This week, congressional budget panels approved President Obama’s fiscal year 2010 budget outline, although both House and Senate committees trimmed spending amounts somewhat. On March 25, the House Budget Committee marked up its $3.45 trillion version, it would reduce more than $100 billion in spending called for by the president’s $3.55 trillion budget outline issued on Feb. 26. The Senate Budget Committee completed the markup of its version. The House and Senate plans assume a federal deficit of $1.2 trillion next year, compared with $1.4 trillion under Obama’s plan. Further, the Senate budget resolution proposes to bring the FY 2014 deficit to about $508 billion, down from estimates of a $1.7 trillion deficit during that year. Obama’s budget proposal forecasted a deficit of approximately $570 billion in FY 2014.
One factor that prompted the committees to trim the administration’s request was a supporting the critical elements of Obama’s agenda in their resolutions, but the House and Senate plans will only preserve Obama’s priorities (which include investing in education and reforming the health care system) if those initiatives do not increase the deficit.
Another key feature of the House markup is health care reform. The House markup, like the president’s plan, assumes health care reform will be paid for while leaving it to the relevant authorizing committees to determine the best way to accomplish that. The markup also includes deficit-neutral reserve funds for health care; child nutrition; structural unemployment insurance reforms; child support; and college access, affordability, and completion. The Senate markup also includes investments in education and training programs to help economic growth and contribute to workforce development, as well as a deficit-neutral reserve fund to allow for increases in Pell grants in line with those proposed in President Obama’s budget. The Senate markup also follows up on the health investments made in the economic recovery package, and includes—as requested by the president—a deficit-neutral reserve fund to allow for a major health reform initiative.
The House resolution includes language that would permit moving health care reform via the budget reconciliation process, which permits passage of legislation in the Senate by a simple majority without the threat of a filibuster, and with no amendments allowed. However, many Republican senators as well as some Democrats have signaled opposition to the reconciliation plan. The Senate version does not include the reconciliation language, but Senate Majority Leader Harry Reid (D-Nev.) said he is not ruling out the possibility of using the procedure. The resolutions do not have the force of law, but do set spending priorities and limits as Congress continues the appropriations process in the coming months. The Obama administration plans to release a detailed version of its FY 2010 budget some time in April.
The Government Accountability Office has begun contacting and visiting state health and human service agencies as part of its oversight of funds received and spent through the American Recovery and Reinvestment Act. The GAO efforts become fully effective in April, and will concentrate on bimonthly reviews of 16 states’ program evaluation, auditing, accountability and transparency systems around ARRA expenditures. According to the GAO, the 16 states were selected to provide a longitudinal analysis because they contain 65 percent of the country’s population and will receive approximately two-thirds of ARRA funds. The states include Arizona, California, Colorado, Florida, Georgia, Illinois, Iowa, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas and the District of Columbia. The GAO indicates it will also gather reports from the remaining states. The GAO says that it will coordinate these efforts with the inspectors general of the various federal agencies through which ARRA funds flow.
In addition to the bimonthly reviews above, the GAO has other accountability and transparency responsibilities. Some selected responsibilities and the deadlines the GAO gave for their completion including the following:
- April 3, 2009 – 13 members appointed to the Health Information Technology Policy Committee
- Each calendar quarter beginning Aug. 25, 2009 – the GAO and Congressional Budget Office comment on the estimated number of jobs created/retained by ARRA-funded projects. The estimated numbers come from ARRA fund recipients.
- Aug. 18, 2010 – The GAO submits a report on how an individual harmed by specific offences under HIPPA concerning security or privacy can receive a percentage of any monetary settlement or compensation.
- April 1, 2011 – The GAO study and report on the effects of past and projected effects of temporary FMAP increases.
- Feb. 18, 2014 – The GAO report on how ARRA impacted overall health care costs, health insurance premiums, reduction of medical errors (and other quality improvements) and adoption of electric health records by providers.
GAO’s plan, which was outlined in recent testimony before the Senate Homeland Security and Government Affairs Committee, is available at http://www.gao.gov/new.items/d09453t.pdf
On March 20, the White House issued a memorandum to the heads of executive departments and agencies with the subject, “Ensuring Responsible Spending of Recovery Act Funds.” The memo has four sections, including merit-based decision making on ARRA grants and other funding decisions; transparency regarding registered lobbyist communications; general provisions; and avoiding funding “imprudent projects.” The banned projects are described in Section 1604, Division A of the ARRA, and include such projects as zoos, swimming pools, aquariums, casinos, golf courses, or gambling establishments. The memorandum is available at http://www.whitehouse.gov/the_press_office/Memorandum-for-the-Heads-of-Executive-Departments-and-Agencies-3-20-09/
On March 25, the Centers for Medicare and Medicaid Services issued guidance to states on the implementation for the increased Federal Medical Assistance Percentage funding. The fact sheet provides information about eligibility of maintenance-of-effort requirements and procedures for states to follow to ensure they qualify for the increased FMAP funds. The guidance discusses changes in waiver program procedures (including medical necessity and level of care determinations) that restrict or limit eligibility for waiver services will put a state at risk for of being ineligible for the increased FMAP. The MOE requirement does not apply to provider rates; the increased FMAP does not apply to the clawback provision; and states can get waivers for the prompt payment requirements. The fact sheet can be found at www.nasmd.org.
