Federal law requires the President to submit an annual budget request to Congress no later than the first Monday in February. The budget informs Congress of the President's overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President's relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President's budget also may include legislative proposals for spending and tax policy changes. Although the President is not required to propose legislative changes for those parts of the budget that are governed by permanent law (i.e., mandatory spending), such changes generally are included in the budget. President Obama submitted his FY2017 budget request to Congress on February 9, 2016.
The Centers for Medicare & Medicaid Services (CMS) is the division of the Department of Health & Human Services (HHS) responsible for administering Medicare, Medicaid, and the State Children's Health Insurance Program (CHIP). CMS also is responsible for administering the private health insurance programs established in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). In FY2017, CMS estimates that almost 125 million individuals will receive coverage through Medicare, Medicaid, and CHIP.
The CMS budget is divided into the following sections: Medicare, Medicaid, program integrity, CHIP, state grants and demonstrations, private health insurance protections and programs, the Center for Medicare & Medicaid Innovation, and program management. The CMS budget includes a mixture of mandatory and discretionary spending. However, the vast majority of the CMS budget is mandatory spending, such as Medicare benefit spending and grants to states for Medicaid. In the President's FY2017 budget, proposed net Medicare outlays make up 59.5% of the CMS budget and proposed net Medicaid outlays comprise 37.9% of the CMS budget.
The President's proposed budget for CMS would be $1.0 trillion in net mandatory and discretionary outlays for FY2017, which would be an increase of $25.3 billion, or 2.5%, over the estimated net outlays for FY2016. This estimate includes the net cost of legislative proposals ($5.6 billion) and the estimated savings from program integrity investments ($1.0 billion).
The President's FY2017 budget contains a number of legislative proposals that would affect the CMS budget. Some of these proposals are program expansions, and others are designed to reduce federal spending.
The following tables provide the names and contact information for CRS experts for each of the legislative proposals in the President's FY2017 budget for CMS. There is a table for each of the following sections of the CMS budget: Medicare (Table 1), Medicaid (Table 2), program integrity (Table 3), CHIP (Table 4), private health insurance protections and programs (Table 5), and program management (Table 6).
Legislative Proposal |
Name/Title |
Phone/Email |
Delivery System Reform |
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Reform Medicare Advantage Payments to Improve the Efficiency and Sustainability of the Program |
[author name scrubbed] |
[phone number scrubbed] |
Implement Bundled Payment for Post‐acute Care |
Scott Talaga |
[phone number scrubbed] |
Expand Basis for Beneficiary Assignment for Accountable Care Organizations to Include Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialists |
[author name scrubbed] |
[phone number scrubbed] |
Allow CMS to Assign Beneficiaries to Federally Qualified Health Centers and Rural Health Clinics Participating in the Medicare Shared Savings Program |
[author name scrubbed] |
[phone number scrubbed] |
Allow Accountable Care Organizations to Pay Beneficiaries for Primary Care Visits up to the Applicable Medicare Cost‐Sharing Amount |
[author name scrubbed] |
[phone number scrubbed] |
