The care was ordinary. A hospital in Modesto, California, treated a 30-year-old man for shoulder and back pain after a car accident. He went home in less than three hours.
The bill was extraordinary. Sutter Health Memorial Medical Center charged $44,914 including an $8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists and usually associated with the most severely injured patients.
The case, buried in the records of a 2017 trial, is a rare example of a courtroom challenge to something billing consultants say is increasingly common at U.S. hospitals.
Tens of thousands of times a year, hospitals charge enormously expensive trauma alert fees for injuries so minor the patient is never admitted.
In Florida alone, where the number of trauma centers has exploded, hospitals charged such fees more than 13,000 times in 2019 even though the patient went home the same day, according to a KHN analysis of state data provided by Etienne Pracht, an economist at the University of South Florida. Those cases accounted for more than a quarter of all the state’s trauma team activations that year and were more than double the number of similar cases in 2014, according to an all-payer database of hospital claims kept by Florida’s Agency for Health Care Administration.
While false alarms are to be expected, such frequent charges for little if any treatment suggest some hospitals see the alerts as much as a money spigot as a clinical emergency tool, claims consultants say.
“Some hospitals are using it as a revenue generator,” Tami Rockholt, a registered nurse and medical claims consultant who appeared as an expert witness in the Sutter Health car-accident trial, said in an interview. “It’s being taken advantage of” and such cases are “way more numerous” than a few years ago, she said.
Hospitals can charge trauma activation fees when a crack squad of doctors and nurses assembles after an ambulance crew says it’s approaching with a patient who needs trauma care. The idea is that life-threatening injuries need immediate attention and that designated trauma centers should be able to recoup the cost of having a team ready — even if it never swings into action.
Those fees, which can exceed $50,000 per patient, are billed on top of what hospitals charge for emergency medical care.
“We do see quite a bit of non-appropriate trauma charges — more than you’d see five years ago,” said Pat Palmer, co-founder of Beacon Healthcare Costs Illuminated, which analyzes thousands of bills for insurers and patients. Recently “we saw a trauma activation fee where the patient walked into the ER” and walked out soon afterward, she said.
The portion of Florida trauma activation cases without an admission rose from 22% in 2012 to 27% last year, according to the data. At one Florida facility, Broward Health Medical Center, there were 1,285 trauma activation cases in 2019 with no admission — almost equal to the number that led to admissions.
“Trauma alerts are activated by EMS [first responders with emergency medical services], not hospitals, and we respond accordingly when EMS activates a trauma alert from the field,” said Jennifer Smith, a Broward Health spokesperson.
Florida regulations allow hospitals themselves to declare an “in-hospital trauma alert” for “patients not identified as a trauma alert” in the field, according to standards published by the Florida Department of Health.
At some hospitals, few patients whose cases generate trauma alerts are treated and released the same day.
At Regions Hospital, a Level I trauma center in St. Paul, Minnesota, patients who are not admitted after a trauma team alert are “very rare” — 42 of 828 cases last year, or about 5%, said Dr. Michael McGonigal, the center’s director, who blogs at “The Trauma Pro.”
“If you’re charging an activation fee for all these people who go home, ultimately that’s going to be a red flag” for Medicare and insurers, he said.
In the Sutter case in Modesto, the patient sued a driver who struck his vehicle, seeking damages from the driver and her insurer. Patient “looks good,” an emergency doctor wrote in the records, which were part of the trial evidence. He prescribed Tylenol with hydrocodone for pain.
“If someone is not going to bleed out, or their heart is not going to stop, or they’re not going to quit breathing in the next 30 minutes, they probably do not need a trauma team,” Rockholt said in her testimony.
Like other California hospitals with trauma center designations, Sutter Health Memorial Medical Center follows “county-designated criteria” for calling an activation, said Sutter spokesperson Liz Madison: “The goal is to remain in position to address trauma cases at all times — even in the events where a patient is determined healthy enough to be treated and released on the same day.”
Trauma centers regularly review and revise their rules for trauma team activation, said Dr. Martin Schreiber, trauma chief at Oregon Health & Science University and board chair at the Trauma Center Association of America, an industry group.
“It is not my impression that trauma centers are using activations to make money,” he said. “Activating patients unnecessarily is not considered acceptable in the trauma community.”
Hospitals began billing trauma team fees to insurers of all kinds after Medicare authorized them starting in 2008 for cases in which hospitals are notified of severe injuries before a patient arrives. Instead of leaving trauma team alerts to the paramedics, hospitals often call trauma activations themselves based on information from the field, trauma surgeons say.
Reimbursement for trauma activations is complicated. Insurers don’t always pay a hospital’s trauma fee. Under rules established by Medicare and a committee of insurers and health care providers, emergency departments must give 30 minutes of critical care after a trauma alert to be paid for activating the team. For inpatients, the trauma team fee is sometimes folded into other charges, billing consultants say.
But, on the whole, the increase in the size and frequency of trauma team activation fees, including those for non-admitted patients, has helped turn trauma operations, often formerly a financial drain, into profit centers. In recent years, hundreds of hospitals have sought trauma center designation, which is necessary to bill a trauma activation fee.
“There must have been a consultant that ran around the country and said, ‘Hey hospitals, why don’t you start charging this, because you can,’” said Marc Chapman, founder of Chapman Consulting, which challenges large hospital bills for auto insurers and other payers. “In many of those cases, the patients are never admitted.”
The national number of Level I and Level II trauma centers, able to treat the most badly hurt patients, grew from 305 in 2008 to 567 last year, according to the American College of Surgeons. Hundreds of other hospitals have Level III or Level IV trauma centers, which can treat less severe injuries and also bill for trauma team activation, although often at lower rates.https://datawrapper.dwcdn.net/uhe6r
Emergency surgeons say they walk a narrow path between being too cautious and activating a team unnecessarily (known as “overtriage”) and endangering patients by failing to call a team when severe injuries are not obvious.
Often “we don’t know if patients are seriously injured in the field,” said Dr. Craig Newgard, a professor of emergency medicine at Oregon Health & Science University. “The EMS providers are using the best information they have.”
Too many badly hurt patients still don’t get the care they need from trauma centers and teams, Newgard argues.
“We’re trying to do the greatest good for the greatest number of people from a system perspective, recognizing that it’s basically impossible to get triage right every time,” he said. “You’re going to take some patients to major trauma centers who don’t really end up having serious injury. And it’s going to be a bit more expensive. But the trade-off is optimizing survival.”
