NOSORH Policy leadership met last week and planned responses to Congress on the FY 18 budget request. Letters have been sent to the Senate and House Appropriations Committee Chairs and to key legislative contacts NOSORH leadership met last month. Appropriations Chairs are accepting comments from congressional members on the committees through June 9 on the President’s budget. Please use these NOSORH letters to be in touch with your members of congress to make comment to support SORH and FLEX funding. You may see members of Congress during their upcoming recess. This is an excellent time to share the work of your SORH and Flex programs with them. If you need help with a state fact sheet or any other messages, please contact Donnap@nosorh.org. Watch your email for images you can use on social media to grow support for SORH work.
The following detailed update was provided by Hall Render, NOSORH Legislative Liaison:
Congresses Passes FY 2017 Spending Bill
On May 5, the President signed into law the fiscal year (FY) 2017 omnibus appropriations bill a day ahead of the midnight deadline. The Consolidated Appropriations Act of 2017 (H.R. 244) enjoyed wide bipartisan support in both the House and Senate and provides discretionary funding for the federal government through at least September 30, 2017.
The bill includes $73.5 billion for Health and Human Services (HHS), a $2.8 billion increase from FY 2016. The Health Resources and Services Administration (HRSA) would receive a $6 million increase for rural health programs. Within the HRSA account, a $2 million increase was provided for Rural Hospital Flexibility (FLEX) grants and the State Offices of Rural Health (SORH) were provided a nearly $500,000 increase over FY 2016. Also within the HRSA account, telehealth would receive an extra $1.5 million, bringing its total to $18.5 million.
White House Submits FY 18 Budget Request to Congress
With both parties strongly backing the FY 2017 spending bill, attention in the appropriations process shifts to FY 2018, which begins in October. On May 23, the White House submitted their proposed fiscal year (FY) 2018 budget request to Congress. The HHS budget request calls for a $610 billion cut to Medicaid and a $12.4 billion cut to HHS’ discretionary funding.
The proposal calls for nearly a 50 percent funding cut to rural health. Included in the cut was zeroing out funding for SORH and FLEX Grants. The SORH and FLEX programs were part of a larger group of HRSA cuts. In total, HRSA funding was down by 10 percent with its telehealth funding reduced from $17 million to $10 million.
Like every Administration’s budget request, the proposal is non-binding with Congress and generally not aimed at seeking bipartisan agreement. Congress has the ultimate say in funding and has shown a preference for funding rural health.
Senate Begins Work on House-Passed AHCA
Republican senators will work through June to make changes to the House-passed American Health Care Act (AHCA). When Congress returns the week of June 5, the House is expected to officially hand over the AHCA to the Senate after the Congressional Budget Office (CBO) confirmed the bill meets the Senate’s procedural requirement of saving at least $2 billion over 10 years.
In their report, CBO detailed that 14 million fewer people will be insured one year after passage and 23 million fewer will be insured in 10 years. These numbers alone will make it difficult for Senate Majority Leader Mitch McConnell (R-KY) to deliver the needed 50 votes for passage. CBO also estimated that the AHCA would cut spending on Medicaid by $834 billion and the program would cover 14 million fewer people.
Republican members have made no secret that the House-passed AHCA will undergo a substantial move back to the center as they seek the magic 50 votes for passage (Vice President Pence would break a 50/50 tie). Changes are believed to include increased funding for rural hospitals that lose subsidies under Affordable Care Act (ACA) repeal, providing a larger share of tax credits to lower income consumers nearing Medicare age (aged 50 to 64) and beefing up the high-risk pool funding for states.
The most optimistic timeline for Senate passage is by the July 4 recess which begins June 30. Republicans then hope the House and Senate are able to reconcile the changes and send it to the White House by the beginning of August.
Senate Finance Advances Telemedicine Bill
On May 18, the Senate Finance Committee marked up the bipartisan CHRONIC Care Act (S. 870) which contains a number of telemedicine related provisions. The bipartisan bill allows Medicare to pay for remote stroke diagnosis and treatment, ACOs to provide telemedicine, Medicare Advantage plans to offer telemedicine as a supplemental benefit, as well as fund home dialysis treatment through telemedicine.
The telemedicine related provisions would increase Medicare spending by $150 million over 10 years according to a Congressional Budget Office (CBO) score. The last public CBO score of telemedicine was back in 2001, when Congress created 1834(m) to allow Medicare to pay for live telemedicine interactions for rural patients in health care settings. The fate of S. 870 is unclear on the House side. The House and HHS Secretary Tom Price are seeking to address Medicare payment issues but spending concerns could be a roadblock.
Rural Health Related Bills Introduced in May
Senator Charles Grassley (R-IA) introduced a bill that seeks to create a new Rural Emergency Hospital classification under Medicare. Under the proposed legislation, the hospital would not have to maintain a minimum number of inpatient beds, but would be required to have an emergency room and outpatient services. Under the new classification, it would be required to maintain protocols to rapidly expedite patients to larger facilities if necessary.
Rep. Sean Duffy (R-WI) introduced a bill that seeks to expand coverage of telehealth services under Medicare to provide coverage for home-based monitoring for congestive heart failure and chronic obstructive pulmonary disease. The bill (H.R. 2291) expands telehealth services to rural clinics and Metropolitan Statistical Areas of 70,000 people or fewer.
Rep. Diane Black (R-TN) introduced a bill (H.R. 2556) seeking to expand access to telehealth services under Medicare.