Texas Health and Human Services Digest: September 18, 2020

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Previous meetings have made alternative arrangements like phone-in capability or have been canceled. These meetings are on the calendar as of today.

September 18, 2020

September 22, 2020

September 23, 2020

September 24, 2020

September 25, 2020

Proposed Rules
Formal Comments via the Texas Register
To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State. Interested parties then can review and comment on the proposed rule. The Secretary of State publishes a new issue of the Texas Register each Friday.

The Administrative Procedure Act (Texas Government Code, Chapter 2001) requires the notice published in the Texas Register to include a brief explanation of the proposed rule and a request for comments from any interested person. The notice also includes instructions for submitting comments regarding the rule to the agency, including the date by which comments must be submitted. Agencies must give interested persons “a reasonable opportunity” to submit comments. The public comment period begins on the day after the notice of a proposed rule is published in the Texas Register and lasts for a minimum of 30 calendar days.

Below is a list of proposed rules that have been published in the Texas Register. The proposed rules that are published in the Texas Register are open for public comment until the end of the comment period.

TitleProject No., DescriptionContactComment End Date
Title 40, Chapter 68 and Title 1, Chapter 354, Subchapter A, Division 11, Section 354.1177 repeal and new Title 1, Chapter 354, Subchapter O, relating to Electronic Visit Verification#19R025: Electronic Visit VerificationHHS Rules Coordination Office10/19/20
Title 1, Chapter 351, Coordinated Planning and Delivery of Health and Human Services#20R056: HHSC 2020 Advisory CommitteeHHS Rules Coordination Office10/19/20
Title 25, Chapter 411, Subchapter A, Joint Committee on Access and Forensic Services, repeal and new Title 1, Chapter 351, Subchapter B, Division 1, Committees#20R044: Joint Committee on Access and Forensic ServicesHHS Rules Coordination Office10/19/20
    
Title 25, Chapter 1, Subchapter V, Adult Stem Cells#20R014: Informed Consent for Investigational Stem Cell TreatmentHHS Rules Coordination Office10/12/20
Title 25, Chapter 97, Subchapter A, Control of Communicable Diseases#20R059: Notifiable ConditionsHHS Rules Coordination Office10/12/20
Title 40, Chapter 9, Sections 9.153 and 9.553; Chapter 42, Section 42.103; Chapter 45, Section 45.103; and Chapter 49, Sections 49.102, 49.208 – 49.210, 49.532, 49.551, 49.601, 49.702, and new Section 49.561#20R048: Convert Open-Ended Contracts to Term ContractsHHS Rules Coordination Office10/12/20
Title 25, Chapter 37, Maternal and Infant Health(link is external)#19R012: Texas School Health Advisory CommitteeDSHS School Health9/28/20
Title 25, Chapter 85, Local Public Health(link is external)#20R003: Data Request Process for Public Health Practice PurposesDSHS Center for Health Policy and Performance9/28/20
Title 25, Chapter 221, Meat Safety Assurance(link is external)#20R013: Low-Volume Livestock Processing EstablishmentsDSHS PSQA Meat Compliance Unit9/28/20
Title 1, Chapter 355, Reimbursement Rates(link is external) #20R054: HCS and TxHmL Respite and Day Habilitation ReimbursementHHS Rate Analysis Department9/21/20

Draft Rules Informal Comments

Informal opportunities to comment occur before a rule is published in the Texas Register. HHS staff may solicit informal public and stakeholder input by:

  • inviting stakeholders to submit comments on potential rule changes during rule development.
  • sharing a draft rule with stakeholders for review.
  • using existing HHS advisory committees to comment on rules.
TitleProject No.ContactComment Start DateComment Start Date
Title 25, Chapter 228, Retail Food, concerning Texas Food Establishments#20R023DSHS Consumer Protection Division9/8/209/30/20
Title 40, Chapter 85, Subchapter A, Section 85.2, Definitions, and Subchapter D, Section 85.302, Nutrition Services#20R031HHS Rules Coordination Office9/4/209/18/20
Title 1, Chapter 393, Section 393.1, Section 393.2, and new Section 393.3#20R093Allison Levee9/8/209/15/20

To better serve Texans seeking mental or behavioral health assistance, the Statewide Behavioral Health Coordinating Council is launching its redesigned Mental Health Texas website, mentalhealthtx.org, linking people to available local resources in one website.

