Congressional leaders finalized a $900 billion COVID-19 relief package and $1.4 trillion omnibus spending bill on Dec. 20, narrowly averting a government shutdown by passing a 24-hour continuing resolution to complete action on the catch-all appropriations and pandemic relief measure. While the process has been beset by delays, House and Senate leaders voted on the package late at night on Dec. 21. The relief package includes a new round of stimulus checks, unemployment benefits, funding for small businesses, transportation, COVID-19 vaccine distribution and schools. Of note, state and local aid and a liability shield – which had been debated for months – were not included. The legislation also includes a number of provisions of interest to the health care community and practice of cardiology. Highlights include:

Surprise Medical Billing
The agreement includes a long sought-after provision to stop the practice of surprise medical billing. Patients are only required to pay the in-network cost-sharing amount for any out-of-network emergency care, for certain ancillary services, and for out-of-network care at in-network facilities without the patient's informed consent. The legislation provides for a 30-day open negotiation period for providers and payers to settle out-of-network claims. It also states that if the parties are unable to reach a negotiated agreement, they may access a binding arbitration process – referred to as Independent Dispute Resolution (IDR) – in which one offer prevails. Providers may batch similar services in one proceeding when claims are from the same payer. The IDR process will be administered by independent, unbiased entities with no affiliation to providers or payers. It also states that a group or individual health plan shall include on their plan or insurance identification card issued to the enrollee the amount of the in-network and out-of-network deductibles and the in-network and out-of-network out-of-pocket maximum limitations.

Medicare Physician Fee Schedule Budget Neutrality
The bill addresses concerns by specialists practicing in the Medicare program to blunt the impact of an 11% budget neutrality conversion factor reduction required by the 2021 Medicare Physician Fee Schedule. The bill blocks newly created code G2211 for three years, which is projected to mitigate these cuts by roughly $3 billion. Separately, it also injects $3 billion into the physician fee schedule in 2021. Those two changes will result in a conversion factor reduction of 4% instead of 11%, mitigating disruption during the ongoing COVID-19 pandemic. (If one is estimating fee schedule payment impacts using the ACC calculator, payment amounts will be roughly 7% higher for each service. The calculator will be updated when CMS issues an updated conversion factor.) The bill also continues the current Alternative Payment Model (APM) thresholds for two additional years, allowing more providers to qualify for the 5% APM payment who would otherwise have been disqualified because of statutory increases in threshold amounts. The legislation also delays the 2% Medicare sequester cuts that were slated to resume Jan. 1, 2021, for three additional months.

Paycheck Protection Program
The measure sets aside $284 billion towards forgivable small-business loans under the Paycheck Protection Program (PPP) and specifies that forgiven PPP loans will not be included in taxable income. It also clarifies that deductions are allowed for expenses paid with proceeds of a forgiven PPP loan, effective as of the date of enactment of the CARES Act and applicable to subsequent PPP loans. This same tax treatment also applies to EIDL grants and certain loans and loan repayment assistance. The bill also provides $248 billion for a second, forgivable loan for small businesses with 300 or fewer employees that can demonstrate a 25% loss of revenue in any quarter for 2020. In addition, the bill expands PPP eligibility to certain organizations, including non-profits, critical access hospitals, and others. It also simplifies forgiveness process for loans of $150,000 or less.

General COVID Relief
The package provides $1.250 billion in emergency funding for National Institutes of Health (NIH) research and clinical trials related to long-term COVID-19 studies; $166 billion on direct "Economic Impact Payments" to individuals making up to $75,000 and couples making $150,000; $120 billion for unemployment insurance, including an additional $300/week boost to unemployment benefits; $22 billion for state COVID testing and tracing programs; $20 billion to purchase vaccines to be made available at no cost; and $9 billion to assist states and the Centers for Disease Control and Prevention (CDC) in vaccine distribution.

FY21 Appropriations
Under the bill, most of ACC's FY21 appropriations priorities receive increased funding levels in FY21. The spending package provides funding increases for medical research and disease prevention programs at the NIH and CDC. Specifically the bill provides the National Heart Lung and Blood Institute (NHLBI) with $3.664 billion; the CDC Division for Heart Disease and Stroke Prevention with $143 million; the CDC WISEWOMAN program with $28 million; CDC congenital heart disease research with $7 million; and the CDC Office on Smoking and Health with $237.5 million. The bill also provides $338 million for the Agency for Healthcare Research and Quality (AHRQ), the same as the 2020 enacted level; and it provides $1.2 billion, an increase of $30 million, for HRSA's Bureau of Health Professions programs to support the medical workforce.

Clinical Topics: COVID-19 Hub

Keywords: ACC Advocacy, Coronavirus, Coronavirus Infections, severe acute respiratory syndrome coronavirus 2, COVID-19, National Heart, Lung, and Blood Institute (U.S.), Small Business, Medicare

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