Which healthcare policies were kept in a doomed second version of the continuing resolution?

A slimmed-down version of a year-end government funding package retained some of the core healthcare provisions from a larger previous version, but little was certain after the second version failed to pass the House of Representatives.

After President-elect Donald Trump spoke out against a bipartisan agreement Wednesday night, Republicans in the House drafted a streamlined bill that Trump endorsed Thursday.

The bill, which would have funded federal government operations through March, fell well short of passage Thursday amid opposition from Democrats and some conservative Republicans. A shutdown loomed Friday night if the sides could not come to an agreement.

Key provisions retained

Thursday’s version of the bill included a delay through March 31 of an $8 billion cut to Medicaid disproportionate share hospital payments. The cut is set to begin Jan. 1 without a legislative adjustment. Not included was a provision from the earlier bill that would modify the hospital-specific DSH payment limit to account for care provided to patients who are dually eligible for Medicare and Medicaid.

Medicare supplemental payments for low-volume hospitals and Medicare-dependent hospitals would have continued through Q1 2025, according to the new bill.

Waivers also would have been maintained for expanded coverage of telehealth services and for inpatient-level services delivered in the home. Whereas the earlier bill pushed the expiration of those waivers to the end of 2026 for telehealth and 2029 for hospital-at-home, the new version would have required the waivers to be extended again when the continuing resolution expired at the end of March.

No increase in Medicare physician payments was contained in the new bill, leaving physicians with a 2.83% reduction in the conversion factor for 2025. The earlier spending package would have limited the reduction to roughly 0.33%.

The new bill retained the current floor for the work geographic practice cost index (GPCI), helping rural practices better afford labor.

In what likely would come as a relief to hospitals, the new bill left out a requirement for off-campus hospital outpatient departments to obtain their own national provider identifier and to bill Medicare using that unique NPI.

Limited funding for public health

Many public-health provisions from the earlier bill were left out of the new version. But funding for graduate medical education, community health centers and the National Health Service Corps remained, as did an extension of the Special Diabetes Program.

Among the provisions excluded were continued funding for the Public Health Emergency Preparedness Program and the Hospital Preparedness Program, reauthorizations and updates for the SUPPORT Act, and funding for a 2022 law that was drafted to support the health and wellness of healthcare professionals.

In addition, policies to impose constraints on pharmacy benefit managers were nowhere to be found in the second bill.