November 2022

November 2022

Medicare to Expand Access to Behavioral Health and Substance Abuse

Last week the Centers for Medicare and Medicaid Services (CMS) finalized policies aimed at expanding access to behavioral health and substance use disorder treatment services for Medicare beneficiaries in rural areas.

Starting Jan. 1 of next year, the annual Medicare physician payment rule and Medicare hospital outpatient and ambulatory surgical centers rule will do the following:

  • Make it easier for addiction counselors, family therapists and others to offer services, particularly in rural areas.
  • Make a pandemic-era flexibility permanentthat allows hospital outpatient departments to bill for in-home telebehavioral health services.
  • Extend Medicare coverage to include opioid treatment programs that initiate the prescribing of buprenorphine — a medication-assisted treatment — via telehealth. Medicare will also cover such services provided through mobile units.
  • Other provisions include new monthly payments for comprehensive treatment and management services for patients with chronic pain, as well as expanded access to certain cancer-screening coverage and dental care.

In addition, CMS will offer enhanced Medicare payments to incentivize hospitals to purchase N95 respirators manufactured in the United States, in an effort to sustain domestic production of the masks for future public health emergencies.

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Congress Plans Post-Election Legislation

As has been the practice for years now, no matter which party controls Congress, it failed to pass the legislation that is needed to fund the government for the next fiscal year, which started Oct. 1.

That means that after the elections tomorrow, Congress will be back in session, called a lame-duck session, to try and pass the needed legislation. If the Democrats lose the majorities in one or both houses of Congress, this will be their last chance to pass the kind of legislation they want. The lame-duck session is scheduled to start on Nov. 28.

Because of that, Democrats are floating a combined FY2023 spending bill for the entire federal government, along with a separate bill for the Defense Department that will authorize it to spend the money it says is needed for the nation’s defense.

As a result, lawmakers are flooding leaders with items they want attached to both bills they are seeking to pass in December. Leaders in both parties are reviewing long lists of priorities—including many touching on health-care—to be part of either bill.

Details of the spending bill will not be known for weeks, as Democrats and Republicans have not agreed on the total amounts for defense and nondefense spending.

Among the spending priorities being discussed are extensions of expiring Medicare and Medicaid programs, including the continuation of Covid-era bonus Medicare payments to avert a looming 4% cut to them.

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Senators from both Parties Want to Stop Medicare Payment Cuts

In a related story, a bipartisan group of 46 Senators sent a letter to the Senate leadership asking them to address looming Medicare payment cuts to providers before the new year, when they would take effect.

“It is essential in the coming weeks that we make sure providers have the resources they need to keep their doors open for seniors and families,” the senators wrote.

The letter comes a day after the Centers for Medicare and Medicaid Services released its final rule confirming the cuts, which are required by law.

It took no time for providers to voice concerns about the final rule — in fact, they had been pushing for Congress to act before CMS published its final rule.

The group of senators is looking for sustainable changes — alongside a quick fix — to the current payment system.

“Going forward, we support bipartisan, long-term payment reforms to Medicare in a fiscally responsible manner,” the senators wrote.

Health care providers had already sounded the alarm over their financial futures going into next year.

Inflation and rising labor costs have been a major concern for clinics and hospitals — especially as there are few signs that reimbursements will keep pace with increasing expenses.

The government’s cash infusions from the pandemic are running dry, and another Covid-19 package from Congress seems less than likely, even as some hospitals face a concerning number of Covid, flu and RSV infections.

The worries are not all new, though — Congress has adjusted the payment rate before to mitigate cuts.

This year, a solution has already been proposed, with Reps. Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.) introducing a bill that would stop the cuts.

Whether through that legislation or another vehicle, the persistent lobbying efforts from providers seem to be paying off as bipartisan consensus grows.

Those groups insist the decisions made in the coming weeks will affect patients in 2023.

