House Votes to Defund ACA
The U.S. House voted this morning (230-189) to attach a permanent defunding of the health care law to a continuing resolution (“CR”) spending bill. The spending bill (H.J. Res. 59) would fund the federal government for a limited time and also block all federal funds for the 2010 Affordable Care Act (“ACA”). While the CR extends government programs only through the fall, the defunding language would have no time limit.
The defunding language would block the federal government from enforcing the law’s statutes, despite the law remaining on the books. Therefore, if passed, the law would exist as it does today, but the government would not be able to pay for enforcing its requirements.
While the Senate is unlikely to adopt H.J. Res. 59 in its entirety, the two sides must agree to some sort of continuing resolution by September 30 to avoid a government shutdown.
SGR Update
The Senate Finance and House Ways and Means committees are still drafting their own version of a permanent doc fix to replace the current Sustainable Growth Rate formula. Expect the Senate version to be released in early October and the House version to come out some time next month as well. The House Energy and Commerce Committee released their doc fix bill this summer (HR 2810). While the bill lacks any cost offsets, it would repeal the current statutory formula and replace it with an annual 0.5% increase to the base rate for 2014-2018, at a cost of $63.5 billion.
If Congress fails to pass something this year, doctors will have their Medicare payments cut by about 24% starting January 1, 2014.
CMS Finalizes Medicaid DSH Cuts
On September 13, CMS finalized an ACA rule gradually reducing Disproportionate Share Hospital (“DSH”) payments to facilities that serve a high concentration of low-income patients.
According to a CMS fact sheet, the final rule adopts a proposal to ignore states’ decisions on the now-optional Medicaid expansion over the next two years when calculating DSH reductions totaling $1.1 billion.
The final rule implements a reduction methodology for only FY 2014 and FY 2015, with a methodology for subsequent years to follow based on the experience and data gained in FY 2014 and FY 2015. The proposed methodology incentivizes states to target Medicaid DSH payments to high Medicaid volume hospitals and hospitals with high levels of uncompensated care.
CMS Posts Payment Rule on Federally Qualified Health Centers
On September 18, CMS posted a proposed rule that would establish Medicare payment rates and a payment system for federally qualified health center services. The rule, if finalized, would mean federal health centers would be paid about 30% more than current rates. CMS plans to implement the new pay system in October 2014.
The proposal would pay federally qualified health centers a single encounter pay rate per beneficiary, per day. CMS will accept comments on the proposed rule until November 18 and will release a final regulation in 2014.
Bills Introduced This Week
H.R. 3144: Rep. McDermott (D-WA) introduced a bill that would amend title XVIII of the Social Security Act to provide Medicare coverage of extended care services without regard to a requirement for a three-day prior hospitalization.
H.R. 3128: Rep. Matsui (D-CA) introduced a bill that would amend title XVIII of the Social Security Act to create additional penalties applicable to psychiatric hospitals and units that fail to comply with Medicare discharge planning process requirements.
Next Week in Congress
The Senate will take up the House passed CR. Meanwhile, the House, which was scheduled to be on recess, will return September 25 to respond to likely Senate changes to the continuing resolution and take action on a new measure that adds a delay in implementation of the ACA to an increase of the federal debt limit.
For more information, please contact John F. Williams, III at 317-977-1462 or jwilliams@hallrender.com.
