Senate Republicans planned to introduce their proposed coronavirus (COVID-19) relief bill but, as of this writing, have not resolved differences with the White House. The Trump Administration won two federal appeals court cases related to short-term, limited-duration insurance plans and site-neutral hospital payments. The Secretary of Health and Human Services (HHS) extended the COVID-19 public health emergency.
Negotiations Continue on Next Relief Bill. Rumors continue to fly as to what will be included in the next COVID-19 relief and stimulus package, and when a deal will ultimately come together. On July 23, a draft topline summary agreement between Senate Republicans and the White House surfaced, and included an additional $25 billion for testing, $26 billion for vaccine research, distribution and use, $25 billion for the Provider Relief Fund (PRF), and an extension of the recoupment period for the Advance and Accelerated Payment Program. The draft also extended some of the telehealth flexibilities made available during the pandemic through 2021, though the proposal did not specify which flexibilities would be extended. This is still very much a draft and subject to change before being formally unveiled. Even then, it will be reflective of Republican priorities only. Expect negotiations on this bill to continue through early August as House Democrats push to have their priorities, as reflected in the HEROES Act, included.
Lawmakers Eye Telehealth Expansion. House Ways and Means Committee Republicans released draft legislation to make permanent some of the COVID-19 telehealth waivers and flexibilities. The bill would permanently remove restrictions that limit patients’ ability to access telehealth services from home, lift restrictions on the use of telehealth for Federally Qualified Health Centers and Rural Health Clinics, expand the types of providers who can offer telehealth services and allow for Medicare reimbursement of audio-only telehealth visits. Senator Ron Wyden (D-OR), Ranking Member of the Senate Finance Committee, also released a bill this week that would expand the ability to provide routine medical care and mental health services via telehealth in addition to lifting restrictions around the location of the patient. The proposals add to a growing list of bipartisan bills aimed at broadening use of and access to telehealth services. There are on-going efforts to include some of these changes in the next relief package. Additionally, stakeholders are expecting the Centers for Medicare and Medicaid (CMS) to include proposed telehealth policy changes in the upcoming Medicare Physician Fee Schedule update rule. Additional information on the current telehealth waivers under the authority of CMS and those requiring congressional action is available in this McDermottPlus analysis.
HELP Committee Chairman Introduced Pandemic Preparedness Bill. The Preparing for the Next Pandemic Act (S. 4231) was introduced by Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN). The bill provides $5 billion over the next 10 years to support the improvement and expansion of domestic manufacturing during public health emergencies. It also provides $10 billion over the next 10 years to help states create and maintain their own stockpiles of supplies, and allows the Secretary of HHS to enter into agreements with private companies for the procurement, maintenance and storage of supplies for the national stockpile. The bill comes on the heels of a Request for Information, and a HELP Committee hearing several weeks ago, seeking feedback on policy solutions for appropriate preparation for a future pandemic. Senator Alexander plans to retire after this Congress and will likely fight hard to get his bill over the finish line this year, either as part of the next relief package or as stand-alone legislation.
Provider Relief Fund Updates
For more detailed information on the PRF, see our Toolkit.
Federal Appeals Court Issued Two Wins for Trump Administration. The first decision upheld the Administration’s 2018 rule expanding the use of short-term, limited-duration insurance (STLDI) plans. Patient advocates and safety net health plans challenged the rule, arguing that STLDI plans offer insufficient coverage and undermine the Affordable Care Act (ACA). A federal district court held in July 2019 that the Administration was within its authority when it expanded STLDI plans, and the federal appeals court affirmed that ruling. Separately, a federal appeals court ruled that CMS acted within its authority when in 2019 and 2020 it implemented site-neutral payments for certain off-campus provider-based hospital departments. This ruling reverses a 2019 decision by a federal district court and means the payment policy stands unless the decision is reversed by the US Supreme Court. The plaintiff hospitals have not announced plans to appeal the decision. After the lower court ruling in favor of hospitals, CMS stated that it would repay hospitals impacted by the site-neutral payment cut. With the appeals court now ruling in the agency’s favor, CMS may go back to these hospitals to recoup these payments.
Expect to see text of the Republican COVID-19 relief package and for negotiations on the bill to begin in earnest as lawmakers work to reach an agreement before the scheduled August recess. The Senate Finance Committee will hold a hearing on the US medical supply chain.
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