At Oregon Health & Science, 24% of patients treated under trauma alerts over 12 months ending this spring were not admitted, Schreiber said.
“If this number gets much lower, you could put patients who need activation at risk if they are not activated,” he said.
On the other hand, rising numbers of trauma centers and fees boost health care costs. The charges are passed on through higher insurance premiums and expenses paid not just by health insurers but also auto insurers, who often are first in line to pay for the care of a crash victim.
Audits are uncommon and often the system is geared to paying claims with little or no scrutiny, billing specialists say. Legal challenges like the one in the Sutter case are extremely rare.
“Most of these insurers, especially auto insurance, do not look at the bill,” said Beth Morgan, CEO of Medical Bill Detectives, a consulting firm that helps insurers challenge hospital charges. “They automatically pay it.”
And trauma activation charges also can hit patients directly.
“Sometimes the insurance companies will not pay for them. So people could get stuck with that bill,” Morgan said.
A few years ago, Zuckerberg San Francisco General Hospital charged a $15,666 trauma response fee to the family of a toddler who had fallen off a hotel bed. He was fine. Treatment was a bottle of formula and a nap. The hospital waived the fee after KHN and Vox wrote about it.
Trauma alert fatigue can add up to a nonfinancial cost for the trauma team itself, McGonigal said.
“Every time that pager goes off, you’re peeling a lot of people away from their jobs only to see [patients] go home an hour or two later,” he said.
“Some trauma centers are running into problems because they run themselves ragged. And there is probably unneeded expense in all the resources that are needed to evaluate and manage those patients.”
The Biden administration is looking at the idea of expanding Medicare’s definition of medically-necessary dental coverage, according to a senator’s office, and such a move potentially could bring down the cost of congressional Democrats’ plan to add a new dental benefit to Medicare as part of a broad budget reconciliation package later this year. However, the administration has not committed to any action and whether the move would bring down costs depends on several factors, stakeholders said.
A spokesperson for Sen. Ben Cardin (D-MD), a long-standing Medicare dental coverage advocate, said the senator has supported expanding the medically-necessary dental services definition to cover additional medically necessary conditions, and continues to encourage the administration to make this change. The spokesperson said the request is on the administration’s radar.
CMS and the White House did not respond to a request for comment.
Medicare Part A currently covers a narrow set of medically-necessary dental services received in a hospital, and some Medicare Advantage plans offer dental benefits. Medicare statute prohibits coverage of routine dental care and dental prostheses.
Consumer advocates and progressive lawmakers have led a push for expanding Medicare benefits to include dental care, along with hearing and vision, and they hope to accomplish this through the budget reconciliation package. Senate Majority Leader Chuck Schumer (D-NY) announced Tuesday night that he intends to fully fund Medicare dental, hearing and vision care through the $3.5 trillion Senate budget resolution that budget committee Democrats agreed to earlier this week.
Schumer didn’t say how much money could be devoted to the new benefits. But draft Senate budget documents circulating in June put the cost at $299.6 billion over 10 years, with $233.6 billion of that to pay for dental care.
The Congressional Budget Office score of a new Medicare dental benefit might be driven down if CMS expanded the definition of medically-necessary dental coverage, said Meredith Freed, a policy analyst at Kaiser Family Foundation.However, the impact would depend on what services CMS moved to consider medically-necessary and which would be covered under a new law, among other things, Freed added.
Melissa Burroughs, associate director for strategic partnerships at Families USA, said it’s unclear how much an expanded definition of medically-necessary dental coverage would bring down the CBO score for a dental benefit, but she said research shows covering dental services would bring down other health care costs.
A community statement from over 150 medical and beneficiary organizations — including Families USA, the Center for Medicare Advocacy, AARP and the American Medical Association — points out that untreated oral infections are linked to many chronic conditions, which disproportionately affect Medicare beneficiaries and thus pose significant costs to the program. The statement implores Congress and the administration to look at options for extending dental coverage to Medicare beneficiaries.
Consumer advocates have called on CMS to expand the medically-necessary dental coverage definition for years and across administrations, saying the agency already has the authority to do so, but no action has been taken by CMS in the past. Then-CMS Administrator Seema Verma said in early 2019 that the agency was looking closely at medically-necessary dental benefits but worried the agency didn’t have the authority to cover expanded care.
The Center for Medicare Advocacy believes the statutory exclusion of dental care in Medicare doesn’t apply when the dental care is primarily for the purpose of preventing risks from other medical conditions or treatment, like when oral infections need to be addressed before heart surgery or chemotherapy, said Center for Medicare Advocacy Policy Attorney Kata Kertesz.
“Authorizing dental coverage in such circumstances does not require legislation, but could be accomplished by CMS more quickly, through a national coverage determination or policy guidance,” Kertesz said in an email.
The Biden administration hasn’t made any commitment towards expanding medically-necessary dental coverage, Kertesz said. But she added the Center for Medicare Advocacy has sensed some administration interest in and an understanding of the benefits of expanding the definition. CMA remains hopeful the issue will be addressed, Kertesz added. — Maya Goldman
Hospitals, doctors, hospices, home health agencies and others are asking Senate leadership in both parties not to extend Medicare sequestration to pay for some of the bipartisan infrastructure deal, but one lobbyist says there are a number of unanswered questions about how Medicare sequester cuts could factor into both the infrastructure bill and the Senate budget resolution deal announced earlier this week.
The American Hospital Association, American Medical Association, American Health Care Association, National Association for Home Care & Hospice, National Hospice and Palliative Care Organization and Association for Clinical Oncology asked Senate Majority Leader Chuck Schumer (D-NY) and Senate Minority Leader Mitch McConnell (R-KY) in a July 15 letter not to use Medicare cuts — through an extension of sequestration — to pay for the bipartisan infrastructure package.
Hospital groups had previously urged lawmakers to avoid using Medicare cuts to pay for non-Medicare projects last month when a document surfaced listing a sequester extension as an offset. But lawmakers continue to discuss how to pay for the infrastructure deal and reportedly are looking at changing some offsets, spurring health care providers to step up their lobbying to keep a sequester extension out of the package. Time is of the essence as Schumer has indicated he wants to move the infrastructure package as soon as this month.
AHA separately on Friday (July 16) also urged lawmakers not to take back COVID-19 provider relief funds to offset unrelated spending, and asked Congress to push HHS to release the rest of that funding.
On the sequester, the provider groups say they don’t believe Medicare funds should be used to pay for non-health care programs.
