Health Care-Related Expiring Provisions of the 117th Congress, First Session
Congressional research reportJun 14, 2021
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Health Care-Related Expiring Provisions of
the 117th Congress, First Session
June 14, 2021
Congressional Research Service
https://crsreports.congress.gov
R46818
SUMMARY
Health Care-Related Expiring Provisions of the
117th Congress, First Session
This report describes selected health care-related provisions that are scheduled to expire during
the first session of the 117th Congress (i.e., during calendar year [CY] 2021). For purposes of this
report, expiring provisions are defined as portions of law that are time-limited and will lapse once
a statutory deadline is reached, absent further legislative action. The expiring provisions included
in this report are any identified provisions related to Medicare, Medicaid, the State Children’s
Health Insurance Program (CHIP), or private health insurance programs and activities. The report
also includes any identified expiring provisions among other health care-related provisions
enacted or extended in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148) or
extended under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L.
114-10). In addition, this report describes health care-related provisions within the same scope
that expired during the 116th Congress (i.e., during CY2019 or CY2020). Although the
Congressional Research Service (CRS) has attempted to be comprehensive, it cannot guarantee
that every relevant provision is included in this report.
R46818
June 14, 2021
Julia A. Keyser,
Coordinator
Analyst in Health Care
Financing
Phoenix Voorhies,
Coordinator
Analyst in Health Care
Financing
This report focuses on two types of health care-related provisions within the scope discussed above. The first, and most
common, type of provision provides or controls mandatory spending, meaning it provides temporary funding, temporary
increases or decreases in funding (e.g., Medicare provider bonus payments), or temporary special protections that may result
in changes in funding levels (e.g., Medicare funding provisions that establish a floor). The second type of provision defines
the authority of government agencies or other entities to act, usually by authorizing a policy, project, or activity. Such
provisions also may temporarily delay the implementation of a regulation, requirement, or deadline or establish a moratorium
on a particular activity. Expiring health care provisions that are predominantly associated with discretionary spending
activities—such as discretionary authorizations of appropriations and authorities for discretionary user fees —are excluded
from this report.
Certain types of provisions with expiration dates that otherwise would meet the criteria set forth above are excluded from this
report. Some of these provisions are excluded because they are transitional or routine in nature or because they have been
superseded by congressional action that modifies their intent. For example, statutorily required Medicare payment rate
reductions and payment rate rebasings that are implemented over a specified period are not considered to require legislative
attention and are excluded from this report.
The report provides tables listing the relevant provisions scheduled to expire in CY2021 and those that expired in CY2020 or
CY2019. The report then describes each listed provision and provides a legislative history of that provision. Appendix A
includes relevant demonstration projects and pilot programs that are scheduled to expire during the first session of the 117th
Congress or that expired in the 116th Congress. Appendix B provides new expiration dates for provisions and demonstration
projects or pilot programs that were included in CRS Report R46331, Health Care-Related Expiring Provisions of the 116th
Congress, Second Session, but are beyond the scope of this report.
Congressional Research Service
Health Care-Related Expiring Provisions of the 117th Congress, First Session
Contents
Overview ....................................................................................................................... 1
CY2021 Expiring Provisions ............................................................................................ 5
Social Security Act (SSA) Title XVIII: Medicare............................................................ 5
Exclusion of Complex Rehabilitative Manual Wheelchairs from Medicare
Competitive Acquisition Program (SSA §1847(a); 42 U.S.C. §1395w-3(a))................ 5
Extension of Temporary Suspension of Medicare Sequestration
(2 U.S.C. §901a(6)) ........................................................................................... 6
Home Health Prospective Payment System Add-On for Rural Counties (SSA
§1895; 42 U.S.C. §1395fff note) .......................................................................... 7
Reporting Requirements with Respect to Clinical Diagnostic Laboratory Tests
(SSA §1834A(a)(1)(B); 42 U.S.C. §1395m-1(a)(1)(B)) ........................................... 8
Supporting Physicians and Other Professionals in Adjusting to Medicare Payment
Changes During 2021 (SSA §1848; 42 U.S.C. §1395w -4(t))..................................... 9
SSA Title XIX: Medicaid .......................................................................................... 10
Additional Medicaid Funding and Federal Medical Assistance Percentage Rate
for the Territories (SSA §1108; 42 U.S.C. §1308) ................................................. 10
Other CY2021 Expiring Provisions ............................................................................ 12
Application of Premium Tax Credit in Case of Individuals Receiving
Unemployment Compensation During 2021 (IRC §36B; 26 U.S.C. §36B)................ 12
Exemption for Telehealth Services (IRC §223; 26 U.S.C. §223) ................................ 13
Health Coverage Tax Credit (IRC §35; 26 U.S.C. §35)............................................. 14
Preserving Health Benefits for Workers (ARPA §9501) ............................................ 15
Reduced Cost Sharing (42 U.S.C. §18071) ............................................................. 16
Temporary Special Rules for Health and Dependent Care Flexible Spending
Arrangements (§214 of Division EE of the Consolidated Appropriations Act,
2021)............................................................................................................. 17
CY2019 and CY2020 Expired Provisions ......................................................................... 18
Other Health Care-Related Provisions......................................................................... 18
Pregnancy Assistance Fund (42 U.S.C. §18201-42 U.S.C. §18204) ............................ 18
SSA Title XVIII: Medicare........................................................................................ 19
Home Health Prospective Payment System Rural Add-On for High-Utilization
Counties (SSA §1895; 42 U.S.C. §1395fff note) ................................................... 19
Medicare Access and CHIP Reauthorization Act of 2015 Technical Assistance to
Small Practices and Practices in Health Professional Shortage Areas (SSA
§1848(q)(11); 42 U.S.C. §1395w-4(q)(11)).......................................................... 20
Funding for Implementation of Section 101 of the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA Section 101(c)(3)) ..................................... 21
Priorities and Funding for Measure Development (SSA §1848(s);
42 U.S.C. §1395w-4(s)).................................................................................... 22
Temporary Extension of Long-Term Care Hospital Site-Neutral Payment Policy
Transition Period (SSA §1886(m)(6)(B)(i); 42 U.S.C. §1395ww(m)(6)(B)(i))........... 22
Temporary Exception for Certain Spinal Cord Conditions from Application of the
Medicare LTCH Site-Neutral Payment for Certain LTCHs
(SSA §1886(m)(6)(F); 42 U.S.C. §1395ww(m)(6)(F))........................................... 23
Transitional Payment Rules for Certain Radiation Therapy Services
(SSA §1848(b)(11); 42 U.S.C. §1395w-4(b)(11)) ................................................. 24
SSA Title XXI: State Children’s Health Insurance Program............................................ 25
Congressional Research Service
Health Care-Related Expiring Provisions of the 117th Congress, First Session
Increase to Enhanced Federal Medical Assistance Percentage (SSA §2105(b);
42 U.S.C. §1397ee(b))...................................................................................... 25
Tables
Table 1. Provisions Expiring in the 117 th Congress, First Session ............................................ 2
Table 2. Provisions That Expired in the 116th Congress ......................................................... 4
Table A-1. Demonstration Projects and Pilot Programs Set to Expire
in the 117th Congress, First Session ............................................................................... 27
Table A-2. Demonstration Projects and Pilot Programs That Expired in the 116th Congress ....... 27
Table B-1. Provisions Included in the Previous CRS Health Care-Related Expiring
Provisions Report That Were Not Included in This Report ................................................ 28
Table B-2. Demonstration Projects and Pilot Programs Included in the Previous CRS
Health Care-Related Expiring Provisions Report That Were Not Included in This
Report ...................................................................................................................... 30
Table C-1. Laws That Created, Modified, or Extended Current Health Care-Related
Expiring Provisions .................................................................................................... 31
Appendixes
Appendix A. Demonstration Projects and Pilot Programs .................................................... 27
Appendix B. Provisions Included in the Previous CRS Health Care-Related Expiring
Provisions Report....................................................................................................... 28
Appendix C. Laws That Created, Modified, or Extended Current Health Care-Related
Expiring Provisions .................................................................................................... 31
Contacts
Author Information ....................................................................................................... 34
Congressional Research Service
Health Care-Related Expiring Provisions of the 117th Congress, First Session
Overview
This report describes selected health care-related provisions that are scheduled to expire during
the first session of the 117th Congress (i.e., during calendar year [CY] 2021). For purposes of this
report, expiring provisions are defined as portions of law that are time-limited and will lapse once
a statutory deadline is reached, absent further legislative action. The expiring provisions included
in this report are any identified provisions related to Medicare, Medicaid, the State Children’s
Health Insurance Program (CHIP), or private health insurance programs and activities. The report
also includes any identified expiring provisions among other health care-related provisions
enacted or extended in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148) or
extended under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 11410). 1 In addition, the report describes health care-related provisions within the same scope that
expired during the 116th Congress (i.e., during CY2019 or CY2020). Although the Congressional
Research Service (CRS) has attempted to be comprehensive, it cannot guarantee that every
relevant provision is included in this report.
The two types of provisions discussed in this report generally are enacted in the context of
authorization laws and thus typically are within the purview of congressional authorizing
committees. The duration for which a provision is in effect usually is regarded as creating a
timeline for legislative decisionmaking. In choosing this timeline, Congress navigates tradeoffs
between the frequency of congressional review and the stability of funding or other legal
requirements that pertain to the program.
The first type of provision in this report provides or controls mandatory
spending, meaning it provides temporary funding, temporary increases or
decreases in funding (e.g., Medicare provider bonus payments), or temporary
special protections that may result in changes in funding levels (e.g., Medicare
funding provisions that establish a floor). 2
The second type of provision in this report defines the authority of government
agencies or other entities to act, usually by authorizing a policy, project, or
activity. 3 Such provisions also may temporarily delay the implementation of a
regulation, requirement, or deadline, or they may establish a moratorium on a
particular activity.
1 T his report is the latest in a series of reports in which the Congressional Research Services (CRS)
has tracked health
care-related expiring provisions related to Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP),
or private health insurance. CRS also has tracked a group of other health-related provisions that were enacted or
extended in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148) or extended under the Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10), which have been periodically extended with
Medicare, Medicaid, CHIP, and private health insurance provisions. Any applicable provisions within these categories
are included in the CRS health care-related expiring provisions report for a given year.
2 Mandatory spending is controlled by authorization acts; discretionary spending is controlled by appropriations acts.
For further information, see CRS Report R44582, Overview of Funding Mechanisms in the Federal Budget Process,
and Selected Examples.
3 For further information about these types of authorization provisions, see CRS Report R42098, Authorization of
Appropriations: Procedural and Legal Issues.
Congressional Research Service
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Expiring health care provisions that are predominantly associated with discretionary spending
activities—such as discretionary authorizations of appropriations and authorities for discretionary
user fees—are excluded from this report.4
Certain types of provisions with expiration dates that otherwise would meet the criteria set forth
above also are excluded from this report. Some of these provisions are excluded because they are
transitional or routine in nature or because they have been superseded by congressional action
that otherwise modifies their intent. For example, statutorily required Medicare payment rate
reductions and payment rate rebasings that are implemented over a specified period are not
considered to require legislative attention and are excluded from this report.
