Health Care Policy & Legislation Updates
Congressional leaders announced a budget and debt deal
23 July 2019—Robert Silverstein, lobbyist and principal of Powers Pyles Sutter & Verville PC reported to the DRRC and the ACRM Policy and Legislation Committee that a budget and debt deal was announced Monday by the White House and congressional leaders. The debt will be raised through July 2021 and the budget deal would be for FY’20 and 21.
In FY’20, federal agencies overall would get a nearly 4 percent increase over the FY’19 levels with $738 billion for defense spending and $632 billion for non-defense. In FY’21 those amounts would be $740.5 billion for defense and $634.5 billion for non-defense.
The agreement also includes language that the 12 appropriations bills won’t include any policy riders or changes to transfer authority, such as the administration’s ability to move money to Trump’s border wall project, unless there is bipartisan agreement on those issues.
The House is expected to pass the legislation on Thursday. Passage in the Senate is expected next week. Sources have stated that Senate markups of individual appropriations bills will begin shortly after they return from the August break.
Azar v. Allina case impacts Medicare payment for services
July 2019—The United States Supreme Court issued a 7-1 decision last month in Azar v. Allina Health Services, which will have far-reaching implications for the validity of the Centers for Medicare and Medicaid Services’ (CMS) sub-regulatory guidance governing Medicare payments to providers of rehabilitative services and devices. The Court held that CMS must use notice-and-comment rulemaking before issuing guidance that establishes or changes a substantive legal standard governing Medicare payment for services. Read More >>
Nondiscrimination proposed rule
June 2019—The ACRM Policy and Legislation Committee would like to share with members an important memo on the administration’s proposed rule for replacing the current implementation of Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, disability, age, and sex. Comments on the Proposed Rule are due 60 days after publication in the Federal Register. Read More >>
Proposed Rule on Inpatient Rehabilitation Facility Prospective Payment System
On 24 April 2019, the Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services (HHS) published a proposed rule in the Federal Register updating the prospective payment rates for inpatient rehabilitation hospitals and units (IRFs) and proposing other changes in regulations for federal fiscal year (FY) 2020. With certain notable exceptions, most of the proposed regulatory changes described are highly technical and are of most relevance to IRFs and their operations. CMS has also published a fact sheet for the rule. Comments on the proposed rule are due 17 June 17 2019 by 5:00 PM EDT. Read More >>
Summary and Excerpts from FY 2020 House Labor, HHS, Education Appropriations Bill
May 2019—On 8 May, the House Appropriations Committee reported out the FY 2020 Appropriations bill for Labor, Health and Human Services (HHS), Education (ED), and related agencies. The bill is accompanied by a written report that includes statements of congressional intent and charts documenting appropriated levels for specific programs. Members are encouraged to review excerpts from the bill and the Appropriations Chart here. Follow the “Read More” link for a summary memo to the DRRC. Read More >>
Analysis of ACL/NIDILRR Reorganization Notice
May 2019—On May 9, 2019, the Administration for Community Living published an updated Statement of Organization, Functions, and Delegations of Authority in the Federal Register. Follow the link to review a comparison of the newly released notice with the original statement of organization published in 2015, when NIDILRR was moved under the umbrella of ACL. No substantive or policy changes to NIDILRR’s structure or organization have been made, and only minor retitling, technical and conforming changes were made to the 2015 statement. Read More >>
Update on the MedPAC Episode-Based Payment Model for Post-Acute Care
May 2019—The March meeting of the Medicare Payment Advisory Commission (MedPAC) continued the discussion of implementing a unified payment system for post-acute care (PAC) using an episode-based payment model. To review the key points of that meeting, please follow the link to a memo summary. It presents an overview of the stay-based and episode-based models. It also includes recommendations presented by MedPAC for transitioning to a PAC unified payment system. The important take-away of this debate is that MedPAC Commissioners appear to be taking a pause in their deliberation of designing a unified PAC payment system. Read More >>
ICDR Government-Wide Strategic Plan – 2018-2021
