With the balanced-budget bill only a presidential signature away from law, the next act will be played out at HCFA, which must implement all the rules, regulations and new projects called for in the legislation.
But there's one problem. HHS Secretary Donna Shalala said her department, which oversees HCFA, needs about $150 million in new funding over the next five years to complete the task.
"We got a list of things to do, demonstrations and everything else with no resources, zip," Shalala said. She added that there is a "serious gap" between the workload called for in the budget bill and the dollars available to HCFA.
She stopped short of saying the new rules and regulations wouldn't be ready on time without additional funds. The first year of the five-year balanced-budget plan starts Oct. 1.
However, some observers said HCFA would be hard pressed to meet the deadlines in the bill, even with new funds.
"In some cases the deadlines are too ambitious and in other cases they are downright crazy. (HCFA) never moves that fast," said one healthcare lobbyist, who didn't want to be identified.
The funding is not currently included in the appropriations bills in Congress. Appropriations bills allocate federal budget dollars to various departments and projects.
Shalala said congressional leaders are not inclined to give her department more money.
"We'll be lucky if we get a dime," Shalala lamented.
The budget bill is loaded with new programs, projects and regulations that will fall under HCFA's jurisdiction.
For example, Shalala is responsible for determining the solvency standards under which provider-sponsored organizations will operate.
GOP lawmakers have said they believe the risk-based solvency standards being developed by the National Association of Insurance Commissioners should be the starting point for the new regulations. Last week, Shalala said she believed the NAIC standards "are something we can probably work with."
Hospital groups have opposed the NAIC rules, arguing that they do not sufficiently recognize the unique properties of PSOs.
One area where the department is ahead of the budget bill is on children's healthcare.
Shalala said HCFA began preparing for the changes several months ago and already has established a task force with several other government agencies. The budget bill includes $24 billion for children's healthcare, most of which will be sent to the states in the form of block grants (See story, p. 6).