The American Academy of Family Physicians issued a statement of support for the Bipartisan Budget Agreement (HR 1892) announced on February 7 which passed the Senate 71-28 and the House 240-186. The bill was signed into law by President Trump on February 9.
The deal announced by Senate leaders extends the Children’s Health Insurance Program (CHIP) for an additional 4 years and extends funding by 2 years for Community Health Centers, the Teaching Health Center Graduate Medical Education (GME) program, and the National Health Service Corps.
Listed below are provisions in the bipartisan budget agreement that were AAFP priorities:
Physician Payment
- Modifies the Merit-Based Incentive Payment System (MIPS), including allowing the Centers for Medicare and Medicaid Services to extend Pick Your Pace through 2021, and easing the transition into using resource use (cost) measures.
- Extends Work Geographic Practice Cost Index (GPCI) Floor through Wednesday, January 1, 2020.
- Repeals requirement under Meaningful Use (now re-branded as Advancing Care Information) that electronic standards for electronic health record use become more stringent over time.
- For Calendar Year 2019, reduces positive update to Medicare physician payment conversion factor from 0.5% to 0.25%.
Delivery Reform
- Extends the length of the Independence at Home Demonstration by two years; increases the cap on the total number of participating beneficiaries from 10,000 to 15,000; and gives practices three years to generate savings against their spending targets.
- Repeals Medicare payment cap for therapy services (includes a targeted medical review for services above a threshold of $3,000 before 2028 and increasing thereafter).
- Within Medicare, recognizes Attending Physician Assistants (PAs) as Attending Physicians to serve hospice patients.
- Within Medicare, allows PAs, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs.
“Primary Care Cliff”
- Extends funding for National Health Service Corps ($310 million for each of Fiscal Year (FY) 2018 and 2019).
- Extends funding for Teaching Health Center GME ($126.5 for each of FYs 2018 and 2019).
- Extends grant funding for Community Health Centers to cover the cost of treating uninsured patients ($3.8 billion in FY 2018 and $4 billion in FY 2019).
Health Care for All/Public Health
- Extends CHIP funding through fiscal year 2027.
- Extends Family-to-Family Health Information Centers ($6 million in each FY 2018 & 2019).
- Extends Maternal, Infant, and Early Childhood Home Visiting Program through FY 2022
- Extends funding for outreach and assistance for low-income programs; state health insurance assistance program reporting requirements ($13 million in each FY 2018 & 2019).
- Extends Special Diabetes Program ($150 million for each of FYs 2018 and 2019).
- Includes $4.8 billion in Medicaid funding for Puerto Rico and $142.5 million in Medicaid funding for U.S. Virgin Islands. Both also have a two-year 100% disaster Federal Medical Assistance Percentage (FMAP).
- Cuts the ACA Prevention and Public Health Fund $1.35 billion over 10 years.
Rural Health
- Extends increased inpatient payment adjustments for low-volume hospitals through 2023.
- Extends Medicare-Dependent Hospital Program through Sunday, October 1, 2022.
- Extends Home Health Rural Add-On through Tuesday, January 1, 2019.
- Calls for a Government Accountability Office Study/Report on Medicare-Dependent, small rural hospital program to analyze payer mix, inpatient/outpatient utilization, and financial status.
Other
- Repeals the Independent Payment Advisory Board.