State of Nevada
All Directives and Declarations from Governor Sisolak and State of Nevada Executive Department can be found here:
PHASE 4: Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act – proposed by Senate republicans 7/27/20
The $1 trillion Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act may be introduced through multiple bills sponsored by several senators. The proposal includes a reduced federal unemployment benefit, business liability protection from COVID-19-related lawsuits, additional Paycheck Protection Program loans for certain qualifying businesses and a second round of stimulus checks.
Paycheck Protection Program Flexibility Act – 6/5/20 (H.R.7010)
The Paycheck Protection Program Flexibility Act of 2020 (H.R. 7010) amended the Paycheck Protection Program. Loan forgiveness was expanded from eight weeks of eligible costs to the 24 weeks or December 31, 2020, whichever is earlier; alternatively, a business whose PPP loan was made before June 5 may opt to use the eight-week period instead. PPP loans made on or after June 5 must have a minimum term of five years, rather than two years. At least 60% of the loan forgiveness amount must be for payroll costs, rather than 75%. The safe harbor provision that loan forgiveness will not decrease if the business rehires employees and restores wage reductions by June 30 is extended to December 31. Loan forgiveness will not decrease if the business was unable to rehire its employees on February 15 and is unable to hire similarly qualified employees by December 31. Loan forgiveness will not decrease if the business is unable to return to its previous level of business activity due to compliance with requirements or guidance from the Department of Health and Human Services, the Centers for Disease Control, or the Occupational Safety and Health Administration between March 1 and December 31, involving COVID-19-related standards for worker safety or customer safety. The deferral of principal and interest payments was extended to the date that loan forgiveness is remitted to the lender or, if the borrower does not apply for loan forgiveness, ten months after the end of the covered period. Employer payroll tax deferral is allowed even after loan forgiveness is approved. PPP loan proceeds are required to be spent only on allowable costs during the eight- or 24-week covered period.
PHASE 3.5: Paycheck Protection Program and Health Care Enhancement Act – 4/24/20 (H.R.266)
Paycheck Protection Program and Health Care Enhancement Act (H.R. 266) is a $484 billion law that increases funding to the Paycheck Protection Program and also provide more funding for hospitals and testing for COVID-19.
This Act is referred to as “Phase 3.5” as it includes “interim” funding that replenishes one of the programs established by the CARES Act (Phase 3). The CARES Act created the $349-billion Paycheck Protection Program, which provided low-interest loans to small businesses that were forgivable if they maintained their employees and payroll. The $349 billion was fully allocated within 13 days. During those 13 days, 1.6 million loans were approved by nearly 5,000 banks and other lenders.
Provisions of the Paycheck Protection Program and Health Care Enhancement Act include the following.
- Appropriates an additional $320 billion of funding for the Paycheck Protection Program, which provides low-interest loans for payroll costs and other expenses to small businesses that are forgivable under certain circumstances. Of that amount, $60 billion is for PPP loans made by small banks, small credit unions, and community financial institutions
- Appropriates an additional $10 billion for emergency Economic Injury Disaster Loans
- Expands eligibility for emergency Economic Injury Disaster Loans to farms and agricultural-related businesses.
- Appropriates $50 billion for Small Business Administration disaster loans.
- Appropriates an additional $75 billion to the Public Health and Social Services Emergency Fund for health care providers’ expenses or lost revenues related to coronavirus.
- Appropriates $25 billion to the Public Health and Social Services Emergency Fund for researching, developing, validating, manufacturing, purchasing, administering, and expanding capacity for COVID-19 testing.
- Appropriates $2.1 billion for salaries for the Small Business Administration.
