Federal budget continuing resolution battle could derail telehealth extensions, physician fee increase, PBM reforms

December 19, 2024 | by | No Comments

It’s two days to the Friday 20 December shutdown deadline for the expiring Federal budget extension. How can this be? The continuing resolution (CR) that would extend Federal budgets to 14 March 2025 is running into severe headwinds in Congress. Conservative Republicans in both houses, plus President-elect Donald Trump, and DOGE co-heads Elon Musk and Vivek Ramaswamy have come out against the 1,547-page CR.

Nearly all legislators have NOT read it, to no one’s surprise. Instead of a clean CR, it’s hung like a Christmas tree with ornaments like provisions on health care (discussed below).  Among the ornaments: permitting year-round sales of E15 ethanol fuel (a really bad idea), $100 billion in badly needed disaster aid, the rebuilding of the wrecked Francis Scott Key Bridge in Baltimore–and, outrageously, a pay raise for Congress members! (Somehow the spending-free requirement requiring AM radio in all vehicles sold in the US, a linchpin of our national Emergency Alert System, was forgotten.) All of these should have been handled in discrete bills passed much earlier, reducing the CR to a manageable 100 pages or less.

For context, the current Congress ends on 3 January 2025. New Members will be sworn in on that date if not before (in the case of vacant seats). Control of Congress will remain with Republicans in the House and switch to them in the Senate.

In healthcare, what was tossed on the tree at various points:

In telehealth, the American Telemedicine Association (ATA) applauded, perhaps too early, the following measures:

  • 2-year extension of Medicare telehealth flexibilities (Ed.–for geographic and originating sites plus types of providers)
  • 2-year extension of first dollar coverage of High Deductible Health Plans-Health Savings Accounts (HDHP-HSA) tax provision (Ed.–commercial coverage)
  • 5-year extension of Acute Hospital Care at Home program (Ed.–originally developed during the pandemic)
  • Allows cardiopulmonary rehabilitation services to be furnished via telehealth at a beneficiary’s home under Medicare in 2025 and 2026
  • 5-year extension of the Medicare Diabetes Prevention Program (MDPP) Expanded Model through 2030 and allows beneficiaries to participate virtually and in-person
  • Enacts the SPEAK Act which facilitates guidance and access to best practices on providing telehealth services accessibly

The Medicare physician fee schedule (Medicare PFS) has a 2.5% increase. This counteracts a 2.8% decrease enacted in November.

Bonuses to alternative payment models and a reauthorization of the SUPPORT Act for dealing with the opioid crisis.

PBM reforms. The bonuses would be paid for by transparency requirements for pharmacy benefit management (PBM) companies, including banning spread pricing in Medicaid and ensuring Part D plan sponsors delink PBM fees from the price of a drug. The PBM trade lobby charges that the delinking alone will increase premiums in Part D by $13 billion and benefit drug manufacturers.

FierceHealthcare 16 Dec, 16 Dec. Fox News  CBS News    This story is developing fast and will be updated.

Over 400 telehealth groups urge Congress to retain CARES Acts gains on remote care

July 28, 2021 | by

430 telehealth and remote care companies, along with major health providers and associations, have organized to petition Congress to make permanent the changes instituted by the Coronavirus Aid, Relief, and Economic Security (CARES) Act for the duration of the COVID-19 public health emergency (PHE). These changes will expire this year unless the pandemic emergency extends into 2022.

Like the Senate Telemental Health Care Access Act of 2021 that would extend telemental health Medicare coverage to patients without a prior in-person visit [TTA 16 June], the extension of CARES Act coverage would require Congressional action to amend the Social Security Act: for telemental health, Title XVIII; for telehealth, Section 1834(m). While the Telemental bill is actually in the Senate, the permanent expansion of telehealth and remote care would require its own and far more complicated bill and corresponding regulations.

Based on the letter (PDF link), these changes would include:

  1. Remove Obsolete Restrictions on the Location of the Patient and Provider. This is the rural geographic restriction.
  2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and
    Modalities for Telehealth. This would expand the list of practitioners, services, and also expand telehealth in some cases to audio-only consults.
  3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics
    Can Furnish Telehealth Services After the PHE. These are the ‘safety net’ providers for underserved and rural areas.
  4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services
    Offered Through Telehealth. This covers much the same ground as the Telemental bill.

What is unclear, of course, it being Washington, is how quickly Congress will bestir itself to enact these changes to existing law before the end of 2021 and the expiration of the CARES Act window with, presumably, the end of the PHE. American Telemedicine Association (ATA) release,  HealthcareITNews, FierceHealthcare