Federal

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The means by which Senate Republicans can pass an Affordable Care Act (ACA) repeal/replace bill by a simple majority budget process called reconciliation (and thus not requiring Democratic support of any kind) ends next week, at the end of September.

The Graham/Cassidy bill is now presenting a major threat to Medicaid – it replicates cuts presented in previous health proposals (using exact language from the Better Care Reconciliation Act – BCRA). According to earlier Congressional Budget Office (CBO) estimates, it will cut Medicaid (outside of expansion) by $175 billion between 2020–2026, and $39 billion will be cut from the Medicaid program in 2026 alone.

RCPA requests members to contact Senators Casey and Toomey, and ask them to OPPOSE the Graham/Cassidy bill. For your convenience, the following materials will give you valuable information and talking points when speaking with staff or the Senators.

Questions, contact Jack Phillips, RCPA Director, Government Affairs.

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Please join Sen. Bob Casey (PA) as he addresses the Graham-Cassidy proposal and the effects on Medicaid, adults with disabilities, children with complex health needs, schools, veterans, and those who are aging. Details for joining below:

What: Conference call with Sen. Bob Casey
When: Friday, September 22, 5:45 pm–6:15 pm EDT
Call in number: 866-317-5076, no PIN or ID necessary
No RSVP necessary

Questions, contact Jack Phillips, RCPA Director, Government Affairs

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ALERT – Act Now to Stop Irreparable Medicaid Cuts!
Latest Available data on Graham/Cassidy

The next few days are critical!
Call Congress at (202) 224 3121 and
click here to send your Senators an email to VOTE NO.

The process by which Senate Republicans can pass an Affordable Care Act (ACA) repeal/replace bill by a simple majority budget process called reconciliation (and thus not requiring Democratic support of any kind) ends next week, at the end of September.

The Graham/Cassidy bill is now presenting a major threat to Medicaid – it replicates cuts presented in previous health proposals (using exact language from the Better Care Reconciliation Act – BCRA). According to earlier Congressional Budget Office (CBO) estimates, it will cut Medicaid (outside of expansion) by $175 billion between 2020-2026, and $39 billion will be cut from the Medicaid program in 2026 alone.

The situation has gotten worse. Last night, Chairman Alexander (R-TN) of the Senate HELP Committee who was leading bipartisan ACA fix efforts announced that the bipartisan deal is dead. That leaves the door wide open for Graham/Cassidy passage. Republican Senators are being told that the bill will benefit their state – that is false. This is a bill that seeks to save billions of federal dollars, not make policy improvements to health care programs.

The ACA will be replaced by block grants with likely less funding to states than they currently receive. and all of that money stops flowing completely to states in 10 years. The Medicaid program will be cut significantly and states will be expected to either pick up the bill or make tough decisions about whose lives are most at stake.

So here’s the timeline:

There are two Jewish holidays in the next two weeks that shorten the Senate session calendar. Today, Senators leave to observe Rosh Hashanah and will return Monday. They will have to pass a bill by Wednesday or Thursday because Yom Kippur (also observed by the Senate) begins at sundown next Thursday.

We will soon see a new Congressional Budget Office summary on the impact of Graham/Cassidy, and we expect the bill to be pushed hard next week to get to passage. We need three Republican Senators to oppose the bill in order for it to fail. Key Senators that could stop the bill are the same champions that ANCOR has awarded Congressional Leadership Awards to this year for defending our programs – Senator McCain (R-AZ), Senator Collins (R-ME), and Senator Murkowski (R-AK). Please make sure that if you are a constituent, or have connections in their states, that they hear from you!

IF YOU LIVE OR HAVE FRIENDS, FAMILY, OR COLLEAGUES IN STATES WITH REPUBLICAN SENATORS THEY MUST HEAR FROM US THAT THE GRAHAM/CASSIDY BILL WILL CREATE IRREPARABLE HARM TO PROGRAMS THAT PROTECT PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES!

THE NUMBERS ARE CLEAR THAT THIS IS A BAD DEAL FOR STATES! MAKE SURE YOUR REPUBLICAN REPRESENTATIVES IN THE HOUSE ARE RECEIVING THE SAME MESSAGE!

