Omnibus bill eases Medicare rate cuts, expands telehealth reimbursement

Lawmakers unveiled a 4,155-page, $1.7 trillion spending bill on Tuesday that includes provisions affecting the future of how health care is paid for and delivered. health services across the country, from the comfort of one’s home to hospitals in rural communities.

The multi-tiered bill, which requires House and Senate approval, must be passed by the end of Friday or the government will face the risk of a shutdown.

Here’s what’s on the healthcare bill.

Medicare rate cuts

The law provides for a 2% cut to the Medicare rate for doctors by 2023, increasing the following year.

The proposed cuts are an improvement from Recommended rate of 4.5% earlier this year. However, Dr. Jack Resneck Jr., president of the American Medical Association, said he was “extremely worried” that providers might stop accepting Medicare patients, especially due to family stress. inflation, and again called on Congress to reform doctors’ salaries.

“The AMA is deeply disappointed and dismayed that Congress has failed to prevent the cuts to Medicare next year, threatening the financial viability of the practice of doctors and nurses,” Resneck said in a statement. jeopardize Medicare beneficiaries’ access to care,” Resneck said in a statement.

The package also prevents an additional 4% cut from going into effect in 2023 as part of the statutory Pay-As-You-Use Act.

Winston Medical Center, a small rural hospital in Louisville, Mississippi, won’t be able to sustain any of the Medicare cuts, especially when Materials and labor costs have increasedPaul Black, the hospital’s chief financial officer, said.

“Making any cuts is absurd right now,” he said. “It seems they think there are too many hospitals out there.”

Remote healthcare extension

Telehealth reimbursement waivers enacted as part of the CARES Act of 2020 will be extended until December 31, 2024. The waivers were originally supposed to expire 60 days after their end. public health emergency until a bus bill is passed in March extend it to 151 days.

“Honestly, I doubted we could get two years,” said Krista Drobac, executive director of Alliance for Connected Care, a telehealth lobbying group. “I feel more optimistic about the possibility of making them permanent.”

Provisions include ending the requirement that a provider be licensed in the same state as the patient receiving care, allowing a wider range of doctors to provide telehealth, enabling services telehealth has only audio and deferred direct claims for mental health patients seeking treatment through telehealth.

The bill would also extend telehealth services through 2024 to federally qualified health clinics and rural health clinics.

The two-year extension is not without meaning in the future. The bill directs the Secretary of Health and Human Services to study how telehealth has impacted the overall health outcomes of Medicare beneficiaries and whether there are geographic differences in use or not. It also calls for a review of medical claims data. The deadline for initial reports is October 1, 2024.

Home hospital/rural health

The proposal extends the Centers for Medicare & Medicaid Services’ home hospital exemption through 2024. That waiver, set in November 2020 to increase the capacity to admit COVID-19 patients, allows for illnesses The hospital handles emergencies and inpatients off-site. Hospitals across the country adopt home hospital programs as part of a larger effort for virtual care options. As of November, there were 114 health systems and 256 hospitals approved to provide hospital-based care at home.

However, not everyone is completely on board. Some health care organizations have been wary of home hospital plans with no guarantee of future Medicare reimbursement, and private insurers have been reluctant to reimburse care. That is due to the lack of result data. Some nurses and advocacy groups have questioned the safety of relying on telemedicine in acute cases.

This legislation would expand funding for the rural hospital program, such as a 1% rural home health supplement payment, federal subsidies for training medical professionals serving in rural areas and the Rural Small Hospital Improvement Grant Program. But the 3.925% cut for home health providers is expected to go into effect in January.

redefine Medicaid

States will begin reviewing members’ eligibility for Medicaid in early April, regardless of when the COVID-19 public health emergency officially ends.

Local officials promised to pause cuts to their public benefits during the emergency declaration in exchange for federal COVID-19 relief. According to a December report from the Kaiser Family Foundation, the economic impacts of the pandemic and a pause in state decisions have sent Medicaid enrollments to an all-time high, rising to more than 90. million lower-income adults and children in August.

According to a December report from the Robert Wood Johnson Foundation, an estimated 18 million individuals could lose coverage as states begin to review patients’ eligibility for the Health Insurance and Assistance Program. Medical level for Children.

States are expected to resume eligibility checks after the administration of President Joe Biden announced the end of the public health emergency due to COVID-19. For now, it’s slated to end in April.

The proposal marks a victory for 25 Republican governors, who sent a letter to the Biden administration on Monday calling for a halt to Medicaid redetermination decisions to end in April, says the fund. federal increases are not enough to cover patients’ medical costs, and states are incurring “hundreds of millions” in additional costs.

States will have 14 months to complete an assessment of individuals’ eligibility for public health programs and will submit monthly progress reports to the Secretary of Health and Human Services and This report will be made public. The measure guarantees 12 months of continuous coverage for children on Medicaid and CHIP once they are enrolled.

Some individuals who are no longer eligible for Medicaid are expected to switch to exchange coverage, many of whom will be eligible for the enhanced benefits that Congress passed under the Act. Inflation Reduction Act. Insurance companies have expand their market footprint over the past year in anticipation of attracting members who fell off their state’s Medicaid list. CMS this month recommends set up special enrollment time for people who lost their Medicaid or CHIP benefits because their income increased during the pandemic.

Expanding federal medical assistance

The proposal also includes a handbook to reduce the increased federal funds states receive to pause redefining. The first federal COVID relief package increased states’ Medicaid matching rates by 6.2 percentage points.

The federal government has planned to stop paying the higher rates once the public health emergency ends, which encourages states to move as quickly as possible to weed out ineligible individuals from the public health emergency. their list. For example, Ohio gave its Medicaid agency three months to complete its eligibility check. Patient advocates worry that states rushing to remove individuals from public benefits will result in people being mistakenly removed from Medicaid and without time to apply for new coverage. .

The bill provides for a gradual process to ease increased payments. Starting in April, the federal matching rate will drop by 5 percentage points through June; from July 1 to the end of September, this rate will decrease to 2.5 percentage points; and from October to the end of 2023 reduced to 1.5 percentage points.

sponsor hotline 988

The bill provides funding to advance the nation’s outreach and marketing efforts New three-digit mental health hotline, 988. It moved other mental health hotlines, including a veterans hotline, to the national network.

The measure also provides funding to states and territories to expand crisis response teams and a range of behavioral health services including community health clinics and crisis stabilization centers. panic. Some grants will be dedicated to workforce development, technical support, and data analytics.

The bill allows HHS to conduct annual inspections and implement quality control measures on hotline-related services in cooperation with local governments.

In addition, the federal government will begin collecting demographic data along with usage data to identify disparities in access. That data will be shared with the Centers for Disease Control and Prevention to support epidemiological assessments.

vendor directory

The proposal would also establish federal standards around provider directories for private Medicaid carriers and other managed care companies. Provider directory requirements are now regulated by a variety of state laws.

The measure would require managed care companies to publish a searchable directory of network providers that is updated at least quarterly. Insurers will have to specify the provider’s language and cultural ability, if clinicians are accepting new patients, and whether their office can accommodate people with disabilities.


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