Congress passes COVID-19 relief, spending bill: Here's what hospitals should know

Congress overwhelmingly approved Dec. 21 a spending deal and $900 billion COVID-19 relief package that includes more funding for providers, vaccine distribution and paycheck protection program loans. 

The House approved the package first by a 359-53 vote, followed by the Senate that passed it by a 92-6 margin. 

The 5,593-page bill now heads to President Donald Trump's desk, where he has until Dec. 28 to sign it.

Here are 10 things healthcare leaders should know:

1. Surprise-billing ban. The bill includes a measure that will end surprise medical bills for emergency and scheduled care. In a win for providers, the deal bans arbiters from taking into account Medicare and Medicaid rates when negotiations between insurers and providers stall and they need to decide payment rates through arbitration. Medicare and Medicaid rates are often lower than the rates commercial insurers pay. The measure also forbids arbiters from considering providers' billed charges, which are usually much higher than insurers or patients end up paying. Read more about the surprise billing fix here

2. Provider relief funding. Under the deal, Congress infused $3 billion into the Provider Relief Fund. This is much less than the $35 billion outlined in the bipartisan COVID-19 relief bill. The bill will also require HHS to distribute 85 percent of the grants through an application process that prioritizes such items as financial losses. 

3. Funding for vaccination efforts. The bill includes additional funding to assist the U.S. with its vaccination efforts. In particular, the bill includes $20 billion for the purchase of vaccines to ensure Americans can get the shot for free and more than $8 billion for vaccine distribution.

4. Revenue-reporting rules for COVID-19 grants. Lawmakers included a provision changing how providers can calculate revenue for its provider relief grants. In particular, the bill will allow hospitals to calculate lost revenue by comparing budgeted or actual revenue for 2020. Hospitals have said this tweak will allow them to keep more funding.

5. Medicare sequester. The bill suspends for another three months the 2 percent Medicare payment cut that was set for Dec. 31. Congress delayed the 2 percent cut in the Coronavirus Aid, Relief and Economic Security Act through the end of this year. 

6. Medicaid DSH cuts. Planned cuts to Medicaid disproportionate-share hospital payments will be delayed through fiscal year 2023. The ACA mandated that these cuts, meant to support hospitals that serve a large number of Medicaid and uninsured patients,  be cut by about $43 billion between fiscal 2018 and 2025. 

7. Gag clause ban. The bill includes language that will ban gag clauses in contracts between providers and payers. This will allow health plan beneficiaries, sponsors and referring providers to see cost and quality data on providers.  

8. Paycheck Protection Program loans. The agreement earmarks $284 billion for Paycheck Protection Program loans. This new round of funding extends eligibility for the loans to include more nonprofits, newspapers and TV stations. 

9. Direct payments to Americans. The stimulus bill includes a one-time $600 payment to Americans who earn up to $75,000 and couples filing jointly who make up to $150,000. Parents will also get a $600 payment for every child under 18 years of age. 

10. Testing, tracing. The bill allocates $22 billion to help states with testing, tracing and other COVID-19 mitigation programs.

Read the full bill here. 


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