The current federal budget law requires that the President submit the budget between the first Monday in January and the first Monday in February. The President’s budget is a blueprint which contains legislative proposals Congress may or may not take up as well as administrative proposals which government agencies, such as the U.S. Department of Health and Human Services, may implement without legislation using their administrative authority.  

Below are key elements from President Donald Trump’s budget blueprint. For a detailed overview of the proposals excised from the proposal, click here. Please note the descriptions are directly from the budget proposal with no AHCA commentary on skilled nursing facility impacts. AHCA will prepare an analysis and summary table with probabilities of proposal advancement.  

• Medicare
  • Address “Excessive Payment” for Post-Acute Care Providers by Establishing a Unified Payment System Based on Patients’ Clinical Needs Rather than Site of Care
  • Reduce Medicare Coverage of Bad Debts
  • Expand Basis for Beneficiary Assignment for Accountable Care Organizations 
  • Allow Accountable Care Organizations to Cover the Cost of Primary Care Visits to Encourage Use of the Accountable Care Organization Providers 
  • Repeal the Independent Payment Advisory Board 
  • Expand Prior Authorization to Additional Medicare Fee-for-Service Items at High Risk of Fraud, Waste, and Abuse 
  • Eliminate Excessive Payment in Medicare Advantage by Using Claims Data from Patient Encounters 
  • Implement a More Accurate Payment System for Home Health [Note: Due to the inclusion of home health payment reform the recently passed Continuing Resolution, it is unclear how this provision will be addressed.

• Medicaid
  • Support for the Graham-Cassidy-Heller-Johnson legislation which would implement Medicaid per capita caps or block grants beginning in FY 2020.  
  • Expanded State Section 1115 Medicaid Waiver authority which would foster state level Medicaid reform.
  • Streamlined and permanent Medicaid managed care authority for states. 
  • Improve Data Collection on Medicaid Supplemental Payments
  • Prohibit Medicaid Payments to Public Providers in Excess of Costs 
  • Reduce Medicaid eligibility by lowering allowing home equity

The proposal also includes an array of new program integrity provisions with provider implications. Of the proposals, the unified post-acute payment system and Medicaid reform are the most concerning. However, the Centers for Medicare and Medicaid Services would need legislative authority for both as well as the Medicare Bad Debt proposal.  

During the interim, if you have questions, suggestions or concerns, please contact Michael Cheek, AHCA Senior Vice President of Reimbursement Policy.