Supporting the Physiatrist, Strengthening the Specialty

On December 21, Congressional leaders released the text of the Consolidated Appropriations Act, 2021, a massive “omnibus” package containing government funding legislation for Fiscal Year (FY) 2021, a bipartisan agreement on additional COVID-19 response and relief provisions and a broad sampling of other policies. This package has been under consideration for months and is one of the final acts of the 116^th Congress, encompassing nearly $2.5 trillion in federal spending.

The House of Representatives and the U.S. Senate voted into the evening and passed the bill by wide bipartisan majorities on December 21. Another continuing resolution was included in the bill to avoid a government shutdown as Congress prepares the final bill for Presidential signature. President Trump signed the Consolidated Appropriations Act on December 27, 2020. There were no substantive changes to the bill from the version that was passed by Congress on December 21 and contains government funding legislation for Fiscal Year 2021, a bipartisan agreement on additional COVID-19 response and relief provisions, and a broad sampling of other policies. 

AAPM&R staff and our Washington counsel are reviewing the details of the nearly 5,600-page bill and will provide more information as it becomes available. The full text of the omnibus is available here, and links to summaries and one-page fact sheets regarding the legislation can be found here. Below, please find a brief overview of key provisions impacting physiatrists.

Physician Fee Schedule

• The omnibus includes a partial “fix” to the provider reimbursement cuts previously scheduled to go into effect on January 1, 2021.
  • The bill injects approximately $3 billion into the Physician Fee Schedule (PFS) for 2021, resulting in an approximate 3.75% increase to all services to mitigate the scheduled cuts. These additional payments will apply only for 2021 and will not result in additional adjustments due to budget neutrality.
  • The bill also delays the implementation of the new “complex patient add-on” code (G2211) for three years (until January 1, 2024). The removal of this code will further reduce the impact of the downward budget neutrality adjustments outlined in the PFS final rule.
• The bill also includes a temporary delay of Medicare sequestration cuts scheduled to go into effect on January 1, 2021. These have been delayed until March 31, 2021.

Paycheck Protection Program/Provider Relief Fund

• The Paycheck Protection Program (PPP), instituted under the CARES Act to provide loans to small businesses, will receive an additional $284 billion in funding. The PPP was also extended through March 31, 2021.
  • The bill provides a “second draw” loan program within the PPP, allowing qualifying small businesses who previously received a PPP loan to receive a second loan with a maximum amount of $2 million. The application process for forgiveness of loans under $150,000 is also significantly simplified.
  • The omnibus also includes language clarifying that recipients do not need to consider forgiven PPP loans as gross taxable income, and that qualifying expenses paid for with PPP funds are, in fact, tax-deductible.
• The Economic Injury Disaster Loans (EIDL) program will receive $20 billion in additional funding, specifically targeted for eligible entities in low-income communities. The covered period for these loans was extended through December 31, 2021.
• The bill also includes an additional $3 billion for the Department of Health and Human Services’ Provider Relief Fund, as well as modifications to the program’s reporting guidelines.

Direct Payments/Unemployment Insurance

• The omnibus provides for additional direct stimulus checks to most Americans, following largely the same criteria as the checks distributed earlier this year following the CARES Act. Individuals making less than $75,000 will receive $600, with gradual phase-outs for those with higher incomes.
• The federal enhancement to state and local unemployment insurance (UI) benefits will also return, with the federal government providing an additional $300/week to those qualifying for unemployment. The UI boost will last through March 14, 2021.

Surprise Billing Reform

• The omnibus includes a long-awaited compromise addressing “surprise” medical billing. Patients will only be required to pay their in-network rate for out-of-network emergency care, ancillary services provided by out-of-network providers at in-network facilities, and out-of-network care at in-network facilities provided without the patient’s informed consent.
• Health plans and providers will have a 30-day period to negotiate payments to make up the difference between the in-network rate paid by the patient and the “balance” of the out-of-network bill.
  • After the 30-day period, the plan or provider may elect to move to a binding Independent Dispute Resolution (IDR) process if an agreement has not been reached.
• These patient protections also apply to air ambulance services.
• The surprise billing language also includes new requirements for transparency in rates and network status of providers for scheduled services.

Several provisions that were being eyed for end-of-year action were not included in the FY 2021 omnibus, including legislation to reform the use of prior authorization in Medicare Advantage (H.R. 3107/S. 5044), legislation to reset the timeline for implementing the IMPACT Act of 2014 (H.R. 8826), and legislation to provide broad liability protections against COVID-related lawsuits for businesses, including health care providers.

AAPM&R will continue to monitor further developments regarding these and other key priorities in the next Congress.

