Congress Passes the Big, Beautiful Bill
The U.S. House of Representatives today passed the “big, beautiful” budget reconciliation bill, meeting the Republicans’ self-imposed deadline to pass this tax and spending cuts legislation by the Fourth of July. House members reconvened on Wednesday to consider the Senate’s version and passed an early Thursday morning vote to open discussion on the bill, setting up a final vote. The House took a final vote this afternoon, passing the legislation 218 to 214. It now goes to the White House for President Trump’s signature.
AHCA/NCAL is developing a detailed member summary of the bill, but at a high level, here is what is included that impacts long term care providers.
Medicaid Provider Taxes
The new law makes changes to provider taxes, but Republican lawmakers shielded our sector with specific carve outs for nursing homes and intermediate care facilities to remain at status quo. Other provider types – such as hospitals and managed care organizations – taxed in expansion states will see their allowable percentage of revenues reduced by 0.5% annually beginning in 2028 through Federal Fiscal Year 2032, and no state is allowed to establish any new provider taxes as of the passage of the bill.
Retroactive Coverage
Retroactive coverage for Medicaid beneficiaries other than expansion new adults is revised from 90 days to 60 days. This is an improvement from the earlier House-passed version of the bill, which aimed to reduce retroactive coverage to 30 days.
Staffing Mandate
There is a 10-year delay of the federal staffing mandate for nursing homes, which – in Congressional terms – is essentially a repeal. We have been pushing Congress to resolve this rule since it was finalized and are pleased to see it in the final package. The parts of the rule already enacted remain in place (i.e. facility assessment), and we are seeking relief from the Trump Administration on that paperwork requirement. Meanwhile, we continue to defend our lawsuit and monitor other legal challenges. We are confident that the positive rulings in both Texas and Iowa will stand, and this unrealistic regulation will be rescinded once and for all.
The process over the past several months has been long, but important. Our united efforts have resulted in stronger relationships with members of Congress and an outcome that shows they recognize the importance of protecting vulnerable residents and individuals with disabilities in long term care.
The numbers speak for themselves. A record number of members – more than 750 – attended Congressional Briefing last month and completed more than 250 Congressional office visits! And between January and May, AHCA/NCAL members visited more than 150 offices covering nearly 30 states. More than 65 of these meetings were with key committee members, which has had a tremendous impact.
We faced an existential threat, and in the face of adversity, you all stepped up in droves. In my 20 years of advocating for long term care, I’ve never seen us carved out from cuts. That’s a credit to you. I’m incredibly thankful for your support and determination in fighting for our residents.
While we still have some work to do over the coming years to mitigate downstream impacts on long term care, I’m assured we will continue to succeed. And I look forward to moving on to more exciting, proactive solutions for our sector in the second half of this year.
In the meantime, have a safe and happy July 4th!
Clifton J. Porter, II
President & CEO, AHCA/NCAL
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