Build Back Better, telehealth top Congress’s health agenda for 2022

Next year could be a busy one for Congress, with potential action on several key issues affecting healthcare providers.

Democrats are hoping to pass President Joe Biden’s $1.7 trillion social spending agenda after setbacks in December pushed negotiations into 2022.

Lawmakers are also expected to turn their focus to issues such as telehealth and mental health, which have broad support and pose an urgent need for action due to the COVID-19 pandemic.

Here’s a rundown of issues that could be on the agenda next year:

Build Back Better Act
Biden and congressional Democrats originally hoped to pass the healthcare, climate and tax package by the end of 2021 but negotiations will slip into the new year after resistance from moderate Sen. Joe Manchin (D-W.Va.). Manchin says he is concerned about the the bill’s price tag and argues Democrats are hiding its true costs by extending some programs for only a few years with plans to reauthorize them in the future. The package would include temporarily expand eligibility for Affordable Care Act subsidies, close the Medicaid expansion coverage gap in 12 states, build up the healthcare workforce and more.

Telehealth

The pandemic resulted in an explosion of telehealth use, with the federal government expanding Medicare coverage through temporary waivers. Those waivers are set to expire at the end of the public health emergency and Congress is facing pressure to make the changes permanent.

One of the key waivers slated to end allows all Medicare beneficiaries to use telehealth services from their homes. Prior to the pandemic, Medicare only paid for telehealth services for people living in rural areas, and they had to receive those services at healthcare facilities.

There’s broad agreement about getting rid of the site and geographic restrictions, congressional aides say. It’s less clear whether Congress will do so permanently or only for a few years, and final decisions will likely revolve around cost.

“Cost is the biggest obstacle right now,” said Christina McCauley, legislative director for Rep. Doris Matsui (D-Calif.), who has worked on several telehealth expansion bills.

While the public health emergency is currently set to end mid-January, President Joe Biden is expected to renew it for at least 90 days more.

The most likely path forward appears to be expanding the flexibilities for a few more years so Congress can collect more data on costs and quality, lobbyists following the issue say.

“I would be surprised if the [public health emergency] were to end and nothing has happened,” McCauley said.

Behavioral health

Leaders of the Senate Finance Committee are looking for ways to expand access to mental healthcare, potentially through building up the workforce, strengthening parity laws and expanding telehealth.

Finance Chairman Ron Wyden (D-Ore.) and ranking member. Mike Crapo (R-Idaho) requested input from stakeholders on ways to expand access to behavioral healthcare in September, as lawmakers look ahead to a bipartisan bill next year.

Demand for mental healthcare increased during the pandemic while access to care decreased, according to the Government Accountability Office. Even before the pandemic, there was a great unmet need for behavioral health services.

The GAO cites shortages of behavioral health professionals, low provider reimbursement rates and health system capacity as potential barriers.

One issue that is likely to come up is a requirement President Donald Trump and Congress enacted last year that Medicare patients using telehealth for mental healthcare see their practitioners in person beforehand.

Medical associations and advocacy groups argue the requirement is a barrier to mental healthcare, especially in rural areas where there are fewer providers. Legislation to eliminate this rule has bipartisan support.

Prior authorization

A bipartisan bill proposed by Reps. Susan DelBene (D-Wash.), Mike Kelly (R-Pa.) and 244 other House members would streamline prior authorization in Medicare Advantage and require faster determinations for services that plans routinely approve. The measure has enough cosponsors right now to pass the House if it were called for a vote.

The bill is similar to a rule the Trump administration proposed that would streamline prior authorization requirements in Medicaid and Children’s Health Insurance Program, but not Medicare Advantage. The Biden administration paused the initiative.

The American Hospital Association and other provider groups have pushed the Centers for Medicare and Medicaid Services to amend and reissue the rule to include Medicare Advantage, but the agency hasn’t take steps to do so.

“I’m hopeful that something—whether it’s regulatory or congressional—will happen,” said Claire Ernst, director of government affairs for the Medical Group Management Association.

Government funding

Congress aims to pass the fiscal year 2022 appropriations bills early next year, which could include nearly $400 million in earmarks for projects at hospitals and other healthcare facilities. Lobbyists are also hoping the package will include $10 billion in funding for hospital infrastructure that leaders cut from the Democrats’ social spending bill this year.

Only the House has passed appropriations for the Health and Human Services Department this year. Under that bill, HHS would see a nearly 20% increase over fiscal year 2021. That includes funding increases for the National Institutes of Health, the Centers for Disease Control and Prevention and for healthcare workforce programs.

MACRA

The Senate Finance Committee is likely to hold hearings on the implementation of the Medicare and Chip Reauthorization Act of 2015, which promoted value-based care in Medicare’s physician payment system. Parts of the law expire next year, including a 5% bonus for Advanced Alternative Payment Models.

Letting the bonuses expire “would really undermine the overall shift to value-based care in a time when we should double down on it rather than pulling back,” said Allison Brennan, senior vice president of government affairs for the National Association of ACOs.

Participation in accountable care organizations has dipped in recent years, partly due to changes the Trump administration made in 2018. A bipartisan bill NAACOs supports would roll back those modifications.

Lawmakers also are planning hearings on how MACRA altered the Medicare Physician Fee Schedule. Last year, CMS gave primary care physicians a pay bump that resulted in lower rates to specialists. Congress stepped in to stop the cutslast year and this year, and lawmakers envision a long-term resolution so Congress doesn’t have to deal with the issue every year.