Facing a Thursday shutdown deadline, GOP fills 515 page stopgap funding bill with legislative extras

With money for the federal government running out at midnight on Thursday night, Republicans in the House are pressing ahead with a plan that extends a temporary spending plan into late March, adding in full funding for the military, money for community health centers, along with dozens of unrelated provisions dealing with health care.

Because of all the legislative extras in the bill, the stopgap funding plan weighs in at 515 pages – as the House plans to vote on it today and then see if the Senate will simply accept it.

In legislative parlance, that’s what is known as “jamming” – the House is trying to “jam” the Senate into accepting whatever is passed, no matter whether Senators like the details or not.

Here is some of what the GOP bill would do:

+ Temporary funding for the federal government would be extended through March 23 – just before the Easter break – to give lawmakers time to finish the spending bills for 2018. (That was supposed to be done by October 1 of last year.)

+ While non-defense programs would remain on a temporary funding plan, the bill includes full funding for the military, lasting through the end of the fiscal year on September 30.

+ Require the Secretary of Energy to sell off up to $350 million of crude oil stored in the Strategic Petroleum Reserve to help with maintenance of the facility.

+ $225 million in disaster relief funding for the Small Business Administration.

+ The bill also includes a laundry list of health measures, some pushed by Republicans, some supported by both parties, which cover everything from civil penalties for Medicare fraud to prostate cancer testing, and a provision that boots lottery winners off of Medicaid.

The GOP plan is so expansive, that the section-by-section summary is 29 pages long. You can read that here to get a better idea of what's in the bill.

This is how the GOP described all the extra items on health care, which take up 345 pages of the 515 page stopgap funding bill, which includes a legislative nickname, the “Strengthening and Underpinning the Safety-net to Aid Individuals Needing Care Act of 2018” or the ‘SUSTAIN Care Act of 2018′:

Specifically, the CR will include language from or based on:

⦁ H.R. 3926, the Community Coordination And Resource Empowerment Act (Community CARE Act), authored by Rep. Gus Bilirakis (R-FL), providing FY2017 and FY2018 funding for Community Health Centers.

⦁ H.R. 3935, the Bolstering Organizations and Options to Support Training in Primary Care Act (BOOST Primary Care Act), authored by  #SubEnvironment Chairman John Shimkus (R-IL), providing FY2017 and FY2018 funding for the National Health Service Corps.

⦁ H.R. 3394, the Teaching Health Centers Graduate Medical Education Extension Act, authored by House Republican Conference Chairman Rep. Cathy McMorris Rodgers (R-WA), providing FY2017 and FY2018 funding for Teaching Health Centers.

⦁ H.R. 3924, to amend the Public Health Service Act to extend funding for the special diabetes program for type I diabetes, authored by Rep. Susan Brooks (R-IN) and Rep. Diana DeGette (D-CO), providing FY2017 and FY2018 funding.

⦁ H.R. 3917, to amend the Public Health Service Act to extend funding for the special diabetes program for Indians, authored by Rep. Markwayne Mullin (R-OK) and Rep. Raul Ruiz (D-CA), providing FY2017 and FY2018 funding.

⦁ H.R. 3900, the Youth Empowerment Act, providing FY2017 and FY2018 funding for Title V Sexual Risk Avoidance Education, authored by Rep. Bill Flores (R-TX).

⦁ H.R. 938, the Medicaid Third Party Liability Act, authored by #SubHealth Chairman Burgess. As modified, the provision will improve Medicaid Third Party Liability rules and strengthen Medicaid's role as the payer of last resort by requiring other liable insurers to pay claims for prenatal services before Medicaid pays.

⦁ A permanent repeal of the annual limit on per-patient therapy expenditures in Medicare (therapy caps), authored by #SubCommTech Chairman Marsha Blackburn (R-TN) and Rep. Gus Bilirakis.

