H.R.3253: Sustaining Excellence in Medicaid Act of 2019


Several Medicaid programs would be extended under the Senate-passed version of H.R. 3253, which also would modify Medicare payments for new Part B drugs.

The measure would extend or increase funding for the Certified Community Behavioral Health Clinics (CCBHC) demonstration program, Money Follows the Person (MFP) Rebalancing Demonstration Grant program, and Family-to-Family Health Information Centers program. It also would extend a provision related to spousal income protections.

The House-passed version of the bill included longer extensions for community behavioral health clinics and the Money Follows the Person program (see BGOV Bill Summary). It also included different offsets related to Medicaid drug rebates and didn’t include an extension of the Family-to-Family program.

Under the Senate-passed bill, the CCBHC program would be extended through Sept. 13. It was initially created as a two-year demonstration for states to certify community behavioral health clinics. The eight states that were selected to participate started their programs in April and July 2017, according to a report from the Substance Abuse and Mental Health Services Administration. It was most recently extended through July 14 under Public Law 116-29.

The MFP program, which helps beneficiaries with chronic conditions and disabilities transition from institutions to their communities, would receive additional funding for fiscal 2019 — $254.5 million for the year, rather than $132 million. The program isn’t scheduled to receive any new funding after this year.

The Family-to-Family program, which provides assistance and peer support to families of children with special health-care needs, would be extended through fiscal 2024 at the current funding level of $6 million a year. The measure would permanently extend a provision that directs the Health and Human Services Department to develop centers in all U.S. territories and at least one for American Indian tribes, in addition to states.

The measure also would extend, through Dec. 31, a provision that disregards a spouse’s income when determining Medicaid eligibility for an individual receiving home and community-based services. The provision applies through Sept. 30, and is permanent for beneficiaries in a medical institution or nursing home.

Drug Payments
The measure would reduce payments for new Medicare Part B drugs, which are generally those administered by a provider, consistent with current Medicare rules. The payments are based on the manufacturer’s wholesale acquisition cost plus a certain percentage, which the Centers for Medicare and Medicaid Services (CMS) reduced to 3%, from 6%, as of Jan. 1, 2019.

The CMS rulemaking followed a 2017 Medicare Payment Advisory Commission recommendation, as well as the president’s fiscal 2019 budget request. Provider groups opposed the change, noting the percentages are also further reduced due to sequestration of mandatory funds.

The bill would stipulate that the add-on percentage couldn’t exceed 3% as of Jan. 1, 2019.

Similar provisions were included in a broad drug pricing package the Senate Finance Committee approved on July 25. The Congressional Budget Office estimated the reduced payment provisions in that measure would decrease mandatory spending by $230 million from fiscal 2020 through 2029.

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Date Introduced

June 13, 2019


House Energy and Commerce Committee

Bill Status