March 2019—The Workforce Innovation and Opportunity Act (WIOA) (Public Law 113-128) included a requirement for the ICDR to develop a comprehensive government-wide strategic plan for disability, independent living, and rehabilitation research. Coordinated by the ICDR, the strategic plan is the culmination of an extensive effort to engage WIOA-defined stakeholders – policymakers, representatives from other Federal agencies conducting relevant research, individuals with disabilities, organizations representing individuals with disabilities, researchers, and providers – in order to methodologically produce a document that reflects their priorities and capitalizes on potential interagency synergies. Follow the link to review the final report. Read More >>
Highlights of the NIDILRR 2018-2023 Long Range Plan
January 2019—The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) released its 2018-2023 Long Range Plan (LRP). The LRP presents a comprehensive agenda that will advance the vital work being done in applied disability, independent living, and rehabilitation research and development. The LRP emphasizes consumer relevance and scientific rigor and will enable NIDILRR to further its mission of enhancing the ability of people with disabilities to achieve inclusion and integration into society. Highlights include:
- Role and location of NIDILRR
- Overarching factors influencing the research agenda
- Outcome domains
- Cross-cutting research activities
- Stages of research and development
- Activities that promote the quality and use of sponsored research
New Opioid Bill encourages research on non-opioid pain treatment
October 2018—On Wednesday, 24 October, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act, into law. This bi-partisan bill was widely supported and includes many of the House- and Senate-passed provisions aimed at combating the opioid crisis, reforming regulations to increase access to addiction treatments, encouraging research on non-opioid pain treatments, and increasing law enforcement activities to stop the importation of synthetic opioids into the U.S. The ACRM Policy and Legislation Committee encourages members to review this memorandum that breaks down the key provisions of the bill and potential grant opportunities included. Read More >>
Senate Appropriations Committee Calls for Increased NIDILRR Funding
June 2018 – The ACRM Policy and Legislation Committee is pleased to inform members that the recent Senate Appropriations Committee report accompanying the Labor-HHS-Education appropriations bill included $109M for NIDILRR, which is a $4M increase over the FY2018 omnibus bill. In addition, “the committee continues to support NIDILRR in ACL and does not transfer the program or activities to NIH.” The report also specifies that “the committee provides NIDILRR $4M to fund competitive assistive technology research grants that help individuals with disabilities, with a particular emphasis on seniors, maintain or improve independence.
The Final Rule: Implications for Rehabilitative Services and Devices
17 April 2018 – The Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services (HHS) published in the Federal Register its Notice of Benefit and Payment Parameters final rule for 2019. The Final Rule will be effective on June 18, 2018. Follow the link to review an analysis of the Final Rule’s implications for rehabilitative services and devices, including the States’ role in defining essential health benefits and qualified health plan certification, as well as the costs of coverage and network adequacy. Read More >>
Alarmingly Low Funding Levels in Trump’s 2019 Budget Proposal
26 February 2018 – President Trump’s Fiscal Year 2019 budget proposal released on February 12, 2018 contains a large number of alarmingly low funding levels and structural changes to key disability and rehabilitation programs. However, it is difficult to analyze with precision the true impact of these proposals for three reasons outlined in a memorandum to ACRM and members of the Disability and Research Rehabilitation Coalition (DRRC). The memo summarizes some of the proposed funding amounts for rehabilitation and disability research programs, as well as for related disability programs run by the Administration for Community Living (ACL). Read More >>
Congress Passed Comprehensive Budget Agreement and Funded Government Through 23 March
On 9 February, Congress passed a comprehensive two-year budget agreement including a number of significant Medicare policies known as “Medicare extenders” as well as related health policies, and temporarily extended federal funding through 23 March 2018. Read the memorandum to ACRM members prepared by Powers Pyles Sutter & Verville PC for a summary of the bill. Read More >>
DRRC Meeting with NCMRR Director, Alison Cernich
5 December 2017 — The 13 December 2017 all-member meeting of the Disability and Research Rehabilitation Coalition (DRRC) will be a special one and we encourage ACRM members to participate. We are happy to announce that Dr. Alison Cernich, Director of the National Center for Medical Rehabilitation Research (NCMRR) at the NIH, will be joining us.
