President Signs Bill Staving off Medicare Cuts

  • NAHC Advocacy win preserves almost $2 billion in payments

President Joe R. Biden signed legislation into law to delay significant payment cuts to Medicare providers after the bill easily passed the House of Representatives and Senate earlier in the week.

This represents a major advocacy win for NAHC and our members. By staving off the devasting rate reductions that were slated to start on January 1, 2022, Congress and the President recognize that providers of all kinds, including home health agencies and hospices, continue to be historically challenged by the pandemic and unprecedented workforce shortages. This action ensures that Home Health and Hospice providers can continue serving patients and families at a time when high-quality home-based care has never been more necessary.

“NAHC commends the Congress for coming together to address these backward rate cuts. We also thank the President for his swift signature ensuring home-based care providers across the country can continue to serve their communities without a major payment reduction imminently looming over their heads” said National Association for Homecare & Hospice President Bill Dombi.”

Text of the House bill can be found HERE.

The most relevant Medicare payment provisions in the new law include:

  • A three-month delay of the entire planned 2% Medicare sequester payment reductions, to be in effect January 1, 2022 – March 31, 2022 (i.e. no sequester-related payment reductions in effect for first 3 months of 2022)
  • A three-month, 1% reduction in Medicare sequester payment reductions, in effect April 1, 2022 – June 30, 2022 (i.e. a 1% across-the-board sequester-related payment reduction for Q2 of 2022)
  • A one-year delay until 2023 of the entire planned so-called PAYGO sequestration cuts, which were set to go into effect as a result of the budget deficit impact of the last major COVID-19 legislative relief package passed in March 2021. PAYGO cuts were estimated to be around $36 billion for Medicare providers.

Based on 2019 levels of Medicare spending for home health and hospice ($18.1 billion for home health; $20.9 billion for hospice), NAHC roughly estimates that the total savings across the two programs associated with this legislation reaches ~$1.85 billion.

The sequester-related delays in this bill are paid for by bumping up the sequester payment reduction amounts in the year 2030, and the PAYGO cuts are delayed for only one year until 2023. While this particular bill is very welcome news, the annual stress and threat of continued Medicare cuts is an ongoing challenge to home-based providers’ stability and predictability. NAHC is committed to fighting against harmful payment reductions and advancing sensible long-term sequestration relief.

There are other Medicare-related payment policies in the bill as well, including the maintenance of a 3% pay bump for Part B providers through 2022 under the Medicare Physician Fee Schedule, the delay of payment reductions tied to the clinical laboratory fee schedule, and a one-year postponement of CMMI’s radiation oncology payment model demonstration.

President Signs Bill Staving off Medicare Cuts

NAHC Advocacy win preserves almost $2 billion in payments President Joe R. Biden signed legislation into law to delay significant payment cuts to Medicare providers after the bill easily passed the House of Representatives and Senate earlier in the week. This represents a major advocacy win for NAHC and our members. By staving off the…

Policymakers Debate $400 Billion Boost to HCBS

While it is impossible to determine with certainty whether President Biden’s proposal to increase funding for Medicaid home and community-based services (HCBS) by $400 billion will ultimately be included in one of a number of expected large legislative packages, NAHC is encouraged by recent signaling that the HCBS boost continues to be a priority for the Administration.

The latest indication of support for the increased HCBS funding was its inclusion in the President’s FY2022 budget, released on Friday, May 28th. The budget asks Congress to appropriate the $400 billion investment in HCBS over 10 years, the same proposal Biden has been pushing for as part of his infrastructure-focused American Jobs Plan.

The HCBS proposals currently lack detail, but much of the public positioning on the plan emphasizes supporting the direct care workforce by increasing wages, benefits, and career ladder opportunities. The President’s budget states “The President’s plan makes substantial investments in the infrastructure of America’s care economy, starting by creating new and better jobs for caregiving workers. It would provide home and community-based care for individuals who otherwise would need to wait as many as five years to get the services they badly need.”

While the President’s budget is not a binding document, and Congress is under no obligation to craft legislation that tracks the budget’s requests, it does typically have more influence when there is unified control of Congress and the Presidency, as there is now with the Democratic party. Many observers expect that the President’s budget will serve as the blueprint for congressional leaders’ efforts to craft their own budget resolution, which would be the first step in the process towards passing a massive infrastructure package along party lines using the complex process called “budget reconciliation”.

