On December 27, 2020, President Trump signed into law the fourth round of COVID-19 emergency relief that passed both the U.S. Senate and the U.S. House of Representatives. The Consolidated Appropriations Act, 2021 (“Act”) includes approximately $900 billion in pandemic relief and is reportedly the longest bill (5,593 pages) to be passed in Congress’s history.
In addition to COVID-19 relief, the Act includes the following noteworthy healthcare provisions:
- Medicare Graduate Medical Education (“GME”) Provisions
- Distribution of Additional GME Residency Positions: Starting in fiscal year 2023, the Act increases by 1,000 the GME full-time equivalent (FTE) cap on Medicare-funded residency positions. Over a five-year period the cap will be increased by 200 positions each year until the residency slots are filled. The Department of Health and Human Services (“HHS”) will assign at least 10 percent of these new 1,000 FTE residency positions to each of the following categories of hospitals: (i) rural teaching hospitals; (ii) hospitals that train residents in excess of their FTE caps; (iii) hospitals in states that have new medical schools; and (iv) hospitals that serve areas designated as health professional shortage areas under section 332(a)(1)(A) of the Public Health Service Act. A hospital may not receive more than 25 new FTE residency positions and cannot receive an increase to its limit unless the hospital also agrees to increase the total number of FTE residency positions by the number of such positions made available by such increase under this provision. HHS is tasked with creating an application process to distribute these FTE residency positions to hospitals.
- Medicare GME Treatment of Hospitals Establishing New Medical Residency Training Programs After Hosting Medical Resident Rotations for Short Durations: The Act enables hospitals that have low per-resident amounts (“PRAs”) to establish new PRAs under certain conditions. In addition, a hospital that hosted medical resident rotations for short durations and establishes a new medical residency training program may receive an adjustment to its Medicare GME FTE caps if certain conditions are met.
- Revisions to the Rural Training Track Exception: To promote residency training in rural areas, Congress included incentives in the Act for hospitals not located in rural areas to work with hospitals in rural areas to establish rural training opportunities for residents.
- Medicaid DSH Payments: For fiscal years 2021 through 2023, the Act eliminates cuts to Medicaid disproportionate share hospital payments.
- Amended State Medicaid Reporting Requirements: Similar to requirements in the proposed Medicaid Fiscal Accountability Regulation, the Act imposes certain reporting requirements for states regarding supplemental Medicaid payments.
- Medicare Physician Fee Schedule Payments: For 2021, the Act increases payment amounts made under the 2021 Medicare Physician Schedule by 3.75 percent.
- Surprise Billing: The Act includes protections for patients from surprise medical billing for certain out-of-network care. Surprise medical billing in the Act was previously covered in an article by the Health Law Pulse here.
Norton Rose Fulbright attorneys will continue to monitor the impacts of the Continuing Appropriations Act, 2021 to healthcare providers and will post relevant updates on the Health Law Pulse.