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Capitolwire: Restore PA to be pushed off to the fall, minimum wage hike seems unlikely as part of budget, which could start seeing movement the week of June 17, says Corman.

PA GI Bill, PA Farm Bill could get done before summer recess, adds the Senate Majority Leader, though a “reasonable” budget spend total – which Corman again said will be less than Wolf’s February proposal – still needs to be reached.

By Chris Comisac
Bureau Chief
Capitolwire

HARRISBURG (June 5) – Gov. Tom Wolf has said on multiple occasions his Restore PA proposal isn’t tied to the state budget, and it appears that will indeed be the case this month, as legislative Republican leaders don’t plan to consider the proposal until the fall, at the earliest.

“It’s not linked to the budget – the Governor didn’t link it to the budget, as far as a budgetary request – and we’re not going to address it this month,” Senate Majority Leader Jake Corman, R-Centre, during a late Tuesday afternoon interview with Capitolwire, said of the $4.5 billion infrastructure borrowing plan, with the borrowing costs to be paid by a new severance tax proposal.

“To me, this whole Restore PA thing is more about him [Wolf] getting a severance tax” than it is about infrastructure, said Corman.

“It’s not been vetted yet, and we’re certainly not going to create a revenue source that could be a WAM [walking around money] platform, without knowing how this money is going to be spent,” Corman said, who later said, “the whole issue is off for now” while the Legislature explores other options.

Wolf has campaigned across the state in recent months on behalf of the plan, but the Legislature’s majority Republicans, for the most part, have maintained their opposition to a severance tax, which hasn’t gotten much traction during the four-plus years Wolf has been governor, though some Senate Republicans helped to pass a severance tax in an effort to find a compromise to end the 2017-18 state budget impasse (a proposal that failed to win House approval).

“We’re going to continue to talk about Restore PA, and we’re open to feedback from anyone,” said Wolf spokesman J.J. Abbott on Wednesday in response to Corman’s comments.

Noting that a significant part of Wolf’s public relations blitz has focused on using Restore PA money to expand broadband, Corman said, “It’s a great need and he [Wolf] has identified the need, but, unfortunately, the proposal is very specific on the tax he wants to levy – which, obviously, is his crown jewel as he’s been trying for five years to get it – but it has very little specifics on how the broadband would be deployed and how we’d get the private sector involved with this.”

Abbott said the administration has had conversations with plenty of stakeholder groups, and will continue to do so. He also noted Restore PA legislation would soon be introduced [EDITOR’S NOTE: House Bill 1585 and Senate Bill 725 were introduced on Wednesday, though they were not yet available on the General Assembly’s legislative website on Wednesday afternoon].

Corman said the idea of singling out one business or industry to pay for something beneficial to the whole state, like broadband, doesn’t make sense, “we, as a commonwealth, should be supporting this initiative.”

“It’s a very complicated issue that’s going to take significant private sector investment,” said Corman, explaining that back in the early 2000s, much of the available Internet connectivity was accomplished through telephone companies, which were governed by the state’s Public Utility Commission.

“Because of PUC control, we could do flexible rates for them [telephone companies] to get them to do broadband,” said Corman. “Well that was DSL [Digital Subscriber Line, which offers broadband connectivity, but at far slower speeds than are available from other sources], and nobody wants DSL now.”

To accomplish higher speeds, Corman said “you’re talking cable, you’re talking wireless, and that’s done by the private sector which we don’t regulate.”

“And it’s very costly in deployment, and it’s very costly to maintain, and nothing in the Governor’s plan details how he’s enticing them to get involved with this,” Corman continued. “I’ve spoken to several of the major providers and they have had zero-to-little contact with the Governor’s Office on this.”

“It’s not ready at this time, so it’s something we have to push to the fall, at least, and spend the summer working on it,” as well as a Senate Republican plan, said Corman, who indicated his caucus doesn’t plan to wait on Wolf for details that might never come, since broadband deployment is an important issue.

He noted that some Senate Republicans have suggested an alternative – an infrastructure plan supported by revenue from lifting restrictions on gas drilling underneath state-owned forest land – but Corman said that’s not the Senate GOP Caucus’ plan.

The Senate Majority Leader said he’d like to work with the seven local development districts (LDDs) in Pennsylvania, which he noted have been working for a few years on developing and rolling out their own rural broadband plan.