However, President Biden has not yet definitely signaled that he supports the “reconciliation” route at this time. He continues to engage with a group of Republican lawmakers in an effort to determine if there is a bipartisan deal to be had on an infrastructure bill.

Notably, the latest Republican counterproposal to Biden’s plan, released on May 27th, does not include any HCBS provisions. In an earlier memo from the Administration to the group of GOP negotiators, Biden again called out HCBS as a critical component of an infrastructure vehicle.

While timelines remain fluid, it is expected that if significant progress is not made within the next week or two on a bipartisan compromise, Democratic lawmakers will begin the reconciliation process in earnest, working under the assumption that a large infrastructure package will need to pass with Democratic votes only.

NAHC continues to advocate with policymakers to support HCBS proposals that will benefit our members, their workforce, and the patients and families they serve in every community across the country. We will update our membership as the negotiations unfold and a clearer path on major legislation emerges.

Policymakers Debate $400 Billion Boost to HCBS

While it is impossible to determine with certainty whether President Biden’s proposal to increase funding for Medicaid home and community-based services (HCBS) by $400 billion will ultimately be included in one of a number of expected large legislative packages, NAHC is encouraged by recent signaling that the HCBS boost continues to be a priority for…

Passage of the American Rescue Act of 2021

On Wednesday, March 10, the U.S. House of Representatives approved the American Rescue Plan Act of 2021, following the Senate’s approval of the bill over the weekend. The American Rescue Plan (ARP) Act is the sweeping COVID-19 relief package identified by President Biden as his top legislative priority in the early days of his administration. The law contains $1.9 trillion in new spending, the largest stimulus ever approved by Congress. The legislation includes provisions addressing issues within public health, labor, and small business, as well as many other aspects of the country.

In past COVID-19 relief packages NAHC was successful in advocating for provisions positively impacting home care and hospice providers. That trend continued with the American Rescue Plan through significant funding to the Medicaid HCBS program and additional provider relief funds allocated to rural services. Following is a summary of the provisions of not to home care and hospice providers.

Medicaid HCBS Funding

In past relief packages NAHC and Congressional Champions were left frustrated by the lack of funds and attention given to home and community based services (HCBS) in the Medicaid program. The ARP will provide for a 10% increase for one year starting on April 1st to the Federal Medical Assistance Program (FMAP), the federal share of Medicaid, specifically for HCBS. These funds can be applied towards:

  • Home Health Care services
  • Personal care services
  • PACE services
  • HCBS Services
  • Case Management services
  • Rehab services

While there is excitement around the 10% one year increase as it equates to approximately $12.67 billion, it is important for providers to remember that the 10% increase is temporary. It cannot be characterized necessarily as a reimbursement rate increase. However, states can use it to fund a reimbursement rate increase, among other options.

The only requirement is that it must be used for Home and Community-Based Services. The major thing that providers must watch out for is that IF it is used to fund a rate increase, this increase would expire as of March 31, 2022, and if the state chooses to not keep funding the increase, it will disappear altogether.

Rural Provider Relief Fund Allocation

$8.5 billion has been allocated in provider relief funds specifically for rural providers. The original draft of the legislation limited this provision to providers located in rural areas. NAHC worked with Congress and was successful in changing the provision to open eligibility up to providers that may be located in urban areas, but serve patients in rural areas.

Vaccines

$12.2 billion has been provided to increase vaccination supplies and distribution capacity designed to speed up vaccine administration.

These provisions will prove very helpful to home care and hospice providers in the coming days. While NAHC is grateful to Congress for their action in the ARP, there is still more that can be done to support home care and hospice patients, and the providers of care. NAHC will continue to prioritize further suspension of the Medicare sequester, and passage of the HEAT Act that would provide for telehealth reimbursement in home health, and the Choose Home proposal that would create an enhanced home health benefit serving as an alternative to the skilled nursing facility benefit.

Individual Stimulus Check

$1400 direct payments to individuals are included for those making less than $75, 000 per year or couples making less than $150,000. Additional money is offered for each of their dependent children. The direct payments are phased out for earners at the $80,000 level for individuals, and $160,000 level for couples.

Federal Unemployment Assistance

The law extends $300 federal weekly enhanced unemployment benefit through September 6, 2021. Additionally, the first $10,200 of the UI becomes tax-free for individuals who earn up to $150,000 annually.

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