Policy Update

i Apr 1st No Comments by

The NOSORH Policy Committee asks that all SORH and their partners reach out to their members on appropriations.  NOSORH is seeking an increase in appropriations for the SORH line to $12.5 million to match the SORH authorization language. Please check in with your members of the appropriations committee to ensure their support of increased appropriation, determine the deadline for any requested submission and ask for their support. Please contact Andrew Coats, Legislative Liaison, if you need assistance or with any questions. 

President Releases Fiscal Year 2020 Budget Proposal
On March 11, President Trump released his administration’s fiscal year 2020 budget. As it goes for every presidential budget, the proposal stands zero chance of being implemented in its entirety.  The condensed version of the budget can be found here.

The Health Resources and Services Administration’s (HRSA) budget request does not request funding for the Rural Hospital Flexibility program, State Office of Rural Health, and the Rural Residency Planning and Development. The lack of the funding has been consistent with HRSA budget requests in recent years. With Congress passing into law the Reauthorization of the SORH program at the end of the 2018, we remain hopeful that Congress will fund the SORH line as called for in recent law.

Other health care priorities include: 

Medicaid: The budget calls for trillions in cuts to the growth of Medicaid (and Medicare). The administration is seeking to overhaul Medicaid through block grant funding. By implementing block grant or per capita caps, this would cut $1.5 trillion over 10 years in Medicaid spending.

340B: The budget also calls for giving HRSA more control over 340B by asking for “broad regulatory authority for 340B to set enforceable standards of program participation.” The budget requests Congress require hospitals to report their 340B savings and explain how the money is used. This was included in last year’s budget, and there were a couple bills introduced last Congress mirroring this. If Republicans couldn’t move this last year, there is little chance in the new Congress.

Bad Debt and Uncompensated Care: The budget calls for bringing “transparency to several Medicare payments to hospitals.” The proposal calls for reducing the reimbursement for bad debt from 65 percent to 25 percent over three years starting in fiscal year 2021. Rural hospitals with fewer than 50 beds, critical access hospitals, rural health clinics and FQHCs would be exempt. The budget also proposes to cut uncompensated care payments. Starting in fiscal year 2021, uncompensated care payments would be made to hospitals based on their share of charity care and non-Medicare bad debt, as included on their Medicare cost-reports. The bad debt proposal would save $38.5 billion over 10 years and the uncompensated care proposal would save $98 billion over 10 years.

Others: Another hospital-related proposal of note would consolidate the Hospital Value-Based Purchasing Program, Hospital-Acquired Condition Reduction Program and Hospital Readmissions Reduction Program into a single program.

House Democrats Unveil Single-Payor Legislation
House Democrats introduced sweeping “Medicare for All” legislation, providing the most detailed plan to overhaul the current healthcare system by enrolling all U.S. residents in a single-payer, government-run health plan. It would cover a more expansive set of benefits than the current Medicare program and restructure payment for institutional healthcare providers such as hospitals and skilled nursing facilities. The measure does not include a price tag or specific proposals for financing the new system, which analysts estimate would cost tens of trillions of dollars over a decade. The lead sponsor, Rep. Pramila Jayapal (D-WA), said she will release a separate list of suggested funding mechanisms.

The single-payor, government-run healthcare system under Medicare for All would cover a range of services at no out-of-pocket cost to patients. The measure would not only cover primary and preventive care, as well as inpatient and outpatient hospital services, but also long-term care support services that are not currently covered by Medicare. Every insurance program in the U.S. would be changed, leaving only the veterans’ health program and the Indian Health Service in place. Providers such as hospitals or skilled-nursing facilities would be paid through a global budget so that hospitals would receive a quarterly lump sum to cover items and services. Additionally, individual providers would be paid based on a national fee schedule set by the HHS secretary. A section-by-section summary of the bill, along with other information on the legislation, can be found here.


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