The NOSORH Policy Committee meets the third Tuesday of every month at 2:00 pm Eastern and hears regular policy updates from key partners. A summary of relevant policy and regulatory issues is shared and discussed- click here for this month’s update. The committee is dedicated to addressing policy issues relevant to SORH, including the reauthorization of the SORH program and increasing appropriations. It is expected that legislation to ensure SORH reauthorization will be introduced within the next week. Watch your email for more information on the support needed and a draft of the SORH language.

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

Congress Celebrates National Rural Health Day

On November 16, Congress celebrated National Rural Health Day. NOSORH hosted a webinar that had a number of Congressional staffers on the call. The Senate Rural Health Caucus led by Senator Pat Roberts (R-KS) is actively working to introduce the State Offices of Rural Health Reauthorization Act of 2017. This bill would be a stand-alone measure reauthorizing the SORH program for five years.

On the appropriations front, federal funding is set to expire on December 8. Congress will most likely extend FY 17 funding through a Continuing Resolution for up to one month in hopes of brokering an omnibus spending deal for FY 2018 funding.

FCC Promotes Broadband Expansion

The Federal Communications Commission (FCC) released a draft notice of proposed rulemaking to review its Rural Health Care Program. The goal of the rulemaking is to meet the increasing demand for broadband telehealth services. After the program exceeded the cap in both 2016 and 2017, the FCC also released a draft order to waive the program’s $400 million cap on a one-time basis and consider a permanent expansion of funds. The notice ensures sufficient funding for rural healthcare providers and simplifies program participation. The proposed rulemaking will be addressed at a public hearing on December 14.

Bill Introduced to Prevent 340B Cuts

On November 14, a bipartisan bill was introduced to prevent CMS from implementing the $1.6 billion cut to the 340B drug discount program. The legislation, introduced by Reps. David McKinley (R-WV) and Mike Thompson (D-CA), pushes HHS to maintain the current 340B discount rate of Average Sales Price (“ASP”) + 6 percent. In the 2018 OPPS final rule, CMS revised the payment rate to ASP -22.5 percent, which amounts to an overall cut of more than 28 percent. On November 13, a group of hospital associations and health systems sued the Trump administration in D.C. federal court to block the payment cuts before they are set to begin on January 1.

Proponents of the legislation will push lawmakers to pass it despite opposition from many House and Senate Republicans who have questioned the substantial increase in 340B spending in recent years. If the measure were to pass both houses of Congress, it could very well be vetoed by President Trump, who is unlikely to overturn a decision made by the leadership of CMS that he appointed. Last month, 228 members of the House signed a letter in opposition to the then-proposed 340B cut, while a bipartisan group of 57 senators signed a similar letter.

House E&C Committee Holds MACRA Hearing

On November 8, the House Energy & Commerce Health Subcommittee held a hearing on implementing alternative payment models for physicians and other clinicians under MACRA. In order to boost participation in the alternative payment model provided by MACRA, physician groups claim they need more government support to address barriers, which include the need for technical assistance to help doctors transition from fee-for-service to value-based care, greater access to shared data and the need to test new small-scale models. The hearing occurred the week after CMS finalized a proposed rule to exempt more small providers from complying with MACRA.

Congress is hearing from a range of hospital stakeholders about improving quality and reducing the burden under the Merit-Based Incentive Payment System (“MIPS”). Health Subcommittee Chairman Rep. Michael Burgess (R-TX) has said that MIPS will get its own hearing “in the very near future.”

Physician Payment Rule Released by CMS 

CMS released the CY 2018 Physician Fee Schedule final rule on November 2. The rule finalizes a policy to pay off-campus facilities 40 percent of what would have been paid under outpatient service rates. The reduction in payment is less severe than the agency’s initial proposal to cut payments in half. While CMS argues this change will promote more competition between hospitals and physician practices, providers are criticizing the decision because it would decrease access to care at off-campus facilities in already underserved communities.

CMS will also pay for new telehealth services, such as health risk assessments, psychotherapy for crisis and care planning for chronic care management.

House Passes CHIP Funding Legislation

On November 3, the House passed a bill to reauthorize the Children’s Health Insurance Program (“CHIP”) for five years. After extensive debate from the parties over the pay-for provisions prior to the vote, the proposal passed on a party-line vote: 242 to 174. The measure also includes funding for federally qualified health centers and other health programs. The CHIP funding bill is now moved to the Senate for consideration. While House Republicans passed this legislation, many consider the effort not grounds for a deal since it was partisan. Funding for CHIP has been expired for nearly 60 days so many states have relied on temporary cash infusions from the federal government to fund their programs.

Rural Health-Related Bills Introduced this Week

Rep. Greg Gianforte (R-MT) introduced a bill (H.R. 4390) to reauthorize the rural emergency medical service training and equipment assistance program under section 330J of the Public Health Service Act. Rep. Jodey Arrington (R-TX) introduced a bill (H.R. 4178) to amend Title XVIII of the Social Security Act to provide for a permanent extension of the Medicare-dependent hospital program.

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