Congressional Record, Senate, January 20, 2022, Page S375
Summary
A page of the Congressional Record, Senate, dated January 20, 2022, at page S375. A Senator from Ohio speaks about the infrastructure law, saying he and his staff will spend every day making sure the State gets its fair share of the investment, and mentions $100 million in initial bridge funding announced for Ohio. The page records nominations considered and confirmed, Foreign Service nominations, and a notice from the Committee on the Judiciary that the nomination of Hernan D. Vera to be a United States District Judge for the Central District of California was not reported because of an 11 to 11 tie vote. The remarks are the Senator's own.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
Cite this document
“Congressional Record, Senate, January 20, 2022, Page S375.”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/crec-crec-2022-01-20-crec-2022-01-20-pt1-pgs375-6-aa37dafba5/
, SHA-256 07788b1b5908c04dade23f6aca26e86bd3d119f46ac0a90b3dda7175ba3a5666.Full text
January 20, 2022 CONGRESSIONAL RECORD — SENATE S375
ones. It will connect people with their The nominations considered and con- U.S. SENATE,
jobs and businesses. firmed are as follows: COMMITTEE ON THE JUDICIARY,
I will spend pretty much every day, Washington, DC.
NOMINATIONS PLACED ON THE SECRETARY’S
and my staff will too, making sure that To the Secretary of the Senate:
DESK
PN1512, the nomination of Hernan D. Vera,
our State gets its fair share of this in- IN THE FOREIGN SERVICE of California, to be United States District
vestment and these jobs. PN480–2 FOREIGN SERVICE nomination of Judge for the Central District of California,
If you believe in the dignity of work, Leon Skarshinski, which was received by the having been referred to the Committee on
you fight for the people who make this Senate and appeared in the Congressional the Judiciary, the Committee, with a
country work. We are seeing results. Record of April 27, 2021. quorum present, has voted on the nomina-
On Wednesday, the mayor of Findlay PN903 FOREIGN SERVICE nominations (2) tion as follows—
and I were talking about the Biden ad- beginning John Breidenstine, and ending Mi- (1) on the question of reporting the nomi-
ministration’s announcement of $100 chael Lally, which nominations were re- nation favorably with the recommendation
ceived by the Senate and appeared in the that the nomination be confirmed, 11 ayes to
million in initial bridge funding al-
Congressional Record of July 19, 2021. 11 noes; and
ready on the way to Ohio. That focus
will continue. f In accordance with section 3, paragraph
(1)(A) of S. Res. 27 of the 117th Congress, I
We are doing roundtables. We are LEGISLATIVE SESSION hereby give notice that the Committee has
doing briefings with Federal officials, not reported the nomination because of a tie
with local township trustees and coun- vote, and ask that this notice be printed in
ty officials and mayors and city offi- MORNING BUSINESS the Record pursuant to the resolution.
cials and State officials, talking about Mr. BROWN. Madam President, I ask RICHARD J. DURBIN.
how they can apply for Federal fund- unanimous consent that the Senate (At the request of Mr. DURBIN, the
ing, and to make sure communities are proceed to legislative session and be in following statement was ordered to be
best positioned to make the most of a period of morning business, with Sen- printed in the RECORD.)
this infrastructure. ators permitted to speak therein for up f
Our goal is to leverage this invest- to 10 minutes each.
ment to create jobs in every city, in The PRESIDING OFFICER. Without VOTE EXPLANATION
every county, in every township across objection, it is so ordered. ∑ Mr. TESTER. Mr. President, had I
my great State. f been present when the Senate voted on
I yield the floor. vote No. 11 on confirmation of Execu-
The PRESIDING OFFICER. The Sen- NOTICE OF A TIE VOTE UNDER S. tive Calendar No. 635 Holly A. Thomas,
ator from Ohio. RES. 27 of California, to be United States Cir-
f Mr. DURBIN. Mr. President, I ask cuit Judge for the Ninth Circuit, I
EXECUTIVE CALENDAR unanimous consent to print the fol- would have voted aye.∑
lowing letters in the CONGRESSIONAL f
Mr. BROWN. Madam President, I ask RECORD.
unanimous consent that the Senate There being no objection, the mate- COVID–19 VACCINES
consider the following nomination: rial was ordered to be printed in the Mr. CASEY. Mr. President, as our
Calendar No. 638, Joseph Donnelly, of RECORD, as follows: Nation battles another wave of COVID–
Indiana, to be Ambassador Extraor- 19, I want to detail my efforts to lower
U.S. SENATE,
dinary and Plenipotentiary of the COMMITTEE ON THE JUDICIARY, barriers for Americans to access life-
United States of America to the Holy Washington, DC. saving vaccinations against this ter-
See; that the Senate vote on the nomi- To the Secretary of the Senate: rible disease.
nation without intervening action or PN1501, the nomination of Dale E. Ho, of
The Special Committee on Aging’s
debate; that the motion to reconsider New York, to be United States District
Judge for the Southern District of New York, investigation forced the largest com-
be considered made and laid upon the mercial health insurer in the United
table with no intervening action or de- having been referred to the Committee on
the Judiciary, the Committee, with a States to reverse course and make
bate; that any statements related to quorum present, has voted on the nomina- whole providers who were paid far
the nomination be printed in the tion as follows— below the market rate for admin-
RECORD; and that the President be im- (1) on the question of reporting the nomi- istering COVID–19 vaccines. These ef-
mediately notified of the Senate’s ac- nation favorably with the recommendation forts will help ensure that every pro-
tion. that the nomination be confirmed, 11 ayes to
vider who can administer COVID–19
The PRESIDING OFFICER. Is there 11 noes; and
In accordance with section 3, paragraph vaccines is doing so, helping get more
objection?
