Policy

Policy Update

i Mar 30th No Comments by

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

State Office of Rural Health Bill Nears Finish Line in Senate

During the week of March 19, Senate leadership hotlined (fast-tracked without debate) the State Offices of Rural Health Reauthorization Act of 2018 (S. 2278) through the Senate. Without any of the 100 members objecting, the SORH bill is now set to pass the Senate.

The Senate parliamentary procedure came weeks after the Senate Health, Labor, Education and Pensions (HELP) Committee voted to advance the bill out of committee. The bill advanced after an amendment was agreed to which increases the authorization of appropriations level to $12,500,000 for each of the fiscal years 2018 through 2022. The bill passed the committee unanimously.

Major Spending Bill Passes Congress

On March 23, President Trump signed a major $1.3 trillion spending bill into law, which keeps the government funded through September 30, 2018. The bill passed the House 256-167 and the Senate 65-32. In both bodies, the measure received the support of a majority of members from each party. In the Senate, unanimous consent was needed from all senators to waive procedural rules and set up votes before Friday’s midnight deadline.

The bill includes a total of $78 billion ($10 billion above FY 2017) for the Department of Health and Human Services. Within the HHS funding, the Centers for Medicare & Medicaid Services (“CMS”) received $4 billion in funding for administrative expenses, the Health Resources and Services Administration received $7 billion and the Substance Abuse and Mental Health Administration received $5 billion. The legislation includes nearly $4 billion in resources to combat the opioid crisis through investing in treatment, prevention and law enforcement efforts. More than $2.3 billion in funding is provided for mental health programs and other training.

Rural communities will see a $135 million increase in healthcare program funding, including $100 million for drug addiction treatment and prevention. In addition, Congress appropriated $10 million annually for the State Offices of Rural Health and $49.6 million for rural hospital flexibility grants.

Two provisions that were not included in the bill are stabilization of the ACA’s health insurance markets and providing coverage for patients with high medical costs. The first measure, known as the Alexander-Murray provision, would have reinstated government subsidies paid to health insurers. The second would have provided funding to help states set up high-risk insurance pools to provide coverage for people with high medical costs. Though the ACA stabilization proposal had already been negotiated on a bipartisan basis, Republicans wanted to include language that would ban federal funds from being used for abortions, which Democrats said was a non-starter.

House Energy and Commerce Committee Reviews Solutions to Combat the Opioid Crisis

On the week of March 19, the House Energy and Commerce Health Subcommittee wrapped up a two-day hearing examining 25 bipartisan bills addressing the opioid crisis. The legislation focused on prevention and public health solutions. Energy and Commerce Chairman Greg Walden (R-OR) stated “The unprecedented plague of opioid addiction and substance use disorder in our country requires an unprecedented response.” Legislation reviewed included Jessie’s Law, introduced by Reps. Tim Walberg (R-MI) and Debbie Dingell (D-MI), which would help ensure doctors have access to a consenting patient’s prior history of addiction in order to make fully informed care and treatment decisions.

The Poison Center Network Enhancement Act of 2018 (H.R. 5329), authored by Reps. Susan Brooks (R-IN) and Eliot Engel (D-NY), was discussed to reauthorize the important network of centers within the National Poison Data System that offer free, confidential, expert medical advice 24 hours a day, seven days a week. Oftentimes these programs serve as the primary resource for poisoning information and help reduce emergency room visits. Lawmakers also spent a lot of time debating legislation known as the Overdose Prevention and Patient Safety Act (H.R. 3545) introduced by Reps. Markwayne Mullin (R-OK) and Earl Blumenauer (D-OR). That measure would modernize substance use disorder treatment records to permit records to be shared in accordance with the Health Insurance Portability and Accountability Act for the purposes of treatment. It would also increase penalties in the event of disclosure, add breach notification requirements and provide discrimination prohibitions.

Senate Committee Hearing Assesses 340B Program

On March 15, the Senate HELP Committee held a hearing to examine the 340B drug discount program as some stakeholders have urged lawmakers to scale back its reach. HELP Committee Chairman Lamar Alexander (R-TN) said the purpose of the hearing was to learn more about the program and “how it might be improved so that hospitals and clinics can continue to provide low-income patients with help to afford their health care.” Chairman Alexander said to expect the committee to hold another 340B hearing soon, likely featuring a representative from the Health Resources & Services Administration (“HRSA”), which oversees the program.

