Several important legislative initiatives affecting the health care community have been delayed as deliberations over tax reform continue. The federal government is only funded through Dec. 8; however, lawmakers are expected to pass a short-term continuing resolution (CR) to extend the current level of government funding until late December or they could possibly push the budget debate off until January.
The Medicare Rural Extenders package covers a number of special Medicare payment policies that expired on Oct. 1 or will expire at the end of the year, including:
- Rural ambulance add-on payments;
- Rural home health add-ons;
- Low-volume hospital payment add-on; and
- Outpatient therapy caps.
The Senate Finance Committee released a discussion draft and legislative language yesterday involving the extenders package. This preliminary package did not include cuts to Critical Access Hospitals (CAH) that were part of the House Ways and Means Committee language.
Specifically, the committee draft includes a full extension of the work Geographic Practice Expense Index floor (2 years), permanent repeal of therapy caps, extension of ambulance add-on payments (5 years), extension of the Medicare-dependent hospital (MDH) program (5 years), extension of funding for quality measure endorsement (2 years), extension of the home health rural add-on (5 years) and extension of the low-volume hospital (LVH) payments (5 years). However, of significant concern is that the LVH payment adjustments would be based on total discharges instead of Medicare discharges. For FY18-FY22, the low-volume adjustment standard would be 25% for hospitals with 500 or fewer discharges. The adjustment would decrease on a sliding scale to 0 percent for hospitals with more than 2,500 discharges.
In addition, the Senate Finance Committee approved a clean five-year children’s health insurance program (CHIP) reauthorization, but there has been no Senate floor action. The House passed its version of a five-year CHIP extension, which also extends Federally Qualified Health Center and National Health Service Corps funding for two years. And, it would eliminate the Medicaid DSH cuts in 2018 and 2019. House and Senate negotiators are reportedly closing in on a five-year extension deal. CHIP has traditionally had strong bipartisan support so it is expected to be reauthorized again this year.