On March 26, the Administration for Children and Families announced further details regarding the $1 billion in child support enforcement funds provided in ARRA. The law re-establishes the federal match of child support incentive payments reinvested into state child support activities. A subsequent Action Transmittal released by the Office of Child Support Enforcement notes that the federal 66 percent match will be effective Oct. 1, 2008, to Sept. 30, 2010. Incentive payments spent during FY 2008, however, will not be eligible for the additional federal funds provided in the ARRA statute. The AT also continues to address changes to the OCSE-396A annual reporting form, which will be in compliance with ARRA. More details are available at http://www.acf.hhs.gov/programs/cse/pol/AT/2009/at-09-02.htm.
The OCSE guidance provides additional details on the application of child support offsets pertaining to one-time Economic Recovery Payments established under ARRA. In the ARRA language, payments of $250 are to be made to 60 million recipients of Social Security, Supplemental Security Income, Railroad Retirement Benefits, and Veterans Disability Compensation or Pension Benefits. Normally these payments are exempt from administrative offset procedures; however, the ERPs outlined in ARRA are not considered a benefit payment or cash benefit. Therefore, the normal exemptions for offsets do not apply, and these payments are subject to offset under the Debt Collection Improvement Act. ERP processing is expected to begin in late April. More details on how ERPs will be considered when calculating administrative offsets are at http://www.acf.hhs.gov/programs/cse/pol/AT/2009/at-09-01.htm.
On March 27, the Centers for Medicare and Medicaid Services delayed implementation on a final rule regarding premiums and cost sharing in the Medicaid program. The final rule was published on Nov. 25, 2008, and was scheduled to become effective on March 27, 2009. The notice delays the effective date until Dec. 31, 2009, and reopens the comment period regarding the regulation. The regulation had previously been delayed with an additional comment period, but CMS determined that provisions in ARRA substantially affect provisions in the rule. CMS states that major portions of the previous regulation may need to be changed based on consideration of comments received during the previous comment period and of the ARRA changes. Comments are due by April 27, 2009. For more information, see http://edocket.access.gpo.gov/2009/pdf/E9-6907.pdf.
On March 24, ACF requested a three-year extension of the ACF-204 report that measures state annual maintenance of effort in the Temporary Assistance for Needy Families program. The report is used to capture all expenditures claimed towards state and territory MOE requirements in addition to providing ACF with much of the information used in their annual TANF report to Congress. OMB is required to make a decision within 30 to 60 days from the receipt of ACF’s request.
On March 27, ACF announced a comment request on its call for information that would be used to measure the savings the TANF program attributes to the use of National Directory of New Hires data matches. State TANF agencies are expected to provide OCSE with a written description of their NDNH results. According to ACF, this information will help OCSE as it continues to evaluate its strategic goals in regards to the maintenance of the NDNH.
On March 26, the House Subcommittee on Nutrition held a hearing on obesity in America. The hearing focused on the financial cost of the epidemic and what is needed to combat the issue. Testimony from witnesses included discussions of school nutrition programs; access to healthy, fresh food; and the need for increased physical activity, especially among children. The witnesses were William Dietz of the Centers for Disease Control and Prevention; Anne M. Wolf, University of Virginia Health System; Richard S. Hamburg, Trust for America’s Health; Martin M. Yadrick, American Dietetic Association; and Donna Mazyck, National Association for School Nurses. Written testimony provided by the witnesses is available on the Committee web site at http://agriculture.house.gov/hearings/index.html.
This Week in Washington is published by the American Public Human Services Association each week Congress is in session and on other dates. Editors: Larry Goolsby and Frank Solomon. Writers: Jodie Anthony (health), Rashida Brown (child welfare), Ilana Cohen (health), Robert Ek (TANF, child support), Sue Hall (SNAP), Courteney Holden (child and family services), Katherine Klosek (budget and appropriations), Bertha Levin (child and family services), Ngozi Onunaku (child care), Nanette Relave (health), Damon Terzaghi (health), Emily Wengrovius (legislative affairs), and Angela You (child and family services).