Marilyn Singleton, MD, JD summarizes recently-introduced healthcare-related bills.
Medicare’s Sustainable Growth Rate Repeal and (Dreadful) Replacement
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), H.R. 2, authored by Rep. Michael Burgess (R-TX). This bill passed in the House with 212 Republicans and 180 Democrats on March 26, 2015. The following link provides the names of your representatives and how they voted. https://www.govtrack.us/congress/votes/114-2015/h144. The bill has been sent to the Senate. Full text: https://www.govtrack.us/congress/bills/114/hr2/text.
The bill is 262 pages long and a difficult read – in more ways than one. Please follow this link to the AAPS position paper on this bill. http://www.aapsonline.org/index.php/site/article/doctors_urge_senate_to_reject_boehner-pelosi_doc_fix.
On March 16, 2015, three health-related bipartisan bills were passed
The House approved the Improving Regulatory Transparency for New Medical Therapies Act, H.R. 639. H.R. 639, authored by Health Subcommittee Chairman Joe Pitts (R-PA), Frank Pallone (D-NJ), and Gene Green (D-TX), was approved by a voice vote. This bill seeks to improve the transparency and consistency of the Drug Enforcement Agency’s scheduling of Food and Drug Administration-approved treatments so these drugs can get to patients more efficiently.
The Access to Life-Saving Trauma Care for All Americans Act, H.R. 647 and the Trauma Systems and Regionalization of Emergency Care Reauthorization Act, H.R. 648, were both authored by Rep. Michael C. Burgess, M.D. (R-TX) and Gene Green (D-TX). These two bills would strengthen trauma care systems to help ensure patients in communities all across the country have access to trauma services.
Prescription Drugs: More Practitioner Mandates
On Mar 3, 2015, the Increasing the Safety of Prescription Drug Use Act of 2015, S. 636 was introduced by Sen. Tom Udall (D-NM) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill sets forth requirements for state controlled substances monitoring program databases. The state would be required to: (1) ensure that its database is interoperable with other such programs and electronic health records and provides updated patient information available to a practitioner; (2) require practitioners to use database information to help determine whether to prescribe or renew a prescription for a controlled substance; and (3) require dispensers, where permitted, to enter patient data required by the Secretary into the database, including concerning methadone dispensed.
The bill also (1) imposes confidentiality protections regarding patient information in the database; (2) requires health care practitioners and dispensers who participate in or are employed by a federal or federally funded health care program, and federally qualified health centers, to use the databases of the controlled substance monitoring programs if they are available; (3) directs HHS to establish a peer review process to evaluate prescribing standards; (4) establishes a grant program to educate practitioners about substance abuse.
Practitioner mandates include : (1) requiring health care providers who participate in or are employed by a federal health care program, and federally qualified health centers, to screen patients for abuse of prescription drugs or other controlled substances, conduct brief interventions, and provide referrals for known or suspected abuse of prescription drugs or other controlled substances; (2) requiring practitioners who register or renew a registration to dispense or conduct research with controlled substances in schedules II, III, IV, or V to certify that they have completed continuing medical education regarding prescription drug abuse (in the case of first-time registration) and regarding medical understanding of the proper use of all drugs listed in all of the controlled substances schedules (in the case of renewals).
Finally, the bill would requires HHS to review naloxone to consider whether it should cease to be a prescription-only drug and be available as a behind-the-counter drug, in order to increase access of such drug to community-based organizations and street outreach organizations.
Full text: https://www.govtrack.us/congress/bills/114/s636/text
Bill to Increase Medicaid Payments Requires Board Certification
On March 12, 2015, the Ensuring Access to Primary Care for Women and Children Act, S. 737 was introduced by Sen. Sherrod Brown (D-OH) and referred to the Senate Finance Committee. This bill would amend Medicaid to require that primary care services furnished in 2015 and 2016 be paid not less than 100% of the Medicare Part B rate.
Of note, these providers must be “self-attested as Board-certified” physician self-attests that the physician is Board certified in family medicine, general internal medicine, or pediatric medicine or OB-GYN. The payment also applies to advanced practice clinicians; rural health clinics, federally-qualified health centers, or other specified health clinics; and nurse practitioners, physician assistants, or certified nurse-midwives. Primary care services provided in an emergency department of a hospital are excluded.