Without objection, it is so ordered. (1)(A) of S. Res. 27 of the 117th Congress, I shots in arms.
The question is, Will the Senate ad- hereby give notice that the Committee has Last year, news reports detailed how
vise and consent to the nomination of not reported the nomination because of a tie UnitedHealth had been shortchanging
vote, and ask that this notice be printed in pediatricians who were vaccinating
Joseph Donnelly, of Indiana, to be Am- the Record pursuant to the resolution.
bassador Extraordinary and Pleni- children against COVID–19. In short,
RICHARD J. DURBIN. Medicare set reimbursement rates for
potentiary of the United States of
America to the Holy See? U.S. SENATE,
participating providers at $40 per dose
The nomination was confirmed. COMMITTEE ON THE JUDICIARY, in mid-March 2021. The Federal Gov-
Washington, DC. ernment strongly recommended that
f
To the Secretary of the Senate: private carriers do the same and most
EXECUTIVE CALENDAR PN1509, the nomination of Charlotte N. appear to have done so within weeks,
Mr. BROWN. Madam President, I ask Sweeney, of Colorado, to be United States but UnitedHealth did not.
unanimous consent that the Senate District Judge for the District of Colorado, The committee’s investigation found
having been referred to the Committee on
consider the following nominations: All that UnitedHealth paid in-network pro-
the Judiciary, the Committee, with a
nominations placed on the Secretary’s quorum present, has voted on the nomina- viders roughly 40 percent below the
desk in the Foreign Service; that the tion as follows— Medicare rate until July 1, 2021. Fur-
nominations be confirmed en bloc; that (1) on the question of reporting the nomi- ther, the company delayed action to
the motions to reconsider be consid- nation favorably with the recommendation make providers whole. During the in-
ered made and laid upon the table with that the nomination be confirmed, 11 ayes to vestigation, pediatricians in Pennsyl-
no intervening action or debate; that 11 noes; and vania and beyond raised concerns that
ctelli on DSK11ZRN23PROD with SENATE
In accordance with section 3, paragraph UnitedHealth’s original reimbursement
no further motions be in order to the
(1)(A) of S. Res. 27 of the 117th Congress, I
nominations; and that the President be rate could dissuade providers from ad-
hereby give notice that the Committee has
immediately notified of the Senate’s not reported the nomination because of a tie ministering the vaccine.
action. vote, and ask that this notice be printed in UnitedHealth covers 26 million peo-
The PRESIDING OFFICER. Without the Record pursuant to the resolution. ple in employer and individual market
objection, it is so ordered. RICHARD J. DURBIN. health insurance plans, with 1.4 million
VerDate Sep 11 2014 03:57 Jan 21, 2022 Jkt 029060 PO 00000 Frm 00019 Fmt 4624 Sfmt 0634 E:\CR\FM\G20JA6.068 S20JAPT1
S376 CONGRESSIONAL RECORD — SENATE January 20, 2022
in-network providers and an estimated ministration claims to the Medicare The key to ending this pandemic is get-
14 percent market share. rate across its entire commercial net- ting more people vaccinated.
UnitedHealth’s decision to reimburse work, including individual plans on the I remain committed to removing fu-
providers below the Medicare rate had Affordable Care Act marketplace. On ture roadblocks that may emerge to
the potential to harm families across January 14, 2022, the company reported widespread vaccination against
our Nation at a critical juncture, just that it had processed 1.64 million COVID–19.
as the Food and Drug Administration claims in connection with its commit- This body should do the same.
prepared to expand the availability of ment to the committee—more than 99.8 In closing, I ask unanimous consent
vaccines to children ages 5–11. percent of the affected total—at an av- to have printed in the RECORD the fol-
For parents with questions about erage cost of $14.55 per claim for a total lowing documents: a September 3, 2021
vaccines, pediatricians are trusted ad- of $23.9 million. The company expects Modern Healthcare article detailing
visers who can play a key role in over- the remaining claims, which number UnitedHealth’s under reimbursement
coming lingering concerns or hesi- less than 2,900, to be processed by Feb- for COVID–19 vaccines compared to
tancy, which remains a major issue in ruary 1, 2022. most other major carriers; my October
our Nation. UnitedHealth also committed to 20, 2021 letter to UnitedHealth;
In the long term, ensuring that all more quickly update reimbursement UnitedHealth’s November 5, 2021 re-
hands are on deck to deliver vaccines rates for future emergent vaccines and sponse to my letter; a November 12,
will help end this pandemic. Data has therapeutics, whether for COVID–19 or 2021 supplement to the company’s
shown time and again that being vac- the next pandemic. The company added original response; and a January 14,
cinated against COVID–19 reduces in- that it is ‘‘redirecting additional inter- 2022 email from UnitedHealth providing
fections, severe disease, hospitaliza- nal resources and automating updates further updates.
tion, and death. Vaccinating children whenever possible,’’ while noting that There being no objection, the mate-
also will help protect adults by increas- their new processes still might involve rial was ordered to be printed in the
ing the number of Americans shielded withholding claims ‘‘for a short time,’’ RECORD, as follows:
from the virus, reducing its spread. It which it characterized as no longer [From Modern Healthcare, Sept. 3, 2021]
also reduces the chance for the virus to than 30 days. On January 14, the com- UNITEDHEALTHCARE PAYS PROVIDERS BELOW
mutate and spawn variants, like Omi- pany went further, stating that it will STANDARD RATES FOR COVID–19 VACCINES
cron, that has led to another wave of implement new billing codes in a na- (By Nona Tepper)
illness and death. These concerns are tional public health emergency ‘‘faster Pediatricians across the country are claim-
particularly important for older adults than industry standard,’’ while noting ing the nation’s largest insurer is short-
who are more likely than the general that it has ‘‘learned over the past few changing them for administering COVID–19
population to experience both severe months the required technology and vaccines, jeopardizing access to the main
COVID–19 and breakthrough infections. human resources that need to be tool for stopping the virus’ spread.