Establish a Bonus Payment for Hospitals Cooperating with Certain Alternative Payment Models |
Scott Talaga |
[phone number scrubbed] |
Establish a Hospital‐Wide Readmissions Reduction Measure |
Scott Talaga |
[phone number scrubbed] |
Establish Quality Bonus Payments for High‐Performing Part D Plans |
Suzanne Kirchhoff |
[phone number scrubbed] |
Extend Accountability for Hospital‐Acquired Conditions |
Scott Talaga |
[phone number scrubbed] |
Implement Value‐Based Purchasing for Additional Providers |
[author name scrubbed] |
[phone number scrubbed] |
Scott Talaga |
[phone number scrubbed] |
|
Expand the Ability of Medicare Advantage Organizations to Pay for Services Delivered via Telehealth |
[author name scrubbed] |
[phone number scrubbed] |
Allow the Secretary to Introduce Primary Care Payments Under the Physician Fee Schedule in a Budget-Neutral Manner |
[author name scrubbed] |
[phone number scrubbed] |
Provider Payments |
||
Eliminate the 190‐day Lifetime Limit on Inpatient Psychiatric Facility Services |
Scott Talaga |
[phone number scrubbed] |
Update Medicare Disproportionate Share Formula for Hospitals in Puerto Rico |
Scott Talaga |
[phone number scrubbed] |
Adjust Payment Updates for Certain Post‐acute Care Providers |
Scott Talaga |
[phone number scrubbed] |
Strengthen the Independent Payment Advisory Board to Reduce Long‐Term Drivers of Medicare Cost Growth |
[author name scrubbed] |
[phone number scrubbed] |
Reduce Medicare Coverage of Bad Debts |
Scott Talaga |
[phone number scrubbed] |
Encourage Workforce Development Through Targeted and More Accurate Indirect Medical Education Payments |
Scott Talaga |
[phone number scrubbed] |
Reform Medicare Hospice Payments |
Scott Talaga |
[phone number scrubbed] |
Exclude Certain Services from the In‐Office Ancillary Services Exception |
[author name scrubbed] |
[phone number scrubbed] |
Provide Authority to Expand Competitive Bidding for Certain Durable Medical Equipment |
[author name scrubbed] |
[phone number scrubbed] |
Encourage Appropriate Use of Inpatient Rehabilitation Facilities |
Scott Talaga |
[phone number scrubbed] |
Reduce Critical Access Hospital Reimbursements from 101% of Reasonable Costs to 100% of Reasonable Costs |
Scott Talaga |
[phone number scrubbed] |
Prohibit Critical Access Hospital Designation for Facilities That Are Less than 10 Miles from the Nearest Hospital |
Scott Talaga |
[phone number scrubbed] |
Allow the Secretary to Determine Hospital Acquired Condition Program Penalty Amounts and Distribution |
Scott Talaga |
[phone number scrubbed] |
Clarify the Medicare Fraction in the Medicare Disproportionate Share Hospital Statute |
Scott Talaga |
[phone number scrubbed] |
Modernize Funding for End-Stage Renal Disease Networks |
Scott Talaga |
[phone number scrubbed] |
Recoup Initial Clinical Laboratory Fee Schedule Payments for Advanced Diagnostic Laboratory Tests in Excess of 100% of the Final Payment Amount |
[author name scrubbed] |
[phone number scrubbed] |
Repeal the Rental Cap for Oxygen Equipment |
[author name scrubbed] |
[phone number scrubbed] |
Prescription Drugs |
||
Align Medicare Drug Payment Policies with Medicaid Policies for Low‐Income Beneficiaries |
[author name scrubbed] |
[phone number scrubbed] |
Accelerate Manufacturer Discounts for Brand Drugs to Provide Relief to Medicare Beneficiaries in the Coverage Gap |
Suzanne Kirchhoff |
[phone number scrubbed] |
Modify Reimbursement of Part B Drugs |
[author name scrubbed] |
[phone number scrubbed] |
Require Mandatory Reporting of Other Prescription Drug Coverage |
Suzanne Kirchhoff |
[phone number scrubbed] |
Allow the Secretary to Negotiate Prices for Biologics and High-Cost Prescription Drugs |
Suzanne Kirchhoff |
[phone number scrubbed] |
Change the Part D Coverage Gap Discount Program Agreements from Annually to Quarterly |
