White House Proposes Major Cabinet-level Agency Overhaul, Restructuring of HHS and CMS

The Trump Administration last week proposed a massive overhaul of federal agencies, which would—among other consolidations—restructure the Department of Health and Human Services and rename it the Department of Health and Public Welfare (DHPW).

The administration’s plan, which was led by Mick Mulvaney, director of the Office of Management and Budget, would also create a new office under the DHPW called the Council on Public Assistance, which would oversee public assistance programs such as Medicaid and Supplemental Nutrition Assistance Program (SNAP). SNAP is currently administered by the Department of Agriculture, while Medicaid is administered by the Centers for Medicare and Medicaid Services (CMS). Under this plan, CMS would become part of the newly created Council of Public Assistance, along with the Department of Housing and Urban Development (HUD).

Mulvaney’s plan also would merge the Labor and Education departments.

The 132-page plan, “Delivering Government Solutions in the 21st Century,” is, according to a written statement from Mulvaney, is part of an effort to “drain the swamp” and streamline a government structure which he says currently is “bloated, opaque and inefficient,” Modern Healthcare reported.

According to Lauren Riplinger, JD, senior director of federal relations at AHIMA, this proposal does not appear to jeopardize funding for the Office of the National Coordinator for Health IT (ONC) any more than the annual budgeting process does. Riplinger said the restructuring would move the Agency for Healthcare Research and Quality (AHRQ) into the National Institutes of Health, a change that has been proposed in the last two appropriations cycles.

However, even this move would require the NIH to dissolve at least one other office since NIH is only allowed to have 27 institutes. Riplinger says AHIMA is part of a voluntary coalition of 250 organizations called Friends of AHRQ.

“We’re going to keep monitoring it,” Riplinger said.

Congressional Approval

This reorganization cannot happen without approval from Congress, which involves getting the chairs of key authorization and appropriations committees to hold hearings and votes. There’s also the matter of timing; with midterm elections on the horizon, lawmakers in both parties aren’t eager to make big changes or relinquish key committee assignments.

Modern Healthcare describes the outlook provided by former New Hampshire Republican Sen. Judd Gregg, who admits he supports moving SNAP to HHS but acknowledges the Trump administration will have trouble convincing Congress to support this—even fellow Republicans.

“It’s almost impossible to move these agencies around because the turf issues are so acute,” Gregg told Modern Healthcare. “And this administration has lost most of its political capital up there.”

Former CMS Administrator Andy Slavitt worries that the agency consolidation is just a vehicle to eliminate assistance programs.

“If the money is in different pockets and is overseen by different committees, the administration sees it as offering too many ‘loopholes’ to get services to people,” Slavitt told Modern Healthcare.

The Trump administration has proposed deep cuts to Medicaid. The 2019 budget the White House proposed in February would cut Medicaid funding by $250 billion over ten years, lower spending for food stamps by $213 billion (a reduction of nearly 30 percent), and lower and Temporary Assistance for Needy Families by $21 billion, the Washington Post notes.

Congress Moves on Opioid Legislation

The House of Representatives, in addition to passing opioid privacy legislation supported by AHIMA last week, also passed a bipartisan “suite of legislation,” comprising nearly 60 bills on a vote of 396 to 14.

As characterized by the Washington Examiner, “the legislation contains provisions to improve access to addiction treatment, to block illegal drugs such as fentanyl from entering the US, to clear the way for more research on non-addictive medications to treat pain, and to reduce prescribing of painkillers. It also places new regulations on the ways Medicare and Medicaid are involved in the treatment of pain and addiction.”

Riplinger said it’s too early to predict which direction the Senate will go with the House proposals. Senate Majority Leader Mitch McConnell (R-KY) could choose to pass what the House has, or act on pending legislation already in committee. Riplinger says the fact that the House passed H.R. 6082 by such a big margin demonstrates that there is widespread bipartisan support for the bill which could help ensure that the bill remains in any opioid package that Congress sends to the President for his signature.

Mary Butler is the associate editor at Journal of AHIMA.

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