This Week on the Hill
The House returns today and the Senate returns tomorrow for the “lame duck” session of Congress.
The House is scheduled to consider eight bills under suspension of the rules on Monday, including H.R. 2713, the Title VIII Nursing Workforce Reauthorization Act and H.R. 4365, the Protecting Patient Access to Emergency Medications Act. On Tuesday the House is scheduled to consider four bills under suspension of the rules and on Wednesday and for the balance of the week, is scheduled to consider H.R. 5711 related to commercial aircraft sales to Iran and H.R. 5982, the Midnight Rules Relief Act. House Republicans plan to hold leadership elections on Tuesday while the Democrats will hold elections on Thursday. Several committees have hearings scheduled for the week: the Agriculture Committee will hold a hearing Wednesday on the Supplemental Nutrition Assistance Program (SNAP); the Energy and Commerce Committee will hold a hearing Tuesday on self-driving cars; and two Energy and Commerce Subcommittees will hold a hearing Wednesday on the role of connected devices in cyber attacks.
The Senate returns Tuesday and is scheduled to consider H.R. 4511 related to the Veterans’ history project at the Library of Congress. Several committees have scheduled hearings this week: the Appropriations Energy-Water Subcommittee will hold a hearing Wednesday on the future of nuclear power; and the Appropriations Transportation-HUD Subcommittee will hold a hearing Wednesday on self-driving vehicles.
Fiscal Year 2017 Budget Update
As Congress returns for a four-week “lame duck” session, no plan has been released on funding the government after December 9, which is when the current continuing resolution expires. Several potential paths have emerged: fund the government via a spending agreement (either an omnibus or series of minibuses) through September 30, 2017; fund the government at current levels via a continuing resolution through September 30, 2017; or pass a short-term continuing resolution to fund the government into spring and allow the incoming administration and Congress to pass a spending measure for the remainder of the fiscal year. More details are expected to be released when lawmakers return to the Capitol.
Medicare Part D Clawback Payment Increase: Impact on States
The Centers for Medicare & Medicaid Services (CMS) notified states of their phased-down contribution or “clawback” rates for January through September 2017, resulting in an increase in per-beneficiary monthly charges of 11.93 percent in calendar year 2017. This is the largest increase since the program’s inception and the second year of double-digit increases. Based on analysis by the Federal Funds Information for States (FFIS), state payments in 2017 will be $11 billion, or an increase of $1.2 billion. Beginning in January 2006, prescription drug costs for individuals eligible for both Medicare and Medicaid were no longer part of the Medicaid program. Instead these costs are now included in Medicare Part D and states finance these benefits by providing a payment to the federal Medicare trust fund statutorily known as the phased down state contribution or commonly referred to as “clawback” payments.
CMS Announces Medicare Premium and Deductibles for 2017
Last Thursday the Centers for Medicare and Medicaid Services (CMS) announced the 2017 premiums for the Medicare Part A (inpatient hospital) and Part B (physician and outpatient hospital services) programs. Part B premiums will increase 10 percent for the 30 percent of beneficiaries not covered by the “hold harmless” provision; premiums will increase from $121.80 to $134.00. The release also states that “the Department of Health and Human Services will work with Congress as it explores budget-neutral solutions to challenges created by the “hold harmless” provision”. Medicare Part B beneficiaries not subject to the “hold harmless” provision include beneficiaries who do not receive Social Security benefits, those who enroll in Part B for the first time in 2017, those who are directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, and those who pay an income-related premium. These groups represent approximately 30 percent of total Part B beneficiaries. Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment. The Medicare Part A inpatient hospital deductible that beneficiaries pay when admitted to the hospital will be $1,316 per benefit period in 2017, an increase of $28 from $1,288 in 2016. The full changes are detailed here.
CBO Releases Monthly Budget Review and Summary for Fiscal Year 2016
Last week the Congressional Budget Office (CBO) released a budget summary for fiscal year 2016. The report found that in federal fiscal year 2016, which ended September 30, the federal budget deficit totaled $587 billion – $148 billion more than the shortfall recorded in 2015. Measured as a share of the nation’s gross domestic product (GDP), the deficit increased to 3.2 percent in 2016, up from 2.5 percent in 2015. However, approximately $41 billion of that increase was due to a shift in the timing of some payments the government normally would have made in fiscal year 2017, but were made in fiscal year 2016 because October 1 fell on a weekend. Without that payment shift, the deficit would have represented about 3.0 percent of GDP. In 2016 revenues amounted to $3.3 trillion, less than 1 percent greater than receipts recorded in 2015. Net spending was $3.9 trillion, about 5 percent more than outlays in 2015.