The hearing showed a clear dividing line between Senate Democrats and Republicans on the 340B program, with Democrats advocating that savings from the program are desperately needed for the poorest populations and Republicans stating the program is being abused and needs to be reformed. Sen. Bill Cassidy (R-LA) introduced legislation for expansive changes to the 340B program, such as implementing a two-year moratorium on certain new 340B hospitals and outpatient departments and adding new reporting requirements for hospitals. By contrast, Sen. Patty Murray (D-WA) admitted that calls for transparency and accountability are appropriate, but the 28.5 percent cut CMS made last year for certain 340B drugs was “unnecessary” and fails to address skyrocketing drug costs.

House Ways and Means Committee Holds MACRA Hearing

On the week of March 19, the House Ways and Means Health Subcommittee held a hearing on implementing the Medicare Access and CHIP Reauthorization Act (“MACRA”) of 2015, which featured witnesses from CMS. Demetrios Kouzoukas, Principal Deputy Administrator and Director of the Center for Medicare, testified that the full promise of MACRA has not been realized as too few physicians and clinicians are participating in alternative payment models, and far too many clinicians find the law’s reporting requirements too burdensome. He laid out a plan to move forward on four areas of emphasis: “giving consumers greater control over health information through interoperable and accessible health information technology; encouraging transparency from payers and providers; using experimental models in Medicare and Medicaid to help patients drive value and quality throughout the entire system; and removing government burdens that impede this transformation.”

Providers and industry stakeholders have urged Congress to improve fairness and reduce burdens under the program. In the hearing, Kouzoukas urged stakeholders to work with CMS to increase innovation and submit promising ideas to the Innovation Center.

Health Care Price Transparency Working Group Created By Senators

A bipartisan group of senators are launching a working group to tackle the high price of health care. They are seeking feedback from patients, providers and insurers to help craft legislation to make health care pricing more transparent. Led by Sen. Bill Cassidy (R-LA), the group includes Sens. Todd Young (R-IN), Chuck Grassley (R-IA), Michael Bennet (D-CO), Tom Carper (D-DE) and Claire McCaskill (D-MO). The group is seeking data on what information consumers currently have about prices and out-of-pocket costs, who should ultimately be responsible for providing information to consumers and how to ensure transparency requirements don’t place unnecessary burdens on health care stakeholders.


Back to April Branch

Policy Update

i Mar 1st No Comments by

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

State Office of Rural Health Reauthorization Update
On February 28, the Senate Health, Labor, Education and Pensions (HELP) Committee voted to advance the State Offices of Rural Health Reauthorization Act of 2018 out of committee.  The bill (S. 2278) now heads to the Senate floor for a full Senate vote.  The bill advanced after an amendment was agreed to which increases the authorization of appropriations level to $12,500,000 for each of the fiscal years 2018 through 2022.  The bill passed unanimously.

On the House side, introduction of a companion bill to the House measure is likely to occur in early March. The bipartisan bill will be introduced by members of the House Energy and Commerce Committee.

Congress Passes Massive Budget Bill with Numerous Health Care Provisions
On February 9, Congress passed a two-year budget deal containing substantial implications for health care. The Bipartisan Budget Act of 2018 sets new limits on how much the federal government can spend in the next two years. The budget deal keeps the government operating until March 23, at which point Congress must pass an omnibus appropriations bill to detail spending levels for each government program for the rest of the fiscal year.

The measure sets up a two-year, $300 billion increase in spending on military and domestic programs. It includes a four-year extension of funding for the Children’s Health Insurance Program, which comes on top of the six-year extension that Congress approved last month, and provides $7.8 billion in funding for community health centers over the next two years. The bill also provides $6 billion to combat the opioid crisis and improve mental health care.

Additionally, the legislation delays the reductions in Medicaid Disproportionate Share Hospital payments for two years and fully repeals the Independent Payment Advisory Board. The measure contains significant changes to telehealth reimbursement by allowing those services to be provided as a basic benefit for Medicare Advantage enrollees, expanding the ability of accountable care organizations to use telehealth and increasing the use of telehealth for individuals with stroke symptoms.

Other health care policy provisions in the measure include the following.

  • Permanent repeal of the Medicare payment cap for therapy services
  • Two-year extension of Work Geographic Practice Cost Index floor
  • Five-year extensions of home health rural add-on payments, ground ambulance add-on payments, the Medicare-dependent hospital program and low-volume hospital adjustment
  • Payment reductions for physicians providing Medicare services, home health services, skilled nursing facilities and the Medicare and Medicaid Improvement Funds, which are reduced to zero
  • Increased civil and criminal penalties, both monetarily and via longer sentences, for federal health care fraud and abuse

Trump Budget Proposes Cuts to HHS and Entitlement Programs
On February 12, the White House released President Trump’s FY 2019 budget proposal, which seeks major cuts to the HHS, HRSA and rural health. If enacted into law, the budget would cut the HHS discretionary budget by 21 percent and slash Medicare and Medicaid spending by hundreds of billions of dollars. For the second year in a row, the budget proposed to zero-out funding for the State Office of Rural Health and FLEX grant programs.