The report is organized as follows: Table 1 lists the relevant provisions scheduled to expire in
CY2021. Table 2 lists the relevant provisions that expired during CY2020 or CY2019. The
provisions in each table are organized by expiration date and by applicable health care-related
program. The report then describes each listed provision and provides a legislative history of that
provision. The summaries are grouped by provisions scheduled to expire in CY2021 followed by
those that expired in CY2020 or CY2019. 5
In the appendixes, Table A-1 lists any demonstration projects and pilot programs related to
Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP), or private health
insurance programs and activities or to other health care-related demonstration projects and pilot
programs enacted or extended in the ACA or extended under MACRA that are scheduled to
expire in CY2021. 6 Table A-2 lists relevant demonstration projects and pilot programs that
expired during the 116th Congress. Table B-1 lists the status of provisions included in CRS
Report R46331, Health Care-Related Expiring Provisions of the 116th Congress, Second Session,
that were beyond the scope of this report. Table B-2 lists demonstration projects and pilot
programs included in R46331 that were not included in this report. Table C-1 lists all laws that
created, modified, or extended the health care-related expiring provisions described in this report.
Table 1. Provisions Expiring in the 117 th Congress, First Session
(CY2021)
Expires
After
Health
CareRelated
Program
6/30/2021
Medicare
Provisiona
Exclusion of Complex
Rehabilitative Manual
Wheelchairs from Medicare
Competitive Acquisition
Program
SSA §1847(a)
CRS Contact
Paulette Morgan
42 U.S.C. §1395w-3(a)
4 T he Congressional Budget
Office (CBO) is required to compile this information each year under §202(e)(3) of the
Congressional Budget Act of 1974 (P.L. 93-344, as amended). For information on provisions set to expire on or before
September 30, 2021, see CBO, Expired and Expiring Authorizations of Appropriations: Fiscal Year 2021, May 5,
2021, at https://www.cbo.gov/publication/57023.
5 Within each section, t he provisions are further organized by Social Security Act (SSA) and Public Health Service Act
(PHSA) title and section. A third category includes provisions that are found elsewhere (e.g., the Internal Revenue
Code [IRC]). Freestanding provisions (i.e., new laws) may be grouped in any section with related programs.
6 T his report is the latest in a series of health care-related expiring provisions reports for which CRS has been tracking
Medicare, Medicaid, CHIP, or private health insurance. CRS has also tracked a group of other health related provisions
that were enacted or extended in the ACA (P.L. 111-148) or extended under MACRA (P.L. 114-10), which have been
periodically extended with Medicare, Medicaid, CHIP, and private health insurance provisions. Any applicable
provisions within these categories are included in the report in a given year.
Congressional Research Service
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Expires
After
9/30/2021
Health
CareRelated
Program
Medicaid
Provisiona
Additional Medicaid Funding
and FMAP Rate for the
Territories
SSA §1108
CRS Contact
Alison Mitchell
42 U.S.C. §1308
9/30/2021
Private
Health
Insurance
Preserving Health Benefits
for Workers
ARPA §9501
Ryan Rosso
12/31/2021
Medicare
Extension of Temporary
Suspension of Medicare
Sequestration
2 U.S.C. §901a(6)
Patricia A. Davis
12/31/2021
Medicare
Home Health Prospective
Payment System Add-On
for Rural Counties
SSA §1895
42 U.S.C. §1395fff note
Phoenix Voorhies
12/31/2021
Medicare
Reporting Requirements
with Respect to Clinical
Diagnostic Laboratory Tests
SSA §1834A(a)(1)(B)
42 U.S.C. §1395m1(a)(1)(B)
Jim Hahn
12/31/2021
Medicare
Supporting Physicians and
Other Professionals in
Adjusting to Medicare
Payment Changes During
2021
SSA §1848
42 U.S.C. §1395w-4(t)
Jim Hahn
12/31/2021
Private
Health
Insurance
Application of Premium Tax
Credit in Case of Individuals
Receiving Unemployment
Compensation During 2021
IRC §36B
26 U.S.C. §36B
Bernadette
Fernandez
12/31/2021
Private
Health
Insurance
Exemption for Telehealth
Services
IRC §223
Ryan Rosso
Private
Health
Insurance
Health Coverage Tax
Credit
IRC §35
12/31/2021
Private
Health
Insurance
Temporary Special Rules for
Health and Dependent Care
Flexible Spending
Arrangements
§214 of Division EE of the
Consolidated
Appropriations Act, 2021
(P.L. 116-260)
Ryan Rosso
12/31/2021
Private
Health
Insurance
Reduced Cost-Sharing
42 U.S.C. §18071
Bernadette
Fernandez
12/31/2021
26 U.S.C. §223
26 U.S.C. §35
Bernadette
Fernandez
Source: Congressional Research Service (CRS).
Notes: ARPA = American Rescue Plan Act of 2021 (P.L. 117-2); CY = Calendar Year; FMAP = Federal Medical
Assistance Percentage; IRC = Internal Revenue Code; SSA = Social Security Act; U.S.C. = U.S. Code.
a.
Citations in statute and the U.S.C. are provided where available.
Congressional Research Service
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Table 2. Provisions That Expired in the 116 th Congress
(CY2019 and CY2020)
Expired
After
Health
CareRelated
Program
9/30/2019
Other
Pregnancy Assistance Fund
ACA §10212
Adrienne
FernandesAlcantara
9/30/2019
Medicare
Funding for Implementation of
§101 of MACRA
MACRA §101(c)(3))
Jim Hahn
9/30/2019
Medicare
Priorities and Funding for
Measure Development
SSA §1848(s)
Amanda Sarata
9/30/2019
Medicare
9/30/2019
Medicare
12/31/2019
Medicare
9/30/2020
CHIP
Provisiona
Extension of Blended Site
Neutral Payment Rate For
Certain LTCH Discharges
42 U.S.C. §1395w-4(s)
SSA §1886(m)(6)(B)(i) 42
U.S.C.
Contact
Marco Villagrana
§1395ww(m)(6)(B)(i)
Temporary Exception for Certain
Spinal Cord Conditions from
Application of the Medicare
LTCH Site-Neutral Payment for
Certain LTCHs
SSA §1886(m)(6)(F)
Marco Villagrana
Transitional Payment Rules for
Certain Radiation Therapy
Services
SSA §1848
42 U.S.C. 1395w-4(b)(11)
Jim Hahn
Increase to E-FMAP
SSA §32105(b)
Alison Mitchell
42 U.S.C.
§1395ww(m)(6)(F))
42 U.S.C. §1397ee(b)
9/30/2020
Medicare
MACRA Technical Assistance to
Small Practices and Practices in
Health Professional Shortage
Areas
SSA §1848(q)
42 U.S.C. §1395w-4(q)
Jim Hahn
12/31/2020
Medicare
Home Health Prospective
Payment System Rural Add-On
for High-Utilization Counties
SSA §1895
Phoenix Voorhies
42 U.S.C. §1395fff note
Source: CRS.
Notes: ACA = Patient Protection and Affordable Care Act (P.L. 111-148); CHIP = State Children’s Health
Insurance Program; CY = Calendar Year; E-FMAP = Enhanced Federal Medical Assistance Percentage; LTCH =
Long-Term Care Hospital; MACRA = Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10); SSA
= Social Security Act; U.S.C. = U.S. Code.
a.
Citations in statute and the U.S.C. are provided where available.
Congressional Research Service
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
CY2021 Expiring Provisions
Social Security Act (SSA) Title XVIII: Medicare
Exclusion of Complex Rehabilitative Manual Wheelchairs from Medicare
Competitive Acquisition Program (SSA §1847(a); 42 U.S.C. §1395w-3(a))
Background
Medicare covers a variety of durable medical equipment (DME) when medically necessary and
prescribed by a physician. The amount Medicare will pay for most DME is determined in one of
two ways. First, in competitive bidding geographic areas, Medicare payments for selected items
are determined by bids (or estimates of the cost for providing the item) submitted by winning
DME suppliers. Second, outside of competitive bidding areas, payments are determined through
statutorily specified formulas (fee schedules) that are adjusted based on information from the
competitive bidding process, when such information is available. Not all items of DME are
competitively bid; therefore, not all items outside of competitive bidding areas have their fee
schedule payments adjusted based on competitive bidding information. Competitive bidding
tends to result in lower payment amounts for DME than the fee schedules, so adjusting the fee
schedules based on competitive bidding can result in lower payments.
Certain items of DME were statutorily excluded from the competitive bidding program, including
Group 3 complex rehabilitative power wheelchairs and their accessories. Group 2 complex
rehabilitative power wheelchairs and their accessories were not excluded and were competitively
bid in the first round of the program (January 1, 2011, through December 31, 2013). In general,
the differences between Group 2 and Group 3 complex rehabilitative power wheelchairs are
related to the number of different power accessories that can be plugged into the chair and to the
chair’s power, durability, and performance. Certain accessories can be used with either Group 2
or Group 3 chairs and were part of the competitive bidding process.
The Secretary of the Department of Health and Human Services (HHS) published final
regulations on November 6, 2014, that would have adjusted the fee schedule payments for
wheelchair accessories based on information from the competitive bidding program regardless of
the type of wheelchair the accessory was used with, effective January 1, 2016, for areas outside of
competitive bidding areas. However, the Patient Access and Medicare Protection Act (PAMPA;
P.L. 114-115) prohibited the Secretary from using information from the competitive bidding
program to adjust the fee schedule payments for accessories furnished in conjunction with Group
3 complex rehabilitative power wheelchairs prior to January 1, 2017. The Increasing Choice,
Access, and Quality in Health Care for Americans Act (Division C of the 21 st Century Cures Act;
P.L. 114-255) delayed by six months (to July 1, 2017) the date on which the Secretary could
begin using information from competitive bidding to adjust the fee schedule rates for accessories
used with Group 3 complex rehabilitative power wheelchairs. However, effective July 1, 2017,
the Secretary extended the policy of paying for accessories used with Group 3 complex
rehabilitative power wheelchairs based on fee schedule amounts that had not been adjusted based
on competitive bidding.
Relevant Legislation
Further Consolidated Appropriations Act, 2020 (P.L. 116-94), Division N,
Section 106, expanded the types of wheelchairs excluded from competitive
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
bidding to include complex rehabilitative manual wheelchairs, as determined by
the Secretary, as well as specified pediatric wheelchairs and custom-built
wheelchairs. Section 106 also prohibited the Secretary from using information
from competitive bidding to adjust the fee schedule amounts for accessories and
cushions furnished with those chairs during the period beginning January 1,
2020, and ending June 30, 2021.
Current Status
The prohibition on using information from competitive bidding to adjust fee schedule amounts
for accessories and cushions furnished with complex rehabilitative manual wheelchairs, as well as
specified pediatric wheelchairs and custom-built wheelchairs, expires after June 30, 2021.
Extension of Temporary Suspension of Medicare Sequestration
(2 U.S.C. §901a(6))
Background
The Budget Control Act of 2011 (BCA; P.L. 112-25) provided for increases in the debt limit and
established procedures designed to reduce the federal budget deficit, including the creation of the
Joint Select Committee on Deficit Reduction. The joint committee’s failure to propose deficitreduction legislation that was subsequently enacted into law by a mandated deadline triggered
automatic spending reductions, including the sequestration (i.e., across-the-board reductions) of
mandatory spending in FY2013 through FY2021. Subsequent legislation extended the
sequestration of mandatory spending through FY2030. Medicare benefits are funded through
mandatory spending and are subject to reductions under such sequestration. 7
Section 256(d) of the Balanced Budget and Emergency Deficit Control Act of 1985 (P.L. 99-177)
contained special rules for the Medicare program in the event of a sequestration. Among other
things, it specified that for Medicare, sequestration is to begin the month after the annual
sequestration order has been issued and to continue for one calendar year. Subsequent
sequestration orders are to begin the first month after the previous order ends. Therefore, as the
initial sequestration order was issued March 1, 2013, Medicare sequestration began April 1, 2013,
and is currently scheduled to continue through March 31, 2031.
