The Affordable Care Act offers a Rescue Plan for Outpatient and Ambulatory Settings

To continue the shift from inpatient surgery to outpatient surgery under the Biden Administration’s American Rescue Plan Act of 2021, ambulatory surgery centers (ASCs) may benefit from the Act. COVID-19’s effect on hospitals expedited a trend toward the outpatient setting that had already begun before the pandemic, presumably resulting in a significant rise in ASC investments.

American Rescue Plan Act of 2021

Federal Funding Methodology for 2019 and 2020. The agency issued its program approach for the year 2021 on August 13, 2020.

Included Three measures affecting state operations and federal contributions for a Basic Health Program in the American Rescue Plan Act of 2021, signed into law by President Biden on March 11, 2021.

BHP’s payment methodology for 2020 and 2021 will be affected by these rules, which will result in an upgrade to the values of some components.

According to a report from the Treasury Department in September, in the first six months after Biden signed the law, $700 billion of the $1 trillion in American Rescue Plan relief monies were disbursed. In addition, more than 170 million economic impact payments totaling more than $400 billion, more than 106 million Child Tax Credit (CTC) payments totaling more than $46 billion, and more than 1 million households needing Emergency Rental Assistance totaling more than $5 billion are included in the $450 billion paid directly to families and homes.

To prevent the pandemic and speed up the economic recovery, nearly $240 billion has been allocated to state, territorial, local, and tribal governments.

Nearly $1 billion in American Rescue Plan cash was awarded by the U.S. Department of Health and Human Services to finance significant healthcare building and renovation projects at hospitals.

According to the Kaiser Family Foundation, a $178 billion provider relief fund provided Medicare-enrolled hospitals and ASCs and other providers with grants of at least 2% of their previous annual patient revenue. These funds could cover Pandemic-related losses and unreimbursed expenses.

American Rescue Plan Act reduced ACA and the prices of ASCs

In an issue brief, the United Hospital Fund reported that the American Rescue Plan Act (ARPA) significantly reduced costs for outpatients in ASCs.

As stated by United Hospital Fund, it allows people and families earning more than 400% of the federal poverty level (FPL) to qualify for government subsidies if their county’s benchmark health plan premiums exceed 8.5% of their income. This is the new sliding-scale cap, which is lower than the original income guideline. This amendment applies to the policy years of 2020 and 2022 and expires in 2022. In New York, they compared ARPA premiums to the ACA premiums in the issue brief.

In 2021, persons earning 201 percent of the federal poverty threshold would pay $128 per month in premiums totaling $1,542 per year under the first option. On the other hand, ARPA would charge the same individuals $31 a month in tips, totaling $372 a year. As a result, the ARPA and ACA budgets diverged by 76%.

The percentage difference in savings between ACA rates and ARPA premiums was minor for people with higher incomes.

The ACA’s monthly rates for 400 percent of the federal poverty line were $406, whereas ARPA’s monthly premiums were $349. In comparison to the ACA, the percentage disparity was just 14% smaller under ARPA.

Inhibitors to the growth of ASCs

ASCs appear to have a bright future, but there are significant obstacles that could restrict their expansion. Additionally, various regulatory difficulties pose a threat to the growth of ASC.

As a first step, states have been reluctant to enable ASCs to conduct services traditionally performed in hospitals. The ability of ASCs to develop specific programs, such as cardiovascular programs, is state-specific mainly, as noted in our previously quoted May 11, 2020 post. Specific cardiovascular treatments are not permitted in ASCs in several states. A “hybrid” ASC paradigm, in which an ASC and an office-based laboratory (“OBL”) operate and co-locate, is illegal in some states. The hybrid approach is also permitted in other states, with additional restrictions such as a separate entrance and exit, separate scheduling for ASCs and OBLs, and separate payor contracts for ASC and OBLs. As a result, most states have an application process for an ASC to add/expand services. It takes six months to one year in non-Certificate of Need states and even longer in Certificate of Need (CON) states because the applicant must first get CON board or department of planning approval.

ASCs’ ability and regulatory limitations, such as a maximum 24-hour care requirement, limit the number of inpatient services that can be further transferred from the inpatient environment to the outpatient setting, notwithstanding the CMS waiver and abolition of the IOL of services.

There are also time-limited triggers for ASC expansion. Several COVID waivers and expanded billing rights are only valid for as long as the pandemic continues. Similarly, the Act’s impact on expanded ASC use could confine to the ACA’s two-year expansion in this regard.

Outpatient surgery in the ASC environment expects to continue to grow as healthcare innovation makes it possible to conduct more and more treatments in a non hospital setting safely and cost-effectively. ASC investment will also continue to rise as a result of this trend. However, despite legislative constraints, the capacity of ASCs to deliver a wide range of healthcare operations with equal or better quality than is seen in hospital settings will surely prompt State governments to increase the breadth of services an ASC can give to its patients. Indeed, regulators will take action to sustain the trends by expanding healthcare access to a growing pool of insured individuals.

Inquiring about the effects of COVID-19

As always, the focus of our survey will be on an in-depth evaluation of your ambulatory care business. You should be aware that the return survey activities related to CMS waivers and other extensions will not focus on implementing your emergency operations plan. Instead, we’ll examine your present procedures to ensure that you’re providing safe care and working in a safe workplace after learning how you responded to the coronavirus epidemic.

When it comes to the Centers for Medicare and Medicaid Services (CMS) waivers and ASCs settings, your emergency plan will not be the focus of return survey activity. Instead, we’ll examine your present procedures to ensure that you’re providing safe care and working in a safe workplace after learning how you responded to the coronavirus epidemic.