“There are serious risks facing millions of seniors’ access to surgical care in less than two months — cuts to surgical care will affect how the surgical care team is able to care for patients across the country,” Michael Dalsing, president of the Society for Vascular Surgery, said in a statement following the letter.

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Senator Manchin Says Deal is Needed to “Shore Up” Medicare, Medicaid, and Social Security

West Virginia Senator Joe Manchin said last week that Congress needs to deal with the nation’s “crippling debt” by making changes to shore up Social Security, Medicare, Medicaid, and other programs he said are “going bankrupt.”

Speaking at a conference, Manchin said he would like to see bipartisan legislation over the next two years to deal with entitlement programs, which he said are facing “tremendous problems.”  Some of the trust funds that help support the programs could run out of money in the next 12 years, which would trigger cuts to benefits.

Manchin made his remarks a few days before midterm elections that will decide control of Congress for the next two years. Republicans, who are forecast to take control of the House and are challenging for control of the Senate, are running on promises to rein in government spending.

Some are proposing cutting outlays for Social Security and Medicare, popular but expensive programs that benefit the elderly or disabled and using next year’s deadline to raise the US debt limit to extract concessions from Democrats.

President Joe Biden has vowed to protect the two programs and warned that a standoff over the debt ceiling would unleash economic “chaos.”

Senator Bernie Sanders (I-Vt.) said in a New York Times interview published last Thursday that Democrats should raise the debt limit before the new Congress convenes in January if Republicans win the House or the Senate to protect Social Security, Medicare and Medicaid from cuts. That almost certainly would require Manchin’s backing.

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New Senate Report Says Medicare Advantage Ads Mislead Seniors

TSCL has been warning our supporters that all the ads for Medicare Advantage plans that are seen on TV, heard on radio, seen online, or in mail sent to homes are from insurance companies that want to sell their policies.

We’ve also pointed out that anyone who calls a phone number given in an ad will speak will someone who is a salesperson who will want to sell them a plan.

Now, a new report released last week after an investigation by Senate Finance Committee Democrats confirms that seniors are being flooded with fraudulent and misleading information about switching from traditional Medicare to private Medicare Advantage plans.

The report says that insurers and brokers are going after seniors with advertising for Medicare Advantage plans via in-person sales, television ads, telemarketing calls, and robocalls. The ads for the increasingly popular private plans also sometimes falsely promised coverage for preferred health-care providers or higher Social Security payments, it found.

The Centers for Medicare and Medicaid Services reported in August that the number of complaints about marketing of Advantage plans more than doubled to 39,617 for the first eleven months of 2021, spurring the Finance Committee’s investigation.

“It is unacceptable for this magnitude of fraudsters and scam artists to be running amok in Medicare, and I will be working closely with CMS to ensure this dramatic increase in marketing complaints is addressed,” Finance Committee Chair Ron Wyden (D-Ore.) said in a statement.

Democrats have been concerned about the rapid growth in Medicare Advantage plans, which they say have boosted insurer profits much more than they have benefited seniors. UnitedHealth Group Inc. and Humana Inc. account for nearly half of all Advantage plans, which cover seniors in exchange for a fixed fee from Medicare. Neither company is called out in the report for misleading advertising.

Medicare Advantage could cover the majority of Medicare’s 64.4 million beneficiaries as soon as next year, according to CMS data. Nearly 46% of Medicare beneficiaries are enrolled in Advantage plans this year, an increase of 3% from 2021.

“For too long, Medicare Advantage has put profits over the proper care of our seniors,” Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus, said in a September statement, urging the government to crack down on Medicare Advantage plans denying payment for necessary care.

In one instance cited in the report, marketing materials from an unnamed Advantage plan or its broker were made to look like they came from the federal government, the report found.

“These practices are intentionally deceptive as they blur the lines between official government communication and private health plan marketing,” according to the report.

The report called for reinstating rules loosened under the Trump administration that specify which marketing materials are under CMS scrutiny. Wyden also wants to block cold-calling seniors on Medicare, among other changes.

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