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Northeast-Midwest Legislators Propose Fixes and Expansion of Telehealth
With the ongoing COVID-19 pandemic limiting Medicare patients from in-person medical appointments, several Congressional representatives from the northeast and midwest have introduced legislation to address shortcomings in current Medicare policy that prevents reimbursement for remote medical visits and to ensure that many of these telehealth services continue following the pandemic.
Prior to COVID-19, the Centers for Medicare and Medicaid Services(CMS) slow-marched expansion of Medicare payment for telehealth services, limiting telehealth services to patients living in a rural or health professional shortage area.
When the pandemic closed medical offices and state-issued directives told elderly or disabled individuals to stay home, CMS, under its Section 1135 waiver authority, expanded Medicare payment for a broader set of telehealth services. These expansions included: allowing any provider eligible to bill Medicare for professional services to provide telehealth services; providing telehealth services to patients in their homes; allowing the use of audio-only, i.e. telephone calls, for certain kinds of telehealth services; considering professionals' telehealth services with patients as a "visit" for the purposes of Medicare reimbursement; and paying for telehealth services to patients across state lines. Medicare now has more than 180 payment codes for telehealth services. Telehealth services appear to be very popular with patients and medical professionals to limit the spread of infection, but both fear the loss of payment for these services once the pandemic subsides.
Among the recently introduced bills in the U.S. House are the following:
On June 10th, Representative Glenn Thompson (R-PA) introduced a bill entitled "Helping Ensure Access to Local Telehealth Act" which would consider telehealth services provided by professionals at federally qualified health centers and rural clinics as an outpatient "visit" to the center/clinic for Medicare payment purposes.
On June 15th, Representative Nydia M. Velazquez(D-NY) introduced the "Improving Home Health Services Act of 2020" (H.R. 7006) that would correct an omission from the recent CMS proposed rule that would make telehealth services in home health settings permanent. The proposed rule would allow home health providers to include telehealth services as part of the plan of care but would provide no additional payment. While the CMS proposed rule does not eliminate the requirement of an in-person visit before a physician or non-physician professional signs off on the plan of care, the Velazquez bill would allow full reimbursement of the home health plan of care without requiring an initial in-person visit during the pendency of the pandemic.
On June 26th, Representative Mikie Sherrill (NJ-11) and Representative Kevin Hern (OK-01)'s bipartisan "Protect Telehealth Access Act" goes further by expanding and making Medicare payment for all telehealth services currently available under CMS' temporary waiver authority permanent. Additionally, the Sherrill-Hern bill permanently eliminates the requirement that patients live in a rural or health professional shortage area in order to receive telehealth services.
These bills make important changes in Medicare telehealth policy and guarantee the continuation of these important services during - and after - the pandemic. Additionally, these changes can provide direction for the development of additional Medicare payment policy for further technological improvements in the delivery of health care to Medicare patients.
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U.S. House Passes $1.5 Trillion Infrastructure Package
The U.S. House of Representatives passed a $1.5 trillion infrastructure bill last week. The Moving Forward Act (H.R. 2), which is focused on rebuilding U.S. communities through infrastructure and innovation improvements, was passed on a largely party line vote of 233-188. It remains unlikely that the U.S. Senate will take up the Moving Forward Act, but the Senate Environment and Public Works Committee held a hearing last week on the role that infrastructure investment could play in economic recovery from COVID-19. The same Committee last year approved bipartisan surface transportation legislation that could serve as a template for the Senate to move forward with its own infrastructure package.
The bill that the House passed is comprised from work by the House Transportation and Infrastructure Committee, the Education and Labor Committee, the Financial Services Committee, the Energy and Commerce Committee, the Ways and Means Committee, the Oversight and Reform Committee, and the Natural Resources Committee, and seeks to increase investment in America's roads, bridges, transit, rail, schools, housing, broadband, drinking and wastewater systems, postal service, clean energy sector, and health care infrastructure.
