Telehealth flexibilities in Medicare and waivers that allow hospitals to deliver acute care in patients’ homes were reinstated on Tuesday after President Donald Trump signed legislation ending a partial government shutdown.
The shutdown began Saturday after Congress failed to pass an appropriations bill for a large swath of the government — including the HHS — before funding lapsed on Jan. 31.
The impasse didn’t last long. Senate leaders reached a deal late last week to fund most of the federal government through September, except for the Department of Homeland Security — an area of contention for Democrats after the fatal shooting of intensive care nurse Alex Pretti by federal immigration agents in Minneapolis.
On Tuesday, the House voted 217 to 214 to send the legislation, which funds the HHS through Sept. 30, to the president’s desk. The package does not include DHS funding and starts a two-week clock to renegotiate the agency’s appropriations.
The package also includes notable healthcare reform, including transparency requirements for pharmacy benefit managers. It also prohibits the pharmaceutical middlemen from linking their pay to drug manufacturers’ list prices in Medicare Part D.
PBMs have been facing increased scrutiny from regulators and lawmakers, who argue the middlemen drive up the cost of drugs and steer patients toward affiliated pharmacies at the expense of independent operators.
Pharmacy groups cheered the reforms Tuesday, with Alan Rosenbloom, the president and CEO of the Senior Care Pharmacy Coalition, calling the legislation “a significant step toward greater transparency, accountability, and fairness in the prescription drug marketplace.”
However, PBM lobby the Pharmaceutical Care Management Association said the reforms won’t lower drug prices and argued lawmakers should now target pharmaceutical manufactures for their role in rising medication costs.
“The question today though is, ‘now what?’ PBM reform is done. This boogeyman has been exorcised,” Brendan Buck, the chief communications officer at PCMA, said in a Tuesday statement. “While drugmakers are quietly celebrating this achievement (they do in fact stand to make a lot more money from this law), they should also know that new oversight of their own actions is now coming.”
The package also delayed cuts to Medicaid disproportionate share payments for safety-net hospitals until fiscal year 2028, and moved towards site-neutral payments by requiring providers with off-campus outpatient departments to use separate identification numbers.
Pandemic-era telehealth and hospital-at-home flexibilities have gotten a reprieve under the legislation, too. The package preserves policies that expanded Medicare reimbursement for telehealth through 2027.
And the Acute Hospital Care at Home Program, an initiative that allows approved hospitals to deliver inpatient care in patients’ homes, has been extended through Sept. 30, 2030.
The longer-term policies are significant victories for telehealth and hospital-at-home advocates, who say short extensions create challenges for providers trying to build and sustain their programs.
“This five-year extension is a critical step toward making hospital-at-home a durable part of our health care system,” Krista Drobac, the executive director of industry group Moving Health Home, said in a Tuesday statement. “Long-term certainty allows providers to plan, invest, and scale these programs in ways that benefit patients, caregivers, and communities. Crucially, it also allows large scale collection of data and evidence that we feel confident will definitively convince lawmakers to make this program permanent.”
