On September 26, 2019 the Senate approved H.R. 4378, the Continuing Appropriations Act, 2020, and Health Extenders Act of 2019, which would fund the federal government through November 21, 2019. The House has already approved the legislation, and President Trump is expected to sign the bill. The legislation includes a number of health program funding and policy provisions, including the following:

  • Medicaid Drug Rebate Definitions. The bill would exclude a manufacturer’s authorized generic drug price from the average manufacturer price (AMP) of its brand product. It also would remove manufacturers from the definition of “wholesaler” for Medicaid drug rebate purposes. These policies would be effective on the first day of the first fiscal quarter that begins after the date of enactment.
  • Delay of Reductions in Medicaid DSH Allotments. The bill would delay reduction in the allotments for Medicaid disproportionate share hospitals (DSH) through November 21, 2019. In the absence of this legislation, Medicaid DSH allotments will decrease by $4 billion effective October 1, 2019, as discussed in our recent blog post.
  • Health Program Extenders. The bill would fund through November 21, 2019 various expiring federal health programs, including: Community Health Centers; the National Health Service Corps; the Teaching Health Center Graduate Medical Education program; the Special Diabetes Program; various HHS health education programs; the Certified Community Behavioral Health Clinic demonstration program; programs supporting outreach, enrollment, and education activities for low-income Medicare beneficiaries; the Health Profession Opportunity Grant demonstration; the Temporary Assistance for Needy Families and related programs; and funding for certain contracts relate to Medicare and Medicaid quality measurement and performance improvement activities. It also would extend authorization for the Patient-Centered Outcomes Research Institute (PCORI) to receive funding from the Patient-Centered Outcomes Research Trust Fund through November 21, 2019. Furthermore, the bill would extend the current 100% Federal Medical Assistance Percentage (FMAP) for the territories through November 21, 2019.
  • Medicaid Improvement Fund. The bill would increase the Medicaid Improvement Fund to $2.387 billion, to be available beginning fiscal year 2025.