Policy Corner: December 8, 2023
Categories: Policy Corner Archives
Senator Expresses Concern Over House Proposal for Appropriation Bills
As the two short-term continuing resolutions (CR) funding government end in two stages in January and February 2024, Senate Appropriations Committee Chair Patty Murray (D-Wash.) has pushed back on a possible full-year CR proposed by Speaker of the House Mike Johnson (R-La.) should Congress fail to pass full funding bills before the two CRs expire. In her speech on the Senate floor, she explained how such an approach would be devastating for all Americans. A full-year CR would force across-the-board cuts in April, including deep cuts in military spending in accordance with the June debt ceiling bill agreement, known as the Fiscal Responsibility Act. According to the agreement, should lawmakers not pass appropriation bills, $69 billion would be cut in domestic spending. Virtually all domestic programs would be cut as much as 10 percent impacting education, health care, research, safety net programs, and more. She called on the House Republicans to move on appropriation bills. Speaker Johnson has pitched to his Conference that if the appropriations bills are not finished by the time the CRs expire, then as a back up plan, he proposed a full-year CR.
The House has passed seven out of 12 spending bills for FY 2024, but have been unable to agree to the remaining five due to disagreements among Republicans, as well as Democrats who oppose policy riders to the bills. On Nov. 14, Rep. Kay Granger (R-Tx.), Chair of the House Appropriations Committee, spoke on the House floor on behalf of H.R. 5894 that provides funding for Labor, Health and Human Services, Education and Related Agencies. She explained that the Committee proposed that over 50 programs be cut and that another 60 programs be eliminated with most of them being unauthorized or have expired authorizations. The bill cuts significantly Title I education funding, while other programs for certain populations, such as Americans with disabilities, older Americans, and foster children are maintained at current levels. Title I of the Elementary and Secondary Education Act, as amended by the Every Student Succeeds Act, provides financial assistance to local educational agencies for children from low-income families to help them meet state performance standards.
The Senate has passed three of the 12 annual spending bills, including funding for the Departments of Transportation, and Housing and Urban Development (HUD). The first CR expires Jan. 19 that funds Agriculture, Energy and Water, Military-Construction-Veterans, Transportation, and HUD. The rest of the agencies, including the spending bill for the Departments of Labor, Health and Human Services, and Education, are funded until Feb. 4, 2024.
CMS Finalizes Physician Fee Schedule for 2024
The Centers for Medicare and Medicaid Services (CMS) has finalized the physician fee schedule for Medicare reimbursements in 2024 that will cut payments to physicians by 3.37%. In past years, Congress has enacted legislation to stop cuts from taking place, but has yet to do so. Reps. Gregory Murphy, M.D. (R-N.D.), Jimmy Panetta (D-Calif.), Brad Wenstrup (R-Ohio), and Danny Davis (D-Ill.), have introduced the Preserving Seniors’ Access to Physicians Act of 2023 to stop the Medicare physician payment cut on Jan. 1, 2024. On Dec. 5th, the House Energy and Commerce Committee voted to approve H.R. 6545, the Physician Fee Schedule Update and Improvements Act, introduced by Rep. Mariannette Miller-Meeks (R-Iowa) on Dec. 1. The legislation is to make improvements to the physician fee schedule under the Medicare program.
Lawmakers Introduce Bills on Gun Violence
On Dec. 5, Senators Elizabeth Warren (D-Mass), Cory Booker (D-N.J.), Edward Markey (D-Mass.) and Mazie Hirono (D-Hawaii) introduced S. 3407 to end the epidemic of gun violence and build safer communities by strengthening federal firearms laws and supporting gun violence research, intervention, and prevention initiatives. On Dec. 6, Rep. Hank Johnson (D-Ga.) introduced the house version of the Gun Violence Prevention and Community Safety Act. Both bills would create a federal gun licensing system; require universal background checks; and invest in research and community-based gun violence prevention by provided $120 million in annual funding for federal research into gun violence and creating a new grant program to provide $120 million per year for gun violence intervention programs. Eighteen Representatives signed on as co-sponsors.
CDC Reports on National Concussion Surveillance System Pilot Project
This week, the Centers for Disease Control and Prevention (CDC) released information on the National Concussion Surveillance System (NCSS) Pilot as reported in the Journal of Head Trauma Rehabilitation. The Traumatic Brain Injury (TBI) Program Reauthorization Act of 2018 authorized the concussion surveillance system subject to appropriations. The Brain Injury Association of America (BIAA) and national partners supported the language and annual appropriations since then to fund the system. In absence of full funding for the system, CDC initiated a pilot project, which used a random-digit-dial telephone survey to collect information on concussions and other TBIs.
The primary goals of the NCSS pilot were to evaluate the methodology of collecting self-report information on nonfatal TBIs for the purpose of surveillance and to test and refine a tiered TBI case definition. A total of 10,030 adults participated in the pilot via a random digit-dial telephone survey from September 2018 to September 2019. Respondents were asked whether they had sustained a hit to the head in the preceding 12 months and whether they experienced a series of 12 signs and symptoms because of this injury. Four indicators of TBI severity were assessed in relation to the most recent head injury reported. Of the 10,030 adults surveyed, 1,364 adult respondents (13.5%) reported sustaining at least one head injury 12 months prior to their interview. The most reported signs or symptoms among persons with a brain injury were immediate headache (64.7%) and being dazed, confused, or trouble thinking straight (58.8%). The conclusion was that the TBI case definition can be used within self-report surveys to help with estimating prevalence and incidence along with other existing administrative sources.
CMS Reminds Providers that Medicare Covers Skilled Therapy Services to Maintain Function
On November 20, the Centers for Medicare and Medicaid Services (CMS) reminded providers and contractors that skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits are covered under Medicare when necessary for a beneficiary to maintain function or to prevent or slow decline, as long as:
- The beneficiary requires skilled care for the services to be provided safely and effectively; and
- An individualized assessment of the patient’s condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist are needed for a safe and effective maintenance program.
This reminder is in keeping with the Jimmo vs. Sebelius, a class action lawsuit which was settled on January 24, 2013, that challenged the interpretation of the “improvement standard” in Medicare coverage. For decades, the “improvement standard” had been interpreted to mean that a beneficiary must show improvement in order to continue to receive rehabilitative Medicare services. Many beneficiaries with chronic illnesses and conditions were routinely denied therapy. The Jimmo Settlement Agreement (January 2013), required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech), and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.