The NOSORH Policy Committee continues to work to increase appropriation and reauthorize the SORH program. Several SORH have reported hearing from congressional members after they received a notice of award of the SORH grant. This is a great opportunity to share the work of your SORH and what it means to congress members’ constituents. With the help of SORH, Hall Render continues to keep the message alive that there is a need for SORH reauthorization and increased appropriation. The following update is provided by Hall Render:
Senate Appropriations Committee passes Labor-HHS Bill
On June 9, the Senate Appropriations Committee passed the FY 2017 Labor-HHS-Ed appropriations bill with a vote of 29-1, marking the first time in seven years the measure has moved beyond the committee. Among other items, the bill provides funding for the State Offices of Rural Health (SORH) program at $9,511,000, which is the same amount as fiscal year 2016. Other provisions of note included in the bill are:
- Increased funding by $2 million for rural health outreach;
- Increased funding by $1 million for telehealth programs;
- Increased funding by $5 million for Children’s Hospitals Graduate Medical Education;
- Increased funding by $5 million for the Office of Medicare Hearings and Appeals;
- Increased funding by $80 million for mental health block grants; and
- 18 federal program eliminations equating to over $1 billion in spending reductions.
Despite the Senate advancing the Labor-HHS bill through committee, the prospects for stand-alone passage of the bill are extremely low. The President has yet to sign any of the 12 appropriation bills into law and even the traditionally less contentious appropriation bills are tied up over provisions relating to gun control, abortion and Zika-related funding. The House has yet to release a Labor-HHS bill at the Committee level.
House Passes Hospital Bill Amending Medicare Payment Policies
On June 7, the House of Representatives passed the Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5723) that would modify payment policies under Medicare for certain hospital outpatient departments and some hospital inpatient services. The bill would also change meaningful use standards for some providers practicing in ambulatory surgical centers and extend a demonstration project for rural community hospitals. Despite bipartisan support in the House, Senate aides are skeptical of the bill’s fate on that side of Capitol Hill.
The measure would amend Medicare hospital reimbursement changes included in the Bipartisan Budget Act of 2015, by exempting hospital outpatient departments that were “mid-build” when the budget bill was passed. It would also exempt long-term care hospitals from an expansion moratorium if they were being built when the budget bill took effect. According to a Congressional Budget Office (CBO) cost estimate, about 100 hospitals would have facilities that qualify for the mid-build exemption.
H.R. 5723 would also extend the Rural Community Hospital Demonstration program for five years and allow more hospitals to participate. Under the demonstration, facilities are reimbursed based on the reasonable costs incurred, rather than the Inpatient Prospective Payment System (IPPS), which uses diagnostic codes to determine payments. The CBO estimated that the demonstration extension would reduce mandatory Medicare spending by a $21 million between 2017 and 2026.
There is no specific companion bill in the Senate. However, several measures included in H.R. 5723 have been introduced as stand-alone legislation, including S. 202, which would exempt long-term care facilities from the expansion moratorium, and S. 607, which would extend the rural hospital demonstration.
Senate Passes Bill to Improve Access to Rural Health Care On June 7, the Senate passed the Rural Health Care Connectivity Act (S. 1916), which was introduced by Sen. John Thune (R-SD) in August 2015. The legislation, which was passed after lawmakers inserted it into the conference report on the Toxic Substances Control Act, would provide Federal Commerce Commission (FCC) funding to help health care providers in rural communities gain access to better broadband and telecommunication services.
It does so by allowing public and non-profit skilled nursing facilities (SNF) to apply for financial support from the Universal Service Fund’s (USF) Rural Health Care Program (RHCP), which funds technologies and communication services used to provide health care in rural settings. Under current law, SNFs are not eligible to receive RHCP support. Senator Thune’s bill would also help organizations that assist rural patients connect remotely with physicians and hospitals provide higher-quality care in rural communities.
House Committee Approves Mental Health Reform Bill
On June 15, the House Energy and Commerce Committee unanimously passed the Helping Families in Mental Health Crisis Act (H.R. 2646). The legislation has been stalled in the House for several years over cost, civil liberties and privacy provisions.
As passed by the Committee, the measure would establish a new leadership position within HHS to direct federal mental health and substance abuse programs. The bill would reauthorize existing treatment and suicide prevention programs and create new ones, including a minority fellowship program for mental health providers and a training program that teaches clinicians how to better comply with HIPAA. The legislation would also require HHS to clarify conditions under which covered entities may release protected mental health information and would codify a Medicaid managed care regulation allowing optional state coverage of Institutions for Mental Disease (IMD) care for adults.
H.R. 2646 will go before the full house on the week of July 5th with passage expected. The Senate will try and advance their version of a mental health bill in July before Congress breaks for a seven-week recess beginning July 15. However, concerns over the potential cost of the mental health measure could delay Senate action until September.
CMS Issues Proposed Rule Updating Conditions of Participation for Hospitals
On June 13, CMS released a proposed rule amending the conditions that hospitals and critical access hospitals (CAHs) must meet to be eligible to participate in the Medicare and Medicaid programs. The agency’s proposal, which includes provisions to reduce infections, curb the overuse of antibiotics and prevent patient discrimination, is expected to apply to 6,288 facilities.
CMS’ proposal would require hospitals and CAHs to establish infection prevention and control programs to survey, prevent and control healthcare-associated infections and other communicable diseases. Additionally, the rule would require hospitals and CAHs to create antibiotic stewardship programs to promote appropriate use of antibiotics. As a condition of their participation in Medicare and Medicaid, hospitals and CAHs would be expected to designate leaders for the infectious diseases and antibiotic programs and CAHs would be required to maintain a quality assessment and performance improvement (QAPI) program. The proposed rule would also improve protections for underserved and excluded patient populations in hospitals and CAHs. The agency is accepting comments on its proposed rule through August 15, 2016.
HHS Announces Funding for Quality Payment Program
On June 20 HHS announced that it will award $20 million to assist eligible providers and small practices in transitioning to the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA). In 2015, MACRA authorized $100 million in funding over five years to for the Direct Technical Assistance program.
Entities eligible to apply for assistance from HHS include quality improvement organizations, regional health collaboratives and regional extension centers. The agency has especially encouraged eligible providers and practices in rural and health professional shortage areas to apply. Proposals to receive funding for the Quality Payment Program are due on July 28.
Rural Health Related Bills Introduced this Month
Sen. Jon Tester (D-MT) introduced legislation (S. 3030) to encourage more medical professionals to practice in rural communities and increase the number of providers training in rural settings. The bill would count resident time spent in a critical access hospital as time spent in a non-provider setting for the purposes of making Medicare direct and indirect graduate medical education payments.
Rep. Michael Burgess (R-TX) introduced a bill (H.R. 5395) that would increase patient access to specialty care through telehealth. The bill is intended to connect specialty physicians with primary care providers in rural areas. A companion bill was introduced in the Senate earlier this year by Sen. Orrin Hatch (R-UT) and Sen. Brian Schatz (D-HI).