Suzanne Kirchhoff |
[phone number scrubbed] |
Establish Authority for a Program to Prevent Prescription Drug Abuse in Medicare Part D |
Suzanne Kirchhoff |
[phone number scrubbed] |
Increase Part D Plan Sponsors' Risk for Catastrophic Drugs |
Suzanne Kirchhoff |
[phone number scrubbed] |
Require Evidence Development for Coverage of High-Cost Drugs |
Suzanne Kirchhoff |
[phone number scrubbed] |
Establish Transparency and Reporting Requirements in Pharmaceutical Drug Pricing |
[author name scrubbed] |
[phone number scrubbed] |
Suzanne Kirchhoff |
[phone number scrubbed] |
|
Structural Reforms |
||
Eliminate Beneficiary Coinsurance for Screening Colonoscopies with Polyp Removal |
Sarah Lister |
[phone number scrubbed] |
Increase Income-Related Premiums Under Medicare Parts B and D |
Patricia Davis |
[phone number scrubbed] |
Encourage the Use of Generic Drugs by Low‐Income Beneficiaries |
Suzanne Kirchhoff |
[phone number scrubbed] |
Modify the Part B Deductible for New Beneficiaries |
Patricia Davis |
[phone number scrubbed] |
Introduce Home Health Co-payments for New Beneficiaries |
Scott Talaga |
[phone number scrubbed] |
Medicare Appeals Process |
||
Provide Office of Medicare Hearings and Appeals and Department Appeals Board Authority to Use Recovery Audit Contractor Collections |
[author name scrubbed] |
[phone number scrubbed] |
Establish a Refundable Filing Fee |
[author name scrubbed] |
[phone number scrubbed] |
Establish Magistrate Adjudication for Claims with Amount in Controversy Below New Administrative Law Judge Amount in Controversy Threshold |
[author name scrubbed] |
[phone number scrubbed] |
Expedite Procedures for Claims with No Material Fact in Dispute |
[author name scrubbed] |
[phone number scrubbed] |
Increase Minimum Amount in Controversy for Administrative Law Judge Adjudication of Claims to Equal Amount Required for Judicial Review |
[author name scrubbed] |
[phone number scrubbed] |
Remand Appeals to the Redetermination Level with the Introduction of New Evidence |
[author name scrubbed] |
[phone number scrubbed] |
Sample and Consolidate Similar Claims for Administrative Efficiency |
[author name scrubbed] |
[phone number scrubbed] |
Other Proposals |
||
Allow Beneficiaries to Pay a Sum Certain to Medicare for Future Medical Items and Services |
Suzanne Kirchhoff |
[phone number scrubbed] |
Clarify Calculation of the Late Enrollment Penalty for Medicare Part B Premiums |
Patricia Davis |
[phone number scrubbed] |
Source: Department of Health and Human Services (HHS), Fiscal Year 2017 Budget in Brief: Strengthening Health and Opportunity for All Americans, February 2016.
Legislative Proposal |
Name/Title |
Phone/Email |
Delivery System Reform |
||
Reestablish the Medicaid Primary Care Payment Increase Through CY2017 and Include Additional Providers |
[author name scrubbed] |
[phone number scrubbed] |
Pilot Comprehensive Long‐Term Care State Plan Option |
Kirsten Colello |
[phone number scrubbed] |
Expand Eligibility Under the Community First Choice Option |
Kirsten Colello |
[phone number scrubbed] |
Provide Home- and Community‐Based Waiver Services to Children Eligible for Psychiatric Residential Treatment Facilities |
[author name scrubbed] |
[phone number scrubbed] |
Allow States to Develop Age‐Specific Health Home Programs |
Kirsten Colello |
[phone number scrubbed] |
Expand Eligibility for the 1915(i) Homes and Community‐Based Services State Plan Option |
Kirsten Colello |
[phone number scrubbed] |
Allow Full Medicaid Benefits to All Individuals in a Home- and Community-Based Services (HCBS) State Plan Option |
Kirsten Colello |
[phone number scrubbed] |
Coverage and Services |
||
Create State Option to Provide 12‐Month Continuous Medicaid Eligibility for Adults |
