Al Guida, President and CEO of Guide Consulting Services, is joining Healthsperien as a Partner to expand mental health and substance use disorder policy pursuits. To that end, Al Guida’s presence at GCS and the GCS team itself will remain the same as we build new relationships and tactical strategies to continue serving our clients.

While we are in partnership with Healthsperien, GCS is still a vigorous independent government relations operation. For our current and future clients, what will change is access to additional resources and even better Inside-The-Beltway intelligence to improve your industry’s decision making.

Read the full profile on Al Guida and Healthsperien here.

You can read this newsletter in its entirety here, and sign up to receive future editions of our Capitol Outlook direct to your inbox here.

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February 26, 2025 - We are two months into a new Congress and Administration, and it’s fair to observe a lot has happened in our nation’s capital since January 1st. Guide Consulting Services (GCS) is sending you this note to offer some clarity to the federal budget picture [with one exception – GCS will leave the discussion about the Department of Government Efficiency (DOGE) and mass federal employee layoffs for another day]. In particular, there is considerable confusion between the upcoming federal government funding deadline, the budget reconciliation process, and the latter’s impact on Medicaid. The first thing we want to emphasize is: these are two largely separate legislative processes.

PS: Were you forwarded this message from another sender? If so, you can sign up HERE to personally receive our Capitol Outlook newsletters in the future.

FEDERAL DISCRETIONARY FUNDING

As this newsletter is being written, we are approaching the midpoint of the 2025 federal fiscal year. The federal government is operating under a Continuing Resolution (CR) set to expire on Friday, March 14. Relative to the Department of Health & Human Services (HHS), the CR is keeping the agency’s principal operating divisions – encompassing the Centers for Medicare and Medicaid Services (CMS), the National Institutes of Health (NIH), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Administration for Community Living (ACL) – frozen at FY 2024 funding levels.

Ahead of the March 14 expiration, Congress has three main options for next steps:

• Agree to topline numbers governing all 12 appropriations bills and further agree to detailed line by line House-Senate conference reports governing nearly every federal department (including HHS).

• Conclude that full year bills are not possible and instead agree to a CR governing federal spending for all of FY 2025, which ends on September 30.

• Shut down the federal government for an unknown period of time because of disputes over efforts to use the CR to reign in the activities of DOGE.

With the current environment on Capitol Hill remaining uncertain, we do not have predictions for the outcome. We will provide further updates to your inbox when clear developments happen.

BUDGET RECONCILIATION PROCESS: MEDICAID, MEDICAID, MEDICAID

Explaining the House Passed Budget Resolution
Earlier this week the House of Representatives passed a budget resolution with a 217-215 vote along sharply partisan lines. The action – which is separate from the upcoming federal funding deadline set by the CR – is the starting gun in the race to reshape the Medicaid program. An identical budget resolution passed through the House and Senate allows Congress to later use the budget reconciliation process. The process would enable Congress to bypass a Senate filibuster and pass a reconciliation bill using a simple majority of Republican votes in both chambers. As of now, the budget resolution proposes intended levels of financing, and the budget reconciliation will make the actual tax cuts and spending reductions to programs like Medicaid.

What Happens Now That the Budget Resolution Passed?
Make note – we are only at the first turn of a long race. The next step requires the Senate to adopt an identical version of the House passed budget resolution. After that, the Senate Finance Committee and the House Energy & Commerce Committee must make the actual policy changes to Medicaid necessary to generate truly huge savings. End-to-end, this process will take months. If the House and Senate set a land speed record, a reconciliation bill might be on President Trump’s desk by Memorial Day. 

What’s at Stake for Medicaid?
In short, the House passed legislation proposes $880 billion in Medicaid spending reduction – the equivalent of an 11% cut across the board. In turn, that spending cut would be translated into possibly three policy changes. First, mandatory work requirements. Second, scaling back the financial incentive for the Medicaid expansion in 40 states. Third, the imposition of so-called “per capita caps” on individual Medicaid patient populations. For example, persons with Intellectual and Developmental Disabilities (I/DD)  and people with more serious mental disorders would be slotted into a capped “elderly, blind and disabled” patient category.

The result would be enormous Medicaid cost shifts to state and county budgets and dramatic spikes in the number of people with no health insurance. Just scaling back the Medicaid expansion could cause more than 20 million Americans to lose their Medicaid coverage. 

WHY DOES THIS ALL MATTER?