Under a BCA mandatory sequestration order, Medicare benefit payments cannot be reduced by
more than 2%. With the exception of suspensions related to the Coronavirus Disease 2019
(COVID-19) pandemic (see “Relevant Legislation,” below), Medicare benefit-related
payments—which include payments to health care providers, Medicare Advantage, and Part D
plans—have been subject to 2% reductions since April 1, 2013.
Relevant Legislation
Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116136), Section 3709, waived the application of sequestration to the Medicare
program from May 1, 2020, through December 31, 2020, and extended the
sequestration of mandatory spending for an additional year, through FY2030.
Medicare plans and providers received their full (non-reduced) payments for
health care services provided during this time period.
7 For additional information, see CRS Report R45106, Medicare and Budget Sequestration.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Consolidated Appropriations Act, 2021 (P.L. 116-260), Division N, Title 1,
Section 102, extended the temporary suspension of sequestration from January 1,
2021, through March 31, 2021.
To Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes
(P.L. 117-7), Section 1, extended the suspension of sequestration through
December 31, 2021. 8
Current Status
The sequestration of Medicare benefit payments has been suspended through December 31, 2021.
After this date, Medicare payments to plans and providers for health care services will again be
reduced by the sequester amount.
Home Health Prospective Payment System Add-On for Rural Counties (SSA
§1895; 42 U.S.C. §1395fff note)
Background
Federally certified home health (HH) agencies receive increased payments under the HH
prospective payment system (PPS) for Medicare HH care episodes furnished to beneficiaries in
rural areas. Before the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123), when provided
by legislation, the HH rural add-on was a fixed percentage increase to the HH PPS that was
applied uniformly to Medicare HH care episodes provided in rural counties.
Under BBA 2018, the rural add-on was applied unvaryingly for the first year in which the
legislation extended the increased payment, providing a 3% rural add-on payment to Medicare
HH episodes furnished in any rural county that began in CY2018. After CY2018, BBA 2018
provided HH agencies a 3%, 2%, and 1% HH PPS add-on payment for services furnished in rural
counties beginning during CY2019, CY2020, and CY2021, respectively, unless the Medicare HH
services were (or are) furnished in a rural county with one of the two below-described
designations, in which case alternative add-on payments were (or are) provided:
For HH episodes furnished to beneficiaries who reside in low-population-density
counties, defined as rural counties with a population density of six or fewer
individuals per square mile, BBA 2018 provided 4%, 3%, 2%, and 1% HH PPS
add-on payments for services beginning during CY2019, CY2020, CY2021, and
CY2022, respectively.
For HH episodes provided to beneficiaries who reside in high-utilization
counties, defined as rural counties in the top quartile of all counties rendering HH
services (by the number of HH episodes furnished per 100 Medicare eligibles),
BBA 2018 provided 1.5% and 0.5% HH PPS add-on payments for HH episodes
beginning in CY2019 and CY2020, respectively. BBA 2018 provided no add-on
payment for episodes furnished in high-utilization counties that begin in CY2021
or CY2022.
8 T o offset the costs of extending the Medicare sequestration suspension, P.L. 117-7 also made adjustments to the
percentage reductions applicable in the final year of sequestration, FY2030.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Under BBA 2018, rural counties were to be categorized only once and such determination was to
apply to payment for HH episodes through CY2022. 9
Relevant Legislation
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act
of 2000 (BIPA 2000; P.L. 106-554), Section 508, established a 10% add-on to
Medicare’s HH PPS rates for HH episodes provided to beneficiaries in rural areas
beginning April 1, 2001, through March 31, 2003.
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(MMA; P.L. 108-173), Section 421, provided a 5% add-on for services
beginning April 1, 2004, through March 31, 2005.
Deficit Reduction Act of 2005 (DRA; P.L. 109-171), Section 5201, provided a
5% add-on for services beginning January 1, 2006, through December 31, 2006.
ACA, Section 3131, provided a 3% add-on for services beginning April 1, 2010,
through December 31, 2015.
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 11410), Section 210, provided a 3% add-on for services beginning January 1, 2016
through December 31, 2017.
BBA 2018, Section 50208, provided a 3% add-on for services beginning in
CY2018. BBA 2018 provided a 3%, 2%, and 1% add-on for services beginning
in CY2019, CY2020, and CY2021, respectively, unless the services were
provided in a low-population-density or high-utilization rural county. For
services provided in low-population-density counties, BBA 2018 provided a 4%,
3%, 2%, and 1% add-on for services beginning in years CY2019, CY2020,
CY2021, and CY2022, respectively. For services furnished in high-utilization
counties, BBA 2018 provided a 1.5% and 0.5% add-on for services beginning in
CY2019 and CY2020, respectively.
Current Status
After December 31, 2021, HH agencies are no longer set to receive an add-on payment for
services provided in rural counties that are not designated as low-population-density counties.
Reporting Requirements w ith Respect to Clinical Diagnostic Laboratory Tests
(SSA §1834A(a)(1)(B); 42 U.S.C. §1395m-1(a)(1)(B))
Background
Outpatient clinical laboratory services are paid under the Medicare Clinical Laboratory Fee
Schedule (CLFS). Prior to 2018, CLFS payment rates were based on historical laboratory
charges. The Protecting Access to Medicare Act (PAMA; P.L. 113-93) established a new method
for determining clinical laboratory payments beginning in 2018, with Medicare CLFS payment
rates based on reported private insurance payment amounts.
9 Rural add-on payment designations by county can be found at Centers for Medicare and Medicaid Services
(CMS), “ Home Health Agency (HHA) Center,” at https://www.cms.gov/Center/Provider-T ype/Home-Health-AgencyHHA-Center.
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Per PAMA, the Centers for Medicare and Medicaid Services (CMS) was to collect data from
clinical laboratories (aside from advanced diagnostic laboratory tests, for which PAMA also
altered payment, coding, and coverage) about private payer payment rates beginning in 2016. The
new payment system was to be phased in from 2017 through 2022; during the phase-in period,
payment could not be reduced, compared with the payment amount in the preceding year, by
more than a statutorily specified limit. For each year 2017-2019, the CLFS payment reduction
limit was to be 10%, and for each year 2020-2022, the payment reduction limit was to be 15%.
Beginning in 2018, CMS set CLFS rates based on the weighted median of private payer rates for
each laboratory service, collected from applicable laboratories. These CLFS payment rates are
national and do not vary based on geography.
Relevant Legislation
Further Consolidated Appropriations Act, 2020 (P.L. 116-94), Division N,
Section 105, modified the schedule for implementing the new CLFS payment
system and reporting requirements. A period during which there would be no
reporting required from diagnostic laboratories was established from January 1,
2020, through December 31, 2020. The first required reporting period was set to
begin January 1, 2021, and end March 31, 2021, with subsequent reporting
periods required every three years thereafter. The phase-in schedule was modified
so that the payment reduction limit was to be 10% for each year from 2017
through 2020 and 15% for each year from 2021 through 2023.
CARES Act, Section 3718, delayed the reporting requirements under the new
CLFS payment methodology and made additional revisions to the payment
reduction limits during the phase-in schedule. The provision extended the initial
period during which no reporting is required to the period beginning January 1,
2021, through December 31, 2021, with the first required reporting period to
begin January 1, 2022, and end March 31, 2022. For 2021, there is no payment
reduction (i.e., 0% limit) during the phase-in of the private payer rate
implementation schedule.
Current Status
The payment reduction limit is set to be 15% for 2022 through 2024, when the private payer rate
is to be fully implemented.
Supporting Physicians and Other Professionals in Adjusting to Medicare
Payment Changes During 2021 (SSA §1848; 42 U.S.C. §1395w-4(t))
Background
Medicare Part B covers medically necessary physician services and medical services provided by
some nonphysician practitioners. Covered nonphysician practitioner services include, but are not
limited to, those provided by physician assistants, nurse practitioners, certified registered nurse
anesthetists, and clinical social workers. Certain limitations apply for services provided by
chiropractors and podiatrists. A number of Part B services are paid under the Medicare Physician
Fee Schedule (MPFS), including services of physicians, nonphysician practitioners, and
therapists. There are over 7,000 service codes under the MPFS. CMS adjusts the MPFS and
resultant payments each year to reflect changes in service codes (definitions, additions, and other
modifications) and certain mandated policy objectives. These modifications are subject to a
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budget-neutrality requirement such that projected expenditures under the MPFS based on the new
adjustments do not increase or decrease by more than $20 million from the prior year’s
expenditures.
The COVID-19 pandemic continues to place financial stress on many health care providers and
suppliers, including physicians and nonphysician practitioners. In areas where the impact of
COVID-19 was severe, some health care organizations faced a surge in demand for health care
services to treat those affected by the virus. Simultaneously, during the early weeks of the
pandemic, fewer patients sought care for nonemergency services out of caution, as well as in
response to pleas to allow resources to be directed to responding to COVID-19-related needs.
Additionally, to respond to the changes in demand for their services during the COVID-19 public
health emergency, some health care providers and suppliers postponed furnishing elective and
other nonemergency services, constraining revenue.
Relevant Legislation
Consolidated Appropriations Act, 2021, Division N, Title I, Section 101,
provided an increase of 3.75% in payments for services furnished and billed
under the MPFS in 2021. These MPFS adjustments are to be exempt from the
budget-neutrality requirement for years after 2021. Three billion dollars is to be
transferred from the General Fund of the Treasury to the Federal Supplementary
Medical Insurance (Part B) Trust Fund for this purpose, available until expended,
with additional amounts to be transferred as necessary.
Current Status
The 3.75% increase in MPFS payments will expire for services furnished after December 31,
2021.
SSA Title XIX: Medicaid
Additional Medicaid Funding and Federal Medical Assistance Percentage Rate
for the Territories (SSA §1108; 42 U.S.C. §1308)
Background
Medicaid financing for the territories (i.e., America Samoa, the Commonwealth of the Northern
Mariana Islands [CNMI], Guam, Puerto Rico, and the U.S. Virgin Islands [USVI]) differs from
Medicaid financing for the 50 states and the District of Columbia. 10 Federal Medicaid funding to
the states and the District of Columbia is open-ended, but Medicaid programs in the territories are
subject to annual federal capped funding.
Federal Medicaid funding for the territories comes from a few different sources. The permanent
source of federal Medicaid funding for the territories is the annual capped funding. Since July 1,
2011, the annual capped funding for the territories has been supplemented by additional funding
sources available for a limited time provided through various laws. Prior to the availability of
these additional Medicaid funding sources, all five territories typically exhausted their federal
Medicaid funding prior to the end of the fiscal year.
10 For more information about Medicaid funding for the territories, see CRS In Focus IF11012, Medicaid Financing for
the Territories.