However, as with every presidential budget, the request is seen as more of an aspirational “wish list” than a realistic legislative proposal by most lawmakers on Capitol Hill. Nevertheless, provisions in the budget could find their way into legislation or agency regulations.

The Trump budget would provide HHS with nearly $10 billion in new funding to fight the opioid crisis through drug abuse prevention, treatment and recovery programs. However, it would also reduce Medicare uncompensated care payments, cut coverage of Medicare bad debt payments from 65 percent to 25 percent over a three-year period starting in 2019 and pay all hospital-owned physician offices located off campus at the physician office rate.

Heavy Focus on 340B Program Reform
President Trump’s budget request also calls for significant modifications to the 340B drug discount program. The proposal calls for savings from hospitals providing a certain amount of uncompensated care to be redistributed based on that percentage. Hospitals that do not meet the requirement would not receive any funds and their payment reductions would be returned to the trust. In addition, the budget proposal pushes for a requirement that hospitals report how they use savings from the 340B program, even including proposed legislative language to let HHS audit the records of providers to determine how savings are used.

The budget also calls for $16 million in user fees to help HRSA administer the 340B program. Nonprofit hospitals and other facilities would pay user fees amounting to 0.1 percent of 340B drug purchases. On February 15, Hall Render attended HRSA’s FY 2019 budget rollout where the agency described program priorities. HRSA officials said they are asking for increased regulatory authority over the 340B program to set standards as well as implement the user fee. HRSA administrators indicated they are still ironing out details of the new proposals and will release them as soon as possible.

The 340B program proposals in the president’s budget echo many of the concerns raised by Congress, and several track very closely to recommendations in a report released by the House Energy and Commerce Committee earlier this year. Members of the committee also raised concerns about the 340B program during a recent hearing on the impact of health care consolidation. In his opening statement, Chairman Greg Walden (R-OR) cited the 340B program as one of the reasons for increased consolidation because it “creates an incentive for hospitals to acquire independent physician offices not eligible for the 340B discount, especially those in the oncology space.”

Prior to the budget’s release, the White House Council of Economic Advisors issued a drug-price report suggesting increased oversight of the 340B program. The report suggests restricting the drug discount program to low income patients, and it raises concerns with current 340B eligibility standards.

GOP Moving Away from ACA Repeal Efforts
Congressional Republicans met for their annual policy retreat in February in West Virginia. Key GOP lawmakers stated that there are no imminent plans to try again to fully repeal the Affordable Care Act (“ACA”). Instead, they are shifting their focus to passing legislation for lowering health care premiums. When addressing the Republican legislative retreat, President Trump focused mostly on non-health care priorities, aside from supporting the Right to Try legislation and lowering drug prices.

Rural Health-Related Bills Introduced this Month
Rep. Cheri Bustos (D-IL) introduced the Rural Health Liaison Act of 2018 (H.R. 4945) to amend the Department of Agriculture Reorganization Act of 1994 to establish a Rural Health Liaison.

Sen. Chuck Grassley (R-IA) introduced S. 2415 to amend Title XIX of the Social Security Act to streamline enrollment of certain Medicaid providers and suppliers across state lines.


Back to March Branch

Policy Update: NOSORH Prepares for NRHA Policy Institute

i Feb 1st No Comments by

As of the most recent count, approximately 60 SORH attendees will participate in the National Rural Health Association’s Annual Policy Institute. NOSORH will provide a member and partner brief with Legislative Liaison Andrew Coats (Hall Render) and convene the State Office Council on Monday, February 5 at 6:00 PM.

NOSORH is asking SORH and their partners to request to pass Senate Bill 2278, please introduce a House companion bill to support for reauthorization of the State Office of Rural Health Program and for level funding for the SORH appropriation. A fact sheet is available for all SORH and their partners to print and include in their visit packets during the Policy Institute or to make a simple contact by email.  Printed copies of the fact sheet will be available at the NOSORH members meeting.

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

Congress Votes to End Government Shutdown – What’s Next?
After a three-day government shutdown, the Senate voted 81-18 on January 22 to fund the government through February 8, 2018. The continuing resolution (CR) was then sent to the House, where it passed 266-150. President Trump subsequently signed the bill into law on January 22. The three-week CR includes a six-year funding renewal of the Children’s Health Insurance Program (CHIP). The bill also delays the Affordable Care Act’s medical device tax and Cadillac tax on high-cost health insurance plans for two years and its tax on health insurance providers for one year.

