Congress Snips Key Healthcare Provisions from CR Before Passing It
Working at a furious pace, Republican and Democratic members of the U.S. House of Representatives worked on Friday, Dec. 20, to resurrect a stopgap funding bill to keep the federal government open, and in the process, eliminated provisions long advocated by national associations, before passing a modified version of the bill and sending it on to the Senate and to the desk of President Joe Biden, who signed the bill on Saturday morning, Dec. 21.
The stopgap spending bill, known as a continuing resolution (CR), has been one of the main vehicles that members of the U.S. Congress have used in recent years to fund the federal government and implement a range of legislative provisions, as traditional budgeting processes have repeatedly failed. Essentially, CRs keep the federal government open and funded for a defined period of time, but must be renewed at set dates in order to avert a federal government shutdown.
In this case, interference by industrialist Elon Musk, an informal adviser to President-elect Donald Trump, had caused the initial CR, which had required numerous weeks for House Republicans and Democrats to hammer out, to collapse, on Wednesday evening, Dec. 17, just hours before that bill was set to be voted on. Musk had made a number of accusations, some of them not factual, and his interference led House Republicans to back away from the agreement that House Speaker Mike Johnson (R.-La.) had hammered out with House Minority Leader Hakeem Jeffries (D.-N.Y.), over a period of numerous weeks.
When the House Republicans and Democrats regrouped, they ended up severing several provisions from the CR that national healthcare associations had been working to get into the legislation, among them, a provision to avert most of a scheduled 2.83-percent cut to Medicare physician reimbursement, though the final bill did include a provision to delay an $8 billion reimbursement cut to Medicaid disproportionate-share hospital (DSH) payments through March 31 of next year. The final bill also included the extension of some telehealth flexibilities.
In a statement released on Saturday, Anders Gilberg, senior vice president, government affairs, for the Englewood, Colo.-based Medical Group Management Association (MGMA), said that, "While MGMA is relieved that telehealth flexibilities and the 1.0 work GPCI floor were extended — albeit temporarily — the final Continuing Resolution (CR) represents a huge congressional failure to the detriment of the nation's Medicare patients and their physicians. The previously agreed-upon CR, while not perfect, would have critically averted most of the 2.83-percent cut to physician reimbursement in Medicare beginning January 1. Now physician practices head into the new year facing uncertainty and financial shortfalls that not only negatively impact the viability of their Medicare business, but their commercial contracts tied to Medicare rates, as well as Medicaid reimbursement in states that use Medicare as a benchmark. Lawmakers are playing a dangerous game that will ultimately hurt patient access to physicians who can no longer deal with the chaos caused by congressional inaction to fix a reimbursement system that continues to destabilize the Medicare program.”
What’s more, Gilberg said in the statement, that “Heading into the 119th Congress, while retroactively addressing the 2.83-percent cut to the conversion factor is of utmost importance, permanent reform to the Medicare payment system is needed to sustainably support medical groups and their ability to provide timely access to Medicare patients.”
Meanwhile, in a statement released late Friday night, the California Medical Association said that, “Tonight, the U.S. House of Representatives overwhelmingly (366-34) passed a stopgap bill to keep the government funded until March 14, 2025. The bill now moves to the Senate where both Democrats and Republicans have indicated they will support the bill. However, there will be some lapse in government funding until the Senate can act later this weekend. All of the expiring health care programs were extended until March 14, including the important pandemic-era telehealth flexibilities. The House bill also included $100 billion in disaster aid, but not the debt limit extension as requested by President-Elect Trump. However, in a devastating move for Medicare physicians and patients, the language from the bipartisan deal reached earlier this week that would have stopped most of the Medicare physician payment cut was stripped out of the bill. Therefore, the 2.8-percent Medicare payment cut will go into effect on January 1, 2025. When medical practice inflation is factored in, this is in effect a 6.4-percent payment cut to physicians.”
What’s more, the CMA stated, “California physicians are extremely angry with Congress for allowing the Medicare payment cuts to happen. At a time when physicians are struggling to keep their doors open and millions of Americans are unable to get timely access to care, Congress is advancing a proposal that jeopardizes patient care. Today’s bill will further push physicians to retire early, reduce the number of Medicare patients they see, or shut their doors entirely – all of which hurts patients. Any future agreement from Congress must stop these cuts to Medicare in their entirety. Anything short of that is a failure to serve America’s seniors.”
The CMA also noted that “Other previously agreed to health care provisions were excluded from today’s bill as well, including community health center funding, an extension of the 3.53-percent Medicare Alternative Payment Model incentive payments, a requirement that Medicare Advantage plans maintain accurate provider directories, pharmacy benefit manager pricing reforms, and hospital site of service billing transparency requirements.”
Per that, a large coalition of national healthcare professional associations, including the American Hospital Association (AHA), had sent a letter back on Nov. 22 to the four top congressional leaders—Speaker Johnson and Minority leader Jeffries in the House, and Majority leader Chuck Schumer (D.-N.Y.) and Minority Leader Mitch McConnell (R.-Ky.) in the Senate, in which the coalition stated that, “As you and your colleagues address pressing issues before the 118th Congress adjourns, the undersigned organizations encourage you to pass an end-of-year health care package that includes an extension of Medicare’s Advanced Alternative Payment Model (AAPM) incentive payments, ensures that AAPM qualifying thresholds remain attainable, and replaces a scheduled cut to Medicare’s physician payments with an update reflective of inflationary pressures.”
The coalition noted that, “Since the enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medicare’s AAPM incentives have helped more than 500,000 physicians and other health care providers cover the investment costs of moving to new payment models, provided the financial resources to expand care teams, enabled adoption of population health infrastructure, and aided clinicians in providing services beyond those typically covered by traditional Medicare.”
That coalition included, among many others, the AHA, the American Medical Association, APG (America’s Physician Groups), NAACOS (the National Association of ACOs), Premier Inc., Accountable for Health, the MGMA, AMGA (American Medical Group Association), the American College of Physicians, and America’s Essential Hospitals.
The main provision that survived mostly intact in the final CR was the extension of federal telehealth flexibilities, which had been set to sunset on Dec. 31. The Washington, D.C.-based American Telemedicine Association, the leading nationwide telehealth association, published a press release to its website on Saturday, Dec. 21, noting that the Medicare telehealth flexibilities and the Acute Hospital Care at Home (AHCAH) program have both been extended through March 31, 2025.
“While this isn’t the outcome we had fully hoped for, the ATA and ATA Action are appreciative of this legislation as an important step to avoid disruptions in critical areas of telehealth access,” Kyle Zebley, senior vice president, public policy, the ATA, and executive director, ATA Action, said in that statement. “Looking ahead, we will immediately begin working to ensure Congress makes Medicare telehealth flexibilities and the Acute Hospital Care at Home Program permanent—or secures a much longer extension than 90 days. Simultaneously, we will advocate vigorously to reinstate the vital provisions that were left out of this package.”
Zebley went on to say that, “While we are encouraged that the Medicare flexibilities and AHCAH have been given a short-term extension, this is still far from an ideal outcome. We will continue to foster positive and productive collaboration with Congress and the White House, and expect even more work ahead, with heightened urgency, in the coming months with a new administration and Congress to ensure that high-quality patient care is uninterrupted.”
