Late in the evening on Tuesday, March 8, the House of Representatives’ Appropriations Committee released the text of the FY2022 Omnibus government spending legislation. The situation is very fluid right now and the details of the bill could change. For example, after a dispute among lawmakers, $15 billion in Covid-19 relief funding was pulled out of the $1.5 trillion omnibus package leaving the federal government with only a few months’ supply of coronavirus therapeutics.
It is possible the text of the bill could change, but as of Wednesday afternoon, this is what is in the legislation that matters for hospice.
Importantly, the funding package does not include any relief from impending Medicare sequester payment cuts. As a reminder, a one percent across-the-board reduction in Medicare payments is set to take effect April 1, 2022, lasting through June 30, 2022. The full two percent cuts will begin July 2022, lasting through the end of the calendar year. NAHC continues to advocate strongly for a further delay of the sequester reductions. Even as the pandemic enters a more stable phase, the current labor crisis in health care has increased costs for providers of all kinds, and a Medicare rate cut will only exacerbate the already dire workforce situation.
“We are very pleased to see the extension of the telehealth waivers in the bill as they have proven extremely valuable during the pandemic,” said NAHC President William A. Dombi. “Our hope is to see these become permanent parts of Medicare in the future. Also, we anticipate further legislative opportunities this year to deal with sequestration as well as our Choose Home bill among other crucial matters.”
A summary of the Labor-Health and Human Services portion of the bill (where most of the health care provisions are included) is HERE.
Included in the massive bill are a number of provisions relevant to home-based care providers, including:
Telehealth (Sec. 301-309)
- An extension of the Medicare flexibility allowing hospices to perform the face-to-face (F2F) recertification visit via telehealth (Sec. 306). This flexibility will be extended for 5 months (151 days) after the end of the COVID-19 public health emergency (PHE). The current PHE declaration is in place until April 16, 2022, but it may be extended further till at least the middle of July 2022.
- The inclusion of this specific extension is an advocacy win for NAHC and the hospice community. In recent days, intel from Capitol Hill indicated that the F2F fix was not being considered for extension. NAHC, our members, and other hospice stakeholders ramped up our advocacy to Congress to press for the F2F’s inclusion, and we are pleased to see it in the omnibus. We will continue to fight for a permanent extension.
- Like the F2F telehealth extension, many other pandemic-era telehealth flexibilities are being extended for the same 5-months post-PHE timeframe. This includes the changes to the geographic and originating site requirements (Sec. 301), which are allowing patients to receive telehealth services in their own homes and in non-rural parts of the country. It also includes the flexibility to use audio-only telehealth (Sec. 305) It is through this provision that authorization for using telehealth to conduct the home health face-to-face results.
- There is also a provision that will require both a MedPAC and an HHS OIG report on the expansion of telehealth as a result of the PHE, to inform future payment and program integrity policy (Sec. 308)
- Additionally, beginning July 1, 2022, CMS will be required to publicly post, on a quarterly basis, data on Medicare claims for telemedicine services, including data on utilization and beneficiary characteristics (Sec. 308).
- It is important to note that this legislation does not cover extensions for every single Medicare service that has been allowed to be delivered via telehealth during the pandemic. For example, the current flexibility provided hospices to deliver routine home care (RHC) using telehealth and telephone technology would not be extended by this bill. Likewise, a number of specific interventions that have been added to the Medicare Telehealth Code List only for the duration of the PHE would also not be extended by the omnibus. This includes certain Medicare Part B services that have been used by palliative care providers during the pandemic, such as CPT codes 99341-99345, which are evaluation and management (E&M) codes for home visits to new patients. (The current list of Medicare Telehealth Codes can be found HERE). NAHC believes that it will be up to CMS to determine extension policy for those telehealth services not covered by these legislative expansions.
Hospice Cap Methodology Extension (Sec. 312)
- Included is an extension by one year, until 2031, of the current methodology used to update the Medicare hospice aggregate cap by the annual hospice payment update (APU), as opposed to the Consumer Price Index for Urban areas (CPI-U). This methodology of using the APU to update the cap has been in place since 2016 (as a result of the IMPACT Act of 2014) and was already set to remain effective until 2030 (as a result of the Consolidated Appropriations Act, 2021). The provision in this omnibus package simply extends this methodology to 2031. A one-year extension is expected to save the government ~$55-60 million dollars, so when applied across the nearly 5000 Medicare-certified hospices, this provision does not represent a major impact for providers.
CMS Report on Hospice Respite Care (Included in the Joint Explanatory Statement)
- A congressional request to CMS, in consultation with the Office of the Assistant Secretary for Planning and Evaluation (ASPE), to provide, within 180 days of the enactment of the omnibus bill, a report to the relevant congressional committees on the current capacity and best practices for the provision of hospice respite care, including in the home.
Other important elements of the bill include:
- Health workforce: $1.3 billion, an increase of $72 million above the FY 2021 enacted level, for the Health Resources and Services Administration’s (HRSA) Bureau of Health Professions programs to support health workforce development.
- Program integrity funding: Roughly $659 million for CMS’ program integrity efforts; $102 million for HHS OIG program integrity activity; and $112 million for Department of Justice program integrity work within the health care industry.
Additional summary and explanatory documents related to the bill can be found on the House Appropriation Committee’s press release page HERE.
In addition to the omnibus funding package, the House of Representatives also released a very short-term “continuing resolution” bill that will fund the government for four additional days beyond the current funding expiration date of Friday, March 11, 2022. These four extra days will give the Senate time to review and pass the funding package by the new deadline of Tuesday, March 15, 2022.