Washington Update. HFMA Region 8 MidAmerica Summer Institute August 2017

Transcription

1 Washington Update HFMA Region 8 MidAmerica Summer Institute August 2017

2 Agenda ACA: Repeal and Replace Review Regulatory Update Fall Advocacy Agenda: Other Policy Issues on the Horizon

3 Lack of GOP Unity Groups that Influenced Action in the House Tuesday Group Freedom Caucus

4 AHCA Passes the House Final Vote: No Democratic support 20 Republicans voted No 1. Andy Biggs (AZ-05) 2. Mike Coffman (CO-06) 3. Barbara Comstock (VA-10) 4. Ryan Costello (PA-06) 5. Charlie Dent (PA-15) 6. Dan Donovan (NY-11) 7. Brian Fitzpatrick (PA-08) 8. Jaime Herrera-Beutler (WA-03) 9. Will Hurd (TX-23) 10. Walter Jones (NC-3) 11. Dave Joyce (OH-14) 12. John Katko (NY-24) 13. Leonard Lance (NJ-07) 14. Frank LoBiondo (NJ-02) 15. Tom Massie (KY-04) 16. Pat Meehan (PA-07) 17. Dave Reichert (WA-08) 18. Ileana Ros-Lehtinen (FL-27) 19. Chris Smith (NJ-4) 20. Mike Turner (OH-10)

5 On to the Senate CBO Score: must save as much money as House bill Moving Timeline Areas to watch: Medicaid expansion / redesign Tax credits / ages Pre-existing conditions Key Player - Senate Parliamentarian

6 Pence Breaks Tie on Motion to Proceed

7 Next Steps Reconciliation Process 20 hours of debate, evenly divided Parliamentary objections (Byrd bath) 60-vote threshold for non-scored amendments Vote-a-rama

8 Overview of proposals in Senate AHCA underlying bill Better Care Reconciliation Act Cruz amendment Portman amendment Obamacare Repeal Reconciliation Act Cassidy-Collins Skinny bill

9 American Health Care Act Coverage Incentives Reduce the individual and employer coverage mandate penalties to $0 beginning in 2016 Beginning in 2019, would use penalties for failure to maintain coverage as the incentive to enroll in coverage Beginning in 2020, the federal government would make available agebased, advanced refundable tax credits for individuals without another source of coverage Medicaid Expansion End Medicaid s enhanced federal matching funds for future expansion populations as of Jan. 1, 2020 States can maintain coverage for the existing expansion populations with enhanced FMAP as long as there is no break in an enrollee s coverage after Dec. 31, 2019 After Jan. 1, 2020, a state could expand coverage up to 133% of the federal poverty level, but would receive its standard FMAP New Medicaid Funding Model Replace current federal Medicaid payment system with a per capita cap structure, as of Oct. 1, 2019

10 Senate Plan Better Care Reconciliation Act Medicaid Expansion Phase-down transition for expansion states Per capita caps & block grants Individual and employer coverage mandates Coverage subsidies Opioid funding ACA taxes Failed (Nine Republicans opposed)

11 CBO Score of BCRA

12 Repeal and Delay Bill Obamacare Repeal Reconciliation Act of 2017 Repeal ACA individual and employer mandates and premium and cost-sharing subsidies Retain private market rules (i.e., guaranteed issue, pre-existing protections) Eliminate Medicaid expansion Repeal all ACA taxes Eliminate Medicaid DSH cuts Keep all other provider cuts in place Transfer savings to the Medicare Hospital Insurance Trust Fund Fund CSRs for two years ( ) Failed (Seven Republicans opposed)

13 CBO Score of Repeal and Delay

14 Cassidy/Collins Alternative Patient Freedom Act (S. 191) Allows states to choice among 3 options: 1. Keep 95% of the value of Medicaid expansion and insurance subsidy to design own plan 2. Design own health insurance system without federal funding 3. Retain all the ACA mandates

15 Skinny Bill Repeal employer mandate Repeal individual mandate Keep all taxes except medical device tax CBO estimate 15 million uninsured

16 Skinny Repeal Bill Fails

17 Resources to Assist You Podcasts with latest messages & updates Town Hall Webcasts Summaries, factsheets and analysis Congressional resources Downloadable PowerPoint slides

18 Regulatory Update Outpatient Proposed Rule MACRA Proposed Rule Inpatient Final Rule

19 Outpatient Rule Site-Neutral Provision reduce payment for services in new off-campus provider-based departments from 50% to 25% of OPPS rate Meaningful Use CMS did not propose relief from Stage 3 reporting requirements that begin Jan B reduce payment for drugs purchased under 340B drug pricing program to ASP minus 22.5% Comments due Sept. 11

20 340B Under the Spotlight Cuts Medicare payment for drugs acquired under the 340B Program (goes beyond MedPAC recommendation). Pays at average sales price minus 22.5%, rather than the current rate of ASP plus 6%. Reduces Part B drug payments to 340B hospitals by $900 million. Plans to implement in budgetneutral manner. Calls for suggestions on how to distribute funds.

21 AHA 340B Advocacy Toolkit Customizable Tools for 340B Hospital Leaders Letter to Congress OpEd Case Example Digital and Social Media Resources Video Script *All materials are available at Please share your materials with AHA by ing

22 Additional Actions from the Administration More Executive Action Could Be Coming President s budget calls for greater transparency in the 340B program HRSA interested in how hospitals track and spend 340B savings Executive orders on drug pricing

23 CY2018 MACRA QPP Proposed Rule Proposes updates to key policies for reporting in CY 2018, affecting payment in CY 2020 Right Direction Overall gradual, flexible approach MIPS facility-based measurement option Meaningful use flexibility for docs Work in Progress Virtual group reporting option MIPS bonus points for patient complexity Potential for smallscale socioeconomic adjustment Concerned Limited advanced APM availability Misalignment of hospital meaningful use Comments Due Aug. 21

24 Post ACA Repeal Agenda Debt ceiling New federal fiscal year begins (FY 2018) budget & appropriations Tax reform Medicaid DSH reductions Medicare payment extensions CHIP funding

25 Other Issues Defense Offsets: regular menu site-neutral Tax reform: charitable contributions, bonds, and tax-exempt status Graduate Medical Education Rural payments Bad debt

26 VA Choice Program Funding Running Out Sooner Than Anticipated VA Choice will run out of funds earlier than expected House rejected legislation to fund VA Choice through February 2018 Congress will consider additional funding for the rest of 2018 this year

27 New VA Choice Program Outline of Changes VA is currently working on legislation to contract with community providers, including hospitals, health systems: One program for all care provided outside of VA Payment will be based on Medicare rates Do away with 30-day wait or 40-mile eligibility requirement Instead, VA doctors will decide where veteran should receive care, inside or outside the VA Congress will consider this year to be implemented in 2019