Congress
reached
a
bipartisan
agreement
this
week
on
a
healthcare
funding
and
policy
package
included
in
a
larger
$1.2
trillion
spending
bill
aimed
at
averting
a
government
shutdown.
The
package
includes
a
mix
of
funding
proposals,
policy
reforms
and
program
extensions
designed
to
support
healthcare
providers
and
public
health.
Below
are
seven
things
to
know
about
the
proposal.
—
The
bill
provides
roughly
$116 billion
in
funding
for
HHS
through
fiscal
year
2026.
This
is
$210
million
more
than
the
agency’s
funding
from
fiscal
year
2025,
including
a
$415
million
funding
increase
for
the
NIH.
—
The
agreement
does
not
extend
enhanced
Affordable
Care
Act
premium
tax
credits.
Those
subsidies
were
introduced
during
the
pandemic
to
boost
healthcare
affordability,
but
they
expired
at
the
end
of
last
year.
The
expiration
of
these
subsidies
doesn’t
just
push
coverage
out
of
reach
for
millions
of
Americans
—
but
it
could
also
create
significant
cash
flow
challenges
for
healthcare
providers
already
battling
financial
pressures.
As
premiums
rise
and
enrollment
falls,
hospitals
could
see
higher
uncompensated
care
and
bad
debt.
Last
year,
93%
of
ACA
marketplace
enrollees
received
the
tax
credits.
—
The
proposal
includes
reforms
for
pharmacy
benefit
managers,
requiring
greater
transparency
and
accountability
in
Medicare
Part D.
It
mandates
clearer
reporting
on
PBMs’
pricing,
rebates
and
fees,
as
well
as
directs
CMS
to
define
“reasonable
and
relevant”
contract
terms
that
better
reflect
pharmacy
costs.
The
bill
also
delinks
PBM
compensation
from
drug
list
prices
and
bans
certain
opaque
practices
like
spread
pricing,
aiming
to
reduce
incentives
for
PBMs
to
push
higher‑priced
drugs
and
retain
hidden
margins.
Additionally,
the
reforms
seek
to
improve
pharmacy
network
access
and
give
pharmacies
a
process
to
dispute
unfair
contract
terms.
—
The
legislation
would
extend
telehealth
flexibilities
through
2027.
CMS’
pandemic-era
telehealth
waivers,
which
have
given
providers
the
coverage
they
need
to
offer
virtual
care
at
scale,
will
be
extended
another
two
years
if
the
bill
is
passed.
The
extension
would
give
providers
and
patients
more
certainty
as
virtual
care
remains
a
key
access
point
for
many
patients,
particularly
those
in
rural
communities.
—
Hospital-at-home
received
a
five-year
extension
in
the
bill.
The
extension
preserves
CMS
reimbursement
for
hospital-level
care
delivered
in
patients’
homes.
Hospital
leaders
have
argued
the
program
helps
reduce
capacity
strain,
lower
costs
and
improve
the
patient
experience,
particularly
for
patients
with
chronic
conditions.
—
The
proposal
would
delay
scheduled
Medicaid
Disproportionate
Share
Hospital
(DSH)
cuts
until
fiscal
year
2028.
DSH
payments
help
offset
uncompensated
care
costs,
and
hospital
groups
have
long
warned
that
cuts
could
destabilize
providers
that
serve
a
high
share
of
low-income
and
uninsured
patients.
—
The
bill
extends
CMS’
rural
hospital
payment
programs
for
another
year.
The
proposal
issues
one-year
extensions
for
two
programs
designed
to
support
rural
hospitals:
the
Medicare‑dependent
hospital
payment
adjustment
program
and
the
low‑volume
hospital
payment
adjustment.
These
payments
are
designed
to
offset
higher
operating
costs
and
lower
patient
volumes
in
rural
areas,
where
access
to
care
is
often
limited.
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