On June 22, U.S. Senate Majority Leader Mitch McConnell unveiled the draft Senate health care reform bill, the Better Care Reconciliation Act of 2017. Earlier today, Senate Republican leadership released a new discussion draft. As of this afternoon, Republican leadership reportedly has firm commitments from less than the 50 Senators needed to approve the legislation for final passage (with Vice President Pence breaking any 50/50 deadlock) due to concerns by both conservative and moderate Senate Republicans. One of the stickiest points of contention with the bill are the significant reductions in Medicaid payments. Conservative Republicans reportedly do not believe that the legislation does enough to repeal the Affordable Care Act (ACA), specifically the income-based tax credits and subsidies. This group is also reportedly proposing to expand the exchange plan offerings to include both ACA and non-ACA policies, in order to drive down the price of insurance premiums. Moderate Republicans are concerned about the bill’s Medicaid spending caps, the essential benefits waiver, and the end of Medicaid expansion. With less funding from the federal government, these Senators are concerned that states will be unable to bear the increased financial responsibility for care to the indigent without drastic cuts in covered services and/or reductions in eligible beneficiaries.  Supporters of the draft Senate health care reform legislation hope that the positive response from some health care policy experts and insurers will encourage Republican Senators to vote for the bill. The Congressional Budget Office score of the Senate draft health care reform legislation is expected to be released today or tomorrow. Senate Republican leadership hopes to have the full Senate vote on the bill before the July 3rd recess, perhaps as early as this Thursday or Friday.

On June 20, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule with updates to the second year of the Quality Payment Program (QPP). According to CMS, the proposed changes will alleviate the regulatory burden on clinicians participating in either of the programs two tracks, the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), by allowing flexibility in the program standards. One of CMS’ most notable proposals for the CY 2018 performance period is the increased MIPS low-volume threshold to less than or equal to $90,000 in Medicare Part B allowed charges or less than or equal to 200 Medicare Part B patients. The change in the MIPS low-volume threshold would allow more clinicians to be excluded from participating in the MIPS program. Other proposed changes to the MIPS track include: offering virtual group participation for solo practitioners and smaller practice groups; implementing a new facility-based scoring measure based on the Hospital Value-Based Purchasing Program; offering new hardship exceptions to small practice clinicians; and enabling clinicians  to use either 2014 or 2015 Edition certified electronic health records (CEHRT). The APM track proposals include new criteria for Advanced APM participation, maintaining the nominal amount risk-sharing standard for an APM entity at 8 percent of the estimated average revenue from Medicare Part A and Part B, and providing more detail on the All – Payer Combination Option, which allows clinicians to qualify for APM incentives based on the combined participation of the clinician in both Medicare and non-Medicare alternative payment arrangements. The proposed rule is scheduled to be published in the Federal Register on June 30, 2017. Comments to the proposed rule must be submitted by August 21, 2017.

*We would like to thank Vanessa Stephens, a summer associate in the Washington, D.C. office, for her assistance with the preparation of this post.