The American Academy of Pediatrics has
Vaccinating children helps protect brought forward to accelerate’’ adop- fielded complaints from providers nation-
older generations, particularly older tion of new billing codes in a public wide who are frustrated that UnitedHealth
adults living in multigenerational health emergency. Group is paying about 50% of the federal rate
households, including more than 7 mil- While lacking some details, the steps for vaccine administration, said Dr. Sue
lion grandparents who live with grand- UnitedHealth has described appear to Kressly, who chairs the AAP’s payment ad-
children under the age of 18. be an appropriate response. However, vocacy advisory committee and runs Penn-
Providing more parents with the in- UnitedHealth has not adequately ad- sylvania-based Kressly Pediatrics. While
formation they need to ensure they are dressed an issue that a senior company UnitedHealthcare is not legally required to
pay the federal rate, Kressly said the
comfortable vaccinating their kids will official raised when speaking with
Minnetonka, Minnesota-based insurer is the
help protect all of our children. While Aging Committee investigators in Sep- only national carrier that has not agreed to
pediatric hospitalizations remain rel- tember, that the company’s size and pay at least $40 for vaccine administration.
atively rare, there has nonetheless numerous claims systems presented a The insurer also continues to pay pediatri-
been a significant increase of such hos- barrier to quickly updating COVID–19 cians and family medicine providers below-
pitalizations as the Omicron variant vaccine reimbursement rates in the market rates for COVID–19 tests, Kressly
has spread in recent weeks. The Wall first place. In its responses to subse- said, an issue the New York Times revealed
Street Journal recently reported that quent questions about the issue from in February.
With new variants of COVID–19 continuing
pediatric hospitalizations due to committee staff, UnitedHealth has to emerge, Kressly worried that low fees for
COVID–19 reached pandemic highs in cited reasons such as contracting lan- testing and vaccine administration would
the United States. guage for the delay, but has failed to lead some doctors to stop offering these serv-
Vaccinating more children is essen- provide additional information or ex- ices, worsening the public health crisis, in-
tial to keep schools open for in-person planation in their written responses. creasing medical costs and inspiring more
learning, a live issue for schools The fact that a senior UnitedHealth of- independent practices to shutter, particu-
throughout our Nation that have been ficial told the committee that the com- larly as providers struggle with overwork
forced to return to online classes in the pany’s size negatively affected the during the pandemic.
‘‘They had record-breaking profits in 2020,
face of the Omicron variant. We must quality and efficiency of its inter- and we struggled with getting them to pay
do all that we can to safely keep stu- actions with the market is concerning adequately for COVID testing. That still not
dents in the classroom so that they can and a matter that deserves continued been resolved,’’ Kressly said. ‘‘Now pediatri-
receive the high-quality education oversight from Congress and regu- cians who are giving the vaccine to people
they deserve. School closures also lators. covered by UnitedHealthcare, they’re effec-
cause a disruption in the lives of fami- In recent weeks, the world has been tively opening their wallet, and subsidizing
lies, with parents often struggling to upended by the Omicron variant. Case that patient to get the vaccine.’’
find childcare or forcing them to take rates have skyrocketed, and hospitals At the end of the company’s most recent
second quarter on June 30, UnitedHealthcare
time from work. Vaccinating children are once again filling up, primarily generated $55.5 billion in revenue, up 13%
will help schools remain open, protect with people who have not gotten a from the $49.1 billion reported during the
students and educators, and help par- COVID–19 vaccine or booster. In order same period last year. The company counted
ents stay in the workforce. to leave the tragedy, the disruptions more than 49.6 million enrollees, an increase
After Aging Committee investigators and the closures of the pandemic be- of 1.2 million year-over-year. Meanwhile, the
reached out to UnitedHealth, the com- hind, every person who can be vac- insurer’s low vaccine reimbursement rates
pany quickly and voluntarily com- cinated has a duty to the country to threaten the future of family practices,
ctelli on DSK11ZRN23PROD with SENATE
mitted to change course, commitments roll up their sleeves and get the shot. Kressly said. Unlike most medical services,
federal legislation bars providers from bal-
I detailed in an October 20, 2021, letter. We will continue to learn more about
ance billing patients for the COV[0–19 vac-
In response to my letter, UnitedHealth the Omicron variant and variants to cine.
