Newly Enacted End of Year Legislation Has Impact on Healthcare Providers

On December 27, President Trump signed into law the Consolidated Appropriations Act, 2021 (Act), which was passed by Congress the evening of December 21, after weeks of negotiation. The lengthy legislation, totaling in at 5,593 pages, provides for over $2.3 trillion in funding, $900 billion of which is allocated for COVID-19 relief.

The Act contains several key provisions relevant to the healthcare industry, and particularly, healthcare providers.

Specifically, the Act allocates additional COVID-19 funding, including the following approximate amounts:

• Provider Relief Fund (Relief Fund): $3 billion
• Vaccine Manufacturing and Procurement: $19.7 billion
• Vaccine Distribution: $8.75 billion
• COVID-19 Testing and Tracing: $22.4 billion
• National Strategic Stockpile: $3.25 billion
• Mental Health and Substance Abuse Services and Support: $4.25 billion

Additional Components of the Act

Finally, the Act includes several other components relevant to the healthcare industry, some of which are separate from the COVID-19 pandemic. These include:

• The “No Surprises Act:” Legislation that aims to hold patients harmless for surprise medical bills, including by limiting patient financial responsibility and cost sharing amounts to what would be paid to in-network providers and by establishing a dispute resolution process to settle disputes relating to out-of-network claims. This legislation also will also give patients more transparency by, among other things, requiring health plans to include pertinent deductible and out-of-pocket limit information on member ID cards.

Medicare Payment Changes

In an apparent attempt to alleviate financial hardships on providers caused by the pandemic and certain payment cuts that were implemented through revisions to the Medicare Physician Fee Schedule (MPFS), the Act includes a 3.75% payment bump to the entire MPFS for services furnished from January 1, 2021 through December 31, 2021 and extends the physician work geographic index floor (in areas where labor costs are less than the national average) from December 19, 2020 to January 1, 2024. In addition, the Act extends the temporary suspension on Medicare sequestration for a three-month period ending March 31, 2021.  Further, the Act implements a moratorium on payment of a certain add-on code (G2211) for inherently complex evaluation and management visits through January 1, 2024 in order to reduce the budget-neutrality adjustment.

Source: https://www.jdsupra.com/legalnews/newly-enacted-end-of-year-legislation-48024