WASHINGTON, Dec 6 (Reuters) - The U.S. Congress may be forced to delay until early 2023 final agreement on funding the government through the end of its fiscal year, instead relying on a stopgap measure to keep the lights on, the top Senate Republican said on Tuesday.
The federal government is currently set to run out of money on Dec. 16 without a vote on either an "omnibus" bill funding the government through Sept. 30, 2023, or a short-term bill known as a "continuing resolution," or CR.
"We're running out of time, and that may end up being the only option left that we could agree to pursue," Senate Republican leader Mitch McConnell told reporters a day after meeting his Democratic counterpart Chuck Schumer to discuss a comprehensive omnibus package.
"We don't have agreements to do virtually anything," McConnell said. "We don't even have an overall agreement on how much we want to spend."
An omnibus bill would be expected to exceed the $1.5 trillion funding package Congress approved last March. Senator Richard Shelby, the top Republican appropriator, said the two sides were about $25 billion apart, which he described as "pretty close."
McConnell spoke the day after House Republican leader Kevin McCarthy told Fox News negotiators should hold off until January, when the new Congress with a slim Republican majority in the House is sworn in.
A Republican congressional aide, who asked for anonymity to describe intra-party dynamics, said McCarthy's warning was meant to pressure Democrats to move forward on an omnibus deal. The aide added that McCarthy has privately backed a longer-term bill to avoid a funding stand-off early in 2023.
Schumer acknowledged that there was still "a lot of negotiating left to do" to get an omnibus bill.
"Leader McConnell and I have agreed to try and work together to make sure we get a year-long omnibus funding bill done. We hope it can be done this year," Schumer told reporters.
Updated Plan: Ask Congress to STOP the Cuts in the Year End Package
From the National Association for Home Care & Hospice
Following the finalization of the home health rule NAHC engaged with the sponsoring offices of the Preserving Access to Home Health Act (S. 4605/H.R. 8581) on refining the legislation to better its chances for passage before the end of the year, as well as strengthen transparency of CMS in their rate-setting. Our champions on Capitol Hill are working to substitute this amended language in the negotiations for the year-end package. This amendment will not be introduced as new legislation.
While there won't be a new bill to call for congressional action on, you can still advocate for this revised approach.
Please contact our Senators and Representatives requesting they support a year-long delay (2023) of the home health rate cut and call for added transparency in CMS rate-setting practices. The NAHC Legislative Action Center is set up and ready with this message.
If you will be writing your own message or speaking with your elected officials here are helpful talking points:
The Issue
The Centers for Medicare and Medicaid Services (CMS) issued a Final Rule on October 31, 2022, that reduces Medicare payments for home health services by $635 million in 2023 and triggers an estimated $18 billion in payment reductions over the next decade. Congressional action in 2018 required CMS to establish a new payment model that was "budget neutral," not one that cuts support for home health services by $18 billion.
The impact of those payment cuts would exacerbate the ongoing dismantling of this essential benefit that serves over 3 million of the most vulnerable Medicare beneficiaries, providing them with exceptional quality care in their own homes, preventing high-cost hospitalizations, and offering an alternative to life-changing institutional care while saving Medicare billions in spending every year.
Over the past decade, Medicare beneficiaries have experienced significant reductions in access to home health care that were not authorized or sanctioned by Congress.
In the last 10 years, Medicare beneficiaries using home health services has dropped from 3.5 million beneficiaries annually to 3.1 million beneficiaries as a result of continually reduced payment rates.
With the $635 million payment cut in 2023, the permanent rate reduction of 7.85% finalized by CMS, and over $2 billion in planned "clawback" cuts, future care access can only worsen further in the face of $18 billion in current and future payment cuts.
CMS has portrayed the recent action as an increase in Medicare spending on home health services, but that is highly misleading. The 2022 30-day national standardized payment rate is $2,031.64, yet CMS finalized the 2023 30-day national standardized payment rate at $2,010.69. This represents a reduction in year-over-year payment for care provided by home health agencies beginning in January, despite the significantly increased costs home health agencies continue to experience.
CMS has refused to provide the data and information necessary to replicate its calculations and fully assess the validity of its methodology.
Pending bipartisan legislation, the "Preserving Access to Home Health Act of 2022," S. 4605 and HR 8581, would suspend the behavioral adjustment rate cut to give Congress time to address the complex issues presented by the new payment model. A developing revision of this proposal would focus on suspending the payment cut for just 2023.
What Must be Done
Support stability in the home health care community in 2023 by suspending the entirety of the behavioral adjustment cut to the CY 2023 home health payment rate in CMS's CY 2023 Final Rule.
Strengthened disclosure, accountability, and transparency of the payment rate-setting method employed by CMS, including direct stakeholder engagement, to ensure a budget-neutral transition to the new payment system.
Thank you for helping us carry this unified message out to legislators. We ask that you implement and push for grassroots involvement to get this message out.
Confluence of RSV, COVID-19, and Influenza
Healthcare Ready Alert
New hospitalizations for respiratory illnesses, especially influenza and COVID-19, are spiking following the Thanksgiving holiday. Flu hospitalizations “remain at a decade high” and COVID-19 hospitalizations have increased more than 20% compared to the previous week.
