American College of Nurse Practitioners Update

ACNP Legislative Update - April 23, 2012 

Medicaid, Health Reform Funds Targeted in House Budget 

A House committee will vote this week on repealing the prevention fund established in the Affordable Care Act, rescinding state exchange grants, and eliminating "maintenance of effort" requirements for Medicaid and CHIP as part of a plan to replace scheduled automatic cuts in discretionary spending with $78 billion in savings and to achieve more than $180 billion in additional savings over the next decade to reduce the federal budget deficit. 

The plan outlined by the House Energy and Commerce Committee would also defund an insurance co-op program in the health reform law, repeal higher Medicaid funding caps and matching rates for territories, lower the allowable Medicaid provider tax threshold, and cut Medicaid disproportionate share payments to hospitals. 

The House budget resolution for fiscal year 2013 instructs six committees to meet savings targets to reconcile spending priorities. The Ways and Means Committee voted last week to rescind insurance exchange subsidies and Social Services Block Grant funding to meet its $44 billion target, while the Judiciary Committee achieved its savings by adopting medical liability reforms. While the House expects to pass a reconciliation bill before Memorial Day, the Senate has refused to vote on the House-passed budget and appears unlikely to consider the budget reconciliation proposal. 

Senate To Vote on Federal Workers Comp Health Change 

The Senate is poised to vote Tuesday on legislation that would allow nurse practitioners, advanced practice nurses, and physician assistants to diagnose and treat federal employees with job-related traumatic injuries in the initial 45-day continuation of pay period. 

An amendment to the "21st Century Postal Service Act" (S. 1789) offered by Senate Homeland Security and Governmental Affairs Subcommittee on Oversight of Government Management, the Federal Workforce and the District of Columbia Chairman Daniel Akaka (D-HI), would add provisions of the "Federal Workers' Compensation Modernization and Improvement Act" (H.R. 2465) to the U.S. Postal Service reform bill. The House passed H.R. 2465 last November by voice vote. 

Senate leaders are continuing to negotiate on amendments, but it appears that 60 votes will be required both to adopt the Akaka amendment and to finally pass the postal service reform bill. 

Hill Committees Prepare Drug User Fee Legislation 

Senate and House committees have drafted legislation to prevent the expiration of user fees needed to fund the Food and Drug Administration's review of prescription drugs and medical devices, and the first committee votes are expected this week. After releasing the latest in a series of discussion drafts, the Senate Health Education Labor and Pensions (HELP) Committee is set to mark up the "Food and Drug Administration Safety and Innovation Act" Wednesday. At the same time, the House Energy and Commerce Committee is putting the finishing touches on its proposal to reauthorize the Prescription Drug User Fee Act (PDUFA) following a hearing on the latest draft last week. Both the Senate and House bills are expected to include provisions to permanently reauthorize the "Best Pharmaceuticals for Children Act" (BPCA) and the "Pediatric Research Equity Act" (PREA).

PDUFA reauthorization is considered one of the "must-pass" bills on the congressional agenda with the current statute set to expire at the end of September. 

CMS Expects Dual Eligible Demo To Involve 28 States 

About 28 states are likely to take part in the demonstration project aligning payment between Medicare and Medicaid for state residents covered by both programs, the Centers for Medicare and Medicaid Services (CMS) official in charge of the program told Medicaid advisers last Thursday. Medicare-Medicaid Coordination Office Director Melanie Bella told members of the Medicaid and CHIP Payment and Access Commission (MACPAC) a delayed implementation deadline was key to enabling many states' participation. 

Applications must be submitted to CMS by May 31, Bella said, which means states have until the end of next week to publicly post their proposals online for 30 days and still meet the deadline. CMS anticipates six states to send in proposals next week. Ohio, Illinois and Massachusetts have already submitted their proposals to CMS, and the rest are currently in the middle of the state comment period. Nineteen states are pursuing the capitated model, six states are pursuing the fee-for-service model and two states are pursuing both, Bella said.