Dr. Cernich will report on NCMRR’s rehabilitation research portfolio analysis, a project she has led for the past year. She will also report on progress and accomplishments at NIH and share highlights from her Dec. 4 presentation at the NCMRR Advisory Board meeting. We encourage you to join us for what promises to be an enlightening conversation on NCMRR’s work.
We also ask that you please share this invitation with your organization’s research leaders and ask them to participate as well.
Details for the Call
WHEN: Wednesday, 13 December 2017 from 4:45 to 5:45 PM EST
WHERE: Call in number: +1.712.451.0440
ACCESS CODE: 669370#
Senate Health Care Reform Effort & Possible Next Steps
26 September 2017—Senate Republicans decided not to vote on the Graham-Cassidy health care reform legislation to repeal and replace the Affordable Care Act (ACA). They had hoped to advance their legislation prior to the September 30 deadline for the Senate to pass health care reform legislation using the Fiscal Year 2017 budget reconciliation procedure, which would allow Republicans to pass the bill with a simple majority of 51 votes. Unable to secure enough votes to guarantee the bill’s passage, Senate Republicans opted not to bring the bill to the Senate floor. Read More >>
MedPAC Meeting: Encouraging Medicare beneficiaries to use higher-quality post-acute care providers
On 7 September, the Medicare Payment Advisory Commission (MedPAC), an independent legislative branch agency that provides Congress with analysis and policy advice on the Medicare program, held a meeting that included the session, Encouraging Medicare beneficiaries to use higher-quality post-acute care providers. Follow the link to review a memorandum on this meeting. Read More >>
Senate FY 2018 federal appropriations levels for your review
The ACRM Policy and Legislation Committee invites your review of federal appropriations levels across a number of health, education, and labor priorities related to the federal budget items impacting many members. Follow the link to view a chart describing the difference between the Senate FY 2018 Appropriations Committee legislation and previous funding proposals and final amounts. To make the document easier to print, we have hidden a few of the historical columns (from 2013-2016), which you can “unhide” to expand and compare across a longer time frame. Read More >>
Hurricane Harvey Regulatory Relief Memo
7 September 2017—In response to Hurricane Harvey, the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) and private insurers are offering regulatory relief to health care providers to ensure that individuals affected by the storm can access the care and services they need. Shortly after the storm began, HHS Secretary Tom Price declared a public health emergency in Texas and Louisiana. Secretary Price also authorized Social Security Act (SSA) waivers for Texas and Louisiana allowing CMS to reduce the regulatory burden on providers that serve Medicare, Medicaid and State Children’s Health Insurance Program (CHIP) beneficiaries.
Review the Hurricane Harvey Regulatory Relief Memo for information and resources related to regulatory relief for health care providers and facilities in areas affected by Hurricane Harvey, particularly for providers that serve Medicare beneficiaries and people with disabilities. Read More >>
Final Rule Announced on Inpatient Prospective Payment System
On 3 August 2017, the Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services (HHS) published the final rule in the Federal Register updating the prospective payment rates for inpatient rehabilitation hospitals and units (IRFs) for federal fiscal year (FY) 2018. This rule refines the ICD-10-CM list and the 60 Percent Rule presumptive methodology, and changes the IRF quality reporting program (QRP), among other things. Keep reading to review the highlights of the final rule and how CMS responded to comments from rehabilitation stakeholders. Read More >>
DRRC Appropriations request and update
4 August 2017— Last week, members of the DRRC met with Senate Appropriations Subcommittee on Labor-HHS-Ed staff and advocated for DRRC’s FY 2018 Appropriations priorities. Staff encouraged continued advocacy and outreach on these priorities. To that end, the ACRM Policy & Legislation Committee asks members to send the revised letter to Senate Appropriations Subcommittee on Labor-HHS-Ed member personal office staff in support of DRRC’s efforts.
