NOSORH Begins Work during Appropriations Season
On February 9, President Obama released a $4.1 trillion budget proposal for fiscal year 2017. The budget release is the unofficial kickoff to the annual appropriations cycle for Congress, which continued throughout February with a flurry of congressional hearings that saw testimony by cabinet secretaries and agency heads.
Included in the budget request to Congress was $9,511,000 for State Offices of Rural Health under the Health Resources and Services Administration account. Through its new advocacy counsel, Hall Render, NOSORH has been meeting with a number of House and Senate appropriators to request increased funding in FY ’17. These include members of Congress from: Alabama, Arkansas, California, Idaho, Indiana, Kentucky, Kansas, Oregon, South Carolina, and Tennessee. Teryl Eisinger, NOSORH Executive Director reports that “We’re thankful that about one-third of State Offices of Rural Health and their partners around the country have been helping prepare budget request forms to their congressional members. Hall Render provided us with a template for making those requests. We’d like to hear from any SORH or partner who may need help supporting the effort to move forward.”
The next step in the appropriations process will be for Congress to adopt a budget resolution that would set the various spending caps for the 12 appropriation bills. Republican leaders in the House and Senate have expressed a desire to return to “regular order” and pass each of the 12 appropriations bills individually. However, this will be difficult given a myriad of factors including: a potential block of a Supreme Court nominee vote by Senate Republicans, lower than anticipated statutory limits in discretionary spending, a condensed Congressional calendar and typical election year jitters by lawmakers facing re-election.
On February 2, CMS acting Administrator Andy Slavitt announced the agency will develop a rural health council to review regulations for their impact on providers in rural settings and to make recommendations for rural-focused health care policies.
The panel, which will include CMS regional health officers, is intended to improve access to care in rural areas, support the rural health care economy, and ensure the agency’s innovation programs appropriately fit rural markets.
CMS recently announced additional funding for an expansion of the National Rural ACO Consortium to support the growth of 23 rural ACOs that serve half a million Medicare beneficiaries across the country. The agency will also begin to test new models for integrated health care in geographically-isolated areas using telemedicine, swing beds, and other forms of care delivery through the Frontier Community Health Integration Project. Slavitt said the council will seek input into CMS’ 2016 agenda at one of the agency’s Rural Health Open Door forums.
Expanded Telehealth Proposed in President’s Budget/Introduced in Congress
Included in the President’s proposed fiscal 2017 budget was funding to allow federally qualified health centers and rural health clinics to be originating telehealth sites under Medicare and to expand telehealth services in the Medicare Advantage program. The proposal allows the HHS secretary to expand telehealth services in Medicare Advantage organizations by eliminating Part B requirements that certain covered services be provided only through face-to-face meetings. The beneficiary would determine whether to use the telehealth benefit or not.
The proposal is similar to legislation that was introduced in the Senate by Senator Brain Schatz (D-HI), and in the House by Rep. Diane Black (R-TN). The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (S. 2484) helps providers meet the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) by eliminating Medicare’s location-based reimbursement restrictions and allowing telehealth and RPM to be basic benefits under Medicare Advantage.
The legislation establishes a bridge program that enables doctors participating in MIPS to apply for waivers that would exempt them from limitations Medicare imposes on telehealth coverage. Providers participating in alternative payment models would be automatically exempt from Medicare telehealth restrictions. The measure would also expand coverage of remote patient monitoring technologies for patients with chronic conditions to non-hospital facilities, including community health centers, rural health clinics, dialysis facilities, and telestroke evaluation and management sites.
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