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Year-End Appropriations Bill Includes Myriad Medicare Policy Changes | Manatt, Phelps & Phillips, LLP


The Big Picture
Until late December, few if any Medicare policy changes were anticipated as part of a year-end healthcare package, barring extensions of funding for programs that otherwise would have expired. But after several days of closed-door negotiations, congressional leaders unveiled and very shortly thereafter Congress passed a legislative package containing an amalgam of Medicare policy changes.
The Consolidated Appropriations Act, 2021 (the Act) includes significant payment adjustments, rural health improvements, transparency requirements for certain manufacturers of drugs covered under Medicare Part B, and fixes to long-standing coverage and benefits issues such as eliminating beneficiary cost-sharing for colorectal cancer screenings. None of these changes, taken individually, represent a monumental shift in administration of the Medicare program. But as a whole, they represent an important body of policies that address long-standing concerns. ....

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Congress Sets New Rural Emergency Medicare Category


Tuesday, January 5, 2021
Year-end COVID-19 relief legislation approved by Congress established Rural Emergency Hospitals (REHs) as a new Medicare provider type effective January 1, 2023. REHs, defined as providers that furnish certain outpatient hospital services in rural areas, including emergency department services, will be reimbursed at a rate higher than the otherwise-applicable payment under the Medicare Outpatient Prospective Payment System (OPPS). REHs will be subject to enrollment requirements and must comply with conditions of participation to be set forth in more detail by the Centers for Medicare & Medicaid Services (CMS) in future rulemaking and guidance.
IN DEPTH
Background
Under current Medicare program rules, there is no provider category under which Medicare payment is available for a provider that provides only emergency department services or hospital outpatient services. Only entities defined by Medicare as “hospitals” can receive ....

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Congress Prepared To Pass COVID-19 Relief Package - Coronavirus (COVID-19)


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Lawmakers in Washington have reached an agreement on a
legislative package that will provide $900 billion in COVID-19
relief and approximately $1.4 trillion in government funding in
2021. Highlights of the health care-related provisions include $3
billion more for the Provider Relief Fund, suspension of the
Medicare sequester for the first three months of 2021, surprise
medical billing and price transparency requirements, an additional
$3 billion for the Medicare Physician Fee Schedule and the creation
of a new Medicare payment designation that allows either a Critical
Access Hospital or a small, rural hospital with less than 50 beds ....

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