On Thursday, March 27, the House gave approval to a bill that will likely extend the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program into 2015. It came about when the House of Representatives passed another “patch” to the Medicare law that modifies the formula determining how doctors are reimbursed. The “doc-fix,” as it is called, has become an annual congressional ritual since it was included in a 1997 budget act. The coalition of home visiting programs and supporters had been working aggressively over the past several weeks to get any kind of home visiting extension attached to the Medicare bill under the belief it might be one of the only or the only “vehicle bill” that will be passed this year.
The MIECHV program, first included as part of the Affordable Care Act (ACA, P.L. 111-148), was authorized for five years with current funding set at $400 million a year in mandatory funds. The program sets new standards for the allocation of human service funding in that it requires states to spend 75 percent of its funding on evidenced-based and research-based models. The remaining 25 percent can be used for more experimental models but they too must undergo serious evaluation.
Although Congress has taken to passing the Medicare “doc-fix” (SGR, Sustainable Growth Rate) bill annually, this year’s effort took a few different turns and time was running out on the month and on how long Congress had to fix this year’s formula. While Finance Committee Chair, Senator Ron Wyden (D-OR) was crafting a permanent fix that would stretch out beyond ten years, Senate Majority Leader Harry Reid (D-NV) and House Speaker John Boehner (R-OH) were crafting a deal that would extend the patch through this year. That House-Senate deal included funding for the home visiting program. The deal had been reached on Wednesday but overnight the doctors groups started to sound the alarm about the shortness of the deal. At that point it looked like the House leadership might lose the needed two-thirds approval for the vote that had been taken up bypassing the rules committee. However, some behind the scenes discussions resulted in an agreement for a voice vote with neither side asking for a roll call, allowing members to not be on the formal voting record. Once the House moved the bill the Senate was scheduled to act, but that has been delayed until today.
In the Senate, a vote on Wyden’s ten year, permanent fix, is likely but not likely to pass because of opposition to using as savings the end of the war costs. When that vote fails, the Senate is expected to move the House bill. The deal allows the home visiting program to continue for one more year, requiring advocates to quickly refocus on the next round.