“Americans rely on hospitals and health systems, physicians, skilled nursing facilities, hospice and home care to care for them and maintain their health. We understand that addressing core infrastructure needs can allow us to continue to serve our communities and our patients,” the letter from the various provider groups about the sequester says.
“However, we are opposed to the use of an extension of mandatory Medicare sequestration as a pay-for in any infrastructure package. Additionally, we do not believe that Medicare funds should be used to pay for non-health care programs.”
The groups also say that extending sequestration adds a “destabilizing element to health care access” as experience has shown that Medicare pay bumps already don’t account for cost increases.
Lobbyists say that without infrastructure bill text, it’s not clear exactly how changes to sequestration cuts could play out in the infrastructure package, but the groups say the cuts should be taken off the list of possible pay-fors.
Schumer’s office did not respond to questions about the groups’ letter, or to questions on whether additional sequestration cuts coming down the pike due to the cost of the American Rescue Plan might be averted through either the infrastructure or budget resolution deals.
One lobbyist also said stakeholders will be watching to see how lawmakers handle the cost of the new packages, if they aren’t completely paid for, or whether any additional costs that could lead to more sequestration cuts might be kept from the so-called PAY-GO scorecard.
The lobbyist said those questions have all been asked, but nothing is clear at the moment.
Schumer has said the budget resolution deal could be fully paid for and such an option is “on the table.”
“One of the things that was presented in our caucus is that we could fully pay for the bill, that is one of the options on the table, that is doable,” Schumer said at a recent press conference.
The Medicare sequester is currently on hold until 2022.
Senate Democrats’ plan to expand Medicare coverage would help a growing senior population often struggling with hefty out-of-pocket medical expenses, potentially providing ballast for the economy in coming years.
Democrats on the Senate Budget Committee agreed Tuesday on a $3.5 trillion spending level for a bill to carry most of President Joe Biden’s economic agenda into law without Republican support. The bill would include one key item that wasn’t in Biden’s plans: vision, dental and hearing benefits for Medicare recipients, who are disproportionately those over 65 years old.
That would provide tens of millions of seniors — many of whom have low incomes — with care that they don’t currently have, likely boosting not only health spending but also freeing up money to go toward other goods and services, particularly essential goods. With 10,000 Baby Boomers turning 65 each day across the U.S., Democrats hope the expanded coverage will also help provide political wins.
“This would be a very significant change for Medicare,” said Tricia Neuman, executive director of the Kaiser Family Foundation’s program on Medicare policy, who said it would be the biggest change since the start of Medicare’s drug benefit in 2006. “How big an impact it will have will depend on the details of the proposals.”
Democrats are leaning toward expanding Medicare Part B, which pays for outpatient services, to include these new benefits, according to two senior Senate staffers familiar with the discussions. Like many other parts of Medicare, there would be no cost-sharing for preventative services and limited copays for elective procedures.
Part B is voluntary and includes premiums, which could rise with the addition of new benefits.
The additional benefits would increase Medicare spending by roughly $358 billion in the decade through 2029, according to a Congressional Budget Office estimate of a previous similar proposal. Two-thirds of that would be for dental and oral health, the nonpartisan agency said. Government spending on this level would provide a boost for gross domestic product.
Dental care, which is closely linked to overall health, is one of the most expensive services. About 30 million seniors haven’t had a dental appointment in the past year, according to Kaiser Family Foundation, including 16 million with annual incomes above $40,000.
About a quarter of Americans over 65 years old have disabling hearing loss, accordingto the National Institute on Deafness and Other Communication Disorders.
People with hearing loss have much higher health costs and lower employment, said Amanda Davis, a senior adviser at AARP. For Medicare-aged beneficiaries that carries knock-on costs for the government and retirement savings as those with hearing loss have less in savings and higher medical bills.
Hearing loss is estimated to cost those affected $297,000 over their lifetime, according to a study published in 2000 by the International Journal of Technology Assessment in Health Care. And the total national cost of first-year hearing loss treatment is projected to rise to $51.4 billion in 2030 from $8.2 billion in 2002, according to a 2010 study in Journal of the American Geriatrics Society.
Senate Democrats laid out an ambitious $3.5 trillion tax and spending agreement that’s slated to include a major expansion of both Medicare and Medicaid, paid for partly with cuts to prescription drug spending.
President Joe Biden hasn’t yet said himself whether he supports the proposal unveiled by Democrats on the Senate Budget Committee Tuesday night, though top aides have expressed enthusiasm. “We’re going to get this done,” Biden told reporters as he arrived at the Capitol yesterday to meet with senators on the measure.
If it holds, the budget agreement will be a victory for the president, bridging divisions among party factions over the size and scope of the package. But it’s a crucial moment for Biden, who will need to persuade Democratic progressives to agree to lower spending more than they wanted while keeping moderates from balking at the price tag. The budget measure would accompany a separate, $579 billion bipartisan infrastructure plan that Biden has endorsed, raising the total spending of his economic agenda beyond $4 trillion.
A senior Democratic official said the $3.5 trillion in proposed spending would be offset by health care savings, tax hikes on companies and the wealthiest Americans, and economic growth.
One leading proponent of closing the “Medicaid gap” said yesterday that extending coverage to more than 2 million Americans will have a hefty price tag, possibly as much as $400 billion, Alex Ruoff reports.
Sen. Bernie Sanders (I-Vt.) told reporters that the budget resolution will include a placeholder for extending insurance coverage to the roughly 2.2 million people in 12 states who could’ve been in Medicaid if their state governments would expand their public health insurance programs under the Affordable Care Act’s rules.
However, a debate continues over the best way to accomplish that goal and proponents say it’s costly.
Rep. Lloyd Doggett (D-Texas) said it could cost $400 billion to get all 2.2 million covered. Some of Doggett’s colleagues have floated the idea that the ACA has already paid for this cost, but the Texas Democrat rejected that as “wishful thinking.”
“The notion that we already paid for it is not going to fly with the Congressional Budget Office,” Doggett told reporters yesterday.
The price tag is the main impediment for including this in a budget reconciliation package, Rep. Jim Clyburn (D-S.C.), the House Majority Whip, told reporters. “All the ways are pretty expensive and that’s the reticence part,” he said.
Medicare Expansion Would Help Seniors: The plan to expand vision, dental and hearing benefits for Medicare recipients, who are disproportionately those over 65 years old, would help a growing senior population often struggling with hefty out-of-pocket medical expenses, potentially providing ballast for the economy in coming years.
