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  • November 22, 2019

Washington Update - November 22, 2019


MONDAY CALL — The next Public Policy Update Call will be held on Monday, Nov. 25, 12:30 p.m. ET. Please register in advance.

CONGRESSIONAL SCHEDULE — The Senate and House will both be on recess next week. 

NEWSLETTER SCHEDULE — There will be no edition of Washington Update next Friday, Nov. 29. We will return to our normal schedule on Friday, Dec. 6, and wish you a warm Thanksgiving with your families and loved ones.


CR funding government until Dec. 20 enacted, additional DSH cut delay included
The president has signed a second FY 2020 continuing resolution (CR) providing temporary funding for discretionary government programs until Dec. 20. The government had been operating under a previous CR which expired at midnight Thursday. The new CR will maintain funding for government programs at FY 2019 levels for the next four weeks while Congress and the president attempt to come to agreement on FY 2020 appropriations bills. The new CR also extends provisions delaying the onset of Medicaid DSH cuts—the cuts are now delayed from taking effect until Dec. 20. However, negotiations on longer term relief from the DSH cuts and addressing other expiring Medicaid payment policies continue on Capitol Hill. There are multiple potential scenarios for what happens when the new CR expires Dec. 20, including the possibility of a third CR extending into early 2020. John Knapp

Tennessee submits block grant proposal to CMS for review
This week, Tennessee submitted its Medicaid block grant proposal to CMS for federal approval. Though the state modified some aspects of its original proposal in response to public comments, it retained the original drafts’ fundamental structure. The state seeks to turn its Medicaid program into a “modified block grant” that would set a limit on its federal Medicaid funding, but allow for a per capita adjustment in funds to reflect some enrollment increases. Certain costs and populations are excluded from the block grant, but children and pregnant women are included. 

The state seeks substantial flexibility to administer its Medicaid program, including relief from all federal Medicaid managed care requirements and flexibility to design its benefits and a closed formulary for inpatient prescription drugs without CMS approval. Revisions to the original proposal include: 

  • an explicit statement that the state is not seeking to waive the Early and Periodic Screening, Diagnostic and Treatment guarantee for children and will make no changes to that benefit
  • an assertion that the state will not reduce benefits under the proposal and only use the flexibility it seeks to enhance or add benefits 
  • affirmation that the state is not seeking to change its appeals processes
  • an assurance that the state will maintain an exceptions process under its commercial-style formulary and does not intend to limit off-label use of drugs for children

Once the proposal is posted on the CMS website, there will be a 30-day public comment period. We are reviewing the proposal and will provide a revised summary in an upcoming Washington Update. We will also engage in discussions with Tennessee hospitals regarding the implications of the revised proposal. 

Also this week, federal block grant guidance was withdrawn from the Office of Management and Budget where it had been under review since June. It is not yet clear whether or not that withdrawal is an indication that CMS will release the guidance soon. Jan Kaplan 

House Energy and Commerce Committee marks up tobacco and maternal health bills

This week, the House Energy and Commerce Committee marked up and passed 18 bills, including three pertaining to tobacco laws and maternal health improvement:

The maternal health bills have bipartisan support; floor action has not yet been scheduled in the House and discussions on maternal health legislation are also ongoing in the Senate. The Reversing the Youth Tobacco Epidemic Act is overwhelmingly Democratic in terms of co-sponsors and, while the bill may pass the House, it is unlikely to be picked up in its current form by the Senate. Amanda Major


Register today: Children’s Hospitals’ Engagement in 2020 Census webinar
On Dec. 5, 1:00-2:00 p.m. ET, a timely panel discussion will help you learn more about the importance of the decennial census from a hospital’s perspective and why an accurate child count is so crucial. Experts from Ann & Robert H. Lurie Children’s Hospital of Chicago, Children’s National Hospital and Nationwide Children’s Hospital will share their census promotion strategies, lessons learned, and tips on educating patients and hospital staff. The discussion will build on conversations from last month’s Government Relations Professionals Meeting and will be helpful for hospitals considering their level of engagement, partnerships, and strategies for promoting census engagement. Please register in advance. Alex Rothenburger 

CHA hosts Capitol Hill briefing promoting the importance of kids’ coverage 
In partnership with the Children’s Health Care Caucus and allied children’s groups, CHA hosted a Nov. 18 briefing on the recent documented decline in insurance coverage for kids and the critical importance of Medicaid and CHIP. The panel included speakers from Georgetown University Center for Children and Families, Children’s National Hospital, Children’s Choice Pediatric Dentistry and Orthodontics, and CHA. A special thanks to Dr. Mark Weissman of Children’s National Hospital for serving as the pediatric expert on Medicaid and CHIP. For those that were unable to attend, slides are available. Amanda Major