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The federal share of most Medicaid expenditures is determined by the federal medical assistance
percentage (FMAP) rate. The regular FMAP rates for the 50 states and DC are determined
annually and vary by state according to each state’s per capita income. The rates can range from
50% to 83%. By contrast, the regular FMAP rate for the territories is set in statute and does not
vary according to each territory’s per capita income.
Relevant Legislation
ACA, Section 2005, as modified by Section 10201
Additional federal Medicaid funding was provided to the territories
totaling $6.3 billion. The funding was available between July 1, 2011, and
September 30, 2019.
The regular FMAP rate was increased from 50% to 55% for the territories.
ACA, Section 1323
Additional federal Medicaid funding in the amount of $1.0 billion was
provided to the territories that did not establish health insurance exchanges. 11
This funding was available from January 1, 2014, through December 31,
2019.
Consolidated Appropriations Act, 2017 (P.L. 115-31), Division M, Title II,
Section 202
Additional federal Medicaid funding was provided for Puerto Rico in the
amount of $295.9 million. This funding was available through September 30,
2019.
BBA 2018, Section 20301
Additional federal Medicaid funding was provided for Puerto Rico in the
amount of $3.6 billion and for USVI in the amount of $106.9 million. This
funding was further increased by $1.2 billion for Puerto Rico and $35.6
million for USVI because certain conditions were met. 12 This funding was
available January 1, 2018, through September 30, 2019.
The regular FMAP rate for Puerto Rico and USVI was increased from 55%
to 100% (i.e., fully federally funded) for this additional federal Medicaid
funding.
Additional Supplemental Appropriations for Disaster Relief Act, 2019 (P.L.
116-20), Title VIII, Section 802
Additional federal Medicaid funding was provided for CNMI in the
amount of $36 million for the period of January 1, 2019, through September
30, 2019.
The regular FMAP rate was increased from 55% to 100% for the $36
million in additional federal Medicaid funding provided for CNMI. For
American Samoa and Guam, the regular FMAP was increased from 55% to
11
Because none of the territories established exchanges, the territories all received additional federal Medicaid funds.
T he provision specified that Puerto Rico receive $925 million, and the Secretary of the Department of Health and
Human Services (HHS) distributed the remaining funding among the other four territories.
12 T he certain conditions were that the HHS Secretary needed to certify that each territory (i.e., Puerto Rico and the
U.S. Virgin Islands [USVI]) has taken steps to (1) report reliable data to the T ransformed-Medicaid Statistical
Information System and (2) establish a Medicaid Fraud Control Unit.
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100% for the territories’ share of the $6.3 billion in additional Medicaid
federal funding provided in the ACA.
Continuing Appropriations Act, 2020, and Health Extenders Act of 2019
(P.L. 116-59), Division B, Title III, Section 1302
The regular FMAP rate for territories was increased from 55% to 100% for
October 1, 2019, through November 21, 2019.
Further Continuing Appropriations Act, 2020, and Further Health
Extenders Act of 2019 (P.L. 116-69), Section 1302
The regular FMAP rate for the territories was increased from 55% to 100%
for November 22, 2019, through December 20, 2019.
Further Consolidated Appropriations Act, 2020, Division N, Title I, Section
202
Additional federal Medicaid funding was provided for the territories
totaling $3.0 billion for FY2020 and $3.1 billion for FY2021.
The regular FMAP rates for the territories were increased from 55% to
83% for American Samoa, CNMI, Guam, and USVI and from 55% to 76%
for Puerto Rico for part of FY2020 (i.e., December 21, 2019, through
September 30, 2020). 13
Family First Coronavirus Response Act (P.L. 116-127), Division F, Section
6009
The additional federal Medicaid funding amounts were increased to $3.1
billion for FY2020 and $3.2 billion for FY2021. 14
Current Status
The additional Medicaid federal funding and the increased regular FMAP rates expire after
September 30, 2021.
Other CY2021 Expiring Provisions
Application of Premium Tax Credit in Case of Individuals Receiving
Unemployment Compensation During 2021 (IRC §36B; 26 U.S.C. §36B)
Background
Individuals (and families) who meet income and other eligibility criteria receive federal financial
assistance in the form of a premium tax credit (PTC), which reduces the cost of purchasing health
insurance offered through exchanges. The credit amount is calculated according to a formula that
13
T he federal medical assistance percentage (FMAP) rates for the remainder of FY2020 and FY2021 could be reduced
if the territories do not comply with certain program integrity requirements.
14 Section 6008 of the Family First Coronavirus Response Act (FFCRA; P.L. 116-127) increases the FMAP rate for all
states, the District of Columbia, and the territories by 6.2 percentage points beginning January 1, 2020, and ending on
the last day of the calendar quarter in which is the last day of the Coronavirus Disease 2019 (COVID -19) pandemic
public health emergency period. As a result, in FY2020 and FY2021, during this period, the FMAP rate for American
Samoa, CNMI, Guam, and USVI is 89.2% and the FMAP rate for Puerto Rico is 82.2%. For more information about
the FFCRA FMAP increase, see CRS Report R46346, Medicaid Recession-Related FMAP Increases.
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generally provides larger amounts to individuals with lower incomes. Unemployment
compensation (UC) generally counts toward the calculation of income; therefore, receipt of UC
affects the amount of income used to determine eligibility for and the amount of the PTC. 15
Relevant Legislation
ACA, Section 1401, authorized the PTC, specified the eligibility criteria for
claiming the credit, specified the formula to calculate the credit, and made
conforming amendment to the U.S. Code for purposes of financing the credit.
American Rescue Plan Act of 2021 (ARPA; P.L. 117-2), Section 9663,
expanded eligibility for and increased the amount of the PTC for individuals who
receive UC in 2021. It temporarily deemed individuals who receive UC for any
week in CY2021 to have met the PTC income eligibility criteria for tax year
2021. It also temporarily disregarded any household income above 133% of the
federal poverty level (FPL) for purposes of determining the credit amount.
Current Status
The PTC rules applicable to individuals who receive UC will expire after December 31, 2021.
Exemption for Telehealth Services (IRC §223; 26 U.S.C. §223)
Background
A health savings account (HSA) is a tax-advantaged account that individuals can use to pay for
unreimbursed medical expenses (e.g., deductibles, co-payments, coinsurance, and services not
covered by insurance). 16
Individuals are eligible to establish and contribute to an HSA if they have coverage under an
HSA-qualified high-deductible health plan (HDHP), do not have disqualifying coverage, and
cannot be claimed as a dependent on another person’s tax return.
To be considered an HSA-qualified HDHP, a health plan must meet several criteria: (1) it must
have a deductible above a certain minimum level, (2) it must limit out-of-pocket expenditures for
covered benefits to no more than a certain maximum level, and (3) it can cover only specified
services before the deductible is met.
For example, if a health plan satisfied the first two of these criteria and provided coverage for
preventive care services and prescription drugs before the deductible is met, that health plan
would not be considered an HSA-qualified HDHP because it provides prescription drug benefits
before the deductible is met.
Disqualifying coverage is generally considered any other health coverage that is not an HSAqualified HDHP or that provides coverage for any benefit covered under an individual’s HSAqualified HDHP. Some types of health coverage are not considered disqualifying for purposes of
being eligible to establish and contribute to an HSA.
15 For additional background about the premium tax credit, see CRS Report R44425, Health Insurance Premium Tax
Credit and Cost-Sharing Reductions.
16 For more information on health savings accounts (HSAs), see CRS Report R45277, Health Savings Accounts
(HSAs).
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Relevant Legislation
MMA, Section 1201, authorized HSAs.
CARES Act, Section 3701, allowed HSA-qualified HDHPs to provide telehealth
and other remote care services before the deductible is met and still be
considered an HSA-qualified HDHP. It also provided that telehealth and other
remote care would not be considered disqualifying coverage that would prevent
an otherwise eligible individual from being HSA-eligible. These rules apply to
services provided on or after January 1, 2020, with respect to plan years that
begin on or before December 31, 2021. 17
Current Status
The temporary HSA eligibility rules regarding telehealth and other remote care will expire for
plans that begin after December 31, 2021.
Health Coverage Tax Credit (IRC §35; 26 U.S.C. §35)
Background
The Health Coverage Tax Credit (HCTC) subsidizes 72.5% of the cost of qualified health
insurance for eligible taxpayers and their family members. Potential eligibility for the HCTC is
limited to two groups of taxpayers. One group is composed of individuals eligible for Trade
Adjustment Assistance (TAA) allowances because they experienced qualifying job losses. The
other group consists of individuals whose defined-benefit pension plans were taken over by the
Pension Benefit Guaranty Corporation because of financial difficulties. HCTC-eligible
individuals are allowed to receive the tax credit only if they either cannot enroll in certain other
health coverage (e.g., Medicaid) or are not eligible for other specified coverage (e.g., Medicare
Part A). To claim the HCTC, eligible taxpayers must have qualified health insurance (i.e.,
specific categories of coverage, as specified in statute). The credit is financed through a
permanent appropriation under 31 U.S.C. §1324(b)(2); therefore, HCTC financing is not subject
to the annual appropriations process.
Relevant Legislation
Trade Act of 2002 (P.L. 107-210), Sections 201-203, authorized the HCTC,
specified the eligibility criteria for claiming the credit, and made conforming
amendment to the U.S. Code for purposes of financing the credit.
American Recovery and Reinvestment Act of 2009 (ARRA; P.L. 111-5), Part
VI: TAA Health Coverage Improvement Act of 2009, expanded eligibility for
and subsidy of the HCTC, including retroactive amendments, and provided $80
million total for FY2009 and FY2010 to implement the enacted changes to the
HCTC.
Trade Adjustment Assistance Extension Act of 2011 (P.L. 112-40), Section
241, established a sunset date of before January 1, 2014.
17 Internal Revenue Service (IRS), “ COVID-19 Guidance Under §125 Cafeteria Plans and Related to High Deductible
Health Plans,” Notice 2020-29, at https://www.irs.gov/pub/irs-drop/n-20-29.pdf.
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Trade Preferences Extension Act of 2015 (P.L. 114-27), Section 407,
retroactively reauthorized the HCTC and established a new sunset date of before
January 1, 2020.
Further Consolidated Appropriations Act, 2020, Section 146, established a
new sunset date of before January 1, 2021.
Consolidated Appropriations Act, 2021, Division EE, Section 134, established
a new sunset date of before January 1, 2022.
Current Status
Authorization for the HCTC expires after December 31, 2021.
Preserving Health Benefits for Workers (ARPA §9501)
Background
Private-sector employers that have at least 20 employees and offer health insurance benefits to
their employees are required to provide qualified individuals (and their families) who experience
specified qualifying events with the option of enrolling in Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA; P.L. 99-272) continuation coverage (i.e., of continuing their
coverage under the employer’s group health insurance plan). 18 Specified qualifying events include
both voluntary and involuntary termination of employment, a reduction in hours, and other
statutorily defined events; the qualifying event also must result in an individual losing health
insurance coverage. State and local government workers are covered by similar federal COBRA
requirements. In addition, many states have enacted “mini-COBRA” laws, which require that
continuation coverage be offered to employees of smaller firms.
