Reform Update: Shutdown may stop ACA grants, but other spending mostly unaffected

Leading up to the launch this week of the state insurance exchanges, the Obama administration made clear that the online marketplaces would go live despite a government shutdown if Congress failed to pass a spending bill. But what about the implementation of other provisions in the Patient Protection and Affordable Care Act?

A day before the government closed down, the Congressional Research Service—Congress' research arm—released a 21-page report on the appropriations process and the ACA, but didn't delve into how individual programs in the landmark law will be affected.

Overall, the CRS concluded that “substantial ACA implementation might continue” during a lapse in appropriations. That's largely because mandatory spending accounts for most of the projected spending in the law. This includes spending for the premium tax credits and cost-sharing subsidies, the federal government's portion of the costs for Medicaid expansion and tax credits for small employers.

“But what will be at issue is the discretionary spending,” said Amy Gordon, a partner with McDermott Will & Emery in Chicago. She was referring to the type of funding made available through the federal appropriations process. “It's more of the grants that were being offered. For those that have been paid out, that train's already left the station,” she added. “For future grants, those will be questionable.

According to the CRS report, the ACA created numerous new discretionary grant programs and provided for each one an authorization of appropriations. So far, though, “few of those programs have received discretionary funding.” In addition, the law reauthorized funding for existing discretionary grant programs under the Public Health Service Act, such as federal workforce programs under HHS' Health Resources and Services Administration.

One major ACA program that appears to be unaffected by the federal budget woes is the Bundled Payments for Care Improvement Initiative. The CMS Innovation Center began the second phase of the program as planned on Oct. 1—the same day the exchanges launched and the government shut down, according to a CMS official. Deirdre Baggot, who served as an expert panelist for application reviews in the bundled payment initiative, said she does not anticipate any delays in the bundling initiative from the shutdown.

“BPCI continues to roll out with 65 facilities going live Oct. 1,” said Baggot, a nurse who is vice president at the Camden Group. “We have been in constant contact with the (Innovation Center) team over the last week and have observed them to be very responsive.”

About 450 organizations were expected to participate in the program this week. At deadline, a representative for the CMS did not have more details on the program. As Baggot explained, the remaining 385 organizations chose to start in January 2014.

“Making the transition to fee-for-value is no small thing,” Baggot said. “Most sites happily opted for additional time to ready themselves for taking on the inherent financial risk of bundles.”

The Kaiser Family Foundation this week released a list of 150 frequently asked questions to help consumers understand how the ACA could affect them. Questions include who is eligible for premium tax credits in the exchanges; what “grandfathered” and “catastrophic” plans are; and how consumers can learn if a particular physician is in their plan's network.

Similarly, America's Health Insurance Plans on Thursday highlighted an infographic on AHIP's site to help consumers navigate the open enrollment process and sign up for coverage.

While the nation was focused on the launch of the exchanges and the looming government shutdown, a coalition of behavioral healthcare providers (PDF) sent suggestions to Congress on how Medicare and Medicaid should be reformed to improve access and quality of care for people with behavioral and mental healthcare needs. The groups—which include the National Association of Psychiatric Health Systems, the National Council for Behavioral Health and the National Alliance on Mental Illness—also addressed what legislative and regulatory barriers are preventing Medicare and Medicaid recipients from getting the care they need.

Follow Jessica Zigmond on Twitter: @MHjzigmond