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CEO Update 225

House Passes Budget Resolution, Clearing Path for Future Reconciliation Bill

House lawmakers on Thursday narrowly passed the Senate-amended budget resolution, clearing the way for a future reconciliation bill that would extend the Tax Cut and Jobs Act of 2017 that sunsets at the end of 2025, create some new tax cuts, and reduce the deficit.
 
The bill is also expected to include deep cuts to the Medicaid program, which has been a major point of contention for congressional Democrats, advocates and some Republicans.
 
Now that both chambers have officially agreed on a budget blueprint, House and Senate committees must begin drafting legislation to meet their assigned reconciliation targets. In addition to likely cutting back on Medicaid funding, GOP lawmakers could also address the expiring Patient Protection and Affordable Care Act (ACA) tax credits, Medicare Advantage overpayments, and other health care policies like implementing site-neutral payments in Medicare or finally reversing CMS’s 2.8% cut to the Medicare physician fee schedule.
 
Tax and spending bills considered under budget reconciliation rules are immune to Senate filibusters, which require 60 votes to end, and can pass both chambers on simple majority votes. The GOP has a 220-213 majority in the House and a 53-47 edge over Democrats and allied independents in the Senate. Under this measure, House committees must find at least $1.5 trillion in spending cuts while Senate committees have to meet a much smaller $4 billion minimum.
 
The budget instructs the House Energy and Commerce Committee, which has jurisdiction over Medicaid and Medicare, to slash spending by $880 billion. When it comes to healthcare, Medicaid is the most likely target for spending cuts. According to the Congressional Budget Office, the Energy and Commerce Committee has access only to $135 billion in spending it can eliminate if Medicare and Medicaid are excluded, and President Trump has ruled out Medicare cuts. However, the Senate Finance Committee, which oversees the same programs, is not subject to that order. When lawmakers in the two chambers draft the actual reconciliation bills, Congress will have to reconcile the differences.
 
The Majority must decide on which of the Medicaid financing reforms being discussed for months they should pursue. Work requirements appear to be the Majority’s most favored option, but other options being considered include lowering the minimum 50% Federal Medical Assistance Percentage (FMAP), reducing the enhanced match rate for Medicaid expansion, implementing per capita caps, and restricting states’ current ability to use provider taxes to help finance their share of Medicaid costs.
 
NABH and other advocates are strongly opposing these proposals, which would essentially strip coverage from millions of Americans. NABH is contacting House and Senate members with data on what cuts would mean for patients receiving care for severe mental illness and substance use disorders.
 
NABH is also asking its members to contact their Members of Congress, and opposing Medicaid cuts will be a priority topic when NABH members meet with House and Senate offices during our annual Hill Day on Wednesday, May 14.

CMS Finalizes Medicare Advantage Rates and Program Changes for 2026

The Centers for Medicare & Medicaid Services (CMS) recently released two rules that update Medicare Advantage (MA) payment rates and feature program improvements for 2026.
 
The agency updated plan requirements and other provisions in its rule published on April 4 and followed with a rate update in its rule published on April 7. The final update of 5.06 percentage points, relative to 2025, is a substantial increase of almost three percentage points over the update that the previous administration proposed.
 
NABH will compare this increase with Medicare fee-for-service rates for inpatient psychiatric hospitals and units, and other behavioral healthcare service providers, that CMS will propose in upcoming rules.
 
The final MA changes include improvements that NABH advocated for, including:

  • Holding Plans to Approved Admission Decisions: MA plans will no longer be able to
    reopen and modify a previously approved inpatient hospital decision on the basis of information gathered after the approval. Such reopening only will be allowed in cases of obvious error or fraud.
  • Closing MA Appeals Loopholes: The rule clarifies that MA appeals rules apply to denied claims, regardless of whether the decision is made before, after, or during the receipt of services. MA appeals process protocols also apply to decisions made concurrent to the enrollee’s receipt of services.
  • Notifications: The rule codifies the requirement for plans to notify beneficiaries, as well as providers requesting on their behalf of coverage approvals and denials.
  • Payment Liability: The rule also clarifies that an MA enrollee’s liability to pay for services only can be determined when a plan makes a coverage decision on a provider’s claim, which helps ensure enrollee appeal rights on ongoing treatment.

CMS noted its plan to consider future rulemaking related to the use of artificial intelligence by MA plans, as well as other MA policies, to ensure alignment with the White House deregulation executive order, including annual health equity analysis of MA plan utilization management policies and procedures; requirements to provide culturally and linguistically appropriate services; and quality improvement and health risk assessments focused on equity and social determinants of health.

ICYMI: NABH Joins Mental Health Partners in Statement About Recent HHS Job Cuts

NABH recently was one of 12 organizations that released a statement highlighting the effects that HHS’ recent staffing cuts will have on patients who require mental health (MH) and substance use disorder (SUD) treatment services.
 
Together with NAMI, Mental Health America, the American Psychiatric Association, the American Psychological Association, and other organizations, NABH expressed serious concerns about what comes next for the many MH and SUD programs that the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, and the National Institutes of Mental Health oversee.
 
“Unfortunately, the immediate reduction in force means these agencies will lose staff with years of experience and expertise, and the pathway for the transition of their knowledge and the critical services they operate is unclear,” the letter said. “This has the potential to jeopardize years of work and recent progress, like reducing overdose deaths.”
 
NABH and our partners urged the Trump administration to reconsider the steep job cuts and ask HHS Secretary Robert F. Kennedy, Jr. to explain “the impact of these significant changes to HHS staffing for mental health, suicide prevention, and substance use programs and the expected impact on outcomes for the tens of millions of Americans with behavioral health conditions.”

Annual Meeting Hotel Cut-off Date is Next Friday, April 18!

The Salamander Washington, DC cut-off date to reserve a room for our Annual Meeting is one week from today, Friday, April 18.
 
This year NABH will welcome presenters who will discuss what you need to know about the present telemedicine and telehealth landscape; what’s critical to understand in today’s uncertain regulatory environment; how to better train supervisors at your systems; NABH’s work on apprenticeships to help members with their workforce needs; and more.
 
So please be sure to reserve your hotel room and register for the meeting if you haven’t yet.
We look forward to seeing you in Washington!

Fact of the Week

Compared with patients who received provider-initiated consultations, patients who received AI screening for opioid use disorder risk had 47% lower odds of being readmitted to the hospital within 30 days after their initial discharge, according to new findings from a National Institutes of Health (NIH)-supported clinical trial.

“Addiction care remains heavily underprioritized and can be easily overlooked, especially in overwhelmed hospital settings where it can be challenging to incorporate resource-intensive procedures such as screening,” Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse said in an announcement about the findings. “AI has the potential to strengthen implementation of addiction treatment while optimizing hospital workflow and reducing healthcare costs.”

For questions or comments about this CEO Update, please contact Jessica Zigmond.