Zotec Partners Anesthesiology Digest | August 2020

September 22, 2020

Radiology Digest: News from August 2020.

Senate GOP Narrows COVID-19 Relief Asks, Removes Provider Funding
By Rachel Cohrs | August 18, 2020
Senate Republicans are considering a new, slimmer COVID-19 relief bill that includes no additional funds for healthcare provider grants.

The proposal comes as negotiations between congressional Democrats and the White House collapsed in recent weeks. The new bill includes liability protections that healthcare providers wanted but doesn’t set aside the additional $100 billion in grants providers had asked for or relax Medicare loan terms, according to draft text of the proposal.

Funding for the federal government expires at the end of September, so there could be a must-pass vehicle for further legislation at that time.

The more modest legislation is scaled back from the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act that Senate Republicans proposed last month. The new bill includes funds for COVID-19 testing, an extension of more modest federal unemployment benefits, a second round of forgivable Paycheck Protection Program loans for hard-hit small businesses, and money for vaccine production and distribution.

Senate Republicans’ initial offering would have added $25 billion to the $175 billion Provider Relief Fund that lawmakers created to help healthcare providers offset lost revenue and coronavirus-related expenses. That funding is excluded from the narrower bill.

Hospitals have also been asking Congress to relax the repayment terms and interest rates on Medicare loans many providers took out at the beginning of the COVID-19 crisis, but the scaled-back Senate GOP proposal doesn’t include that policy either.

An extension of telehealth flexibilities through at least 2021 was also left out of the smaller bill.

McConnell’s liability legislation has drawn criticism from Democrats, who are instead pushing to force the Occupational Safety and Health Administration to issue emergency standards to protect workers.
To read more, go to Modern Healthcare.

Insurers Should Get Unpaid ACA Subsidies, Appeals Court Rules
By Shelby Livingston | August 14, 2020
A federal appeals court ruled on Friday that the Trump administration violated the law when it abruptly stopped paying for subsidies intended to reduce healthcare costs for low-income individuals who buy coverage on the Affordable Care Act exchanges.

In a separate decision also issued Friday, the same court said health insurers should not collect a windfall from the decision. While the U.S. Federal Circuit Court of Appeals said insurers are entitled to the full amount of unpaid cost-sharing reduction subsidies for 2017, the amount owed for 2018 should be reduced because insurers were able to raise premiums to make up for the loss of subsidies.

“We hold that the claims court must reduce the insurers’ damages by the amount of additional premium tax credit payments that each insurer received as a result of the government’s termination of cost-sharing reduction payments,” the opinion in Maine Community Health Options v. United States, states.

The Federal Circuit remanded that case to the lower court to figure out the amount by which the insurers’ damages should be reduced. It noted that determining the damages will be “a fact-intensive task,” and may require new summary judgment motions or a trial. The ACA established cost-sharing reduction subsidies for individuals whose incomes were below 250% of the federal poverty level. The Trump administration ended those subsidies in late 2017, claiming that it lacked an appropriation. But the law still required insurers to reduce copayments and other cost-sharing for eligible individuals.

Insurers in 2018 increased premiums for silver plans on the exchanges to make up for the lack of CSR payments. Because of the way ACA premium tax credits are structured, the federal government ended up paying substantially higher premium tax credits as a result.

Numerous health insurers have sued the federal government over the past few years to recoup unpaid subsidies. Several more filed lawsuits in recent weeks in the wake of an insurer victory in a U.S. Supreme Court challenge over another ACA program known as risk-corridors. That victory suggested insurers may also prevail in their efforts to recoup cost-sharing reduction subsidies. To read more, go to Modern Healthcare.

Senate Leaves Until September without Coronavirus Relief Deal
By Jordain Carney | August 13, 2020
The Senate left Washington, D.C., on Thursday until September — the latest sign that a deal on a fifth coronavirus relief package is, at least, weeks away.

Senate Majority Leader Mitch McConnell (R-Ky.) had kept the chamber in session this week, which was technically the first in its August recess, as a last-ditch attempt to create space for the administration and congressional Democrats to get an agreement.
But with talks stalemated, senators argue there is little reason for them to keep holding daily, roughly 1 1/2-hour sessions. The House already left town and isn’t expected to return until Sept. 14.

