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NTOCC Policy Update: May 2014

Posted on 5/5/2014 by NTOCC ® in Public Policy Updates
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In March, President Obama released his $3.9 billion budget proposal for FY2015, which outlines the administration’s policy priorities for the coming year. Because spending levels have already been established in the two-year agreement negotiated by Senate Budget Chairwoman Patty Murray (D-WA) and House Budget Chairman Paul Ryan (R-WI), which was passed in December of 2013, the White House’s budget proposal is largely viewed as a Democratic messaging blueprint for the Administration’s priorities, and one that was missing any controversial policies given that midterm elections are coming up for several key Democratic members of Congress.

In addition, the President’s budget includes broad language supporting the bipartisan efforts to reform SGR, while touting models that encourage coordinated care, value-based purchasing programs and other reforms to improve Medicare’s physician payment system. However, unsurprisingly, the FY 2015 budget does not include any suggestions or directions to pay for reforming SGR.

Of particular note for NTOCC, is that the Administration’s budget includes several post-acute care payment policy reforms that are projected to save Medicare over $100 billion, such as reducing payments to inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and home health agencies, and starting in 2019, implementing a bundled payment system for these entities.  In addition, the President’s budget includes a proposal to expand the “All-Inclusive Care for the Elderly Program,” a Medicaid-Medicare dual eligible program currently providing comprehensive, team-based, long-term care support services to ages 55+. The proposal would create a pilot demonstration to test whether the program could effectively serve qualifying individuals between 21-55 years without increasing costs.

The President’s budget will not be considered in its entirety by Congress, but rather will serve as a reference document for Members of Congress who are looking for reform proposals—specifically those that will save the federal government money—going forward.  NTOCC will continue to keep an eye on legislators that could cherry pick policies from the Administration’s budget to pay for other initiatives.

On a more positive note, NTOCC has been engaging with the office of Senator Ron Wyden (D-OR), Chairman of the Senate Finance Committee, on Better Care Lower Cost Act (S. 1932/ H.R.3890), legislation he recently introduced with Senator Johnny Isakson (R-GA) and Representatives Erik Paulsen (R-MN) and Peter Welch (D-VT).  The broad Medicare reform bill seeks to improve outcomes and lower health care costs by allowing health plans and groups of providers to form “Better Care Plans” or “Better Care Practices” (BCPs) to provide team-based, specialized care for Medicare beneficiaries with chronic illnesses. Participating providers would receive newly calculated risk-adjusted, capitated payments to manage care for beneficiaries that opt-in to the program.  The bill would also encourage the use of telemedicine and knowledge networks to increase access to care in rural areas.  

We are pleased to see that there are several policies included in Senator Wyden’s bill that highlight the importance of care transitions and focus on the need for continuity in team-based care.  NTOCC’s Policy & Advocacy work group members have been reviewing the bill and are currently working on providing Wyden’s staff with suggested enhancements that align with NTOCC’s seven essential elements and support best practices for improving care transitions.