Evelyne Baumrucker |
[phone number scrubbed] |
Strengthen Medicaid in Puerto Rico and the U.S. Territories |
[author name scrubbed] |
[phone number scrubbed] |
Extend Enhanced Federal Match for New Medicaid Expansion States |
[author name scrubbed] |
[phone number scrubbed] |
Permanently Extend Express Lane Eligibility Option for Children |
Evelyne Baumrucker |
[phone number scrubbed] |
Require Full Coverage of Preventive Health and Tobacco Cessation Services for Adults in Traditional Medicaid |
Evelyne Baumrucker |
[phone number scrubbed] |
Create Demonstration to Address Over‐Prescription of Psychotropic Medications for Foster Care Children |
Evelyne Baumrucker |
[phone number scrubbed] |
Require Coverage of Early and Periodic Screening, Diagnostic, and Treatment for Children in Inpatient Psychiatric Treatment Facilities |
[author name scrubbed] |
[phone number scrubbed] |
Provide Full Medicaid Coverage to Pregnant and Postpartum Beneficiaries |
Evelyne Baumrucker |
[phone number scrubbed] |
Extend 100% Federal Match to All Indian Health Programs |
[author name scrubbed] |
[phone number scrubbed] |
Expand State Flexibility to Provide Benchmark Benefit Packages |
Evelyne Baumrucker |
[phone number scrubbed] |
Streamline Certain Medicaid Appeals Processes |
[author name scrubbed] |
[phone number scrubbed] |
Quality and Cost-Effectiveness |
||
Extend Funding for the Adult Health Quality Measures Program |
Amanda Sarata |
[phone number scrubbed] |
Require Remittances for Medical Loss Ratios for Medicaid and CHIP Managed Care |
[author name scrubbed] |
[phone number scrubbed] |
Rebase Future Medicaid Disproportionate Share Hospital Allotments |
[author name scrubbed] |
[phone number scrubbed] |
Medicaid Drug Coverage and Reimbursement |
||
Create a Federal‐State Medicaid Negotiating Pool for High‐Cost Drugs |
[author name scrubbed] |
[phone number scrubbed] |
Lower Medicaid Drug Costs and Strengthen the Medicaid Drug Rebate Program |
[author name scrubbed] |
[phone number scrubbed] |
Promote Program Integrity for Medicaid Drug Coverage |
[author name scrubbed] |
[phone number scrubbed] |
Dual-Eligible Individuals |
||
Improve Alignment of Medicare Savings Program and Part D Low‐Income Subsidy Income and Asset Definitions |
[author name scrubbed] |
[phone number scrubbed] |
Allow for Federal-State Coordinated Review of Dual Special Need Plan Marketing Materials |
[author name scrubbed] |
[phone number scrubbed] |
Integrate Appeals Process for Medicare‐Medicaid Enrollees |
[author name scrubbed] |
[phone number scrubbed] |
Source: HHS, Fiscal Year 2017 Budget in Brief: Strengthening Health and Opportunity for All Americans, February 2016.
Legislative Proposal |
Name/Title |
Phone/Email |
Medicare |
||
Retain a Portion of Medicare Recovery Audit Contractor Recoveries to Implement Actions That Prevent Fraud and Abuse |
[author name scrubbed] |
[phone number scrubbed] |
Suspend Coverage and Payment for Questionable Part D Prescriptions and Incomplete Clinical Information |
[author name scrubbed] |
[phone number scrubbed] |
Allow Prior Authorization for Medicare Fee‐for‐Service Items and Services |
[author name scrubbed] |
[phone number scrubbed] |
Allow Civil Monetary Penalties for Providers and Suppliers Who Fail to Update Enrollment Records |
[author name scrubbed] |
[phone number scrubbed] |
Assess a Fee on Physicians and Practitioners Who Order Services or Supplies Without Proper Documentation |
[author name scrubbed] |
[phone number scrubbed] |
Establish a Registration Process for Clearinghouses and Billing Agents |
[author name scrubbed] |
[phone number scrubbed] |
Allow Collection of Application Fees from Individual Providers and Suppliers |
[author name scrubbed] |
[phone number scrubbed] |
