From telehealth to prior authorization, hospitals brace for busy lame duck session in Congress

Hospital groups are seeking more financial relief from Congress in the short lame duck session next month as well as passage of reforms to prior authorization and extensions of rural hospital programs. 

Several groups laid out their priorities for the last legislative session of the year, which starts after the midterm elections on Nov. 8. The hospital industry wants more help from Congress to weather a lingering staffing crisis caused by the pandemic as well as inflation and a potential recession.

“All of these financial pressures are still being faced by the hospitals, but we don’t have the financial support that was there with some of the COVID relief money,” said Jason Kleinman, senior associate director of federal relations for the American Hospital Association (AHA), in an interview with Fierce Healthcare. 

The AHA (PDF) and the Federation of American Hospitals (FAH/PDF) sent separate letters to congressional leadership this week seeking several priorities. Chief among them is waiving a 4% cut to Medicare payments set to start next year under the PAYGO law, which mandates cuts if federal spending reaches a certain threshold.

The FAH also called for Congress to step in and cut off a 4.5% cut to doctor payments in the Physician Fee Schedule.

“Updating the Medicare physician payment system to include annual increases that account for inflation would offer financial stability and predictability to providers across the country,” the letter said. 

At the onset of the pandemic, Congress delivered a major $174 billion relief fund intended to prop up providers facing debilitating revenue shortfalls. While Congress has included some other allocations, lawmakers have not been able to agree on additional relief.

“I think we are all wanting to move forward from the pandemic, but we have to recognize that these challenges persist,” Kleinman said. “These providers are still working tirelessly to provide this care to the patient.”

Last push for legislation

In addition to the funding issues, the hospital industry is hoping to get several key pieces of legislation through before the end of this Congress, which could change hands depending on the outcome of the election. 

Chief among the priorities is the Improving Seniors’ Timely Access to Care Act, which introduces prior authorization reforms to Medicare Advantage plans. Prior authorization is a major source of administrative burden for providers and the legislation would improve the process for approving requests, including the installation of electronic prior authorization. 

The legislation overwhelmingly passed the House and has more than 40 co-sponsors in the Senate. But the chamber has a truncated timetable that includes passage of a government funding bill and potential legislation to raise the debt ceiling. 

Another area with notable bipartisan support is telehealth. The House also passed legislation that extends key telehealth flexibilities through December 2024. Currently, such flexibilities, including waivers of originating site requirements that made it easier for doctors to get reimbursed for telehealth via Medicare, are expected to go away five months after the COVID-19 public health emergency, which could expire next year. 

“During the ongoing pandemic, telehealth has proven to be a critical and value-added component of our healthcare delivery system,” FAH’s letter said.

Both groups also hope Congress extends permanently two programs aimed to help rural hospitals that will go away after Dec. 16, which is the same deadline to pass a funding bill. 

The Medicare-dependent hospital and low-volume adjustment programs are meant to adjust payments to rural hospitals based on the number of Medicare patients they serve. The hospital lobbying is hoping to extend the programs permanently or at least for another five years.