GCS represents many mental health and substance use provider organizations as well as other collectives who serve related populations, and we are concerned about a range of impacts. First, since most Medicaid behavioral health benefits are optional, states may be forced to reduce the array of covered mental health and substance use services. Second, the aforementioned cost shifts to state budgets will put downward pressure on Medicaid reimbursement rates. In turn, could push individual providers like clinical social workers and certified mental health counselors to withdraw from the Medicaid program. Third, a spike in the number of Americans without health insurance is guaranteed to increase uncompensated care costs for community based mental health and substance use treatment providers.

Again, we are only in the very beginning of the entire budget reconciliation process. While there are many unknowns at this point, we can share one note of wisdom from previous reconciliation battles – grassroots and grasstops advocacy efforts will make all the difference in the outcome of these procedures. 

January 8, 2025 - In opting for a short-term Continuing Resolution (CR) to extend key health care programs and nearly all federal funding through March 14, the 119th Congress is now facing a potential health care traffic jam akin to the worst Beltway backups. Let’s take an offramp and briefly outline what might be on Congress’s route over the next few months.
PS: Missed our quarterly Capitol Outlook? If so, you can sign up HERE to personally receive our newsletters in the future.

NOMINATIONS

Senate floor time and a decent amount of political capital will be consumed with securing nominations for the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). The current selections could be referred to as unorthodox. For example, Robert F. Kennedy, Jr., the pick for HHS Secretary, possesses controversial views on vaccines and has in the past proposed a nationwide system of farms as a treatment methodology for substance use disorders. Simultaneously Dr. Mehmet Oz, the selection for CMS Administrator, is most well-known for his former role as a celebrity TV talk show host. Whatever the efficacy of these policy and clinical solutions, our point is that the Senate will be fighting rush hour traffic to get these nominations confirmed (and RFK Jr. might even end up enjoying bipartisan support).

THE EXTENDERS ARE BACK

For nearly 18 months, there have been discussions on the Medicare telehealth, Community Health Center (CHC) expansion funding, and Medicaid Disproportionate Share Hospital (DSH) delay extension. Without further congressional action, they are all now set to expire – again – in March. This is to say nothing of the substantial reforms to Pharmacy Benefit Management (PBM) practices across both Medicare and Medicaid which were nixed at the last minute from inclusion in the end of year package.

The continuation of the covid-era Medicare telehealth flexibilities is particularly important for mental health and substance use treatment providers. Previous extensions include continuation of reimbursement for so-called “audio only” telehealth visits, tele-mental health care offered by Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and delayed implementation of the statutory in-person tele-mental health requirement. Additionally, as state Medicaid programs often mimic the federal telehealth waivers, hundreds if not thousands of Community Mental Health Centers (CMHCs) and Community Behavioral Health Organizations (CBHOs) – along with the patients they serve – would benefit from congressional telehealth wavier extensions.

REAUTHORIZATION OF SUPPORT ACT & PAHPA

The bipartisan SUPPORT Act was enacted in 2018 and signed into law by President Donald Trump to confront the emerging opioid crisis that to this day is still taking the lives of tens of thousands of Americans. Last reauthorized in 2019, the Pandemic and All-Hazards Preparedness Act (PAHPA) is a measure that aims to improve the nation's ability to respond to and prepare for public health emergencies. Neither of these laws were extended at the end of the 118th Congress. This could become problematic because the Trump Administration’s new Department of Government Efficiency (DOGE) has proposed the elimination of funding for all unauthorized federal programs.

BUDGET RECONCILATION PROCESS

The principal value of reconciliation bills is that they enable the U.S. Senate to bypass the filibuster and pass budget measures by simple majority votes. In the past, health care legislation – specifically large, proposed Medicaid funding reductions – has ridden on tax measures typically designed to cut corporate and individual tax rates. The current floor for Medicaid change is a nationwide work requirement that generates savings near $110 billion, with most of this savings from disenrollments. Additional revisions range from safety net hospital supplemental payment reforms and scaling back the matching rate for state Medicaid expansions to huge architectural changes like Medicaid block grants or per-capita caps.

In 2017, the Congressional Budget Office (CBO) scored this entire proposed package of Medicaid statutory modifications as saving $1 trillion over 10 years. At the same time, millions of low-income Americans would lose health insurance coverage and already-low Medicaid provider reimbursement rates would be further reduced while provider uncompensated care caseload would spike. These statements are a summary of the CBO reports from 2017.

WHO IS RUNNING TRAFFIC CONTROL? 

