“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.”