The U.S. House of Representatives released its $1.1 trillion spending bill yesterday to fund the federal government through September 2015. The bill would keep spending levels consistent with federal fiscal year (FFY) 2014 levels and includes a number of other health care provisions, such as emergency funding for Ebola preparedness. The bill does not include a long-term fix to the sustainable growth rate, which — if not addressed by March 31 — will result in large cuts in Medicare payments to physicians. CHA worked with appropriators and the leaders of California’s congressional delegation in support of the funding for Ebola preparedness, children’s hospital graduate medical education and recovery audit contractor relief, as well as to oppose further delay of implementation of ICD-10 (which was not included in the bill).
A brief summary of the bill’s important health care provisions follows.
- Ebola preparedness funding: The bill includes $5.4 billion in emergency funding to address the Ebola crisis internationally and domestically. Funding would be provided to the Department of Health and Human Services to implement a regional strategy for designating treatment centers, as opposed to the President’s request to designate at least one treatment center in each state. In addition, the bill would allocate $1.77 billion to the Centers for Disease Control and Prevention through Sept. 30, 2019, for the transportation, medical care, treatment and other related costs of persons quarantined or isolated under federal or state quarantine law, and would provide funds for medical worker training.
- Centers for Medicare & Medicaid Services: The bill would fund the Centers for Medicare & Medicaid Services (CMS) at levels equal to those enacted in FFY 2014 and consistent with sequestration requirements.
- Recovery audit contractors (RACs): The bill directs CMS to develop procedures to reduce the backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA) level. The bill requires the FFY 2016 budget request to include a timeline, milestones and measurable goals to address concerns with the RACs to reduce the appeals backlog. CMS is also directed to submit a report on the agency’s strategy to analyze and improve the entire appeals process within 180 days of the bill’s enactment.
- Office of Medicare Hearings and Appeals (OMHA): The bill would fund the OMHA at $87.4 million, an increase of $5 million from FFY 2014. The bill directs OMHA to use the additional funds to address its current backlog and to increase its capacity to process the rising caseload. The bill also requests a report no later than 90 days after enactment describing the plan to resolve the current and future backlog at OMHA.
- Children’s hospital graduate medical education (CHGME): The bill would provide $265 million for CHGME, consistent with FFY 2014 levels.
- 340B Drug Pricing Program: The bill would require the Health Resources and Services Administration (HRSA) to report to the appropriations committees by March 3, 2015, on its progress in making 340B ceiling prices available to covered entities through a website. In addition, the bill directs HRSA to work with covered entities to better understand the way these entities support direct patient benefits from 340B discounted sales.
- Rural health programs: The bill would increase funding to rural health programs by $5 million, including increases for rural outreach grants, rural hospital flexibility grants, rural access to emergency devices and expansion of telehealth services.
- Critical access hospitals (CAHs): The bill directs CMS to provide a report within 90 days of enactment on a proposal to eliminate CAH status from facilities located less than 10 miles from another hospital in rural communities.
- Access to home health care: The bill would require CMS in its FFY 2016 budget request to quantify and explain how the policy directing physicians to conduct face-to-face certifications for home health care has prevented fraud, increased access to health care, and impacted costs to the Medicare and Medicaid programs. CMS would also be required to explain how provider documentation for face-to-face requirements can be simplified.
- Independent Payment Advisory Board: The bill would eliminate $10 million in Affordable Care Act funding for the Independent Payment Advisory Board.
The House is expected to vote on the bill Thursday, with the Senate likely to take up the bill over the weekend. Funding for the current continuing resolution expires Thursday, so both houses will have to pass a stop-gap measure to avoid a government shutdown in the days between House and Senate passage of the larger agreement. The legislation is available at www.gpo.gov/fdsys/pkg/CPRT-113HPRT91668/pdf/CPRT-113HPRT91668.pdf.