Policy Corner: December 20, 2019

Congress Sends Appropriation Bills to President

Congress has passed the fiscal year 2020 appropriations package, consisting of two spending bills, which has been sent to the president for his signature. This avoids the possibility of a government shutdown should an appropriations measure had not passed before midnight Dec. 20. The first minibus funds agencies that have a national security focus, such as the Departments of Defense and Homeland Security. The second minibus includes funding for the Departments of Labor, Health and Human Services, Education, Housing and Urban Development, Transportation, and Veterans Affairs. For the first time in more than 20 years, funding is appropriated for gun violence research to be conducted by the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH).

The funding measures also extended funding for programs which had or were set to expire such as Temporary Assistance for Needy Families; Patient-Centered Outcomes Research Institute, reauthorized through Sept. 30, 2029; and the Money Follows the Person and spousal impoverishment protections with regard to home and community-based services through May 22, 2020.

Department of Health and Human Services (HHS)

The Federal Administration for Community Living (ACL) Traumatic Brain Injury Program is leveled funded at $11.321 million, same as current funding level, which funds state partnership grants and grants for Protection & Advocacy Systems. The ACL National Institute on Disability, Independent Living, and Rehabilitation Research received an increase of $3 million of which $2 million is for continued investment in research focused on independent living, addressing the disabled aging populations, and targeting rural, frontier, and tribal communities; and $1 million increase directed to assistive technology formula grant funding.

The NIH received an overall increase of $2.6 billion (6.65%) to a total of $41.7 billion. Within that increase are the following:

• A $350 million increase for Alzheimer’s research to a total of $2.8 billion;
• $500 million for the BRAIN Initiative, a $71 million increase;
• $500 million for the All of Us precision medicine initiative, up $161 million;
• A total of more than $800 million for opioid addiction research, alternative pain management research, and treatment;
• $578 million for Clinical and Translational Science Awards, up more than $18 million; and includes $3.9 billion for mental health programs, which represents an increase of $328 million.
• $1.56 billion for the National Institute on Child Health and Human Development, which houses the National Center on Medical Rehabilitation Research, an increase of $50 million; and
• $2.45 billion for the National Institute of Neurological Disorders & Stroke, the largest single funder of disability and rehabilitation research within NIH, an increase of $170 million.

The CDC’s National Center for Injury Prevention and Control received a $30 million funding increase of which:

• $12.5 million for firearm injury and mortality prevention research
• $10 million for suicide prevention
• $4 million for adverse childhood experiences

The bill also includes protections for manual complex rehabilitation technology (CRT) wheelchairs from competitive bidding, which the Brain Injury Association of America (BIAA) supported and was the purpose of the Association Health Plans Act of 2019, H.R. 2294. This specialized equipment is provided through a clinical team model and requires extensive evaluation, configuration, fitting, adjustment, and programming. This bill will permanently exempt manual CRT wheelchair bases from competitive bidding, and suspends the competitive bidding rates for manual CRT wheelchair accessories for an 18-month period, beginning Jan. 1, 2020, and lasting until June 31, 2021. Power CRT wheelchair bases and accessories were already “fixed” by Centers for Medicare and Medicaid Services (CMS) and excluded from competitive bidding. The suspension of the competitively bid rates for manual accessories will allow time to work with CMS to make this permanent and consistent with the existing policy for power wheelchairs.

The minibus package also included report language directing CMS not to publish any regulation restricting Medicaid non-emergency medical transportation services until the Medicaid and CHIP Payment and Access Commission studies the impact of those restrictions on beneficiaries.

Department of Labor

Language was included directing the department to evaluate incorporating resilience training and trauma-informed practices into Workforce Innovation and Opportunity Act in youth job training programs and directed the department to consult with organizations with nationally recognized expertise in such practices.

The spending package included $300,000 within the Federal Administration to establish a Disabled Veteran Program (DVP) to address the high unemployment and low labor force participation rate of veterans with service-connected and non-service-connected disabilities. The DVP will help increase employment and advancement opportunities for veterans with disabilities by working with federal, state, and private partners to promote the hiring of veterans with disabilities, improve coordination of available employment services and supports, and to identify and share employment best practices for hiring, retaining, and advancing veterans with disabilities in the workforce.

BIAA Signs on to Letters Regarding “Intensity of Therapy” Requirements

BIAA has joined other disability and rehabilitation organizations in signing on to the American Academy of Physical Medicine and Rehabilitation (AAPM&R) letters to Reps. Glenn Thompson (R-Pa.) and G.K. Butterfield (D-N.C.) in support of legislation introduced last year. The Access to Inpatient Rehabilitation Therapy Act of 2017, H.R. 626, aims to eliminate burdensome regulations and provides needed flexibility to the “intensity of therapy” requirement that the CMS uses to help determine which Medicare beneficiaries are appropriate for treatment in an inpatient rehabilitation hospital (IRF) and unit. BIAA also signed on to a letter to Reps. Bill Pascrell, Jr. (D-N.J.), and Butterfield asking them to sponsor the Access to Inpatient Rehabilitation Therapy Act of 2019. Reps. Thompson (R-Pa.) and Mike Kelly (R-Pa.) have agreed to introduce the bill this year.

The new version of the Access to Inpatient Rehabilitation Therapy Act would restore physician judgment in selecting the mix of skilled therapies that meet the “intensity of therapy” requirement used by the CMS to determine which Medicare beneficiaries are appropriate for treatment in an inpatient rehabilitation hospital or unit. In order to qualify for treatment in an IRF, Medicare beneficiaries must require a “relatively intense” program of rehabilitation therapy. One of the factors CMS uses to determine whether this criterion is met, known as the “three-hour rule,” requires the patient to participate in and benefit from, at least three hours of rehabilitation therapy per day, five days per week (or 15 hours within a seven consecutive day period in certain cases, if documented appropriately).

BIAA also signed on to a letter along with AAPM&R, the American Therapeutic Recreation Association, and the American Medical Rehabilitation Providers Association, to Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) to consider including the Access to Inpatient Rehabilitation Therapy Act of 2019 in the proposed 21st Century Cures 2.0 legislation.

Congress Recesses for the Holidays

The Senate and House are adjourning and will return to work on Jan. 7, 2020. The next Policy Corner will be produced Jan. 10, 2020. Have a safe and happy holiday!