On December 21, Congressional leaders released the text of the Consolidated Appropriations Act, 2021, a massive “omnibus” package containing government funding legislation for Fiscal Year (FY) 2021, a bipartisan agreement on additional COVID-19 response and relief provisions and a broad sampling of other policies. This package has been under consideration for months and is one of the final acts of the 116^th Congress, encompassing nearly $2.5 trillion in federal spending.

The House of Representatives and the U.S. Senate voted into the evening and passed the bill by wide bipartisan majorities on December 21. Another continuing resolution was included in the bill to avoid a government shutdown as Congress prepares the final bill for Presidential signature. President Trump signed the Consolidated Appropriations Act on December 27, 2020. There were no substantive changes to the bill from the version that was passed by Congress on December 21 and contains government funding legislation for Fiscal Year 2021, a bipartisan agreement on additional COVID-19 response and relief provisions, and a broad sampling of other policies. 

AAPM&R staff and our Washington counsel are reviewing the details of the nearly 5,600-page bill and will provide more information as it becomes available. The full text of the omnibus is available here, and links to summaries and one-page fact sheets regarding the legislation can be found here. Below, please find a brief overview of key provisions impacting physiatrists.

Physician Fee Schedule

• The omnibus includes a partial “fix” to the provider reimbursement cuts previously scheduled to go into effect on January 1, 2021.
  • The bill injects approximately $3 billion into the Physician Fee Schedule (PFS) for 2021, resulting in an approximate 3.75% increase to all services to mitigate the scheduled cuts. These additional payments will apply only for 2021 and will not result in additional adjustments due to budget neutrality.
  • The bill also delays the implementation of the new “complex patient add-on” code (G2211) for three years (until January 1, 2024). The removal of this code will further reduce the impact of the downward budget neutrality adjustments outlined in the PFS final rule.
• The bill also includes a temporary delay of Medicare sequestration cuts scheduled to go into effect on January 1, 2021. These have been delayed until March 31, 2021.

Paycheck Protection Program/Provider Relief Fund

• The Paycheck Protection Program (PPP), instituted under the CARES Act to provide loans to small businesses, will receive an additional $284 billion in funding. The PPP was also extended through March 31, 2021.
  • The bill provides a “second draw” loan program within the PPP, allowing qualifying small businesses who previously received a PPP loan to receive a second loan with a maximum amount of $2 million. The application process for forgiveness of loans under $150,000 is also significantly simplified.
  • The omnibus also includes language clarifying that recipients do not need to consider forgiven PPP loans as gross taxable income, and that qualifying expenses paid for with PPP funds are, in fact, tax-deductible.
• The Economic Injury Disaster Loans (EIDL) program will receive $20 billion in additional funding, specifically targeted for eligible entities in low-income communities. The covered period for these loans was extended through December 31, 2021.
• The bill also includes an additional $3 billion for the Department of Health and Human Services’ Provider Relief Fund, as well as modifications to the program’s reporting guidelines.

Direct Payments/Unemployment Insurance

• The omnibus provides for additional direct stimulus checks to most Americans, following largely the same criteria as the checks distributed earlier this year following the CARES Act. Individuals making less than $75,000 will receive $600, with gradual phase-outs for those with higher incomes.
• The federal enhancement to state and local unemployment insurance (UI) benefits will also return, with the federal government providing an additional $300/week to those qualifying for unemployment. The UI boost will last through March 14, 2021.

Surprise Billing Reform

• The omnibus includes a long-awaited compromise addressing “surprise” medical billing. Patients will only be required to pay their in-network rate for out-of-network emergency care, ancillary services provided by out-of-network providers at in-network facilities, and out-of-network care at in-network facilities provided without the patient’s informed consent.
• Health plans and providers will have a 30-day period to negotiate payments to make up the difference between the in-network rate paid by the patient and the “balance” of the out-of-network bill.
  • After the 30-day period, the plan or provider may elect to move to a binding Independent Dispute Resolution (IDR) process if an agreement has not been reached.
• These patient protections also apply to air ambulance services.
• The surprise billing language also includes new requirements for transparency in rates and network status of providers for scheduled services.

Several provisions that were being eyed for end-of-year action were not included in the FY 2021 omnibus, including legislation to reform the use of prior authorization in Medicare Advantage (H.R. 3107/S. 5044), legislation to reset the timeline for implementing the IMPACT Act of 2014 (H.R. 8826), and legislation to provide broad liability protections against COVID-related lawsuits for businesses, including health care providers.

AAPM&R will continue to monitor further developments regarding these and other key priorities in the next Congress.