⦁ Technical corrections to MACRA, authored by #SubHealth Chairman Burgess.

⦁ H.R. 3263, to extend the Medicare Independence at home Medical Practice Demonstration program, authored by #SubHealth Chairman Burgess and Rep. Debbie Dingell (D-MI), would extend the Independence at Home Medical Practice Demonstration Program (IAH), which provides a home-based primary care benefit to high-need Medicare beneficiaries with multiple chronic conditions, ideally allowing them to avoid unnecessary hospitalizations, ER visits, and nursing home use, for two additional years.

⦁ H.R. 1148, the Furthering Access to Stroke Telemedicine Act of 2017, authored by  #SubOversight Vice Chairman Morgan Griffith (R-VA) and Rep. Joyce Beatty (D-OH). H.R. 1148 will expand the ability of patients presenting at hospitals or at mobile stroke units to receive a Medicare reimbursed neurological consult via telemedicine.

⦁ H.R. 3163, the Medicare Part B Home Infusion Services Temporary Transitional Payment Act, authored by #SubEnergy Chairman Upton (R-MI). H.R. 3163 will create a temporary transitional payment policy, for services related to infusion drugs before a permanent payment policy, included as part of the 21st Century Cures Act is finalized.

⦁ H.R. 3271, the Protecting Access to Diabetes Supplies Act of 2017, authored by Rep. Diana DeGette and Rep. Susan Brooks, would address several issues beneficiaries have reported facing under the competitive bidding program regarding Diabetes Test Strips (DTS). Among them include: providing enhanced reporting that will aid Congress and CMS in ensuring beneficiaries are receiving the diabetic testing supplies they need to manage their condition.

⦁ H.R. 2465, the Steve Gleason Enduring Voices Act of 2017, authored by House Republican Conference Chairman Rep. Cathy McMorris Rodgers, House Majority Whip Rep. Steve Scalise (R-LA), and Rep. John Larson (D-CT). H.R. 2465 will make coverage of speech generating devices under "routinely purchased durable medical equipment" permanent under the Medicare program.

⦁ H.R. 3245, the Medicare Civil and Criminal Penalties Act, authored by Rep. Gus Bilirakis and Rep. Kathy Castor (D-FL). H.R. 3245 will update both penalties within the Medicare program, many of which have not been updated in 20 years.

⦁ H.R. 3120, to reduce the volume of future electronic health record-related significant hardship requests, authored by #SubHealth Chairman Burgess and Rep. Debbie Dingell. H.R. 3120 would amend the Health Information Technology for Economic and Clinical Health (HITECH) Act to remove the mandate that meaningful use standards become more stringent over time and allows the Department of Health and Human Services (HHS) to be more deliberative in such evaluations.

⦁ Modifying the reductions in Medicaid DSH payments, authored by #SubHealth Chairman Burgess.

⦁ H.R. 2557, the Prostate Cancer Misdiagnosis Elimination Act of 2017, authored by Rep. Larry Bucshon (R-IN) and Rep. Bobby Rush (D-IL), will provide for coverage of DNA specimen provenance assay (DPSA) testing for prostate cancer.

⦁ H.R. 829, the Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, authored by #SubEnergy Chairman Fred Upton. H.R. 829 will disenroll lottery jackpot winners from Medicaid, in order to prioritize the most vulnerable.

The new bill language doesn’t have a table of contents, so I put one together for the health provisions included in this stopgap budget.

