability. The CARES Act provides immunity from federal and state malpractice lawsuits to healthcare professionals who volunteer to provide medical care during the COVID-19 national public health emergency. To obtain this protection, healthcare providers need to act within the scope of their professional license and without expectation of reimbursement (with the exception of travel) or payment. Notably, immunity will not be available if a provider causes harm through willful or criminal misconduct, gross negligence, reckless misconduct, or conscience flagrant indifference to the rights or safety of the individual. Immunity also does not extend to providers who render medical care while under the influence of alcohol or an intoxicating drug.

4. Redirects Service Corp providers and forms Ready Reserve Corp. The CARES Act authorizes the Secretary of HHS to reassign National Health Service Corp (NHSC) providers from their current assignment in order to respond to the COVID-19 pandemic. In addition, Congress updated the U.S. Public Health Service to have a “Ready Reserve Corps” — a corps of trained doctors and nurses who are ready to respond to the COVID-19 pandemic and future public health emergencies.

5. Extends increased funding for health centers and NHSC. In an effort to further fund community health centers and teaching centers with graduate medical education serving low-income populations, the CARES Act extends mandatory funding for these centers through Nov. 30, 2020. This funding is above what otherwise would have been authorized as appropriations for these programs and allows the centers to continue serving low-income populations during the COVID-19 pandemic. In addition, the CARES Act includes $1.32 billion in supplemental funding to community health centers.

6. Reauthorizes rural health grant programs. The CARES Act reauthorizes three rural health grant programs until 2025 — Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Grant Programs. These HRSA grant programs attempt to strengthen the health of rural communities by focusing on quality improvement, increasing healthcare access, coordinating care and integrating services. The reauthorization modernizes certain language based on experience with the programs and increases the amount appropriators can fund to these programs in future years.

7. Reauthorizes health training programs. The CARES Act also reauthorizes multiple health professions workforce training programs until 2025. These programs support clinical training and faculty development for family medicine, general internal medicine, geriatrics, pediatrics and other medical specialties, including but not limited to nursing. The reauthorization language prioritizes programs aimed at training the workforce to serve rural (including tribal health) and other medically underserved areas. In addition, the CARES Act directs HHS to develop a coordinated plan for the various health workforce programs and provide an updated report to Congress within two years that proposes various ways to strengthen the programs. Finally, Congress revised language to focus on the healthcare needs of certain populations, including older Americans and those with chronic diseases, who have higher COVID-19 risks.

8. Extends the health professions workforce demonstration project. Finally, the CARES Act extends certain demonstration projects through Nov. 30, 2020, for health professions opportunity grants. This program helps low-income individuals obtain education or training to work in healthcare jobs. The extension will continue the demonstration projects already in place at their current funding levels in an effort to further ongoing efforts. Existing demonstrations may then be considered exemplars for future training programs.

The various provisions described above may assist rural healthcare providers in responding to the COVID-19 pandemic and strengthen the overall healthcare workforce in the years to come. Notably, however, some members of Congress did not believe the above-mentioned provisions go far enough, so we may see additional legislative efforts in this area and in response to the COVID-19 pandemic.

The CARES Act also includes telehealth and hospital provisions that could assist rural communities, which will be the subject of future legal alerts.

Please contact the authors for additional information on how the CARES Act could affect the delivery of rural healthcare and the training of healthcare providers. McGuireWoods has published additional thought leadership related to how companies across various industries can address crucial coronavirus-related business and legal issues, and the firm’s COVID-19 response team stands ready to help clients navigate urgent and evolving legal and business issues arising from the COVID-19 pandemic.