President Biden Announces Health Care Arrangements As Part Of Build Back Better Framework | King and Spalding

Last week, President Biden previewed a $ 1.75 trillion Build Back Better (BBB) ​​social spending reconciliation framework resulting from months of negotiations with House and Senate Democrats. Congressional negotiations continue on certain health care provisions, such as negotiating the price of prescription drugs and extending Medicare benefits to dental and hearing care (the framework only included an extension of the hearing services coverage). With a 50-50 Senate and a three-vote majority in the House of Representatives, Democratic lawmakers continue to face the challenge of securing unanimous support in the Senate and losing no more than three votes in the House. As a result, while efforts are being made to finalize the BBB framework as quickly as possible, the timing of the review by the House and Senate as a whole is uncertain.
A summary of the health care arrangements follows.

• Affordable health coverage. The BBB framework includes the following initiatives related to affordable health coverage:

  • Affordable Care ActThe BBB framework would provide improved temporary help in reducing the cost sharing of the Affordable Care Act (ACA) market to people with household income below 138% of the Federal Poverty Line (FPL) who are not not eligible for government sponsored insurance. This provision may be intended to fill gaps in Medicaid coverage for people who live in non-expanding states. To provide health insurance consumer information, $ 100 million would be provided for the ACA Medicare Consumer Information Grants. Assistance to reduce ACA cost sharing would also be provided to people receiving unemployment benefits. These provisions would all apply to calendar years 2022 to 2025.

  • Other provisions. The BBB framework would also establish a health insurance affordability fund, which would make $ 10 billion available to states for calendar years 2023 to 2025. States could use the funds to provide financial assistance that would reduce spending. personal or to establish a government reinsurance program. CMS would be required to establish and implement a term reinsurance program in states that do not spend amounts under the state plan.

• Medicaid. The BBB framework includes the following Medicaid initiatives:

  • Home and community services. Improvement planning grants would be provided to states to develop plans to expand access to Home and Community Services (HCBS) and strengthen the HCBS workforce, in combination with increases in the percentage of federal medical assistance (FMAP). The Secretary of HHS would be required to report on grants and provide technical assistance to States for the implementation of HCBS improvement programs. HHS would also be required to publish HCBS quality metrics for state Medicaid programs. The spousal impoverishment protection for people whose partners receive Medicaid HCBS would be permanently extended and funding would be made permanent for the person’s money rebalancing demonstration following.

  • Other Medicaid Provisions. State Medicaid programs would be required to provide 12 months of continuous eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) to postpartum women; 12 months of continuous eligibility for children enrolled in Medicaid and CHIP; and coverage for those involved in justice 30 days before their release. A new option would be allowed for states to provide coordinated care to pregnant and postpartum women through a nursing home. Investments would also be made to expand access to behavioral health and extend 100% FMAP for an additional two years for urban Indian organizations and Hawaiian indigenous health centers. Comprehensive dental, vision and hearing services would be added as mandatory Medicaid benefits.

  • DSH payments. Duplicate payments would be eliminated in states where people below 100 percent of poverty will be able to enroll in market coverage. It also adjusts Medicaid Disproportionate Hospital Allowances (DSH) for these states to reflect the lower rates of unpaid care.

  • Territories. The FMAP for each territory would be increased to 83%.

  • Maintain effort. States would be encouraged to maintain Medicaid eligibility standards that were in place before the public health emergency. Efforts would be made to ensure that Medicaid accurately reimburses prescription drugs. Medicaid’s expansion FMAP would be increased to 93% until 2025.

• SNF servicesThe BBB framework includes the following initiatives related to Medicare-reimbursed Qualified Nursing (SNF) services:

  • Data validation. $ 50 million would be allocated to HHS starting in FY 2026 for the purpose of validating nursing home quality data submitted through the minimum dataset, SNF value-based purchasing program, or the payroll-based journal staffing dataset. Subparagraph 1888 (e) (6) (A) of the Social Security Act would also be amended to reduce SNF payments by 2% starting in fiscal 2026 for SNFs that submit inaccurate data through the one of these data systems.

  • Audit of SNF cost reports. $ 250 million would be allocated to HHS in FY2023 through FY2031 for the audit of SNF Medicare cost reports.

  • Survey improvements. $ 325 million would be allocated to HHS in FY2023 to FY2031 for improving existing investigations and enforcement processes to improve compliance with the SNF Terms of Participation.

  • Nursing Staffing Ratio Studies. $ 50 million would be allocated to HHS in FY2023 through FY2031 to conduct studies on whether to establish minimum staff-to-resident ratios in NFS, which HHS will promulgate through regulations.

• Seniors justice initiatives. The BBB framework includes the following initiatives relating to health services for the elderly:

  • Grants to Nursing Home Workers. $ 400 million would be allocated in FY2023 through FY2026 for state grants to support workers in long-term and long-term care facilities. Authorized uses of funds include wage subsidies, student loan repayments, tuition assistance, child care, and transportation assistance, among others.

  • Long-Term Care Ombudsman Programs. $ 112.5 million would be allocated in FY2023 to FY2025 for state grants for long-term care ombudsman programs to address complaints of abuse and neglect.

  • Medico-legal partnerships$ 500 million would be allocated to establish a grant program that would allow states to develop forensic partnerships, which would combine clinical staff with social workers and lawyers at a single site of care to meet social needs. of patients (eg, housing, food, education, and access to care) are met.

• Residency programs. The BBB framework would amend Medicare law to exclude from the residency cap all residents who have attended rural and underserved training programs at certain hospitals recognized by the Accreditation Board for Graduate Medical Education to have committed to certain additional training requirements.

• Opportunity grants to health professionsThe BBB framework would authorize $ 425 million for scholarships under the Health Profession Opportunity Grant program, under which the HHS awards grants to organizations to provide education and training to certain low-income people for occupations in the field of health.

• VA financing. The BBB framework would provide funding for certain Department of Veterans Affairs (VA) health care-related initiatives, including $ 2.4 billion for immediate and long-term infrastructure needs, $ 1.8 billion for major medical and clinical leases; and $ 268 million for up to 500 residency positions in VA facilities over 7 years.

• Children’s health insurance program. Permanent funding for CHIP would be authorized, as well as permanent funding for several programs linked to CHIP (including the pediatric quality measures program and the contingency fund for the registration of children). CHIP programs could receive low-cost prescription drugs and states would have the option of increasing CHIP eligibility levels.

• Hearing services health insurance coverage. Additional professionals would be allowed to provide hearing assessment services, effective January 1, 2024. Hearing aids would be covered by Medicare Part B, provided people meet certain conditions.

• Public health. The BBB framework would include allocations for health infrastructure and manpower; pandemic preparedness; fight against maternal mortality; mental health and drug addiction treatment and prevention; HIV health care service programs; research capacity in institutions serving minorities; research related to development delays; the Health Program of the World Health Center; and the health of native Hawaiians.

For a copy of the Rules Committee’s current version of the Build Back Better Act, please click here. For a section-by-section summary, please click here.