Senate Majority Leader John Thune (R-SD) and House Speaker Mike Johnson (R-LA) will bear primary responsibility for sorting out the priorities described above and for keeping the trains running on time. We foresee at least two potholes: the very narrow House majority and the upcoming vote on lifting the federal debt ceiling.

On top of everything else, the Fiscal Year 2025 appropriations process must be brought to a conclusion. In these circumstances, it is not unusual for House and Senate conference reports to be agreed to sometime before the Easter recess (March 17-21).

During this extremely busy first session of the 119th Congress, count on Guide Consulting Services for regular Capitol traffic updates, administrative reports, and legislative delay advisories. 

Via GCS

For the third year running, our Senior VP and COO Sarah Corcoran has received a Top Lobbyist recognition from The Hill.

Via The Hill

Our full Capitol Outlook is available here with an abbreviated version below:

October 2024 – Washington, DC: Now that the Fall recess is in full swing, speculation is rampant in Washington, D.C. about what the lame duck session will bring in terms of health care policy after the presidential election.

UNWRITTEN LAME DUCK RULE
Congress is set to return to Washington on Tuesday, November 12th.  There are some unofficial rules that guide so-called “lame duck” sessions. For one, if there is a new incoming administration entering the White House in 2025, virtually all substantive policy decisions are usually punted to the early months of next year. A corollary to that rule is that a large omnibus appropriations bill sustains a similarly substantial end of year health care package. By contrast, potential Continuing Resolutions in December make for small and temporary health care patches. Finally, three out of every five lame duck sessions are truly lame. But the memory of the big year-end blockbusters keeps all the players at the table. These conventions will structure debates around the following health care policy issues:

TELEHEALTH
Both the House Energy & Commerce Committee and the Ways & Means Committee have passed similar legislation to extend rules expanding access to virtual health care for Medicare patients before such provisions expire at year’s end.  For example, both measures continue reimbursement for so-called “audio only” telehealth visits and both provide payment for tele-mental health care offered by Federally Qualified Health Centers and Rural Health Clinics. The policy questions still in play are what is the length of the telehealth extensions and what is the cost. The House bills extend telemedicine waivers for two years with a budget score of roughly $2 billion per year, but neither measure fully offsets the cost.

DOCTORS, CLINICS, HOSPITALS
The last day of 2024 confronts Congress with a series of deadlines for Medicare and Medicaid health care providers. Medicaid Disproportionate Share Hospital (DSH) cuts are scheduled to impact safety net hospitals around the United States. In addition, operating funds for hundreds of Community Health Centers (CHCs) are also set to expire. Not to be left out, physicians are seeking help from members of the Senate Finance Committee and the House Ways and Means Committee to avert a scheduled cut to how much Medicare pays doctors, which is set to go into effect in early 2025.

LEGACY HEALTHCARE AGENDAS
An astonishing number of senior members from key health care committees of jurisdiction are retiring at the end of the 118th Congress. Many will be seeking to secure their legislative legacies in the lame duck session.  Here are two examples:

Rep. Cathy McMorris Rodgers, Chair of the powerful House Energy & Commerce Committee, has allocated an enormous amount of committee time and political capital to reforms of – and improvements to – the Medicaid Home and Community Based Services (HCBS) program. Since its inception more than 40 years ago, Medicaid recipients – typically persons with disabilities or multiple chronic conditions – must demonstrate a need for an institutional level of care to qualify for an HCBS placement in the community. Chair Rogers strongly supports an ambitious bill that would remove that requirement, thereby substantially expanding access to home-based care.

Sen. Debbie Stabenow, a social worker by trade, has spent many years advocating in Congress for better mental and behavioral health care, and much of the last fifteen years building on President John F. Kennedy’s legacy to create a nationwide system of truly effective community-based services for persons with serious mental illness, called Certified Community Behavioral Health Clinics (CCBHCs). In her remaining days in Congress, it is reported that Sen. Stabenow may see an opportunity to make CCBHCs a permanent part of the Medicaid program by securing appropriate reimbursement for intensive community-based care, while also seeking to expand the role of clinical social workers in Medicare.

HOMELESS WOMEN AND FAMILIES
In the last year, we have seen increasing bipartisan attention on Capitol Hill and in the Administration aimed towards Social Determinants of Health (SDOH) such as housing, food security, education, and other factors. A particularly tight focus is on the nationwide plight of shelters and safe havens who serve homeless women and children. This summer, the Senate Appropriations Subcommittee on Transportation, Housing, and Urban Development (THUD) released specific committee report language on interagency technical assistance for housing-related supportive services and behavioral healthcare. Further, they directed the Department of Housing and Urban Development (HUD) to review its implementation of grants for emergency shelters. To our knowledge, this is the first THUD report in a long time that points to the importance of homeless shelters and the need to support their continuum of operations. We anticipate more attention and action will focus on these issues.