Under federal COBRA rules, eligible individuals who experience qualifying events must be
notified of their right to elect COBRA coverage. In accordance with such notification, eligible
individuals have the right to elect COBRA coverage within an election period, defined as (at
least) 60 days from the later of two dates: (1) the date coverage would be lost due to the
qualifying event or (2) the date on which the beneficiary is sent notice of his or her right to elect
COBRA coverage. An individual electing COBRA coverage ordinarily w ill receive the same
coverage that he or she was receiving immediately before the qualifying event. In general, the
COBRA coverage for the employee and the employee’s spouse and dependent children must be
allowed to continue for 18 months from the date of the qualifying event. In certain circumstances,
an employer may cut short COBRA coverage or be required to extend such coverage according to
statutory limits.
When offering COBRA coverage to qualified individuals, employers are permitted to charge the
covered beneficiary a premium for COBRA continuation coverage that is 102% of the employersponsored insurance premium. In other words, the COBRA premium can equal the sum of (1) the
portion of employer-sponsored insurance premium normally paid by the employee, (2) the
portion of the premium normally paid by the employer (if any), and (3) an additional 2%
administrative fee. For disabled individuals who qualify for an additional 11 months of COBRA
coverage (i.e., qualify for 29 total months of COBRA coverage), the employer may charge up to
150% of the premium for these additional months.
18 For more information on Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA; P.L. 99-272)
continuation coverage, see CRS Report R40142, Health Insurance Continuation Coverage Under COBRA.
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Relevant Legislation
ARPA, Section 9501, provided temporary premium assistance for COBRA
continuation coverage for certain individuals who lost employer-based health
insurance as a result of an involuntary termination or a reduction in hours—
specifically, a 100% premium subsidy of COBRA coverage during the period
beginning April 1, 2021, and ending September 30, 2021. It also provided
employers (or, in some instances, multiemployer plans or insurers) with a
refundable payroll tax credit to reimburse the employers for unpaid premium
amounts.
Current Status
ARPA COBRA premium assistance will no longer be available to applicable COBRA coverage
provided after September 30, 2021.
Reduced Cost Sharing (42 U.S.C. §18071)
Background
Certain individuals (and families) who are enrolled in health plans through health insurance
exchanges and are eligible for the PTC also may receive federal assistance that reduces their costsharing requirements. To receive cost-sharing reductions (CSRs), individuals must meet income
and other eligibility criteria. There are two types of CSRs, and both types provide larger subsidies
to individuals with lower incomes. UC generally counts toward the calculation of income, so
receipt of UC affects the amount of income used to determine eligibility for and the amount of
CSRs. 19
Relevant Legislation
ACA, Section 1402, established and specified the two types of CSRs and
specified the eligibility criteria for receiving the CSRs.
ARPA, Section 2305, expanded eligibility for and the amount of CSRs for
eligible individuals who receive UC during CY2021. It temporarily deemed
individuals who receive UC for any week in CY2021 to have met the CSR
income eligibility criteria for plan year 2021. It also temporarily disregarded any
household income above 133% FPL for purposes of determining the level of
CSRs.
Current Status
The CSR rules applicable to individuals who receive UC will expire after December 31, 2021.
19 For additional background about the cost -sharing reductions, see CRS Report R44425, Health Insurance Premium
Tax Credit and Cost-Sharing Reductions.
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Temporary Special Rules for Health and Dependent Care Flexible Spending
Arrangements (§214 of Division EE of the Consolidated Appropriations Act,
2021)
Background
Health flexible spending arrangements (FSAs) are employer-established benefits that reimburse
employees for certain medical expenses. 20 Employers generally offer health FSAs through a
cafeteria plan, which allows employees to reduce their taxable salaries and instead put such
money, pretax, toward a qualified benefit. Participation in a health FSA is tied to a set period of
time (plan year), which generally lasts 12 months and does not need to follow the calendar year.
Plan years are associated with the year in which the plan starts (e.g., a health FSA with a plan
year that begins in July 2021 follows 2021 health FSA rules).
When FSAs are funded through a cafeteria plan, employees elect an annual amount to contribute
to their FSAs prior to the start of a plan year; that amount generally cannot be changed during the
plan year, except in limited circumstances (e.g., change in family status). Over the course of the
plan year, the employee contributes amounts to the FSA that sum to the elected amount. The
maximum amount an employee can contribute to a health FSA is $2,750 in 2021. Employers also
may provide limited contributions.
The total health FSA election amount must be made available to employees at the start of the plan
year, even though the contributions typically are spread throughout the year. For example, an
employee who elects to contribute $2,400 to his or her health FSA for a given plan year ($200 a
month) would be able to access all $2,400 on the first day of the plan year, even if he or she has
contributed only $200.
When offered as a cafeteria plan benefit, health FSAs generally are subject to cafeteria plan rules.
One such rule is a use-or-lose rule that prevents any cafeteria plan benefit from providing
deferred compensation. As such, health FSA plans have only a limited ability to permit unused
health FSA balances to be used after the end of the plan year. In general, employers must
incorporate one of three mutually exclusive policies for the treatment of an employee’s unused
health FSA balances at plan year’s end:
1. Employees forfeit unused balances, which then revert to the employer.
2. Employees are given a “grace period” of up to 2½ months after the end of the
plan year. Employees can be reimbursed for expenses incurred during this
additional time. At the end of the grace period, unused amounts are forfeited and
revert to the employer. For example, medical expenses incurred by March 15,
2021, could be reimbursed from FSA contributions for a January-December 2020
plan year.
3. Employees may carry over a limited amount of unused health FSA funds into the
next FSA plan year (up to $550 in 2020 contributions).
To the extent that an individual has a health FSA balance after the end of the grace period or has a
balance that exceeds the allowable carryover amount (where applicable), such amounts are
forfeited to the employer.
20 Flexible spending arrangements (FSAs) also may be offered for dependent -care expenses. Given this product’s focus
on health care-related expiring provisions, this report covers only health FSA expiring provisions.
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Because health FSAs generally are available only to current employees of employers offering
such benefit, a terminated employee may forfeit his or her FSA balance. In some instances,
individuals may be able to retain access to their health FSAs through COBRA continuation
coverage. If an employee is terminated mid-plan year having withdrawn more money from an
FSA than he or she contributed, the employee generally cannot be charged for the negative
balance.
Relevant Legislation
Consolidated Appropriations Act, 2021, Division EE, Section 214, established
temporary health FSA rules. Specifically, employers who offer health FSAs are
allowed to provide the following flexibilities:
Allow employees to carry over unused health FSA balances from FSAs that
end in 2020 or 2021.
Extend grace periods from 2½ months to 12 months for health FSAs that end
in 2020 or 2021.
Allow individuals who stop participating in an FSA (e.g., as a result of
termination) in CY2020 or CY2021 to continue to access unused balances
through the end of the applicable FSA plan year.
Allow employees to prospectively modify their contribution amounts in the
middle of a plan year that ends in 2021.
Current Status
Individuals who stop participating in a health FSA after December 31, 2021, will not be able to
access unused balances through the end of the applicable health FSA plan year. 21 All other
temporary FSA flexibilities will not apply to health FSAs that end after December 31, 2021.
CY2019 and CY2020 Expired Provisions
Other Health Care-Related Provisions
Pregnancy Assistance Fund (42 U.S.C. §18201-42 U.S.C. §18204)
Background
The Pregnancy Assistance Fund (PAF) program focused on meeting the educational, social
service, and health needs of vulnerable expectant and parenting individuals and their families
during pregnancy and the postnatal period. The program identified eligible populations as
expectant and parenting teens; college students; and women of any age who experience domestic
violence, sexual violence, sexual assault, or stalking. HHS administered the PAF program, and
funding was awarded competitively to the 50 states, DC, U.S. territories, and tribal entities
(hereinafter, state grantees) that applied successfully. Grantees could use funds (1) to establish,
operate, or maintain pregnancy or parenting services at institutions of higher education, high
21
For employers that provide this flexibility, employees who stopped participating in a health FSA in CY2021 may
continue to receive reimbursements that applied when the employee stopped participating in the health FSA through the
end of the plan year. T his extended period may extend beyond CY2021 if the FSA has a non -calendar plan year that
spans parts of 2021 and 2022.
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schools, or community service providers; (2) to provide, in partnership with the state attorney
general’s office, certain legal and supportive services for women who experience domestic
violence, sexual violence, sexual assault, or stalking while they are pregnant or parenting an
infant; and (3) to support, either directly or through a sub-grantee, public awareness about PAF
services for the expectant and parenting population that is eligible for the program.
Relevant Legislation
ACA, Section 10212, established the PAF and provided $25 million annually
from FY2010 through FY2019.
Current Status
Funding for the PAF authorized under the ACA expired after September 30, 2019.
SSA Title XVIII: Medicare
Home Health Prospective Payment System Rural Add-On for High-Utilization
Counties (SSA §1895; 42 U.S.C. §1395fff note)
Background
HH agencies receive increased payments under the HH PPS for Medicare HH care episodes
furnished to beneficiaries in rural areas. Before BBA 2018, when provided by legislation, the
HH rural add-on was a fixed percentage increase to the HH PPS that was applied uniformly
to Medicare HH care episodes provided in rural counties.
Under BBA 2018, the add-on was applied unvaryingly for the first year in which the legislation
extended the increased payment, providing a 3% rural add-on payment to Medicare HH episodes
furnished in any rural county that began in CY2018. After CY2018, BBA 2018 provided HH
agencies a 3%, 2%, and 1% HH PPS add-on payment for services furnished in rural counties
beginning during CY2019, CY2020, and CY2021, respectively, unless the Medicare HH services
were (or are) furnished in a rural county with one of the two below-described designations, in
which case alternative add-on payments were (or are) provided:
For HH episodes furnished to beneficiaries who reside in low-populationdensity counties, defined as rural counties with a population density of six or
fewer individuals per square mile, BBA 2019 provided 4%, 3%, 2%, and 1% HH
PPS add-on payments for services beginning during CY2019, CY2020, CY2021,
and CY2022, respectively.
For HH episodes provided to beneficiaries who reside in high-utilization
counties, defined as rural counties in the top quartile of all counties rendering HH
services (by the number of HH episodes furnished per 100 Medicare eligibles),
BBA 2018 provided 1.5% and 0.5% HH PPS add-on payments for HH episodes
beginning in CY2019 and CY2020, respectively. BBA 2018 provided no add-on
payment for episodes furnished in high utilization counties that begin in CY2021
or CY2022.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Under BBA 2018, rural counties were to be categorized only once and such determination was to
apply to payment for HH episodes through CY2022. 22
Relevant Legislation
BIPA 2000, Section 508, established a 10% add-on to Medicare’s HH PPS rates
for HH episodes provided to beneficiaries in rural areas beginning April 1, 2001,
through March 31, 2003.
MMA, Section 421, provided a 5% add-on for services beginning April 1, 2004,
through March 31, 2005.
DRA, Section 5201, provided a 5% add-on for services beginning January 1,
2006, through December 31, 2006.
ACA, Section 3131, provided a 3% add-on for services beginning April 1, 2010,
through December 31, 2015.
MACRA, Section 210, provided a 3% add-on for services beginning January 1,
2016, through December 31, 2017.
BBA 2018, Section 50208, provided a 3% add-on for services beginning in
CY2018. BBA 2018 provided a 3%, 2%, and 1% add-on for services beginning
in CY2019, CY2020, and CY2021, respectively, unless the services were
provided in a low-population-density or high-utilization rural county. For
services provided in low-population-density counties, BBA 2018 provided a 4%,
3%, 2%, and 1% add-on for services beginning in CY2019, CY2020, CY2021,
and CY2022, respectively. For services furnished in high-utilization counties, it
provided a 1.5% and 0.5% add-on for services beginning in CY2019 and
CY2020, respectively.