PHASE 3: The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) – 3/27/20 (H.R.748)
The Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) was signed into law on March 27, 2020 and provides resources and flexibility for rural hospitals, such as:
New Access to Capital
- New funding for health care providers, including $150M that will go directly to CAHs via the Small Hospital Improvement Program (SHIP)
- Small business loans via the “Paycheck Protection Program”
Medicare/Medicaid Payment Improvements and Flexibilities
- Temporary elimination of Medicare sequestration
- Expanded option for accelerated payments
- Medicaid DSH cut reduction and delay
Telehealth Access and Flexibilities
- Additional funding for telehealth
- Improved Medicare beneficiary access to telehealth
- RHCs as distant sites
RESOURCE: AHA CARES Act: Provisions to Help Rural Hospitals
RESOURCE: H.R. 748 The Coronavirus Aid, Relief, and Economic Security Act
RESOURCE: The Small Business Owner’s Guide to the CARES Act
PHASE 2: The Families First Coronavirus Response Act (FFCRA) – 3/18/20 (H.R.6201)
The Families First Coronavirus Response Act (FFCRA) was signed into law on March 18, 2020 and per a statement, the White House, “provides paid leave, establishes free coronavirus testing, supports strong unemployment benefits, expands food assistance for vulnerable children and families, protects front-line health workers, and provides additional funding to states for the ongoing economic consequences of the pandemic, among other provisions.” Among other things, this new law includes:
- The Emergency Family and Medical Leave Expansion Act (EFMLA), which amends the Family and Medical Leave Act of 1993 (FMLA) to provide up to 10 weeks of protected paid leave to eligible employees for a coronavirus related reason
- The Emergency Paid Sick Leave Act (EPSLA) provides full time employees up to a two-week period of paid sick leave for coronavirus related reasons
*Note: Health care providers may be exempted from Paid Sick Leave or Expanded Family and Medical Leave by their employer under the FFCRA. Per the Department of Labor, a health care provider is defined anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, Employer, or entity. This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.
RESOURCE: Department of Labor: COVID-19 and the American Workplace
RESOURCE: H.R.6201 – Families First Coronavirus Response Act
PHASE 1: Coronavirus Preparedness and Response Supplemental Appropriations Act – 3/6/20 (H.R.6074)
The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074) is an act of Congress enacted on March 6, 2020. The legislation provided emergency supplemental appropriations of $8.3 billion in fiscal year 2020 to combat the spread of coronavirus disease 2019 (COVID-19) and counter the COVID-19 pandemic.
Broken down by category, the bill provides funding for the following purposes:
- More than $3 billion for “research and development of vaccines, as well as therapeutics and diagnostics”
- $2.2 billion “in public health funding to aid in prevention, preparedness and response efforts — including $950 million to support state and local agencies”
- Almost $1 billion for “medical supplies, health-care preparedness, Community Health Centers and medical surge capacity”
- $1.25 billion to fight COVID-19 internationally.
Emergency Declaration 1135 Waivers
On March 13, 2020, the President declared the ongoing Coronavirus Disease 2019 (COVID-19) pandemic of sufficient severity and magnitude to warrant an emergency declaration for all states, tribes, territories, and the District of Columbia pursuant to section 501 (b) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. 5121-5207 (the “Stafford Act”).
The Trump Administration has issued an array of temporary regulatory waivers and new rules, which apply for the duration of the emergency declaration, to equip the healthcare system with the flexibility it needs to respond to the COVID-19 pandemic.
The goals of these temporary waivers are as follows:
- To ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites (aka CMS Hospital Without Walls);
- To remove barriers for physicians, nurses, and other clinicians to be readily hired from the community or from other states so the healthcare system can rapidly expand its workforce;
- To increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home;
- To expand in-place testing to allow for more testing at home or in community based settings; and
- To put Patients Over Paperwork to give temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, and States can focus on providing needed care to beneficiaries affected by COVID-19.
RESOURCE: Summary of COVID-19 Emergency Declaration Waivers & Flexibilities for Health Care Providers
RESOURCE: Hospitals: CMS Flexibilities to Fight COVID-19
RESOURCE: Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19
RESOURCE: Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): CMS Flexibilities to Fight COVID-19