On February 9, 2018, President Trump signed H.R. 1892, the Bipartisan Budget Act of 2018. The new law reauthorizes federal funding for many health programs, modifies scheduled reductions in Medicaid disproportionate share hospital (DSH) allotments to states, tightens third party liability (TPL) billing requirements, and updates requirements affecting Medicare Advantage plans, accountable care organizations (ACOs), and providers’ adoption of telehealth. The new law also:
- Reauthorizes federal grant funding for community health centers (CHCs), the National Health Service Corps, and teaching hospitals/health centers that operate graduate medical education (GME) programs.
- Extends the January 2018 re-authorization of the Children’s Health Insurance Program (CHIP) from federal FY 2023 to FY 2027.
- Postpones $6 billion in reductions in Medicaid DSH allotments to states scheduled under prior law for FY 2018 - FY 2019. R. 1892 keeps a $4 billion reduction for FY 2020. It cuts allotments for FY 2021 – FY 2023 by $6 billion ($3 billion in FY 2021, $2 billion in FY 2022, and $1 billion in FY 2023).
- Adjusts a TPL rule that had stopped Medicaid and CHIP from requiring other liable insurers to be primary payers for prenatal care.
- Permanently reauthorizes Medicare Advantage special needs plans (SNPs) for vulnerable populations.
- Enables SNPs to improve care management and to offer a wider array of targeted supplemental benefits for vulnerable populations beginning in FY 2020.
- Allows greater flexibility for Medicare Advantage plans, Medicare ACOs, and Medicare providers to use telehealth to monitor high need patients in remote locations, such as patients with stroke symptoms and patients with end-stage renal disease who elect home dialysis.
- Extends the Independence at Home (IAH) Medical Practice demonstration program, which has offered home-based primary care to high need Medicare beneficiaries with chronic conditions to reduce emergency room visits, hospital admissions, and nursing home care. H.R. 1892 extends this Affordable Care Act (ACA) program for another two years.