Published April 24, 2020

Show Us the Money: $25 Billion for Testing in the Paycheck Protection Program and Health Care Enhancement Act   

On April 24, the President signed the latest COVID-19 relief bill, the Paycheck Protection Program and Health Care Enhancement Act (PPP/HCE). The PPP/HCE comes with a $484 billion price tag, less than a quarter of the CARES Act. It includes four major appropriations:

  1. An additional $320 billion to the Payroll Protection Program (PPP)
  2. An additional $60 billion for the Economic Injury Disaster Loan (EIDL) Program
  3. An additional $75 billion for the Provider Relief Fund
  4. $25 billion for coronavirus testing

The funding for the PPP and EIDL breathes new life into these programs, both of which exhausted their CARES Act funding in a matter of days. Please see our latest article on the re-opening of the PPP. Regarding the Provider Relief Fund, please see our latest article about the Department of Health and Human Services’ (HHS) recent announcement on allocation of those funds.

Most of the $25 billion to research, develop, validate, manufacture, purchase, administer, and expand capacity for COVID-19 testing and surveillance is directed to specific recipients. First, HHS must distribute not less than $11 billion to states, territories, localities, and tribal organizations to develop, purchase, administer, process, and analyze COVID-19 tests and to conduct related surveillance.

The PPP/HCE requires HHS to distribute this $11 billion by May 24. Of this amount, HHS must distribute within 30 days not less than $2 billion to states, localities, and territories according to the formula that applied to the Public Health Emergency Preparedness Cooperative Agreement in FY 2019. Using that formula, PYA estimated the following distributions (with minor differences due to rounding):

Recipient Projected Allocation Amount Recipient Projected Allocation Amount
Alabama $30,439,000 Montana $18,143,000
Alaska $18,143,000 N. Mariana Islands $1,491,000
American Samoa $1,493,000 Nebraska $18,604,000
Arizona $39,575,000 Nevada $23,025,000
Arkansas $22,942,000 New Hampshire $18,143,000
California $128,473,000 New Jersey $46,524,000
Chicago $29,334,000 New Mexico $19,268,000
Colorado $33,670,000 New York $54,569,000
Connecticut $25,178,000 New York City $53,667,000
Delaware $18,143,000 North Carolina $52,425,000
Florida $96,092,000 North Dakota $18,143,000
Georgia $52,968,000 Ohio $57,649,000
Guam $1,933,000 Oklahoma $26,660,000
Hawaii $18,143,000 Oregon $27,650,000
Idaho $18,143,000 Palau $1,358,000
Illinois $50,989,000 Pennsylvania $62,120,000
Indiana $37,656,000 Puerto Rico $23,668,000
Iowa $23,512,000 Rhode Island $18,143,000
Kansas $22,533,000 South Carolina $31,224,000
Kentucky $28,761,000 South Dakota $18,143,000
Los Angeles County $60,015,000 Tennessee $37,969,000
Louisiana $29,528,000 Texas $125,706,000
Maine $18,143,000 Utah $23,532,000
Marshall Islands $1,483,000 Vermont $18,143,000
Maryland $35,059,000 Virgin Islands (U.S.) $1,690,000
Massachusetts $38,497,000 Virginia $44,960,000
Michigan $50,874,000 Washington $41,031,000
Micronesia $1,695,000 Washington, D.C. $20,953,000
Minnesota $33,333,000 West Virginia $18,143,000
Mississippi $22,833,000 Wisconsin $34,143,000
Missouri $35,394,000 Wyoming $18,143,000
TOTAL $2,000,000,000

Also, HHS must distribute within 30 days $4.25 billion of the $11 billion to states, localities, and territories using a formula of its own devising based on the relative number of cases of COVID-19. Another $750 million must be distributed to tribal organizations. Although the PPP/HCE does not specify how the remaining $4 billion of the $11 billion must be distributed, the new law requires HHS to submit its allocation formulas to specified congressional committees one day prior to awarding any such funds.

Each state, locality, territory, or tribal organization that receives funding must submit to HHS within 30 days its 2020 testing plan, including the following elements:

  • Month-by-month estimates of the number of tests needed.
  • Month-by-month estimates of laboratory and testing capacity.
  • A description of the way in which the recipient will use its resources for testing, including as it relates to easing any COVID-19 community mitigation policies.

Of the funds not distributed to states, localities, territories, or tribal organizations, the PPP/HCE requires HHS to make the following allocations:

  • Up to $1B to reimburse providers for the cost of testing uninsured individuals (in addition to the $1B previously appropriated for the same purpose under the Families First Coronavirus Relief Act).
  • Not less than $1B to the Centers for Disease Control for surveillance, epidemiology, laboratory capacity expansion, contact tracing, public health data surveillance, and analytics infrastructure modernization.
  • Not less than $1B for the Biomedical Advanced Research and Development Authority for advanced research, development, production, and purchase of diagnostic, serologic, or other COVID-19 tests.
  • Not less than $1B to the National Institutes of Health to develop and implement testing and associated technologies and to accelerate development and implementation of point-of-care and other rapid testing.
  • $600M in grants to federally qualified health centers to support testing.
  • $225M in grants to rural health clinics to support testing.
  • Not less than $500M for the National Institute of Biomedical Imaging and Bioengineering to accelerate development and implementation of point-of-care and other rapid testing.
  • Not less than $306M for the National Cancer Institute to develop, validate, improve, and implement serological testing and associated technologies.
  • $22M for the Food and Drug Administration to support activities associated with diagnostic, serological, antigen, and other tests.

The PPP/HCE requires HHS to submit several reports to Congress:

  • Within 21 days, a report on the status of COVID-19 testing to include: (1) data on demographic characteristics including race, ethnicity, age, sex, and geographic region; and (2) the number and rates of COVID-19 cases, hospitalizations, and deaths.
  • Within 30 days, a COVID-19 strategic testing plan to assist states, localities, territories, and tribal organizations to understand COVID-19 testing for both active infection and prior exposure. The plan must include estimates of testing production that account for new and emerging technologies, and detail by what means HHS will increase domestic testing capacity, including testing supplies.
  • Within 180 days, a report on the number of positive diagnoses, hospitalizations, and deaths as a result of COVID-19, disaggregated nationally by race, ethnicity, age, sex, geographic region, and other relevant factors. The report also must include an epidemiological analysis of such data.

PYA will closely monitor emerging local strategies for expanded testing, the role of healthcare providers and employers in these strategies, and in what way they move us closer to containing the virus and fully re-opening our economy.

Should you have questions about any of this information or need additional COVID-19 guidance, visit PYA’s COVID-19 hub, or contact one of our PYA executives below at (800) 270-9629.

Disclaimer: To the best of our knowledge, this information was correct at the time of publication. Given the fluid situation, and with rapidly changing new guidance issued daily, be aware that some or all of this information may no longer apply. Please visit our COVID-19 hub frequently for the latest updates, as we are working diligently to put forth the most relevant helpful guidance as it becomes available.

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