Congressional Year - End Omnibus Legislation (Summary)

Medicare Payment Cuts

+ Congress stopped 6% of the 8.5% Medicare fee-for-service payment cuts facing physicians. Therefore, physicians will experience a 2.5% conversion factor payment cut to the 2023 Medicare Fee Schedule. Physicians will also see a 1.25% cut in 2024.

+ The expiring 5% bonus payment for Advanced Alternative Payment Models, including Accountable Care Organizations was extended for one year at 3.5%.

Medicare Telehealth Flexibilities Extended for Two Years

+ Congress extended all COVID -19 telehealth waivers through the end of 2024. (Payment parity with inperson visits, audio and video, no restrictions on geographic regions or originating sites so patients can be at home.)

More Graduate Medical Education Residency Positions

+ Provides 200 new GME residency positions; half of the positions are dedicated to psychiatry and psychiatry subspecialties to meet the nation’s growing mental health needs.

Physician Wellness Program Expansion

+ Provides an exception to the Stark laws to allow hospitals and other entities to also provide evidence -based physician wellness programs, to improve mental health, increase resiliency, and prevent suicide. This builds on the Lorna Breene, MD Act that Congress passed earlier in the year.

Enhanced Medicaid Pandemic Funding to States Ends, But Additional Coverage Provided

+ Enhanced Medicaid FMAP provided to states during the COVID -19 pandemic ends April 1, 2023. States must begin the process of initiating redeterminations of eligibility over a period of at least 12 months. States would be able to receive enhanced Medicaid funding from April 1 through December 31, 2023, subject to meeting certain conditions such as updating beneficiaries’ contact information and using more than one modality to contact beneficiaries in the event of returned mail.

+ Provides every child in Medicaid and CHIP (40 mi llion children nationwide) one year of continuous coverage when they enroll. This will reduce disruptions in coverage and care for children.

+ Provides funding for 12 months of postpartum coverage to pregnant women in Medicaid and CHIP. California and 26 other states have already implemented this coverage.

Combating Medical Supply and Drug Shortages

+ New initiatives to strengthen the medical supply chains, increase stockpiles, and actively address drug shortages, including incentivizing domestic manufacturing.

+ Requires HHS to award new contracts to increase the domestic manufacturing capacity of certain antibiotic drugs with identified supply vulnerabilities, or the active pharmaceutical ingredient or key starting material of such antibiotic drugs.

Increase d Pandemic Preparedness

+ Updates the nation’s ability to respond to future pandemics, with new pl ans to strengthen medical supply chains and stockpiles, bolster public health agencies, revitalize the public health workforce, enhance biomedical research and more.

Maternal Health, Mental Health and Substance Use Disorder Investments

+ Reauthorizes exist ing funding and makes new investments in mental health grants, suicide prevention, substance use disorder prevention -treatment-recovery services, opioid crisis response, high quality recovery housing, maternal mental health, the mental health workforce with an emphasis on pediatric mental health, grants to train primary care and mental health professionals on eating disorder treatments, and expands mental health parity protections.

+ Improves treatment for opioid addiction by expanding physicians’ ability to prescribe medication -assisted treatment.

Medicare Improvements

+ Makes substantial improvements to Medicare coverage of mental health, including coverage of intensive outpatient mental health care and payment for mental health mobile crisis units. Requires GAO to do a study on mental health parity between Medicare Advantage and traditional Medicare.

+ Requires HHS to conduct outreach to physicians on the requirements to determine eligibility and bill for opioid treatment services.

+ Delays for one year the Clinical Lab payment reduction and reporting requirements.

+ Permits coverage of oral antiviral drugs with an emergency use authorization (EUA) from the Food and Drug Administration (FDA) under Medicare Part D through December 31, 2024.

+ Provides Medicare coverage of physician -prescribed compression garments for seniors with Lymphedema a chronic condition often occurring with aging or cancer treatment.

+ Provides permanent Medicare coverage for items and services related to the administration of intravenous immune globulin (IVIG), beginning on January 1, 2024.

+ Extends for one year the temporary blended payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in certain non -competitive bid areas.

+ Extends the expiring Medicare Dependent Hospital program and the Low Volume Adjustment Hospital program for two years which helps rural and low-income communities.

Additional Health Care and Research Programs

+ Extends for two years the flexibility to exempt telehealth services from the deductible in high -deductible health plans that can be paired with a Health Savings Account.

+ Provides five years of funding at higher levels for the Maternal, Infant and Early Childhood Home Visiting Program.

+ Improves access to health care for justice-involved youth through Medicaid and CHIP by helping them maintain coverage and get connected to needed services.

+ Makes a series of FDA reforms, including protecting the infant formula supply, ensuring diversity in clinical trials, regulating cosmetics, and modernizing the accelerated approval process.

+ Authorizes the Advanced Research Projects Agency for Health (ARPA-H) to accelerate innovation in health and medicine by investing in novel, broadly applicable, high -risk, high-reward research projects.