Capitol  Switchboard: (202) 224-3121

Graham/Cassidy Text

  • Medicaid per capita cap section begins Section 124, page 65
  • Provider tax reduction is Section 123, page 64
  • Penalization to states that overspend, page 66
  • Per capita formula base period, page 68
  • Per capita formula inflation rate (CPI-M+1% until 2026 then CPI-M), page 76

Limited HCBS demo (we have intel this is for fear that per capita caps will end some state HCBS programs and need demo money to survive), page 96

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The Federal Department of Labor (DOL) is seeking comments from the public concerning the Fair Labor Standards Act (FLSA) overtime exemptions regulations. As you may recall, the Obama Administration wanted to increase the overtime threshold from $23,660 to $47,476. At the time, RCPA submitted comments to the Department of Labor objecting to the increase. RCPA also presented testimony in front of the Pennsylvania State Senate regarding the impact that the DOL’s Overtime Exemption Rule would have on health and human service providers in Pennsylvania.

Before the rule took effect, a federal judge issued an injunction halting the FLSA rule. The judge granted the injunction because the FLSA rule “exceeded its delegated authority and ignored Congress’ intent such that it supplants the duties test.” (The duties test refers to one of the conditions that determines which workers are exempt from overtime rules.)

You may submit comments on the Federal Register’s website. Questions, contact Jack Phillips, RCPA Director of Government Affairs.

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A new Request for Information (RFI) has been released by the US Department of Labor. This RFI pertains to the overtime rule that defines those employees exempt from the minimum wage and overtime requirements of the Fair Labor Standards Act. In order to gather information to consider when deciding if and how to revise the regulation, the agency is requesting comments from the public.

RCPA is hosting a free educational webinar on the Federal ORP (order, refer, or prescribe) Requirements on Wednesday, August 16, 2017, 1:00 pm – 3:00 pm. The webinar will be presented by David C. McAdoo, MBA, Executive Director, Southwest Behavioral Health Management, Inc. and Jamie Buchenauer, Director, Bureau of Fee for Services. Registration is required. Please register here to participate.

The Affordable Care Act requires all physicians including psychiatrists, physician assistants, and certified registered nurse practitioners to directly enroll in PA State Medicaid (PROMISe) to order, refer, or prescribe medications, testing, services, or other items billed to Medicaid. Any MD acting as the Medical Director in a licensed substance abuse or mental health facility must meet this requirement for the facility to bill Medicaid. Specifically, each psychologist, MD, CRNP, or PA touching the PA State Medicaid program must have at least one PROMISE ID under the NPI number on their license.

This webinar will address the requirement, the specific services that are covered, documentation that must be collected, the modifications needed in claims to bill Medicaid moving forward, and strategies for maintaining patient safety and uninterrupted access to medication and services during the transition to full compliance with this new requirement.

Outline

  • Introductions
  • Overview of Goals
    1. Understand the purpose of the ORP
    2. Understand which medical licenses are covered under the ORP
    3. Understand which medications, labs, services, and other benefits are covered under the ORP
    4. Understand the impact of the ORP on Medicaid and Medicare access to:
      1. Medications
      2. Lab Testing
  • PH Testing
  1. Behavioral Health Services
    • BHR Services
    • Peer Support and Psych Rehab
    • Family Based
    • BH services with an identified “medical director”
  • Understand the technical requirements for paper and electronic claim submission compliance with the ORP
  • Identify the changes and/or modifications needed in BH services to document ORP compliance
  • Identify the actions that are needed to assure all clients have uninterrupted access to BH and all prescribed medications
  • Review the timelines for ORP implementation in PA

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This weekend, Senator McConnell announced that there would be no vote on the BCRA this week, and the Congressional Budget Office (CBO) announced that there would not be a score of the BCRA, either. Additionally, the State Senate is scheduled to return today in the midst of a possible state budget action. Because of this, Wednesday’s press conference is being postponed.  We will keep you updated on future events.