Despite passing the CR, lawmakers remain under increasing pressure to reach a long-term budget agreement. In order to strike such a deal, Republicans will need support from at least nine Senate Democrats. While CHIP now has long-term financial support, funding for many other health programs, including “Medicare extenders” and DSH, expired at the end of September but were not included in the most recent CR. In a meeting with senior health care policy staff on Capitol Hill, Hall Render attorneys were told that lawmakers plan to include money for Medicare extenders and DSH in the next government funding bill that must be passed before February 8, if offsets can be found to cover the costs. Historically, Congress has covered such costs by implementing new cuts for providers, and it is expected that lawmakers will do so again in this case.

340B Remains Active Topic in Congress
On January 17, Sen. Bill Cassidy (R-LA) introduced a bill (S. 2312) that seeks to prevent certain hospitals from entering the 340B drug discount program until certain transparency measures and reporting requirements are strengthened. The Cassidy bill is the Senate version of the recently introduced 340B Pause Act and can serve as another reason for the Senate Health Education Labor and Pensions (HELP) Committee to hold future 340B oversight hearings.

The measure would create a moratorium on new DSHs from entering the 340B program for at least two years or until the Health Resources and Services Administration (HRSA) writes regulations for the 340B program with additional transparency measures and reporting requirements for hospitals. The bill would also require hospitals to use CMS’s new 340B claims modifier on drugs purchased through the program.

Under the Cassidy bill, critical access hospitals, rural referral centers, sole community hospitals, grantees and PPS-exempt children’s or cancer hospitals would still be able to enroll in the 340B program. The bill also exempts grantees and rural and critical access hospitals from most of the bills reporting requirements.

On January 10, the House Energy and Commerce Committee released a report following a broad review of the 340B program and several oversight hearings held in 2017. While the report highlights the strong bipartisan support of the program, the report also includes its perceived weaknesses such as the lack of transparency and oversight. The report concluded HRSA lacks sufficient regulatory authority to adequately oversee the program and the audit process in place is inadequate. The report also claims there is a lack of reliable data on how program savings are used because the 340B statute does not include reporting requirements for covered entities.

 Azar Confirmed as HHS Secretary
The Senate confirmed Alex Azar as the next Secretary of Health and Human Services in a 55-43 vote. Six Senate Democrats and Independent Angus King (I-ME) joined nearly all Republicans in backing Azar’s nomination. Sen. Rand Paul (R-KY) was the only Republican to oppose Azar, which he said was due to his disagreement with Azar over drug re-importation. As the country’s top health official, Azar has pledged to prioritize lowering drug prices.


Back to February Branch

Policy Update

i Jan 8th No Comments by

NOSORH welcomes new Policy Committee Co-Chair Scott Daniels (HI), stepping in for Mark Schoenbaum who retired earlier this month. Watch for the article in the Roots newsletter next week for a tribute to Mark’s great work for NOSORH over the years. Lisa Davis (PA) will continue to serve on the Board as the Policy Ex-Officio. In addition, Matt Strycker, NOSORH Project Manager, will be adding support to the important work of the the Policy Committee.

NOSORH has resources to help you and your state partners prepare for the National Rural Health Association Policy Institute being held Feburary 6-8 in Washington, DC. One-page state profiles are available to help SORH document rural health and the impact of their work. For help in completing your state’s profile, contact Donna Pfaendtner. A NOSORH request factsheet will be prepared for your use at the Policy Institute and Hall Render staff are available to join you on hill visits if you’re interested. Please plan to join the member and State Office Council meeting February 5 at 6 pm. In addition, NOSORH will host a webinar on January 18 at 2:00 pm ET to help SORH and their partners prepare for the Institute.

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

SORH Reauthorization Bill Introduced in the Senate
On January 4, a bipartisan group of Senators introduced the State Offices of Rural Health (SORH) Reauthorization Act of 2017. Co-Chairs of the Senate Rural Health Caucus, Senators Pat Roberts (R-KS) and Heidi Heitkamp (D-ND), introduced the stand-alone bill which NOSORH has endorsed.

The legislation seeks to reauthorize the State Offices of Rural Health grant program for the first time, maintains the three-to-one federal to state match, and ensures greater accountability to HHS from state grantees. Other Senators who have endorsed the legislation as original co-sponsors are John Barrasso (R-WY), Bob Casey (D-PA), Charles Grassley (R-IA) and Tammy Baldwin (D-WI). All SORH and partners are asked to reach out to their Senators to inquire about their interest in sponsoring the bill.

With the stand-alone Senate bill now introduced, NOSORH will focus on getting a companion measure introduced in the House of Representatives.