“By redesigning our one-stop shop for behavioral health resources we’re speeding up the process for Texans to access the services they need,” said Sonja Gaines, HHS deputy executive commissioner for Intellectual and Developmental Disability and Behavioral Health Services. “Helpful behavioral health services exist across more than 20 state-funded agencies in addition to other behavioral health resources and this website brings those critical resources together in one place.”

This online resource is available for people seeking mental health and substance use disorder services, crisis hotline numbers, local mental health authorities, as well as information about common behavioral health conditions and social services from multiple government agencies. Behavioral health resources related to the COVID-19 pandemic are also available on the website.

Enhancements to the website include guidance to people seeking help for themselves or loved ones on selecting the right provider and access to resource documents and provider trainings. New content also features information on common topics such as suicide, bipolar disorder, anxiety, psychosis, trauma, substance use, depression, and intellectual and developmental disabilities. Additionally, the behavioral health information and resources are organized in a user-friendly format by population groups: children, teens, veterans, and seniors. In addition to resources, the website contains a calendar of behavioral health public events.

“The most important feature of this website is its capacity for hosting the resources of so many organizations, ensuring easier access to behavioral health resources in a way that respects the rich diversity of our great state,” said Danette Castle, CEO of the Texas Council of Community Centers.

The site was launched by the Statewide Behavioral Health Coordinating Council to provide a single place to learn about behavioral health services available through the council’s member agencies.

For more information, visit mentalhealthtx.org.

About the Statewide Behavioral Health Coordinating Council
In 2015, the Texas Legislature established the Statewide Behavioral Health Coordinating Council to ensure a strategic approach to providing behavioral health services throughout Texas. SBHCC is comprised of representatives of 23 state agencies and institutions of higher education that receive state funding for behavioral health services.

DUR Board Meeting Scheduled for Oct. 22 and 23
The next Texas Drug Utilization Review Board will take place over two days. Thursday, Oct. 22 is scheduled to allow public testimony regarding the new drug classes: anticonvulsants, antihemophilic, antineoplastic (i.e., anti-cancer), antiretroviral (i.e., anti-HIV), and medications used to treat multiple sclerosis. The remainder of the meeting takes place Friday, Oct. 23. Registration is forthcoming.

Pharmacy Provider Email Addresses Requested
HHSC and the Texas Medicaid and Healthcare Partnership (TMHP) are redesigning the current provider enrollment revalidation process for all providers with a new online portal. The new Provider Enrollment and Management System will begin in early 2021. Pharmacy providers enrolled with VDP can start requesting a TMHP portal account beginning mid-Dec. 2020. To accommodate this change, VDP requests enrolled pharmacy providers ensure their contact information is update.

Reminders

HHSC has published an overview of new expansion of visitation guidelines for NF, ALF, ICF/IID, HCS providers, and inpatient hospices. New rules will be released on September 24, 2020. Read the Overview: Expansion of Reopening Visitation (PDF).

Texas Department of State Health Services is accepting informal comments from stakeholders on the following draft rules. The comment period ends October 1, 2020.

Department of State Health Services Title 25, Part 1, Chapter 289, Subchapter E, Registration Regulations, Section 289.226, Registration of Radiation Machine Use and Services. Comments can be emailed to DSHS Consumer Protection Division.

Questions can be emailed to HHS Rules Coordination Office.
Visit the HHS Rulemaking website for more information or see the rule comment opportunity listed above.

Radiation Oncology Model will modernize Medicare payments for radiotherapy services

Today, the Centers for Medicare & Medicaid Services (CMS) finalized a new Innovation Center model expected to improve the quality of care for cancer patients receiving radiotherapy and reduce Medicare expenditures through bundled payments that allow providers to focus on delivering high-quality treatments. The new Radiation Oncology (RO) Model allows this focus on value-based care by creating simpler, more predictable payments that incentivize cost-efficient and clinically effective treatments to improve quality and outcomes. The RO Model, part of a final rule on specialty care models issued by CMS, will begin on January 1, 2021 and is estimated to save Medicare $230 million over 5 years.