confirmed its plans to retroactively in- come. However, there is one thing ‘‘If we don’t at least make enough money
crease reimbursements for approxi- about this variant, past variants, and to cover our costs, then we won’t be here as
mately 2 million COVID–19 vaccine ad- future variants that will not change: practices to serve the community beyond the
VerDate Sep 11 2014 03:57 Jan 21, 2022 Jkt 029060 PO 00000 Frm 00020 Fmt 4624 Sfmt 0634 E:\CR\FM\G20JA6.014 S20JAPT1
January 20, 2022 CONGRESSIONAL RECORD — SENATE S377
public health emergency,’’ Kressly said. so that providers were no longer losing largest commercial payer—with 26 million
‘‘That’s a bigger problem.’’ money when they were paid people enrolled in employer and individual
UnitedHealthcare is not the only payer of- UnitedHealthcare rates, said Dr. Reshma plans, 1.4 million in-network providers and
fering clinicians low fees for vaccine admin- Chugani, a pediatrician at the Atlanta Chil- an estimated 14 percent market share—it is
istration—some regional plans and employ- dren’s Clinical Center. The insurer also an- critical that the company do all it can to en-
ers are also paying below the federal rate, nounced it would increase the rate paid for sure that vaccines are available to every per-
Kressly said. But she said these payers are the tests, as well as allow pediatricians to son that is eligible to receive one. To that
likely just slow to react to payment stand- resubmit patient claims, she said. But they end, the Aging Committee requested that
ards. In March, the Centers for Medicare and are still not offering to reimburse providers UnitedHealth provide information about the
Medicaid Services nearly doubled what it for tests previously paid at below-market company’s reimbursement rates, the timeli-
was paying providers for giving the vaccine, rates. ness of future fee schedule updates and the
after the American Medical Association ‘‘We lost money on every United patient,’’ company’s progress toward making providers
found the previous rate did not cover the Chugani said. whole for vaccines they administered while
costs associated with administering the shot. Additionally, the insurer has made it dif- UnitedHealth was reimbursing below reim-
Most of these payers are just confused about ficult for providers to recoup the money it bursement rates set by CMS.
the update and, when Kressly reaches out to said it owes them, forcing them to go
The ongoing effort to increase COVID–19
them, she said they generally immediately through multiple administrative layers and
vaccination rates across our Nation demands
increase their rate. But UnitedHealthcare still failing to reimburse one type of test at
an all-hands-on-deck approach. Ensuring
has refused to increase what it is paying pe- the full rate, said AAP’s Kressly. She said
that all eligible children are vaccinated
diatricians. she talked to UnitedHealthcare about this
against COVID–19 is key to improving the
‘‘They say, ‘Our fee schedule is our fee issue two weeks ago and that it has still not
overall vaccination rate, which will better
schedule, it’s up to the contract that the been resolved.
‘‘They’ve put barriers for us to have to act protect older Americans by helping stem the
practice has with UnitedHealthcare, let spread of the virus. Such efforts are of par-
them try to have the conversation,’ ’’ Kressly when we have no time, energy or resources
to do so,’’ she said. ticular importance ahead of the Food and
said. Drug Administration’s (FDA) expected con-
UnitedHealthcare, for its part, said it re- --
OCTOBER 20, 2021. sideration of COVID–19 vaccines for young
cently offered to increase reimbursement for children later this month. Older Americans
COVID–19 testing for some pediatric and Sir ANDREW WITTY,
Chief Executive Officer, have been among those hit hardest by
family medicine practices that met specific COVID–19 and face the greatest health risks
criteria. When it comes to vaccines, UnitedHealth Group.
DEAR SIR ANDREW: I write in regard to if they contract the disease, even after being
UnitedHealthcare said it is continually re- vaccinated. Recognizing the elevated risk of
viewing its reimbursement rates. commitments UnitedHealth Group
(UnitedHealth) made to the U.S. Senate Spe- breakthrough infections in older adults, the
Dr. George Rogu, president of the Inde- Biden administration recently authorized
pendent Pediatric Collaborative of Long Is- cial Committee on Aging related to reim-
bursement policies for the administration of third doses of the Pfizer-BioNTech vaccine
land and head of RBK Pediatrics, hopes to be for people ages 65 and over. The serious
one of the providers paid more for giving COVID–19 vaccines. UnitedHealth’s past poli-
cies appeared to have created access barriers health risks COVID–19 poses for older adults
UnitedHealthcare enrollees COVID–19 vac- are especially acute for those living in
cines. for children seeking COVID–19 vaccination
from their primary care pediatrician—bar- multi-generation households, including more
When Rogu reached out to the insurer last
riers that affected younger and older Ameri- than 7 million grandparents who live with
month. a UnitedHealthcare customer service
cans alike. I appreciate the company’s deci- grandchildren under the age of 18. Those
representative blamed his low rates on his
sion to reprocess certain COVID–19 vaccine older Americans are at even greater risk of
different customers’ plans and the different
claims, which I expect will facilitate the exposure when they live with unvaccinated
fee schedules associated with each. The cus-
broadest possible access to COVID–19 vac- individuals, an important consideration
tomer service representative said Rogu was
cines among UnitedHealth’s members. I ex- given the greater impact of the delta variant
the first provider to complain about the mat-
pect that the steps UnitedHealth has com- on children. The current wave of COVID–19
ter and offered to refer his case to the com-
mitted to take will help children seeking has led to higher pediatric case rates, record
pany’s management team.