“I think that developing plan has some merit to it, but, again, it needs some work, which makes the whole issue more of a fall issue than a this-month issue,” said Corman, who later added, “I’m not saying it will get done this fall … if he [Wolf] has more details this fall, then it’s a conversation we’ll have.”

Abbott said the administration welcomes hearing other proposals from the Legislature.

A minimum wage hike, for which there was a rally in the state Capitol Rotunda on Tuesday, and which has been linked by some to the budget, also appears to be trending toward a discussion at a later date, as both sides in the issue are, again, waiting to hear from the other.

“I haven’t had any conversations with the administration regarding the minimum wage,” said Corman.

He noted he said this past February that if Wolf were to offer a “reasonable” minimum wage proposal, he’d be willing to have a conversation about it, but he pointed out the Governor’s current proposal remains “unreasonable, and something we wouldn’t even consider.”

“That has not come forward; they have not reached out to talk with me about minimum wage,” said Corman. “So, I’m still in the same position I was back in February.”

When asked if he thinks a minimum wage conversation could begin and be finished before the state budget is completed this month, Corman responded: “I don’t have an idea where they are on how reasonable they want to be … if they want to come and have a conversation that’s maybe a cost-of-living adjustment, that’s something we can discuss, but I’m waiting for them to come forward.”

“At this point, it’s getting late” to get something done before the budget is completed, acknowledged Corman.

Abbott said the administration has made their position known, with the Governor’s minimum wage proposal announced in February as part of his FY2019-20 spending plan. The administration is waiting to see a proposal from legislative Republicans.

“Once we know what they’re willing to consider, then we can start negotiations,” said Abbott.

As for when the FY2019-20 state budget might be completed, Corman said it’s possible, at least at the moment, things could be done and dusted sometime during the week of June 17, but until the votes have been taken in the General Assembly, things are always subject to change.

“You never know,” said Corman. “Would we like to be doing it that week? Sure.”

“I’d like to have it done next week if I could, but that’s not likely,” said Corman, adding that things still have to develop, and depending on that, staying beyond the week of June 17 is still a possibility.

He noted House and Senate Republican leaders are, for the most part, on the same page with regard to the budget – though there are details to still be worked out – but there have been no high-level discussions between legislative GOP leaders and the Wolf administration as yet, only staff-level meetings. Those higher-level discussions are expected “soon,” said Corman.

Abbott confirmed there have been several productive staff-level meetings, but leader-level meetings have not yet occurred.

While indications from the GOP suggest a lot of Wolf’s larger budget-related proposals might not factor into the final product, Corman said some of the smaller ticket items have a chance to make their way into the enacted budget, assuming they fit into the final budget spend total.

Some of those items include the Pennsylvania GI Bill, with the House and Senate having passed their own bills; and the PA Farm Bill, Republican and Democratic bills reflecting Wolf’s proposal which the House on Wednesday advanced from committee. The Senate has already passed its own agriculture-related legislation.

Corman said he thinks the GI Bill can get to Wolf’s desk before the General Assembly’s post-budget summer recess, but he indicated there’s still some more work to be done on the agriculture bills, though he expressed the hopeful intention – which was echoed by House members on Wednesday – of getting those done before the summer break.

“He zeroed out the current agriculture programs and then proposed to spend money on other agriculture programs,” stated Corman. “Clearly we’re going to have to go back and restore those things, as we’ve had to do in the past, and after that, see what we can do with those new initiatives.”

“I’m not going to fund his [initiatives] and then have to figure out how to fund ours,” said Corman. “I’m going to fund ours first.”

“Clearly, we’re all supportive of agriculture in our caucus,” continued Corman. “It’s something we want to do, but we’ll have to get to a reasonable [budget] spend number that includes that.”

And what about that spend number? Abbott said the administration has yet to be given a spend figure by legislative Republican leaders, so they’re waiting for the GOP to reach agreement between the two chambers, which would allow budget negotiations to ramp up.

Corman says his caucus hasn’t moved from the position he and other GOP legislative leaders expressed in early May while talking about the better-than-expected revenue filling the General Fund this year.

“It’s going to be less than what the Governor asked for,” said Corman. Wolf’s Fiscal Year 2019-20 budget proposal released in February asks for a total spend of $34.1 billion. However, there appears to be hundreds of millions of dollars of proposed spending not reflected in the proposed General Appropriations spending lines, in addition to a roughly $500 million supplemental appropriation request to cover unbudgeted costs from the current FY2018-19 enacted last June.

