AACU News & Notes
Congress Passes Sweeping COVID-19 Relief Package
posted: December 31, 2020
$900B bill bans surprise billing; provides relief to physician practices
In the waning hours of the 116th Congress, lawmakers passed a $900 billion stimulus package designed to assist those impacted by the COVID-19 pandemic and to boost the economy. The measure was attached to a $1.4 trillion omnibus spending bill that funds the federal government through FY 2021.
The Consolidated Appropriations Act, 2021, which President Trump signed into law on December 27, contains a variety of healthcare provisions that will directly impact physicians and patients. Summarized below are the measures AACU has been most actively engaged on over the last year, as well as in years past.
Surprise Billing Ban: The agreement prohibits “surprise” medical bills for out-of-network emergency and scheduled care. Importantly, billing disputes between payers and providers will be resolved through an independent and binding arbitration process. (Earlier legislative fixes proposed benchmarking payment rates to the median rate in the geographic area.) The measure also bans arbiters from considering providers' billed charges or the payment rates paid by Medicare and Medicaid programs. Out-of-network providers will be prohibited from “balance billing” unless they provide a cost estimate at least 72 hours before treatment and receive patient consent. For more on the No Surprises Act, read the AMA’s summary.
Budget Neutrality Cuts: The bill provides $3 billion to the Medicare Physician Fee Schedule to increase Medicare Part B payments by 3.75 percent in 2021. The additional funds, combined with a three-year moratorium on the implementation of a new complexity add-on code (G2211), will result in a conversion factor reduction of 4 percent instead of 10.2 percent in 2021. The AMA prepared a table estimating the impact of the Medicare payment changes on each of the medical specialties.
Provider Relief Fund: Under the deal, Congress injected an additional $3 billion into the Healthcare Provider Relief Fund, which reimburses providers for added expenses and lost revenue resulting from the pandemic. While significantly less than the $35 billion proposed in an earlier version of the bill, a provision in the relief package allows providers greater flexibility in terms of how they calculate and report lost revenue (budgeted vs. actual) when applying for relief grants.
Telehealth: The package includes $250 million in funding for the Federal Communications Commission’s COVID-19 Telehealth Program, which was created by the CARES Act in March to support healthcare providers in expanding or developing connected health platforms. The bill prioritizes the expansion of broadband connectivity in rural and underserved areas and enhances oversight of the program to ensure funds are allocated to eligible applicants in each state.
Graduate Medical Education: The legislation ends a nearly 25-year freeze by funding 1,000 new Medicare-supported GME positions. Residency slots will be prioritized for teaching hospitals in rural areas, in states with new medical schools, and hospitals that care for underserved communities. Hospitals that were adversely affected by small numbers of resident rotators will have a 5-year period to re-establish new per-resident amounts and GME caps.
There are many other health provisions in the 5,593-page bill that may also be of interest to AACU members, including:
- A two-year freeze on MACRA’s Alternative Payment Model (APM) incentive thresholds to allow more providers to qualify for a 5 percent APM payment
- A three-month delay of the 2 percent Medicare sequester cuts through March 31, 2021
- An additional $284 billion in forgivable loans under the small business Paycheck Protection Program (PPP)
- A ban on gag clauses in contracts between providers and payers so all parties can see cost and quality data on providers
The AACU will continue to monitor ongoing discussions in Congress to tweak or expand upon elements of the bill and looks forward to working with the incoming Biden Administration to implement the initiatives summarized above.