It would provide tens of millions of seniors — many of whom have low incomes — with care that they don’t currently have, likely boosting not only health spending but also freeing up money to go toward other goods and services, particularly essential goods. With 10,000 Baby Boomers turning 65 each day across the U.S., Democrats hope the expanded coverage will also help provide political wins.
Democrats are leaning toward expanding Medicare Part B, which pays for outpatient services, to include these new benefits, according to two senior Senate staffers familiar with the discussions. Like many other parts of Medicare, there would be no cost-sharing for preventative services and limited copays for elective procedures. Part B is voluntary and includes premiums, which could rise with the addition of new benefits. Read more from Katia Dmitrieva and Alexander Ruoff.
Nursing homes want HHS to release the estimated $24 billion in unallocated provider relief soon and allocate $10 billion specifically for nursing homes, estimating nearly 2,000 facilities are at risk of closing over the course of the pandemic.
The American Health Care Association and National Center for Assisted Living warned of possible closures over a month ago when it asked for more provider relief and joined other advocates to ask HHS to extend the provider relief spending deadline beyond June 30. Nursing homes also drummed up support from 50 lawmakers, who on June 4 asked HHS to dedicate $10 billion in provider relief for long-term care facilities.
HHS stopped short of giving a complete extension on June 11 and instead tied the spending deadline to when providers received relief, giving each recipient one year to spend all their relief.
AHCA renewed its call in a press release Monday (July 12) for HHS to quickly distribute the remaining provider relief.
The last provider relief distribution was announced in October, and HHS is still making distributions to providers — sometimes months after they applied. Some experts see the existence of a fourth reporting period as proof that there will be another provider relief distribution. In December, Congress directed HHS to consider provider losses and expenses through March 2021 when determining the next distributions.
“While overall the situation has improved, this battle with the virus is not over, and now we face a new battle. Our sluggish economic recovery puts thousands of facilities in danger of closing, threatening access to long term care for vulnerable seniors and individuals with disabilities,” Mark Parkinson, AHCA president and CEO, said in the press release Monday.
AHCA found in a recent survey of members that only 24% of long-term care facilities are confident they can stay afloat until next year. Nursing homes say on top of long-standing Medicaid underfunding, they’re dealing with increased costs and reduced revenue.
The American Hospital Association has also asked HHS to quickly distribute the remaining provider relief. Hospitals also are concerned, according to a letter to Senate leadership on June 29 that Congress might try to use outstanding provider relief and an extension of the Medicare sequester to offset the bipartisan infrastructure deal’s costs. Hospitals again raised concerns about a possible sequester extension in a letter this week.
The administration and Congress have yet to announce whether they plan to use provider relief or the Medicare sequester to pay for the final bipartisan infrastructure bill, though both were listed in an earlier document on the bipartisan deal. — Dorothy Mills-Gregg (dmillsgregg@iwpnews.com)
Senate Majority Leader Chuck Schumer (D-N.Y.) set a deadline to wrap talks on both the bipartisan infrastructure package and an agreement among all Democrats on moving forward on a budget resolution.
The move puts pressure on Republicans to cut a deal quickly on the $579 billion infrastructure plan and on moderate Democrats to agree to the $3.5 trillion budget blueprint that is moving on a separate, parallel track. Schumer has to manage the tension between centrist Democrats who have led a push for the bipartisan measure, and the party’s progressives, who don’t want to move forward on infrastructure without assurances their priorities will be addressed in the bigger, Democrats-only budget package.
“The time has come to make progress. And we will,” Schumer said today on the Senate floor.
Schumer said he would take a crucial procedural step on Monday that would clear the way for an initial vote next Wednesday on the on the $579 billion infrastructure package. He also said he wants Senate Democrats to agree by Wednesday on moving forward with the budget resolution that will carry other major portions of President Joe Biden’s agenda.
The move creates some political risk. Republicans don’t want the two packages linked, and some Democrats are withholding their support for the budget plan until more details are filled in. In addition, some GOP senators are balking at moving forward on the infrastructure plan without having legislation fully ready. Schumer would need 60 votes in the 50-50 Senate to proceed.
The group of Democratic and Republican senators working on the infrastructure bill were meeting today in an attempt to complete negotiations and discuss Schumer’s deadline. Read more from Erik Wasson and Steven T. Dennis.
Meanwhile, Speaker Nancy Pelosi (D-Calif.) said today the House can be expected to change and “realign some of those priorities” contained in the $3.5 trillion Senate Democrat budget blueprint, Billy House reports.
Senate Majority Leader Chuck Schumer set a Wednesday deadline for agreements on the duo of packages carrying President Joe Biden’s infrastructure and economic agenda, putting pressure on Republicans and moderate Democrats.
The House Ways & Means Committee is looking at a proposal to close the so-called Medicaid gap by expanding premium tax subsidies so that those affected could buy an exchange plan, according to health subcommittee Chair Lloyd Doggett (D-TX), but he said the House Energy & Commerce Committee is drafting a plan to close the gap through a new federal Medicaid-like program.
The work comes as congressional leaders lay plans to tackle the Medicaid gap issue as part of Democrats’ upcoming reconciliation package.
Both approaches have advantages and disadvantages, Doggett said during a webinar hosted by the Southerners for Medicaid Expansion coalition Wednesday (July 14). The purported Energy & Commerce proposal would provide more comprehensive coverage and benefits than exchange plans, but it would take time to set up. The Ways & Means proposal could be established quickly but there are questions about how to deal with deductibles and co-pays with exchange plans, the congressman said.
Doggett, who has also introduced a bill that would let local governments expand Medicaid themselves in non-expansion states, said he wouldn’t disparage either approach. But he added that he doesn’t want to see a temporary fix or a solution that switches people between the marketplace and Medicaid.
“That is a false hope and confusion for disadvantaged people that will just mean that they don’t get what they deserve after more than a decade of waiting,” he said.
A spokesperson for Ways & Means did not directly answer questions about the details of the proposal Ways & Means is crafting, but said the committee is working with others, as well as congressional leadership, and details are still being worked out. The spokesperson said the committee wants to find a comprehensive solution that can be implemented quickly.
An Energy & Commerce spokesperson did not respond to questions about Doggett’s assessment of the committee’s plan.