To read the full RO Model release, click here:

https://www.cms.gov/newsroom/press-releases/cms-announces-innovative-payment-model-improve-care-lower-costs-cancer-patients

To read the Radiation Oncology Model Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/radiation-oncology-ro-model-fact-sheet

More information on the Model is available at: https://innovation.cms.gov/initiatives/radiation-oncology-model/

These Models are a part of a CMS final rule on Medicare Program; Specialty Care Models To Improve Quality of Care and Reduce Expenditures (CMS-5527-F), which can be viewed at: https://innovation.cms.gov/media/document/specialty-care-models-rule

Radiation Oncology Model will modernize Medicare payments for radiotherapy services

Today, the Centers for Medicare & Medicaid Services (CMS) finalized a new Innovation Center model expected to improve the quality of care for cancer patients receiving radiotherapy and reduce Medicare expenditures through bundled payments that allow providers to focus on delivering high-quality treatments. The new Radiation Oncology (RO) Model allows this focus on value-based care by creating simpler, more predictable payments that incentivize cost-efficient and clinically effective treatments to improve quality and outcomes. The RO Model, part of a final rule on specialty care models issued by CMS, will begin on January 1, 2021 and is estimated to save Medicare $230 million over 5 years.

To read the full RO Model release, click here:
https://www.cms.gov/newsroom/press-releases/cms-announces-innovative-payment-model-improve-care-lower-costs-cancer-patients

To read the Radiation Oncology Model Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/radiation-oncology-ro-model-fact-sheet

More information on the Model is available at: https://innovation.cms.gov/initiatives/radiation-oncology-model/

These Models are a part of a CMS final rule on Medicare Program; Specialty Care Models To Improve Quality of Care and Reduce Expenditures (CMS-5527-F), which can be viewed at: https://innovation.cms.gov/media/document/specialty-care-models-rule

Today, the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) on a Recommended Measure Set for Medicaid-Funded Home and Community-Based Services (HCBS). The RFI seeks feedback on potential benefits of and challenges that could result from a nationally available set of recommended quality measures for voluntary use by states, managed care organizations, and other entities engaged in the administration and/or delivery of Medicaid-funded HCBS.  Comments should be submitted by e-mail no later than October 19, 2020.

The Centers for Medicare & Medicaid Services (CMS) announces the availability of the 2020 Change Review Process (CRP) for electronic clinical quality measures (eCQMs). The CRP provides eCQM users the opportunity to review and comment on draft changes to the eCQM specifications and supporting resources under consideration by the measure steward. The goal of the CRP is for eCQM implementers to comment on the potential impact of draft changes to eCQMs so CMS and measure stewards can make improvements to meet CMS’s intent of minimizing provider and vendor burden in the collection, capture, calculation, and reporting of eCQMs.

This latest installment of the CRP for eligible professional/eligible clinician and eligible hospital/critical access hospital issues will be conducted using the web-based public comment tools on the ONC Project Tracking System eCQM Issue Tracker during fall 2020. Note that an ONC Project Tracking System account is required to post a question or comment. New users can create an account via the ONC Project Tracking System website.

CRP updates regarding issues available for public comment will be posted on the ONC Project Tracking System eCQM Issue Tracker summary page. To subscribe to weekly CRP digest emails containing updates on CRP activities, please email CRP@mathematica-mpr.com.

For More Information: To find out more about eCQMs, visit the Electronic Clinical Quality Improvement Resource Center. To report questions and comments regarding eCQMs, visit the eCQM Issue Tracker. To submit technical questions and issues related to the development and implementation of the Clinical Quality Language (CQL) standard, visit the CQL Issue Tracker

Governor Greg Abbott today held a press conference to provide an update on the state’s ongoing efforts to combat COVID-19. During the press conference, the Governor issued Executive Orders expanding occupancy levels for restaurants, retail stores, office buildings, manufacturing facilities, gyms and exercise facilities and classes, museums, and libraries, and re-authorizing elective surgeries for a majority of the state of Texas. The Governor also announced new guidance related to visitations at nursing homes and long-term care facilities across the state.

