Health Heavy Omnibus Bill Closes Out 117th Congress While the 118th Congress Faces Uncertain Future and Possible Gridlock

by Steve Rixen

Vizient Senior Government Relations and Public Policy Director

Swearing-in day for the new Congress is known to be a festive day in Washington where new and reelected members celebrate the fruits of their campaign labors. However, this year, the 118th Congress has been off to a…uhh…different start, as House Republican leader Kevin McCarthy (R-CA) struggled to secure the needed votes to become Speaker of the House. After a historic 15 votes and extensive negotiations with holdouts, McCarthy finally assumed the gavel, but not without heartburn and serious questions about the outlook for legislative accomplishments in the Congress ahead.  

Given the abundance of uncertainty generated by the opening of the 118th Congress and the challenges of legislating during a divided government in general, maybe it's best to take a moment to look back on the 117th Congress which was surprisingly productive. During that time, Congress worked together, in a bipartisan fashion, to pass significant legislation including the Infrastructure Investment and Jobs Act and the CHIPS and Science Act, among others. Today though, I want to focus on the last bipartisan act of the 117th Congress — the Consolidated Appropriations Act of 2022 or "the omnibus."

Spanning 4,000+ pages, the omnibus is a $1.7 trillion law that funded the federal government through the remainder of the fiscal year, while also including myriad other policy provisions — including many healthcare policies that Vizient has been advocating for over the last several years. While there is far more policy included than we can cover in a quick blog post, some key highlights of the bill for hospitals and healthcare providers include:

• Prevents looming payment cuts for physicians and hospitals: The law suspends a 4% reduction in Medicare payments due to Pay-As-You-Go (PAYGO) requirements through 2024 and reduces the scheduled 4.47% reduction in Medicare reimbursements for physicians by 2.5% in 2023 and 1.2% in 2024. Another notable item is the temporary extension of the bonus payment to incentivize physician participation in Medicare Advanced Alternative Payment Models for one year. While the extension is positive news, it reduces the bonus to 3.5% (from the previous 5% bonus).
• Extends telehealth flexibilities: The omnibus provides an extension of telehealth flexibilities that have been permitted throughout the COVID-19 pandemic, such as relaxing originating site and geographic restrictions, coverage of audio only services, behavioral healthcare services and other telehealth flexibilities until at least Dec. 31, 2024. While some reports have mentioned a two-year extension of these flexibilities, the truth is that a previous law already extended them through much of 2023. With that said, though, the bottom line is telehealth flexibilities broadly will be extended through Dec. 31, 2024.
• Extends Hospital-at-Home flexibilities: The law also extends until Dec. 31, 2024, the waiver that allowed for the expansion of the Acute Hospital Care at Home program. While questions remain about the long-term future of Hospital-at-Home models, including reimbursement, utilization and safety, the program has demonstrated enough value that Congress is extending it to better understand the criticality of providing inpatient-level care in the home setting.
• Support for mental and behavioral health: The omnibus includes the bipartisan Restoring Hope for Mental Health and Well Being Act, which reauthorizes and expands several existing mental health and substance use disorder programs, eliminates the so-called "X-waiver" to allow more physicians to prescribe buprenorphine for opioid abuse and provides additional funding for states to continue responding to the opioid abuse crisis. The omnibus also provides Medicare coverage for marriage and family therapists and mental health counselors, provides funding for states to better enforce mental health parity laws and funds mobile mental health crisis units among other mental and behavioral health provisions.
• Healthcare workforce investments: The omnibus includes an increase of 200 new Medicare-supported Graduate Medical Education (GME) slots in 2026. Continuing the law's focus on mental and behavioral health, 100 of those new slots are dedicated for training psychiatrists and psychiatry subspecialties. The law also extends the Conrad 30 visa program for foreign-born physicians to practice in shortage areas through Sept. 30, 2023, and reauthorizes the Public Health Workforce Loan Repayment Program.
• Support for maternal and infant health: The law reauthorizes the Children's Health Insurance Program (CHIP) until 2029, requires states to provide one year of continuous coverage for children in CHIP and Medicaid beginning Jan. 1, 2024, permanently extends the Medicaid state plan option to provide postpartum coverage for one year, extends the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program and improves state coordination and Medicaid payments for coverage among other investments.
• Supply chain improvements and pandemic preparedness: The law includes several important elements of a major bipartisan bill, the PREVENT Pandemics Act, which seeks to stabilize the supply chain and prepare for future pandemics. PREVENT provides grants to invest in warm base manufacturing in order to improve domestic manufacturing of vaccines and other medical countermeasures, curbs counterfeit medical devices, improves transparency in the Strategic National Stockpile and provides grants to establish state-based stockpiles and updates regulatory processes to extend the shelf-life of prescription drugs. Also included in the omnibus is enhanced cybersecurity considerations that require device makers to submit plans to monitor, identify and address post-market security concerns and provide for a "software bill of materials" to the FDA.
• Rural health provisions: The law also extends two critical programs for rural hospitals through FY 2024, the Medicare Dependent Hospital Program and the Medicare Low-Volume Adjustment. It also extends the ground ambulance add-on payment through 2024. Additionally, it provides for funding the establishment of an Office of Rural Health within the Centers for Disease Control and Prevention. 

Although the omnibus addresses many critical healthcare policies, hospitals and providers continue to face persistent challenges with reimbursement, workforce, pediatric mental health issues and inflation. Vizient will continue to advocate on behalf of our provider members to help educate policymakers on these persistent challenges.

While the 118th Congress has not yet inspired confidence in the ability of Washington to address some of these challenges, there is always hope that bipartisan solutions can be found.

Fun Fact: the longest election for House Speaker took place in 1855-1856 when Speaker Nathanial Banks claimed victory after more than two months and 133 rounds of votes. Thankfully, we won't have to wait that long before this Congress can get to work.