On Sunday evening, September 24, U.S. Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana) released a revised version of their Affordable Care Act (ACA) repeal legislation in advance of the Senate Finance Committee hearing scheduled for Monday, September 25, at 2 PM EST.

The amended bill is similar to the legislation previously released in that it would provide block grants to states to use for health care, repeal the expansion of Medicaid under the ACA, and eliminate the tax credits that assist people purchase insurance on the ACA exchanges. The revised legislation released Sunday evening would provide additional federal funds to certain states that would appear to include Alaska, Maine, Arizona, and Kentucky. Senators from these states have indicated that they either oppose the Graham-Cassidy repeal legislation (John McCain (R-Arizona)) and Rand Paul (R-Kentucky)) or are leaning against supporting it (Lisa Murkowski (R-Alaska)) and Susan Collins (R-Maine)).

The amended bill also includes new provisions that enable states to establish many of their own health care standards without obtaining waivers from the federal government. For example, states could lift existing caps on out-of-pocket costs and enable insurers to forego providing benefits that are now required, for example, coverage for mental health care, drug addiction treatment, and maternity care. In applying for federal funds, states would have to describe how they would “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”

The Senate has until Saturday, September 30, to approve the Graham-Cassidy ACA repeal legislation under the reconciliation rules that allow for passage by a simple majority rather than the 60 votes necessary to overcome a filibuster. The Congressional Budget Office has indicated it will release this week a partial score of the Graham-Cassidy repeal bill, but such analysis will not include the revisions made to the legislation over the weekend.

In a letter dated September 19, 2017, to the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association (AHA) has requested CMS to issue guidance regarding its policy on hospital co-location and shared space arrangements.  In a May 2015 webinar, a CMS official explained that certain hospital co-location and shared space arrangements with other providers/suppliers violate the Medicare Conditions of Participation for hospitals and the provider-based status regulatory requirements. The AHA asks CMS to issue guidance describing its hospital co-location/shared space policy, and if it cannot do so by October 1, issue a Survey and Certification Memorandum “stating that while the guidance is in development, hospitals not be required to dismantle sharing arrangements that are safe and provide important access to care.”