WILD CARDS
Players at the table always have wild cards are they are not showing. In the health care space, we are not talking about a hidden card up a sleeve, but rather legislation associated with substantial projected Congressional Budget Office (CBO) scored savings. In the context of this lame duck, there are at least four.

Repealing the Medicaid Nursing Home Staffing Standard: Over the summer, the Center for Medicaid and CHIP Services promulgated a set of regulations that established minimum staffing requirements for hundreds of nursing facilities across the country. On a party-line vote, the House Energy & Commerce Committee recently passed legislation repealing those rules.
Hospital Site Neutral Legislation: For several years now, there has been substantial bipartisan interest – in both houses of Congress – in standardizing Medicare payments for outpatient services regardless of the healthcare facility in which they are delivered. These bills have triggered furious opposition from hospitals who say they cannot afford payment cuts for care provided at their outpatient facilities.    
Pharmacy Benefit Managers (PBM): There seems to be endless television and digital advertising to the front-page New York Times stories exposing seemingly shady PBM dealings. To say that there is significant bipartisan momentum to reform the business practices of PBMs, which are intermediaries who negotiate rebates between insurers and drug companies, is the understatement of 2024. 
Hurricane Relief:  The upcoming disaster supplemental funding bill has the potential to completely upend the lame duck session. There are credible reports that the legislation could exceed $100 billion with all the funding directed at red states – Florida, Georgia, North Carolina, and Tennessee – making it a must past legislative vehicle by New Year’s Eve. Bills of this type have historically become Christmas trees attracting all manner of health policy ornaments. [See the legacy items discussed above].

One more quick, non-partisan note…

HAVE YOU CHECKED YOUR VOTER REGISTRATION?
‘Tis the season for doing your civic duty. At Guide Consulting Services, we encourage full participation in the election process and ask that you take a moment to verify, update, or register your voter status. For a quick overview of the process and to find your state’s election site, check out https://www.usa.gov/confirm-voter-registration.
 
We will see you after the election with an end-of-year update. In the meantime, stay healthy and enjoy the fall colors. You can sign up HERE to personally receive our newsletters in the future.

As Congress finalizes FY25 appropriations, starkly different mental health funding proposals have emerged. GCS’s Sarah Corcoran breaks down priorities, provisions, and politics in her latest Beltway Update.

Via MindSite News

The Washingtonian, a go-to magazine that provides the D.C. area with the latest in news, politics, and culture, has released its list of experts and advocates in Washington, D.C. who have had the most notable influence in the policy-making space.

Via The Washingtonian.

As the 118th Congress reaches its midpoint, dive into the latest mental health policy updates with GCS’s Sarah Corcoran as she highlights bipartisan initiatives and funding priorities.

Via MindSite News.

Guide Consulting Services (GCS) analyzes Congress's health policy landscape, from Medicaid reauthorization to budget requests and appropriations, while highlighting the significance of ongoing advocacy for children's healthcare needs.

Via GCS Capitol Outlook.

Guide Consulting Services (GCS) Highlights Mental Health Legislation and Policy Predictions for 2024, Including the SUPPORT Act Reauthorization, Social Work in Health Care, Expanding Access to Methadone, 988 Crisis Lifeline Implementation, and Legislative Deadlines.

Via GCS Capitol Outlook

The Hill, a top U.S. political news outlet, released its list of the corporate lobbyists, hired guns, association leaders and grassroots activists who leveraged their expertise and connections to make a difference in the nation’s capital this year.

Via The Hill

As the push for mental health parity faces a hurdle, GCS President & CEO Al Guida highlights the challenges posed by the slow adoption of electronic health records within behavioral health care.

Via Politico

Guide Consulting Services (GCS) Analyzes Uncertain Legislative Outlook for the 118th Congress, Discusses Pending Behavioral Health Legislation and Impacts of Federal Rules, Amidst Potential Government Shutdown Concerns and Prospects for End-of-Year Health Care Package.

Via GCS Capitol Outlook

Compromise bill to lift the debt ceiling, signed by President Biden, raises concerns as GCS VP Sarah Corcoran warns of potential reductions in future mental health funding, citing the Fiscal Responsibility Act of 2023's impact on previously appropriated funds and potential cuts to key federal agencies over the next two fiscal years.