COVID–19 vaccines as well as older Ameri- pediatric hospitalizations and school clo-
‘‘We cannot in good conscience say, ‘Oh, we
cans under the purview of the Aging Com- sures that have affected more than 900,000
can’t give you the vaccine because you have
mittee, including the millions who live with students at 1,800 schools across 44 states in
UnitedHealthcare.’ That’s not right,’’ Rogu
and care for their grandchildren or other August and September alone.
said. ‘‘It’s just not humanely right. But peo-
ple that have a large panel of younger relatives. I appreciate your com- During calls in September with Aging
UnitedHealthcare customers? It’s killing pany’s assurance that UnitedHealth will Committee staff, UnitedHealth officials con-
them.’’ keep the Aging Committee updated on its firmed press accounts that reported a
Rogu said he is still waiting to hear back progress toward expeditiously resolving the months-long period when the company was
from the insurer. concerns raised with the company. reimbursing providers up to 40 percent less
He said he noticed that he was being paid The Aging Committee’s attention was for COVID–19 vaccine administration than
below the federal rates in May and asked drawn to this issue by press reports high- the rate set by the CMS. While other major
New York-based Canid Vaccines, his vaccine lighting that during a four-month period ear- payers reportedly adopted the reimburse-
administration software system, about the lier this year, UnitedHealth reimbursed pedi- ment rate set by CMS swiftly, UnitedHealth
problem. The startup verified that atricians at rates that failed to meet the continued reimbursing at a lower rate until
UnitedHealthcare reimbursed him at about costs of administering COVID–19 vaccines. the end of June. During conversations with
half the rate that other insurers did. Canid During that time, other large insurers re- staff, UnitedHealth reported that it had
Vaccines said it has identified at least 25 portedly reimbursed pediatricians and other problems uploading the CMS rate to the
independent practices representing more health care providers at a higher rate, in line company’s various fee schedules. Aging Com-
than 350 providers nationwide that with what the Centers for Medicare & Med- mittee staff have heard concerns from pro-
UnitedHealthcare is paying at less than the icaid Services (CMS) set in March 2021. Pedi- viders that the reimbursement issues pedia-
federal rate. atricians raised concerns that tricians experienced with UnitedHealth ear-
Among pediatric circles, UnitedHealthcare UnitedHealth’s low reimbursement rates lier this year could resurface when the FDA
is often referred to as the ‘‘evil empire’’ would deter in-network providers from ad- authorizes a COVID–19 vaccine for 5–11 year-
since they are the least transparent and ministering COVID–19 vaccines, creating olds, which will carry a different billing
least cooperative among the major insurers, barriers for patients. The additional costs of code.
said Dr. Peter Pogacar, vice president of the administering COVID–19 vaccines have been Following the concerns raised by the Aging
Rhode Island chapter of the AAP and a pedi- significant for providers, a point that CMS Committee last month, UnitedHealth in-
atrician at East Greenwich Pediatrics. He noted at the time it increased reimburse- formed Aging Committee staff during a call
said UnitedHealthcare is underpaying physi- ment rates, citing ‘‘updated information on October 6 that the company planned to
cians for COVID–19 vaccine administration about the costs involved in administering address the concerns outlined above. Specifi-
there too. the COVID–19 vaccine for different types of cally, UnitedHealth committed to reprocess-
‘‘Healthcare should be about healing with providers and suppliers and the additional ing all of its commercial claims—not just pe-
business as a sideshow, not the main event,’’ resources you need to safely and appro- diatric claims—from the time CMS issued
Pogacar wrote in an email. priately administer the vaccine.’’ The agen- new rates for COVID–19 vaccines in mid-
ctelli on DSK11ZRN23PROD with SENATE
The insurer isn’t just offering low rates for cy furthermore encouraged private payers to March to the time United updated its fee
administering the COVID–19 vaccine. follow suit, noting that ‘‘in light of CMS’s schedule on July 1. Company officials further
UnitedHealthcare has also reimbursed pro- increased Medicare payment rates, CMS will stated that United Health would reprocess
viders for less than what it cost them to pur- expect commercial carriers to continue to the claims automatically and that providers
chase COVID–19 testing kits. After signifi- ensure that their rates are reasonable in would not be required to resubmit claims for
cant media attention, the manufacturer and comparison to prevailing market rates.’’ reprocessing. Noting that the company ex-
distributor of the tests dropped their prices Given UnitedHealth’s status as the Nation’s pected to reprocess ‘‘millions’’ of claims that
VerDate Sep 11 2014 03:57 Jan 21, 2022 Jkt 029060 PO 00000 Frm 00021 Fmt 4624 Sfmt 0634 E:\CR\FM\A20JA6.008 S20JAPT1
S378 CONGRESSIONAL RECORD — SENATE January 20, 2022
were submitted by providers during the letter, we are writing to confirm the fol- Affordable Care Act and Medicaid Managed
three-and-a-half month period prior to July lowing details related to our reimbursement Care plans.’’
1, UnitedHealth officials told Aging Com- for COVID–19 vaccine administration: Answer: As discussed with staff, we have
mittee staff that they hoped to make ‘‘sig- UnitedHealthcare (UHC) has been reim- been paying providers according to their con-
nificant progress’’ within 30–45 days. Com- bursing providers using the new CMS rates tracts since the vaccines first became avail-
pany officials further committed to: since July 1, 2021, consistent with timing able. These provider contracts explicitly pro-
1. Review UnitedHealth’s claims process to specified in UHC’s contracts with providers. vide how new procedure codes are imple-
minimize delays in making payments to pro- UHC will adjust claims paid less than $40 mented and on what timeline; those provi-
viders for COVID–19 vaccines; between March 15 and June 30, 2021 to reim- sions are agreed to by all parties. Because
2. Verify that there are no similar under- burse at $40 per administration, so providers United paid its network providers according
payment issues in its Affordable Care Act can benefit from the increase CMS an- to these contracts, there have been no ‘‘un-
Exchange and Medicaid Managed Care books nounced on March 15, 2021. derpayments.’’ Nevertheless, after reviewing
of business: and The voluntary retroactive reimbursement concerns about the contracted reimburse-
3. Provide updates to Aging Committee changes are in process and claims will be ad- ment amounts paid earlier this year, we
staff on the company’s progress toward justed accordingly. Providers will not need elected to voluntarily increase reimburse-
meeting these goals. to take action to receive the change in reim- ment—above and beyond contractual rates—
As part of these updates, please also pro- bursement. for all commercial plans (including indi-
vide me with the following information no UnitedHealth Group recognizes the impor- vidual plans purchased via ACA exchanges),
later than November 5, 2021: tant role that reimbursement plays in ad- for dates of service between March 15, 2021