Rural Broadband Program Expanded by FCC
In December, the Federal Communications Commission (FCC) voted to put additional funds into its rural health broadband subsidy program. The funds will be redistributed to ensure all eligible applicants in 2017 receive money. The Rural Health Care Program distributes $400 million annually for rural doctors, hospitals and nursing homes to adopt and pay for broadband internet access. The additional funds were necessary since the program reached its funding cap the last two years due to the increase in telemedicine use, as well as nursing homes being eligible for subsidies.

On January 2, the FCC issued a notice of proposed rulemaking seeking suggestions on how to expand its Rural Health Care Program. The notice mulls several possible changes to the program beyond merely raising the cap, including changing the definition of “rural health care” and cracking down on perceived waste, fraud and abuse. The NOSORH Policy and Program Monitoring Team will be crafting comments and response to the notice. Comments are due Friday, February 2.

Congress Passes Stopgap Spending Bill to Avoid Government Shutdown
After passing the most significant tax reform legislation in decades, Republicans avoided a government shutdown on December 22 by passing legislation that temporarily funds the government through January 19, 2018. The House voted 231-88 to approve the short-term spending bill, and the Senate quickly followed, passing the bill on a 66-32 vote.

The spending package maintains FY 2017 spending levels and waives the Pay-As-You-Go rules that would have resulted in billions of dollars in cuts to programs like Medicare. It also funds the Children’s Health Insurance Program (“CHIP”) through March 31, 2018 with $2.85 billion in allocated funds. Congress is likely to come to terms on a FY 2018 spending package by mid-January.  Congress will then shift its focus to the FY 2019 appropriations process.

Congress Shifts Focus to 340B Drug Discount Program
Starting January 1, 2018, hospitals will receive the average sales price minus 22.5 percent, a change that will result in payment cuts of $1.6 billion. In the House, almost 100 lawmakers from both sides of the aisle have cosponsored a measure (H.R. 4392) that would reverse the action taken by CMS.

In early December, a bipartisan group of six senators submitted a letter to Senate leadership calling for the passage of legislation to prevent a dramatic reduction in payments for hospitals participating in the 340B drug discount program.

In late December, Rep. Larry Bucshon (R-IN) introduced the 340B Protecting Access for the Underserved and Safety-Net Entities Act, or 340B PAUSE Act (H.R. 4710), to amend the Public Health Service Act to establish a moratorium on the registration of certain new 340B hospitals and associated sites. The legislation was introduced to address concerns of lack of transparency or oversight in the program. The 340B PAUSE Act temporarily pauses new enrollment of Disproportionate Share Hospitals into the 340B discount drug program and requires basic data reporting. Critical access hospitals, sole community hospitals and rural referral centers would not be affected by this legislation.


Back to January Branch

Policy Update

i Nov 30th No Comments by

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.


Back to December Branch

Policy Update

i Nov 1st No Comments by

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

NOSORH Makes October Hill Visits
On October 25-26, NOSORH and SORH visited Washington DC to meet with Hill leaders. The group met with House and Senate offices to discuss an upcoming SORH reauthorization bill being introduced in November and began discussions on fiscal year (FY) 2019 appropriations.

Hatch-Brady Proposal Introduced as Alternative Market Stabilization Plan
On October 24, Senate Finance chairman Orrin Hatch (R-UT) and House Ways and Means chair Kevin Brady (R-TX) proposed a bicameral agreement for ACA market stabilization. Similar to the Senate HELP Committee proposal released last week, Hatch-Brady includes two years of funding for the ACA’s cost-sharing subsidies. The Hatch-Brady plan would also waive the ACA’s individual mandate for five years. Further, employers would not be penalized through the employer mandate if coverage was not provided for the previous two years.

Both Senate proposals were introduced shortly after the White House announced that it will no longer make the ACA’s cost-sharing reduction payments. Eighteen Democratic state attorneys general sued to force the administration to keep making the payments until the courts can decide whether it is legal for the funds to be cut unilaterally. However, U.S. District Court Judge Vince Chhabria ruled last week that the administration does not have to continue making the payments.

For Republicans to pass one of these market stabilization bills, they would need to secure 60 votes in the Senate. As it stands, the Alexander-Murray bill appears to have 60 votes in the Senate, but the vote count on Hatch-Brady is unclear. The sticking point for Hatch-Brady would be that Democrats are expected to oppose any waiver of the individual mandate. Thus, it is likely that Republicans will either have to pass Alexander-Murray, with some minor modifications, or not pass anything at all.