Current Status
After December 31, 2020, HH agencies no longer received add-on payments for services
provided in rural counties designated as high-utilization counties.
Medicare Access and CHIP Reauthorization Act of 2015 Technical Assistance to
Small Practices and Practices in Health Professional Shortage Areas (SSA
§1848(q)(11); 42 U.S.C. §1395w-4(q)(11))
Current Law
MACRA made several fundamental changes to how Medicare pays for physician and practitioner
services by (1) changing the methodology for determining the annual updates to the conversion
factor; (2) establishing new methods for paying for professional services under Medicare Part B,
including a merit-based incentive payment system (MIPS) to consolidate and replace several
existing incentive programs and to apply value and quality adjustments to the MPFS; and (3)
establishing the development of, and participation in, alternative payment models (APMs). 23
22 Rural-add-on-payment designations by county can be found at CMS, “ Home Health Agency (HHA) Center,”
https://www.cms.gov/Center/Provider-T ype/Home-Health-Agency-HHA-Center.
23 For more information on Section 101 of T he Medicare Access and CHIP Reauthorization Act of 2015 (MACRA;
P.L. 114-10), see CRS Report R43962, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L.
114-10).
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
To provide technical assistance to small practices and practices in health professional shortage
areas, MACRA required the HHS Secretary to enter into contracts or agreements with appropriate
entities (such as quality-improvement organizations, regional extension centers, or regional health
collaboratives) to offer guidance and assistance to MIPS-eligible professionals in practices of 15
or fewer professionals. MACRA required that, under the technical assistance program, priority be
given to professionals in rural areas, health professional shortage areas, or practices with low
composite scores under the new payment system. The guidance and assistance were to be
provided with respect to the MIPS performance categories or with respect to how to transition to
the implementation of and participation in an APM.
For purposes of implementing the technical assistance program, $20 million from the Federal
Supplementary Medical Insurance (SMI) Trust Fund was made available to CMS for each of
FY2016-FY2020. These amounts were to be available until expended.
Relevant Legislation
MACRA, Section 101, provided for the transfer of $20 million from the
Medicare SMI Trust Fund for each of FY2016 through FY2020.
Current Status
No funds to support the technical assistance program have been authorized beyond FY2020.
Funding for Implementation of Section 101 of the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA Section 101(c)(3))
Background
Section 101 of MACRA made fundamental changes to the way Medicare payments to physicians
are determined and updated. 24 To implement the payment modifications in Section 101 of
MACRA, the law authorized the transfer of $80 million from the SMI Trust Fund for each fiscal
year beginning with FY2015 and ending with FY2019. The amounts transferred were to be
available until expended.
Relevant Legislation
MACRA, Section 101, provided for the transfer of $80 million from the
Medicare SMI Trust Fund for each of FY2015 through FY2019.
Current Status
Appropriated funds to support the activities under this subsection were not enacted for FY2020 or
subsequent fiscal years.
24 For more information on §101 of MACRA, see CRS Report R43962, The Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA; P.L. 114 -10).
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Priorities and Funding for Measure Development (SSA §1848(s);
42 U.S.C. §1395w-4(s))
Background
Social Security Act (SSA) Section 1848(s) required the HHS Secretary to develop a plan, to be
updated as needed, for the development of quality measures for use in the MIPS program. The
subsection also required the Secretary to enter into contracts or other arrangements to develop,
improve, update, or expand quality measures, in accordance with the plan. In entering into
contracts, the Secretary was to prioritize developing measures of outcomes, patient experience of
care, and care coordination, among other things. The HHS Secretary, through CMS, annually
reports on the progress made in developing quality measures under this subsection.
Relevant Legislation
MACRA, Section 102, provided for the transfer of $15 million from the
Medicare SMI Trust Fund for each of FY2015 through FY2019.
Current Status
Appropriated funds to support the activities under this subsection have not been enacted for
FY2020 or subsequent fiscal years. However, funds appropriated prior to FY2020 are available
for obligation through the end of FY2022.
Temporary Extension of Long-Term Care Hospital Site-Neutral Payment Policy
Transition Period (SSA §1886(m)(6)(B)(i); 42 U.S.C. §1395ww(m)(6)(B)(i))
Background
Medicare pays long-term care hospitals (LTCHs) for certain inpatient hospital care under the
LTCH prospective payment system (LTCH PPS); payments under the LTCH PPS typically are
higher than payments for inpatient hospital care under the inpatient prospective payment system
(IPPS). The Pathway for SGR (Sustainable Growth Rate) Reform Act of 2013 (PSRA; P.L. 11367) amended the law so that the LTCH PPS payment is no longer available for all LTCH
discharges but instead is available only for those LTCH discharges that meet specific clinical
criteria. Specifically, LTCHs are paid under the LTCH PPS if a Medicare beneficiary either (1)
had a prior three-day intensive-care-unit stay at a hospital paid under the IPPS immediately
preceding the LTCH stay or (2) is assigned to an LTCH PPS case-mix group that is based on the
receipt of ventilator services for at least 96 hours and had a prior hospital stay at a hospital paid
under the IPPS immediately preceding the LTCH stay. Discharges involving patients who have a
principal diagnosis relating to a psychiatric diagnosis or rehabilitation do not qualify for the
LTCH PPS rate. Subsequent legislation provided for other criteria to temporarily receive payment
under the LTCH PPS (see section “Temporary Exception for Certain Spinal Cord Conditions from
Application of the Medicare LTCH Site-Neutral Payment for Certain LTCHs
(SSA §1886(m)(6)(F); 42 U.S.C. §1395ww(m)(6)(F))”).
The PSRA specified that, for LTCH discharges that did not qualify for the LTCH PPS based on
these clinical criteria, a site-neutral payment rate similar to the PPS for IPPS was to be phased-in.
The site-neutral rate was defined as the lower of an “IPPS-comparable” per diem amount, as
defined in regulations, or the estimated cost of the services involved.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Relevant Legislation
PSRA, Section 1206(a), established patient criteria for payment under the LTCH
PPS and a site-neutral payment rate for LTCH patients who do not meet these
criteria. During a phase-in period for discharges in cost-reporting periods
beginning in FY2016 and FY2017, LTCHs received a blended payment amount
based on 50% of what the LTCH would have been reimbursed under the LTCH
PPS rate and 50% of the site-neutral payment rate. For cost-reporting periods
beginning in FY2018 and subsequent years, the LTCH was to receive the siteneutral payment rate.
BBA 2018, Section 51005, extended the transition period to site-neutral
Medicare payments for LTCH patients who do not meet the patient criteria for an
additional two years, to include discharges in cost-reporting periods beginning in
FY2018 and FY2019. During this period, LTCHs continued to receive the 50/50
blended payment for discharges that did not meet certain LTCH PPS criteria.
Current Status
The extended transition period to site-neutral payments, during which LTCHs received a blended
payment for discharges that did not meet the patient criteria, expired for discharges occurring in
cost-reporting periods beginning in FY2020 and subsequent years.
Temporary Exception for Certain Spinal Cord Conditions from Application of
the Medicare LTCH Site-Neutral Payment for Certain LTCHs
(SSA §1886(m)(6)(F); 42 U.S.C. §1395ww(m)(6)(F))
Background
Medicare pays LTCHs for inpatient hospital care under the LTCH PPS, and payments under the
LTCH PPS typically are higher than payments for inpatient hospital care under the IPPS.
Effective for cost-reporting periods beginning in FY2016, LTCHs are paid the LTCH PPS rate for
patients that meet one of the following two criteria: the patient (1) had a prior three-day intensivecare-unit stay at a hospital paid under the IPPS immediately preceding the LTCH stay or (2) is
assigned to an LTCH PPS case-mix group that is based on the receipt of ventilator services for at
least 96 hours and had a prior hospital stay at a hospital paid under the IPPS immediately
preceding the LTCH stay. Discharges involving patients who have a principal diagnosis relating
to a psychiatric diagnosis or rehabilitation do not qualify for the LTCH PPS rate. For LTCH
discharges that did not qualify for the LTCH PPS based on these criteria, a site-neutral payment
rate was phased in for cost-reporting periods beginning in FY2016-FY2019. Subsequent
legislation provided for other criteria to temporarily receive payment under the LTCH PPS. (See
section “Temporary Extension of Long-Term Care Hospital Site-Neutral Payment Policy
Transition Period (SSA §1886(m)(6)(B)(i); 42 U.S.C. §1395ww(m)(6)(B)(i))” for details related
to site-neutral payment.)
Relevant Legislation
Cures Act, Division C, Section 15009, established an additional temporary
criterion for payment under the LTCH PPS related to certain spinal cord
conditions for discharges occurring in cost-reporting periods FY2018 and
FY2019. Specifically, the LTCH PPS rate would apply to an LTCH discharge if
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
all of the following conditions were met: (1) the LTCH was a not-for-profit on
June 1, 2014; (2) at least 50% of the LTCH’s CY2013 LTCH PPS-paid
discharges were classified under LTCH diagnosis-related groups associated with
catastrophic spinal cord injuries, acquired brain injury, or other paralyzing
neuromuscular conditions; and (3) the LTCH during FY2014 discharged patients
(including Medicare beneficiaries and others) who had been admitted from at
least 20 of the 50 states, as determined by the HHS Secretary based on a patient’s
state of residency.
Current Status
The authority for the temporary criterion related to certain spinal cord conditions to receive
payment under the LTCH PPS expired for discharges occurring in cost reporting periods
beginning in FY2020 and subsequent years.
Transitional Payment Rules for Certain Radiation Therapy Services
(SSA §1848(b)(11); 42 U.S.C. §1395w-4(b)(11))
Background
Currently, Medicare payments for services of physicians and certain nonphysician practitioners,
including radiation therapy services, are made on the basis of the MPFS.
To set payment rates under the MPFS, relative values units (RVUs) are assigned to each of more
than 7,000 service codes that reflect physician work (i.e., the time, skill, and intensity it takes to
provide the service), practice expenses, and malpractice costs. The relative value for a service
compares the relative work and other inputs involved in performing one service with the inputs
involved in providing other physicians’ services. The relative values are adjusted for geographic
variation in input costs. The adjusted relative values are then converted into a dollar payment
amount by a conversion factor.
CMS, which is responsible for maintaining and updating the MPFS, continually modifies and
refines the methodology for estimating RVUs. CMS is required to review RVUs no less than
every five years; the ACA added the requirement that the HHS Secretary periodically identify
physician services as being potentially misvalued and make appropriate adjustments to the
relative values of such services under the MPFS.
In determining adjustments to RVUs used as the basis for calculating Medicare physician
reimbursement under the MPFS, the HHS Secretary has authority, under previously existing law
and as augmented by the ACA, to adjust the number of RVUs for any service code to take into
account changes in medical practice, coding changes, new data on relative value components, or
the addition of new procedures.
Through the Innovation Center, CMS has announced a radiation oncology (RO) alternative
payment model (APM) that aims to improve the quality of care for cancer patients receiving
radiotherapy while moving toward an episode-based rather than fee-for-service payment system.
