Congress approves tentative budget deal; Mostly Medicare salary cuts are reflected in the documents
Congress reached a Initial budget deal On Tuesday, that largely — but not entirely — reversed a 2.8% cut in the Medicare physician fee schedule, which will expand some telehealth flexibility and try to rein in pharmacy benefit managers (PBMs).
The deal, which still must be passed by both the House and Senate, increases payments under the Medicare physician fee schedule by 2.5%, largely offsetting the 2.8% reduction finalized by CMS, but still leaving it up to doctors A decrease in payment of 0.3%. However, it does not include Improving Access to Timely Care for Seniors Actwhich would have created an electronic prior authorization process for Medicare Advantage (MA) plans that would standardize clinical transactions and attachments, increase transparency around MA prior authorization requirements, and require HHS and other agencies to report to Congress on their efforts to improve the electronic prior authorization process .
“MGMA [Medical Group Management Association] We are pleased that Congress has responded to our call to expand telehealth flexibility through the end of 2026 [and] Increase APM [alternative payment model] “Stimulus payments are up to 3.53%,” Anders Gelberg, the group’s vice president of government affairs, said in a statement.Disclosure: Gilberg is a member of MedPage Today Editorial Board.) “These are big wins for the medical groups.” Telehealth flexibility includes removing geographic requirements and expanding the original locations of telehealth services, as well as expanding the type of practitioners qualified to provide services via telehealth.
“On the other hand, we are deeply disappointed that Congress has failed to fully address the looming 2025 Medicare payment cuts for physician practices,” Gilberg continued. “Any reduction, no matter how partial, is unacceptable. Finally, not including the legislation for prior authorization reform, which has the support of bipartisan majorities in the House and Senate, nearly 500 stakeholder organizations… and little to no opposition, represents A dismal failure for Congress at the end of the year and another victory for Big Insurance at the expense of America’s patients.”
The Regulatory Relief Alliance, a group of specialty physician organizations that advocate for reducing the regulatory burden in Medicare, said it was “outraged” the legislation was not included. “Our nation’s seniors are counting on Congress to act to restore their timely access to medically necessary health care,” the group said in a statement. “Unfortunately, this Congress has failed them by putting aside smart policy in favor of political bickering. This massive failure to respond to public outcry to improve oversight and transparency of the MA program is completely unacceptable.”
The tentative deal also includes legislation to more tightly regulate PBMs. The provisions include a requirement that PBMs provide detailed drug spending data to group health plans, and also pass through 100% of drug rebates and rebates to the employer or health plan on whose behalf it negotiates. The legislation also requires CMS to set “reasonable” contract terms for Medicare Part D drug plans, allowing “any willing pharmacy” to serve Medicare patients. It also prohibits PBMs from tying their reimbursements to the Medicare price of a drug.
Other elements of the deal include:
- License renewal for 5 years Support lawwith the aim of combating the opioid crisis
- A 5-year extension of the Teaching Health Center’s graduate medical education program, which is designed to increase the primary care workforce
- A provision to prevent reductions in the Medicaid Disproportionate Share Hospital program
- Reauthorizes the Pandemic and All-Hazards Preparedness Act for two years
Sen. Ron Wyden (D-Ore.) praised the deal’s inclusion of “improvements to Medicare, especially cracking down on ghost networks in Medicare Advantage that have prevented seniors from finding a doctor or psychiatrist on their health plan.”
“There is a lot of work to be done to improve mental health care for all Americans, but making sure you can find a doctor when you need care is the first step,” he said in a statement.