By: NACHC Federal Affairs Team
With Members of Congress scheduled to attend the party conventions this week and next, and then to head back to their districts for the August recess, Congress will be out of Washington for the next seven weeks. With National Health Center Week looming, the recess is a great opportunity to get Members to come visit your health center. While Congress is scheduled to return to DC after Labor Day, reports indicate that depending on a number of factors, that session could be very short. So that all advocates are up to speed, we wanted to share some updates on key legislative issues as Congress heads home.
Last week, the House Appropriations Committee approved the Fiscal Year (FY) 2017 Labor, Health, and Human Services (LHHS) Appropriations bill. The bill was considered over two days and 30 amendments were considered. The legislation was ultimately passed by a vote of 31-19, with nearly all of the Democrats on the committee opposing the legislation. The timing of potential consideration and a final vote on the FY17 LHHS bill in the House is unclear.
The legislation contained the full health center funding request for fiscal year 2017 (FY17) of $5.1 billion in funding for health centers. This is level funding compared with FY16 and composed of $1.5 billion in discretionary funding from the Appropriations Committee and $3.6 billion in funding from the mandatory Health Centers Fund, which was extended last year by H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015.
As you will recall, the Senate proposed FY17 LHHS bill allocated $100 million out of the $5.1 billion in available health center funding to be evenly split between mental health ($50 million) and opioid abuse ($50 million) expansion efforts. The House FY17 health center funding levels funding levels matched the Senate, but the bill did not specify $100 million the funds should be used for mental health and opioid abuse treatment. However, the House LHHS Committee report clearly indicates support for expansions in health centers in those two areas.
That is just one issue that will have to be resolved when the House and Senate begin negotiations over the summer and into the fall. It is widely expected Congress will move to pass a continuing resolution (CR) to extend funding at current levels before the end of the current fiscal year on September 30th. Reports from the Hill indicate Republican leadership is debating the length of time of the potential CR. It is unclear as to whether the CR will run until just after the election or into January – or even March – of next year. Either way, Congress does not appear to be ready to pass an omnibus bill (wrapping up all of the 12 appropriations into a single yearlong funding bill) at the moment. An omnibus will almost certainly not come up as an option until the elections are settled.
Opioid legislation was one of the only bills actually passed into law before Congress adjourned. On an overwhelmingly bipartisan basis, both chambers passed the conference report on S. 524, the Comprehensive Addiction and Recovery Act (CARA), legislation that would seek to address the current opioid epidemic through a variety of grants and programs related to prevention, treatment, and recovery. NACHC previously sent a letter to House and Senate Conferees urging them to remove the federal restriction preventing both physician assistants (PAs) and nurse practitioners (NPs) from prescribing buprenorphine for the purposes of Medication-Assisted Treatment (MAT), and the final bill authorized NPs and PAs who meet certain criteria to prescribe buprenorphine for a period of five years – an important step forward. The bill briefly hit a snag when Democrats and the President voiced serious concerns about the lack of new funding provided for these programs, but ultimately the bill garnered nearly unanimous support in both the House and Senate and was signed into law with the hopes that further funding would be included as part of the appropriations process later this year.
In addition to passing opioid legislation, the House moved forward with a broader mental health bill, voting 422-2 to pass H.R. 2646, the Helping Families in Mental Health Crisis Act, a bill to strengthen federal infrastructure for mental health, improve Medicaid coverage for adults and children receiving treatment in an institution for mental disease (IMD), clarify HIPAA regulations, and bolster federal, state, and local grants and programs to address mental illness. Of particular importance to health centers is a provision to extend FTCA liability protections to health professional volunteers serving at community health centers. NACHC is working with Senate health center champions to ensure this language, introduced in the Senate as S. 2151 , the Family Health Care Accessibility Act, is included in their version of mental health legislation which may be considered when Congress reconvenes in the fall. NACHC also advocated for provisions to require that states allow same-day billing by Medicaid for behavioral health and physical health services (some states currently allow this, some don’t), but those provisions were watered down due to cost concerns. The future of mental health legislation depends on whether Congress is able to overcome legislative and political hurdles related to potential gun amendments, cost concerns, and a dwindling number of days in the legislative session.
ACO Parity for FQHCs
In a bit of good news from Congress, Congresswoman Jenkins (R-KS) and Congresswoman Linda Sanchez (D-CA) recently introduced H.R. 5667, the Rural ACO Provider Equity Act, a bill to allow FQHCs and rural health clinics to assign their patients to ACOs under the Medicare Shared Savings Program. The Senate version of the legislation, S. 2261, was introduced by Senators Thune, Cantwell, and Murray and passed the Senate unanimously on December 17, 2015. If this is an issue that is important to your health center we encourage you to ask your Representative to cosponsor the bill. To help you with those discussions, NACHC put together a one-page overview that you can use to explain the issue.
After nearly five months of on and off negotiations, Congress was unable to come to an agreement to fund the Zika response before adjourning for the summer. As expected, the last week of legislative business before recess resulted in a second failed vote in the Senate on the conference report passed by the House – the measure failed 52-44, short of the 60 votes needed for the bill to advance toward a final passage vote. Again this vote broke down largely along party lines, with Democrats pointing to several issues of concern within the Republican-led conference report, as detailed in this post, and Republicans blaming Democrats for voting down a bill that would have addressed the current crisis before the seven-week recess.
Also right before the summer recess, a bipartisan group of senators introduced legislation to create a permanent fund to address public health emergencies, The Public Health Emergency Response and Accountability Act, S.3280. Recognizing that public health emergencies like Zika are inevitable and Congress is not necessarily inclined to act quickly in the face such emergencies, the legislation would allow for Congress to provide immediate resources where they are needed most. Similarly, the House included in its draft of the FY2017 Labor, Health and Human Services (LHHS) Appropriations bill a provision to create the “Infectious Diseases Rapid Response Reserve Fund” to make funds available through the annual appropriations process, which could be tapped into quickly to respond to future infectious disease emergencies. While these can be viewed as positive developments, as with the original funding request to address the Zika virus, we will be waiting until after Labor Day to see where Congress will go from here.