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McDermottPlus Check-Up: November 16, 2018

This Week’s Diagnosis: Newly elected congressional members were welcomed to Washington this week, while currently serving members returned for a brief, but important post-election lame duck session.


Leadership Elections. Republicans held House and Senate leadership elections on Wednesday. Senator Mitch McConnell (R-KY) will retain his position as Senate Majority Leader, while Representative Kevin McCarthy (R-CA) will become the House Minority Leader, replacing retiring Speaker Paul Ryan (R-WI) as the lead Republican in the House.. Senate Democrats also voted on Wednesday to keep Chuck Schumer (D-NY) as Senate Minority Leader. House Democrats will hold their leadership elections after Thanksgiving. There is growing uncertainty as to whether Congresswoman Nancy Pelosi (D-CA) has sufficient support to take the Speaker’s gavel.

PEPFAR. The House passed reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR) by voice vote on Tuesday. PEPFAR began as a government initiative to address HIV/AIDS on a global scale in 2003, focusing primarily on supporting efforts in Africa. PEPFAR was set to expire at the end of the year. Despite historic bipartisan support, an extension of the popular program became uncertain when conservative Members objected to reproductive health provisions. In the end, the bill that passed the House was a straight reauthorization, with no changes to the program. The House version is expected to pass in the Senate with no changes.

Budget. The Joint Select Committee on Budget and Appropriations, formed by the Bipartisan Budget Act of 2018, is required to make legislative recommendations for improving efficiencies in the budget process by November 30, 2018. Some leaders of the Committee have expressed disappointment that the recommendations are not more ambitious, but one is noteworthy: moving to a two-year budget cycle The two-year budget cycle would free up a significant amount of committee and floor time currently dedicated to the annual process. The Budget Committees still need to vote on the recommendations for them to become effective.


Medicaid IMD Waiver Changes. The Centers for Medicare and Medicaid Services (CMS) announced that states can now use the Medicaid innovation waiver process to effectively get around the so-called “Institutions for Mental Diseases (IMD) exclusion” for serious mental health issues. Existing law limits federal Medicaid funding for services provided at certain residential treatment facilities. There have been recent efforts to eliminate this restriction. The the final opioid bill (H.R. 6) included a limited change to the IMD exclusion. Now states can turn to the CMS waiver process for additional tools to treat this population.

Administration Hints At Social Determinants Demo. In a speech this week, Secretary of Health and Human Services Alex Azar spoke about the importance of addressing social determinants of health, such as food, housing, and the environment. Center for Medicare and Medicaid Innovation Director Adam Boehler spoke of an early stage model, Model One, which could allow for a single payment that an accountable entity could use to invest in social needs. The administration’s efforts build on existing models, such as Accountable Health Communities, Accountable Care Organizations, and Medicare Advantage plan efforts to address social determinants.

Next Week’s Dose

Members leave again for Thanksgiving break. They return to a long list of to-dos, including keeping the government open and House Democratic Leadership elections.

© 2019 McDermott Will & Emery


About this Author

Mara McDermott, McDermott Law Firm, Washington DC, HealthCare Law Executive

Mara is an accomplished health care executive with a deep understanding of federal health care law and policy, including delivery system reform, physician payment and Medicare payment models.

Most recently Mara served as the senior vice president of federal affairs at America’s Physician Groups (formerly the California Association of Physician Groups, CAPG), a professional association representing medical groups and independent practice associations practicing in capitated, coordinated care models. As head of the Washington, DC, office, Mara...

Rachel Stauffer, McDermott Law Firm, Washington DC, Health Policy Consultant

Rachel is a highly experienced government relations and legislative affairs strategist and advocate who is informed by a solid foundation of health policy knowledge.

Prior to joining McDermottPlus, Rachel served as the director of policy and government relations for a health IT contractor, where she developed the company’s first strategic plan for government relations. She grew the company’s profile on Capitol Hill by establishing new relationships with key leaders in the federal, state and military health program space. As a result, the company became an authoritative source on a variety of legislative approaches, especially related to veterans’ health.

Prior to that role, Rachel was lead legislative liaison at the US Department of Health and Human Services’ Office of the National Coordinator for Health IT (ONC) where she was instrumental in providing research, analysis and feedback to Members of Congress and staff on the 21st Century Cures legislation, among other relevant policies. Rachel also created short- and long-term strategic outreach plans that increased ONC’s visibility and profile.