The following update was provided by Hall Render, NOSORH Policy Liaison:
FY 20 Spending Bills Introduced in Congress
On April 29, the House Labor-HHS Appropriations Subcommittee introduced their fiscal year (FY) 2020 spending bill. The bill provides $12,500,000 for the State Offices of Rural Health, a $2.5 million increase over FY 2019 funding. Also included in the spending bill is $59 million for Medicare Rural Hospital Flexibility Grants and $19,942,000 for the Small Rural Hospital Implementation Grant Program. The House subcommittee meets on April 30 to advance the spending bill to the full House Appropriations Committee. The Senate Labor-HHS subcommittee is expected to introduce their spending bill in May. Funding for FY 2020 begins on October 1, 2019.
CMS Proposes Changes to How Rural Hospitals Are Paid
On April 23, CMS issued its proposed hospital inpatient payment update for fiscal year 2020. In particular, CMS proposed changing the formula to reimburse rural hospitals. The proposal changes how it calculates the Medicare wage index to limit the disparity between what high-and-low-wage index hospitals get paid. If implemented, the rule would increase the wage index for hospitals below the 25th percentile, and decrease the wage index for hospitals above the 75th percentile. The proposal would be in effect for at least four years starting this October. Decreases in a hospital’s wage index would be capped at five percent for FY 2020. The Medicare wage index has long been a source of frustration for Congress. The deadline for submitting comments on the proposed rule is June 24, 2019.
House Committee Advances Legislation to Bolster ACA
During the first week of April, the House Energy and Commerce Committee advanced six measures intended to bolster the ACA. The measures include more funding for state-based ACA marketplaces, federal navigator programs and a reinsurance bill intending to lower ACA premiums (H.R. 1385, H.R. 1386, H.R. 1425).
The three other measures passed are focused on Trump administration policies aimed at changing the ACA: H.R. 1010 reverses the administration’s expansion of short-term health plans; H.R. 986 requires the administration to rescind guidance that made it easier for plans to soften protections for pre-existing conditions; and H.R. 987 that would restore ACA outreach and enrollment funding.
This legislation was advanced hours after the House passed a resolution condemning the Trump administration’s decision to support a federal court case in Texas that repeals the ACA. In a 240 to 186 vote, the House passed a resolution calling on the Justice Department to “halt its new advocacy for abolishing the Affordable Care Act,” which the measure calls ‘an unacceptable assault’ on Americans’ health care. The resolution is largely symbolic, as the Republican-led Senate will not advance the measure.
Rural Health Bills Introduced this Month
Sen. Shelley Moore Capito (R-WV) introduced S. 1190 to amend Title XVIII of the Social Security Act to provide for payments for certain rural health clinic and federally qualified health center services furnished to hospice patients under the Medicare program. The bill would remove a statutory barrier in current law that inhibits seniors’ access to hospice in rural communities, allowing them to receive hospice from their local primary care practitioner. The bill seeks to allow RHCs and FQHCs to receive payment for practitioners’ services while caring for their patients in hospice care.
Sen. Todd Young (R-IN) introduced S. 1045 to amend the Public Health Service Act to expand the authority of the HHS Secretary to permit nurses to practice in health care facilities with critical shortages of nurses through programs for loan repayment and scholarships for nurses.