Heads up: this issue is from March 27, 2025. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.
On March 14, 2025, Congress passed the Full-Year Continuing Appropriations and Extensions Act, 2025. This will fund most programs and activities at fiscal year 2024 levels, though there are some adjustments, including a reduction in non-defense spending by approximately $13 billion. Most notably, they did not pass a fix to the reductions in the Medicare fee schedule.
A summary of key healthcare-related provisions follows below and largely involves extensions of the current laws until the end of the Medicare FISCAL year without any new items. There are rumors that Medicaid will be cut, but that will be part of the budgeting process, and we will have that for you when it happens.
- Extends the Medicare low-volume hospital payment adjustment through September 30, 2025.
- Extends the Medicare-Dependent Hospital (MDH) program through September 30, 2025.
- Extends the Medicare ground ambulance add-on payments through September 30, 2025.
- Provides funding to the Centers for Medicare and Medicaid Services (CMS) for quality measure selection and to contract with a consensus-based entity to carry out duties related to quality measure endorsement, input, and selection activities through September 30, 2025.
- Provides funding for State Health Insurance Assistance Programs (SHIPs), Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs), and a contract with an entity to inform older Americans about benefits available under Federal and State programs through September 30, 2025.
- Extends the 1.0 work Geographic Practice Cost Index (GPCI) floor used in the calculation of payments under the Medicare Physician Fee Schedule through September 30, 2025. This is the twelfth time this has been extended by my count.
- Extends Medicare telehealth flexibilities that were extended in the Consolidated Appropriations Act, 2023, through September 30, 2025.
- Extends the Acute Hospital Care at Home initiative, as currently authorized under CMS waivers and flexibilities, through September 30, 2025.
- Extends Medicare Part D coverage of certain oral antiviral drugs through September 30, 2025.
- Adjusts the amount of funding in the Medicare Improvement Fund from $1.251 billion to $1.804 billion.
- Extends in order to finance the health care provisions, includes a two-month extension of the 2% Medicare sequestration cut to July 2032. Two months is not hard to take, but 7 years is.
- Delays the Medicaid Disproportionate Share Hospital (DSH) cuts, which are set to begin on April 1, 2025. The remaining DSH cuts would be in effect from fiscal year 2026 through fiscal year 2028.
Other rumors are swirling about many other items. Most notably, there are Trump consultants who would like to revive the "Most Favored Nation Pricing" (MFN) as part of the IRA negotiations. The only good thing about that is the first two letters of MFN.