1. How many claims does UnitedHealth ex- dressing the COVID–19 pandemic, which is and June 30, 2021.
pect to reprocess for COVID–19 vaccinations why we are taking action to adjust previous Within ACA Exchanges, we similarly have
that were administered prior to July 1, 2021? claims and accelerating our processes to up- paid according to contracts agreed to with
What was the average difference between the date reimbursement rates when changes are providers. ACA Exchange plans will be in-
initial reimbursement and the reprocessed announced by CMS. In your letter dated Oc- cluded in the voluntary increase in reim-
claim? What was the total amount that bursement described above. The completion
tober 21, 2021, you asked for the following in-
UnitedHealth paid to providers to settle of that increase will be on the same time
formation:
these claims at the CMS rates? The number of COVID–19 vaccine adminis- frame as commercial plans. With respect to
2. UnitedHealth told Aging Committee managed Medicaid, as we noted in our first
tration claims UHC expects to reprocess.
staff that it is difficult to quickly update its The average difference between the initial discussion with staff on September 22, 2021,
reimbursement rates when new vaccine bill- those plans pay according to rates set by
reimbursement and the reprocessed claim.
ing codes and rates are issued by CMS. The total amount that will be reimbursed. state law and state payment policies. United
UnitedHealth further stated that its ex- Information on how we will ensure pro- has paid for vaccine administration con-
pected solution for this issue may involve de- viders will be reimbursed in a timely manner sistent with those parameters and will con-
laying payments to providers to give the when CMS issues new rates for COVID–19 tinue to do so.
company’s payment systems time to reflect vaccine claims going forward. Staff asked that we provide detail about
new codes and rates. In order to minimize ac- Approximately two million COVID–19 vac- how we will timely reimburse providers for
cess delays in the future, what steps is cine administration claims paid between emergent vaccines and therapeutics unre-
UnitedHealth taking to ensure that pediatri- March 15 and June 30, 2021 will be impacted lated to COVID–19 and the current Public
cians and other providers will be reimbursed by this retroactive adjustment. We antici- Health Emergency (PHE).
in a timely manner when CMS issues new pate the average adjustment will be approxi- Answer: In the event of a future pandemic
rates for COVID–19 vaccines or other emer- mately $12.50 per claim, for total additional or new PHE we will take immediate actions
gent vaccines and therapeutics in the future? reimbursement of approximately $25 million. (noted below) to accelerate reimbursement
Thank you for your attention to this im- updates. Outside of a pandemic or PHE how
UHC has already begun processing these re-
portant issue. If you or your staff has ques- we update codes and payment rates will con-
imbursements.
tions, please contact Peter Gartrell, Chief With regard to new rates for COVID–19 vac- tinue to be guided by our existing contracts
Investigator for Chairman Casey. with providers. Consistent with industry
cinations or other emergent therapeutics for
Sincerely, practice, those contracts provide for timely
COVID–19, we will be accelerating our proc-
ROBERT P. CASEY, Jr., and substantial payment to providers while
ess for updating our reimbursement to sup-
Chairman, we complete the update to our systems. At
port the COVID–19 vaccine codes and rates
U.S. Senate Special Committee on Aging. all times we will follow all applicable state
implemented by CMS as they become avail-
able. Specifically, UHC will implement new and federal requirements.
NOVEMBER 5, 2021. Staff noted the complexity of adjusting re-
COVID–19 codes and rates upon the publica-
Chairman BOB CASEY, imbursement rates for new procedure codes
tion of this information by CMS rather than
U.S. Senate Special Committee on Aging, and asked for details on how United might
including these changes in our scheduled
Washington, DC. make those adjustments more quickly in the
DEAR CHAIRMAN CASEY: On behalf of quarterly reimbursement update processes.
This will ensure provider payments are up- future.
UnitedHealth Group, including our over Answer: We hope that under less exigent
120,000 frontline doctors, nurses, and other dated as quickly as possible.
We appreciate the services provided by circumstances CMS will provide additional
health care practitioners, thank you for your lead time for its pronouncements, but United
recent letter regarding retroactive payment health care professionals during the pan-
is not relying on that to speed its processes
for COVID–19 vaccine administration. Like demic. The actions we are taking to adjust
during this PHE. Instead, we are devoting
many individuals and families, clinicians COVID–19 vaccine claims build on the many
significant time and effort to ensuring that
and essential health workers have sacrificed steps we have taken to support providers
the process of updating new COVID–19-re-
deeply these past two years as our country over the last eighteen months, including ac-
lated codes within our systems begins at the
worked together to fight COVID–19. celerating claims payments, assisting in
time of publication of those codes and with-
We share your commitment to ensuring processing and administering CARES Act
out regard to contractual timelines. This in-
and expanding access to critically important Federal funding to providers, working with
cludes, for example, redirecting additional
health care services and understand these HHS to ensure clinicians who provided
internal resources and automating updates
are extraordinarily challenging times for the COVID–19 testing or treatment for individ- whenever possible. While some claims filed
millions of people we are privileged to serve, uals without insurance were reimbursed for immediately after new payment codes are
as well as employers, health care providers, their services, and removing administrative announced might be held for a short time
governments, and the health care system. requirements in highly impacted areas. while those updates are being made (gen-
We welcome this opportunity to provide you We appreciate the opportunity to address
erally no longer than 30 days after receipt),
with an overview of the significant actions the Committee’s questions. we believe this will result in overall faster
we have voluntarily taken regarding vaccine Sincerely, reimbursement at updated rates. Indeed, it is
reimbursement and the steps we are taking BRIAN THOMPSON, common in the industry to hold claims dur-
to quickly address the concerns expressed. CEO, UnitedHealthcare. ing a period of change or uncertainty to help
UnitedHealth Group is committed to help- ensure that those claims are paid accurately.