While RSV may have peaked in some areas, overall increases in hospitalizations from COVID-19 and flu in adult and pediatric populations puts additional strain on hospitals that are already at or above capacity. Such strain, especially with months of the respiratory season still ahead, may further constrain capacity to care for critically ill patients of all ages across the US.
Some facilities have reported upticks in illness in staff, creating staffing impacts that further constrain the surge capacity of hospitals and other facilities.
CDC is encouraging use of masks to help prevent spread of COVID-19, flu, and RSV during the holiday season.
The uptake of COVID-19 and influenza vaccines will be a crucial factor for limiting respiratory-related hospitalizations throughout the winter months.
Vaccination rates of children for both COVID-19 and influenza remain very low. American Academy of Pediatrics analysis based on CDC data shows only 10% of children aged 6 months to 4 years old have received at least one dose of the COVID-19 vaccine.
As of 11/19, about 40% of children between the ages of 6 months and 17 years have been vaccinated for influenza for the 2022-2023 season.
Providers Cheer CMS Proposal to Streamline Prior Authorizations
McKnight’s Home Care | By Diane Eastabrook
Provider advocates are applauding a proposed rule by the Centers for Medicare & Medicaid Services that would speed up prior authorization of healthcare services by payers.
The proposal would require Medicare Advantage (MA) plans, Medicaid and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to streamline their prior authorization processes. Payers would be required to respond to urgent requests for healthcare services within 72 hours and standard requests within seven calendar days. They would also be required to include a specific reason when denying requests and publicly report certain prior authorization metrics.
“We are very pleased that CMS has recognized the value and importance of expediting prior authorizations in MA plans and Medicaid,” National Association for Home Care & Hospice President and CEO Willimam Dombi told McKnight’s Home Care Daily Pulse on Wednesday. “Patient needs warrant quick and accurate decisions by payers.”
The proposal also includes other administrative guardrails, including a requirement that certain payers implement standards that would allow patient data be exchanged seamlessly between payers when a patient switches coverage or when they have concurrent coverage.
CMS Administrator Chiquita Brooks-LaSure said the goal of the rule is to “improve the care experience across providers, patients and caregivers — helping us to address avoidable delays in patient care and achieve better health outcomes for all.”
CMS will accept public comment for the proposed rule through March 13, 2023.
The agency isn’t the only group in Washington taking aim at prior authorization by payers, especially among MA plans. Legislation that would require MA plans to streamline the process sailed through the House last September and is pending before the Senate.
MA plans have also come under fire from government watchdog Office of Inspector General for denying and delaying services to older adults covered under those plans.
Supreme Court Declines to Hear Case Against Home Health Certificate of Need Laws
Home Health Care News | By Andrew Donlan
A home health care company hoping to operate in Louisville, Kentucky has hit a road block in its fight against Certificate of Need (CON) laws.
CON laws vary by state. Some have home health CON barriers, while others do not. That results in some states having far more home health agencies than others.
Because Kentucky has CON laws in home health care, Dipendra Tiwari and Kishor Sapkota – two Nepalese immigrants – were met with resistance when they tried to open up an agency specifically tailored to the Nepali speaking people of Jefferson County and Louisville.
Due to language barriers, Tiwari and Sapkota believed that there was a need for home health care services in the community, and were hoping to keep more Nepali-speaking people out of nursing homes by offering up these services. The agency was to be dubbed Grace Home Care.
After a request for a CON was denied by the state of Kentucky, Tiwari and Sapkota filed a lawsuit. The lawsuit was dismissed, however, and eventually, they requested for the U.S. Supreme Court to review their case. They failed to convince the court, however.
“In these cases, the challengers often mischaracterize what CON laws do, what they represent and how they actually function,” Matt Wolfe, a shareholder at the law firm Baker Donelson, told HHCN in an email. “Each state’s CON law operates a little differently, but every CON law allows for and encourages public input, involves various stakeholders – including businesses, providers, and patients – and is flexible to adapt its approach to the changing needs of the communities it covers.”
CON laws have undergone much legal scrutiny in the past, something that Wolfe does not think will stop just because of this case in Kentucky.
Home Health Care News has reported on the pros and cons of certificate of need laws in the past. While some believe that CON laws uphold quality in home health services, others argue that it hurts access and also deters competition. In Tiwari and Sapkota’s case specifically, they were trying – in part – to argue CON laws are unconstitutional.
“There is a coordinated and well-funded campaign by ‘free market’ special interest groups to continue to bring these types of legal challenges to the constitutionality of CON laws in federal and state courts,” he said.
And while the cases against CON laws often make intellectual sense, Wolfe does not believe that the evidence has created a good case against them.
“CON laws play an important role in ensuring access to quality, affordable care,” he said. “The reality is that health care is not provided in a free market. Repealing or substantially limiting CON laws would do nothing to address access issues. In fact, in states that have repealed CON laws, we have seen a proliferation of providers with no appreciable improvement in access. Instead, home health agencies experience small and unsustainable patient censuses.”