Under the potentially misvalued codes authority, in 2015, the HHS Secretary identified certain
radiation therapy codes as being potentially misvalued. However, because of concerns that the
existing code set did not accurately reflect the radiation therapy treatments identified, CMS
created several new codes during the transition to an episodic APM.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Relevant Legislation
PAMPA, Section 3, required CMS to apply the same code definitions, work
RVUs, and direct inputs for the practice expense RVUs in CY2017 and CY2018
as applied in CY2016 for these transition codes, effectively keeping the payments
for these services unchanged, subject to the annual update factor. PAMPA
exempted these radiation therapy and related imaging services from being
considered as potentially misvalued services under CMS’s misvalued codes
initiative for CY2017 and CY2018. PAMPA also instructed the HHS Secretary to
report to Congress on the development of an episodic APM under the Medicare
program for radiation therapy services furnished in non-facility settings.
BBA 2018, Section 51009, extended the restrictions through CY2019.
Consolidated Appropriations Act, 2021, Division CC, Title 1, Section 133,
delayed the start date for the RO model until no earlier than January 1, 2022.
Current Status
The payment restrictions expired after December 31, 2019.
SSA Title XXI: State Children’s Health Insurance Program
Increase to Enhanced Federal Medical Assistance Percentage (SSA §2105(b);
42 U.S.C. §1397ee(b))
Background
The federal government’s share of CHIP expenditures (including services and administration) is
determined by the enhanced federal medical assistance percentage (E-FMAP) rate. The E-FMAP
rate is based on the FMAP rate, which is the federal matching rate for the Medicaid program. The
FMAP formula compares each state’s average per capita income with average U.S. per capita
income. FMAP rates have a statutory minimum of 50% and a statutory maximum of 83%.
The E-FMAP rate is calculated by reducing the state share under the regular FMAP rate by 30%.
Statutorily, the E-FMAP (or federal matching rate) can range from 65% to 85%. For some CHIP
expenditures, the federal matching rate is different from the E-FMAP rate. For instance, the
matching rate for translation and interpretation services is the higher of 75% or states ’ E-FMAP
rate plus 5 percentage points.
Relevant Legislation
ACA, Section 2101, included a provision to increase the E-FMAP rate by 23
percentage points (not to exceed 100%) for most CHIP expenditures from
FY2016 through FY2019.
Making Further Continuing Appropriations for the Fiscal Year Ending
September 30, 2018, and for Other Purposes (P.L. 115-120), Section 3005,
extended the increase to the E-FMAP rate for one year, through FY2020.
However, for FY2020, the increase to the E-FMAP was 11.5 percentage points
instead of 23 percentage points.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Current Status
The increase to the E-FMAP expired after September 30, 2020.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Appendix A. Demonstration Projects and Pilot
Programs
This appendix applies to selected health care-related demonstration projects and pilot programs
with portions of law that are time-limited and will lapse once a statutory deadline is reached,
absent further legislative action. The relevant expiring demonstration projects and pilot programs
are any related to Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP), or
private health insurance programs and activities, or they are health care-related demonstration
projects and pilot programs that were enacted or extended in the Patient Protection and
Affordable Care Act (ACA; P.L. 111-148) or extended under the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA; P.L. 114-10). Table A-1 lists the relevant demonstration
projects and pilot programs that are scheduled to expire during the first session of the 117 th
Congress (i.e., during calendar year [CY] 2021). Table A-2 lists any relevant demonstration
projects and pilot programs that expired in CY2019 or CY2020.
Although the Congressional Research Service (CRS) has attempted to be comprehensive, it
cannot guarantee that every relevant demonstration project and pilot program is included here.
Table A-1. Demonstration Projects and Pilot Programs Set to Expire
in the 117th Congress, First Session
(CY2021)
Expires
After
9/30/2021
Health CareRelated
Program
Medicare
Provision
Independence at Home
Demonstration
CRS Contact
SSA §1866E
42 U.S.C.
§1395cc-5
Jim Hahn
Source: Congressional Research Service.
Notes: CY = Calendar Year; SSA = Social Security Act; U.S.C. = U.S. Code.
Table A-2. Demonstration Projects and Pilot Programs That Expired
in the 116th Congress
(CY2019 and CY2020)
Expired
After
11/30/2020
Health CareRelated
Program
Other
Provision
Demonstration Projects to
Address Health Professions
Workforce Needs
CRS Contact
SSA §2008(c)
42 U.S.C.
§1397g
Elayne Heisler
Source: Congressional Research Service.
Notes: CY = Calendar Year; SSA = Social Security Act; U.S.C. = U.S. Code.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Appendix B. Provisions Included in the Previous
CRS Health Care-Related Expiring Provisions
Report
This appendix provides information on the provisions that were included in the previous
Congressional Research Service (CRS) report on health care-related expiring provisions (CRS
Report R46331, Health Care-Related Expiring Provisions of the 116th Congress, Second
Session), hereinafter referred to as R46331, but were not detailed in this report.
As does this report, R46331 included identified expiring provisions (of the same two types
discussed herein) related to Medicare, Medicaid, the State Children’s Health Insurance Program
(CHIP), or private health insurance programs and activities. R46331 also included other health
care-related provisions that were enacted or extended in the Patient Protection and Affordable
Care Act (ACA; P.L. 111-148) or extended under the Medicare Access and CHIP Reauthorization
Act of 2015 (MACRA; P.L. 114-10). R46331 covered extensions through the Coronavirus Aid,
Relief, and Economic Security Act (CARES Act; P.L. 116-136) and described health care-related
provisions that, at the time of publication, expired during the first session of the 116th Congress
(i.e., during calendar year [CY] 2019).
Some of the provisions detailed in R46331 fell within the scope of this report. Such provisions
expired in CY2019 or CY2020. Table B-1 includes the provisions detailed in R46331 that remain
expired or were extended to dates beyond the first session of the 117th Congress (i.e., after
CY2021). The third column in Table B-1 provides each provision’s expiration date as it was in
R46331. The fourth column reflects updated information, providing the current expiration date
for provisions extended pursuant to congressional modification. For more detailed background
information on the provisions included in Table B-1, see CRS Report R45781, Health CareRelated Expiring Provisions of the 116th Congress, First Session, and R46331.
The demonstration projects or pilot programs that did not expire in the 116th Congress but were
included in R46331 are listed in Table B-2. These demonstration projects or pilot programs are
not scheduled to expire at the end of the session in question, nor did they expire in the previous
Congress.
Table B-1. Provisions Included in the Previous CRS Health Care-Related Expiring
Provisions Report That Were Not Included in This Report
Health
CareRelated
Program
Provision
Expires After Date as of
CRS Report R46331,
Health Care-Related
Expiring Provisions of the
116th Congress, Second
Session
Current
Expiration:
Expires
After
CRS
Contact
Medicaid
Protections for
Recipients of Home
and Community-Based
Services Against Spouse
Impoverishment
SSA §1924
42 U.S.C. 1396r5 note
11/30/2020
9/30/2023
Kirsten
Colello
Medicare
Outreach and
Assistance for LowIncome Programs
MIPPA §119
42 U.S.C.
§1395b-3 note
11/30/2020
9/30/2023
Kirsten
Colello
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Health
CareRelated
Program
Provision
Expires After Date as of
CRS Report R46331,
Health Care-Related
Expiring Provisions of the
116th Congress, Second
Session
Current
Expiration:
Expires
After
CRS
Contact
Medicare
Quality Measure
Selection
SSA §1890A
42 U.S.C. §1395a
aa-1
11/30/2020
9/30/2023
Amanda
Sarata
Medicare
Contract with a
Consensus-Based Entity
Regarding Performance
Measurement
SSA §1890(d)
42 U.S.C. §1395a
aa
11/30/2020
9/30/2023
Amanda
Sarata
Medicare
Floor on Work
Geographic Practice
Cost Indices
SSA §1848(e)(1)
11/30/2020
12/31/2023
Jim Hahn
Other
Sexual Risk Avoidance
Education Program
SSA §510
42 U.S.C. §710
11/30/2020
9/30/2023
Adrienne
FernandesAlcantara
Other
Personal Responsibility
Education Program
SSA §513
42 U.S.C. §713(f)
11/30/2020
9/30/2023
Adrienne
FernandesAlcantara
Other
Community Health
Centers Fund a
ACA §10503
11/30/2020
9/30/2023
Elayne
Heisler
Other
Special Diabetes
Programs for Indians
PHSA §330C
42 U.S.C. §254c3(c)(2)
11/30/2020
9/30/2023
Elayne
Heisler
Other
Special Diabetes
Programs for Type I
Diabetes
PHSA §330B
42 U.S.C. §254c2(b)(2)
11/30/2020
9/30/2023
Elayne
Heisler
Other
National Health Service
Corps Appropriationsb
ACA §10503
11/30/2020
9/30/2023
Elayne
Heisler
Teaching Health
Centersc
PHSA §340H
42 U.S.C. §254b2(H)
11/30/2020
9/30/2023
Elayne
Heisler
Other
42 U.S.C.
§1395w4(e)(1)(E)
42 U.S.C. §254b2(b)(1)(F)
42 U.S.C. §254q
Source: Congressional Research Service.
Notes: ACA = Patient Protection and Affordable Care Act (P.L. 111-148); MIPPA = Medicare Improvements for
Patients and Providers Act of 2008(P.L. 110-275); PHSA = Public Health Service Act; SSA = Social Security Act;
U.S.C. = U.S. Code.
a.
Community Health Centers Fund provides funding for the Health Center Program, which is authorized in
PHSA §330 (42 U.S.C. §254b). Health centers funded by the Community Health Center Fund received
additional appropriations under the American Rescue Plan Act of 2021 (ARPA; P.L. 117-2).
b.
The Community Health Center Fund provides funding for the National Health Service Corps program,
which is authorized in PHSA §§ 331-338N (42 U.S.C. §§254d-254). This program received additional
appropriations under ARPA.
c.
This program received additional appropriations under ARPA.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Table B-2. Demonstration Projects and Pilot Programs Included in the
Previous CRS Health Care-Related Expiring Provisions Report That Were Not
Included in This Report
Health CareRelated
Program
Provision
Expiration Date as
of CRS Report
R46331, Health
Care-Related
Expiring Provisions of
the 116th Congress,
Second Session
Current
Expires
After Date
CRS Contact
Medicaid/Other
Demonstration
Program to Improve
Community
Behavioral Health
Clinicsa
PAMA §223(f)
42 U.S.C.
§1396a
11/30/2020
9/30/2023
Alison Mitchell
Medicaid
Money Follows the
Person Rebalancing
Demonstration b
DRA §6071
42 U.S.C.
§1396a note
11/30/2020
9/30/2023
Kirsten Colello
Medicare
Medicare IVIG
Access
Demonstration c
SSA §1833
42 U.S.C. §1395l
12/31/2020
12/31/2023
Cliff Binder
Source: Congressional Research Service.
Notes: DRA = Deficit Reduction Act of 2005 (P.L. 109-171); IVIG = Intravenous Immune Globulin; PAMA =
Protecting Access to Medicare Act of 2014 (P.L. 113-93); SSA = Social Security Act; U.S.C. = U.S. Code.
a.
PAMA established the Demonstration Program to Improve Community Mental Health Services for eight
states to implement Certified Community Behavioral Health Clinics (CCBHCs). The Coronavirus Aid,
Relief, and Economic Security Act (P.L. 116-136) added two states to the demonstration program.
b.
