December 21st of 2020 saw the passing of the sequel COVID relief legislation. As part of the Bipartisan-Bicameral Omnibus COVID Relief Deal at the end of the year, with one of the largest stimulus packages in history. The provisions under the same require interpretation, especially since the healthcare industry’s ramifications will be momentous. The 5,593-page 2021 Consolidated Appropriations Act was voted on and approved on December 21, 2020, before congressional leaders took a break for the holidays. However, the relief bill provides some respite to individuals, businesses, and hospitals and is aimed to lighten the economic strain that the pandemic caused. Consequently, the legislation includes  USD 300 per week in additional unemployment benefits, direct payments of USD600 to individuals, USD 330 billion in small business loans, approximately USD 80 billion for schools, and USD 69 billion for vaccine development and deployment.  The relief bill was included as Division N of a larger legislative package that included government funding and other bills. 


As mentioned, the second round of payments has been authorized to cover the earlier economic-impact relief received in the summer, amounting to USD 166 billion. Households would receive USD 600 for each adult and USD 600 for each dependent, instead of USD 1,200 and USD 500, respectively, in the first round. Mixed-status households, where some people are ineligible noncitizens, would get payments based on the number of eligible people in the households. Furthermore, a point of measurement will be past income from 2018, so that phasing out of individuals with a gross income of over USD 75000 can be begun. This is USD 150,000 for married couples. Consequently, households with income that is too high to qualify or with added dependents may not qualify for full payments immediately but can request the remainder in their 2020 tax returns. 

For workers, a federal unemployment subsidy is available at USD 300 a week. This also includes gig workers and others who do not usually qualify for benefits. The legislation would also extend to 50 weeks the amount of time for which workers may claim benefits through state and federal programs. The measure also provides an additional USD 100-a-week subsidy for workers who have both wage and self-employment income but whose basic unemployment benefits don’t take into account their self-employment income. The cost of the enhanced unemployment benefits is projected at USD 120 billion.


The bill provided USD 25 billion as assistance to tenants for rent, dispended by the Treasury Department by the states’ population. This provision has been enacted alongside an eviction prohibition that shall last until the end of January 2021,  extending the CDC eviction moratorium until January 31, 2021

The safeguards for landlords and building owners mean that they can apply on behalf of tenants who meet the eligibility criteria, which usually refer to those who make less than half the area’s median income. Assistance is prioritized for renter households whose incomes do not exceed 50 percent of AMI and renter households who are currently unemployed and have been unemployed for more than ninety days. All financial assistance provided is non-taxable for households receiving such assistance.


Under Division M, the bill provides USD 82 billion for public and private K-12 schools and colleges. It is provided as flexible funding to support the educational needs of States, school districts, and institutions of higher education and the students they serve in response to coronavirus.

USD 819 million  is also supplied to outlying areas and Bureau of Indian Education-operated and funded schools and Tribal Colleges and Universities, not inclusive of  the Emergency  Relief Fund that allows the schools to conduct repairs and improvements as well as addressing learning losses in students who might not be as equipped to cope with the effects of the pandemic 

The Emergency Relief Fund for higher education provides for public, private, and non-profit institutions, depending on the number of students enrolled and including distance learners. Furthermore, an allocation of USD 1..7 billion has been set aside for Historically Black Colleges and Universities, Tribal Colleges and Universities, Hispanic Serving Institutions, and certain other institutions. Specifically, the bill includes USD 11 million for the National Technical Institute for the Deaf, USD 20 million for Howard University, and USD 11 million for Gallaudet University.


A major development is that the vaccine distribution funding falls upon Bill’s state and federal agencies. The Department of Health and Human services provide for a basic understanding of what this would entail: USD  73 billion to support public health in terms of research, development, manufacturing, procurement, and distribution of vaccines and therapeutics; diagnostic testing and contact tracing; mental health and substance abuse prevention and treatment services; child care support; and other activities related to coronavirus. This also provides for USD 20 billion to the Biomedical Advanced Research and Development Authority [ BARDA] involved in the aforementioned activity of procuring vaccines and therapeutics.  

The Centre for Disease Control and Prevention is allocated USD8.75 billion to support federal, state, local, territorial and tribal public health agencies to distribute, administer, monitor, and track coronavirus vaccination with USD 4.5 billion for reserved  State, Territorial, and Tribal Public Health Departments.  USD 300 million is reserved for financing the distribution and delivery of vaccines to high-risk and underserved populations, including racial and ethnic minority populations and rural communities


Increasing numbers of aviation workers will have their livelihood back for at least several months under the new bill, incorporating USD 15 billion to fund wages and pensions until late March. The debt relief package includes USD 1 billion in financial assistance for airline contractor payrolls.

