Congress' $1.5 trillion spending deal includes 340B, telehealth coverage

Congress reached a deal early Wednesday morning on a $1.5 trillion package to fund the government, but additional money to respond to the COVID-19 pandemic was stripped out at the last minute.

The long-awaited package comes after months of negotiation between Democrats and Republicans and disagreements over additional COVID-19 funding. The House plans to pass the package Wednesday with a vote in the Senate potentially by the end of the week.

About $15.6 billion in supplemental funding was removed from the bill Wednesday afternoon after some Democratic members objected to the offsets: cuts in planning relief funding to state and local governments.

The $15.6 billion was already $7 billion less than the Biden administration had asked for, and now it's not clear when or if Congress will pass additional COVID-19 response funding.

"It is heartbreaking to remove the COVID funding, and we must continue to fight for urgently needed COVID assistance, but unfortunately that will not be included in this bill," House Speaker Nancy Pelosi (D-Calif.) wrote in a letter Wednesday to Democratic members.

More than $10.5 billion of the funding would have gone to the Health and Human Services Department for research, manufacturing, production and distribution of vaccines, treatments, diagnostics and medical supplies.

The remainder of the funding would have gone toward the global COVID-19 response.

The supplemental funding doesn't include money for an HHS program that reimburses providers for treating uninsured COVID-19 patients. The Biden administration had initially asked Congress for $3 billion to replenish this fund, which is expected to run out of money by spring or early summer.

Congressional Republicans had raised concerns about how the money has been spent so far.

The Biden administration says all of the funding that was appropriated by Congress in the past to respond to COVID-19 has been spent or obligated.

The overall package also does not include several other provider group requests, including another delay of Medicare payment cuts, which are set to partially resume in April.

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The package also does not include more money for the Provider Relief Fund, which helps providers offset financial losses due to COVID-19, nor does it include a suspension of Medicare loan repayments.

Providers did score some wins. Some hospitals that fell out of the 340B Drug Discount Program during the pandemic due to a change in patient mix and volume will be allowed to stay in the program through Dec. 31. More than 50 hospitals have already been kicked out of the program during the pandemic, according to the American Hospital Association. However, the language is not retroactive, meaning that hospitals that already lost eligibility may not benefit.

"The AHA appreciates Congress' effort to restore some access to the 340B program for hospitals that lost eligibility to the program due to COVID-19-related changes to their payer mix," said Aimee Kuhlman, vice president of federal relations for the AHA. "We are pleased that these affected 340B hospitals and their patients will be able to benefit from the program as they continue to weather the financial and operational challenges of the pandemic."

The package will also extend Medicare coverage of telehealth services for 151 days after the end of the public health emergency, allowing beneficiaries to continue accessing care from their homes, at least temporarily.

Under the public health emergency, Medicare has temporarily waived several restrictions on coverage, including a requirement that beneficiaries be at a rural healthcare facility to receive telehealth services. Many of those waivers expire at the end of the public health emergency, which could end as soon as July 15.

The temporary extension will allow Congress more time to study the impacts of expanding telehealth access under Medicare and to decide whether lawmakers want to make those changes permanent. The extension also applies to coverage of audio-only telehealth.

HHS will receive a 12% funding increase under the proposal, including more money for the National Institutes of Health, the Centers for Disease Control and Prevention and various priorities for lawmakers, including maternal health and the substance use crisis.

Some of the department's funds will be earmarked for a new agency that will focus on accelerating the pace of scientific breakthroughs for cancer and diseases like Alzheimer's, fulfilling a key Biden administration priority. Additional money will go toward modernizing public health data surveillance and public health workforce initiatives.

The Substance Abuse and Mental Health Services Administration would receive $6.5 billion — a $350 million increase. That funding would go toward supporting mental health services and substance use treatment. The Health Resources and Services Administration would receive $9 billion, or a 20% increase in funding. Some of that would go toward workforce programs, including a new loan repayment program for physicians who specialize in pediatrics, and a funding increase for the Children's Hospitals Graduate Medical Education program.

The package also includes several new grant programs to address maternal health, including $9 million in annual grants intended to spur innovative approaches to improving maternal health outcomes. The HHS funding also creates a $5 million-a-year grant program for medical and nursing schools to train students to care for racial and ethnic minorities. Other grant programs would focus on care integration, vaccine awareness, data collection and care in rural areas. More than $4.7 billion would go toward addressing the nursing shortage.