Here are 5 things to watch for this year in terms of healthcare legislation.
Published March 2022.
#1: The Build Back Better Act (BBBA)
The BBBA was stalled at the end of 2021, but a scaled-down version of this bill may get passed this year. The scaled-down bill will likely keep child care funding, universal Pre-K, more generous Affordable Care Act (ACA) tax credits and public health infrastructure. The bill will likely leave out big-ticket items like Medicare coverage for hearing, and Medicaid coverage in non-expansion states. This legislation tackles a laundry list of items from climate change to college education.
In terms of healthcare funding and policy, the BBBA “would extend the most significantly enhanced marketplace subsidies authorized under the American Rescue Plan Act (ARPA) through the end of 2025,” according to Health Affairs.
This legislation would also close the Medicaid coverage gap through the end of 2025 and add hearing benefits to the Medicare program.
The coverage provisions in this legislation are estimated to reduce the number of uninsured people by 3.4 million (from 2022-2025). The Kaiser Family Foundation did additional analysis of the potential costs and impact of the BBBA.
#2: The No Surprises Act (NSA)
Effective January 1, 2022, the NSA is a collection of federal rules designed by the Department of Health and Human Services (HHS) with other federal departments to protect patients from surprises in medical costs. Specifically, the NSA protects self-pay and uninsured patients from receiving bills that are substantially more than expected, and protects insured patients from receiving unexpected bills from out-of-network facilities or providers for certain emergency or nonemergency services.
Looking into the upcoming year, there are several clarifications and implementation related pieces of legislation that should be passed. For instance, there are many provisions to the Good Faith Estimate that we may see in the coming year, including Good Faith Estimates for insured patients.
See our free webinar on the No Surprises Act and our free ebook on the Good Faith Estimate for more information.
#3: Medicare Payment Reductions
At the end of 2021, Congress passed a bill to protect providers from reducing Medicare Part B payments for many providers by about 10%. The Medicare conversion factor was reduced due to 2021 coding changes (2% Medicare sequester cuts and 4% in cuts under PAYGO rules).
This legislation provided a 3% increase in all Part B payments and postponed PAYGO cuts for a year. There are currently no sequester cuts (first quarter of 2022), but will return to pre pandemic sequestration level by the end of 2022.
This legislation is the second consecutive year that Congress stepped in to mitigate Medicare payment cuts, and Congress will have to step in again to prevent cuts next year.
#4: Drug Pricing and User Fee Agreements
Drug pricing reform is a hot topic in Congress, and multiple fragments of legislation have been created but not passed. If the scaled-down BBBA is passed, it will potentially have drug pricing provisions (e.g., Medicare Part D benefit restructuring and new cap on monthly insulin out-of-pocket expenses).
Though drug pricing legislation is not at all concrete as of right now, there is one piece of legislation that is clear: user fee agreements for most medical products must be reauthorized prior to expiration on Oct. 1. Without reauthorization, “medical product review divisions cannot collect user fees attached to new product applications, significantly reducing funding for these divisions and preventing or considerably delaying approvals on new products,” said Holland & Knight Law.
#5: Telehealth
As the federal public health emergency extends until likely mid-2022, HHS provided blanket waivers and Section 1135 waivers relating to otherwise applicable requirements under Medicare, Medicaid and other laws.
Because of the pandemic, flexible telehealth options were made available (e.g., services can be furnished via phone with video and audio capabilities and via audio-only calls for certain E/M visits). Another flexibility: Providers may furnish telehealth services from their homes.
We are likely to continue to see the same, if not increased, telehealth options this year or next.
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