Please reference the Senate Staffers spreadsheet for contacts regarding DRRC’s priorities, as well as this sample message. Senate Appropriations Committee staff are actively working on the Labor-HHS-Ed bill, with a possible markup in early September, so it is imperative to support DRRC’s coalition efforts with your outreach to the Senate as soon as possible.
Impact on Health Care of Trump’s FY2018 Budget Proposal
26 May 2017—Last week, President Trump released his FY 2018 Budget. According to A New Foundation for American Greatness, a document prepared by the Office of Management and Budget (OMB), the Budget includes:
- $3.6 trillion in spending reductions over 10 years;
- $54 billion increase in defense spending in 2018 which is fully offset by $54 billion in reductions to non-defense pro-grams; and
- A plan that would reduce non-defense budget authority by two percent each year, to reach approximately $385 billion in reduced spending by 2027, or just over 1.2 % of gross domestic product (GDP).
DRRC Meeting with NIH Leadership
23 May 2017—Representatives of several DRRC member organizations and Powers Law staff met with NIH officials at the NIH campus to discuss federal medical rehabilitation and disability research and the implementation of recently-passed legislation. The group also sought feedback and input from the NIH staff on specific NIH research developments as well as the implementation of Section 2040 of the 21st Century Cures Act (PL 114-255) known as the Enhancing the Stature, Visibility and Coordination of Medical Rehabilitation Research at NIH Act of 2016. Read More >>
Proposed Rule on Skilled Nursing Facility Prospective Payment System
4 May 2017—The Centers for Medicare & Medicaid Services (CMS) published a proposed rule in the Federal Register to revise the payment rates used under the prospective payment system for skilled nursing facilities (SNF) for fiscal year 2018. In an effort to continue to shift Medicare payments from volume to value, CMS also proposes additional policies and measures for the implementation of the Skilled Nursing Facility Value-Based Purchasing Program and the Skilled Nursing Facility Quality Reporting Program as well as an update on the SNF Payment Models Research project among other things. Your comments on the proposed rule are encouraged and due 26 June. Read More >>
The House GOP Affordable Care Act repeal and replacement legislation
6 March 2017—The House Committee on Ways and Means and the House Committee on Energy and Commerce released legislation to repeal and replace the Patient Protection and Affordable Care Act (ACA). The House bill, called the American Health Care Act (AHCA), would significantly impact the individual and small group markets for health care coverage, with many of its sections repealing or significantly altering key components of the ACA. Follow the link for a summary of current law, contrasted with the proposals made in the AHCA and analysis of the bill’s key provisions and impact. The following memorandum offers a summary of current law, contrasted with the proposals made in the AHCA, followed by analysis of the bill’s key provisions, impact, and associated commentary. Read More >>
NIH Research Plan on Rehabilitation released
15 September 2016—The National Center for Medical Rehabilitation Research (NCMRR) Director, Alison Cernich announced the release of the NIH Research Plan on Rehabilitation. Per the NICHD’s website, “This 5-year plan lays out priorities in medical rehabilitation research that will guide NIH support for rehabilitation medicine and will benefit individuals with temporary or chronic limitations in physical, cognitive, or sensory function that require rehabilitation.” This long-anticipated update coincides nicely with DRRC legislative work to advance S.800/H.R. 1631, legislation intended to enhance the stature and visibility of medical rehabilitation research at the NIH. Read More >>
Helping Hospitals Improve Patient Care Act (H.R.5273)
On 7 June 2016, the full House of Representatives passed the Helping Hospitals Improve Patient Car Act (H.R. 5273) via voice vote. The bipartisan legislation’s main objective is to advance hospital and Medicare payment reforms, among other changes. One of the most signicant provisions of the legislation provides relief related to Medicare payments for certain hospital outpatient departments (HOPDs). Read More >>
