Federal lawmakers raced to pass a $1.7 trillion year-end spending package this week in order to avoid the expiration of government funding on Friday, Dec. 23. The Omnibus legislation impacts various ACC advocacy priorities including updates to Medicare cuts, a two-year extension of Public Health Emergency (PHE) Medicare telehealth flexibilities, modifications to postpartum Medicaid coverage, and funding for cardiovascular disease research, among others. Unfortunately, while the legislation provides partial relief from Medicare reimbursement cuts slated for Jan. 1, 2023, it fails to address the entire roughly 8.5% cut, subjecting clinicians to a -2% reduction in 2023.

“While the year-end spending package does reduce Medicare cuts for the next two years, the ACC is disappointed that Congress did not go further and stop the cuts altogether,” said Health Affairs Committee Chair Samuel O. Jones IV, MD, MPH, FACC. “More than 63 million Americans use Medicare. Ongoing cuts paired with a lack of an annual inflationary update threaten patient access to care and jeopardize the financial viability of clinician practices.”

However, Jones adds that despite the failure to address the Medicare reimbursement cuts in full, the ACC recognizes the efforts made to stave off more significant reductions. “The College also supports several other provisions in the bill that will fund crucial cardiovascular research, provide critical health care coverage for women and children and extend telehealth flexibilities for the next two years,” he said. “We look forward to partnering with the 118th Congress to achieve long-term reforms that stabilize the Medicare system, protect patient access to care, and improve outcomes for all." 

Highlights from the legislation include: 

Medicare Cuts: 

• Waiver of 4% PAYGO sequester
  
• 2-year partial physician payment relief of the 4.5% conversion factor cut
  
  • Relief of 2.5% in 2023
    
  • Relief of 1.25% in 2024
    
• Provisions relating to clinical labor were NOT included in the bill, so additional reductions relating to year 2 of the clinical labor update policy transition will continue. (See the clinical labor coalition letter that was sent to congressional leadership on Nov. 14.) 

Other Priorities: 

• 1-year extension of APM bonus at 3.5%, down from 5%
  
• 5-year fix for Puerto Rico Medicaid funding, which was set to decrease from 76% to 55% without congressional action and would have devastating implications on patient access to care.
  
• 2-year extension of telehealth flexibilities granted as part of the COVID-19 Public Health Emergency, until Dec. 31, 2024
  
• 2-year extension of Hospital at Home
  
• 2-year extension of the Children’s Health Insurance Program (CHIP) through 2029 – a long-time priority for ACC Advocacy and the College’s Adult Congenital and Pediatric Cardiology Section 
  
• Modifications to postpartum coverage, making permanent a state option to continue to provide 12 months of continuous coverage during the postpartum period under Medicaid or CHIP 

Appropriations: 

• National Institutes of Health (NIH) and National Heart, Lung, and Blood Institute (NHLBI)
  
  • $47 billion for the NIH, $2.5 billion more than FY22 
    
  • $8 million for implementation of the ACC-supported Cardiovascular Advances in Research and Opportunities Legacy (CAROL) Act, of which $5 million is to expand an existing, national sudden cardiac arrest registry to capture data from all states and $23 million for heart valve disease education and awareness 
    
  • An increase to strengthen and expand evidence-based heart disease and stroke prevention activities focused on high-risk populations
    
• Centers for Disease Control and Prevention (CDC)
  
  • $246 million for the CDC Office of Chronic Disease Prevention and Health Promotion for tobacco prevention, including funds to prevent e-cigarette use during pregnancy 
    
  • $200 million for the CDC to conduct heart disease and stroke prevention efforts
    
  • $5 million for the Million Hearts Program 
    
  • $125 million for the Office of Smoking and Health
    
  • $8.2 million increase to further implement the screening, surveillance, research, and awareness activities authorized by the Congenital Heart Futures Reauthorization Act
    
  • $34 million for WISEWOMAN, including a $5 million increase for the program to be expanded to additional states
    
• Agency for Healthcare Research and Quality (AHRQ)
  
  • Support for studying and assessing the current evidence for lipid control and cardiovascular event reduction. Along with an agreement directing AHRQ to assess the current evidence surrounding the costs and benefits (including the costs to the Federal Treasury of angioplasties conducted in non-emergency situations) and make recommendations based on its findings within 180 days of enactment of this Act 
    
  • $10 million for Long COVID research by health systems on how to best deliver patient-centered, coordinated care to those living with Long COVID, including the development and implementation of new models of care to help treat the complexity of symptoms  

Pay-Fors: 

• $3 billion in savings by extending the Medicare sequester in the back end of the budget window; additionally, this will also smooth out the policy in the later years so that it is not higher than 2%.
  
• $7 billion from the Medicare Improvement Fund, and changes to hospice cap and clinical diagnostic testing policies.   

ACC Advocacy staff are continuing to review the legislative package and will provide updates on ACC.org and in the Advocate newsletter as they become available. Access the full bill here, and a summary of the legislation here.

Clinical Topics: Anticoagulation Management, COVID-19 Hub, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Lipid Metabolism, Interventions and Structural Heart Disease, Smoking

Keywords: Lipids, Health Services Accessibility, Postpartum Period, Angioplasty, Registries, Physicians, Centers for Disease Control and Prevention, U.S., Heart Valve Diseases, Policy, Financial Management, Telemedicine, Heart Diseases, Cardiology, COVID-19, Electronic Nicotine Delivery Systems, Cost-Benefit Analysis, Children's Health Insurance Program, Factor V, Puerto Rico, Leadership, Vaping, National Heart, Lung, and Blood Institute (U.S.), Hospices, Medicaid, Cardiovascular Diseases, Medicare, Tobacco, ACC Advocacy

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