The Latest Healthcare Regulation and Policy Updates from Zotec Partners

June 19, 2023

Zotec continues to engage in advocacy at the local, state, and federal levels to protect our physician clients’ ability to make a living so that they can focus on providing lifesaving care. Below is the latest that could impact healthcare businesses nationwide, and updates that clinicians need to be aware of as they go into Q3.

The Ending of the Medicaid Continuous Enrollment Provision

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act, which included a provision that Medicaid programs keep people continuously enrolled through the end of the COVID-19 public health emergency (PHE), in exchange for enhanced federal funding.

As part of the Consolidated Appropriations Act, 2023, signed into law on December 29, 2022, Congress delinked the continuous enrollment provision from the PHE, ending continuous enrollment on May 11, 2023.

It is estimated that over 15 million patients will lose coverage nationwide.  Most recently, Florida dropped nearly a quarter million Floridians from Medicaid. In the state of Arkansas, almost 73,000 patients were dropped in April. 

Zotec Partners emailed a renewal reminder to over 450,000 of our client’s Medicaid patients. We also added a reminder message to our Interactive Voice Response (IVR) system.  

Potential Impact

  1. Decreased revenue – Current Medicaid patients will lose coverage and patients will become self-pay.
  2. Increased costs – additional statements, postage, Medicaid eligibility checks.
  3. Payer-mix shift and increase in AR and Days in AR.
  4. Increased bad debt, coupled with changes in collection rules.

Medicaid Renewal

The Medicaid renewal process is different for every state. However, it is very easy for people to find information on the website. For more information:

Listen here: Zotec Answers Podcast – What can physicians do to help mitigate over 15M Medicaid recipients from losing their benefits?

Watch here: Zotec Shares – Preparing for the End of the Medicaid Continuous Enrollment Provision

Breast Cancer Screening – Supplemental Diagnostic Exams

On May 6, federal bill H.R. 3608, the “Find It Early Act” was introduced. This bill provides for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer.

Recently several states have passed similar legislation, including Maryland, Tennessee, and Washington. However, there are 29 states that don’t have any laws for expanding breast imaging.  We will be continuing to monitor HR 3608 and reach out to our Advocates to help support this bill in the future.

If you are an Advocate, we thank you for your support.  If you would like to sign up, please text ZOTEC to 52886.

No Surprises Act Update

We are seeing a slowdown in carriers terming contracts with physicians and practices.  Also, with the independent dispute resolution process we are seeing physicians winning the vast majority of disputes.

Recently Ashutosh Rao, Radiologist and Partner with Quantum Radiology in Atlanta, was asked by ACR to participate in Senate HELP committee testimony regarding the No Surprises Act.  Senators Sanders (I-VT) HELP Committee Chair and Cassidy (R-LA) along with several other senators were at the meeting. ACR will follow up with staffers, but the goal is for the Senate Help Committee to call a formal hearing.

Price Transparency/Site-neutral Payments

Momentum is building in Congress with legislative provision H.R. 3561 – the “Patient Act of 2023,” which expands site-neutral payments in Medicare, a move that could reduce payments to hospitals by billions of dollars per year. Early estimates say it could save Medicare $153 billion over 10-years, reducing the national deficit by a potential $279 billion.  Legislation is required to make changes to current Part B payments and enact site-neutral payment policies.

The AHA and other national hospital groups reiterated to committee leaders their opposition to the proposal and to site-neutral policies in general, which fail to account for the fundamental differences between hospital outpatient departments (HOPDs) and other ambulatory care sites. 

We will continue to monitor this bill and let our Advocates know when it is time to take action.

By: Mark Isenberg, EVP Healthcare Advocacy

Learn more about Zotec Partners here.