(Updated 2/8/18): This bill was amended from its original form to serve as the legislative vehicle for a continuing resolution (CR) to fund the government through March 23; increase budget caps by $316 billion over two years; provide $89 billion in disaster relief; fund community health centers for two years; raise the debt limit through March 1, 2019; and extend provisions of Medicare among other provisions. Originally the bill authorized governors to lower the flag to half-staff following the death of a first responder in the line of duty. The House subsequently used it as a vehicle for the CR, community health center funding, Medicare extenders, and a year’s worth of defense spending. A summary of the bill in its current form can be found below.
This section of the bill would fund the government at current, prorated levels through March 23, 2018 as the government is currently set to run out of funding at midnight on February 8. It would also:
Provide additional funding to avoid delays in preparation for the 2020 Census.
Authorize the Secretary of Energy to make up to $350 million in sales from the Strategic Petroleum Reserve fund as authorized by the Bipartisan Budget Act of 2015.
Provide the Judiciary with additional juror fees to accommodate increased juror usage.
Provide emergency funding to the Small Business Administration so it may continue to issue disaster loans and aid recovery in areas affected by 2017 natural disasters.
Continue the Dept. of Education’s authority to make account maintenance fee payments to guarantee agencies under the Federal Family Education Loan program.
Provide authority for new construction starts for urgently-needed projects associated with the F-35A program to avoid schedule delays and anticipated cost increases identified by the AIr Force.
Provide funding for the staffing of newly opened or expanded Indian Health Service.
It would provide operating funds for the Southeastern Power Administration which are fully offset by collections from power customers.
Budget Caps & Debt Limit
This section of the bill lifts the budget caps enacted by the Budget Control Act of 2011 (aka sequestration), increasing defense spending by $185 billion over the next two years and discretionary domestic spending by $131 billion over the same period.
The debt ceiling would be increased through March 1, 2019.
This section of the bill would provide $89.3 billion in emergency supplemental appropriations to help states, communities, businesses, and individuals respond and recover from recent hurricanes, wildfires, and other disasters. Within that total is $4.9 billion to increase Medicaid caps for Puerto Rico and the U.S. Virgin Islands for two years.
Some other key provisions of this section include:
$23.5 billion for the Federal Emergency Management Agency Disaster Relief Fund to cover the estimated needs for Hurricanes Harvey and Irma, and FY18 estimated needs for Hurricane Maria.
$17.39 billion for the U.S. Army Corps of Engineers, largely targeted for projects to reduce the risk of future damages from flood and storm events.
$28 billion for the Dept. of Housing and Urban Development Community Development Fund to help communities rebuild damaged homes, buildings, and infrastructure.
$2.46 billion to restart operations at elementary and secondary schools affected by the hurricanes and wildfires, and temporary assistance for schools (including private schools) outside of affected areas serving displaced students.
$1.65 billion for the Small Business Administration to further support the disaster loan program, and $600 million to the Dept. of Commerce for Economic Development Administration grants to support immediate relief efforts and long-term recovery projects.
Community Health Centers
This section of the bill would extend funding for Community Health Centers and several other public health programs for two years through 2019. Funding for the programs would be offset by shortening the grace period during which premiums could be paid, and reducing funding for the Prevention and Public Health Fund by $6.3 billion over the 2018-2027 period. Funding for these programs technically expired with the end of fiscal year 2017 on September 30.
Among the other public health programs that would be extended include:
The Special Diabetes Program for Indians, and the Special Diabetes Program for Type I Diabetes.
Payments to teaching health centers that operate graduate medical education programs.
Family-to-family health information centers.
The Youth Empowerment Program and the Personal Responsibility Education programs.
Provisions related to Medicare Part A in this bill would:
Extend the Medicare-dependent hospital (MDH) program which provides higher payments to small, rural hospitals with a high proportion of patients on Medicare through 2019.
Extend the low-volume program, which provides increased payments to hospitals with a low volume of discharges through 2019.
Provisions related to Medicare Part B in this bill would:
Extend the 2-percent urban, 3-percent rural, and 22.6-percent super rural ground ambulance add-on payments for five years.
Extend the Geographic Practice Cost Indices (GPCI) floor, which makes geographically-adjusted payments to physicians to reflect the varying cost of delivering physician services until January 1, 2020.
Repeal the Medicare payment cap for outpatient therapy services and replace it with a limitation that claims over the current exception threshold indicate that the services are medically necessary.
Other Healthcare / Family Services Provisions
The Children's Health Insurance Program (CHIP) would be funded for four additional years beyond the six years authorized by the previous CR.
$6 billion would be provided to fight opioid addiction by funding grants, prevention programs, and law enforcement efforts in vulnerable communities across the country.
$2 billion in funding would be provided over two years for the National Institutes of Health (NIH).
The Independent Payment Advisory Board (IPAB), created by Obamacare to impose mandatory cuts to Medicare absent congressional action, would be repealed.
Special Needs Plans available under Medical Advantage would be permanently reauthorized.
The Independence at Home Demonstration Program would be extended for two years to continue providing home-based primary care to high-need Medicare beneficiaries with multiple chronic conditions, allowing them to avoid unnecessary hospitalizations, ER visits, and nursing home use.
Access to telehealth programs would be expanded for Medicare Advantage enrollees and individuals undergoing treatment for stroke.
States would be given the option of using some of their federal funding provided for foster care services on activities directly related to preventing the need for children to enter foster care or for their safety, permanency, or well-being.
States would be required to have a plan for preventing child abuse and neglect fatalities.
Federal financial participation would be limited for placements that aren’t into foster family homes.
Family reunification services would be available no matter how long a child has been in foster care, as such services are currently time-limited.
Adoption and legal guardianship incentive programs would be reauthorized for five years.
Two joint committees would be established to address budget / appropriations and pension reform by studying the respective issues and recommending legislation to Congress by the end of the year.