New Federal Laws and Regulations to Know for 2020

Funding, access, transparency, wages, and more— the new year brings many new federal rules for the practice of healthcare. We round up a year’s worth of changes that could affect you in 2020.

To date, the 116^th United States Congress has enacted 65 public laws, including legislation reforming and funding or defunding Medicaid programs and the Affordable Care Act, expanding access to mental health and substance abuse services, protecting children, and reforming the tax code.  In addition, federal agencies developed new regulations to implement and modify many of these types of laws. Keeping track of so many changes is hard, so we’ve boiled them down for you here.

How are Medicaid programs and funding changing?

The Medicaid Extenders Act of 2019  made appropriations for Medicaid programs for the period between October 1, 2019 and September 30, 2020. It also revised Medicaid’s Money Follows the Person (MFP) program.  Through the MFP program, state Medicaid programs receive grants from the Center for Medicare and Medicaid Services (CMS) to promote and support the use of home- and community-based services (HCBS) over institution-based services.  

The law also temporarily extends the applicability of Medicaid spousal impoverishment benefits for recipients of HCBS.  Spousal impoverishment benefits allow the spouse of a Medicaid beneficiary to retain some assets and income when a patient is admitted to a Medicaid-certified skilled nursing facility.  However, the law also reduces the federal government’s Medicaid matching rate for states that fail to implement asset-verification programs when reviewing an individual’s Medicaid eligibility.

The Sustaining Excellence in Medicaid Act reauthorized and improved the MFP program, and it extended spousal impoverishment protections and a Medicaid pilot program for serious mental illness and substance abuse disorders. 

The Medicaid Services Investment and Accountability Act, altered several Medicaid programs, including:

• Penalize drug manufacturers that misclassify drugs
• Require drug manufacturers with Medicaid rebate agreements to disclose drug product information
• Expand a state option for health homes (i.e., a designated provider or team of healthcare professionals) for children with complex medical conditions
• Expand funding for various Medicaid demonstration projects
• Modify Medicaid funding and billing provisions

What’s happening with Medicaid expansion?

The Trump administration has continued to pursue its goals of repealing the ACA, rolling back Medicaid expansion, and using administrative agency actions to impose rigid caps on federal Medicaid spending. 

The ACA’s Medicaid expansion begins the current administration’s hard-sought wind-down when, as of January 1, 2020, the federal government stopped funding newly-enrolled childless adults. Moving forward, enrollees will be funded only if they (a) had Medicaid before 2020 and (b) did not have any lapse in coverage.

What’s the current status of the ACA?

Most efforts of the Administration and Congressional Republicans to undo ACA were legislatively unsuccessful, and it remains the law.  The most significant recent change was effected by the 2017 Republican tax law, which significantly eroded the penalties for those who do not comply with the “individual mandate” (i.e., the requirement that everyone maintain health insurance).

However, keep an eye on a case winding its way through the federal courts – Texas v. United States – wherein several states have joined together to challenge the constitutionality of the ACA.  A significant ruling was issued by the U.S. Fifth Circuit Court of Appeals just before Christmas, and legal scholars predict that ultimately,  it will land before the United States Supreme Court in the coming year. Whether the Supreme Court will hear the case remains to be seen.

How will health plans change in 2020?

CMS issued its annual Payment Notice (officially called its Patient Protection and Affordable Care Act Notice of Benefit and Payment Parameters for 2020). The Payment Notice did several things and took effect last summer:

• Lower user fee rate for qualified health plans (QHPs) sold on federal or state-based exchanges, with the goal of reducing premiums
• Encourage use of lower-cost generic drugs
• Reduce eligibility errors when individuals are automatically re-enrolled in their plans
• Implement various programs to stabilize the health plan marketplaces
• Improve Risk Adjustment Data Validation (RADV) audits to confirm the accuracy of diagnosis codes that insurers submit for risk adjustment transfer calculations
• Allow QHP issuers and web brokers to directly enroll QHP applicants through non-Exchange websites in a way that still considers those enrollments to have been made through the Exchange
• Create a new special enrollment period (SEP), allowing individuals who experience a decrease in household income and satisfy other criteria to enroll in a different plan

The Payment Notice allows insurers to prepare their coverage offerings for the subsequent year.

Are any prescription drug price transparency changes coming?

As of May, CMS requires drug manufacturers to disclose the list price for a 30-day supply of the drug in any TV ads.  A group of pharmaceutical companies sued over this change and a federal judge recently ruled in the companies’ favor.  The ruling appears to relate more to a technicality than to the substance of drug price transparency, however, and similar changes are expected to continue to be enacted.

Have Medicare beneficiary telehealth offerings been expanded?

Medicare Advantage plans can include additional telehealth benefits, resulting in the expansion of technology and care options to beneficiaries. This change was triggered in April when CMS implemented a new rule that leverages some new powers the agency obtained from the previous year’s Congressional budget law. Under the previous rule, original Medicare beneficiaries could obtain telehealth benefits only if they lived in rural areas.

Do federal buildings need lactation rooms now?

Certain public federal buildings with a public restroom must now provide a lactation room, per the Fairness for Breastfeeding Mothers Act of 2019, enacted in July.  The lactation room cannot be a bathroom, it must be hygienic, and it must be made available to members of the public to express breastmilk. The previous law required federal agencies to provide this space to employees, and the protection is now extended to public visitors to federal buildings.

Have funding programs for children’s health been reauthorized?

A few other laws had the exact impact one would expect from their names:

• The Emergency Medical Services for Children Program Reauthorization Act reauthorizes the referenced program and provides funding of $22.3 million per year for fiscal years 2020 through 2024.  The Health Resources and Services Administration administers this program, which focuses on improving emergency health care for children who are seriously ill or injured.
• The Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act of 2019 reauthorizes the previous Autism CARES Act.  This is the primary source of federal funding for autism research, services, training, and monitoring.  The reauthorization provides $369 million per year in funding for fiscal years 2020 through 2024.

How are the federal overtime wage requirements changing in 2020?

The Department of Labor raised the salary threshold for employees who are exempt from federal overtime rules.  Under the new rule, a worker must earn a weekly salary of at least $684 per week (versus the old rule’s $455 per week threshold) for an employer to avoid overtime pay obligations. By raising the threshold for “white collar exemptions” to those earning $35,568/year, the number of overtime-eligible employees is expected to increase by 1.3 million in 2020.

What if there’s a pandemic?!

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI), strengthens existing preparedness and response programs for both natural and deliberate public health threats. PAHPAI will ensure that healthcare professionals are properly trained for responding to pandemic outbreaks, prioritize the nation’s stockpile of vaccines and medical equipment, and create new task forces charged with developing action plans for protecting the most vulnerable populations during public health crises.

And as tax season approaches: are any changes forthcoming from the IRS?

The Taxpayer First Act modernizes and improves the IRS by amending the Internal Revenue Code. It specifically contains provisions relating to the IRS’s customer service, enforcement procedures, cybersecurity and identity protection, information technology management, and use of electronic systems. 

Conclusion

The challenge for healthcare practices has always been staying on top of the ever-changing laws while remaining focused on patient care. We hope that our summary helps you understand the regulatory landscape so that you can stay compliant and avoid the penalties that can derail your practice. Remember that there are professionals in your area, including healthcare attorneys like Jackson LLP, who can provide guidance and tools to comply with federal and state laws— allowing you to do what you do best.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader and should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.