The bill incorporates the nearly $500 billion INVEST in America Act, which includes a multi-year surface transportation bill that was approved by the House Transportation Committee earlier in the month. Additionally, the bill includes some key provisions that would directly and indirectly impact the Great Lakes region. These include:
- Authorizes the Great Lakes Restoration Initiative (GLRI) through FY 2026, while incrementally increasing the GLRI authorization by $50 million a year to $475 million by FY 2026;
- Authorizes EPA's Search Results Water Pollution Control (Section 106) grants at $300 million through FY 2025;
- Authorizes EPA's Sewer Overflow and Stormwater Reuse Municipal Grants (CWA Section 221) at $400 million through FY 2025;
- Authorizes the Clean Water State Revolving Fund (CWSRF) at $8 billion annually through FY 2025;
- Provides a definition of PFAS to the Safe Drinking Water Act to mean "a perfluoroalkyl or polyfluoroalkyl substance with at least one fully fluorinated carbon atom;"
- Increases the authorization incrementally to the Drinking Water State Revolving Fund (DWSRF) through FY 2025;
- Authorizes $3 billion for a NOAA coastal resiliency fund aimed at shovel-ready coastal restoration projects; and
- Authorizes $50 million annually through FY 2025 for Living Shorelines projects.
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U.S. House Appropriations Committee to Begin Markup the FY 2021 Appropriations Bills
The House Appropriations Committee will begin marking up its annual appropriations bills for FY 2021 this week. Multiple subcommittees are scheduled to take up a handful of the FY 2021 bills between today and Wednesday, with the full Appropriations Committee expected to convene on Thursday and Friday.
Today, July 6, the respective subcommittees will markup the State & Foreign Operations bill, the Agriculture bill, and the Military Construction bill; tomorrow, July 7, the respective subcommittees will markup the Interior & Environment bill, the Energy & Water bill, the Labor, Health, & Education bill, the Homeland Security bill, and the Legislative Branch bill; and on Wednesday, July 8, the respective subcommittees will markup the Commerce, Justice, & Science bill, the Transportation & Housing bill, the Financial Services bill, and the Defense bill.
Currently the full Appropriations Committee is scheduled to convene on Thursday, July 9, to consider the final FY 2021 budget allocations, the State and Foreign Operations bill, the Agriculture bill, and the Military and Construction bill. The Committee could also convene on Friday, July 10, when it could take up additional bills, including the Interior and Environment bill. NEMWI will continue to monitor the FY 2021 appropriations process as it continues to develop.
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U.S. House Select Committee Releases Report on the Climate Crisis
Speaker Nancy Pelosi (D-CA) and Chair Cathy Castor (D-FL) unveiled a plan called
"Solving the Climate Crisis: The Congressional Action Plan for a Clean Energy Economy and a Healthy, Resilient, and Just America." Established in 2019 the House Select Committee on the Climate Crisis is set to release brand new climate change legislation that is going to address air pollution, changing to clean sources of energy, and preparedness for natural disasters fueled by climate change.
The committee's report is to find science-based solutions to climate change and to propose them to standing committees with the jurisdiction to act on climate change. The Climate Crisis Action Plan would put America on a path to net-zero carbon-emissions by 2050, or earlier. And independent analysis puts the number of American lives saved from reduced air pollution due to the plan at more than 60,000.
The plan has already received the support of over 90 outside, independent organizations from the building, public health, energy, and transportation sector. According to the Chair of the select committee Cathy Castor "Our plan will put people back to work and rebuild in a way that benefits us all...We chart the course to good-paying jobs in solar and wind energy, in manufacturing American-made electric vehicles, and in strengthening communities..." This action on climate change is projected to save the economy $8 trillion through 2050 due to reduced healthcare costs and natural disasters.
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Urban Institute Study Highlights State Tax Revenue Decline in May
The Urban Institute's Tax Policy Center has released its Monthly State Tax Revenue Highlights covering state revenue trends in the month of May 2020, with the TPC report titled "
State Tax Revenues Continued to Decline in May 2020"
showing steep declines in state sales tax revenues in May.
Of the eighteen northeastern and midwestern states, only Maine has not turned some shade of red on TPC's latest map of fiscal distress.
NEMWI Senior Fellow for Public Finance Policy Thomas Cochran commented: "From a macroeconomic stand-point, the fact that total state tax revenue has turned 'sharply negative,' as documented by the TCP, underscores the Federal Reserve Chairman Jay Powell's increasingly blunt warnings that the state (and local) revenue shortfalls and their accompanying budget cuts can only lengthen what is now best being characterized as either a 'swoosh' or a reverse square root shaped recovery." He also noted, "Whatever label we use for this slow recovery, we know that it will mean prolonged pain for state and local governments."
The local government sector is experiencing its own case of extreme fiscal distress, as the Center for American Progress'
Alan Cohen
and
Michael Madowitz
summarized in this May 2020 report, available here.
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NEMWI: Strengthening the Region that Sustains the Nation
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