Late final month, earlier than President Joe Biden took workplace and proposed his pandemic aid plan, Congress handed a virtually 5,600-page legislative package deal that offered some pandemic aid together with its extra normal allocations to fund the federal government in 2021.
Whereas the $900 billion that lawmakers included for pressing pandemic aid bought many of the consideration, some even larger modifications for well being care had been buried within the different components of that massive legislative package deal.
The bundle included a ban on shock medical payments, for instance — an issue that key lawmakers had been wrestling with for 2 years. Beginning in 2022, due to the brand new regulation, sufferers typically won’t pay extra for out-of-network care in emergencies and at in any other case in-network amenities.
However shock payments weren’t the one well being care problem Congress addressed because it ended a tumultuous 12 months. Lawmakers additionally answered pleas from strained well being amenities in rural areas, agreed to cowl the price of coaching extra new docs, sought to strengthen efforts to equalize psychological well being protection with that of bodily medication and instructed the federal authorities to gather information that might be used to rein in excessive medical payments.
Listed below are some particulars about these massive modifications Congress made in December.
Rural Hospitals Get a Enhance
Throwing a lifeline to struggling rural well being techniques — and, it seems, a bone to an outgoing congressional committee chairman — lawmakers gave rural hospitals a option to receives a commission by Medicare for his or her companies no matter whether or not they have sufferers in beds.
The regulation creates a brand new class of supplier, referred to as a “rural emergency hospital.” Beginning in 2023, some hospitals will qualify for this designation by sustaining full-time emergency departments, amongst different standards, with out being required to supply in-patient care. The Division of Well being and Human Providers will decide how this system is carried out and which companies are eligible.
Medicare, the federal insurance coverage program that covers greater than 61 million People 65 and older or with sure disabilities, at present doesn’t reimburse hospitals for emergency or hospital outpatient companies except the hospital additionally presents in-patient care.
That requirement has exacerbated monetary issues for rural hospitals, a lot of which steadiness serving communities with fewer sufferers — and fewer want for full in-patient companies — with the necessity for emergency and outpatient companies. One research final 12 months discovered 120 rural hospital amenities had closed up to now 10 years, with extra in danger.
Hospital teams have praised the change, which was launched by Sen. Chuck Grassley (R-Iowa), who has championed rural well being points and ended his time period as chairman of the Senate Finance Committee this month. “I labored to make sure rural America wouldn’t go neglected,” he mentioned in a press release.
Medicare Invests in Extra Docs
Hoping to deal with a nationwide scarcity of docs that has reached essential ranges in the course of the pandemic, Congress created an extra 1,000 residency positions over the subsequent 5 years.
Medicare will fund the positions, which contain supervised coaching to medical college graduates going into specialties like emergency medication and are distributed amongst hospitals most in want of personnel, together with rural hospitals.
Critics like The Wall Road Journal’s editorial board have famous that is Congress’ try to repair an issue it created within the late Nineteen Nineties, when lawmakers capped the variety of Medicare-funded residency positions in the USA, fearing too many docs would inflate the price of Medicare.
Whereas Medicare isn’t the one supply of academic funding and hospitals could add their very own residency slots as wanted, Medicare typically will reimburse hospitals for the variety of residents they’d on the finish of 1996. Amongst different penalties of that 1996 cap, most Medicare-funded residencies are clumped at Northeastern hospitals, a 2014 research confirmed.
In distinction to the 1,000 positions created as a part of the stimulus package deal, one bipartisan proposal in 2019 that was by no means enacted would have added as much as 15,000 positions over 5 years.
Strengthening Psychological Well being Parity
The legislative package deal strengthens protections for psychological well being protection, requiring federal officers to review the restrictions insurance coverage corporations place on protection for psychological well being and substance use dysfunction remedies.
In 1996 Congress handed the primary regulation barring well being insurers from passing alongside extra of the associated fee for psychological well being care to sufferers than they might for medical or surgical care. The Reasonably priced Care Act, constructing on earlier legal guidelines, made psychological well being and substance use dysfunction remedies an “important well being profit” — in different phrases, it required most medical health insurance plans to cowl psychological well being care.
However imposing that normal has been a problem, partially as a result of violations could be onerous to identify and the system has usually relied on sufferers to note — and report — them.
In December, lawmakers accepted a measure requiring insurers to investigate their protection and supply their findings to state and federal officers upon request.
Additionally they instructed federal officers to request the findings from no less than 20 plans per 12 months which will have violated psychological well being parity legal guidelines and inform insurers tips on how to right any issues they discover — beneath penalty of getting insurer violations reported to their prospects if they don’t comply.
The regulation requires federal officers to publish an annual report summarizing the analyses they acquire.
Extra Transparency in Price and High quality
People usually have no idea how a lot they are going to be anticipated to pay after they enter a health care provider’s workplace, an ambulance or an emergency room.
Taking one other modest step towards transparency, Congress banned so-called gag clauses in contracts between well being insurers and suppliers.
Amongst different issues, these types of “gag” restrictions beforehand have prevented insurers and group well being plans from sharing with sufferers and others — equivalent to employers — details about a supplier’s costs or high quality. The December laws additionally prohibited insurers from agreeing to contracts that forestall them from getting entry electronically to claims and different data from suppliers on behalf of the insurer’s enrollees.
In 2018, Congress banned gag clauses in contracts between pharmacies and insurers or pharmacy profit managers. These gag clauses had prevented pharmacists from sharing price data with sufferers, like whether or not they might pay a cheaper price for a prescription by paying out-of-pocket quite than utilizing their insurance coverage protection.
The proposal accepted in December’s laws got here from an enormous, bipartisan package deal of well being care price fixes handed in 2019 by the Senate Well being, Schooling, Labor and Pensions Committee, however not by the remainder of Congress. The committee’s Republican chairman, Sen. Lamar Alexander of Tennessee, retired from Congress this month. His Democratic companion on that package deal, Sen. Patty Murray of Washington, will take over the chairmanship as Democrats assume management of the Senate and has vowed to give attention to well being care affordability.
Shoppers First, a well being consumer-focused alliance of well being professionals, labor unions and others, led by Households USA, praised the ban. The change is “a big step ahead” to cease “the abusive practices from hospitals and well being techniques and different segments of the well being care sector which can be driving up well being care prices and making well being care unaffordable for our nation’s households, staff, and employers,” it mentioned in a press release.
KHN senior correspondent Sarah Jane Tribble contributed to this report.