Extended and amended most recently by the Consolidated Appropriations Act, 2021 (P.L. 116-260). The
provision made changes to the institutional residency requirement by reducing the minimum stay for
participant eligibility from 90 days to 60 days and allowed for days admitted for short-term rehabilitation to
count toward the minimum stay. It made certain changes to state application requirements and provided
additional funding for technical assistance, oversight, and quality assurance and improvement systems. It
further required reports from the Secretary of the Department of Health and Human Services on best
practices and from the Medicaid and CHIP Payment and Access Commission on qualified home and
community-based settings criteria. States that do not currently participate in the Money Follows the Person
demonstration may be eligible to apply for grant funding. For more information, see Medicaid.gov, “Money
Follows the Person,” at https://www.medicaid.gov/medicaid/ltss/money-follows-the-person/index.html.
c.
Extended, expanded participation, and amended most recently by the Consolidated Appropriations Act,
2021. For more information, see Centers for Medicare and Medicaid Services, “Medicare Intravenous
Immune Globulin (IVIG) Demonstration,” at https://innovation.cms.gov/innovation-models/ivig.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Appendix C. Laws That Created, Modified, or
Extended Current Health Care-Related
Expiring Provisions
Table C-1. Laws That Created, Modified, or Extended Current Health Care-Related
Expiring Provisions
P.L.
Number
Abbreviation
Act Title
P.L. 97-248
TEFRA
Tax Equity and Fiscal Responsibility Act of 1982
P.L. 101-239
—
Omnibus Budget Reconciliation Act of 1989
P.L. 101-508
OBRA 90
Omnibus Budget Reconciliation Act of 1990
P.L. 104-191
HIPPA
Health Insurance Portability and Protection Act of 1996
P.L. 104-193
PRWORA
Personal Responsibility and Work Opportunity Reconciliation Act of 1996
P.L. 105-33
BBA 97
Balanced Budget Act of 1997
P.L. 106-113
BBRA 99
Balanced Budget Refinement Act of 1999
P.L. 106-554
BIPA 2000
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
P.L. 107-210
—
Trade Act of 2002
P.L. 107-360
—
An Act to Amend the Public Health Service Act with Respect to Special Diabetes
Programs for Type 1 Diabetes and Indians
P.L. 108-40
WREA 2003
Welfare Reform Extension Act of 2003
P.L. 108-74
—
State Children’s Health Insurance Program Allotments Extension Act
P.L. 108-89
—
An Act to Extend the Temporary Assistance for Needy Families Block Grant Program,
and Certain Tax and Trade Programs, and For Other Purposes
P.L. 108-173
MMA
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 a
P.L. 108-210
WREA 2004
Welfare Reform Extension Act of 2004
P.L. 108-262
—
TANF and Related Programs Continuation Act of 2004
P.L. 108-308
—
Welfare Reform Extension Act, Part VIII
P.L. 109-4
WREA 2005
Welfare Reform Extension Act of 2005
P.L. 109-19
—
TANF Extension Act of 2005
P.L. 109-91
—
QI, TMA, and Abstinence Programs Extension and Hurricane Katrina Unemployment
Relief Act of 2005
P.L. 109-171
DRA
Deficit Reduction Act of 2005
P.L. 109-432
TRHCA
Tax Relief and Health Care Act of 2006
P.L. 109-482
—
National Institutes of Health Reform Act of 2006
P.L. 110-48
—
An Act to Provide for the Extension of Transitional Medical Assistance, and Other
Provisions
P.L. 110-90
—
TMA, Abstinence Education, and QI Programs Extension Act of 2007
P.L. 110-92
—
Making Continuing Appropriations for the Fiscal Year 2008, and for Other Purposes
P.L. 110-116
—
Department of Defense Appropriations Act of 2008
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
P.L.
Number
Abbreviation
Act Title
P.L. 110-137
—
Making Further Continuing Appropriations for the Fiscal Year 2008, and for Other
Purposes
P.L. 110-149
—
Making Further Continuing Appropriations for the Fiscal Year 2008, and for Other
Purposes
P.L. 110-173
MMSEA
Medicare, Medicaid, and SCHIP Extension Act of 2007 b
P.L. 110-275
MIPPA
Medicare Improvements for Patients and Providers Act of 2008 c
P.L. 111-3
CHIPRA
Children’s Health Insurance Program Reauthorization Act of 2009 d
P.L. 111-5
ARRA
American Recovery and Reinvestment Act of 2009 e
P.L. 111-148
ACA
Patient Protection and Affordable Care Act of 2010 f
P.L. 111-152
HCERA
Health Care and Education Reconciliation Act of 2010 g
P.L. 111-309
MMEA
Medicare and Medicaid Extenders Act of 2010
P.L. 112-40
—
Trade Adjustment Assistance Extension Act of 2011
P.L. 112-78
TPTCCA
Temporary Payroll Tax Cut Continuation Act of 2011
P.L. 112-96
MCTRJCA
Middle Class Tax Relief and Job Creation Act of 2012
P.L. 112-240
ATRA
American Taxpayer Relief Act of 2012 h
P.L. 113-67
BBA 13/ PSRA
Continuing Appropriations Resolution of 2014, which includes Division A, the
Bipartisan Budget Act of 2013, and Division B, the Pathway for SGR Reform Act of
2013
P.L. 113-93
PAMA
Protecting Access to Medicare Act of 2014
P.L. 113-198
—
An Act to Provide for the Extension of the Enforcement Instruction on Supervision
Requirements for Outpatient Therapeutic Services in Critical Access and Small Rural
Hospitals Through 2014
P.L. 114-10
MACRA
Medicare Access and CHIP Reauthorization Act of 2015 i
P.L. 114-27
—
Trade Preferences Extension Act of 2015
P.L. 114-112
—
An Act to Provide for the Extension of the Enforcement Instruction on Supervision
Requirements for Outpatient Therapeutic Services in Critical Access and Small Rural
Hospitals Through 2015
P.L. 114-113
—
Consolidated Appropriations Act of 2016
P.L. 114-115
PAMPA
Patient Access and Medicare Protection Act
P.L. 114-255
Cures Act
The 21 st Century Cures Act j
P.L. 115-31
—
Consolidated Appropriations Act, 2017
P.L. 115-63
—
Disaster Tax Relief and Airport and Airway Extension Act of 2017
P.L. 115-96
—
An Act to amend the Homeland Security Act of 2002 to require the Secretary of
Homeland Security to issue Department of Homeland Security-wide guidance and
develop training programs as part of the Department of Homeland Security Blue
Campaign, and for other purposes
P.L. 115-120
—
Making Further Continuing Appropriations for the Fiscal Year Ending September 30,
2018, and for Other Purposes
P.L. 115-123
BBA 2018
Bipartisan Budget Act of 2018 k
P.L. 116-3
—
Medicaid Extenders Act of 2019
P.L. 116-16
—
Medicaid Services Investment and Accountability Act of 2019
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
P.L.
Number
Abbreviation
Act Title
P.L. 116-20
—
Additional Supplemental Appropriations for Disaster Relief Act, 2019
P.L. 116-39
—
The Sustaining Excellence in Medicaid Act of 2019
P.L. 116-59
—
Continuing Appropriations Act, 2020, and Health Extenders Act of 2019
P.L. 116-69
—
Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of
2019
P.L. 116-94
—
Further Consolidated Appropriations Act, 2020
P.L. 116-127
FFCRA
Families First Coronavirus Response Act l
P.L. 116-136
CARES Act
Coronavirus Aid, Relief, and Economic Security Act m
P.L. 116-159
—
Continuing Appropriations Act, 2021 and Other Extensions Act
P.L. 116-215
—
Further Continuing Appropriations Act, 2021, and Other Extensions Act
P.L. 116-260
—
Consolidated Appropriations Act, 2021
P.L. 117-2
ARPA
American Rescue Plan Act of 2021 n
P.L. 117-7
—
To prevent across-the-board direct spending cuts, and for other purposes
Source: Congressional Research Service (CRS).
Notes:
a.
See CRS Report RL31966, Overview of the Medicare Prescription Drug, Improvement, and Modernization Act of
2003, and CRS Report RL32005, Medicare Fee-for-Service Modifications and Medicaid Provisions of H.R. 1 as
Enacted.
b.
See CRS Report RL34360, P.L. 110-173: Provisions in the Medicare, Medicaid, and SCHIP Extension Act of 2007.
c.
See CRS Report RL34592, P.L. 110-275: The Medicare Improvements for Patients and Providers Act of 2008.
d.
See CRS Report R40226, P.L. 111-3: The Children’s Health Insurance Program Reauthorization Act of 2009.
e.
The Health Information Technology for Economic and Clinical Health Act was incorporated into ARRA. A
description of the Medicare provisions in that bill can be found in CRS Report R40161, The Health
Information Technology for Economic and Clinical Health (HITECH) Act.
See CRS Report R41196, Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary
and Timeline, and CRS Report R41210, Medicaid and the State Children’s Health Insurance Program (CHIP)
Provisions in ACA: Summary and Timeline.
f.
g.
See CRS Report R41124, Medicare: Changes Made by the Reconciliation Act of 2010 to the Patient Protection and
Affordable Care Act (P.L. 111-148).
h.
See CRS Report R42944, Medicare, Medicaid, and Other Health Provisions in the American Taxpayer Relief Act of
2012.
i.
See CRS Report R43962, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10).
j.
See CRS Report R44720, The 21st Century Cures Act (Division A of P.L. 114-255), and CRS Report R44730,
Increasing Choice, Access, and Quality in Health Care for Americans Act (Division C of P.L. 114-255).
k.
l.
See CRS Report R45126, Bipartisan Budget Act of 2018 (P.L. 115-123): Brief Summary of Division E—The
Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, and CRS Report R45136, Bipartisan Budget
Act of 2018 (P.L. 115-123): CHIP, Public Health, Home Visiting, and Medicaid Provisions in Division E.
See CRS Report R46316, Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116-127.
m.
See CRS Report R46334, Selected Health Provisions in Title III of the CARES Act (P.L. 116-136).
n.
See CRS Report R46777, American Rescue Plan Act of 2021 (P.L. 117-2): Private Health Insurance, Medicaid,
CHIP, and Medicare Provisions.
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Health Care-Related Expiring Provisions of the 117th Congress, First Session
Author Information
Julia A. Keyser, Coordinator
Analyst in Health Care Financing
Jim Hahn
Specialist in Health Care Financing
Phoenix Voorhies, Coordinator
Analyst in Health Care Financing
Alison Mitchell
Specialist in Health Care Financing
Cliff Binder
Analyst in Health Care Financing
Paulette C. Morgan
Specialist in Health Care Financing
Kirsten J. Colello
Specialist in Health and Aging Policy
Ryan J. Rosso
Analyst in Health Care Financing
Patricia A. Davis
Specialist in Health Care Financing
Amanda K. Sarata
Specialist in Health Policy
Adrienne L. Fernandes-Alcantara
Specialist in Social Policy
Marco A. Villagrana
Analyst in Health Care Financing
Bernadette Fernandez
Specialist in Health Care Financing
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
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copy or otherwise use copyrighted material.
Congressional Research Service
R46818 · VERSION 1 · NEW
34
This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.