On Monday, President Trump released a 4.4 trillion dollar FY 2019 budget proposal. While the budget would boost military spending and increase border security, it would provide major cuts to many domestic programs. For the healthcare community , the proposal calls for billions of dollars in savings through changes in Medicare and Medicaid and a boost in health spending to combat opioid abuse and mental health and drug-related issues.
Although Trump pledged not to interfere with the Medicare entitlement program, his plan would expand Medicare’s policy on site-neutral payments, in which providers would be paid equally regardless of where they deliver care, saving taxpayers an estimated $80 billion over a decade. Another $34 billion would be saved by paying independent practices the same as hospital-owned doctor practices. On Medicaid, Trump intends to rescind Obamacare’s expansion, instead providing block grant funding to states. The proposal would make it easier for states to move toward managed care, increase co-payments for emergency room visits, and reinforce requirements that Medicaid recipients show immigration status before enrolling.
President Trump’s budget proposes $10 billion in discretionary funding for the Health and Human Services Department (HHS) to combat America’s opioid crisis and assist in programs geared toward curbing drug abuse and mental health related issues. This is an effort to expand drug abuse prevention, treatment and recovery programs and give HHS more opportunity to direct resources toward this growing issue. The budget also seeks to crack down on high-opioid prescribers and utilizers in Medicaid and would require plans to participate in a program to prevent prescription drug abuse in Medicare Part B. Furthermore, while many states are tackling the opioid issue with more stringent prescribing and disposal laws, many of these laws include exemptions for prescribers treating patients under hospice care. NHPCO believes that these exemptions recognize the sensitivity and vulnerability of those suffering advanced illness and at the end of life, and accommodate their needs. It is crucial that these exemptions are preserved and further efforts to reduce opioid prescribing do not unintentionally decrease the ability of hospice and palliative care providers to manage their patients’ pain needs effectively.
NHPCO will closely track this proposal and weigh in with policymakers to ensure that the interests of the hospice and palliative care community are protected.