Last week the U.S. Senate rejected three health care reform proposals intended to repeal all or parts of the Affordable Care Act (ACA).  On Tuesday, Vice President Mike Pence cast the deciding vote 51-50 for the Senate to begin debate on legislation to repeal significant parts of the ACA.  Later Tuesday evening, however, the Senate denied by a 43-57 vote the Better Care Reconciliation Act, Senate Republicans’ primary health care reform legislation.  On Thursday, the Senate voted down the Obamacare Repeal Reconciliation Act, which would have repealed the ACA without a replacement.  Thursday night Senate Majority Leader Mitch McConnell (R-KY) released the Health Care Freedom Act, the so-called “skinny repeal” bill, which would have repealed the ACA’s individual and employer mandates, delayed the medical device tax, expanded contributions to Health Savings Accounts, and prohibited funding for Planned Parenthood for one year with increased funding for community health centers. Very early Friday morning the Senate by a 49-51 vote failed to pass the skinny repeal legislation, with three Republican Senators voting no, Susan Collins (R-ME), Lisa Murkowski (R-AL), and John McCain (R-AZ).  The Trump Administration reportedly is considering whether to continue funding to reimburse insurers for waiving deductibles and co-payments for low-income insureds.          

On Tuesday, the Centers for Medicare & Medicaid Services released its home health proposed rule for 2018.  The proposed rule would update payment rates and the wage index for home health agencies in 2018.   Under the proposed rule the home health payment update percentage for home health agencies that submit the required quality data for the Home Health Quality Reporting Program would be one percent in 2018.  In addition, the rule proposes a redesign of the payment system in 2019.  Specifically, the rule proposes case-mix methodology refinements for CY 2019, including a change in the unit of payment from 60-day episodes of care to 30-day episodes of care.