NOSORH is preparing members for the National Rural Health Association’s Policy Institute next week. A membership meeting will be held February 6th at 5:30 PM in the Capitol Room at the Omni Shoreham hotel, with a reception to honor former Federal Office of Rural Health Policy employee, Keith Midberry. A fact sheet on the request for increased appropriation for SORH is available on the NOSORH website.  Any member SORH who would like support preparing for a hill visit, please contact NOSORH Legislative Liaisons Andrew Coats or John Williams.

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

Trump Issues Executive Orders Aimed at Curbing Regulations

In the two weeks since being sworn-in as President, the Trump administration has issued a number of executive orders intended to slow the regulations coming out of federal agencies.

On January 20, the administration issued a 60-day regulatory freeze that requires federal agencies to not publish any new regulations or guidance documents unless approved by a Trump appointee. The memorandum, which has been standard for incoming administrations, also states that any Obama regulations that have been published but not yet taken effect be postponed 60 days for review. The memo states that regulations and guidance subject to statutory or judicial deadlines should be excluded from the regulatory freeze. CMS has three outstanding rules under review by the Office of Management and Budget. These were a proposed rule on Medicaid Supplemental Payment and Accountability, a final rule on program integrity, and an interim final rule on preexisting condition insurance plan program updates.

The administration issued a January 30 executive order announcing the policy of the executive branch that for every one new regulation issued, at least two prior regulations be identified for elimination. Specifically, whenever an executive department or agency publicly proposes for notice and comment or otherwise promulgates a new regulation, it shall identify at least two existing regulations to eventually be repealed. The order will also apply to guidance documents, as long as the guidance meets the definition of a regulation outlined in the executive order.

The order also requires agencies to control the costs of all new rules within their budget. Under the order, agencies will also be prohibited from imposing any new costs in finalizing or repealing a rule for the remainder of 2017 unless that cost is offset by the repeal of two existing regulations.

On January 23, the administration issued an order putting into effect a hiring freeze for all public employees. The order states that no vacant positions existing at noon on January 22, 2017, may be filled and no new positions may be created, except in limited circumstances.

Senate Seeks Confirmation of Price as HHS Director

On January 31, the Senate Finance Committee was scheduled to confirm Rep. Tom Price as the new Secretary of Health and Human Services. The confirmation vote was delayed due to Senate democrats’ objections to Price. Despite the delay, final confirmation is expected. The confirmation comes after consecutive weeks of appearances before the two prominent Senate Committees with health jurisdiction.

January 18, Price testified before the Senate HELP Committee in what turned out to be the longest nomination hearing the committee has held in over two decades. Price answered questions for over four hours from senators on both sides of the aisle covering the health care spectrum. Senate Democrats questioned the former Georgia lawmaker for legislation he sponsored in the House that would cut Medicare and block grant Medicaid funding to the states. Price responded that he would not pull the rug out from beneficiaries. He also touted the Indiana Medicaid expansion program that Vice President Pence developed with CMS Administrator-nominee Seema Verma as a “best practice” for Medicaid reform.

In responding to a question from HELP Chairman Lamar Alexander (R-TN), Price agreed that there was a “bipartisan consensus” in the 21st Century Cures Act, which was signed into law in December, to reform meaningful use, in particular the third stage.

Price also spoke in support of telemedicine during his hearing, noting that “exciting innovation” was improving access to doctors throughout the country. Price delivered tempered praise for the Center for Medicare/Medicaid Innovation when asked if he would eliminate the ACA-created body to test new ways to pay hospitals and other providers.

On January 24, Price appeared before the Senate Finance Committee for his formal confirmation hearing. Price indicated the administration does not intend to administratively eliminate the individual mandate before Congress acts to replace the law. Price used the hearing to voice support for telemedicine and the CMS Innovation Center and was critical of many Obama era regulations, including meaningful use and the impact it has on rural providers.

Trump Signs Executive Order to Start ACA Repeal Process

Hours after taking the oath of office on January 20, President Trump signed a two-page executive order that encourages federal agencies to take whatever steps possible to “ease the burdens” on individuals and states created by the Affordable Care Act (ACA).

While the executive order carries no immediate effect, and the ultimate impact won’t be known until HHS Nominee Tom Price is confirmed, federal agencies like HHS, Treasury and the IRS could use the order to undue executive rules and guidance created by the Obama administration to originally implement the ACA. Most notably, the Trump administration could stop enforcing the mandate requiring individuals to purchase health insurance. In addition, the order directs agencies to provide relief to states, which many believe is a nod toward expanding the ACA’s 1332 waiver program that provides states discretion to implement the health law.

Symbolically, the order may alleviate pressure on Congress to immediately repeal the ACA. A number of leading congressional Republicans have indicated they are looking for executive relief against the ACA while Congress works to repeal and replace. Senate Health Committee Chairman Lamar Alexander (R-TN) indicated that the ACA replacement process, including implementation, could go on for several years and stated it will consist of a series of bills rather than a single comprehensive bill.

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