END-OF-YEAR DEAL on APPROPRIATIONS AND MORE

from Ntl FV:

House and Senate negotiators have reached a deal on spending for FY 2020, which began on October 1. See Lawmakers Pile on the Spending In $1.4 Trillion Deal (The Hill, 12/16/19), and the House has passed the measure. See Massive Spending, Tax Packages Headed for Senate (Roll Call, 12/17/19). The legislation will also extend some important health programs for five months, and includes some other significant policy provisions, as explained below.

 

Significantly, the deal does NOT include any provisions to address surprise medical billing. See Surprising Swings In Momentum For Legislation On Surprise Medical Bills (Kaiser Health News, 12/17/19). Nor does the deal include any major measures to control the cost of prescription drugs. The Health 202: Congress Failed to Pass a Drug Pricing Overhaul. So It Set Another Deadline (Washington Post "Power Post," 12/17/19).

 

Appropriations: Some programs of importance to children and youth with special health care needs (CYSHCN) and their families will receive increased funding this fiscal year. The deal will provide $7.04 billion for the Health Resources and Services Administration (HRSA), a $193 million increase over the FY 2019 level. Of that, there is an increase of $17 million for the Maternal and Child Health Bureau (MCHB), which includes an increase of $10 million for the Title V MCH block grant. The deal also includes an increase of $5.25 million for the National Center on Birth Defects and Developmental Disabilities (NCBDDD) within the Centers for Disease Control and Prevention (CDC). Details about funding levels for programs within HRSA, the CDC, and other agencies of the Department of Health and Human Services (HHS) begin on page 15 of this report. The report's section on special education (p. 136) also includes language regarding Medicaid expenditures in schools: "Medicaid Services - Opportunities exist to streamline access to and improve the quality of special education services, and steps should be taken to reduce administrative barriers for providing health services in and in coordination with schools. The Office of Special Education and Rehabilitative Services should coordinate with the Centers for Medicare & Medicaid Services to develop training and provide technical assistance to assist with billing and payment administration for Medicaid services in schools."

"Health Extenders": number of important health programs will be funded until May 22, 2020. These "health extenders" include: Community Health Centers; the Community Mental Health Services Demonstration program; the Money Follows the Person (MFP) demonstration program; Medicaid spousal impoverishment protections for home- and community-based services (HCBS); the Special Diabetes Program; the Special Diabetes Program for Indians; the National Health Service Corps; and the Teaching Health Center Graduate Medical Education Program. While advocates are disappointed that these funding extensions are not longer, an advantage of the shorter extension is that it may be possible to get a permanent extension of some of the programs when their funding is reconsidered in May. Negotiators may have decided to provide only the short-term extensions in order to create pressure to enact legislation on surprise medical billing and prescription drug costs at that time. See The Health 202: Congress Failed to Pass a Drug Pricing Overhaul. So It Set Another Deadline (Washington Post "Power Post," 12/17/19).

Medicaid in the Territories: The legislation will extend funding for the territories for two more years (through FY 2021, two years less than the committees of jurisdiction had approved) and increase the federal Medicaid matching rate from 55 to 70 percent in Puerto Rico and 55 to 83 percent in the other territories (the highest that any state gets).

PCORI: The deal includes a 10-year extension of the Patient-Centered Outcomes Research Trust Fund, which funds the Patient-Centered Outcomes Research Institute (PCORI), a government-sponsored non-profit that investigates the effectiveness of medical treatments to improve patient care. The legislation includes a provision for PCORI to better address issues faced by people with intellectual and development disabilities, and stops the use of the Medicare Trust Fund as a source for PCORI funding.

Other Significant Provisions 

• Medical expense deductions: The legislation includes a temporary 2-year extension of the 7.5% threshold for the medical expense deduction.
• Tobacco: The measure raises, from age 18 to 21, the federal age limit for selling tobacco products, including both cigarettes and e-cigarettes.
• Minor Rx drug provisions: The deal includes a provision requiring brand-name drug manufacturers to share drug samples with generic drug manufactures so that generics will be more readily available. It also includes provisions to help get lower-cost, biosimilar insulin to the market faster.
• Gun violence research: The bill includes $25 million for the CDC and the National Institutes of Health to study gun violence, essentially reversing a rule in effect since 1996 that had prohibited the CDC from funding research that could be used to advocate for gun control. See Congressional Deal Could Fund Gun Violence Research for First Time Since 1990s (Washington Post, 12/16/19). 

The legislation also includes some funding for a border wall, and repeals three different taxes established in the Affordable Care Act that had previously been delayed, including taxes on "Cadillac" health insurance policies and medical devices.

 

The president is expected to sign the bill by Friday, December 20, when the current temporary funding law ("continuing resolution") expires.