Chicago Sun-Times (Sunday)


4 vital health issues addressed in huge spending bill

- BY EMMARIE HUETTEMAN Contributi­ng: Sarah Jane Tribble

Late last month, before President Joe Biden took office and proposed his pandemic relief plan, Congress passed a nearly 5,600page legislativ­e package that provided some pandemic relief along with more general allocation­s to fund the government in 2021.

While the $900 billion that lawmakers included for urgent pandemic relief got most of the attention, some even bigger changes for health care were buried in that huge legislativ­e package.

The bundle included a ban on surprise medical bills, for example — a problem key lawmakers had been wrestling with for two years. Starting in 2022, because of the new law, people generally will not pay more for out-of-network care in emergencie­s and at otherwise in-network facilities.

But surprise bills weren’t the only health care issue Congress addressed. Lawmakers also answered pleas from strained health facilities in rural areas, agreed to cover the cost of training more new doctors, sought to strengthen efforts to equalize mental health coverage with that of physical medicine and instructed the federal government to collect data that could be used to rein in high medical bills.

Here are some details about those big changes Congress made in December.

Rural hospitals get a boost

Throwing a lifeline to struggling rural health systems — and, it appears, a bone to an outgoing congressio­nal committee chairman — lawmakers gave rural hospitals a way to get paid by Medicare for their services regardless of whether they have patients in beds.

The law creates a new category of provider, known as a “rural emergency hospital.” Starting in 2023, some hospitals will qualify for this designatio­n by maintainin­g full-time emergency department­s, among other criteria, without being required to provide in-patient care. The Department of Health and Human Services will determine how the program is implemente­d and which services are eligible.

Medicare, the federal insurance program that covers more than 61 million Americans 65 and older or with certain disabiliti­es, currently does not reimburse hospitals for emergency or hospital outpatient services unless the hospital also offers in-patient care.

That requiremen­t has exacerbate­d financial problems for rural hospitals.

Hospital groups have praised the change, which was introduced by Sen. Chuck Grassley, R-Iowa, who has championed rural health issues and ended his term as chairman of the Senate Finance Committee this month. “I worked to ensure rural America would not go overlooked,” Grassley said.

Medicare invests in more doctors

Hoping to address a national shortage of doctors that has reached critical levels during the pandemic, Congress created an additional 1,000 residency positions over the next five years.

Medicare will fund the positions, which involve supervised training to medical school graduates going into specialtie­s like emergency medicine and are distribute­d among hospitals most in need of personnel, including rural hospitals.

Critics like The Wall Street Journal’s editorial board have noted this is Congress’ attempt to fix a problem it created in the late 1990s, when lawmakers capped the number of Medicare-funded residency positions in the United States, fearing too many doctors would inflate the cost of Medicare.

While Medicare isn’t the only source of educationa­l funding and hospitals can add their own residency slots as needed, Medicare generally will reimburse hospitals for the number of residents they had at the end of 1996. Among other consequenc­es of that 1996 cap, most Medicare-funded residencie­s are clumped at hospitals in the Northeast, a 2014 study showed.

Strengthen­ing mental health parity

The legislativ­e package strengthen­s protection­s for mental health coverage, requiring federal officials to study the limitation­s insurance companies place on coverage for mental health and substance use disorder treatments.

In 1996, Congress passed the first law barring health insurers from passing along more of the cost for mental health care to patients than they would for medical or surgical care. The Affordable Care Act, building on earlier laws, made mental health and substanceu­se disorder treatments an “essential health benefit” — requiring most health insurance plans to cover mental health care.

But enforcing that standard has been a challenge. That’s in part because violations can be hard to spot, and the system often relied on patients to report them.

In December, lawmakers approved a measure requiring insurers to analyze their coverage and provide their findings to state and federal officials upon request.

They also instructed federal officials to request the findings from at least 20 plans per year that might have violated mental health parity laws and tell insurers how to correct any problems they find — under penalty of having insurer violations reported to their customers if they don’t comply.

The law requires federal officials to publish an annual report summarizin­g the analyses they collect.

More transparen­cy in cost, quality

Americans often don’t know how much they will be expected to pay when they enter a doctor’s office, an ambulance or emergency room.

Taking another modest step toward transparen­cy, Congress banned so-called gag clauses in contracts between health insurers and providers. Among other things, these sorts of “gag” restrictio­ns previously have prevented insurers and group health plans from sharing with patients and others — such as employers — informatio­n about a provider’s prices or quality. The December legislatio­n also prohibited insurers from agreeing to contracts that prevent them from getting access electronic­ally to claims and other informatio­n from providers on behalf of the insurer’s enrollees.

In 2018, Congress banned gag clauses in contracts between pharmacies and insurers or pharmacy benefit managers. Those clauses had prevented pharmacist­s from sharing cost informatio­n with patients — like whether they could pay a lower price for a prescripti­on by paying out-of-pocket rather than using their insurance coverage.

The proposal approved in December came from a big, bipartisan package of health care cost fixes passed in 2019 by the Senate Health, Education, Labor and Pensions Committee but not by the rest of Congress. The committee’s chairman, Sen. Lamar Alexander, R-Tenn., retired this month. His Democratic partner on that package, Sen. Patty Murray of Washington, will take over the chairmansh­ip and has vowed to focus on health care affordabil­ity.

Consumers First — a health consumerfo­cused alliance of health profession­als, unions and others, led by Families USA — praised the ban, calling it “a significan­t step forward” to stop “the abusive practices from hospitals and health systems and other segments of the health care sector that are driving up health care costs and making health care unaffordab­le for our nation’s families, workers, and employers.”

 ?? AP FILE ?? U.S. Sen. Chuck Grassley, R-Iowa, pushed to help rural hospitals as he ends his term as chairman of the Senate Finance Committee.
AP FILE U.S. Sen. Chuck Grassley, R-Iowa, pushed to help rural hospitals as he ends his term as chairman of the Senate Finance Committee.

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