Section 2101: Extension of the Medicare-dependent hospital (MDH) program
Section 2102: Extension of increased inpatient hospital payment adjustment for certain low-volume hospitals
Section 2103: Studies relating to hospital programs paid outside of prospective systems
Section 2104: Extension of home health rural add-on

Subtitle B—Medicare Part B
Section 2111: Ground ambulance services cost reporting requirement
Section 2112: Extension of work Geographic Practice Cost Indices (GPCI) floor
Section 2113: Repeal of Medicare payment cap for therapy services; replacement with limitation to ensure appropriate therapy

Subtitle C—Miscellaneous
Section 2121: Providing continued access to Medicare Advantage special needs plans for vulnerable populations
Section 2122: Extension of certain MIPPA funding provisions; State health insurance assistance program reporting requirements
Section 2123: Extension of funding for quality measure endorsement, input, and selection; reporting requirements

Title II—Additional Medicare Policies Relating to Extenders
Section 2201: Home health payment reform
Section 2202: Information to satisfy documentation of Medicare eligibility for home health services
Section 2203: Voluntary settlement of home health claims
Section 2205: Extension of enforcement instruction on Medicare supervision requirements for outpatient therapeutic services in critical access and small rural hospitals
Section 2206: Technical amendments to Public Law 114-10
Section 2207: Revised requirements for Medicare intensive cardiac rehabilitation programs

Title III—Creating High-Quality Results and Outcomes Necessary to Improve Chronic (Chronic) Care
Subtitle A—Receiving High Quality Care in the Home
Section 2301: Extending the Independence at Home Demonstration Program
Section 2302: Expanding access to home dialysis therapy

Subtitle B—Expanding Innovation and Technology
Section 2311: Adapting benefits to meet the needs of chronically ill Medicare Advantage enrollees
Section 2312: Expanding supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees
Section 2313: Increasing convenience for Medicare Advantage enrollees through telehealth
Section 2314: Providing accountable care organizations (ACOs) the ability to expand the use of telehealth
Section 2315: Expanding the use of telehealth for individuals with stroke

Subtitle C—Identifying the Chronically Ill Population
Section 2321: Providing flexibility for beneficiaries to be part of an ACO

Subtitle D—Empowering Individuals and Caregivers in Care Delivery
Section 2331: Eliminating barriers to care coordination under ACOs
Section 2332: GAO study and report on longitudinal comprehensive care planning services under Medicare Part B

Subtitle E—Other Policies to Improve Care for the Chronically Ill
Section 2341: GAO study and report on improving medication synchronization

Section 2342: GAO study and report on impact of obesity drugs on patient health and spending
Section 2343: HHS study and report on long-term risk factors for chronic conditions among Medicare beneficiaries

Title IV—Medicare Part B Miscellaneous Policies
Subtitle A—Medicare Part B Improvement Act
Section 2401: Home infusion therapy services temporary transitional payment
Section 2402: Orthotist's and prosthetist's clinical notes as part of the patient's medical record
Section 2403: Independent accreditation for dialysis facilities and assurance of high quality surveys
Section 2404: Modernizing the application of the Stark rule under Medicare

Subtitle B—Additional Provisions
Section 2411: Making permanent the removal of the rental cap for durable medical equipment under Medicare with respect to speech generating devices
Section 2412: Increased civil and criminal penalties and increased sentences for Federal health care program fraud and abuse
Section 2413: Reducing the volume of future EHR-related significant hardship requests
Section 2414: Coverage of certain DNA specimen provenance assay tests under Medicare
Section 2415: Strengthening rules in case of competition for diabetic testing strips

Title V – Public Health Extenders
Section 2501: Extension for community health centers, the National Health Service Corps, and teaching health centers that operate GME programs
Section 2502: Extension for special diabetes programs
Section 2503: Extension for family-to-family health information centers
Section 2504: Extension for sexual risk avoidance education
Section 2505: Extension for personal responsibility education

Title VI: Child and Family Services and Support Family First Prevention Services Act, Social Impact Partnerships, and Related Pay fors
Subtitle A: Family First Prevention Services Act
SUBCHAPTER A—PREVENTION ACTIVITIES UNDER TITLE IV–E
Section 2621: Foster care prevention services and programs.
Section 2622: Foster care maintenance payments for children with parents in a licensed residential family-based treatment facility for substance abuse
Section 2623: Title IV–E payments for evidence-based kinship navigator programs.