Summary of Hearing on Concussions in Youth Sports
May 2016—Following an initial roundtable discussion in March, the House Energy & Commerce Oversight & Investigations Subcommittee held a hearing earlier this month to examine concussions and head trauma in youth sports. The hearing focused primarily on prevention and protection of young athletes from brain trauma, as well as next steps in developing evidence-based policies. Even though more than 30 million children annually participate in organized sports, there is a lack of substantial awareness, prevention, and research related to head trauma and injuries among child and adolescent athletes. Read More >>
ACRM Members Call to Action: Critical legislation needs co-sponsors
On 19 March 2015, companion bipartisan bills (S. 800; H.R. 1469) were introduced to enhance the stature and visibility of medical rehabilitation research at NIH. DRRC has been working with members of Congress and NIH for years to craft this bill and enthusiastically supports these companion bills. They send a powerful message that our Nation can and must improve the quality of life of persons with disabilities and chronic conditions by enhancing medical rehabilitation research at NIH and, by so doing, improve the provision of rehabilitation services and devices. We urge you to contact your members of Congress in person when they are in the district, asking them to co-sponsor this critical legislation.
Priority Proposed for RRTC on Self-Directed Care to Promote Wellness for Individuals with Serious Mental Illness
The Administrator of the Administration for Community Living proposes a priority for the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). This notice proposes a priority for an RRTC on Self-Directed Care to Promote Recovery, Health, and Wellness for Individuals with Serious Mental Illness. We take this action to focus research attention on an area of national need. We intend this priority to contribute to improved employment for individuals with serious mental illness (SMI) and co-occurring conditions. Comments must be received before 27 March 2015. Read More
Policy and Legislation Committee Offers Draft Wording for Review
On 22 July 2014, President Obama signed into law the Workforce Innovation and Opportunity Act (WIOA). The legislation includes significant changes to Title II of the Rehabilitation Act pertaining to the National Institute on Disability and Rehabilitation Research (NIDRR) and the Interagency Committee on Disability Research (ICDR), including amendments previously proposed by ACRM and others. A draft ACRM statement applauding Congressional action that made these changes is available for review and comment. Responses to any questions will be announced in eNews.
Review Draft ACRM Statement
Congressional Leaders Announced Bipartisan/Bicameral Agreement Reauthorizing the Workforce Investment Act and Rehabilitation Act (May 21, 2014)
On May 21, 2014 congressional leaders announced a bipartisan/bicameral agreement reauthorizing the Workforce Investment Act and the Rehabilitation Act. The bill number is H.R. 803 and the short title of the bill is the Workforce Innovation and Opportunity Act. View the bill, a section-by-section analysis prepared by congressional staff, and a one-page summary here.
The following documents may also be of interest to ACRM members. The NIDRR Reauthorization Agreement summarizes the key changes to Title II of the Rehabilitation Act (Research and Training).
The Redline of Title II Amendments compares the language in the bill to current law by indicating deleted language by using “strike-through” and by indicating new language by using bold and underline.
The Senate is expected to act within a month, followed by the House. The President has indicated he will sign the bill. You may contact Robert “Bobby” Silverstein, Principal of Powers, Pyles, Sutter and Verville, PC with questions, direct: 202.872.6754.
DOD Request for Information: Ongoing Blast Injury Prevention Standards Recommendation (BIPSR) Process (February 6, 2014)
The BIPSR Process is currently focused on Human Lower Extremities (LE) Blast Injury Prevention Standards. The LE includes: lower limb, femur, knee, tibia, ankle (talus), foot and heel (calcaneus). The BIPSR Process injury types of interest are Fracture, Vascular Injury, Nerve Injury, Muscular Injury, Ligament and Tendon Injury, Traumatic amputation, and Dermal Burns.