Opioid Crisis Declared National Public Health Emergency
On October 26, President Trump officially declared the opioid epidemic a national public health emergency under federal law. The administration took action because drug overdoses are now the leading cause of death by injury in the United States, topping both traffic crashes and gun-related violence. The directive included action items, such as opioid training for prescribers and lifting a restriction in some states on inpatient treatment. However, there was no new funding announced to address the emergency.

The administration established the President’s Commission on Combating Drug Addiction and the Opioid Crisis in March of 2017. The Commission noted the fastest way to increase treatment would be to waive the prohibition on using Medicaid funds to pay for inpatient substance abuse treatment. The administration’s directive indicates it will follow the Committee’s recommendation by allowing many states to waive this prohibition. Additionally, the White House said it will extend the use of telemedicine to address the opioid epidemic by allowing for the remote prescribing of medicine used for the treatment of substance abuse and mental health.

White House, Congress Continue Scrutiny of 340B Program
On October 6, the White House Office of Management and Budget (OMB) began review of the proposed rule on 340B ceiling prices and manufacturer penalties. The 340B rule was originally proposed by HRSA in the final days of the Obama Administration and has been delayed multiple times by the Trump Administration. The rule sets penalties for manufacturers that “knowingly and intentionally” overcharge 340B providers and also includes a formula for calculating discounts.

Over the past three months, the House Energy and Commerce Committee has conducted multiple hearings on the issue and expressed repeated concerns over program growth in recent years. On October 18, the Committee held a hearing examining how 340B entities are using the program, including how much money is saved, how entities track their savings, the types of drugs purchased and prescribed within the program and how those savings are used to improve patient care.

Though the 340B program received praise for supporting many other programs through savings, Republicans raised concerns over lack of transparency and data on the program since Congress is responsible for making sure the program is running correctly. OMB is still reviewing the CY 2018 OPPS final rule that is expected to include changes to the 340B payment structure. The proposed rule had hospitals being paid 22.5% less than the average sales price for drugs acquired under the 340B program, which is a major change from the current 6% on top of the average sales price.

Rural Health-Related Bills Introduced This Week
Sen. Michael Bennett (D-CO) introduced the Medicare-X Choice Act (S.1970). The bill intends to establish a public insurance plan offered on the individual and small business health exchanges. Initially, Medicare-X would only be available in rural areas, but the goal is to have Medicare-X expand to all places by 2023.

Rep. Kristi Noem (R-SD) introduced the Rural Home Health Extension and Regulatory Relief Act. This legislation would amend title XVIII of the Social Security Act to delay application of, transition to, and limit savings for the home health groupings model under the Medicare home health prospective payment system.


Back to November Branch

Policy Update

i Sep 28th No Comments by

The following update was provided for our members by Hall Render, NOSORH Legislative Liaison, on September 27, 2017:

Senate Committee Advances HHS Spending Bill

Congress returned in September after their annual August recess. With Fiscal Year (FY) 2017 funding set to expire October 1, Congress and the White House quickly agreed to terms on a three-month continuing resolution (CR) for FY 17 funding. The three-month CR will keep FY ’17 funding levels in place until December 8, 2017. Congress will then most likely pass an Omnibus FY 2018 spending bill sometime before Christmas.

On September 7, the Senate Appropriations committee voted to advance the FY 2018 Labor, HHS, and Education (Labor-HHS) Appropriations Bill. The bill includes $79.4 billion in discretionary funding for HHS, a $1.7 billion increase above FY 2017 and a $4.5 million increase for rural health programs over FY ’17.

Among the highlights to rural health, the committee provided $10 million for State Offices of Rural Health (SORH), which matches the House appropriated number from earlier in the spring. The committee also provided $67.5 million for the Rural Health Outreach program, which is $2 million above the FY ’17 level. $43.6 million was provided for Rural Hospital Flexibility Grants and $9.3 million for the Rural Health Research program.

NOSORH Attends Senate Rural Health Summit

On September 13, NOSORH leadership was in Washington to attend the annual Senate Rural Health Summit.  NOSORH leaders met with and heard from members on the importance of rural health programs. While in Washington, NOSORH leaders also met with the staff director of the Senate Rural Health Caucus to discuss the SORH Reauthorization bill. NOSORH is hoping a stand-alone SORH reauthorization bill will be introduced in the coming months.

House Committee Seeks Information on 340B

Leaders from the House Energy and Commerce Committee are soliciting information from providers regarding the 340B drug discount program. The Committee has asked providers for details on how much savings are received from the 340B program, who the drugs go to, as well as how the savings are used. Earlier this summer, the committee held a 340B oversight hearing where members expressed concern about the rapid growth and lack of oversight in the Health Resources and Services Administration (HRSA) program.  The Committee is intending to use the information to broaden understanding of how program savings are being utilized by covered entities to help patients.