In addition, the Governor implemented the use of reliable, data driven hospitalization metrics used by doctors and medical experts to help guide the state’s ongoing efforts to contain COVID-19 and expand occupancy for businesses and services. This metric focuses on areas with high hospitalizations — referring to any Trauma Service Area (TSA) that has had seven consecutive days in which the number of COVID-19 hospitalized patients as a percentage of all hospitalized patients exceeds 15%, until such time as the TSA has seven consecutive days in which the number of COVID-19 hospitalized patients as a percentage of all hospitalized patients is 15% or less. A current list of areas with high hospitalizations will be maintained at www.dshs.texas.gov/ga3031.

Using this metric, 19 of the 22 TSAs in Texas qualify to increase occupancy levels to 75% for restaurants, retail stores, office buildings, manufacturing facilities, gyms, exercise facilities and classes, museums, and libraries beginning September 21st. In addition, these 19 TSAs can also resume elective surgeries. Three of the 22 TSAs (S-Victoria, T-Laredo, and V-Lower Rio Grande Valley) must remain at 50% occupancy and continue postponing elective surgeries until the hospitalization metric requirements are met. These three TSAs contain the following counties: Calhoun, DeWitt, Goliad, Jackson, Lavaca, Victoria, Jim Hogg, Webb, Zapata, Cameron, Hidalgo, Starr, and Willacy.

The Governor announced new visitation guidance for eligible nursing homes, assisted living facilities, intermediate care facilities, home and community-based service providers, and inpatient hospice effective Thursday, September 24th. Under the new rules, residents will be allowed to designate up to two essential family caregivers who will be provided necessary training to allow them to safely go inside a facility for a scheduled visit, including in the resident’s room, to help ensure their loved one’s physical, social, and emotional needs are being met. Designated caregivers will not be required to maintain physical distancing, but only one caregiver can visit a resident at a time.

A long-term care facility resident (or legal representative) can designate the essential caregiver, who can be a family member, friend, or other individual. Facilities are required to train essential caregivers on the proper use of personal protective equipment (PPE) and other infection control measures. Proper PPE must be used at all times during these scheduled visits, and the caregiver must test negative for COVID-19 within the previous 14 days before the initial visit.

For general visitors who are not a designated essential caregiver, these updated emergency rules will allow approved facilities to schedule outdoor no contact visits, open window visits, or indoor visitation with the use of plexiglass safety barriers to prevent the spread of COVID-19. Physical contact between residents and general visitors is not permitted. Facilities also must continue to meet all additional visitation requirements outlined in the emergency rules.

View the Governor’s Executive Order related to expanded capacity of certain services.

View the Governor’s Executive Order related to hospital capacity.

Reported cases represent less than half-a-percent of students who have returned to campus –
In collaboration with the Texas Education Agency, the Texas Department of State Health Services today posted on the DSHS website the statewide number of cases of COVID-19 reported by Texas public schools. The reported count of on-campus student cases of COVID-19 in the state’s public schools is 2,344 out of an estimated 1.1 million students who have been on campus for instruction or activities since the beginning of the 2020-21 school year. The total count of on-campus staff cases during the same period is 2,175.

The number of student and staff COVID-19 cases in Texas public schools will be updated each Wednesday. Beginning Sept. 23, it will include data by school district. TEA will link to the data from TEA’s COVID-19 website.

TEA previously directed all school districts to submit information about COVID-19 cases going back to the start of the school year. Information is submitted via an online form each Monday by those school systems that were notified in the previous week that a student, teacher, or staff member who participates in any on-campus activity has tested positive for a current COVID-19 infection. Antibody tests, which indicate a previous infection, are not required to be reported.

The data will provide an overview of the burden of disease in Texas schools over time and inform public policy decisions about COVID-19. School districts and other local authorities will continue to be the best source of the most current and specific information about cases in their schools.

Reporting this information to the state does not replace the legal requirement that schools notify public health officials in their area of all cases. Additionally, as per TEA guidance, schools will still be required to inform all parents, teachers, and campus staff of any positive cases tied to their on-campus instruction or activities.

By providing financial support to households, businesses, and state and local governments, federal laws enacted in response to the 2020 coronavirus pandemic will offset part of the deterioration in economic conditions brought about by the pandemic.

