Biden Signs Funding Bill Extending Telehealth Flexibilities, but no Relief for Doctors — or PBM Reform

Healthcare Dive / By Rebecca Pifer

President Joe Biden signed a stripped down funding bill on Saturday, averting a government shutdown during the holiday season.

Congress agreed to a sweeping package earlier last week that included a number of important healthcare provisions, including an extension of telehealth flexibilities, relief from scheduled Medicare cuts for physicians and reform for controversial pharmacy benefit managers.

However, of the major healthcare changes only an extension of virtual care waivers made it into the final bill, after President-elect Donald Trump and billionaire Elon Musk panned the initial package as overly expensive.

Physicians slammed Congress for failing to prevent the Medicare cuts from going into effect.

“For the fifth consecutive year, Congress has adjourned and allowed Medicare cuts. What will be the result? Patients struggling to access health care. Physicians closing or selling their private practices while others opt to leave the profession,” said Bruce Scott, the president of the American Medical Association, in a statement.

Congress has to step in at the end of the year and avert scheduled cuts due to statutory requirements around how Medicare pays doctors. That creates significant stress for physicians, who have amplified calls for a permanent fix to the situation.

Without relief in the stopgap funding bill, physicians’ Medicare funding will fall by 2.8% in 2025.

With that cut, Medicare rates have fallen 33% over the past two decades when adjusted for physician costs, according to the AMA.

“The Medicare payment system is broken,” Scott said. “Congress must enact meaningful long-term reforms.”

Physician groups support tying annual reimbursement hikes to a measure of inflation, a policy backed by some members of Congress and influential advisory groups.

Reform will likely be on the table in Congress next year. There’s also a chance lawmakers could pass relief in 2025 that’s applied retroactively, making physicians whole for some or all of the 2.8% cut…

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The Top 10 Home Health Care News Stories Of 2024

Home Health Care News / By Joyce Famakinwa
 
Major deals hit snags. Home health cuts continued. Regulatory noise came in from all sides, in Medicare and in Medicaid. All of those realities made their way into Home Health Care News’ most popular stories for the year. In order to summarize the 2024 that providers had, HHCN is revisiting 10 of its most widely read stories.
 
1. Home Care Industry Slams Finalized 80-20 Rule, Warns Agency Closures Are Coming (April 22)
  
2. Court Orders VitalCaring to Share 43% of Profits With Encompass Health, Enhabit (December 3)
   
3. How The Supreme Court’s Chevron Decision Could Help Stop Home Health Cuts (June 28)
 
4. DOJ Sues To Block ‘Anticompetitive and Illegal’ UnitedHealth Group-Amedisys Deal (November 12) 
  
5. Home Care’s Industry-Wide Turnover Rate Reaches Nearly 80% (July 3)
 
6. The Looming Home Care Disaster In New York State (March 18) 
  
7. ‘We Need A Break, Please!’: Home Health Providers Sound Off On CMS Over Rate Cuts (October 11)
 
8. Enhabit Walks Away From UnitedHealthcare After ‘9 Months Of Unsuccessful Negotiations’ (August 7) 
 
9. 6 Home Care Leaders To Watch, According To Other Home Care Leaders(January 29)
  
10. Pinnacle Home Care CEO: Home Health Margins Will Increase ‘Significantly’ With AI (October 22)

Three Major Health Care Policy Issues to Watch in 2025

Stat News / By John Wilkerson

WASHINGTON — Health care did not play a big role in the election that’s sending President Trump back to the White House and giving Republicans control of Congress. That doesn’t mean Congress will avoid the topic next year.

Trump mostly avoided talking about health care during his 2024 campaign, a contrast from 2016, when he ran on the promise of repealing and replacing the Affordable Care Act. But he did promise to “not cut one penny” from Medicare, and he said he’d give prominent vaccine critic Robert F. Kennedy Jr., now his pick to run the Department of Health and Human Services, broad rein to reshape health care. 

However, Trump did promise to extend individual tax cuts that Republicans passed in 2017 and that are set to expire at the end of next year. He also wants to further cut corporate tax rates. 

That tax plan would significantly increase the already ballooning deficit, so Republicans will likely need to rely on health care policy changes to help offset it, according to three former government health care officials, all of whom ran the agency overseeing Medicare and Medicaid. 