Airline companies received approximately USD 25 billion to finance employees’ pensions and conditions and consented not to slash any jobs in the interim until October 1st under the CARES Act.  Consequently, Section 404 of Title IV in Division N mandates that to receive funding, an air carrier or contractor must [A.] recall involuntarily furloughed employees [B.] provide backpay to returning employee, [C.] restore the rights to the employees that they had before the furlough, [D.] not enact layoffs or reduce pay rates until March 31, 2020 [E.] refrain from purchasing equity security of the entity or the direct or indirect parent company of the applicant that is listed on a national securities exchange until March 31, 2021; and  [F.] not pay dividends, or make other capital distributions, concerning the common stock (or equivalent interest) of the entity until March 31, 2021, The bill also provides USD 2 billion for airports and air travel businesses. 


The bill would provide USD 1 billion in relief funds to Amtrak to help the national passenger railroad avoid further layoffs and furloughs of its workers.  Consequently, the amount meted out is intended to support Amtrak’s ability to operate Northeast Corridor, State-supported, and long-distance passenger rail service, including USD 284.7 million to assist States commuter rail providers in making required payments to Amtrak. Since Amtrak had difficulty in eking back costs due to lost ridership, workers are protected from further employee furloughs, especially since Amtrak is mandated to recall workers as passenger rail service is restored and explicitly disallowed from replacing any furloughed workers with contractors, 

The Transit Emergency Relief Fund is allocated USD 14 billion for operating assistance, not including the amount set aside by the CARES Act tailored to both urban and rural transit agencies based on their operating expenses. The bill also provides USD 50 million and spending flexibility for paratransit providers and USD 2 billion for the bus industry, and USD 10 billion for state highways.


The USD 325 billion allotted to help small businesses includes USD 284 billion for first and second forgivable Paycheck Protection Program loans and expands eligibility for local newspapers and TV and radio broadcasters. The bill also includes USD 20 billion for Economic Injury Disaster Loans. It clarifies that gross income does not include any amount that would otherwise arise from the forgiveness of a Paycheck Protection Program (PPP) loan and adds that deductions are allowed for otherwise deductible expenses paid with PPP loan proceeds forgiven. It must be kept in mind, then, that the tax basis and other attributes of the borrower’s assets will not be reduced due to the loan forgiveness, effective from the enactment of the CARES Act. The provision provides similar treatment for Second Draw PPP loans, effective for tax years ending after enacting the provision.

Title III of Division addresses this matter in detail.  It allows expenses to be made forgivable under Paycheck Protection Program funds as long as they are either [A.] covered operations expenditures which would provide for software and cloud computing payments, other human resources and accounting needs, [B.] covered property damage costs which would entail those costs accrued to property damage from earlier political uprisings not covered  by insurance, [C.] covered supplier costs which entail those expenses a supplier has had to undergo under a contract, purchase order, or order for goods in effect before taking out the loan that is essential to the recipient’s operations at the time at which the expenditure was made, [D.] covered worker protection expenditure which would essentially be personal protective equipment and adaptive investments to help a loan recipient adhere to COVID-19 measures 

The provision allows these loans to utilize the expanded forgivable expenses as long as it is not availed of by borrowers who have already had their loans forgiven.


The bill effectively allows a little leeway from the CARES Act’s stringent measures on the U.S. Postal Service. For example, the STOP Act’s implementation is modified, providing that shipments may be authorized if the Postmaster-General or the Commissioner of Customs and Border Patrol determines that the risk has a slim probability of violating any statutes or regulations. 

The bill provides a loan of USD 10 billion that the Postal Service is not required to repay, as long as the Congress is supplied with information as to its functioning; a plan about its long-term financial solvency must be provided to the Postal Regulatory Commission within 180 days detailing how the Postal Service will use the loan. 


Apart from the PPP levy, the bill would expand the tax incentive to distressed employers who retain workers on the payroll, allowing beneficiaries of such tax benefits to apply based on their 2019 wages; in certain cases, lower-income for 2020 could limit their approval.

This would also extend the tax breaks for wind energy and carbon capture. Controversial in the debate it sparked, the deduction also includes subsidies of meals for business trips.  The erstwhile memorandum issued for employers to defer withholding employees’ share of social security taxes mandated employers to raise withholding and pay the deferred amounts from wages and compensation paid between January 1, 2021, and April 31, 2021, will see penalties accruing from May. However, the repayment period is extended to December 31, 2021, whereinafter penalties and interest on deferred unpaid tax liability will begin to accrue. 

Lower excise taxes on beer, wine, and spirits set to expire on Dec. 31 will be permanently extended, and tax incentives for businesses that invest in low-income areas and hire workers from disadvantaged groups will be extended for five years.

Further Aspects of Division M – Coronavirus Response and Relief Supplemental Appropriations Act, 2021

The Bill includes additional funding through the Public Health and Social Services Emergency Fund (PHSSEF) of USD 23 billion to prevent, prepare for, and respond to the coronavirus. The relief module offers a further USD 22.4 billion in PHSSEF for testing, contact tracing, surveillance, containment, and prevention to detect and suppress COVID-19. Also, the relief package specifies that, for any reimbursement to a subsidiary of a parent organization, the parent organization may assign some of the requirements of reimbursement onto a subsidiary of the parent institution, including the reimbursements referred to as “Targeted Distribution” by the Secretary of Health & Human Services (HHS).

