How a lame-duck Congress could affect hospital finances
With less than two months left until the end of year, Congress could take several actions with broad financial implications for hospitals, policy watchers say.
A short-term funding bill to avert a government shutdown is considered “must-pass” legislation, according to a post-election report from Manatt this week. Current federal government funding expires Dec. 11, the same date a hold expires on cuts to Medicaid Disproportionate Share Hospital (DSH) payments.
“It is likely that the two priorities could be merged into one legislative package given the tight congressional calendar,” the Manatt report states.
Vince Ventimiglia, president of Leavitt Partners Collaborative Advocates, said this week that Congress could extend the funding package containing the pause in Medicaid DSH cuts through “March or April.”
Alternatively, a series of Senate Republican bills introduced this week could result in a negotiated agreement to extend federal funding through October 2021.
Such a bill also could include funding for a package of Medicare and Medicaid policies known as extenders, he said.
Possibility of COVID-19 aid for providers
During the lame-duck session, Republicans and Democrats also may overcome their differences and approve another funding package in response to the pandemic. House Democrats in September introduced a $2.2 trillion package, which included extensive funding for state and local governments. Senate Republicans have discussed a range of $500 billion to $1 trillion, with aid more tightly focused on the direct response to the pandemic.
“It remains to be seen if a deal is possible, but there is some indication of interest,” Ventimiglia said.
No action is expected during the lame-duck session on resolving surprise medical bills. Competing bills have stalled in Congress over the key question of how to determine what rates would be paid in such cases.
“We still think the political challenges of getting that kind of policy through [during] this time of year favor not acting on surprise billing,” Ventimiglia said.
Prospects for more moves from the Trump administration
The remaining weeks in the year and up to the Jan. 20 inauguration could see the release of more healthcare administrative rules by the Trump administration.
On Nov. 9, the administration released the 2020 Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule. The rule updates policies last addressed in 2016 and allows Medicaid health plans to make changes to rates and provider networks.
The American Hospital Association raised concerns that the final rule “no longer requires states to set time and distance standards for network adequacy and will allow states to set quantitative network adequacy standards.”
Potential rules also could involve:
- Stark/Anti-Kickback changes
- Medicaid value-based drug purchasing implementation
- Medicaid Fiscal Accountability Rule (MFAR) implementation
MFAR has drawn bipartisan concern and opposition from hospital groups, and CMS Administrator Seema Verma had indicated that it was being placed on hold.
Additionally, the Trump administration could approve more pending Medicaid and Affordable Care Act marketplace waivers. CMS recently approved an unprecedented 10-year extension of Indiana’s Section 1115 waiver, as well as new Section 1332 and Section 1115 waivers for Georgia.
There are 27 Section 1115 Medicaid waivers still pending at CMS, according a Kaiser Family Foundation tracker.