Legislative Update: August 20, 2019

The Congress is in recess and scheduled to return to work on Monday, September 9th. 

Prior to the August recess, the Congress passed, and the Administration signed in to law, the “Bipartisan Budget Act of 2019 (H.R. 3877)”. This legislation set forth the topline spending levels for federal budget for the next two years (FY2020 and FY2021). It would specifically allow up to $1.3 trillion in spending on domestic and defense programs over this timeframe.

Now that the framework for the federal budget has been set, Congress can turn to finalizing appropriations for individual federal agencies, including the U.S. Department of Health and Human Services. Funding for individual federal agencies is set to expire on September 30th (the end of the federal fiscal year). 

It is possible that Congress will come to agreement on funding for some of the individual agencies by the end of September. However, it is likely that not all appropriations bills will be finalized. In this scenario, Congress will need to pass a stopgap funding measure by September 30th – otherwise called a “continuing resolution” – to ensure continued funding and avoid a government shutdown. 

All of the work described above is carried out by the Appropriations Committees in the House and Senate.

While this work is underway, separate Committees will continue work related to health care proposals. Specifically, the Senate Finance and the Health, Education, Labor and Pensions (HELP) Committees as well as the House Ways&Means, Energy&Commerce and Education&Labor Committees will continue considering proposals related to prescription drug pricing, surprise medical billing and other Medicare and Medicaid proposals. 

As part of this work, ElevatingHOME, VNAA and their partners at LeadingAge continue to urge these key Congressional Committees to take action to address concerns with the Medicare Home Health Patient-Driven Groupings Model (PDGM) system.

On July 11th, CMS released the Calendar Year 2020 (CY20) proposed Medicare rule on changes to Home Health Prospective Payment System (Home Health PPS).

The CMS proposed rule requires the new Medicare Home Health Payment-Driven Groupings Model (PDGM) to be implemented effective January 1, 2020. The PDGM system was created in the Balanced Budget Act of 2018 (“BBA of 2018", P.L. 115-123). Unfortunately, the CMS proposed rule would require an 8% Medicare payment reduction as part of the PDGM implementation. 

In response, lawmakers introduced the “Home Health Payment Innovation Act (H.R. 2573, S. 433)”. This legislation would protect access to home health care by ensuring any PDGM payment changes are made based only on actual experience and data. The legislation would specifically prohibit any payment reductions until 2025 and cap any payment reduction at no more than 2% per year.

During August, it is critical that ElevatingHOME and VNAA members reach out to their Members of Congress to urge lawmakers to sign on as a supporter of the PDGM legislation (H.R. 2573/S.433). 

The more lawmakers that agree to cosponsor and support the PDGM legislation, the better chance the legislation will be taken up by key Committees in time to fix PDGM before the January implementation. 

We appreciate your work in contacting your local lawmaker on this critical issue.