A critical new federal government funding bill could make big changes in Medicare home health care rules.

The bill could also lead to big changes in Medicare chronic care benefits rules.

The proposed changes are in the current draft of the new “Further Extension of Continuing Appropriations Act, 2018″ (FECAA) bill. The bill would give the government the spending authorization it needs to stay open until March 23.

(Related: Trump Signs ACA Tax Blocker Bill)

The current spending authority, in the Extension of Continuing Appropriations Act, 2018 (ECAA), will expire on on Thursday.

The House Rules Committee plans to meet to package the FECCA bill for House floor action at 2 p.m. Eastern time.

The committee will stream live video of the meeting here.


Proposed Medicare Changes

Here’s a look at five key Medicare provisions, other than straightforward funding and program extension provisions, in the current version of the FECCA text.

If approved, and implemented, as written, FECCA could:

1. Shorten the standard “unit of service” Medicare home health billing to 30 days, from 60 days. (Section 2201)

In the past, home health agencies have said that change could cut home health care spending and make it harder for patients to get Medicare home health benefits.

2. Let the secretary of the U.S. Department of Health and Human Services (HHS) cut home health care benefits if the HHS secretary thinks that, in the recent past, home health care providers have been overbilling. (Section 2201)

3. Let HHS use a home health agency’s own medical records, as well as the records of hospital or nursing home physician, to show whether a patient is eligible for Medicare home health benefits. (Section 2202)

4. Make it easier for the HHS secretary to let Medicare Advantage plans cover telehealth services. (Section 2313)

Comments on how that should work would be due in November.

5.  Fund government studies that could eventually change Medicare wellness, condition management and care planning programs.

  • Section 2332 would have the U.S. Government Accountability Office look into the idea of having the Medicare Part B physician services and outpatient services plan pay for comprehensive care planning through a separate payment code. The “comprehensive care planning” could include planning for long-term care services, such as home health care and skilled nursing facility care.

  • Section 2342 would have the GAO look into Medicare enrollees’ use of obesity drugs, and whether the drugs are working.

  • Section 2343 would have HHS report on long-term risk factors for chronic conditions among Medicare enrollees. The drafters of the section want to HHS to talk about any barriers to collecting information about Medicare enrollees’ risk factors, such as obesity and tobacco use, and come up with ideas for removing those barriers.


FECCA Mechanics

House Republican leaders have packaged FECCA as a “House amendment to the Senate amendment to H.R. 1892.”

Medicare card (Image: Centers for Medicare and Medicaid Services)

(Image: Centers for Medicare and Medicaid Services)

H.R. 1892 itself is a minor bill that would simply correct an out-of-date statute reference in a law that governs how how U.S. facilities go about flying the U.S. flag at half-staff when a first responder dies in the line of duty.

The House Rules Committee is preparing to get FECCA ready for floor action at a meeting set to start at 2 p.m. Eastern time today.

Republican leaders hope to get the bill approved by the full House sometime today, and they hope to get the bill through the Senate by Thursday.

Members of Congress could change FECCA, or they could replace the current version of the text with a different version.

Many are saying that the Senate is unlikely to approve FECCA in its current form.

What Else Is in FECCA?

The House FECCA draft PDF file takes up 515 pages. If approved as written, FECCA could do many things other than keeping the federal government in business until March.

FECCA could:

  • Extend many existing Medicare rules and programs, such as a special support program for small, Medicare-dependent rural hospitals and the Medicare Advantage special needs plan program.

  • Provide $3.6 billion in funding per year, for two years, for community health centers.

  • Include lottery winnings in people’s income for Medicaid eligibility determination purposes.

  • Fund programs that states can use to keep children out of foster care and help children who are already in foster care, or likely to be in foster care.

  • Reauthorize $43 million per year in funding for state adoption and legal guardianship incentive programs.

  • Require a prison to report the incarceration of an individual to the Social Security Administration with 15 days, rather than 30 days, to get the full $400-per-prisoner prison data reporting incentive payment.


Resources

The House Rules Committee has posted links to FECCA resources, including a copy of the text, and a copy of a summary, here.

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