Several Democratic lawmakers, including House Majority Whip Jim Clyburn (D-SC), have said getting these people coverage is a priority in the upcoming reconciliation package, likely to be voted on this fall. Sen. Raphael Warnock (D-GA) already introduced a bill Monday (July 12) that takes the route Energy & Commerce is reported to be exploring by directing CMS to create a federal Medicaid look-alike program available in the states that have not yet expanded Medicaid to people making up to 138% of the federal poverty level.
Senate Majority Leader Chuck Schumer (D-NY) told Inside Health Policy Wednesday morning there is space for legislation to close the so-called Medicaid coverage gap in the $3.5 trillion budget resolution presented Tuesday night (July 13), which provides a framework for the reconciliation package. House Speaker Nancy Pelosi (D-CA) reaffirmed this in a letter sent to House members about the budget deal Wednesday.
Schumer did not give details on how much money could be devoted to closing the Medicaid coverage gap, but a senior Democratic aide said the deal will be offset in part by drug pricing reforms, including a repeal of the Trump administration’s rebate rule.
A press release for Warnock’s bill said the plan requires no additional offsets, since Congress already appropriated funding for Medicaid expansion in the Affordable Care Act. But Doggett disagrees.
“The notion that we already paid for it is not going to work with the Congressional Budget Office,” Doggett said. “We haven’t already paid for it, and in fact, most of the pay-fors for the Affordable Care Act have been subsequently repealed by Congress.”
The Urban Institute put out a report on June 30 estimating how much it would cost to expand eligibility for premium tax credits for exchange plans to people making below 100% of the federal poverty level.
This kind of expansion, using the ACA’s subsidy schedule from before the American Rescue Plan enhancement of the subsidies, would cost the federal government an estimated $181 billion over 10 years. Enhancing all subsidies to match the ARP would cost $270 billion over 10 years, and enhancing premium and cost-sharing subsidies would cost $335 billion over 10 years, the report says.
A follow-up report published Wednesday from some of the same researchers found that a public option that pays providers at Medicare rates and is offered in the exchanges to people in the Medicaid coverage gap would cost the federal government less than using exchange benchmarks. — Maya Goldman
Home health agenices want the Biden administration to reconsider a proposed rule that would reduce their Medicare payment rate by nearly 4.4% for a third straight year in 2022.
The “behavior assumption adjustment” in the proposed Home Health Prospective Payment System rule would lower Medicare payments, on the “assumption” that home health agencies would alter their billing and coding activity to maximize reimbursements under the Patient-Driven Groupings Model (PDGM), a value-based payment system that Medicare implemented in 2020.
After lowering payments by nearly 4.4% in 2020 and 2021, the PDGM’s behavioral adjustment and other factors call for another 4.36% reduction in 2022 in order to meet federal budget neutrality requirements.
But industry groups say the Centers for Medicare & Medicaid Services is setting payment rates based on flawed assumptions about agencies’ anticipated behavior under the PDGM system. They cite a recent analysis of 2020 Medicare claims data by health economists at Dobson DaVanzo & Associates, that shows agencies didn’t change their billing and coding practices as the CMS expected.
The dispute is the industry’s latest dust up involving the PDGM, the biggest change in Medicare home health reimbursement in more than 20 years.
“To continue this cut for the third year, we think is not appropriate,” said Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare. “We think the 4.36% cut should be halted.”
The proposed rule expects some home health agencies to list the highest paying diagnosis code as the “principal diagnosis code” in order to “be placed into a higher-paying clinical group.”
It also anticipates agencies will report more patient ailments, or “secondary diagnoses,” in order to receive a “comorbidity adjustment” to their Medicare payments. It further envisions agencies increasing home visits to get higher Medicare payments.
William Dombi, president of the National Association for Home Care & Hospice, questioned the methodology, calculations, and modeling that the CMS used to project the likelihood of these questionable practices.
“Looking at behavioral changes is completely different from simply looking at the outcome of a model from a spending perspective,” Dombi said. “They need to go back to the drawing board to come up with a methodology that fits an analysis of behavioral change.”
Home health agencies provide services to beneficiaries who are homebound and need skilled nursing care or therapy. In 2019, traditional Medicare spent $17.8 billion on home health services for 3.3 million beneficiaries, according to the Medicare Payment Advisory Commission.
While home health care is far less costly than institutional care, Medicare has historically overpaid for services. This limits their cost-saving impact on the program.
The PDGM sets Medicare payments for home health agencies based on patients’ clinical characteristics—like the type and severity of ailment—rather than the volume of care provided. It’s part of Medicare’s move to value-based care, a concept that’s replacing traditional fee-for-service payments by creating greater incentives for providers to control costs and improve patient outcomes.
The PDGM was designed to curb the volume of therapy services provided by home health agencies. But ever since it was implemented in 2020, industry groups have chafed at the behavioral assumptions Medicare uses to adjust payments.
The CMS originally expected sketchy billing and coding practices to increase Medicare’s home health payments by 6.4%, or $1 billion, in 2020. Similar estimates have since guided agency efforts to reduce the payments.
But the the industry-backed study found that Medicare home health spending was 1.3% lower than projected in 2020.
“Given Medicare’s own data about home health provider behavior, it is troubling that the agency continued the unjustified behavioral assumption cut for 2022,” Cunningham said in a recent partnership statement. “However, we remain encouraged that the agency states their intent to continue examining the data with the prospect of a future payment adjustment. We intend to continue working with the agency to ensure an adjustment is properly made.”
Dombi said any rate cuts should be based on actual observed evidence of billing and coding misbehavior. But with only the Covid-affected data from 2020—the first year that PDGM was implemented—the CMS has to rely on its projections until enough data is available.
“We hoped we wouldn’t have any kind of contentious circumstances with this proposed rule out there. But there does seem to be, at its core, a significant difference of view as to what CMS should be looking at,” Dombi said.
Both groups are expected to submit formal comments to the CMS on the proposed rule.
Senate Democrats say they’ll fully pay for their $3.5 trillion plan for child tax credits, climate measures, education, and other measures, but it’s unclear how many of their proposed pay-fors will actually raise revenue or cut spending.
Democrats plan to adopt a budget resolution with reconciliation instructions for a major legislative package that would include corporate tax hikes and a higher income tax for top earners, according to an outline by a senior Democratic aide. An expansion of Medicare would be funded by cuts to drug prices, while higher emission standards and carbon tariffs would be used to combat climate change, Bloomberg News’ Jordan Fabian and Erik Wasson report.
But the plan also banks on “long-term economic growth” as a pay-for, a reference to dynamic scoring, which could score the bill as less costly due to potential economic growth spurred by its investments.