Administration Releases Updated Foster Care Data for 2015
The U.S. Department of Health and Human Services Administration for Children and Families (ACF) recently released Adoption and Foster Care Analysis and Reporting System data for fiscal year 2015. The data found that the number of children in foster care nationally has increased for the third year in a row, to a total of 428,000. Seventy-one percent of states reported an increase in the number of children entering foster care from 2014 to 2015. Further, from 2012 to 2015 the percentage of removals where parental substance use was cited as a contributing factor increased 13 percent, the largest percent increase compared to any other circumstance around removal. In interviews with state child welfare directors, the directors emphasized that recent trends in substance abuse are sometimes affecting entire families and neighborhoods, making a placement with relatives an unviable option.
SAMHSA Awards $77 Million in Substance Abuse Treatment Grants
On Wednesday the Substance Abuse and Mental Health Services Administration (SAMHSA) announced up to $77.2 million in funding will be available over several years to support programs promoting screening, brief intervention and referral to treatment (SBIRT). SBIRT is an integrated public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those at-risk. The two grant programs included in the SAMSHA announcement are: SBIRT health professions student training grants where up to 13 grantees may receive up to $290,000 each year for up to three years; and SBIRT grants where up to 8 grantees (state and tribal health departments) may receive up to $1.7 million a year for up to five years.
Court Halts Implementation of Nursing Home Arbitration Rule
Last week a federal district court issued an injunction to halt the implementation of a rule from the Centers for Medicare and Medicaid Services (CMS) that blocks nursing homes from using binding arbitration agreements that require patients and their families to agree to arbitration for potential future disputes. A lawsuit was filed against the rule in October in the U.S. District Court for the Northern District of Mississippi, alleging the agency overstepped its statutory authority when issuing the rule. The rule had been set to take effect on November 28. The final rule from CMS can be found here.
Governors and State Legislatures Weigh in on Education’s “Supplement, Not Supplant” Rule
As part of the rulemaking process for the U.S. Department of Education’s draft rule for “supplement, not supplant” under the newly passed Every Student Succeeds Act, the National Governors Association and National Conference of State Legislatures (NCSL) submitted a joint letter with comments on the rule. The rule is intended to ensure that poor students receive a fair share of state and local education funding, in additional to federal Title I funding. The joint letter indicates serious concerns with the proposed regulations, related to compliance burdens and overly prescriptive mandates. A fact sheet on the proposed rule can be found here.
CMS Announces $66 Million Available for Zika Prevention and Treatment
The Centers for Medicare and Medicaid Services (CMS) announced a funding opportunity providing up to $66.1 million to support prevention activities and treatment services for health conditions related to the Zika virus. The funding was part of the $1.1 billion in Zika funds approved as part of the continuing resolution passed by Congress in September (P.L. 114-223). Entities eligible to apply for this funding include states, territories, tribes or tribal organizations with active or local transmission of the Zika virus, as confirmed by the Centers for Disease Control and Prevention (CDC). According to the CDC, eligible entities would include American Samoa, Puerto Rico, the U.S. Virgin Islands, and Florida. Allocations are based on the percent of active and local Zika cases reported by the CDC and the size of the population in those areas.
Recently Released Reports
Medicaid & CHIP: August 2016 Monthly Applications, Eligibility Determinations and Enrollment Report, Centers for Medicare and Medicaid Services
State Leadership Driving the Shift to Clean Energy: 2016 Update, Georgetown Climate Center
The Slowdown in Employer Insurance Cost Growth: Why Many Workers Still Feel the Pinch, The Commonwealth Fund
Measures of Last Resort: Assessing Strategies for State-Initiated Turnarounds, The Center on Reinventing Public Education
Twelve Facts about Incarceration and Prisoner Reentry, The Hamilton Project
Economic News
Job Openings Little Changed at 5.5 Million in September
The number of job openings were little changed at 5.5 million on the last business day of September, according to data recently released by the U.S. Department of Labor. Job openings increased in September for professional and business services (+33,000), durable goods manufacturing (+20,000), construction (+29,000) and financial activities (+22,000) but decreased in government (-12,000). The number of hires was edged down to 5.1 million in September and the hires rate was slightly lower at 3.5 percent. The number of separations was little changed at 4.9 million. The 3.1 million quits reported in September were little changed from August; many economists closely watch the number of quits as a measure of employee confidence in finding another job. Finally, layoffs and discharges were down by 218,000 in September, with 1.5 million. Over the 12 months ending in September 2016, hires totaled 62.7 million and separations totaled 60.1 million, yielding a net employment gain of 2.6 million.