In March and April of 2020, four major federal laws were enacted in response to the 2020 coronavirus pandemic. Those laws, which contained a wide array of conventional and unconventional fiscal policies, will add $2.3 trillion to the deficit in fiscal year 2020 and $0.6 trillion in 2021, according to the Congressional Budget Office’s estimates.

By providing financial support to households, businesses, and state and local governments, the legislation will offset part of the deterioration in economic conditions brought about by the pandemic. CBO estimates that the legislation will boost the level of real (inflation-adjusted) gross domestic product (GDP) by 4.7 percent in 2020 and 3.1 percent in 2021. From fiscal year 2020 through 2023, for every dollar that it adds to the deficit, the legislation is projected to increase GDP by about 59 cents. In the longer term, the legislation will reduce the level of real GDP, CBO estimates. All of those estimates are subject to considerable uncertainty.

The Effects of Pandemic-Related Legislation on the Deficit and on GDP, Fiscal Years 2020 to 2023
PolicyEffect on the Deficit (Billions of Dollars)Cumulative Effect on GDP (Billions of Dollars)Cumulative Effect on GDP
per Dollar of Effect on the Deficit
(Dollars)
Paycheck Protection Program and Related Provisions628 231 0.37
Enhanced Unemployment Compensation442 301 0.68
Recovery Rebates for Individuals292 177 0.61
Direct Assistance for State and Local Governments150 133 0.89
Other Spending Provisions700 621 0.89
Other Revenue Provisions 425 100 0.24
 Total2,637 1,564 0.59

Short-Term Effects
In the short term—that is, from 2020 through 2023—the pandemic-related legislation will affect the economy through several channels. Payments and tax credits issued to individuals will boost the overall demand for goods and services by providing resources to households, many of which have experienced a significant loss in income. Loans, grants, and tax benefits will provide liquidity to businesses experiencing financial distress, increasing the likelihood that they will survive and preserve jobs for their employees while economic activity is weak. Federal assistance to state and local governments will help pay for rising expenditures related to the pandemic as those governments’ tax revenues fall. And payments to health care providers will help support further testing for and treatment of COVID-19, the disease caused by the coronavirus.

Over the next several years, as a result of the pandemic, output is projected to remain well below its potential level, and inflation is projected to stay below the Federal Reserve’s long-run objective. CBO therefore expects that the Federal Reserve will not respond to the legislation’s effect on demand by raising short-term interest rates. So the boost to output is expected to be larger than it would have been if output had been closer to its potential and inflation had been higher, because then the Federal Reserve would have been more likely to respond.

In CBO’s assessment, the short-term boost in economic activity caused by the legislation will be tempered by social distancing, especially during the second and third quarters of this year. Social distancing refers to certain actions that households, businesses, and governments in the United States and around the world have taken to limit in-person interactions and thus slow the spread of the coronavirus. Those actions include reducing social activities, dining out, and travel; curtailing the activity of schools and businesses; prohibiting large gatherings; and working from home. CBO estimates that social distancing will cause the economic boost resulting from the legislation to be smaller than it would have been during a period without social distancing. CBO also expects that some of the spending by individuals and businesses that is hampered in the near term by social distancing will resume as those measures continue to ease.

Longer-Term Effects
The legislation will increase federal debt as a percentage of GDP, and in the longer term, CBO expects that increase to raise borrowing costs, lower economic output, and reduce the income of U.S. households and businesses. In addition, the higher debt—coming at a time when the longer-term path for debt was already high—could eventually increase the risk of a fiscal crisis or of less abrupt economic changes, such as higher inflation or the undermining of the U.S. dollar’s predominant role in global financial markets. The timing and likelihood of those effects are not possible to estimate with precision.

Uncertainty
CBO’s estimates of the economic effects of the legislation are subject to considerable uncertainty and represent the middle of the distribution of potential outcomes. Some important sources of that uncertainty are how consumers and businesses may respond to various policy changes included in the legislation; how the timing, scale, and breadth of the legislation may affect consumers’ and businesses’ confidence; how responses to policy changes may be altered by the pandemic and social distancing; what the course of the pandemic may be; how social distancing may change; and how quickly safe and effective vaccines and therapies may become widely available.