ing people live healthier lives and making NOVEMBER 12. 2021. We are confident we will be able to update
the health care system work better for ev- Addendum to UHG—Senate Aging Com- new codes for all claims platforms on a time-
eryone. We do this by working with stake- mittee Response on 11/5/21 ly basis.
holders and partners to address the biggest Thank you for the email of November 8, Finally, staff asked for updates as to our
ctelli on DSK11ZRN23PROD with SENATE
challenges facing our system. As we shared 2021 with follow-up questions to UHG’s letter progress on increasing the reimbursement
during our conversation, we have been in dated 11/5/2021, and for your continued en- amount for the approximately two million
close contact with the American Academy of gagement regarding how we reimburse pro- claims impacted by our decision to volun-
Pediatrics regarding concerns they raised viders for COVID–19 vaccine administration. tarily increase reimbursement for COVID–19
about vaccine reimbursement. Please see our additional responses below: vaccine administration.
Consistent with the discussion with your Staff asked that we clarify whether ‘‘simi- Answer: To date, we have resolved approxi-
staff on October 6th and your October 21st lar underpayment issues occurred in United’s mately 60% of these claims. We expect the
VerDate Sep 11 2014 01:46 Jan 21, 2022 Jkt 029060 PO 00000 Frm 00022 Fmt 4624 Sfmt 0634 E:\CR\FM\A20JA6.009 S20JAPT1
January 20, 2022 CONGRESSIONAL RECORD — SENATE S379
remaining claims to be completed in the harming migratory birds under the Mi- ticide. Are farmers now risking prison time
coming 6–8 weeks. We will update you when gratory Bird Treaty Act. While there for growing the food that feeds America and
all claims are complete. has been a lot of discussion about the the world?
-- The Biden Administration has entertained
From: Prible, John M.
impact on the energy industries, Sarah the idea of an ‘‘incidental take permit’’ that
To: Gartrell, Peter (Aging) Falen points out how the new rule might remove some of the liability for birds
Cc: Hartman, Doug (Aging); Shakow, Peter could affect the agriculture industry. that are accidentally killed, however they
Subject: RE: Follow Up on It is important that Congress note have not developed the idea enough to know
UnitedHealthcare’s Response these consequences and the uncer- what the permit would look like. There
Date: Friday, January 14, 2022 5:12:29 PM tainty created by the Biden adminis- aren’t any standards for what actions would
Peter, thank you for your recent email, in tration’s rule. be exempt from liability under the permit
which you asked for an update on our vol- Mr. President, I ask unanimous con- system and the MBTA office doesn’t have
untary efforts to retroactively increase re- enough staff to begin handling the undoubt-
sent to have printed in the RECORD the edly thousands of permit applications they
imbursement to $40 for COVID–19 vaccine ad- opinion editorial written by Sarah L.
ministration. Answers to your questions are will receive.
provided below; however, we expect that this
Falen. The government has often implemented
confidential information will not be shared There being no objection, the mate- rules, promising it will not take advantage
with third parties. rial was ordered to be printed in the of its authority, but time after time this has
To date, we have retroactively reimbursed RECORD, as follows: proven to be just a way to get a rule ap-
providers for 1,640,996 claims, or more than THE GOVERNMENT’S WORD: SHOULD WE TRUST proved or legislation passed. From wolves
99.8% of all affected claims. The average ad- IT? and grizzly bears to ever changing defini-
ditional payment for those claims was $14.55, tions of ‘‘navigable waters,’’ the government
(By Sarah L. Fallen)
for a total of approximately $23.9 million in has proven that its word should not be trust-
Americans trust the U.S. government less ed and the MBTA is no exception.
additional payments. At this time, fewer
and less. In fact, according to the Edelman
than 2,900 claims (less than 0.2% percent of
Trust Barometer, trust in the federal govern- f
all affected claims) remain to be reprocessed.
ment hovers around 40%. Yet, with the rev- PUBLIC SERVICE REVIEW
Because the original paid amount on those
ocation of the Trump Administration’s rule
remaining claims averaged about $36, the av-
that prohibits prosecution for accidentally
Mr. WICKER. For all who are looking
erage additional reimbursement to be paid for encouragement about the future of
harming migratory birds under the Migra-
will be about $4. Those remaining reimburse- our country, I want to call attention to
tory Bird Treaty Act (MBTA), the Biden Ad-
ments continue to be prioritized and sent out the Fall 2021 issue of ‘‘Public Service
ministration is asking citizens to do just
the door. We anticipate those few remaining
claims will be completed by February 1, 2022.
that, ‘‘trust’’ the federal government. Review,’’ produced by the Stennis Cen-
People involved in industries such as en- ter for Public Service and available at
We note that you asked for claims and pay-
ergy or agriculture have a clear under- www.stennis.gov. ‘‘Public Service Re-
ment data by state. There are a few reasons
standing of how environmental legislation,
we are not able to cut this data cleanly by view’’ features rising young leaders
originally passed with the best intention,
state, including that providers submit claims across the country sharing their own
has been weaponized to negatively affect
via tax identification numbers (TIN), many experiences, insights, and aspirations
their livelihoods. One of the lesser known,
of which cover physicians (and therefore as they engage in public service, both
but just as dangerous environmental swords
claims) from multiple states.