The BIPSR Process identified a need to define injury criteria and test methods to establish thresholds for protective systems designed to protect the military service members’ lower extremities from all blast injury categories and types in their respective operational environments. Read More
January 2014 Status Update on the Convention on the Rights of Persons with Disabilities (CRPD) in the U. S. Congress
Reported by Powers, Pyles, Sutter & Verville, PC
The negotiations on the Convention on the Rights of Persons with Disabilities (CRPD) are currently at a stand-still in Congress. The U.S. Senate Committee on Foreign Relations last held a hearing on the matter on Thursday, 21 November 2013. During the hearing, testimony as given by Secretary of State John Kerry; Frances W. West, Worldwide Director, Human Ability & Accessibility Center; C. Boyden Gray, Former White House Counsel and Ambassador Read More
Washington, DC: A large coalition of rehabilitation, disability, research, and provider organizations endorsed federal legislation intended to improve, coordinate and enhance rehabilitation research at the National Institutes of Health (NIH) to address the needs of people with injuries, illnesses, disabilities and chronic conditions.
The Disability and Rehabilitation Research Coalition (DRRC) commended Senator Mark Kirk (R-IL) and Senator Tim Johnson (D-SD) for their bipartisan introduction of S. 1027, the Kirk/Johnson Rehabilitation Improvement Act, to spotlight the importance of advancing rehabilitation research at NIH and across other federal agencies. Read More.
On 10 April 2013, President Obama released his FY 2014 budget, two months after the official deadline by which the President is legally obligated to offer a spending proposal for the next fiscal year. His budget totals $3.77 trillion for 2014 and includes $580 billion in tax increases and over $1 trillion in spending cuts over the next ten years to achieve a total of $1.8 trillion of additional deficit reduction. While the President’s proposal brings the deficit down to 1.7% of the Gross Domestic Product (GDP) by 2023, it does not eliminate the annual deficit entirely. Read More
Act locally to defend research funding. Now is the time to reach out to your Representatives and tell them that health services research, and the Agency for Health Care Research and Quality, must be protected.
Departments of Labor, Health and Human Services, Education, and Related Agencies
FY 2012 Appropriation Bill
On February 6, 2012, ACRM submitted comments on the Agency for Healthcare Research and Quality draft report, Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury. ACRM comments address concerns that the report reveals:
- Inadequate understanding of TBI post-acute rehabilitation;
- Deficiencies in the methodology;
- Insufficient consideration of the unintended consequences of paper on individuals with TBI and their families;
- Lack of recognition of the fiscal implications of the recommendations calling for a comprehensive research agenda; and
- Lack of summary comments.
By Robert “Bobby” Silverstein, Principal
Powers, Pyles, Sutter & Verville PC
MARCH 21, 2012 – Yesterday, the House Democrats introduced the Workforce Investment Act of 2012. The provisions relating to NIDRR and disability and rehabilitation research are virtually identical to the provisions in the bipartisan Senate bill marked up last year. The Senate bill includes many of the recommendations made by DRRC. The House bill includes what is referred to as “cut and bite” amendments, which means that the bill amends current law by striking certain language and inserting other language. If you have not memorized current law, it is virtually impossible to figure out what is being proposed. To facilitate understanding of what’s in the bill, please review the red-line version of Senate draft (changes reflected in current law). There is no red-line version of the House Democrats bill. Below are the major categories of changes included in the House Democrats bill:
- Reaffirms the focus of NIDRR on the research domains of employment, community participation (independent living), and health and function as well as assistive technology and disability demographics.
- Promotes the implementation of evidence-based practices and emphasize the importance of knowledge translation and new methods of sharing and disseminating information.
- Expands the list of designated members of the ICDR.
- Directs ICDR to host a disability and rehabilitation research summit that will establish a strategic plan for disability and rehabilitation research conducted by federal agencies.