Pay Recovery Auditor After a Qualified Independent Contractor Decision on Appealed Claims |
[author name scrubbed] |
[phone number scrubbed] |
Require a Surety Bond or Escrow Account to Cover Overturned Recovery Auditor Determinations |
[author name scrubbed] |
[phone number scrubbed] |
Medicaid |
||
Expand Funding for the Medicaid Integrity Program |
[author name scrubbed] |
[phone number scrubbed] |
Track High Prescribers and Utilizers of Prescription Drugs in Medicaid |
[author name scrubbed] |
[phone number scrubbed] |
Strengthen CMS Compliance Tools in Medicaid Managed Care |
[author name scrubbed] |
[phone number scrubbed] |
Require States to Suspend Medicaid Payments When the Secretary Determines There Is a Significant Risk of Fraud |
[author name scrubbed] |
[phone number scrubbed] |
Expand Medicaid Fraud Control Unit Review to Additional Care Settings |
[author name scrubbed] |
[phone number scrubbed] |
Consolidate Redundant Error Rate Measurement Programs |
[author name scrubbed] |
[phone number scrubbed] |
Prevent Use of Federal Funds to Pay State Share of Medicaid or CHIP |
[author name scrubbed] |
[phone number scrubbed] |
Medicare and Medicaid |
||
Allow the Secretary to Reject Claims from New Providers and Suppliers Located Outside Moratorium Areas |
[author name scrubbed] |
[phone number scrubbed] |
Protect Program Integrity Algorithms from Disclosure |
[author name scrubbed] |
|
Permit Exclusion from Federal Health Care Programs if Affiliated with Sanctioned Entities |
[author name scrubbed] |
[phone number scrubbed] |
Establish Gifting Authority for the Healthcare Fraud Prevention Partnership |
[author name scrubbed] |
[phone number scrubbed] |
Publish the National Provider Identifier for Covered Recipients in the Open Payment Program |
[author name scrubbed] |
[phone number scrubbed] |
Source: HHS, Fiscal Year 2017 Budget in Brief: Strengthening Health and Opportunity for All Americans, February 2016.
Legislative Proposal |
Name/Title |
Phone/Email |
Extend CHIP Funding Through FY2019 |
[author name scrubbed] |
[phone number scrubbed] |
Extend the Child Enrollment Contingency Fund Through FY2019 |
[author name scrubbed] |
[phone number scrubbed] |
Reauthorize the Performance Bonus Fund Through FY2019 |
[author name scrubbed] |
[phone number scrubbed] |
Source: HHS, Fiscal Year 2017 Budget in Brief: Strengthening Health and Opportunity for All Americans, February 2016.
Legislative Proposal |
Name/Title |
Phone/Email |
Allow Marketplaces to Access National Directory of New Hires |
[author name scrubbed] |
[phone number scrubbed] |
Develop Uniform and Transparent Consumer Health Care Billing Documents |
Namrata Uberoi |
[phone number scrubbed] |
Eliminate Surprise Charges for Privately Insured Patients |
Namrata Uberoi |
[phone number scrubbed] |
Increase Access to Consumer Protections in Self‐Insured Non‐Federal Governmental Plans |
Annie Mach |
[phone number scrubbed] |
Source: HHS, Fiscal Year 2017 Budget in Brief: Strengthening Health and Opportunity for All Americans, February 2016.
Legislative Proposal |
Name/Title |
Phone/Email |
Provide Mandatory Administrative Resources for Implementation |
[author name scrubbed] |
[phone number scrubbed] |
Extend Funding for the Medicaid Adult Health Quality Measures Program |
[author name scrubbed] |
[phone number scrubbed] |
Allow CMS to Reinvest Civil Monetary Penalties Recovered from Home Health Agencies |
[author name scrubbed] |
[phone number scrubbed] |
Allow CMS to Assess a Fee on Medicare Providers for Payments Subject to the Federal Levy Program |
[author name scrubbed] |
[phone number scrubbed] |
Other User Fee Proposals |
[author name scrubbed] |
[phone number scrubbed] |
Source: HHS, Fiscal Year 2017 Budget in Brief: Strengthening Health and Opportunity for All Americans, February 2016.