Sen. Joe Manchin (D-W.Va.), a key moderate, told reporters he’s OK with some reliance on dynamic scoring in the effort to ensure the bill is fully paid for. But Manchin said he raised concerns during a lunchtime meeting between President Joe Biden and Senate Democrats that inflation could be triggered by a flood of spending.
“I said I’m concerned about inflation, and I said I want to see more of the details,” Manchin told reporters yesterday.
Related: Manchin, Tester Hold Back on Budget Deal Awaiting Details
More broadly, though, some fiscal conservatives are wary of the promise that the $3.5 trillion bill’s cost will be fully offset. Maya MacGuineas, president of the Committee for a Responsible Federal Budget, said she’s concerned lawmakers won’t rely on entirely legitimate offsets, especially because they relied on gimmicks to agree to pay-fors in infrastructure talks.
“So far, the only real indication we have is the bipartisan infrastructure bill, which is the first piece of all of this, and a lot of the pay-fors unfortunately are either exaggerated or not going to score properly,” MacGuineas said in an interview on Bloomberg Radio’s Balance of Power yesterday. “And they call it fully paid for, but it’s going to come up well short of that promise. That leaves me very concerned that this next bill will also not be really paid for in a meaningful way.”
Read more: Biden Agenda Gains Senate Ground With Big Hurdles Remaining
Bicameral Agreement: Speaker Nancy Pelosi (D-Calif.) praised the Senate Democratic outline yesterday, calling it “a victory for the American people” in a letter to colleagues. “Our House Committees stand ready to work with the Senate, as this topline agreement is turned into legislative text,” Pelosi wrote.
Firearm injuries in the U.S. cost more than $1 billion per year, with public insurance programs picking up more than half the tab, according to a federal watchdog.
Senate Democrats’ $3.5 trillion spending package will unleash a gusher of hundreds of billions of dollars for progressive priorities, from climate programs to an expansion of Medicare to promised green cards for some undocumented immigrants, according to new details released on Wednesday.
Majority Leader Chuck Schumer, Budget Chair Bernie Sanders (I-Vt.) and Sen. Mark Warner (D-Va.), a moderate on the budget panel, briefed the rest of the Democratic caucus during lunch with President Joe Biden in the Capitol on Wednesday. They discussed some of the biggest components of the planned spending bill that Democrats aim to pass without Republican support using the budget process. That filibuster-proof process starts with a budget resolution, which Senate Democrats have agreed to set at a ceiling of $3.5 trillion.
And while that resolution’s text is still forthcoming, once it arrives it will have few specifics of how Democrats will turn Biden’s priorities into legislation. That makes the policy highlights unveiled Wednesday, as vague as they are, a meaningful spotlight on the scope of the party’s spending ambitions, which would be financed by a shaky combination of tax reform, health savings like lowering prescription drug costs, and the assumption of long-term economic growth.
“Let me be clear — this is a huge bill. This is a complicated bill. This is a transformative bill,” Sanders told reporters after lunch. “In some cases, it doesn’t provide all the funding that I would like right now.”
But with 50 Democrats in the upper chamber and no votes to lose, “compromises have to be made,” Sanders said.
The proposal would expand Medicare to cover dental, vision and hearing services for seniors. It would also fund health care for about 2 million people living in red states that have refused to expand Medicaid. Both provisions were major priorities for liberals, who had originally pushed for trillions of dollars more in a total package.
As promised, the plan will include key commitments from Biden’s “families” and “jobs” plans, including universal prekindergarten for 3- and 4-year-olds, child care subsidies and an increase in the maximum Pell Grant to defray college costs for lower-income students. Democratic leaders also intend to fulfill the president’s pledge to provide more nutrition assistance, paid family and medical leave, and affordable housing.
Democrats plan to use the package to extend the popular increase in the Child Tax Credit, which Congress boosted in March, to a maximum of $3,600 a year for children under 6 years old and $3,000 for older kids. The plan would also continue the current increase for the Earned Income Tax Credit and the tax break for child care costs.
Many Democrats have called for a permanent extension of the Child Tax Credit, which the IRS will start sending out in monthly payments on Thursday. But Senate Democrats aren’t yet specifying the length of the extension they want to provide, stressing that it depends on the cost of the bill and additional input from lawmakers.
Rep. Pramila Jayapal (D-Wash.), who leads the Congressional Progressive Caucus, cited key wins during a call with reporters on Wednesday, including universal child care, paid leave and the Medicare expansion provisions.
“There isn’t a big area of our priorities that was left out,” she said. Still, progressives will be pushing for bigger investments in child and elder care.
“You can be assured, we are pushing for as much as we can possibly get,” Jayapal said.
The inclusion of immigration policy in Democrats’ still-unwritten party-line spending bill is another huge demand for both progressives and members of the Congressional Hispanic Caucus. Both groups were relieved to see their issue included in the budget highlights, though they received few details. It’s also unclear if immigration reform will withstand the scrutiny of the Senate parliamentarian, the official who decides which provisions pass muster with the byzantine rules guiding the budget reconciliation process that governs the bill’s fate.
Progressives and Hispanic Caucus members have pushed for a pathway to citizenship for several key undocumented groups, including so-called Dreamers who were brought to the U.S. as children and “essential workers” during the pandemic, including farmworkers. But a senior Democratic aide confirmed only that the budget would include legal permanent residence for immigrants, without providing additional details — which may not be known for weeks.
The early approval that the budget blueprint won from the left wing of the party didn’t extend across the entire House Democratic caucus. Several moderates privately balked at the overall price tag, which they feared would require hefty tax hikes to pay for the package and fuel GOP attacks.
To help pay for the plan, Senate Democrats plan to beef up tax enforcement and raise corporate and international taxes. They are also seeking to hike rates on “high-income” individuals, but have yet to agree on exactly what income brackets would be hit and how much more those earners would pay.
Three kinds of tax hikes are off that table, however: increases on families making less than $400,000 a year, small businesses and family farms — a sign that Democrats are leery of attacks casting them as “tax-and-spend” liberals.
On climate, Democrats plan to include a clean energy standard that would deliver 80 percent clean electricity by 2030. How to structure that standard in order to survive the arcane reconciliation rules remains unclear, although Democrats and environmental advocates have brainstormed a number of possible approaches.
The budget resolution would also spell out funding for clean energy and electric vehicles incentives, a civilian climate corps, a clean energy accelerator and programs to boost weatherization and electrification of buildings. Democrats are pledging to deliver on Biden’s promise to curb greenhouse gas emissions by 50 percent across the U.S. economy by 2030.
