To date (April 24, 2020), Congress has passed, and the President has signed, four stimulus bills in response to the COVID-19 pandemic. Summaries of each highlighting sections most relevant to the addiction prevention and treatment community are below.

*This page will be updated as events progress and additional details emerge.*

1. The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020ⁱ  (P.L. 116-123), signed into law on March 6, 2020, provides $8.3 billion in emergency funding for federal agencies to respond to the coronavirus outbreak. 

• Most of the funding ($6.2b) was directed to the Department of Health and Human Services (HHS) for the Office of the Secretary – Public Health and Social Services Emergency Fund to develop vaccines, therapeutics and diagnostics; for the Centers for Disease Control and Prevention (CDC) to support state and local response efforts; for the National Institute of Allergy and Infectious Diseases (NIAID) to research vaccines, therapeutics and diagnostics; and to the Food and Drug Administration (FDA) to review vaccines, therapeutics and medical devices and address potential supply chain interruptions. 
• The bill also included a waiver removing restrictions on Medicare providers allowing them to offer telehealth services to beneficiaries regardless of whether the beneficiary is in a rural community.

2. The Families First Coronavirus Response Actⁱⁱ  (P.L. 116-127) was signed into law on March 18, 2020. It includes nearly $3.5 billion in total funding along with federal nutrition program waivers; the Emergency Family and Medical Leave Expansion Act; the Emergency Paid Sick Leave Act; and health provisions regarding coverage of SARS-CoV-2 testing. 

• The funding is designated for food and nutrition programs run by the U.S. Department of Agriculture; unemployment insurance grants to states; and detection of SARS-CoV-2 or diagnosis of the virus that causes COVID-19 within the Defense Health Program (TRICARE), the Indian Health Service, the Veterans Health Administration (VA), and the National Disaster Medical System.
• The health provisions require private insurers (group and individual plans, including grandfathered plans, Medicare, Medicaid and CHIP, TRICARE, the VA, the Indian Health Service, and plans covering federal employees to cover detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 and the associated visit without cost-sharing, without needing to meet a deductible, and without prior authorization or other utilization management. 

• Nearly $350 billion in federally guaranteed loans to provide eight weeks of cash-flow assistance to small businesses with fewer than 500 employees, including non-profits and physician practices, who maintain their payroll during this emergency. The maximum loan amount is $10 million. If employers maintain their payroll, the loans would be forgiven. 
• $100 billion for a new program to provide grants to hospitals, public entities, not-for-profit entities, and Medicare- and Medicaid-enrolled suppliers and institutional providers to cover unreimbursed health care-related expenses or lost revenues attributable to the public health emergency resulting from the coronavirus. Examples of unreimbursed expenses include increased staffing or training, personal protective equipment, and lost revenue. HHS is expected to issue guidance on the application process shortly.
• $45 billion to the Disaster Relief Fund of the Department of Homeland Security to provide for the immediate needs of state, local, tribal, and territorial governments, including medical response and personal protective equipment (PPE).
• $1.5 billion for the CDC to support States, locals, territories, and tribes in their efforts to conduct public health activities, including:
  • Purchase of personal protective equipment;
  • surveillance for coronavirus;
  • laboratory testing to detect positive cases;
  • contact tracing to identify additional cases;
  • infection control and mitigation at the local level to prevent the spread of the virus; and
  • other public health preparedness and response activities.
• $1 billion for the Defense Production Act to support the production of PPE, ventilators, and other medical supplies.
• $425 million for SAMHSA to increase access to mental health services through Community Behavioral Health Clinics ($250m), suicide prevention programs ($50m), and emergency response grants ($100m) that can target support where it is most needed, such as outreach to those experiencing homelessness.
• $275 million for the Health Resources and Services Administration (HRSA), including $90 million for Ryan White HIV/AIDS programs and $185 to support rural critical access hospitals, rural tribal health and telehealth programs, and poison control centers.
• Substantial changes to 42 CFR Part 2 that allow the contents of substance use disorder (SUD) patient records to be used or disclosed by a covered entity, business associate, or Part 2 program for treatment, payment or healthcare operations as permitted by the Health Insurance Portability and Accountability Act (HIPAA), after prior written patient consent has been obtained. Any information so disclosed may then be redisclosed in accordance with the HIPAA regulations. A patient’s prior written consent to be given once for all such future uses or disclosures for purposes of treatment, payment, and health care operations, until such time as the patient revokes such consent in writing. *See ASAM's page on 42 CFR Part 2 for more information.*
• Expansion of Medicare telehealth authority to remove a restriction that limits telehealth coverage during the COVID-19 emergency period to situations where the physician or other professional has treated the patient in the past three years. This will enable beneficiaries to access telehealth, including in their home, from a broader range of providers, reducing COVID-19 exposure. The bill also allows for Federally Qualified Health Centers and Rural Health Clinics to serve as a distant site (where the clinician is located) for telehealth consultations for Medicare beneficiaries.
• Extension of the Medicaid Community Mental Health Services demonstration that provides coordinated care to patients with mental health and substance use disorders, through November 30, 2020. It would also expand the demonstration to two additional states.
• Clarification that doctors who provide volunteer medical services during the public health emergency related to COVID-19 have liability protections.

4. The Paycheck Protection Program & Health Care Enhancement Act was signed into law on April 24. It includes $484 billion dollars to supplement funding for programs created by the CARES Act, including the Provider Relief Fund and the Paycheck Protection Program. Key provisions include:

• An additional $321 billion in federally guaranteed loans to provide cash-flow assistance to small businesses with fewer than 500 employees, including non-profits and physician practices, who maintain their payroll during this emergency.
• An additional $75 billion to provide grants to hospitals, public entities, not-for-profit entities, and Medicare- and Medicaid-enrolled suppliers and institutional providers to cover unreimbursed health care-related expenses or lost revenues attributable to the public health emergency resulting from the coronavirus.
• 25 billion to the HHS Public Health and Social Services Emergency Fund to cover expenses related to development, manufacture, and administration of COVID-19 tests, among other expenses such as workforce support and expansion of relevant laboratories. 

The AMA has created a CARES Act: Loans & Other Financial Assistance for Physician Practices summary, available by clicking here.

ASAM continues to advocate on behalf of its members and the addiction treatment community to ensure patients can access needed care during this national crisis, and to ensure addiction specialist clinicians and their teams have the resources and policy flexibility they need to provide that care. 

i. For a more detailed breakdown of the funding allocation, see https://www.kff.org/global-health-policy/issue-brief/the-u-s-response-to-coronavirus-summary-of-the-coronavirus-preparedness-and-response-supplemental-appropriations-act-2020/

ii. For more information, see https://www.kff.org/global-health-policy/issue-brief/the-families-first-coronavirus-response-act-summary-of-key-provisions/