Corman did say coming up with a “reasonable” spend number is being made difficult by the FY2018-19 supplemental request and additional adjustments made by the administration to the FY2019-20 proposal, which, according to Corman, “make it a heck of a lot more spending than he originally proposed” in February, with much of those increases coming in human services budget lines.

“He’s going to have to make a decision: does he want money for human services or does he want money for education?” said Corman of the Governor. “We’d rather spend it on education.”

Arguing Wolf didn’t account for the additional FY2018-19 spending during the year the money was spent, Corman said the Governor “is going to have to look to some of his lines [in the FY2019-20 budget] to make room for it.”

As for the prospective surplus, which some state lawmakers recently have been suggesting could, at least in part, be used for something other than covering FY2018-19 unbudgeted expenses and increasing the state’s Rainy Day Fund, Corman said his caucus, as he stated in early May, still plans to focus the money on balancing the FY2018-19 budget and addressing the state’s budgetary reserves – something Wolf has indicated to be a priority as well.

“We’re not going to spend like drunken sailors, using up all the surplus, and then wake up with a big hangover and a huge budget hole,” said Corman.

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

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On May 15, Representatives Grace Napolitano (D-CA) and John Katko (R-NY), co-chairs of the Congressional Mental Health Caucus, hosted a very important briefing in Washington, DC as part of Mental Health Awareness Month. This briefing addressed the decarceration of transition age youth with intellectual/developmental disabilities (I/DD) and mental disorders. Key presentations outlined the issue, its impact (including impact upon families), and needed solutions.

Rep. Napolitano opened with welcoming remarks, whereby she decried the plight of many children and young adults with disabilities and emphasized the need to move toward community care. Additional information about the briefing can be found here.

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Office of Children, Youth and Families (OCYF)

[Announcement from DHS Secretary Miller, from letter to staff]

Good Afternoon,

After more than 30 years of dedicated service to Pennsylvania’s child welfare system, Cathy Utz resigned effective May 3. I am grateful for Cathy’s leadership and service at both the county and state level and for all of her work to strengthen Pennsylvania’s child welfare system and protect children.

Amy Grippi, OCYF’s Chief of Staff, will be the primary point of contact. I am confident that Amy will be a strong leader for OCYF during this transition.

Each of you work some of the most challenging jobs in state government. You face heartbreaking and unthinkable tragedies, provide support for children and families in difficult situations, and most importantly, do critical work to make the world a safer place for children. Thank you for all that you do every day – I am lucky and grateful to work among people who care so much for the children and families each of you work with and protect.

Thank you,

Teresa D. Miller
Secretary

RCPA wishes Cathy Utz the best and looks forward to working with Chief of Staff Grippi, and the rest of OCYF staff, in the future.

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(From the Pennsylvania Attorney General’s office)

Attorney General Josh Shapiro Announces Grand Jury Recommendations for the Pennsylvania Medicaid Program

FOR IMMEDIATE RELEASE — April 15, 2019
CONTACT: Joe Grace, 717-574-9095, jgrace@attorneygeneral.gov

HARRISBURG — Attorney General Josh Shapiro today announced recommendations from a statewide Grand Jury investigation into the Pennsylvania Medical Assistance (MA) Program. The legislative actions recommended by the Grand Jury aim to assist the Pennsylvania Department of Human Services in identifying and preventing fraud from occurring in the program and provide law enforcement, particularly the Pennsylvania Office of Attorney General’s Medicaid Fraud Control Section, with the tools it needs to effectively investigate fraud within the program.

The Pennsylvania Medical Assistance—or Medicaid—program is implemented by the Department of Human Services and provides care to more than 2.7 million low-income Pennsylvanians. The Office of Attorney General’s Medicaid Fraud Control Section is dedicated to prosecuting anyone who defrauds the MA Program through unlawful billing or failing to provide services to those whom the program serves.

In the 2017 and 2018 calendar years, the Medicaid Fraud Control Section made a total of 292 arrests, achieved 173 convictions, and recovered more than $34 million for the commonwealth, making it the third highest ranking Medicaid fraud control unit in the country. Last month, the Section was nominated and selected for the U.S. Inspector General’s Award for Excellence in Fighting Fraud, Waste, and Abuse.

