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House of Representatives Passes Cap Flexibility Report Language in Appropriations Package

The House today passed, on a 226 to 203 vote, a package of fiscal year 2020 appropriations bills. The package consists of four bills that fund federal departments including Labor, Health and Human Services (Labor HHS), Education, Defense, State, and Energy from October 1, 2019 to September 30, 2020.


Included in the Labor HHS appropriations bill is Cap Flexibility report language that does several things. The language (1) acknowledging the nation's physician workforce shortages; (2) directs the Centers for Medicare & Medicaid Services (CMS) to "utilize its discretion" to extend teaching hospital's Medicare cap window or residency programs in areas facing physician shortages; and (3) recommends that CMS "meet with physician, hospital, and other industry stakeholders from underserved areas to better understand changes in population health. The agency shall provide an update to the Committees on Appropriations on these efforts within 90 days of enactment" of the appropriations bill.


The passage of the report language in the House appropriations package is a great step forward for the cap flexibility initiative as it puts the CMS on notice that Congress is serous about addressing our nation's physician workforce shortages, it encourages the agency to start looking at its authority to establish caps in order to address shortages, and it prompts the Senate to consider cap flexibility and to include the language in any FY 2020 final appropriations bill.

FY 2020 Report Language (House Labor HHS Appropriations - Pg. 137):[1]


“New Medical Residency Training Programs.—Given the growing physician workforce shortage, the Committee strongly encourages CMS to utilize its discretion to extend the time period described in section 413.79(e) of title 42, Code of Federal Regulations, for new residency programs in areas facing physician shortages before a full-time equivalent resident cap is applied, as authorized in P.L. 105–33. Moreover, the Committee recommends that the agency meet with physician, hospital, and other industry stakeholders from underserved areas to better understand changes in population health. The agency shall provide an update to the Committees on Appropriations on these efforts within 90 days of enactment of this Act”

[1]https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/FY2020%20LHHS%20Filed%20Report%20-%20HR2740.pdf

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