The following update was provided by Hall Render, NOSORH Legislative Liaison:

115th Congress Begins Session
On January 3, lawmakers were sworn-in for the beginning of the 115th Congress. The Republican controlled House and Senate returns to Washington with a lengthy to-do list of legislative items.

Senate Majority Leader Mitch McConnell (R-KY) has vowed the Senate’s first action will be bringing to the floor a budget that includes a fast-track process allowing Senate Republicans to repeal parts of the Affordable Care Act (ACA) through a simple majority vote. The House is expected to follow suit after the Senate acts, presumably the week of January 9.

The short-term Republican goal is to clear the budget before President-elect Trump takes office on January 20.  While the budget won’t technically repeal the ACA, the fast-track process, known as reconciliation, contains instructions for committees to write ACA repeal bills. Republicans would like to have an actual repeal bill on the President’s desk by the end of February.

The starting place for a repeal and replace bill is the reconciliation package passed by the House and Senate in December 2015, but vetoed by the President. That bill included a two-year transition for most of the replacement provisions to take effect. The bill would eliminate many of the ACA mandates, including the individual and employer mandate by eliminating penalties for failure to comply and make comprehensive Medicaid reforms.

Limiting Article 1 Authority:  Another early agenda item for Congressional Republicans will be passing the REINS Act, a measure that would require congressional approval of any executive branch regulation that costs more than $100 million.

Republicans also intend to pass a “midnight rules” bill that would allow Congress to repeal recent Obama regulations under the Congressional Review Act. The law allows Congress to rescind any regulations that had been approved in the prior 60 legislative days with a simple majority vote in both chambers.

Appropriations:  Republicans start the new Congress saddled with two spending bills crammed into one year. In December, Congress passed a continuing resolution that keeps the government running through April 28. This means Congress will now have to deal with both the fiscal 2017 and fiscal 2018 spending bills this year.

The process will begin when the White House submits their first full budget request. Traditionally, this gets done in early February, however, President Obama submitted his first budget months late and many expect Trump to do the same. This could significantly delay floor action on spending bills.

Telemedicine Bill Signed into Law
In December, the House passed S. 2873, a Senate-passed bill that promotes telemedicine. The Expanding Capacity for Health Outcomes Act (ECHO Act) asks HHS to study whether telemedicine could promote collaborative clinical learning and disseminate best practices among providers, primarily those in rural and underserved areas. The bill was signed into law in late December by President Obama.

According to the bill sponsors, Senators Orrin Hatch (R-UT) and Brian Schatz (D-HI), the bill is intended to increase access to healthcare in rural areas though Continuing Medical Education focused on telehealth technology.

Additionally, the ECHO Act would require the HHS Secretary to submit a report to Congress by December 2018 about the use and integration of these models by healthcare providers and the impact on healthcare provider retention as well as on the quality of, and access to, care for patients. The report directed HHS to address barriers faced by healthcare providers in adopting these models and ways such models have been funded by HHS over the past five years.

Congress Passes 21st Century Cures Bill in Final Days of 2016
In December, the Senate passed the sweeping 21st Century Cures bill (H.R. 34), clearing the way for President Obama to sign the bill into law. The comprehensive $6.3 billion medical research funding bill includes FDA reform, mental health reforms, funding for opioid abuse and minor changes to Medicare.

The bill includes provisions to change site-neutral policies for facilities under construction and excludes prospective payment system-exempt cancer hospitals from the site-neutral payment policies. The bill also includes a provision that would allow for certain safety net hospitals to compare their readmission rates against each other, instead of against all hospitals. The change in calculation of penalties would kick in during fiscal year 2019.

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