November 26, 2021

Volume XI, Number 330

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November 24, 2021

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Congress Passes New and Additional Support For Health Care Providers, Patients, COVID-19 Mitigation and Vaccination

On Monday, December 21, Congress enacted a $900 billion stimulus package that includes support for American health care providers and patients impacted by COVID-19, and additional funding for COVID-19 mitigation and vaccination.

The complete stimulus package contains a significant number of health care measures. The following is not intended to be a comprehensive review of all these measures, but rather a highlight of those that we feel may be of particular importance or interest to our clients. 

Support for Providers and Hospitals

  • Provides $3 billion to the Provider Relief Fund, a source of funding to health care service providers who have lost revenue due to COVID-19; allows the federal Department of Health and Human Services (HHS) to distribute 85% of the grants through a process that will prioritize, among other things, a provider’s financial loss.

  • Changes how providers calculate revenue loss for purposes of applying for provider relief grants in an effort to reflect more accurate revenue losses for providers and hospitals; allows hospitals to calculate lost revenue based on their budgeted revenue, as long as a budget was in place by March 27, 2020.

  • Delays implementation of parts of the Medicare Physician Fee Schedule (specifically, the GPC1X) to mitigate the impact of cuts to certain health care providers.

  • Provides a 3.75% boost to all health care providers to offset the impact of the final implementation of the complete Medicare Physician Fee Schedule.

  • Suspends for another three months the 2% Medicare payment cut that was required under sequestration and scheduled to take effect on December 31, 2020.

  • Delays planned cuts to Medicaid disproportionate-share hospital (DSH) payments through fiscal year 2023, a provision that will help hospitals that service a high number of Medicaid patients. 

Ending Surprise Medical Billing, Increasing Transparency in Provider Quality, Cost Data

  • Enacts the “No Surprises Act” to include a provision to end surprise medical billing, the circumstance in which a patient is treated out-of-network, leading to unanticipated costs for the health care services; requires providers and insurers to negotiate an agreement, with binding arbitration available if an agreement cannot be reached.

  • Prohibits gag clauses in contracts between providers and payers, allowing individuals, including patients and referring providers, to see cost and quality data on providers.

  • Makes changes to clarify aspects of the Food and Drug Administration’s (FDA) review of biosimilars and orphan drugs.

  • Provides increased transparency around biologic patents by codifying and updating the “Purple Book” maintained by the FDA.

    Support for COVID-19 Mitigation and Vaccination
    • Provides $20 billion to fund free vaccinations for all Americans; also provides $8 billion to facilitate an effective and efficient vaccination process.

    • Provides $22 billion to states for help with testing, tracing, and other COVID-19 mitigation efforts.

©2021 Pierce Atwood LLP. All rights reserved.National Law Review, Volume X, Number 359
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About this Author

Andrea Maker Healthcare Attorney Pierce Atwood Law Firm Portland
Partner

Andrea Maker provides governmental relations services in Maine and in Washington, DC with Maine's Congressional delegation. Her practice includes lobbying, government contracts, and strategic positioning of organizations. Her advocacy focus areas include economic development, workforce development, health care and real estate.

Andrea maintains strong relationships with Maine’s legislative leaders, Governors and cabinet members. She is well connected across the State and has personal relationships with countless other policy makers, business...

207-791-1101
Ann Robinson, Pierce Atwood Law Firm, Augusta and Portland, Health Care Law Attorney
Partner

Ann Robinson is a partner in Pierce Atwood's Government Relations and Health Care Practice Groups.

A highly regarded Maine attorney and lobbyist, Ann was a partner and former Chair of the Government Affairs Practice Group at a large Maine law firm, where she built an active legislative and regulatory law practice focusing primarily in the areas of health care, insurance, and professional regulation.

Ann most recently served as General Counsel and Director of Government Affairs for Spectrum Medical Group, P.A., Northern...

207-791-1186
Newell Augur Government Relations Attorney Pierce Atwood Law Firm
Counsel

Newell Augur has nearly 20 years of experience in Maine in the fields of government relations and administrative law, cultivating long-standing relationships with state government officials and other policy leaders. Newell’s experience includes designing and executing his clients’ legislative strategy, enlisting and organizing stakeholders, serving as spokesperson for press events, and monitoring initiatives that affect client operations.

In addition to representing businesses, nonprofits, and other clients before the Maine Legislature and state agencies, Newell has led three...

207-791-1281
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