Energy and Commerce Committee Republicans Question Medicaid's Use of Provider Taxes

On February 18, House Energy and Commerce Subcommittee on Health Chairman Joe Pitts (R-PA) and Vice Chairman Brett Guthrie (R-KY) sent a letter to CMS regarding the lack of oversight in how state Medicaid programs use provider taxes to pay for their expenditures. Pitts and Guthrie said that while states continue to use more provider taxes to pay for their share of Medicaid, CMS may not have the data needed to ensure that states are in compliance with program requirements.

CMS indicated in a July 2014 letter that some states may only be taxing Medicaid managed care organization ("MCO") services. The agency raised concern that the states' taxing practices are not consistent with applicable CMS requirements because they target Medicaid providers and treat those providers differently for the purposes of the provider tax. The Government Accountability Office said in a July 2014 report that CMS was not able to guarantee that its data on state Medicaid program financing was accurate.

Pitts' and Guthrie's letter asked CMS to provide more information on the oversight duties of the agency, including: what actions CMS has taken regarding the possibility that some states were only taxing Medicaid MCOs; what actions CMS has taken to ensure that states comply with federal provider tax regulations; whether CMS performs regular audits or reviews of state provider tax arrangements; whether any states have provider tax waivers; and what actions CMS has taken against states that were out of compliance with provider tax arrangements. Pitts and Guthrie have asked the agency to respond within 30 days.

List of Entitlement Cuts Being Assembled by House Committees

The chairmen of several authorizing committees in the House are putting together a package of potential cuts to entitlement programs such as Medicare and Medicaid. The cuts in mandatory spending, which are believed to be in the tens of billions, would be offered as an incentive to win conservative Republican support for a fiscal year 2017 budget resolution that keeps the higher discretionary budget caps approved in last year's budget deal.

House leaders plan to move the proposal in stand-alone bill that would most likely go to the floor ahead of the appropriation bills that are expected later this spring. While passing a stand-alone bill cutting mandatory spending is feasible in the House, the size of the cuts would almost certainly need to be scaled down, or abandoned altogether, to garner sufficient support to overcome a filibuster in the Senate.

CMS Releases New Medicare Provider and Service Utilization Data Sets

On February 22, CMS published two public databases tracking the availability of health care providers and the utilization of certain services by Medicare beneficiaries. The tool sets include interactive maps and national, state and county-level data for provider and supplier services that includes information on how often they are used. The databases also enable users to compare and validate provider and supplier information against Medicare data.

Consumers can determine the availability and use of services provided to beneficiaries by ground ambulance suppliers, home health agencies and other fee-for-service providers and suppliers approved to bill Medicare. The provider data set includes individual and organizational provider and supplier enrollment information consisting of names, national provider identifiers, specialty, enrollment type and address.

The new databases were developed using ground ambulance and home-health agency paid claims data collected by CMS for Medicare fee-for-service enrollees from October 1, 2014 to September 30, 2015. Information is available for all 50 states and their counties. The data will be updated quarterly.

HRSA Announces $6 Million Telehealth Grant Program

The Health Resources and Services Administration ("HRSA") released an announcement soliciting applications for the Telehealth Network Grant Program. The program will support telehealth services for school-based health centers in underserved, rural and frontier communities.

HRSA will accept applications through April 8 for fiscal year 2016 awards. The agency anticipates providing up to 20 grants of $300,000 a year for four years. Eligible applicants include rural or urban nonprofit entities that will provide services through a telehealth network. The Federal Office of Rural Health Policy will host a technical assistance webinar on Monday, February 29 at 2:00 PM ET to review the funding opportunity and provide clarifying information for potential applicants.

Health-Related Bills Introduced This Week

Rep. Gene Green (D-TX) introduced the Incentivizing Medicaid Expansion Act (H.R. 4588) providing all states with several years of full federal funding when they expand Medicaid. The bill would eliminate the 90 percent match rate that would take effect in 2017 and would instead allow states that expand in the future to receive 100 percent backing from the federal government for three years from the date of expansion.

Rep. Tom MacArthur (R-NJ) introduced H.R. 4589, the Excellence in Medicare Act, which is intended to motivate providers to better care for seniors through performance incentives that would also reduce copays and premiums for Medicare Advantage beneficiaries. The legislation would make plans that have received four or five stars under the Medicare Advantage star rating system eligible to receive incentives and rebates that would be returned to enrollees in the form of additional or enhanced benefits.

Sen. Debbie Stabenow (D-MI) introduced the NURSE Act (S. 2590), which allows schools or state agencies to apply for federal grants to reduce the cost of hiring nurses. School districts will be eligible to apply for the additional resources based on the number of their students who qualify for free or reduced price school meals. The federal share of the grant will start at 75 percent of the total cost of hiring a nurse.

Next Week in Washington

The House and Senate return on February 29. On March 3, the Senate Labor-HHS Appropriations Subcommittee will hold a hearing on the HHS fiscal year 2017 budget proposal. On the same day, the House Labor-HHS Appropriations Subcommittee holds a hearing examining the fiscal year 2017 Substance Abuse and Mental Health Administration budget proposal.