The Biggest Changes in President Trump’s Proposed 2021 Budget

The Trump Administration has released their proposed fiscal year 2021 budget. There are many proposed changes that will impact providers across the entire spectrum of healthcare. We have included some notable excerpts from the White House’s Budget for America’s Future below. Stay tuned for more details and analysis.

Changes for Mental Health and Addiction Treatment

The Budget invests $5 billion in HHS to combat the opioid epidemic, making critical investments in research, surveillance, prevention, treatment, access to overdose reversal drugs, and recovery support services. This funding includes $1.6 billion, an $85 million increase from the 2020 enacted level, for State Opioid Response grants, which support prevention, treatment, and recovery support services. States are also given flexibility to use these funds to address the emerging drug issue, which is the increasing number of overdoses related to psychostimulants, including methamphetamines.

The Budget includes $225 million for Certified Community Behavioral Health Clinics (CCBHC) expansion grants, and extends, through 2021, the CCBHC Medicaid demonstration programs to improve community mental health services for the eight States currently in the demonstration.

Under current law, Medicaid cannot pay for certain inpatient stays at Institutions for Mental Diseases (IMDs). The Budget modifies the Medicaid IMD exclusion to provide targeted flexibility to States to provide inpatient mental health services to Medicaid beneficiaries with SMI, as part of a comprehensive strategy that includes improvements to community-based treatment.

Addresses Improper Payments in Medicare and Medicaid

In 2019, $1 out of every $15 spent in Medicare, and $1 out of every $7 spent in Medicaid, were considered an improper payment. Improper payments include intentional fraud and abuse, as well as unintentional payment errors, both of which are harmful to the integrity of the Federal Government and to taxpayers. The Budget includes proposals to reduce the monetary loss from improper payments and strengthen the integrity and sustainability of the Medicare program. In addition, the Budget proposes reforms to improve stewardship of taxpayer dollars by strengthening the Centers for Medicare and Medicaid Services’ (CMS) ability to address weaknesses in provider screening, enrollment, and identification, as well as beneficiary eligibility determinations in Medicaid. The Budget strengthens CMS’s ability to recover overpayments due to incorrect eligibility determinations in the program. Combined with investments in the Health Care Fraud and Abuse Control program, the Budget provides the resources and tools necessary to combat waste, fraud, and abuse and to promote high-quality and efficient healthcare.

Protects and Improves the Medicare Program

The Budget includes proposals to eliminate wasteful spending, preserve beneficiaries’ access to care, and enhance choice and competition, consistent with Executive Order 13890. The Budget prioritizes use of the trust funds to pay for seniors’ healthcare and incentivizes quality and efficiency in Medicare. The Budget proposes to align payments for post-acute care with patients’ needs and the most clinically appropriate site of care, while expanding access to telehealth services. The Budget would extend the solvency of the Medicare program by at least 25 years for America’s seniors.

The President’s vision would build on efforts outlined in the Executive Order 13877, “Improving Price and Quality Transparency in American Healthcare To Put Patients First,” to provide greater transparency of healthcare costs and enshrine the right of a patient to know the cost of care before it is delivered. It focuses on lowering the price of medicine, ending surprise medical bills, breaking down barriers to choice and competition, and reducing unnecessary regulatory burdens. The President’s reforms will ensure healthcare is affordable and accessible for all Americans. Reforms will give Americans more control over healthcare choices and improve incentives for cost control. Reforms will also prioritize Federal resources for the most vulnerable and provide assistance for low-income individuals. Medicaid reform will restore balance, flexibility, integrity, and accountability to the State-Federal partnership. Medicaid spending will grow at a more sustainable rate by ending the financial bias that currently favors able-bodied working-age adults over the truly vulnerable.

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