After a brief overnight shutdown, Congress passed a budget bill that includes a number of health provisions. The bill, the Bipartisan Budget Act of 2018, was signed by President Donald Trump on February 9. In addition to extending a variety of Medicare provisions, the legislation repealed the controversial Independent Payment Advisory Board (established by Sec. 3403 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148)), extended the Children’s Health Insurance Program (CHIP) through fiscal year (FY) 2027, and funded community health centers.
Senate bill. Division E of the Senate draft, entitled the "Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act," repeals the Medicare payment cap for outpatient therapy services and extends the following:
- CHIP through FY 2027;
- the work geographic cost practice index (GPCI) floor through December 31, 2019;
- Medicare add-on payments for certain ground ambulance services;
- the inpatient hospital payment adjustment for low-volume hospitals;
- the Medicare-Dependent Hospital Program through October 2022;
- funding for state health insurance programs (see Sec. 3306 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148)); and
- the home health rural add-on (see ACA Sec. 3131(c)).
In addition, Senate Minority Leader Charles Schumer (D-N.Y.) announced that the Senate bill provides $6 billion to fund the fight against the opioid and mental health crises. "This will be used for programs and reforms to address mental health care and opioid substance use disorders through prevention, treatment, and recovery programs." It also funds CHCs through FY 2019.
House bill. The House stop-gap bill similarly extends a number of Medicare programs, including the home health rural and ambulance add-ons, and repeals the outpatient therapy cap. However, many House Republicans consider the bill to be "doomed" in the Senate due to issues with defense and nondefense spending levels.
Looming shutdown. Resolving budget issues has been particularly burdensome for Congress of late. A short-term spending bill passed in January allowed the federal government to reopen through February 8, 2018, and provided six years of funding for the Children’s Health Insurance Program (see Short-term spending bill reauthorizes CHIP, delays ACA taxes, January 23, 2018). In December Congress passed a short-term joint resolution that funded the government through December 22 (see Appropriations Act would keep agencies running, redistribute CHIP allocations . . . for now, December 8, 2017) and a Continuing Resolution that funded the government through January 19, 2018 (see Same but different; shutdown averted, CHIP gets temp funding, December 22, 2017).
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