As Congress enters its lame-duck period, several critical health policy deadlines loom:
- Dec. 31, 2024: Current continuing resolution (CR) to fund the federal government expires.
- Dec. 31, 2024: Emergency telehealth flexibilities expire.
- Jan. 19, 2025: Medicare sequester (budget) cuts take effect.
- Feb. 1, 2025: Children’s Health Insurance Program (CHIP) funding requires reauthorization.
Republican leadership favors extending current federal budget funding through March 2025, though retiring health committee members in both chambers are pushing for final legislative achievements. Key factors influencing negotiations:
- 12 retiring committee chairs seeking legacy legislation
- $14 billion in expiring health care programs
- Pending disaster relief supplemental
- Year-end Medicare payment adjustments
What could a final lame-duck session health package look like?
Congress usually adds policy provisions that need attention to continuing resolutions (CRs) due to funding deadlines or emergencies. Here are potential policy provisions that could be considered:
Disaster Aid
FEMA's disaster relief fund received a $20.9 billion injection in September 2024, but Hurricanes Helene and Milton depleted 78% of these funds within 60 days. The Biden administration’s supplemental funding request seeks $100 billion in emergency disaster aid. Current projections show FEMA's relief fund will be exhausted by February 2025 without additional appropriations, potentially affecting response capabilities for the winter storm season.
Health Care
The 118th Congress has generated over 250 health-related bills, but only 12 have become law. Key pending legislation includes the HELP Committee’s safety-net funding package ($25 billion). A bipartisan coalition is advancing the Lower Costs, More Transparency Act (H.R. 5378), which would require hospitals to publish actual procedure costs and mandate pharmacy benefit manager (PBM) pricing transparency.
Medicare
Several Medicare programs, telehealth waiver flexibilities, and temporary reimbursement increases expire Dec. 31.
Among these is a boost to Medicare provider payments that helped offset a more than 3% cut in CY 2024 and upward payment adjustments for low-volume and Medicare-dependent hospitals. Congress is expected again to at least partially offset the anticipated 2.8% payment cut for Medicare providers in CY 2025, as it has for the past 4 years, and maintain the policies noted above for at least 2 years.
A potential congressional fix to increase provider payment is H.R. 10073, the Medicare Patient Access and Practice Stabilization Act of 2024, which was introduced by a bipartisan group of lawmakers.
Temporary telehealth flexibilities that were put in place during the COVID-19 public health emergency and have been extended multiple times also expire at the end of the year.
The House & Energy Commerce Committee passed the Telehealth Modernization Act with bipartisan support. The bill (H.R. 7623) continues many telehealth flexibilities for an additional 2 years, through the end of 2026.
The telehealth flexibilities in the bill allow for:
- a moratorium on the required in-person visit within 6 months of a preliminary telehealth visit for mental health treatments.
- rural health clinics and federally qualified health centers to serve as the distant site (i.e., the location of the health care practitioner).
- the home of a beneficiary to serve as the originating site (i.e., the location of the beneficiary) for all services.
- inclusion of all Medicare beneficiaries to receive telehealth services.
- all types of practitioners (e.g., occupational and physical therapists, audiologists) to furnish telehealth services, as determined by the Centers for Medicare & Medicaid Services (CMS).
- Medicare-approved practitioners to use audio-only services for the provision of telehealth services.
Provider Workforce Investments
Pending legislation seeks to strengthen the health care and mental health workforce through several key initiatives. The Bipartisan Primary Care and Health Workforce Act, alongside the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, represents major legislative efforts to address these needs. These bills, combined with additional programs, aim to tackle persistent provider shortages and improve access to care across the health care and mental health care systems.
Prior Authorization Relief
Advocacy organizations are pressing Congress to pass the Improving Seniors’ Timely Access to Care Act (H.R. 3173), which would reform Medicare Advantage (MA) prior authorization processes. The bill would require MA plans to provide 24-hour decisions for urgent care requests and 7-day decisions for routine care. Plans would also need to publicly report their approval rates and establish electronic prior authorization systems. A recent Office of Inspector General report found that 13% of prior authorization denials were for services meeting Medicare coverage rules, affecting an estimated 85,000 beneficiaries in 2019.
NBCC is monitoring discussions on the possibility of a lame-duck session health package and overall 2024–25 budget bill and will provide regular updates for NCCs. NBCC is advocating for the passage of the Telehealth Modernization Act and increases in Medicare reimbursement during the lame-duck session.
