On December 20, President Trump signed into law a massive year-end legislative package, which includes government funding for FY 2020 as well as a slew of health care and tax provisions known as “extenders.” The package represents a negotiated deal between Republicans and Democrats in the House and Senate.
Funding is split between two “minibuses” containing appropriations for all 12 funding categories, with a national security-focused package including the Department of Defense; Commerce, Justice, Science, and Related Agencies; Financial Services and General Government Appropriations; and the Department of Homeland Security. The second domestic and international minibus includes the Labor, Health, and Human Services, and Education; Agriculture, Rural Development, and Food and Drug Administration; Energy and Water Development; Interior and Environment; Legislative Branch; Military Construction and Veterans Affairs; State and Foreign Operations; and Transportation and Housing and Urban Development appropriations bills.
The text of the 8-bill domestic and international minibus can be found here, and the 4-bill national security minibus can be found here.
A Message from AAPM&R President, Dr. Gittler
AAPM&R President, Michelle S. Gittler, MD, FAAPMR, expressed her excitement over this new legislation: “I am thrilled to let you all know about a HUGE legislative win for physiatry and our patients! Through dogged perseverance on the part of the Academy, we have been able to move legislation which will stop Medicaid/Medicare payment cuts on critical components of manual wheelchairs and end the Competitive Bidding Program on manual wheelchairs! Over and over again we have demonstrated that when physiatrists speak with one voice, people listen."
Overview of Major Healthcare Funding Decisions
The L-HHS-Ed funding bill includes $184.9 billion in discretionary funding, an increase of $4.9 billion over FY 2019 funding levels. The Department of Health and Human Services receives an increase of $4.4 billion over FY 2019 levels for a total of $94.9 billion.
- The National Institutes of Health (NIH) receives an increase of $2.6 billion over FY 2019 funding levels, bringing the total NIH funding to $41.7 billion for FY 2020. Each Institute and Center will receive at least a 3.3 percent increase over the previous year’s funding. NIH funding includes:
- $2.8 billion for Alzheimer’s disease research, $3.1 billion for HIV/AIDS research, and $200 million for research to develop a universal flu vaccine
- $500 million for the All of Us precision medicine research initiative (a $161 million increase)
- $500 million for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative (a $71 million increase)
- $195 million for the Cancer Moonshot research program and $50 million for the Childhood Cancer Data Initiative
- The National Institute on Child Health and Human Development (NICHD), which houses the National Center on Medical Rehabilitation Research (NCMRR), receives an increase of $50 million for a total funding level of $1.56 billion for FY 2020. AAPMR worked on this, through our work with DRRC.
- The Centers for Disease Control and Prevention (CDC) receives an increase of $636 million over FY 2019 funding levels, bringing the total CDC funding to $8 billion for FY 2020.
- The Agency for Healthcare Research and Quality (AHRQ) receives a total funding level of $338 million.
- The Centers for Medicare and Medicaid Services (CMS) receives $4 billion for administrative expenses.
- The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) receives an increase of $3 million over FY 2019 levels, with:
- $2 million for continued investment in research focused on independent living, addressing the disabled aging populations, and targeting rural, frontier, and tribal communities. AAPM&R worked on this, through our work with DRRC.
- $1 million increase directed to assistive technology formula grant funding.
Additional Major Healthcare Provisions
- The Patient-Centered Outcomes Research Institute (PCORI), whose authorization lapsed on Sept. 30, 2019, receives a reauthorization for ten years (through FY 2029) for a total of $2.9 billion in funding over the next decade.
- PCORI is directed to highlight two new national priorities for research: intellectual and developmental disabilities, and maternal health.
- Three healthcare taxes originally included in the Affordable Care Act are permanently repealed, including:
- The “Cadillac” tax on high-cost employer-sponsored health plans;
- The 2.9% medical device excise tax;
- And the health insurance tax (HIT) on insurance providers
- Complex Rehabilitation Technology (CRT) manual wheelchairs will be protected from competitive bidding rates – manual CRT wheelchair bases are permanently exempted from the competitive bidding program, and competitively bid rates for manual CRT wheelchair accessories will be suspended for 18 months (through June 30, 2021).
- AAPM&R has advocated for this for years through its work with the ITEM Committee. Now that this bill is law, there will be a permanent exemption from competitive bid pricing for manual complex rehab technology wheelchair bases, and an 18-month moratorium on competitive bid pricing on manual CRT accessories. AAPM&R and ITEM’s continuing strategy is to approach CMS during that 18-month period and try to get them to impose a permanent competitive bidding ban on manual CRT accessories on their own authority, since the base CRT manual wheelchair codes are permanently exempt. This would be consistent with what CMS did on power CRT accessories 1.5 years ago. If CMS does so, all CRT power and manual wheelchairs and accessories would be protected from competitive bidding, which will significantly help preserve access to CRT for beneficiaries with significant mobility impairments.
- Reimbursement cuts for Disproportionate Share Hospital (DSH) facilities will be delayed yet again until May 23, 2020.
- The federal minimum age to purchase tobacco products will be raised to 21 years.
- So-called health “extenders,” extensions of programs whose authorizations/funding already had or were about to lapse, received only a five-month extension, punting the debate about further extensions or permanent reauthorizations to May 22, 2020. Programs receiving an additional five months of funding include:
- Medicaid Community Mental Health Services Demonstration program
- Medicaid Spousal Impoverishment protections
- Medicaid Money Follows the Person (MFP) Rebalancing Demonstration program. AAPM&R did a sign-on letter supporting this.
- Medicare Outreach and Assistance for Low-Income Programs
- Temporary Assistance for Needy Families program and related programs
- Sexual Risk Avoidance Education program
- Personal Responsibility Education program
- Community Health Centers
- National Health Service Corps
- Teaching Health Centers that operate Graduate Medical Education programs
- Medicaid funding for U.S. territories
Get Involved
Stay tuned to your Academy communications for an upcoming Action Alert to reach out to your representatives to support the Ensuring Access to Quality Complex Rehabilitation Technology Act (HR 2408), a bill that will ensure better access in coverage, coding, and supplier standards for custom wheelchairs and assistive technology by establishing a separate benefit category for complex rehab technology in Medicare.