Via Mindsite News

With a divided Congress for 2023, it’s easy to assume policymaking is over. In the GCS view, that analysis is off base for a few reasons.

Via GCS Capitol Outlook

Congress Races Against the Clock to Pass Year-End Funding Package with Historic Victories for Mental Health, as Sarah Corcoran Highlights Key Provisions and Policy Measures.

Via MindSite News

HIRING: Policy Associate

If interested, please submit a cover letter, resume, three references and writing sample to guideconsultingservices@gmail.com with the subject line “Policy Associate – (your last name)”. Application closes on January 22, 2023.

GUIDE CONSULTING SERVICES OVERVIEW:

Guide Consulting Services (GCS) is a boutique, full-service government relations firm representing non-profits and ethically responsible businesses to advance their health and social policy goals into law. We prioritize getting results for our clients through strategy, legislative drafting, government relations and public affairs services.

POSITION OVERVIEW:

The position entails a wide-ranging government relations and advocacy coordination for multiple Guide Consulting clients focused in mental and behavioral health, suicide prevention and crisis services, and Medicare/Medicaid. As we scale-up, we are seeking a candidate who is interested in growing with our business, independent, organized, highly detail-oriented, and a team player. If you are looking for a great opportunity to train and grow with a bipartisan firm that makes real change for people through legislation and regulation, this is the place for you.

POSITION RESPONSIBILITIES:

Position responsibilities include, but are not restricted to, the following:

• Monitor and attend congressional hearings and other briefings/events, producing memos and notes for clients

• Monitor, analyze, and summarize legislative and regulatory developments on a wide variety of issues at the federal level

• Research legislative history, academic research, and policy to help design and advance legislative goals

• Assist team with organization operations and managing clients

• Conduct outreach to Capitol Hill staff to help increase sponsorship on pending legislation or requested attendance at an event

• Help organize congressional staff briefings, Capitol Hill/lobby days, virtual action days for clients

• Provide moderate IT/ technical assistance for GCS staff

• Enhance and support social media and marketing presence of coalitions/GCS and general management of accounts

QUALIFICATIONS/SKILLS:

The ideal candidate will possess the following qualifications:

• Bachelor’s degree from an accredited institution in political science, history, communications, English, international relations, public policy, or related degree program

• 2-4 years legislative or government relations experience

• Preferred familiarity with health care and behavioral health care

• General working knowledge and strong interest in Congress and federal agencies

• Technical skills include mastery of Microsoft Office (Word, Excel, Outlook, and PowerPoint) and Zoom

• General facility with social media including Twitter and LinkedIn, and preferred familiarity with editing website content

The ideal candidate will possess the following skills:

• Highly organized, detail-oriented and able to work in a fast-paced environment

• Strong writing and editing skills, including ability to attend congressional hearings/mark-ups and provide summarized, detailed memorandums

• Ability to develop new skills quickly

• Strong research skills

• Passionate about advocacy and meaningful messaging

• Excellent interpersonal and communications skills

• Ability to work independently but also thrive in a team

• Self-motivated and flexible, along with a can-do attitude

• Ability to multi-task and juggle multiple projects with quick deadlines

• Ability to think and act tactically

• Good judgement

• Positive attitude and sense of humor

• Creativity, flexibility, and willingness to contribute ideas

SALARY & BENEFITS:

Salary range for the Policy Associate role is $45,000-50,000 annually. Competitive benefits package offered including employer paid health, dental and transportation benefit. Extensive paid vacation, retirement contribution and professional development benefit.

This is a full-time, exempt position at 40 hours per week. There may be instances where the Policy Associate is asked to work additional hours, as needed. This position is based in Washington, DC; GCS operates on a hybrid working arrangement.

HOW TO APPLY:

If interested, please submit a cover letter, resume, three references and writing sample to guideconsultingservices@gmail.com with the subject line “Policy Associate – (your last name)”. Application closes on January 22, 2023.

Guide Consulting Services provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

The Hill, a top U.S. political news outlet, released its list of the corporate lobbyists, hired guns, association leaders and grassroots activists who leveraged their expertise and connections to make a difference in the nation’s capital this year.

Via The Hill

Each year NILE sets out to create an annual Top Lobbyist list to recognize and spotlight the amazing work done by lobbyists, PAC managers/directors, and grassroots professionals across the U.S.

Via NILE

As midterms come crashing closer, GCS’s Sarah Corcoran analyzes outstanding policy items that could pass before the 118th Congress comes into office.

Via MindSite News