The March meeting of the NOSORH policy committee included discussion on NOSORH’s strategy on an appropriation increase. Based on the current environment, the committee made a recommendation to the Board to adjust the request to Congress for SORH appropriation down to a $1 million increase for the SORH line. This is a decrease from the ask made during NRHA’s Policy Institute and hill visits. Members of Congress are preparing for appropriation requests and many have a process of receiving and vetting requests through a required form. It’s time for you to check in with your members and make requests. For help or questions, please contact Teryl Eisinger, Executive Director.

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

Appropriations Update:  Funding for the federal government expires on April 28. Congressional leaders have indicated that their goal is to update fiscal year 2017 spending levels and not pass another continuing resolution. The procedural strategy is to group all remaining fiscal 2017 bills, which includes the Labor-HHS appropriations bill, into an omnibus and send it to the White House. Congressional leaders from both sides have indicated negotiations on the appropriations bill are progressing despite two potential hurdles.

The White House is asking Congress to cut $18 billion from discretionary spending bills for FY 17. The proposed cuts would be absorbed over the five months left in the current fiscal year. The Trump administration is calling for broad across the board cuts with the Labor-HHS spending bill seeing the steepest cuts. Much of the administration’s proposed cuts would come through grant funding. The second hurdle is the calendar, as Congress is scheduled to be in session for only eight legislative days in April.

Fiscal Year 2018 Budget Request: Earlier in March, the Trump Administration released a broad budget request to Congress. The blueprint proposes to cut HHS spending by 18 percent for fiscal year 2018. The plan sets HHS’ budget at $69 billion, a decrease of roughly $15 billion from 2017. The budget however does not touch Medicare or Social Security nor does it address changes to mandatory spending. The budget also doesn’t address specific funding levels for HHS programs and sub-agencies such as Health Resources Services Administration. The Trump Administration will address this in a more detailed budget that’s expected to be released in May.

The proposed HHS funding cuts has run into significant resistance from Congress. Members on both sides of the aisle have expressed concerns with the President’s proposed funding levels.

AHCA Pulled Before House Vote: On March 30, Republican leadership in the House pulled the American Health Care Act (AHCA) minutes before a vote was scheduled to take place. The move comes after Republican conservatives and moderates in the House found themselves unable to align on a bill that would repeal large portions of the ACA and significantly reform the Medicaid program.

Prior to the decision to the pull the bill, NOSORH wrote to Congress to express concerns about the impact the AHCA could have on rural communities. NOSORH wrote that in the AHCA’s current form, the bill could threaten the stability of the rural health system. Click here to read the letter.

Despite the significant setback, House Republicans met this week in attempt to find a solution on the repeal and replace of the ACA. While it’s unclear if the House leadership will attempt to bring an ACA repeal bill back to the floor this year, House Speaker Paul Ryan (R-WI) told reporters late Friday, “We’re going to be living with Obamacare for the foreseeable future.”

There are a number of reasons to be pessimistic about the chances of an ACA repeal bill getting done this year. The biggest being that the House Freedom Caucus (Caucus) has not changed their position and there is a belief that other than full repeal, there is little the Caucus can support. The White House has also indicated little appetite to bring back the ACA debate. The Trump Administration seems intent on moving to tax reform coupled with an infrastructure bill.

HHS Delays CMMIs Bundled Payments, 340B Ceiling Price, FDA Rule: On March 20, CMS published an interim final rule further delaying two Medicare bundled payment programs from the CMS Innovation Center (CMMI). The Federal Register Notice postpones an expansion of its bundled payment program for knee and hip replacements and the Cardiac Rehabilitation Incentive Payment Model. The programs were part of a final rule issued in December. While a member of Congress, HHS Secretary Tom Price was critical of CMMI’s mandatory demonstration programs.

On March 27, the Health Resources and Services Administration (HRSA) delayed implementation of the 340B ceiling price and civil monetary penalty rule. HRSA previously delayed implementing the rule from March 6 until March 21, and the interim final rule released on March 17 delays implementation until May 22. HRSA is also seeking comments on whether to further delay the rule until October. The rule, which was finalized shortly before the start of the Trump Administration, laid out penalties for manufacturers that “knowingly and intentionally” overcharge 340B providers.  HRSA has also indicated it intends to take a broader look at the 340B program.

And on March 20, the FDA published a notice in the Federal Register delaying the implementation of the final rule regulating off-label drug promotion until March 19, 2018.

Rural Health Related Bills Introduced in March

Rep. Karen Bass (D-CA) introduced the Health IT Modernization for Underserved Communities Act. The bill (H.R. 1604) would amend title XIX of the Social Security Act to extend to physician assistants eligibility for Medicaid incentive payments for the adoption and use of certified electronic health records, whether or not such physician assistants practice at a rural health center or Federally qualified health center.

Senator Jon Tester (D-MT) introduced a bill (S. 455) that would amend title XVIII of the Social Security Act to count time spent in a critical access hospital as resident time spend in a non-provider setting for purposes of making Medicare direct and indirect graduate medical education payments.

Rep. Lynn Jenkins (R-KS) introduced a bill (H.R. 1284) that would amend title XVIII of the Social Security Act to provide that physician assistants can provide primary care to hospice patients, which is not currently covered under Medicare payment policy.


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