Senate Takes Action on Budget Compromise


Today, the Senate voted on a procedural move to begin wrapping up debate on the House-passed budget agreement that I reported to you last week.  That 60-vote cloture sets in motion a final vote as early as Friday on a measure that the President will likely sign into law.

Thanks to the countless Hill visits, in-district meetings, events and other outreach, there is a great deal of good news for our profession in this budget bill.  Nothing has changed regarding the agreement since the House passed it last week.  Highlights include:


As I shared last week, the negotiated deal increases discretionary spending. To recap, the pay-fors are:

  • Federal workers pay more into their pensions and a change in cost-of-living increases for future military retirees;
  • TSA fees increase from $2.50 to $5.00 per ticket;
  • The 2 percent sequestration cut to Medicare is extended an additional two years through 2022 and 2023.

This measure funds the government through the end of next year, ending the need to pass continuing resolutions every few months.


Included in the budget bill is a three-month doc fix that extends until March 31, 2014. Nothing has changed in the Senate today; we are not the pay-for in this short-term doc fix.  The pay-fors include:

  • Rebasing disproportionate share hospital (DSH) payments to save $4 billion;
  • Establishing stricter criteria for Long Term Acute Care Hospitals (LTACHs) to save $3 billion;
  • Other miscellaneous savings of $1.2 billion.

Heading into the first several months of 2014, there is momentum for both House and Senate committees to finalize proposed language and begin discussing pay-fors to fund a permanent doc fix.   We are working on a strategy to ensure our interests are front and center on the minds of Hill staffs.  I'll say more about that below.


The three-month extension of the doc fix included in this budget bill also extends the therapy cap exceptions and manual medical review (MMR) processes for three months.

As I mentioned last week, a permanent repeal of therapy caps and significant relief in the MMR process could potentially be included in the permanent doc fix discussions in early 2014. We will continue to voice our support and offer solutions. 


As I write this, we are meeting internally to develop a comprehensive strategy for when Congress returns January 6th.  We will not let up in our push to see that the sector is not cut, and that we will be in a position to offer constructive alternatives to any proposals that threaten to harm our members.   Here's what you can expect soon after the New Year:

  • Full-court lobbying press on key House and Senate members as both chambers deliberate pay-for language in a permanent doc fix;
  • Those efforts include the Medicare extenders, where we will be pushing hard to repeal the therapy cap exceptions process, along with relief on the MMR issue;
  • Congressional fly-ins from key states for that local perspective on how important these issues are to our members;
  • Letters, calls, district events - all in an effort to enhance Members' understanding of the important work you do;
  • Press stories and opinion pieces to reach Hill staffs;
  • Political events

At the appropriate time, we are ready to deploy the resources you have entrusted to us here at AHCA. While we are pleased with the outcome today, there will be more challenges to tackle in the New Year. AHCA/NCAL will continue to focus on being a powerful voice for our profession in 2014.

On behalf of all of us at AHCA/NCAL, let me thank you for the opportunity to be part of this great cause. We know what is at stake and will use the energy from this result to fight even harder. Together we are the solution.

Have a great holiday.


Mark Parkinson
President & CEO