Beyond Coronavirus, New Health Legislation is Being Passed
We are all exhausted hearing the words of Covid-19, pandemic, etc. but that’s not the only health legislation Biden is working to move forward.
What 4 key issues you might have missed:
Ban on surprise medical bills - we wrote about this proposed legislation a couple of weeks ago, but it is officially a law! Starting in 2022, your out-of-network care , emergencies and care for in-network that might not be covered by your insurance historically will be reduced in price. The new legislation sets a limit to the cost that an individual can incur.
This was just the first step in increasing cost transparency of healthcare. Congress enacted a “gag measure” to prevent contracts made between health insurers and providers. This spans a wide range of actions that have historically resulted in both payers and providers, pharmacies, benefit companies, etc. negotiating contracts that paid them kickbacks in the fee-for-service healthcare model. The legislation moves us further in the direction of value-based care that Americans can actually afford.
Rural hospitals receive funding from Medicare- rural hospitals are not going to receive payments from Medicare for services. “Rural emergency hospital” is a new classification of medical facilities accepted by Medicare. Starting in 2023, if a rural hospital maintains a full-time emergency department, they can now be reimbursed by Medicare.
This is following a trend over the last 10 years of rural hospitals closing due to lack of funding. Already challenged by balancing caring for a small number of residents and the overhead of a hospital system, 120 rural hospitals had to close in the last 10 years, a recent study found. (npr.org)
Announcement of 1,000 new residency positions available for new doctors - the Pandemic continues to teach us many lessons, but the glaring shortage of doctors and nurses is too apparent for Congress to ignore. Over the next 5 years, Medicare is going to fund the creation of 1,000 new residency positions in emergency medicine and other specialties. This extends to all hospitals including those in rural areas.
This is a reversal of a 1990s rule that capped the amount of funding Medicare would provide for residency positions. The fear was that too many doctors would inflate the costs of Medicare. This resulted in a highly competitive residency race, primarily centered around the Northeast. Hospitals are encouraged to additionally create residency positions, since Medicare funding is not the only financial resource available.
Mental health protections strengthened - Federal Officials are required by this legislation to study the limitations imposed by insurance companies in respect to mental health. Now, the Affordable Care Act enforces mental health and substance use treatments as “essential health benefits” meaning insurance companies are mandated to cover mental health coverage. (npr.org)
This legislation builds on an Act passed by congress in 1966 preventing insurance companies from billing mental health cost more than they would for other routine care and procedures. Now, insurers are required to analyze their annual findings on coverage for mental health. Measurement is key because without the data, it’s easy to turn a blind eye. This is a step in the right direction, also requiring Federal Officials to analyze mental health data and forcing insurers to report directly to their clients if there was a violation.
Led by Families USA, Consumers First is an alliance of health professionals and labor unions who see these policies as “a significant step forward” (npr.org) and stating “the abusive practices from hospitals and health systems and other segments of the health care sector that are driving up health care costs and making health care unaffordable for our nation’s families, workers, and employers.” (npr.org)