SUBCHAPTER B—ENHANCED SUPPORT UNDER TITLE IV–B
Section 2631: Elimination of time limit for family reunification services while in foster care and permitting time-limited family reunification services when a child returns home from foster care
Section 2632: Reducing bureaucracy and unnecessary delays when placing children in homes across State lines.
Section 2633: Enhancements to grants to improve well-being of families affected by substance abuse

SUBCHAPTER C—MISCELLANEOUS
Section 2641: Reviewing and improving licensing standards for placement in a relative foster family home
Section 2642: Development of a statewide plan to prevent child abuse and neglect fatalities.
Section 2643: Modernizing the title and purpose of title IV–E.

CHAPTER 2—ENSURING THE NECESSITY OF A PLACEMENT THAT IS NOT IN A FOSTER FAMILY HOME
Section 2651: Limitation on Federal financial participation for placements that are not in foster family homes.
Section 2652: Assessment and documentation of the need for placement in a qualified residential treatment program.
Section 2653: Protocols to prevent inappropriate diagnoses.
Section 2654: Additional data and reports regarding children placed in a setting that is not a foster family home.
Section 2655: Criminal records checks and checks of child abuse and neglect registries for adults working in child-care institutions and other group care settings.
Section 2656: Effective dates; application to waivers.

CHAPTER 3—CONTINUING SUPPORT FOR CHILD AND FAMILY SERVICES
Section 2661: Supporting and retaining foster families for children.
Section 2662: Extension of child and family services programs.
Section 2663: Improvements to the John H. Chafee Foster Care Independence Program and related provisions.

CHAPTER 4—CONTINUING INCENTIVES TO STATES TO PROMOTE ADOPTION AND LEGAL GUARDIANSHIP
Section 2665: Reauthorizing adoption and legal guardianship incentive programs.

CHAPTER 5—TECHNICAL CORRECTIONS
Section 2667: Technical corrections to data exchange standards to improve program coordination.
Section 2668: Technical corrections to State requirement to address the developmental needs of young children.

CHAPTER 6—ENSURING STATES REINVEST SAVINGS RESULTING FROM INCREASE IN ADOPTION ASSISTANCE
Section 2669: Delay of adoption assistance phase-in.
Section 2670: GAO study and report on State reinvestment of savings resulting from increase in adoption assistance.

Subtitle C—Supporting Social Impact Partnerships to Pay for Results
Section 2681: Supporting social impact partnerships to pay for results.

Subtitle D—Modernizing Child Support Enforcement Fees
Section 2691: Modernizing child support enforcement fees.

Subtitle E—Increasing Efficiency of Prison Data Reporting
Section 2699: Increasing efficiency of prison data reporting.

Title VIII—Offsets
Section 2701: Payment for early discharges to hospice care
Section 2702: Home health market basket reduction
Section 2703: Reduction for non-emergency ESRD ambulance transports
Section 2704: Extension of target for relative value adjustments for misvalued services and transitional payment rules for certain radiation therapy services under the physician fee schedule
Section 2705: Delay in authority to terminate contracts for Medicare Advantage plans failing to achieve minimum quality ratings
Section 2706: Medicare Improvement Fund
Section 2707: Payment for outpatient physical therapy services and outpatient occupational therapy services furnished by a therapy assistant
Section 2708: Changes to long-term care hospital payments
Section 2709: Non-Budget Neutral Transitional pass-through payment change for certain products
Section 2710: Third party liability in Medicaid and CHIP
Section 2711: Treatment of lottery winnings and other lump-sum income for purposes of income eligibility under Medicaid
Section 2712: Modifying reductions in Medicaid DSH allotments
Section 2713: Medicaid improvement fund rescission
Section 2714: Sunsetting the exclusion of Biosimilars from the Medicare Part D coverage gap
Section 2715: Prevention and Public Health Fund

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