AHCA Negotiations Continue Ahead of Lawmakers’ Return to Washington

In an effort to produce a victory on health care in President Trump’s first 100 days in office, House Republicans renewed discussions this week on the American Health Care Act (“AHCA”), the bill designed to repeal and replace much of the Affordable Care Act (“ACA”). Moderate House Republicans and members of the conservative Freedom Caucus are searching for a compromise that would retain the ACA’s preexisting conditions requirement but allow states to opt out of other benefits. The new provisions, which have not been released as legislative text, would also require that states opting out of additional benefits set up a risk-sharing program to protect against sicker patients being priced out of the market. It remains unclear if the proposal will attract enough Freedom Caucus and moderate Republican votes to pass the bill in the House. President Trump is urging the House to vote on ACA repeal by next Thursday. However, lawmakers don’t return until Tuesday, and with the vote not currently on the House calendar, a vote the week of May 1 seems more likely.

CMS Releases FY 2018 Hospital Payment Proposal

Late last week, CMS issued a proposed hospital inpatient prospective payment rule for FY 2018. The rule would increase payment rates to acute care hospitals in FY 2018 compared to the previous fiscal year. The measure also includes request for information on regulatory, sub-regulatory and policy changes CMS could make that would “contribute to making the Medicare delivery system less bureaucratic…and how CMS can reduce burdens for providers in a way that increases quality of care and decreases costs.”

CMS also proposed using data from its National Health Expenditure Accounts instead of data from the Congressional Budget Office to estimate the change in the rate of uninsured, which is used to calculate the total amount of uncompensated care payments available to Medicare Disproportionate Share Hospitals (“DSHs”). CMS estimates this proposed change would increase DSH payments by $1 billion in FY 2018.

Other notable provisions in the proposed rule include:

  • Shortening the 2018 reporting period to 90 days for the meaningful use electronic records policy and creating exemptions for providers who offer “substantially all” of their services at ambulatory surgery centers;
  • Easing enforcement of the Critical Access Hospital 96-hour certification requirement; and
  • Extending the Rural Community Hospital Demonstration program for an additional five-year period, which was included in the 21st Century Cures Act that was recently signed into law.

The rule will be published in the Federal Register on April 28, and public comments will be accepted through June 13, 2017.

President Signs Bill Extending Private Sector Health Program

On April 19, President Trump signed legislation S. 544 extending the Veterans’ Choice Program. The legislation removes the program’s August sunset date and allows the Veterans Affairs Department (“VA”) to spend nearly $1 billion in remaining emergency funding to subsidize non-VA hospital care for veterans who live more than 40 miles away from a VA hospital or can’t get an appointment to a VA medical facility within 30 days. The bill, which easily passed the House and Senate earlier this month, allows more time for the VA to provide medical care through the program while Congress and the VA negotiate a long-term fix. The VA is expected to announce a replacement for the Choice Program this fall.

Health-Related Bills Introduced This Week

No legislation was introduced this week as Congress was out of session.

Next Week in Washington

The House and Senate return next week. In addition to the possible AHCA vote in the House, lawmakers must address funding for the federal government, which expires on April 29. Congress will most likely pass a one-week funding extension to provide more time to reach a compromise.

The Senate HELP Committee will vote on Scott Gottlieb’s nomination to become the next FDA Commissioner on Wednesday. Gottlieb is widely expected to gain approval. The HELP Committee will also consider four health care-related bills with bipartisan support at Wednesday’s hearing. They include proposals to improve screening for childhood hearing loss and to bolster efforts to prepare for new public health threats like the Zika virus.