Full text: https://www.govtrack.us/congress/bills/114/s737/text
More Government Control
On March 26, 2015, H.R. 1687, the Sugar-Sweetened Beverages Tax Act was introduced by Rep. Rosa DeLauro (D-CT) and referred to the House Energy and Commerce and Ways and Means Committees. This bill would impose an excise tax on the sale or transfer of any specified sugar-sweetened beverage product by the manufacturer, producer, or importer. The rate of such tax is 1 cent per 4.2 grams of caloric sweetener contained in such product. The revenues would go to the Prevention and Public Health Fund for the sole purpose of funding programs and research to reduce the human and economic costs of diabetes, obesity, dental caries, and other diet-related health conditions in priority populations.
Full text: https://www.congress.gov/bill/114th-congress/house-bill/1687/text.
More Tweaks to ObamaCare
On March 17, 2015, H.R. 1387, the Fairness for Farmers Act of 2015 was introduced by Rep. Renee Ellmers (R-NC) and referred to the House Ways and Means Committee. This bill would exclude certain “alien agricultural seasonal workers” from the definition of “full-time employee” for purposes of the employer mandate to provide employees with minimum essential health care coverage.
Full text: https://www.govtrack.us/congress/bills/114/hr1387/text
On March 19, 2015, H.R. 1494, the Retirement Health Savings Act of 2015 was introduced by Rep. Jeff Fortenberry (R-NE) and referred to the House Ways and Means Committee. This bill would permit distributions from qualified retirement accounts into Health Savings Accounts of an individual (or of the surviving spouse, a dependent of the surviving spouse, or alternate payee.
Full text: https://www.govtrack.us/congress/bills/114/hr1494/text
On March 23, 2015, H.R. 1547, the Family Health Care Flexibility Act was introduced by Rep. Erik Paulsen (R-MN) and referred to the House Ways and Means Committee. The identical Senate bill, S. 836 was introduced by Sen. John Barrasso, M.D. (R-WY) and referred to the Senate Finance Committee.
This bill would repeal the portions of the ACA that (1) restrict payments from health savings accounts, medical savings accounts, and health flexible spending arrangements for medications to prescription drugs and insulin only (thus allowing payments for over-the-counter medications); and (2) impose a $2,500 limitation on salary reduction contributions to a health flexible spending arrangement under a cafeteria plan.
Full text House bill: https://www.govtrack.us/congress/bills/114/hr1547/text
Full text Senate bill: https://www.govtrack.us/congress/bills/114/s836/text
On March 26, 2015, H.R. 1664, the Health Insurance Freedom Act of 2015 was introduced by Rep. John Culberson (R-TX) and referred to the House Energy and Commerce and Ways and Means Committees. This bill would grandfather existing health plans as complying with the ACA.
Bill to Ensure Freedom To Privately Contract in Medicare
On March 26, 2015, H.R. 1650, the Medicare Patient Empowerment Act of 2015 was introduced by Rep. Tom Price, M.D. (R-GA) and referred to the House Energy and Commerce and Ways and Means Committees. This bill would make it clear that Medicare beneficiaries are free to enter into a contract with an eligible professional (whether or not the professional is a participating or non-participating physician or practitioner) for any item or service covered under Medicare. The beneficiary can submit claims and payments would be made to the beneficiary in the same amounts as if it were a “participating” professional from whom they obtained services.
Other requirements include :
(1) the contract must be in writing, signed by the Medicare beneficiary and the eligible professional, and establishes all terms of the contract (including specific payment for items and services covered by the contract) before any item or service is provided pursuant to the contract;
(2) the beneficiary shall be held harmless for any subsequent payment charged for an item or service in excess of the amount established under the contract during the period the contract is in effect;
(3) the contract cannot be entered into at a time when the Medicare beneficiary is facing an emergency medical condition or urgent health care situation.
Changes to Medicare Provide More Government Coverage
It is clear that even opponents of the ACA are married to Medicare and continue to “enhance” it. The constituents are mollified by adding more Medicare benefits as the program self-destructs.
