House Passes CR Through Nov. 21

The House of Representatives passed a continuing resolution (CR) (H.R. 4378) last week by a vote of 301-123 to avoid a potential government shutdown on October 1. The stopgap spending bill would extend current government funding through November 21, when lawmakers are scheduled to leave for Thanksgiving recess, giving them additional time to finish work on $1.3 trillion in spending for fiscal year (FY) 2020 as agreed to in the July budget deal. The CR was drafted following bipartisan, bicameral negotiations and is expected to be approved by the Senate this week before the end of the FY on September 30.

The CR includes a package of health extenders that would temporarily extend current funding for several public health programs that have expired or are set to expire at the end of the month, including funding for the Medicaid programs in Puerto Rico and other U.S. territories, Community Health Centers, the Demonstration Program for Certified Community Behavioral Health Clinics, the National Health Service Corps (NHSC), teaching health centers’ graduate medical education (GME) programs, the Special Diabetes Program, and the Special Diabetes Program for Indians. The CR would also delay Medicaid disproportionate share hospital (DSH) cuts. It would temporarily extend a contract with the National Quality Forum (NQF) to support Medicare and Medicaid quality measure development as well as funding authorizations for the Patient-Centered Outcomes Research Trust Fund and funding for the State Health Insurance Assistance Programs, Area Agencies on Aging, Aging and Disability Resource Centers, and the Health Profession Opportunity Grant. The Medicaid Improvement Fund would be increased to $2.39 billion for states beginning in FY 2025 to improve their mechanized claims systems. The CR would also implement the Medicaid and CHIP Payment and Access Commission’s (MACPAC) to exclude an authorized generic’s drug price from the average manufacturer price of the brand product, and to remove manufacturers from the definition of wholesaler in the Medicaid drug rebate program.

Senate Appropriations Update

Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Chairman Roy Blunt (R-Mo.) released the panel’s fiscal year (FY) 2020 spending bill last week. The bill contains $178.3 billion in discretionary funding, $223 million above current levels. The U.S. Department of Health and Human Services (HHS) would receive $93.4 billion, including:

  • $42.1 billion for the National Institutes of Health (NIH), $3 billion more than FY 2019;
  • $3.9 billion to address opioid abuse, a $70 million increase;
  • $3.7 billion for mental health programs, $305 million more than FY 2019; and
  • $1.63 billion for community health centers.
The bill would provide $266 million to support the President’s initiative to reduce HIV infections by 90 percent over the next decade, including $140 million for the Centers for Disease Control and Prevention (CDC), $120 million for the Health Resources and Services Administration (HRSA), and $6 million for the NIH. The measure would increase funding for the Children’s Hospitals GME program, which the administration proposed eliminating, by $15 million. It would also extend several policies blocking any federal funds for the purposes of needle exchange programs, research involving human embryos, activity to promote the legalization of schedule I drugs without significant evidence of a therapeutic advantage, and the adopting of standards related unique health identifiers for patients until legislation is enacted to specifically approve such standards. The bill would also extend funding for some health programs that are scheduled to expire on October 1 for an additional year. Unlike the House’s Labor-HHS- Education spending bill, the Senate legislation does not include any funding for gun violence prevention research at the CDC or NIH.

The Senate Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration (FDA), and Related Agencies advanced its fiscal year (FY) 2020 spending bill last week by unanimous consent. The measure includes $23.1 billion in discretionary funding, a $58 million increase over current spending levels. The FDA would receive $3.1 billion.

Senate Republicans sought to vote last week on whether to consider a package of spending bills that would fund most of the federal government for FY 2020, including Labor-HHS-Education, as an amendment to the House-passed appropriations legislation, since not all of the individual appropriations bills have successfully been advanced by the Senate appropriations panels. The vote to begin debate on the measure did not receive the 60 votes needed due to Democratic objections related to funding for the President’s border wall. Senate Appropriations Committee Chairman Richard Shelby (R-Ala.) has warned that absent an agreement on the border wall, Congress may have to pass additional short-term spending measures.

Ed & Labor Postpones Vote on Surprise Billing Legislation

The House Education and Labor Committee cancelled a vote last week on the panel’s bill to address the issue of surprise insurance gaps. The markup, which had not been formally scheduled, was called off amidst divisions among the committee members who were expected to consider surprise billing legislation that was fundamentally aligned with the bill that has been advanced out of the Energy and Commerce Committee. According to Chairman Bobby Scott (D-Va.), the panel is still negotiating technical details to ensure that the final plan applies to all forms of health coverage, including ERISA. The panel also has yet to reach a bipartisan consensus on whether to use a benchmark payment rate or independent dispute resolution (IDR) to settle payment disputes between providers and payers. While Education and Labor Committee leadership have reiterated their commitment to advancing a bipartisan solution to protect patients from surprise medical bills, it is unclear if or when the vote will be rescheduled. Staff for the House Ways and Means Committee have stated that they are also continuing work to draft their own bipartisan surprise billing legislation.

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