“Medicaid provides essential care to some of Pennsylvania’s most vulnerable citizens, including low-income individuals, children with serious health conditions, and individuals suffering from substance use disorder,” said Attorney General Josh Shapiro. “When bad actors take advantage of the system, they deny these people the care they deserve, take advantage of hard-working care providers, and scam Pennsylvanians out of their hard-earned tax dollars.”

This investigation stemmed from two independent Medicaid Fraud investigations that prompted the Grand Jury to conduct an investigation into how to identify and prevent fraud and ensure delivery of satisfactory care within the MA Program.

The Grand Jury heard testimony from state regulators, law enforcement officials, managed care organizations (MCOs), and health care providers about the MA program. They identified the following three systemic issues within the MA program that permit the exploitation of care-dependent Pennsylvanians for financial gain and impact the quality of care provided:

  1. The MA system does not currently require the individual providing services to be identified on the claim submitted for payment.
  2. MA claims submitted for payment do not require specific date and time information before payment is made.
  3. The individuals providing these services lack the knowledge and training to provide quality care and to properly bill for those services.

The Grand Jury heard evidence from six cases that illustrate these deficiencies in the system. In one case, an individual who was simultaneously working for three behavioral health agencies and as a substitute special education teacher would submit timesheets claiming she was providing services which overlapped with each other and/or her work as a teacher. The Grand Jury concluded that her fraud would have been caught sooner if there had been a mandate that the claims identify her as the individual providing the services and include specific dates and times of the services.
In a second case, a mother of a daughter with autism was directing her daughter’s caregivers to provide unauthorized services such as painting the house, feeding the dog, and running household errands. She was also instructing the workers to report their services incorrectly and falsely reporting that her husband and son provided services. The Grand Jury concluded that if the program had a standardized training module, the workers would have been able to identify that they were being required to document their services improperly and that the tasks assigned to them were not authorized. They would have also been more informed about how to report these violations.

The Grand Jury provided the three following recommendations to address these deficiencies. The Grand Jury asserted its belief that these recommendations will assist DHS in carrying out its mission and will provide the MFCS with the tools it needs to effectively combat fraud, resulting in increased criminal convictions and recoveries:

  1. State Provider Identifier (SPI): The legislature should enact a statute mandating that any individual seeking to provide services paid for, in whole or in part, with MA funds who does not have a National Provider Identifier (NPI) be required to register with the Commonwealth of Pennsylvania and obtain a SPI prior to the performance of said services. The legislation should mandate that every claim for MA services identify the actual individual providing the services by requiring that the providing individual’s NPI or SPI be placed on every claim.
  2. Date and Time Specificity: The legislature should enact a statute mandating that every claim for MA services document every date that a service was provided as well as the start and end times for each date of service.
  3. Standardized Training: The legislature should require that DHS establish and mandate standardized training for all persons providing services utilizing SPI. The standardized training should be specific to the type of services being provided and focus on the required level of care the recipient is to receive and what services are appropriately billable under that program. The training should also provide information on how to contact Protective Services and where to report fraud within the MA program.  The standardized training for each specific type of service must be completed prior to providing services.

“Working with our partners in Governor Wolf’s Department of Human Services, we’re dedicated to doing everything in our power to ensure that the Medical Assistance Program runs as effectively as possible and minimize its vulnerability to fraud,” said Attorney General Shapiro. “I am grateful for the work of the Grand Jury to develop comprehensive, manageable recommendations for how to identify and prevent fraud in the program. These recommendations will make it easier for law enforcement to protect Pennsylvanians and for DHS to make sure people are getting the care they need.”

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The Pennsylvania Department of Labor & Industry’s (L&I) has reached out to RCPA in response to our letter last summer requesting an extension for the regulatory public comment period on the white collar overtime exemptions from Pennsylvania’s Minimum Wage Act. L&I has received numerous comments from stakeholders indicating that there is a lot of interest in the proposed rulemaking regarding the overtime exemptions.

As a result, L&I has contacted RCPA to determine if there is member interest in roundtable education and discussions on the white collar exemptions. L&I wants the opportunity to engage employers and affected organizations in a frank discussion on the application of these exemptions, and how the department can help employers and organizations comply with the exemptions’ requirements. Some of the public comments received indicated that there is some misinformation surrounding the required factors that would trigger any of the overtime exemptions. L&I stated that they would be open to any constructive suggestions that impacted individuals and groups may have in moving forward with modifications to the existing proposal.

