AHCA Webinar to Focus on American Health Care Act Bill

Carl J Pucci in Finance & Reimbursement

AHCA will conduct a webinar this Thursday, March 23, 2017 at 3:30 pm to provide an update on the American Health Care Act. Below is AHCA’s letter from Mark Parkinson with further details.

Repeal and Replace Goes to House Rules Committee for Mark-Up

Late yesterday evening, amendments were released for debate in the House Rules Committee hearing on the "American Health Care Act," the bill to repeal and replace the Affordable Care Act. The proposed amendments are divided into two sets; one set is technical or clarifying in nature, and the other would make substantive policy changes to the bill introduced on March 6.

Assuming passage by the House Rules Committee, the bill, H.R. 1628, could then move to the House floor for a final vote possibly as early as Thursday.

On Thursday, March 23 at 3:30 p.m. EDT, AHCA/NCAL will host a webinar to provide an update on this bill and additional explanation about the amendments mentioned above. All members are welcome to join the webinar. 

If you would like background information on the Medicaid reform provisions of the original bill, you can access a previously recorded webinar on ahcancalED. Please note the webinar requires a member login. 

Impact of Proposed Amendments on Our Sector

Substantial reforms, including reductions in Medicaid funding and implementation of per capita caps, still exist in this bill and would affect nursing centers, assisted living membership and providers who serve individuals with intellectual or developmental disabilities if it becomes law. However, I am happy to report to you that four critical amendments have been proposed to the original bill. As discussed in previous memos, there will be an upper limit on the amount of Medicaid funding states can receive from the federal government. States will be able to exercise more discretion on who and what services are funded and in what amounts, resulting in increased competition for funds among providers. We provided a more detailed explanation of the impacts of this bill in our email to you on March 6. 

Several amendments have been proposed that could improve the legislation for the beneficiaries we serve. 

  • House leadership has proposed an amendment that will provide a higher annual growth rate for the aged and blind/disabled categories. This change from the Consumer Price Index (CPI)-Medical growth rate to CPI-Medical plus 1 percent will result in increased funding.   
  • In the original bill, AHCA/NCAL did not believe the growth from one fiscal year would be compounded in subsequent fiscal years. This would have resulted in considerably less federal funds for state Medicaid programs and for health care providers. An amendment has been proposed to clarify that the annual cap rate growth compounds year over year, resulting in more funding for states and providers.  
  • Another proposed amendment will eliminate the provision which would have required Medicaid eligibility redetermination every six months - rather than annually. The provision that prohibits retroactive Medicaid eligibility for up to three months prior to the date of application remains in the bill. 
  • AHCA/NCAL believed the original legislation could have been interpreted as excluding provider taxes and related supplemental payments from the base year, Fiscal Year 2016. In the technical amendments, changes have been proposed which would include provider tax and supplemental payment programs in the base year. 
  • Services for aged and blind and disabled beneficiaries are excluded from a proposed block granting option. A significant proposed change to the bill is an amendment which would create a new block grant option. Therefore, states would have two Medicaid financing options from which to choose. 
    • Under the first option, as under the original bill, states could receive a per capita cap allocation amount for all Medicaid populations (aged, blind/disabled, children, adults, and other adult populations).  
    • Under the new, proposed second option, states would be able choose to receive a block grant for children, adults, and other adult populations. However, the proposed block grant amendment would not allow states to receive a block grant for the aged or blind/disabled populations. These two groups would have to remain under the per capita cap financing structure which affords more protections to providers and beneficiaries than block grants.  

Concerns with the Bill

While the higher per capita cap growth rate is helpful, AHCA/NCAL is concerned about how the additional funds might be directed to high need vulnerable populations such as people who rely on long-term services and supports, older adults, and people with disabilities. In the coming days, we will be working hard to tell Members of Congress that these populations need as many protections as possible in the reform efforts.   

Furthermore, additional clarification is needed to describe how provider taxes and supplemental payments are treated year over year. AHCA/NCAL will continue to work with the House and the Senate to ensure we get clarity on these issues.  

How You Can Help 

As the bill continues to move through the legislative process, there is still an opportunity to make changes to it. We need you to continue to respond in force to let Congress know not to cut Medicaid for our vulnerable patients and residents. There are two ways you can help. First, participate in our grassroots letter writing campaign. Already over 50,000 contacts have been made, but we need more to make sure our voices are heard! 

Hundreds of our members have been in town to visit the Hill and help us on this important issue. If you can come to D.C. in the coming days and weeks, please contact Matt Smyth, and we will help plug you into key meetings on the Hill. If you can't come to D.C. but have a relationship with a Republican House or Senate member, let us know, and we will provide you talking points for a call or visit in district. We have already prepared a one-page brief for nursing centers and assisted living communities to help explain the importance of protecting Medicaid funding for seniors and individuals with disabilities. 

Other issues 

As I reported in my email to you last week, we have continued our outreach to the new administration on other important issues as well. Last week, we sent a letter to newly confirmed Secretary of Health and Human Services Tom Price. We asked Secretary Price to address several regulatory issues that are an immense burden on our skilled nursing facilities. Just this week, HHS announced it would delay the effective date of the final rule that implemented three new mandatory bundled payment rules. We will continue to work on all the issues outlined in our letter to Secretary Price. The announcement this week was encouraging, and we remain hopeful that we can make meaningful progress on other issues as well. 

This week has demonstrated that each contact we make with a House or Senate member is important. We need Congress to continue to take steps to protect the neediest and frailest citizens of our country. With your help, we can make a difference. 


Mark Parkinson
President & CEO


Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36