The next year can be challenging for Congress as it may take action on several key issues affecting healthcare providers.
Democrats are hoping to approve President Joe Biden’s $ 1.7 trillion social spending plan after December setbacks pushed negotiations towards 2022.
Lawmakers are also expected to focus on issues such as telehealth and mental health, which enjoy widespread support and urgent action in response to the COVID-19 pandemic.
Here’s a rundown of what might be on the agenda for next year:
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Biden and Congressional Democrats initially hoped to pass a health, climate and tax package by the end of 2021, but negotiations will move into the new year following resistance from moderate Senator Joe Manchin (DW.Va.). Manchin says he is worried about the cost of the bill and claims Democrats are hiding its true cost by extending some programs for just a few years with plans to re-authorize them in the future. The package will include a temporary expansion of subsidy eligibility under the Affordable Care Act, closing gaps in expanding Medicaid coverage across 12 states, building up a healthcare workforce, and more.
The pandemic led to an explosive increase in telemedicine use when the federal government extended Medicare coverage with temporary waivers. These waivers will expire at the end of the public health emergency and Congress is under pressure to make the changes permanent.
One of the key denials that must be stopped is allowing all Medicare members to use telemedicine services from home. Before the pandemic, Medicare paid for telemedicine services only for people living in rural areas, and they had to get these services in health facilities.
There is broad agreement on getting rid of site and geographic restrictions, congressional aides said. It is less clear whether Congress will do this permanently or only for a few years, and final decisions are likely to depend on cost.
“Cost is the biggest hurdle right now,” said Christina McCauley, Republican director of legislative affairs for Doris Matsui, California, who has worked on several bills to expand telemedicine.
While the public health emergency is currently wrapping up in mid-January, President Joe Biden is expected to extend it for at least another 90 days.
The most likely way forward is to expand flexibility for a few more years so that Congress can collect more data on cost and quality, say lobbyists monitoring the issue.
“I would be surprised if [public health emergency] should have ended and nothing happened, ”McCauley said.
Senate Finance Committee leaders are looking for ways to expand access to mental health care, possibly by increasing staff numbers, strengthening parity laws, and expanding telehealth.
Finance Chairman Ron Wyden (Democrat) and Distinguished Member. Mike Crapo (Idaho) requested stakeholder comments on ways to expand access to mental health care in September as lawmakers anticipate a bipartisan bill next year.
Demand for mental health care increased during the pandemic, while access to health care decreased, according to Chamber of Accounts of the Government… Even before the pandemic, there was a large unmet need for mental health services.
The GAO cites a shortage of behavioral health professionals, low reimbursement rates for providers, and the capacity of the health system as potential barriers.
One problem that is likely to arise is a requirement by President Donald Trump and Congress, passed last year, that Medicare patients using telehealth for mental health care should meet in person with their medical practitioners in advance.
Medical associations and support groups argue that this requirement is a barrier to mental health services, especially in rural areas where there are fewer providers. Legislation to repeal this rule enjoys bipartisan support.
A bipartisan bill, proposed by Susan DelBene (Washington State), Mike Kelly (Pennsylvania), and 244 other House Representatives, would simplify Medicare Advantage prior authorization and require more rapid identification of the services that plans typically approve. The measure has enough co-sponsors right now to pass it if it goes to a vote.
The bill is similar to a rule proposed by the Trump administration that would simplify prior authorization requirements for Medicaid and the child health insurance program, but not Medicare Advantage. The Biden administration put the initiative on hold.
The American Hospital Association and other provider groups pushed the Centers for Medicare and Medicaid Services to change and reissue the rule to include Medicare Advantage, but the agency did not take steps to do so.
“I hope that something – whether regulatory or congressional – will happen,” said Claire Ernst, director of government affairs at the Medical Group Management Association.
Congress is set to pass FY2022 appropriation bills early next year, which could include about $ 400 million for projects in hospitals and other healthcare facilities. Lobbyists also hope the package will include $ 10 billion in funding for hospital infrastructure, which leaders cut from a Democratic social spending bill this year.
This year, only the House has accepted appropriations for the Department of Health and Human Services. Under this law, HHS expects an increase of nearly 20% over fiscal 2021. This includes increased funding for the National Institutes of Health, the Centers for Disease Control and Prevention, and health workforce programs.
The Senate Finance Committee is likely to hold a hearing on the implementation of the 2015 Medicare and Re-Authorization Chips Act, which promoted cost-based care in Medicare’s physician payment system. Certain parts of the law will expire next year, including a 5% bonus for improved alternative payment models.
The duration of the bonuses “will really undermine the overall shift to value-based care at a time when we should double it, not back down,” said Allison Brennan, senior vice president of government for the ACO National Association.
Participation in accountable care organizations has declined in recent years, in part due to changes introduced by the Trump administration in 2018. A bipartisan bill supported by NAACO will roll back these changes.
Legislators are also planning a hearing on how MACRA changed the schedule for Medicare physician fees. Last year, CMS raised the salaries of primary care physicians, which resulted in lower rates for specialists. Congress stepped in to halt the cuts last year and this year, and lawmakers are envisioning a long-term solution to prevent Congress from having to deal with the issue every year.