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Earlier today, the U.S. House of Representatives released the legislative text for the Consolidated Appropriations Act (CRA) of 2021, a massive bill that combines a $1.4 trillion omnibus government spending bill with a $900 billion COVID-19 relief package. Among a large number of provisions impacting nearly every corner of the American economy, the final bill includes several measures that will affect those living with serious illness, including direct payments, increased funding for telehealth and nutrition services.

  • To read the full text of the bill, please click here
  • To read a summary of the COVID-19 Relief provisions, please click here
  • To read a summary of the appropriations provisions, please click here

The House and Senate are expected to pass the bill later this evening, and then it will be sent to President Trump’s desk, where he has signaled that he will sign it into law.

The core stimulus measures in the package remain those that have been the focus of Congressional negotiations over the past few weeks: a $300 boost in weekly federal unemployment benefits, $600 relief checks for individuals, more than $300 billion for small business aid, including a new pot of money for the Paycheck Protection Program (PPP), and boosted funding for schools, hospitals, and COVID-19 testing, tracing, and vaccine distribution. Notably absent from the bill are two policies that proved especially contentious: a COVID-19-related liability shield that would protect businesses from legal action, and a new round of financial aid for state and local governments.

In addition to the above, the following provisions from the bill are broadly relevant for people and families facing serious illness and health care entities of all kinds that support them, as well as the underserved low-income and communities of color that have been most negatively impacted by the pandemic:

  • Extension of the temporary suspension of the Medicare sequestration from December 31, 2020 to March 31, 2021
  • A one-time, one-year increase in the Medicare physician fee schedule of 3.75%
  • $3 billion in additional funding for the Provider Relief Fund (PRF), and clarification that providers can calculate lost revenue for the PRF reporting requirements “using the Frequently Asked Questions guidance released by the Department of Health and Human Services in June 2020 including the difference between such provider’s budgeted and actual revenue budget if such budget had been established and approved prior to March 27, 2020.”
  • Additional funding for “hardest hit” businesses to receive a second Paycheck Protection Program (PPP) loan if they have 300 or less employees and have sustained a 25% percent revenue loss in year-over-year revenue
  • Simplification of the PPP loan forgiveness process for those with loans of $150,000 or less by only requiring a one-page attestation form
  • The extension of funding for key federal health programs, including Community Health Centers, the National Health Service Corps, the State Health Insurance Assistance Program (SHIP), GME Teaching Centers, and more.
  • $12 billion in targeted emergency investments to organizations such as community development financial institutions (CDFIs) and minority depository institutions (MDIs) to help low-income and minority communities withstand the economic impact of the COVID-19 pandemic.
  • A freeze of Alternative Payment Model (APM) payment incentive thresholds at current levels through 2024 (Currently, to qualify for the bonus clinicians must have 50 percent of payments or 35 percent of patients in the advanced APM. In 2021, the threshold was set to rise to 75 percent of payments or 50 percent of patients)
  • Inclusion of the HOSPICE Act to impose new program integrity standards and intermediate remedies and penalties on hospice programs that are out of compliance with the Conditions of Participation (CoPs).
  • Allowance for physicians at rural health clinics (RHCs) and federally qualified health centers (FQHCs) to bill as hospice attending physicians under Medicare Part B in an effort to expand access to hospice in rural areas per the Rural Access to Hospice Act.
  • Extension from 2025 to 2030 of the IMPACT Act of 2014’s requirement to update the hospice aggregate cap year over year by the hospice payment update rather than the typically more generous Consumer Price Index for Urban Consumers (CPI-U)
  • A 3-year extension of the Independence at Home (IaH) demonstration. IaH is a successful home-based primary care model that focuses on chronically and seriously-ill Medicare beneficiaries.
  • Text from the Improving HOPE for Alzheimer’s Act, which requires CMS to carry out provider outreach and reporting on cognitive assessment and care plan services for beneficiaries with Alzheimer’s Disease and/or related dementias (CPT code 99483). This code includes allowances for the completion of advance care plans for these patients and families.
  • 3-year extension of the Money Follows the Person (MFP) program. MFP provides funds to help transition those residing in long-term care facilities back into their homes and communities.
  • “Surprise billing” legislation that would hold patients harmless from large unexpected medical bills for out-of-network care by ensuring they are only responsible for the in-network payment rates. The bill would require arbiters to settle disputes between providers and insurers.
  • Increased funding for telehealth services, including $250 million for the Federal Communications Commission COVID-19 Telehealth Program
  • 15% temporary increase in individual monthly Supplemental Nutrition Assistance Program (SNAP)
  • Additional funding for senior nutrition services, including Meals on Wheels, and the extension of waivers that provide flexibility in Older Americans Act nutrition services
  • $8.75 billion in funding for the CDC, states, and localities to support vaccine distribution, administration, and tracking efforts
  • $100 million to address abuse, neglect, and exploitation of the elderly, including adult protective service and long-term care ombudsman activities
  • A moratorium on payment under the Medicare physician fee schedule of the add on code for inherently complex evaluation and management visits (HCPCS code G2211) until at least January 2024.
  • $10 million per year for FY 2022-2026 for Project ECHO-like technology-enabled learning collaboratives intended to spread health care training and resources for underserved areas and patient populations
  • The creation of a new public-private entity charged with collecting and analyzing billing data for fraud, waste, and abuse oversight purposes. The entity would be composed of “health plans, Federal and State agencies, law enforcement agencies, health care anti-fraud organizations, and any other entity determined appropriate by the Secretary
  • Delaying CMMI’s new Radiation Oncology Model until no sooner than at least Jan 2022.
  • New transparency requirements for health plans and payers intended to address anti-competitive practices.
  • $100 million for the Medicare Improvement Fund

“We are glad to see lawmakers coming together to craft a relief package for Americans who are struggling in the face of COVID-19,” says C-TAC Executive Director Jon Broyles. “While there is more to be done in the future to support those hurting the most right now, including people and families facing serious illness, many of the policies outlined in this legislation are important steps in the right direction and will provide much-needed help to some of the sickest and most vulnerable among us.”

C-TAC will continue to advocate that future relief legislation include additional policies that are focused on those with serious illness, including provisions that would increase access to high-quality advance care planning. We look forward to continuing our work alongside our partners in Congress and the incoming Biden Administration to advocate for the needs of people living with serious illness and those who matter most to them.

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