CMS Issues RFI for Innovation Center

On September 20, CMS issued an informal request for information to gather feedback on changing the direction of its CMS Innovation Center. Comments will be received through November 20, 2017 and can be submitted here.

The Innovation Center is interested in testing models in eight focus areas including increased participation in advanced alternative payment models, consumer-directed care and market-based innovation, physician specialty models, prescription drug models, Medicare Advantage innovation models, state-based and local innovation, including Medicaid focused models, mental and behavioral health models and program integrity.

 Energy and Commerce Advances Batch of Health Care Bills

On September 13, the House Energy and Commerce Committee advanced a series of bipartisan, Medicare-related bills. Many were similar to measures included in the Senate Finance Committee’s CHRONIC Care Act. The committee advanced H.R. 1148, the Furthering Access to Stroke Telemedicine Act introduced by Rep. Morgan Griffith (R-VA). This would expand access to Medicare-reimbursed neurological consultations via telemedicine for patients at hospitals or mobile stroke units.

The Committee also advanced the Medicare Civil and Criminal Penalties Act, authored by Reps. Gus Bilirakis (R-FL) and Kathy Castor (D-FL), to update penalties within the Medicare program. Neither penalty has been updated in 20 years. Additionally, the committee advanced legislation (H.R. 3120) introduced by Chairman Michael Burgess (R-TX). The legislation is intended to reduce the volume of future electronic health record-related significant hardship requests. It would amend the Health Information Technology for Economic and Clinical Health Act to remove the mandate that meaningful use standards become more stringent over time.

 Ways and Means Advances Hall Render’s Stark Initiative

On September 13, the House Ways & Means Committee advanced three health care bills, including a revised version of the Stark Administrative Simplification Act of 2017 (H.R. 3726). The bipartisan bill, which passed unanimously, is the product of the coalition of hospitals and health systems created by Hall Render. The new measure was introduced by Reps. Kenny Marchant (R-TX) and Ron Kind (D-WI) and would allow hospitals to pay a fixed fee to CMS for technical violations of the Stark Law and create a new protocol for their resolution by CMS. The revised legislation will now be voted on by the full House and then proceed to the Senate where additional revisions are expected.

 The committee also passed H.R. 3727, introduced by Rep. Diane Black (R-TN), to increase telehealth coverage. Currently, Medicare fee-for-service limits reimbursement to rural medical facilities, and the program only covers some types of remote monitoring. H.R. 3727 is intended to increase telehealth services through Medicare by removing some of the barriers to access. Earlier this year, the Senate Finance Committee passed similar legislation in the Medicare CHRONIC Care Act. Additionally, the committee advanced H.R. 3729, introduced by Reps. Devin Nunes (R-CA) and Terri Sewell (D-AL), to improve and extend add-on payments for Medicare’s ground ambulance transport program.

 Health-Related Bills Introduced this Month

Rep. David Young (R-IA) introduced a bill (H.R. 3817) to amend title XVIII of the Social Security Act to improve the accuracy of geographic adjustment factors under Medicare and to permanently extend certain adjustments to such factors for certain localities.  Senator Chuck Grassley (R-IA) introduced a companion bill in the Senate (S. 1825).

Rep. Richard Hudson (R-NC) introduced a bill (H.R. 3789) to amend Title XVIII of the Social Security Act to provide under the Medicare program for conditions of participation, reporting requirements and a quality program with respect to air ambulance services. 

Rep. Elise Stefanik (R-NY) introduced the Community Health Investment, Modernization, and Excellence Act of 2017 (H.R. 3770). This bipartisan legislation would extend funds for community health centers.


Back to October Branch

Policy Update

i Aug 31st No Comments by

Each third Tuesday of the month at 2:00 pm ET the Policy Committee meets to discuss recent legislative and regulatory updates. A copy of the regulatory briefing is available here. The top 3 issues on the regulatory front this month include:

  • CMS is now accepting applications from clinicians eligible for the Merit-based Incentive Payment System (MIPS) to obtain hardship exceptions from the Advancing Care Information (i.e., Meaningful Use) requirements of the program.
  • Two rural-related legislative provisions, the Medicare-Dependent Hospital (MDH) program and the Low-Volume Hospital (LVH) payment adjustment, will expire on October 1, 2017 as discussed in the FY 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule.
  • CMS is deemphasizing review of CAH 96-hour certification requirement, which is also discussed in the IPPS final rule.

Leadership from several SORH and NOSORH have been invited to attend a Senate Democratic Rural Summit in mid-September to provide input to Congressional members and to learn more about rural health.