“We will have our regular pro forma meetings through the end of the state work period. If the Speaker of the House and the minority leader of the Senate decide to finally let another package move forward … it would take bipartisan consent to meet for legislative business sooner than scheduled,” McConnell said as he wrapped up the Senate until next month.
McConnell added that he hoped the Senate would be able to “act sometime soon.”

Senators will get at least 24 hours’ notice to return if congressional Democrats, Treasury Secretary Steven Mnuchin and White House chief of staff Mark Meadows are able to break the impasse and votes are scheduled. Otherwise, the Senate will formally reconvene on Sept. 8.

Sen. Chuck Grassley (R-Iowa) predicted during a conference call on Tuesday that if negotiators didn’t restart by Thursday, the administration’s executive orders would be the only action that takes place until early September.
To read more, go to The Hill.

New Trump Unemployment Plan Could Squeeze State Budgets, Medicaid Rates
By Rachel Cohrs | August 11, 2020
If President Donald Trump’s plan to extend additional unemployment benefits further squeezes state budgets already ravaged by COVID-19, states could look to Medicaid as a way to cut costs.

Trump’s plan via executive order appears to be a double whammy for states. States may now be on the hook for unemployment benefits that until now had been paid by the federal government, and the orders put a screeching halt to negotiations over a congressional deal that could have included more funding or flexibility for states. If things don’t improve, states may have to look to Medicaid to close gaps. Prior restrictions mean some of the only options states are left with to balance Medicaid budgets are cutting provider rates or increasing provider taxes.

Manatt Health counsel Allison Orris said that Medicaid provider rate cuts could be especially harmful in a public health emergency because they would target safety-net providers serving the most vulnerable.

“The administration is throwing states a big curveball and adding another budget item as they are struggling to prioritize spending on healthcare and other needs,” Orris said.

After negotiations between Democratic congressional leaders and administration officials fell apart last week, Trump signed an executive order authorizing up to $44 billion from the Federal Emergency Management Agency’s Disaster Relief Fund to provide a $400 per week supplemental unemployment benefits, but states would be on the hook for 25% of the bill.

Many details of the program remain unclear including its feasibility for states to administer, what happens when federal funds run out, whether states could opt out of the program, and whether states could request to have their portion of fees waived.
To read more, go to Modern Healthcare.

CMS Announces AUC Educational & Operations Testing Period Extension
August 10, 2020
CMS announced the Educational and Operations testing period for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the
AUC program during CY 2020 and CY 2021. CMS still encourages stakeholders to use this period to learn, test and prepare for the AUC program.
More information on the announcement is available at CMS.gov.

Health Insurers Strike Gold with COVID-19
By Shelby Livingston | August 7, 2020
The largest U.S. health insurers posted enormous profits in the second quarter as hospitals and physician practices postponed elective services and patients put off routine medical care during the COVID-19 pandemic.

Insurers paid billions of dollars less in medical claims for care unrelated to the novel coronavirus, producing savings that vastly outweighed any costs for coronavirus testing, hospitalizations and treatment. As a result, the seven biggest publicly traded insurers reported combined profits of $17 billion in the three months ended June 30, an increase of roughly 79% over the same quarter in 2019.

Some of the insurers, including national companies Anthem, Humana and UnitedHealth Group, nearly doubled their profits. Centene Corp., a prominent Medicaid managed care company, grew profit 144%, aided in part by its acquisition of a rival health plan.
To read more, go to Modern Healthcare.

ASA and other Health Care Organizations Send Letter Urging Senate and House Leaders to Waive Budget Neutrality Requirement Associated with E/M Code Update
In a letter to Senate Majority Leader Mitch McConnell and House Speaker Nancy Pelosi, ASA and more than 50 other health care organizations urge Congress to waive the budget neutrality requirements associated with new values for E/M services. The requirement would impose drastic decreases to the Medicare conversion factors.
To read more, go to ASA’s website.

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