On April 30, Congressional leaders reached an agreement to fund the government through the end of September 2017. The House Appropriations Committee released the fiscal year (FY) 2017 Omnibus Appropriations bill, through which the Labor, Health and Human Services, and Education (LHHS) portion encompasses funding and information on some key ASA priorities. This includes an increase in funding for the for the National Institutes of Health (NIH), as well as funds dedicated to addressing the opioid epidemic and direction to establish transparent out-of-network billing policies. The Senate agreed to the omnibus and President Trump signed the bill into law on May 5.
As a member of the Ad Hoc Group for Medical Research, a coalition of more than 200 patient and voluntary health groups, medical and scientific societies, academic and research organizations, and industry dedicated to enhancing the federal investment research, ASA is pleased to see an increase in NIH funding. Included in the bill, ASA supports the $34 billion for the NIH, a $2 billion increase (6.2 percent) in NIH funding over FY 2016. In a statement released by the Ad Hoc Group, “We applaud leaders of the House and Senate Appropriations Committees for persevering in support of a robust investment in NIH in FY 2017 to build on their success in FY 2016…and for continuing the longstanding bipartisan, bicameral tradition of championing the national commitment to medical research.”
Funds for the Substance Abuse and Mental Health Administration (SAMHSA) include an increase of $150 million over last year for programs that address the prevention and treatment of opioid and heroin use. This, combined with $500 million in funding authorized by the 21st Century Cures Act, supports a total increase of $650 million in fiscal year 2017 for initiatives aimed at addressing the nation’s opioid addiction crisis. ASA has worked with other medical societies and the federal agencies, including the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to address the opioid crisis. We are pleased to see Congress continue their work on these efforts.
Lastly, the LHHS portion of the Omnibus also addresses out of network payments for emergency care. The language is related to a lawsuit filed by the American College of Emergency Physicians (ACEP) in response to regulations implementing provisions of the Affordable Care Act (ACA). ACEP filed the suit against the U.S. Department of Health and Human Services (HHS) to require transparency of data and fair insurance coverage for emergency patients who are "out of network" because of a medical emergency. The language reads:
"Out of Network Emergency Care— The Committee is concerned the Center for Consumer Information and Insurance Oversight (CCIIO) has not provided sufficient clarity on how to determine the ``Usual, Customary & Reasonable'' (UCR) amount in its final rule for patient protections (80 Fed. Reg. 72191). Therefore, the Committee requests CCIIO publish guidance, which may come in the form of Frequently Asked Questions, clarifying what constitutes the UCR amount using a transparent and fair standard, such as an independent unbiased charge database."
ASA and a number of medical specialty groups promote benchmarking to a non-conflicted, independent database of billed charges within a specific geographic region for a specific service (not payment rates, not pegging to in-network rates in a certain setting, nor a percentage of Medicare) as the preferred approach.
LHHS FY 2017 Omnibus Summary
Learn more about ASA’s activities to address the opioid epidemic
Visit the Ad Hoc Group for Medical Research website
ASA Leaders Participate in Federal Out-of-Network Payment Roundtable