Congressional lawmakers have eliminated proposals that would move dollars allocated to the COVID-19 Provider Relief Fund (PRF) to pay for infrastructure improvements. Meanwhile, Sens. Michael Bennet (D-Colo.) and Kevin Cramer (R-N.D.) have introduced a separate bill that would extend the PRF’s deadline to use the funds from June 30 to Dec. 31, or until the end of the COVID-19 public health emergency. 

Democrats and Republicans reached a deal this week to allow the $550 billion package to go forward. The initial proposal contained language that would transfer $43.7 billion in unspent Provider Relief Funds to finance infrastructure projects, prompting outcry from a range of health care organizations and providers.

“As more Americans become infected with the delta variant and our health care providers and workforce are still struggling to recover from the last COVID-19 wave, now is not the time to divert critical health care dollars to infrastructure,” said Edo Banach, President and CEO of the National Hospice & Palliative Care Organization (NHPCO). “While improvements in our country’s infrastructure are important, we cannot risk losing access to critical hospice and palliative care for patients and their families.”

The CARES Act, enacted on March 27, earmarked $175 billion to health care providers across the continuum through the Provider Relief Fund. This afternoon, Sen. Ron Wyden (D-Ore.) confirmed to Bloomberg News that the forthcoming infrastructure bill would not take away the remainder of those funds.

The financial and operational impact of the pandemic has been monumental for hospices. Providers have been in dire need of additional supplies, with acquiring personal protective equipment (PPE) as a top priority. The tremendous global demand for those products has driven up prices. Hospices have also had difficulty accessing patients, investing in new telehealth capabilities and covering paid leave for staff who have been exposed to the virus.

The U.S. Department of Health and Human Services (HHS) announced earlier this year that it could require some providers to return PRF payments if the dollars are not spent by June 30. While HHS did allow for some flexibility for some providers, new legislation would extend that date until at least the end of this year.

“This public health emergency has strained every level of America’s health care system, and it’s not over yet,” said Bennet, one of the bill’s sponsors. “We need to extend the payback deadline to ensure hospitals and providers can adequately serve their communities as we work to bring this pandemic to an end.”  

In the eyes of many health care providers one black mark on the infrastructure deal in the extension of Medicare sequestration. Sequestration was established in 2014 by the Budget Control Act. It reduced payments to hospice and other health care providers by 2% across the board.

The practice was originally supposed to expire in 2021, but it has been extended several times. Sequestration is currently slated to end in 2030, but it could go on longer if current language in the infrastructure bill is enacted. 

“The originally planned Medicare sequestration has gone on long past its original design,” said National Association for Home Care & Hospice President William A. Dombi. “Medicare providers should not be considered the ‘go to’ source of funding for Congressional actions.”