On March 16, 2015, H.R. 1383, the Medicare Adult Day Services Act was introduced by Rep. Linda Sanchez (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. This bill would require Medicare to (1) cover certified adult day services furnished in a certified adult day services center and meeting specified requirements; and (2) require the Secretary of Health and Human Services (HHS) to increase by 3% the payment amount otherwise effective for such services furnished in a rural area.
Full text: https://www.govtrack.us/congress/bills/114/hr1383/text
On March 18, 2015, H.R. 1427, the Medicare CGM Access Act of 2015 was introduced by Rep. Tom Reed (R-NY) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would provide Medicare coverage of continuous glucose monitoring (CGM) devices furnished to a CGM qualified individual. A CGM qualified individual is an individual with Type I diabetes (i) who is following an intensive insulin treatment regimen that consists of 3 or more insulin injections per day or the use of a subcutaneous insulin infusion pump; (ii) whose attending physician certifies that the individual’s condition cannot be safely and effectively managed with self-monitoring of blood glucose; and (iii) who has been unable to achieve optimum glycemic control in accordance with evidence-based guidelines or has experienced hypoglycemia unawareness or frequent hypoglycemic episodes.
Full text: https://www.govtrack.us/congress/bills/114/hr1427/text.
On March 19, 2015, H.R. 1458, the Bundling and Coordinating Post-Acute Care Act (BACPAC Act) was introduced by Rep. David McKinley (R-WV) and referred to the House Energy and Commerce and Means Committees. The bill would require a single bundled payment to the physician with primary responsibility for the patient for post-acute care services (within 90 days of hospital discharge) under Medicare parts A (Hospital Insurance) and B (Supplementary Medical Insurance). The bill would have HHS (1) establish a new Transitional Care Management (TCM) code, with respect to geographic adjustments to the physicians’ fee schedule, to pay for care management by a PAC physician; or (2) revise and expand the use of existing TCM codes 99495 and 99494.
Full text: https://www.govtrack.us/congress/bills/114/hr1458/text
On March 24, 2015, H.R. 1571, the Improving Access to Medicare Coverage Act was introduced by Rep. Joe Courtney (D-CT) and referred to the House Energy and Commerce and Ways and Means Committees. The identical Senate bill, S. 843 was introduced by Sen. Sherrod Brown and referred to the Senate Finance Committee.
The bill would amend the Medicare Act to deem an individual receiving outpatient observation services in a hospital to be an inpatient with respect to satisfying the three-day inpatient hospital requirement in order to entitle the individual to Medicare coverage of any post-hospital extended care services in a skilled nursing facility (SNF).
Full text House bill: https://www.govtrack.us/congress/bills/114/hr1571/text.
Full text Senate bill: https://www.govtrack.us/congress/bills/114/s843/text.
On March 24, 2015, H.R. 1559, Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act of 2015 was introduced by Rep. Chris Smith (R-NJ) with 52 co-sponsors and referred to the House Energy and Commerce and Ways and Means Committees. The bill would provide Medicare coverage for an initial comprehensive care plan for Medicare beneficiaries newly diagnosed with dementia.
Full text: https://www.govtrack.us/congress/bills/114/hr1559/text.
On March 26, 2015, H.R. 1653, Medicare Hearing Aid Coverage Act of 2015 was introduced by Rep. Debbie Dingell (D-MI) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would allow Medicare coverage for hearing exams and hearing aids.
Full text: https://www.govtrack.us/congress/bills/114/hr1653/text.
On March 26, 2015, H.R. 1686, the Preventing Diabetes in Medicare Act of 2015 was introduced by Rep. Diana DeGette (D-CO) and referred to the House Energy and Commerce and Ways and Means Committees. Although Medicare provides coverage for screening for diabetes it does not provide adequate services to such beneficiaries to help them prevent or delay the onset of diabetes. Accordingly, this bill requires Medicare to cover medical nutritional therapy services for people with pre-diabetes and risk factors for developing type 2 diabetes. Pre-diabetes means a condition of impaired fasting glucose or impaired glucose tolerance identified by a blood glucose level that is higher than normal, but not so high as to indicate actual diabetes.
Full text: https://www.govtrack.us/congress/bills/114/hr1686/text.