The Legislation
This past March and April, four major federal laws were enacted to address the public health emergency created by the pandemic and to directly assist households, businesses, and nonfederal governments affected by the economic downturn. The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Public Law 116-123), and the Families First Coronavirus Response Act (P.L. 116-127) increased federal funding for some federal agencies and for state and local governments, required employers to grant paid sick leave to employees, and provided payments and tax credits to employers. The Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) provided loans to businesses, payments to health care providers, payments and tax credits to individuals, additional funding to state and local governments, and reductions in certain business taxes. Finally, the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139) increased federal funding for the loans to businesses and payments to health care providers supplied in the CARES Act.
This report analyzes the following provisions in the four laws.

  • Paycheck Protection Program and Related Provisions. Through the Paycheck Protection Program (PPP), the legislation funds loan guarantees for loans to small businesses to help them cover payroll and other costs. CBO expects most PPP loans to be forgiven, so they will effectively become grants. In addition, the legislation allocates funds to the Small Business Administration (SBA), which lends them to businesses, provides debt relief, and administers the Economic Injury Disaster Loan (EIDL) program. That program provides grants to businesses experiencing a temporary loss in income.
  • Enhanced Unemployment Compensation. The legislation temporarily increased unemployment benefits by $600 per week through July 31, 2020. In addition, the legislation created a temporary program for people not otherwise eligible for unemployment benefits, such as self-employed workers and independent contractors, and extended the number of weeks of federally funded benefits available to beneficiaries who qualified for regular unemployment insurance in 2020. Finally, the legislation allowed states to waive work-search requirements for people receiving benefits.
  • Recovery Rebates for Individuals. The legislation provides a refundable tax credit of $1,200 per qualifying adult and $500 per dependent child to taxpayers with income below specified limits. The tax credit begins phasing out once the income of individuals and of married couples filing jointly passes $75,000 and $150,000, respectively.
  • Direct Assistance for State and Local Governments. The legislation provides grants to state and local governments—and to tribal and territorial governments as well—for spending related to the pandemic.
  • Other Spending Provisions. The legislation provides funding to the Department of Health and Human Services, the Department of Defense, the Department of Agriculture, the Department of Housing and Urban Development, the Federal Emergency Management Agency, the Department of Veterans Affairs, and the Department of Transportation. It also increases funding for the Supplemental Nutrition Assistance Program and for public health programs, such as Medicaid and Medicare. Furthermore, it provides aid to people who have student loans (by temporarily suspending their loan payments), credit assistance to airlines and other businesses, and relief to aviation workers.
  • Other Revenue Provisions. The legislation modifies the rules relating to net operating loss deductions and increases the limits on the losses and on the business interest deductions that businesses can use to offset their taxable income. Those changes provide businesses with liquidity by letting them claim certain tax benefits sooner than they would otherwise have been able to. The legislation also provides payroll tax credits to employers to encourage them to retain employees, along with refundable credits to compensate them for providing paid sick leave and family and medical leave. It delays payroll tax payments by businesses, further providing temporary liquidity. And it shifts some of the costs of unemployment benefits from state and local governments and nonprofits to the federal government.
  • The Federal Reserve’s Emergency Lending Facilities. The legislation provides loss-absorbing capital to Federal Reserve programs called facilities, which act as a backstop to financial markets by making loans or purchasing assets under the Federal Reserve’s emergency lending authority.

In total, the pandemic-related legislation is projected to increase the federal deficit by about $2.3 trillion in fiscal year 2020 and $0.6 trillion the following year (see Table 1). Those amounts equal about 11.2 percent of GDP in 2020 and 2.7 percent in 2021. Over the 2020–2030 period, the laws are projected to add $2.6 trillion to the deficit (an amount that does not include budgetary changes resulting from the laws’ effects on the economy).
Some measures recently taken by the Federal Reserve are not analyzed in this report. The Federal Reserve lowered its target range for the federal funds rate—the interest rate that financial institutions charge each other for overnight loans of their monetary reserves—nearly to zero. It also established several facilities, some of them similar to those created during the 2007–2009 financial crisis, to support certain financial markets and to help corporations and municipalities raise funds. And it made temporary adjustments to regulations to let banks expand their balance sheets to support their customers.

Follow This Link for the Complete Report