“It was not a health care election,” said Nancy-Ann Min DeParle, who ran the Obama White House Office of Health Reform. “But no, health care will not take a back seat.”

DeParle, Mark McClellan, and Tom Scully spoke at an American Bar Association conference on Dec. 9. Here are the major policy issues they expect to surface next year. 

Medicaid cuts

DeParle predicted that Republicans will target Medicaid for cuts because Trump has promised not to cut spending for Medicare, Social Security, and defense,leaving Medicaid as one of the only big programs to pay for tax cuts. DeParle ran Medicare during the Clinton administration and is now a partner at the private equity firm Consonance Capital Partners, which she cofounded.

Medicaid is especially vulnerable because Republicans control the White House and both chambers of Congress. That enables them to avoid the Senate filibuster by using a budget process that requires only a simple majority to pass. 

Federal Medicaid spending increased significantly under the Biden administration as enrollment in the health insurance program for the poor swelled, thanks to pandemic-era legislation that prohibited states from disenrolling people. Enrollment began falling after states were allowed to trim their rolls last year. 

Republicans are expected to pursue policies, such as work requirements and capped Medicaid funding levels, that could further reduce enrollment…

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2024 in Review and What to Expect in 2025

SESCO Management Consultants

2024 In Review

• The Fair Labor Standards Act and the White-Collar Exemptions. In April, the U.S. Department of Labor (DOL) issued a rule aimed at raising the salary threshold for overtime exemptions under the Fair Labor Standards Act (FLSA). In November, a federal judge in Texas struck down the DOL's proposed rule on a nationwide basis. As a result, the salary thresholds reverted to the 2019 rule, resetting the White-Collar Exemptions to $35,568 per year.

• The Federal Trade Commission and Non-Compete Agreements. In May, the Federal Trade Commission (FTC) promulgated a rule that effectively banned non-compete agreements and required employers not to enforce them, which was supposed to take effect in September 2024. The National Labor Relations Board also stated its intent to join the FTC's efforts to curb the use of non-compete agreements. The FTC's rule came under fire in federal litigation and has been blocked.

• Equal Employment Opportunity Commission Guidance on the Pregnant Workers Fairness Act. The Pregnant Workers Fairness Act (PWFA) offers protections for pregnant employees, including requiring employers to provide workplace accommodations. In April, the Equal Employment Opportunity Commission (EEOC) published final interpretative guidance and regulations implementing the PWFA, which became effective in June. According to the EEOC, accommodations may be available for the temporary inability to perform an essential job function if the employee is expected to be able to perform the function at a to-be-determined time in the future. Moreover, a qualifying medical condition under the PWFA doesn't have to be solely caused by pregnancy and childbirth and can include conditions such as lactation, vomiting, abortion, and pre-eclampsia. This rule survived an initial federal challenge by a coalition of state attorneys general earlier this year.

• Hourly Earnings. Real average hourly earnings for all employees were unchanged from October to November; this result stems from an increase of 0.4 percent in average hourly earnings combined with an increase of 0.3 percent in the Consumer Price Index (CPI). Real average hourly earnings increased 1.3 percent from November 2023 to November 2024.

What to Expect in 2025

• AI Legislation on the Rise. As 2025 approaches, the legal landscape for employer use of artificial intelligence (“A.”) is poised for further evolution. In 2024 alone, over 400 AI-related bills were introduced across 41 states—a substantial increase from prior years. While Congress has yet to take decisive action, the trends from 2024 suggest a continued rise in state-led AI policies and federal agency guidance in 2025.

• NLRB Poised to Switch to Republican Majority in Early 2025. It is likely there will be changes at the National Labor Relations Board (NLRB or Board). President-Elect Trump likely will remove Jennifer Abruzzo from her position as the NLRB’s current General Counsel. President-Elect Trump will have the opportunity to fill two open Member slots on the Board after his inauguration. While we can safely assume the new Republican Board and General Counsel will unwind many of the Biden Administration-era NLRB’s more controversial decisions, including its notable decisions which changed the standard for review of employer rules and policies, and which concocted a union-friendly procedure for recognition without any election – the timing of such is uncertain.