Late February 2018 was a productive time for Congress with lawmakers resolving a number of pressing issues related to the annual budget and appropriations process. Most notably, Congress reached a bipartisan budget deal to add significant additional funding to both defense and non-defense discretionary programs for fiscal year (FY) 2018 and FY 2019. This action was coupled with lawmakers passing another short-term continuing resolution (CR) to keep the government operating until March 23, 2018. Congress will use the time before the March 23 deadline to rewrite the FY 2018 spending bills with the higher allocations facilitated by the budget deal.
The passage of the most recent CR also resolved a number of critical healthcare issues pending before Congress. Large-scale items addressed through the legislative package include a 10 year (total) extension of the Children’s Health Insurance Program; an extension of funding for Community Health Centers, Teaching Health Centers, and the National Health Service Corps; and $3 billion for FY 2018 and $3 billion for FY 2019 to fight the opioid epidemic. There are also numerous items related to coverage and payment policy at the Centers for Medicare and Medicaid Services (CMS) within the package. Recent changes enacted through the CR and budget deal in this regard include an extension of funding for quality measures endorsement, accelerating the closing of the drug coverage doughnut hole for Medicare beneficiaries, and phasing in a temporary transitional payment policy for home infusion therapy services beginning in 2019. Accommodations are also made to the Merit-Based-Incentive-Pay System to ensure the cost category is weighted more appropriately moving forward (less than originally proposed through MACRA rulemaking).
As Congress was completing work on the budget deal and preparing to finalize more generous spending bills for FY 2018, the administration released its FY 2019 budget request to Congress. The FY 2019 proposal recommends significant new research and healthcare funding to combat the opioid epidemic, but doubles down on previous themes like deep cuts for Medicare and Medicaid, reducing pay for researchers, and eliminating the Agency for Healthcare Research and Quality and consolidating activities at the National Institutes of Health. The FY 2019 budget request also continues the administration’s call for meaningful new resources and strategies for CMS to combat healthcare fraud and abuse.
The budget request would normally provide the administration with the opportunity to respond to congressional recommendations on quality care in EDX medicine included in FY 2018 spending measures, but since the FY 2018 appropriations process is technically unfinished, federal agencies have indicated the corresponding FY 2019 responses will be published at a later date.