L&I is in the process of setting up stakeholder outreach meetings in mid to late May and early June in five locations across the state:

  • Pittsburgh – Wednesday, May 15
  • Erie – Thursday, May 16
  • Harrisburg – Wednesday, May 22
  • Philadelphia region – Wednesday, May 29
  • Scranton region – Wednesday, June 5

While the above dates are tentative, they will be confirmed later this month. If your organization would like to attend one of these meetings, please send your request to Jack Phillips, RCPA’s Director of Government Affairs, by Thursday, April 25.

L&I has requested that participants come prepared with questions about the exemptions, as well as comments on how they believe exemptions may impact their operations. L&I has asked for no more than 15 participants at each session; this will allow them to hear from and engage with each individual and the organization they represent. Thank you in advance for your participation and cooperation. Please forward questions to RCPA Director of Government Affairs Jack Phillips.

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(Source: Buchanan, Ingersoll and Rooney, PC, Daily Health Care Daily Roundup, April 3, 2019)

Following House passage last week, the Senate passed, by voice vote, the Medicaid Services Investment and Accountability Act of 2019 (H.R. 1839), legislation that includes short-term extensions of several Medicaid programs such as the Money Follows the Person Program – which helps transition individuals with chronic conditions and disabilities from institutions back into their local communities to get care – and the Community Mental Health Services Demonstration Program, which allows community providers to expand access to treatment for mental and behavioral health. Specifically, the bill provides $20 million in additional grant funds for the Money Follows the Person Program and extend the Community Mental Health Services Demonstration Program through June 30, 2019, or for two years, whichever is longer. In addition, the bill:

  • Includes provisions of the Right Rebate Act, which allows the Secretary of Health and Human Services to require drug manufacturers to reclassify their drugs and impose civil monetary penalties when drugs are knowingly misclassified in the Medicaid Drug Rebate Program (MDRP);
  • Increases the number of days (from 90 to 100) that a state may delay payments in Medicaid to providers for medical services provided to a child with a medical support order; and
  • Extends states’ flexibility to disregard individuals’ spousal income and assets when determining eligibility for home and community-based services and supports through September 30, 2019.

Finally, the bill includes provisions of the Advancing Care for Exceptional (ACE) Kids Act that creates a state option to establish health homes for children with medically complex conditions, as well as provide two quarters of enhanced federal matching funds for states’ payments to health homes. The bill now heads to the President for his signature.

Questions, please contact Jack Phillips, Director of Government Affairs.

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By Amy Goldstein, MSN News

A federal judge in Washington threw a significant roadblock into the Trump administration’s efforts to require poor people on Medicaid to be compelled to work in exchange for health benefits, rejecting a Kentucky program for a second time while saying that rules in effect in Arkansas “cannot stand.”

The twinned opinions, in a pair of states that have been national leaders in the move towards Medicaid work requirements, cast doubt on the Trump administration’s approvals of efforts to re-envision the public insurance program. The opinions undo the permission the U.S. Health and Human Services Department had given those two states, telling the agency it must reconsider their applications with an eye towards the effect on poor people who depend on the coverage… Read full article here.

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This alert contains information from both the National Council for Behavioral Health and the American Medical Rehabilitation Providers Association (AMRPA).

On Monday, President Trump unveiled his Fiscal Year (FY) 2020 budget request — calling for a $4.7 trillion decrease in federal spending and detailing his Administration’s priorities for next year. The document revives efforts to block grant Medicaid and restrict eligibility, maintains spending to combat opioid addiction, and outlines other major health care priorities. As with most presidential budgets, this proposal stands little chance of being enacted into law as written. Instead, the President’s budget proposal will act more as a messaging tool to Congress, which is currently working to develop and pass a budget for FY 2020 over the next few months.

It is important to note that it is the role of Congress, not the President, to design and pass the federal budget. As with the President’s previous two budgets, this year’s ambitious spending cuts are unlikely to gain traction in Congress. Regardless, they present a starting point for the budget and appropriations processes and outline President Trump’s priorities as he navigates a divided Congress. It remains to be seen if any of the President’s recommendations (detailed below) will be taken up by Congressional appropriators as they move through the budget process.

