UPDATE: $900 billion COVID-19 relief bill in doubt as President Trump refuses to sign

President Donald Trump on Wednesday has thrown doubt over the $900 bilion coronavirus relief package passed by Congress by refusing to sign the bill. He is asking Congress to amend the bill to increase the $600 stimulus to individuals to $2,000, according to CNN. 

Congress this week passed the $2.3 trillion spending package that funds the government through the end of the fiscal year and includes $900 billion in a COVID-19 relief bill.

The bill ends eight months of partisan stalemate for a fifth and final stimulus package that President Trump is expected to sign. Providers get $3 billion, which is far less than the $175 billion included in other provider relief packages earlier this year.

"While we appreciate this funding, hospitals and health systems continue to need additional resources as they deal with a surge in cases and hospitalizations," said American Hospital Association president and CEO Rick Pollack. "As Leader (Mitch) McConnell said about this package, 'more help is on the way,' and as Leader (Chuck) Schumer also said, this package is a 'down payment' and 'cannot be the final word' on COVD-19 relief. The AHA strongly agrees with both leaders."

WHAT PROVIDERS AND OTHERS DO GET

Providers get more flexibility in provider relief fund reporting requirements. The bill allows hospital systems to move targeted relief fund distributions within their systems and use any reasonable method to calculate lost revenue. 

It temporarily freezes the MACRA alternative payment model payment incentive thresholds for two years. The bill encourages continued participation in risk-bearing alternative payment models such as accountable care organizations by freezing the thresholds needed to secure a 5% bonus on annual Medicare payments.

It averts Medicaid disproportionate share hospital payment cuts by eliminating these cuts for the next three years. In 2021, $4 billion was scheduled to be cut.  

It extends the suspension of the 2% Medicare sequester cut by three months and allows public hospitals to claim the COVID-19 employee retention tax credit. 

It funds 1,000 new graduate medical education residency slots. The provision to increase federal support for residency training will end a nearly 25-year freeze by lifting the arbitrary cap on Medicare funding for graduate medical education and adding 1,000 new Medicare-supported GME positions at both rural and urban teaching hospitals, said David J. Skorton, president and CEO of the Association of American Medical Colleges.

The country faces a projected physician shortage of up to 139,000 doctors by 2033, and the COVID-19 pandemic has amplified these shortages, Skorton said.

It provides funding for the Department of Health and Human Services to modernize the public health data infrastructure.

There is $20 billion for vaccine distribution, a $1.25 billion increase to the National Institutes of Health for a total budget of $42.9 billion, and an additional $125 million to the Centers for Disease Control and Prevention, for a total of $7.9 billion, according to The Hill.

The bill extends unemployment benefits at $300 a week through March 14, 2021 and gives Americans earning less than $75,000 a second $600 stimulus check, according to Fox Business. It includes about $325 billion in small business relief, including $284 billion in forgivable loans for small businesses through the Paycheck Protection Program.

SURPRISE MEDICAL BILLS

One measure has prompted both support and censure, the move to end surprise medical billing through an arbitration process. 

Opponents say the use of arbitration, instead of using preset benchmark rates, to resolve disputes between insurers and providers will increase healthcare costs.

The Coalition Against Surprise Medical Billing said, "Despite out-of-network providers and private equity firms trying once again to dismantle and block vital reforms, Congress is taking a first step to remove patients from the middle of abusive surprise billing practices. But American families and employees deserve a better surprise billing solution than arbitration. The experience in the states, including New York, New Jersey and Texas, demonstrates government-mandated arbitration is a costly and burdensome process – one that is prone to abuse from the very same private equity firms and out-of-network providers that caused and exploited the surprise billing crisis."

American Heart Association CEO Nancy Brown said, "The bipartisan agreement shields patients from bills for medical services and removes patients from payment disputes between providers and insurers." 

Eagan Kemp, a healthcare advocate at Public Citizen, said, "Despite healthcare profiteers' efforts, Americans will now be protected from most surprise bills. However, Congress must still act to protect Americans from surprise bills for ground ambulances, a crucial gap in the current compromise."

Matt Eyles, president and CEO of America's Health Insurance Plans said, "While we appreciate Congress' work to protect patients from surprise medical bills, we remain deeply concerned that hardworking American families and businesses will face increased costs and higher premiums as private-equity firms exploit arbitration processes. We have already seen this play out in Texas and New York, which have both experienced first-hand the harms of arbitration on consumers."

Blue Cross Blue Shield Association SVP of the office of policy and representation Justine Handelman said, "We are pleased Congress has taken a first step toward protecting people from unfair and costly surprise medical bills, and that patients will now be taken out of the middle in these situations – including those involving air ambulances. We remain concerned that a complex arbitration process, which has been ineffective in states that have tried it, holds the potential to raise premiums for everyone."
 
REACTION TO OTHER PROVISIONS

Alliance of Community Health Plans president and CEO Ceci Connolly:  "Funding for testing will further the ability for everyone who needs a test to access one. In addition, federal support for vaccine distribution is vital to broad success, but allowing health plans access to vaccination data is key to making sure Americans receive both doses.   
 
"ACHP appreciates Congressional efforts to improve care and coverage for seniors, many who are most vulnerable to the impact of COVID-19. We applaud the improved access to Medicare's mental health services via virtual care and look forward to working with Congress to extend telehealth flexibility and permanency across the entire Medicare program."

The American Society for Radiation Oncology applauded the delay in the start of the Radiation Oncology Advanced Payment Model until January 1, 2022 and congressional support to make changes to the model. Dr. Thomas J. Eichler, chair of the ASTRO Board of Directors said, "The RO Model is a prime example of a payment model gone awry, focusing more on cutting costs than preserving quality and access. Cloaked in the rhetoric of value-based care, Medicare's model will create significant cost and administrative burden for the nearly 1,000 radiation oncology practices forced to participate."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com