The relief package also relates to the Provider Relief Fund’s loss of revenue calculation by stating: That, for any reimbursement from the Provider Relief Fund to an eligible healthcare provider for healthcare-related expenses or lost revenues that are attributable to coronavirus (including reimbursements made before the date of the enactment of this Act), such provider may calculate lost revenues using the Frequently Asked Questions guidance released by HHS in June 2020, including the difference between such provider’s budgeted and actual revenue budget if such budget had been established and approved before March 27, 2020.”  The inclusion of this provision can significantly help healthcare providers understand the portion of their revenues that could not be measured up to during COVID.


Title I – Healthcare provides for the extension of temporary suspension of Medicare sequestration for an additional three months to March 31, 2021. 

It has been made clear that the bill is only viable until the end of 2021. Consequently, to increase the fee schedules thereunder, there is a transferral of USD 3 billion from the General  Fund of the  Treasury to the  Federal  18Supplementary  Medical  Insurance  Trust  Fund. This allows for a  one-time increase in the Medicare physician fee schedule of 3.75 percent in a bid to support physicians and other professionals in adjusting to changes in the Medicare physician fee schedule during 2021 and providing relief during the COVID-19 public health emergency. However, this only is allowed for one year. 

Additionally, there is an extension of CARES act provisions insofar as the protections afforded to individuals are now valid till March 14th, 2021, rather than December 31st. However, no pandemic unemployment assistance is payable for any week beginning after April 5, 2021. The section also extends Pandemic Unemployment Assistance (PUA) to March 14, 2021. It allows individuals receiving benefits as of March 14, 2021, to continue through April 5, 2021, as long as they have not reached the maximum number of weeks, which has increased from thirty-nine weeks to fifty. 

Furthermore, appeals for cases may be enacted at the state level, where authorities are empowered to waive overpayments made without fault on the individual or when such repayment would violate equity and good conscience. Like the previous provisions, the section structures transition guidelines for individuals transitioning between

PUA and the Pandemic Emergency Unemployment Compensation program and restricts the furnishing of retroactive PUA benefits to weeks of unemployment after December 1, 2020

Provides for a one-time, one-year increase in the Medicare physician fee schedule of 3.75 percent to support physicians and other professionals in adjusting to changes in the Medicare physician fee schedule during 2021 and providing relief during the COVID-19 public health emergency. Sec. 102. Extension of Temporary Suspension of Medicare Sequestration. Provides for a three-month delay of the Medicare sequester payment reductions through March 31, 2021

 The Bill allows health insurance to hold patients harmless from unexpected hospital costs. This specifies that patients are indeed obligated to pay in-network cost-sharing, [co-payment, coinsurance and deductibles, out-of-network emergency care expenses for that kind of ancillary services offered by out-of-network providers at in-network facilities and out-of-network care provided at in-network facilities without the patient’s informed consent.]  It also mandates that in-network cost-sharing reimbursement for out-of-network unexpected premiums becomes credited to the person’s in-network deductible.

In addition, the relief kit cites the supplier’s criteria for surprise medical billing, discussing surprise air ambulance bills, clarity about in-network and the out-of-network deductible and out-of-pocket limits, discrimination against providers, and another issue. It also  ensures a one-year rise of 3.75 percent in the Medicare medical fee schedule to assist doctors and other practitioners in adapting improvements to the Medicare medical fee schedule during 2021 and to provide relief during the COVID-19 public health emergency, in conjunction with a three-month delay in the Medicare sequester payment reduction by 31 March 2021

Accountability includes increased transparency by eradicating price and quality information gag clauses, direct and indirect compensation for brokers and consultants to employer-sponsored health plans and planners on the individual market, strengthening equity in mental health and substance use disorder coverage, and disclosing pharmaceutical benefits and medication costs.

In case states are struggling with the accumulation of interest on the federal loans taken to pay unemployment, the extension of temporary assistance is valid until March 14th of 2021. The loans allow states with low balances in their unemployment trust funds to delay employer tax increases or other employer surcharges while the economy is struggling.

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1. Title V – Banking: Subtitle A — Emergency Rental Assistance Sec. 501. Emergency Rental Assistance.  Eligible households are defined as renter households who: (1) have a household income not more than 80 percent of AMI; (2) have one or more household members who can demonstrate a risk of experiencing homelessness or housing instability; and (3) have one or more household members who qualify for unemployment benefits or experienced financial hardship due, directly or indirectly, to the pandemic.

2. Title III – Continuing the Paycheck Protection Program and Other Small Business Support

3. sec. 1415 of title 19 U.S.C

4. Sec. 101. Supporting Physicians and Other Professionals In Adjusting to Medicare Payment Changes During 2021

5. Subchapter I—Extension of CARES Act 1Unemployment Provisions 2SEC.  201.  EXTENSION  AND  BENEFIT  PHASEOUT  RULE  FOR  3PANDEMIC UNEMPLOYMENT ASSISTANCE.

6. Sec. 101. Supporting Physicians and Other Professionals In Adjusting to Medicare Payment Changes During 2021


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