LeadingAge Washington Update

LeadingAge passed along the following details of the budget deal Congress recently passed as they relate to issues impacting our members. This measure is mostly good news, as it averts a government shutdown by raising the debt limit until after next year’s election. Government shutdowns have not been good for our members who get paid under public programs.
The budget deal also provides an opportunity to gain more funding for senior housing and for home- and community-based services under the Older Americans Act. Earlier this year LeadingAge was dismayed by the cuts to Section 202 contained in the fiscal 2016 Transportation/HUD appropriations bill passed by the House. The cuts were due to spending caps Congress adopted in 2011 under the Budget Control Act.
The spending caps restricted both defense and non-defense programs to such an extent that Congress was unable to pass any of the regular appropriations bills for fiscal 2016. The budget deal raises the spending caps by $79.4 billion during fiscal years 2016 and 2017. Half of this funding increase goes to non-defense discretionary programs, a category that includes senior housing and OAA home- and community-based services programs.
Now appropriators on both sides of Capitol Hill will have to reconvene to divvy up the extra funding among all the federal programs subject to the appropriations process. So LeadingAge continues to advocate for a portion of the additional money to go to programs serving seniors.
Medicare and Medicaid are not subject to the spending caps, but Medicare had an issue that also was resolved under the budget deal. Medicare premiums for relatively high-income seniors were due to go up by about 50% in 2016 due to a quirk in the Social Security law that comes into play in years when there is no Social Security cost-of-living adjustment (COLA). The Medicare deductible was also set to rise by a significant amount for all beneficiaries. 
The budget deal heads off both of these developments, holding the premium and deductible increases to what they would have been without the special Social Security hold-harmless provisions. CMS has not yet announced premium levels for 2016; it is expected that an announcement will come in early November.
This premium relief benefits states as well. The quirk in the Social Security law did not protect dual-eligibles from the premium hike, so states would have had to budget for much higher contributions to Medicaid beneficiaries’ Medicare premium payments. Now states will just have to pay whatever increase CMS announces in the base premium. 
As one of the offsets for the premium relief, the budget deal extends the 2% sequester on Medicare payments to health care providers for another year, through 2025.
Another Medicare provision in the budget deal relates to payment codes for services provided in “outpatient hospital departments”. The Ways and Means Committee explained that MedPAC has noted the growing practice of hospitals buying physician practices or ambulatory surgery centers and then billing Medicare for the services these entities provide at the higher rates that apply to hospital services. The budget deal provides that hospitals acquiring physician practices or surgical centers in the future will not be able to change their Medicare billing status.
A fact sheet staff of the Ways and Means and Energy and Commerce Committees wrote on the Medicare provisions of the budget deal can be seen here.
New House Speaker: Rep. Paul Ryan is officially the new speaker of the House, the youngest one chosen since 1869. His accession to the speakership has opened up the leadership of the House Ways and Means Committee, which has jurisdiction over Medicare. The committee has just announced that Rep. Sam Johnson (Texas) will be the interim committee chair pending decisions on a new committee chair and potentially new subcommittee chairs.
LeadingAge is not sure where the change in the committee’s leadership leaves the “big Medicare bill” LeadingAge has been hearing about for several months, or some of the other initiatives that have been brewing in the Health Subcommittee, like a new value-based purchasing bill. LeadingAge will continue to keep you advised of developments. (Barbara Gay, LeadingAge)
November 11, 2015


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