Among the highlights of the President’s budget request for the Health and Human Services Department (HHS) for FY 2020:

Medicaid – Particularly notable among Medicaid proposals in the President’s budget are a requirement for all states to institute work requirements as a condition of enrollment and to eliminate the Medicaid expansion contained in the ACA. Earlier Kaiser Family Foundation estimates have found that a nationwide rollout of Medicaid work requirements could cost between 1.4 and 4 million individuals their health care coverage. Furthermore, the budget calls for Medicaid spending to be redirected into block grants or for per-capita caps to be imposed.

Although Congressional Republicans and the Administration have previously proposed to convert the Medicaid program to block grants through Graham-Cassidy and similar legislation, the Administration has recently given indications that it could attempt to implement block grants for some states through 1115 waiver authority. The budget also calls once again for passing legislation similar to the Graham-Cassidy bill, however, the chances for legislation that would make major changes to Medicaid and/or the Affordable Care Act passing the Democratic-controlled House are nonexistent.

Opioid Crisis — The budget would keep funding for a response to the opioid epidemic relatively flat. The Administration calls for the continuation of the $1.5 billion in State Opioid Response (SOR) grants, the same amount as FY 2019. The budget also asks for $1 billion for the NIH’s opioid and pain research programs, to set minimum standards for drug utilization review (DUR) programs, and $221 million to support and grow the behavioral health workforce. Of the funding to support the behavioral health workforce, $4 million would be set aside to train providers to prescribe medication-assisted treatment (MAT) for opioid use disorders. Additionally, the Administration proposes to continue funding Substance Abuse Prevention and Treatment block grants at $1.85 billion.

ONDCP – Trump’s fiscal 2020 budget blueprint for the third year in a row proposes slashing the White House’s Office of National Drug Control Policy’s (ONDCP) budget by more than 95 percent by moving the office’s two major grant programs into other federal agencies. The $100 million Drug Free Communities program would be folded into the Substance Abuse and Mental Health Services Administration (SAMHSA) while the $254 million High Intensity Drug Trafficking Areas grant would be transferred to the Department of Justice.

Mental Health — The President’s budget calls for $723 million (a $13 million increase) for the Community Mental Health Services Block Grant and $150 million for Children’s Mental Health Services, all level funding from FY 2019. Importantly, the President once again endorsed Certified Community Behavioral Health Clinics (CCBHC) model to care for people with serious mental illness and addiction, calling for level funding for CCBHC expansion grants at $125 million. In response to the Parkland school shooting, the budget also includes $133 million for school violence prevention efforts, which include school safety programs as well as trainings within schools for school personnel to better recognize the signs and symptoms of mental illness in students, such as Mental Health First Aid.

In total, SAMHSA sees its budget reduced by $62 million to $5.5 billion total. Some of that savings comes from regional substance abuse prevention and treatment programs and programs that provide advocacy for individuals with mental illnesses. Notably, the proposal eliminates the Primary and Behavioral Health Care Integration grants, a program that supports providers in implementing integrated care. The National Council will advocate for continued funding of this important program that improves care for individuals with co-occurring behavioral and physical health conditions.

NIH Funding — The budget rolls out the President’s initiative to end the HIV epidemic, a hallmark of his 2019 State of the Union address. HHS would receive $291 million for the initiative, including $140 million to the CDC for diagnosis and testing. The NIH would see an overall budget cut of approximately $5.5 billion.

Post-acute care providers – Unified PAC Payment System. The Budget proposes to “address excessive payment for post-acute care providers by establishing a unified payment system based on patients’ clinical needs rather than the site of care.” The Budget table shows savings from the reform beginning in FY 2020. The HHS Budget-in-Brief explains that the proposal will provide lower annual Medicare payment updates to SNFs, HHAs, and IRFs beginning in FY 2020 through FY 2024. In FY 2025, HHS would implement a unified post-acute care payment system for SNFs, HHAs, IRFs, and LTCHs. The payment rates would be budget neutral in FY 2025, risk adjusted, and established prospectively annually. According to HHS, the episode grouping and pricing would be based on the average cost for providing post-acute care services for a diagnosis, similar to the DRG methodology for inpatient hospitals. The proposal provides the Secretary with authority to adjust payments based on quality of care, geographic differences in labor and other costs, as well as other factors as determined appropriate.

Additional details on the President’s HHS budget request are outlined in the Department’s budget-in-brief document.

Questions, contact RCPA Director of Government Affairs Jack Phillips.

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