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

Fiscal Year 2018 Appropriations Update
In late July, House Appropriators passed their funding proposal for the Labor-HHS-Education fiscal year (FY) 2018 spending bill. The bill includes a total of $77.6 billion for HHS, a decrease of $542 million below the FY 2017 enacted level, but $14.5 billion above the President’s budget request.

The committee funded the Health Resources and Services Administration (HRSA) at $5.8 billion, which is almost $400 million below the FY 2017 level. Within the HRSA account, the committee provided level funding for rural health programs in FY 2018, which included funding the State Office of Rural Health program at $10,000,000 and the Rural Hospital Flexibility Grants at $43,609,000 for FY 2018. Level funding was also provided for telehealth at $18.5 million. Within the report language, the committee encouraged HHS to establish a Telehealth Center of Excellence to test the efficacy of telehealth services in both urban and rural geographic areas.

The Senate is working on a slower timeline as the Senate Labor-HHS subcommittee has yet to introduce or markup its FY 2018 bill. Of the various spending bills, the Labor-HHS bill is almost always the most difficult for Congress to pass due to partisan policy riders and spending levels.

Upon returning to Washington on September 5, the House and Senate will have 12 and 17 legislative days respectively to deal with funding the federal government which expires on September 30. The slower Senate pace will most likely lead to a continuing resolution and the Labor-HHS funding bill being wrapped into an omnibus spending package which many are estimating will be finalized in November or December.

Senate Votes Down ACA Repeal Attempt
Prior to the Senate departing for the August recess, the Senate voted down (49-51) a last-ditch effort by Senate Republican leadership to repeal the ACA. Republican leadership and the White House were hoping to pass a “skinny” ACA repeal bill that would have eliminated the individual mandate and blocked the employer mandate for eight years.

The bill would have also increased the limit on health savings accounts contributions, extended the moratorium on the medical device tax, made changes to the 1332 waiver program, and added $422 million for community health centers. The Congressional Budget Office estimated that the bill would save $178 billion over the next decade. However, it was unclear if the House and Senate would have reconciled the differences in conference to vote out a single bill.

With the defeat, Senate Majority Leader McConnell (R-KY) indicated he would be open to working with Democrats on reforms beyond just stabilizing the ACA marketplace. The Senate’s health committee will hold two hearings on stabilizing the ACA’s insurance markets in early September, as the committee attempts to craft a bipartisan health reform package. The hearings will feature testimony from state insurance commissioners and governors on how to tamp down premiums and increase insurance options in the ACA markets for 2018.

House Examines 340B Program
On July 19, the House Energy and Commerce Oversight Subcommittee held a hearing on the 340B program. While members expressed the importance of the 340B program, the committee highlighted concerns with the program, specifically: (1) the growth of 340B far exceeding HRSA’s limited oversight; (2) HRSA’s oversight reveals high levels of non-compliance; (3) hospitals receiving duplicate discounts; (4) hospitals diverting 340B drugs to ineligible patients; and (5) covered entities are not maintaining 340B databases.

Many members called for program integrity reforms for 340B. Additionally, some members were critical of CMS’s proposed Hospital Outpatient rule from July 14. 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. See the CMS fact sheet detailing the OPPS rule from July.

Rural Health Related Bills Recently Introduced
Rep. Cathy McMorris Rodgers (R-WA) introduced a bill (H.R. 3394) that would reauthorize for three years, 340H of the Public Health Service Act to encourage the expansion, maintenance, and establishment of approved graduate medical residency programs at qualified teaching health centers.

Rep. Bill Johnson (R-OH) introduced the Evidence-Based Telehealth Expansion Act of 2017. The bill (H.R. 3482) would allow the HHS Secretary to review existing services in the Medicare program to determine which are appropriate for telehealth, and waive existing restrictions on those services.

Rep. Jeff Denham (R-CA) introduced the Teaching Health Center Graduate Medical Education Program.  The bill (H.R. 3451) funds 240 new resident spots and would establish a minimum of 10 new residency centers. It also directs the HHS Secretary to prioritize centers located in counties with higher than 35 percent of the population enrolled in Medicaid.

Rep. Gregg Harper (R-MS) introduced a bill (H.R. 3224) that would amend title XVIII of the Social Security Act to clarify reasonable costs for critical access hospital payments under Medicare.

Rep. Lynn Jenkins (R-KS) introduced a bill (H.R. 3331) that would amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology.


Back to September Branch

Policy Update

i Jul 21st No Comments by

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).


Back to July/August Branch

Policy Update

i Jun 1st No Comments by

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.


Back to June Branch