There is much work to be done to keep members of Congress up to date on the work of your SORH. Summer recess brings many members home to their district, so take that opportunity to attend their meetings, reach out to local contacts, even consider offering them a site visit to a rural clinic or community to help them understand the needs your SORH is addressing. NOSORH is ready to help you prepare and position your SORH and stakeholders to tell their story. To keep you informed of rural health policy, the Policy Committee meets each month to focus on policy issues of most importance to State Offices of Rural Health. All members of NOSORH are encouraged to attend and to sign-up for the committee information. If you are not already receiving policy updates, please contact Beth Kolf, NOSORH Program Coordinator, to be added to the Policy Committee list.

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

House Appropriators Finalize FY 2018 Spending Plans On July 12, House Appropriators advanced their funding proposal for the Labor-HHS fiscal year (FY) 2018 spending bill. The subcommittee spending level, which is known as the 302(b) allocation proposes $157.9 billion for the departments of Labor, HHS and Education. That total would be roughly two percent, or $3 billion below the current allocation of $161 billion for FY 2017. The committee funded Health Resources and Services Administration (HRSA) at $5.8 billion which is almost $400 million below FY 2017 levels but $276 million above the President’s request.

The committee recommended the same overall funding level as enacted in FY 2017. That level, $156 million, is $81 million above the president’s requested level of funding. The committee funded the State Office of Rural Health program at $10,000,000 and the Rural Hospital Flexibility Grants at $43,609,000 for FY 2018, representing small increases to both programs

The Senate is working on a slower timeline as the 12 subcommittees have only just begun consideration of FY 2018 spending levels. The first Senate appropriations subcommittee hearings are scheduled to begin in the coming weeks. Of the 12 spending bills, the Labor-HHS bill is almost always the most difficult for the House to pass due to partisan policy riders and spending levels. The slower Senate pace will most likely lead to the Labor-HHS funding bill to be wrapped into an omnibus spending package.

Senate Postpones Vote on BCRA

The Senate postponed voting on a procedural motion to advance the Better Care Reconciliation Act (BCRA). The vote is a major setback for Republicans as they lacked a majority of votes to bring the bill to the Senate floor for full debate. The announcement to postpone comes less than a week after Senate Republicans released their revised health reform bill.

The latest version doesn’t make significant changes to the Medicaid overhaul proposed in the original BCRA, which would cut nearly $800 billion rolling back the ACA’s Medicaid expansion and capping payments for each enrollee. The latest version of BCRA does makes changes intended to allow for more accurate Disproportionate Share Hospital (DSH) related decisions by changing the DSH calculation from per Medicaid enrollee to per uninsured.  Among other new features, the latest draft also keeps some ACA-related taxes on the high-income earners and directs more than $100 billion in new spending to help low-income Americans buy coverage and combat the opioid epidemic.

It’s worth noting that the effort to repeal the ACA is not completely dead. Senate Majority Leader McConnell (R-KY) still plans to hold a procedural vote soon that’s likely to fail. There has been discussion of shifting to a repeal and delay strategy which would repeal major portions of the ACA and replace them at a later time.

CMS Releases 2018 Physician Fee and HOPD Payment Rules

On July 13, CMS released their proposed 2018 payment and policy rule for the Physician Fee Schedule. The proposed rule would update Medicare payment rates for doctors who treat Medicare patients in calendar year (CY) 2018. CMS estimates a 0.31 percent increase in physician payment rates for CY 2018 compared to 2017. It also proposes the addition of new telemedicine payment codes doctors can bill for including psychotherapy for crisis, Health Risk Assessments and care planning for chronic care management. CMS released a fact sheet further detailing the proposed rule.

On the same day, CMS also released a proposed rule that updates payments rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS). The rule proposed to increase prospective payment system rates by 1.75 percent beginning in CY 2018 compared to CY 2017.

Among the provisions in the rule, CMS is proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through 340B at the average sales price minus 22.5 percent, rather than average sales price plus 6 percent. The rule keeps in place Stage 3 meaningful use requirements. The rule would also reinstate for CY 2018 and 2019 the moratorium on enforcement of the direct supervision requirement for outpatient therapeutic services for critical access hospitals and small rural hospitals with 100 of fewer beds.

As the agency has done in other proposed rules including the physician fee schedule, CMS is releasing within the proposed rule a Request for Information on making the Medicare program more flexible and efficient. CMS issued a fact sheet detailing the OPPS rule. Comments on the rule are due by September 11, 2017.

CMS Releases 2018 MACRA Proposed Rule

On June 20, CMS published the massive 2018 MACRA rule. The 1,058 page proposed regulation carries out the 2015 law that seeks to overhaul the payment of doctors based on quality measures. CMS stated the goal behind the regulation is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare.

The proposed rule would amend some existing requirements and contains new policies for doctors and clinicians participating in the Quality Payment Program that would encourage participation in either Advanced Alternative Payment Models or the Merit-based Incentive Payment System (MIPS).

CMS had already exempted from MIPS doctors who either bill Medicare no more than $30,000 a year or see fewer than 100 Medicare beneficiaries. In the CMS proposal, the threshold will be increased to $90,000 in Medicare charges or 200 Medicare beneficiaries.

Doctors in small practices also could seek exemptions from electronic health record requirements. Additionally, CMS proposed delaying a requirement to upgrade electronic health records (EHR) for practices of all sizes.  The rule calls for encouraging providers to upgrade to 2015 certified EHR technology by offering bonus points on performance scores of those that made the switch.

Rural Health Related Bills Introduced this Month

Senator Roger Wicker (R-MS) and Brian Schatz (D-HI) reintroduced legislation that would allow non-rural health providers that serve predominately rural areas to become eligible for the FCCs rural broadband support fund. Currently, the FCC program is only available to providers in rural areas.

Rep. Sam Graves (R-MO) introduced a bill (H.R. 2957) that would amend titles XVIII and XIX of the Social Security Act to provide enhanced payments to rural health care providers under the Medicare and Medicaid program.

Senator Chuck Grassley (R-IA) introduced a bill (S. 1351) to amend the public Health Service Act with respect to the designation of general surgery shortage areas. A companion bill (H.R. 2906) was introduced in the House by Rep. Larry Bucshon (R-IN).

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