You also asked for additional information is the MBTA. While it is easy to see that en- in their communities and around the
about how we will shorten the adoption time ergy industries, such as oil and gas, wind or world. The commitment of these future
of new rates in this or a future national pub- even solar would be impacted by the Biden leaders to keeping our Nation strong
lic health emergency (NPHE). As we stated decision, this Act has the potential for very and free is truly inspiring.
previously, contracts between United and its serious impacts on the agriculture industry. The eight authors featured in the fall
The MBTA is a statute that allows for the
network provider groups specifically provide 2021 issue are Alexis Eberlein of Ohio
criminal prosecution of any person who ‘‘in-
for time to implement new rates in an or- University, Sarah Glaser of the Univer-
cidentally takes’’ a migratory bird. To un-
derly way. We understand this to be routine sity of South Florida, Hannah
derstand the breath of this Act, there are
across the industry, understood and long ac-
two important concepts. First, nearly all Krawczyk of Auburn University, Mia
cepted by the provider community, and en-
tirely proper. If there is another NPHE or
birds in the U.S. are considered migratory. Robertson of Mississippi State Univer-
Second, what constitutes an ‘‘incidental sity, Alanna Cronk of Georgetown Uni-
there are exceptional circumstances which
take.’’ The MBTA states that ‘‘it [is] unlaw- versity, Katie Medford of Harvard Uni-
dictate more timely adoption of new rates,
ful at any time, . . . to pursue, hunt, take, versity, Preeti Chemiti of Princeton
we have learned over the past few months
capture, kill, . . . any migratory bird . . .’’
the required technology and human re- University, and Amitoj Kaur of Miami
16 U.S.C. 703(a). If you read that language, it
sources that need to be brought forward to University.
would make sense that this Act is referring
accelerate. As a point of reference, should ‘‘Public Service Review’’ provides
to someone who intends to kill a migratory
circumstances justify it, we commit to im- young leaders a platform to share sto-
bird. That commonsense reading is what the
plement new codes in an NPHE faster than
industry standard.
Trump MBTA rule enforced . . . only those ries of both challenge and hope as they
engaged in an action that purposefully focus on causes that draw their unique
JOHN PRIBLE,
Vice President, External Affairs, ‘‘takes’’ a migratory bird would be subject to passions. Their stories are hopegiving
UnitedHealth Group. fines and prison time. This is not how the to those of us currently engaged in
Biden Administration reads that language.
f According to the Biden Administration,
public service and offer valuable per-
even if a person is doing something that ac- spectives for younger students looking
MIGRATORY BIRD TREATY ACT to become involved.
cidentally harms a migratory bird, that per-
Mr. BARRASSO. Mr. President, I son can still be criminally liable. Thus, On behalf of my colleagues and fellow
often hear from people in Wyoming someone can be prosecuted for an action or members of the Stennis Center Board
who are concerned about the changes inaction that is otherwise legal, but just so of Trustees, U.S. Senator CHRIS COONS,
being proposed in Washington, DC. happens to ‘‘take’’ a migratory bird. Tom Daffron, U.S. Representative
When the Federal Government changes We should all be concerned about the Biden TERRI SEWELL, and former U.S. Rep-
Administration allowing ‘‘incidental take’’
the rules, authorities, or standards, it resentatives Martha Roby and Gregg
to be prosecuted because there is no limit on
can significantly impact critical Wyo- what can be prosecuted. This means that if a Harper, I commend the Stennis Center
ming industries. farmer uses a pesticide that is legally admin- for this excellent publication and en-
In the ‘‘Wyoming Livestock Round- istered and a migratory bird just so happens courage its wide distribution to audi-
up,’’ a weekly news source for Wyo- to ingest that pesticide, he could be subject ences of all ages.
ming’s ranchers, farmers, and Agri- to criminal prosecution. The MBTA allows f
business community, Sarah L. Falen for up to a $5,000 fine or six months in prison
authored an opinion editorial titled for an incidental take. TRIBUTE TO LINDA WILSON
ctelli on DSK11ZRN23PROD with SENATE
The scenarios under which a person can ac- Ms. MURKOWSKI. Mr. President, I
‘‘The Government’s Word: Should We
cidentally kill a migratory bird are infinite
Trust It.’’ rise today to recognize and congratu-
and can be ridiculous. Yet, the government
She raises concerns about the Biden expects us to believe that they will only late Linda Wilson, who recently retired
administration’s rule revoking the prosecute ‘‘foreseeable’’ accidental killings from the U.S. Department of Education
Trump administration policy prohib- of migratory birds. It is foreseeable that a after over 33 years of service to the
iting prosecution for accidentally bird can ingest a legally administered pes- American people.
VerDate Sep 11 2014 03:57 Jan 21, 2022 Jkt 029060 PO 00000 Frm 00023 Fmt 4624 Sfmt 0634 E:\CR\FM\A20JA6.011 S20JAPT1
File and source
- File
- CREC_crec-2022-01-20_crec-2022-01-20-pt1-pgs375-6.pdf
- Size
- 306,160 bytes
- SHA-256
- 07788b1b5908c04dade23f6aca26e86bd3d119f46ac0a90b3dda7175ba3a5666
- Original
- www.govinfo.gov