President Trump Signs $900 Billion COVID Package
On Dec. 28, President Trump signed a $900 billion COVID relief package, ending speculation that he may veto the package after posting a video on Dec. 22 in which he railed against the amount of pork in the bill unrelated to COVID and called for larger rebate checks for Americans.
The package contains a number of important health care provisions, including:
- Flexibility in Spending Provider Relief Funding – In addition to adding $3 billion to the Provider Relief Fund, the package includes provisions supported by the Wisconsin Hospital Association (WHA) to give hospitals flexibility in spending funds they've already received. This includes the ability to use any reasonable method to calculate lost revenue (consistent with the original June Health and Human Services guidance) and allowing systems to move targeted distributions within their system.
- Funding for Testing, Tracing and Vaccines – The legislation includes additional funding ($22.4 billion) that will go directly to states for testing, contact tracing and COVID mitigation efforts.
- Wisconsin can expect to see between $350-400 million based on previous distribution formulas.
- Additionally, unspent state dollars from the CARES Act will roll over through all of 2021.
- On top of this, the package adds $30 billion in funding for vaccine acquisition, including $4.5 billion going directly to states (Wisconsin is expected to receive around $75 million based on past distribution formulas).
- Surprise Billing – Effective in 2022, the legislation implements the surprise billing solution supported by WHA: independent dispute resolution. Patients are protected from out-of-network bills and providers and insurers can negotiate disputes while using an independent third party as a backstop to ensure providers get paid.
- Notably, the final legislation removes onerous billing provisions WHA had requested to be removed, including establishing a 90-day billing timeline and requiring hospitals to be responsible for billing of professional fees. The legislation does include a new transparency provision requiring providers and health plans to work together to generate a good faith estimate for patients.
- Extends Medicare Sequester Grace Period – The CARES Act had removed the 2% Medicare Sequester cuts through 2020. This legislation extends their removal through March 31, 2021.
- Graduate Medical Education – The package includes legislation introduced by Wisconsin Reps. Ron Kind (D-WI) and Mike Gallagher (R-WI) to fix the rotator cap issue, something WHA has long advocated for. The fix addresses the cases of two Wisconsin hospitals, Bellin and Hospital Sisters Health System St. Vincent, that had their federal Graduate Medical Education (GME) frozen at less than 1.0 full-time employee (FTE) after briefly hosting rotating medical residents in 1996. It also increases GME-funded slots in teaching hospitals by 1,000 slots in 2023.
- Rural Provisions – The legislation extends the Work Geographic Practice Cost Index (GPCI) Floor through 2023 and the Conrad State 30 J-1 visa waiver program, which helps underserved areas recruit foreign-born physicians, through 2021. It also creates a new Rural Emergency Hospital designation which allows existing rural hospitals to continue providing emergency and outpatient services without needing to offer inpatient services.
- Medicare Physician Fee Schedule Payments – The package offsets some of the cuts to specialty services from the 2021 Physician Fee Schedule final rule by including about $3 billion in funding and putting a moratorium on the add-on/complex Evaluation and Management Code until 2024.
Please contact WHA Vice President of Federal and State Relations Jon Hoelter
This story originally appeared in the December 30, 2020 edition of WHA Newsletter