Democrats are also calling for “methane reduction” and “polluter import fees,” though it was not immediately clear what those policies would entail.
Some of the climate provisions are already giving Sen. Joe Manchin (D-W.Va.) heartburn, however. After lunch with Biden, Manchin, a centrist whose vote will be critical to the budget’s success, said he’s concerned about fossil fuels getting short shrift in the final bill.
“I want to see more of the details,” he said.
The policy details unveiled Wednesday are a meaningful spotlight on the scope of the party’s spending ambitions.
Senate negotiators struggled Tuesday to shore up enough support for both a bipartisan infrastructure bill and a large tax and spending measure backed only by Democrats, marking a significant political hurdle for quick congressional approval of President Joe Biden’s $4 trillion economic agenda.
A group of 22 Democratic and Republican senators plans to huddle Tuesday night to sort out lingering problems with their proposed $579 billion physical infrastructure package, while a separate group of Senate Democrats will meet in the evening to discuss the top-line spending level for the second package.
The biggest issue for the infrastructure bill is how Congress intends to pay for it — through increased tax enforcement and user fees — as well as re-purposed pandemic relief money and incentivizing private investment.
The nonpartisan Congressional Budget Office has not agreed with the senators that a $40 billion investment in the IRS will net $100 billion in newly collected tax revenue. Some Republican senators who previously supported the deal said that poses a problem.
Republican Senators Jerry Moran of Kansas and Mike Rounds of South Dakota said they want to see the bill fully paid for in a CBO score. Rounds, however, added that he felt the bill was “getting there.”
Other Republican senators, such as lead negotiator Rob Portman of Ohio and Mitt Romney of Utah, are more willing to forgo official CBO blessing if they are convinced the bill pays for itself. The White House has previously said there is $1 trillion in unpaid taxes to be reaped from increased audits.
Romney said the CBO isn’t likely to give senators full credit for beefed up Internal Revenue Service enforcement, dynamic scoring — which counts on revenue gains from anticipated faster growth — and other items the group believes will pay for the package.
“My test is, is it paid for in my own mind,” Romney said.
Republicans also remain concerned that Democrats will link passage of the infrastructure bill to the budget measure, which so far has no GOP support.
Senator Thom Tillis of North Carolina, one of the 11 Republicans to back the tentative infrastructure deal, said his biggest concern is that House Speaker Nancy Pelosi wants to tie approval of the infrastructure package in her chamber to Senate clearance of the budget resolution.
“I’m actually more concerned about what I’m hearing from Speaker Pelosi on the linkage of this bill to reconciliation. We’ve got to get that sorted out,” Tillis said.
Democrats, who met privately with White House officials Monday night, remain divided over the size of the budget resolution, which would essentially serve as a blueprint for much of Biden’s domestic agenda.
Senate Budget Chairman Bernie Sanders is still fighting for a $6 trillion package, with only $3 trillion of that paid for through tax increases and allowing Medicare to directly negotiate drug prices with pharmaceutical companies. Sanders wants to add an expansion of Medicare, immigration reform, expanded child tax credits and other social spending to Biden’s proposal.
But that is a problem for the most conservative Democrat in the caucus, Joe Manchin of West Virginia, whose vote will be pivotal. Unity is key for the party in the evenly divided Senate, where Vice President Kamala Harris casts tie-breaking votes to pass legislation without Republican support.
Manchin told reporters Tuesday that both the infrastructure bill and the second measure “should be fully paid for.”
“We have put enough free money out,” he said.
Manchin has also said he would not back the full corporate tax increase Biden has proposed, to 28%, favoring instead a 25% rate.
Budget Committee Democrats have said they hope their Tuesday night meeting can clear away some of the differences and allow for a Senate floor vote as soon as next Tuesday.
Democrats are planning to skip formal committee votes and bring the budget resolution, which will outline ceilings for spending and floors for revenue in the follow-on tax and spending package, directly to the floor. Votes this month on the budget will set up further action on that second package in September, or later.
A Democrat attending both sets of Tuesday meetings said to take the turbulence with regard to both tracks in stride.
“A lot of these deals die a thousand deaths before they actually get through,” said Senator Mark Warner of Virginia.
A coalition of health-care organizations called on medical facilities Tuesday to mandate that their workers get vaccinated against the coronavirus, saying the strategy has worked to fight influenza and other infectious diseases and is necessary to contain the pandemic.
“COVID-19 vaccination should be a condition of employment for all healthcare personnel,” the coalition’s statement reads, warning that “a sufficient vaccination rate is unlikely to be achieved” without a vaccine mandate.
The statement and accompanying guidelines — signed by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America and five other medical groups — come amid a raging debate about health care, as some organizations impose new vaccine requirements and as infectious-disease expert Anthony S. Fauci suggested last weekend that “there should be more mandates” at the local level to curb virus spread.
But federal officials have balked at instituting national requirements on health-care workers, and many health-care organizations have said they do not plan to require their staff members to get vaccinated against the coronavirus. Some nurses and other health-care personnel have quit or sued organizations that imposed coronavirus vaccine mandates, claiming that the measures are unethical or illegal, although a federal judge rejected one such lawsuit last month.
The guidelines announced Tuesday — which include recommendations for engaging wary employees, navigating regulations and how to enforce a mandatory coronavirus vaccination policy — were crafted by a team of nearly 30 experts during the past two months.
“We think [it] will provide support for organizations that were thinking about making the vaccine a condition of employment for their health-care workers,” said Hilary M. Babcock, an infectious-disease expert at Washington University School of Medicine in St. Louis and a past president of the Society for Healthcare Epidemiology of America, who co-wrote the guidelines.
Although cases of covid-19, the disease caused by the virus, have plunged nationally, Babcock said the vaccine push remains a priority, pointing to a new outbreak in her state driven by the delta variant.
“If this [variant] isn’t affecting your local community, the next one potentially might,” she said. “It is still a good practice to try and get all health-care workers vaccinated so that they are protected.”
Outside experts agree that vaccine mandates are warranted, more than a year into the pandemic and with tens of millions of adults still refusing to get vaccinated despite the wide availability of shots.
“One thing that really upsets me is we’re hitting a wall,” said Paul A. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, lamenting that national vaccination rates have stalled and that the virus continues to spread. “What do you do then? And I think the only answer to that question is you compel people to vaccinate. It’s certainly legal. It is not your inalienable right as a U.S. citizen to catch and transmit a potentially fatal infection.”
