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MISSION HEALTH 2018 ADVOCACY PRIORITIES

2018 FEDERAL PRIORITIES

340B DRUG PRICING PROGRAM

  • 340B rule finalized by HHS went into effect on Jan. 1st (cuts rate for 340B Part B drugs by 28.5%).
    • December 29, 2017, Judge dismissed AHA lawsuit seeking an injunction
    • Hospital lawsuit will be ‘re-filed’; timing of court ruling uncertain
  • Congress reviewing language to “pause” regulation and/or reform the program
    • David McKinley (R-WV) bill (HR 4392) – halt regulation
    • Larry Bucshon (R-IN) bill (HR 4710) – moratorium on new 340B entities, creates new reporting requirements
    • Chris Collins (R-NY)bill (in draft) – creates new reporting requirements, defines patients, limits contract pharmacies, limits child sites (mirrors much of mega-guidance and other PhRMA requests)


DISPROPORTIONATE SHARE HOSPITAL PAYMENTS

  • Disproportionate Share Hospital payment cuts took effect October 1, 2017.
    • In 2015, MACRA eliminated the FY17 reduction, delayed cuts until FY18, and extended them to FY25.
  • Ways and Means Committee Republicans are generally agreed to delay the FY18 and FY19 cuts.
    • The pay-for is likely to be another date extension, beyond FY25
    • Also under consideration is an increase in the annual cuts starting in FY20
    • Final deal is likely to be included in CHIP/Extenders package in March


GOP TAX BILL

  • Repeals the individual mandate starting in 2019.
  • Expands the medical expense deduction for 2017 and 2018 for medical expenses exceeding 7.5 percent of adjusted gross income. The threshold returns to 10 percent beginning in 2019.
  • Continues and expands the deduction for charitable contributions
  • Allows businesses to immediately write off the full cost of new equipment
  • Preserves the Research & Development Tax Credit
  • Retains the tax-preferred status of private-activity bonds
  • Ends tax-preferred status for all new advance refunding bonds at the end of the year
  • Implements a new 21% excise tax on nonprofits equal to the sum of (a) compensation in excess of $1 million per year paid to the top-five highest paid employees of the organization, plus (b) excess parachute payments for the same employees.
    • Certain types of compensation are excluded from the $1 million limit – including the portion of compensation for licensed medical professionals for the direct performance of medical services.


RURAL HEALTH CARE

  • Proposal to pay-for the Medicare extenders would be to cut payment for Critical Access Hospitals swing beds
    • CAH Coalition is actively working to get this proposal eliminated
  • Medicare Dependent Hospital Program and Low-Volume Adjustment Program have expired but are part of proposals to be extended through the Medicare Extenders legislation
  • Key Issue - there is no Federal rural health policy focused on maintaining this needed infrastructure, need to keep discussing –
    • Clinician Shortage - Rural physicians regulated no differently – except low volume
    • Reimbursement - Reductions in payment rates, Rural costs similar to urban costs


POST-ACUTE CARE REFORM

  • The federal government is pursuing a new post-acute payment alignment strategy – LTCH, IRF, SNF, Home Health
  • Impact Act still moving forward with additional reporting requirements leading to site neutral policy and/or bundled payment system
    • CMS report on a proposed system due to Congress Oct. 2021
  • MedPAC Urging Congress to move forward with Unified Payment System faster than IMPACT Act