December Federal/State Update: Washington Was Busy But Punted on Funding the Government

Congress

Tax Reform and Repeal of the ACA Individual Mandate Signed into Law

• President Trump signed tax reform legislation, which includes repeal of Obamacares individual mandate, into law.  (See the blog for more info.)

Congress passed a Continuing Resolution (“the CR”) to keep the government running through January 19tlh, giving itself yet another extension on passing the bill to fund all the federal agencies through September, 2018.     

• $2.85 billion to keep the Children's Health Insurance Program (CHIP) funded through March 31

   

• Authority for CMS to help states deal with CHIP-related funding shortfalls

• A four-week extension of spy powers under the Foreign Intelligence Surveillance Program

   

• Money for community health centers and other health programs (made possible by a $750 million cut to the ACA Prevention and Public Health fund)

• A waiver to ensure that automatic cuts to mandatory spending programs doesn’t go into effect because of the cost of the tax bill.

   

• Extra funding for some defense programs

Executive Branch

Center for Disease Control (CDC) Releases Updated Mortality Rate Reports

• Topline Summary: U.S. life expectancy fell again for the second year in a row while opioid misuse is up  

   

• CDC found drug overdoses killed 63,600 Americans in 2016, a 21 percent surge in overdoses. driven by a doubling in the rate of deaths from synthetic opioids like fentanyl report

   

• Where drug deaths are highest: West Virginia had the highest rate of drug overdose deaths last year, with 52 deaths per 100,000 people, followed by Ohio, New Hampshire, the District of Columbia and Pennsylvania, all of which reported nearly 40 deaths per 100,000 people.

ACA Open Enrollment Surges to Almost 9 Million Sign-Ups in Final Days

• CMS announced that 8,822,329 individuals had either selected plans or been passively reenrolled for 2018 through HealthCare.gov. This number is only slightly below the 9.2 million plan selections for 2017, even though the open enrollment period was half as long and much less widely publicized.

• Administration Likely to Release New Regulations Regarding Short Term Health Plans

• The Trump administration is expected to release regulations that will expand access to inexpensive, relatively skimpy short-term health plans — a move that could further destabilize the Affordable Care Act's insurance markets on top of the pending repeal of the individual mandate.

   

• Currently, consumers can only keep a short-term plan for three months. The new rule is expected to extend that to a year.

   

• Short Term plans don't have to abide by the ACA's protections for people with pre-existing conditions, and they often don't cover a comprehensive set of benefits. That means they're really only attractive to healthy, younger people. The risk with short-term health plans is that they'll pull healthy people out of the risk pool for ACA coverage, further de-stabilizing state marketplaces

Law Enforcement Mental Health and Wellness Act -- Signed Into Law

• Sponsor: Rep. Susan W. Brooks (R-IN) / Sen. Joe Donnelly (D-IN)

• Summary:

• • This bill directs the Department of Justice (DOJ) to report on Department of Defense and Department of Veterans Affairs mental health practices and services that could be adopted by law enforcement agencies.

     

  • DOJ's Office of Community Oriented Policing Services must report on programs to address the psychological health and well-being of law enforcement officers.

  • Amends the Omnibus Crime Control and Safe Streets Act of 1968 to expand the allowable use of grant funds under the Community Oriented Policing Services (COPS) program to include establishing peer mentoring mental health and wellness pilot programs within state, local, and tribal law enforcement agencies.

     

  • DOJ must coordinate with the Department of Health and Human Services to develop educational resources for mental health providers regarding the culture of law enforcement agencies and therapies for mental health issues common to law enforcement officers.

     

  • DOJ must also: (1) review existing crisis hotlines, recommend improvements, and research annual mental health checks; (2) examine the mental health and wellness needs of federal officers; and (3) ensure that recommendations, resources, or programs under this bill protect the privacy of participating officers.

SAMHSA Announces New Chief of Staff, Mary Fleming

• Mary Fleming has served as SAMHSA’s Director of the Office of Policy, Planning, and Innovation (OPPI) since 2013. Ms. Fleming later served as the Branch Chief of the National Liaison Branch within OPPI, which focused on special topics in behavioral health such as veterans and emergency response. Prior to joining SAMHSA, Ms. Fleming was the chief executive officer of Allegheny HealthChoices, Inc., where she was responsible for fiscal, clinical, and quality oversight and reporting for the Medicaid managed behavioral health care program. In previous positions, she helped manage federal, state, and county resources and was responsible for providing services for persons with mental illness and/or substance use disorders.

CMS Names New Head of CMS’ Innovation Center (CMMI)

• CMS named Adam Boehler, a California startup executive, as the new head of the CMS Innovation Center. CMMI would likely take a turn under Boehler's leadership. Republicans were sometimes frustrated by the perception that providers were being dragooned into novel value-based pay reimbursement strategies, and earlier this year the agency solicited comments on how it might contribute in the future.

SENATE

Alexander-Murray Still Talking ACA Stabilization Deal

• Sen. Alexander (R-TN) and Sen. Murray (D-WA) said in separate interviews that they want to resume their bipartisan talks on a package to prop up Obamacare markets and that the legislation may expand.
• President Donald Trump called Alexander to "reaffirm his interest in a bipartisan health care bill and [to] get it done in January"
• Trump's backing could prove pivotal to getting the support of deeply skeptical House Republicans.

HOUSE

The Bipartisan 'Problem Solvers' To Announce Legislation to Help Stabilize Individual Markets

• This bipartisan House caucus announced a bill backed by 26 House members, including Reps. Tom Reed (R-N.Y.) and Rep. Josh Gottheimer (D-N.J.), although it has little chance of being brought to the floor in the near future.

• The Bipartisan Market Stabilization and Innovation Act would fund Cost Sharing Reduction (CSR) payments, establish a 10-year $115 billion fund for states to stabilize the insurance marketplace; repeal the medical device tax; and narrow the employer mandate so that it only applies to businesses with more than 500 employees.

States

CMS Approves Five-Year Extension of Texas’ 1115 Medicaid waiver and an Unprecedented Ten-Year Extension of Mississippi’s 1115 Waiver

• Texas

   

  • CMS approved a $25 billion, five-year extension of a Medicaid waiver that has funneled  nearly $37 billion to Texas hospitals since 2011.

     

  • The $3.1 billion pool of money that state hospitals use to fund charity care will remain level for the first two years of the waiver, according to a letter from HHS to the state health commission. Starting in October 2019, CMS said it will "resize" that pool to more accurately reflect the hospitals' charity care

     

• Mississippi

   

  • Renews the waiver for the first ever 10 year extension of the Medicaid Section 1115 demonstration

     

  • Allows MS to continue providing family planning services for people with income of up to 194% of the federal poverty level.

     

  • The CMS said the 10-year extension is part of the agency's effort to give states greater flexibility in running their Medicaid programs, without having to ask the government for frequent approvals. Up to now, the agency typically granted Section 1115 waivers, which are supposed to be budget-neutral for the federal government, for five-year periods.

     

  • The waiver program offers benefits for family planning and related services for low-income women and men ages 13 through 44 who are not enrolled in Medicaid, Medicare, the Children's Health Insurance Program, or other qualifying health plans that include family planning services.

     

  • Mississippi has not expanded Medicaid to people with incomes up to 138% of poverty. If it did, many of the waiver beneficiaries would be able to receive family planning along with comprehensive health benefits through the regular Medicaid program.