A number of health systems, including in Maryland and D.C., have moved to require coronavirus vaccines for their employees, arguing that they are essential to protect staff and vulnerable patients. The strategy has boosted vaccination rates: More than 2,000 employees at the University of Pennsylvania Health System in Philadelphia have received shots since the system announced in May that it would require all staff members to be vaccinated by September, said Patrick J. Brennan, the system’s chief medical officer.
But many other organizations have balked, noting that the vaccines have yet to receive full approval from the Food and Drug Administration. The American Hospital Association — which has repeatedly called for mandatory flu shots for health-care workers — has yet to weigh in on coronavirus vaccine mandates. The hospital organization said it is continuing to consult with members and clinical experts on the path forward.
“Let’s be honest,” said Ashish K. Jha, dean of Brown University’s School of Public Health, “some health systems are bold and creative, but a lot of them just want to stay below the headlines and just do their thing and don’t want to be courageous. And right now, this feels courageous because they know they’re going to get some pushback from some small minority of employees, and they’d rather not take that on.”
Jha, who has argued that the Hippocratic oath “demands” that health workers get vaccinated, said holdout hospitals’ concerns were probably overblown, citing the example of Houston Methodist. More than 97 percent of that hospital system’s workers complied with a vaccine mandate, with about 2 percent requesting exemptions and the remaining 153 workers getting fired or resigning last month.
“If hospitals do it in concert … the number of health-care workers who will quit and move is pretty tiny,” Jha predicted. “You’re not going to have 20 percent of health-care workers move out of a city or a state.”
But Jha said he was concerned to learn that some of the unvaccinated workers who left Houston Methodist had been hired by other institutions. “The risks that they pose have now been transferred from Houston Methodist to other institutions,” he said. “The organizations that are stepping up and saying, ‘We’ll hire unvaccinated front-line health-care workers’ … I find [that] a bit more puzzling.”
Some prominent children’s hospitals, such as Boston Children’s Hospital and Children’s Hospital of Philadelphia, have yet to require their staff members to be vaccinated, despite treating many patients who are not yet eligible to receive vaccines. The FDA has yet to authorize coronavirus vaccines for children younger than 12.
Jha said he was disappointed that children’s hospitals had not led the way on vaccine mandates.
“Children’s hospitals literally have a vast majority of their patients unvaccinated — and yet, most children’s hospitals that I’m aware of have not mandated this,” he said. “That strikes me as particularly stunning. And I don’t understand that.”
Offit, who is helping to craft vaccine policies at Children’s Hospital of Philadelphia, said he expects more holdout organizations to move forward with vaccine requirements, including his own.
“We are going to mandate this vaccine, that’s going to happen, [but] I suspect it’s probably not going to happen until these vaccines are approved, which will be soon,” he said. “We just found a lot of the people who were resistant for that reason, even though it’s a bad reason.”
Most physicians, surgeons, and specialists would see only minor increases or reductions in their Medicare payment rates next year under a proposal released Tuesday by the Biden administration.
The rate reductions outlined in the proposed 2022 Medicare physician fee schedule are due to budget neutrality provisions in the Medicare Act that require program payment hikes be offset by equal reductions elsewhere.
In 2021, the Consolidated Appropriations Act provided a “one-time, one-year increase in the Medicare physician fee schedule of 3.75%” to “provide relief during the COVID-19 public health emergency.” The legislation effectively averted a 3.75% cut in 2021 for providers, who were struggling to recoup revenue they had lost during the pandemic.
Congress isn’t likely to do the same in 2022, now that the Covid-19 vaccines have caused infections and deaths to plummet. But a host of medical organizations are seeking congressional action to head off the proposed cut and others that could be coming later.
David B. Hoyt, executive director of the American College of Surgeons, was still going over the 1,700-plus page rule Tuesday evening, but expressed concerns about the pay cuts.
“It appears that while CMS is taking notable strides to improve health equity and access to care, the rule maintains the cuts to surgical care that Congress stopped last year,” Hoyt said in a statement on behalf on the Surgical Care Coalition. “These cuts harm the care patients need and deserve, which is the opposite of what CMS is trying to achieve. Without congressional action, surgical care faces a significant payment cut and threatens patient access to critical treatments and procedures.”
Under the new proposed rule from the Centers for Medicare & Medicaid Services, the multiplier—or “conversion factor” used to determine reimbursement for services and procedures in traditional Medicare—would drop slightly to $33.58 in 2022 from $34.89 in 2021. That would erase the one-time 3.75% increase awarded for 2021.
In a statement, Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association, said his organization “is concerned about the potential impact of the proposed 3.75% reduction to the conversion factor due to budget neutrality requirements and will seek congressional intervention to avert the cut.”
In the new proposal, audiologists, cardiac surgeons, pathologists and infectious disease specialists would see a 1% reduction in payments. Cardiologists, allergy/immunologists, and those practicing nuclear medicine and hematology/oncology would see a 2% reduction.
Interventional radiologists, however, would see cuts of 9%, and vascular surgeons face an 8% reduction, while radiation oncologists and radiation therapy centers would see a 5% Medicare pay cut.
Payment rates wouldn’t change for clinical psychologists and social workers, colon and rectal surgeons, critical care providers, general surgeons, or nephrologists under the proposal. Anesthesiologists, neurologists, nurse practitioners, obstetrician/gynecologists, and those practicing internal medicine would see a 1% bump in payments.
The Surgical Care Coalition is lobbying Congress to act before the end of the year to head off roughly 9% in potential Medicare payment cuts in 2022.
The possible cuts next year include the loss of this year’s 3.75% pay hike, the coalition said. In addition, the moratorium on the 2% Medicare sequestration pay cuts also expires at the end of the year, unless Congress takes action to extend it.
And additional Medicare payment cuts of up to 4% are also possible in 2022 after the massive American Rescue Plan increased the federal budget, which triggered mandatory cuts under the Pay-As-You-Go Act of 2010, the coalition said. Congressional action would be needed to waive the PAYGO cuts.
The proposed rule also would allow patients in any geographic location, including their homes, access to telehealth services for diagnosis, evaluation, and treatment of mental health disorders. The proposal would also Medicare to pay for mental health visits provided by rural health clinics and federally qualified health centers.
“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” said a statement from CMS Administrator Chiquita Brooks-LaSure. “The changes we are proposing will enhance the availability of telehealth and similar options for behavioral health care to those in need, especially in traditionally underserved communities.”
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