Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill
More Plucking Away at the ACA
On June 18, 2015, H.R. 160, the Protect Medical Innovation Act was passed by the House 280 to 140 with 234 Republican and 46 Democrat yeas. No Republicans voted in opposition. See how your representative voted here: https://www.govtrack.us/congress/votes/114-2015/h375
The Protect Medical Innovation Act would repeal the tax on medical devices created by the Affordable Care Act (ACA). The medical device excise tax is paid by medical manufacturers. Proponents of the bill criticize the tax for making production more difficult for medical manufacturers. The bill has 241 Republican and 41 Democratic cosponsors. The bill now goes to the Senate next for consideration.
On June 23, 2015, H.R. 1190, the Protecting Seniors’ Access to Medicare Act of 2015 passed in the House by 244 to 154 with 233 Republican and 11 Democrat yeas. No Republicans voted in opposition. See how your representative voted here: https://www.govtrack.us/congress/votes/114-2015/h376
The Protecting Seniors’ Access to Medicare Act would repeal the sections of the Affordable Care Act that established the Independent Payment Advisory Board, or IPAB. The IPAB is a board of 15 members who can reduce Medicare spending if spending grows too fast. The bill has 215 Republican and 20 Democratic cosponsors. The bill now goes to the Senate next for consideration.
On June 9, 2015, H.R. 2698, the Tanning Tax Repeal Act of 2015 was introduced by Rep. George Holding (R-NC) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code to repeal the 10% excise tax on indoor tanning services.
On June 9, 2015, S. 1531, the Patient Freedom Act of 2015 was introduced by Sen. Bill Cassidy, MD (R-LA) and referred to the Senate Finance Committee. The bill provides states with three options regarding Title I (provisions on health insurance reform, exchanges, and subsidies) of the Affordable Care Act (ACA):
- Continue implementing ACA;
- Do not apply title I of ACA except to prohibit lifetime or annual limits on health insurance benefits and require coverage of dependents up to 26 years old; or
- The second option plus implementation of a health savings account (HSA) deposit system. In states implementing an HSA deposit system, residents who are enrolled in health insurance coverage that meets state standards receive monthly deposits in their HSAs either from states administering federal funds or as a tax credit paid in advance. States that administer deposits are entitled to payments from the Department of Health and Human Services for population health initiatives. States with an HSA deposit system must offer a health insurance plan that is continually available for enrollment and penalize residents who have a break in coverage.
Other provisions include :
- Eliminating the requirement that an individual have a high deductible health plan to be eligible for the tax benefits of an HSA.
- Allowing HSAs to be used to pay premiums for health insurance that meets specified requirements.
- HSA tax benefits only apply to payments for health care for which the provider publishes the price.
- Medicaid would disregard HSA funds for purposes of determining Medicaid eligibility and benefits except for long-term care services.
Full text (Senate bill): https://www.govtrack.us/congress/bills/114/s1531/text
Full text (identical House bill): https://www.govtrack.us/congress/bills/114/hr2756/text
On June 24, 2015, H.R. 2881, the Small Business Job Protection Act was introduced by Rep. Luke Messer (R-IN) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code, as amended by the Patient Protection and Affordable Care Act, to redefine “applicable large employer,” for purposes of the mandate requiring employers to provide health insurance for their employees, to mean an employer with at least 100 full-time employees (currently, 50).
Medicare/Medicaid Fraud Bill Requires National Provider Identifier for Prescriptions
On June 24, 2015, S. 861, the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 was sent out of committee to the whole Senate for consideration. The bill would:
(1) Prohibit sponsors of prescription drug plans from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug’s prescriber.
(2) Direct the HHS Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse by enhancing rewards and extending the incentives to the Medicaid program. According to the House Energy and Commerce Committee, the Medicaid program for fiscal year 2014, CMS reported an estimated improper payment rate for the Medicaid program of 6.7 percent, or $17.5 billion. This was an increase over its 2013 estimate of 5.8 percent, or $14.4 billion.
(3) Require the Secretary to report to Congress the status of recovery audit contractors (RACs) and the types of improper payments they uncovered.
(4) Requires the Secretary to timely address the vulnerabilities identified by RACs.
(5) Authorizes the Secretary to retain 5% of recovered funds for use by the Inspector General to investigate improper payments.
(6) Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges.
Republican-Sponsored Bill for Bundled Medicare Payments
On May 21, 2015, H.R. 2502, the Comprehensive Care Payment Innovation Act of 2015 was introduced by Rep. Diane Black (R-TN) and referred to the House Energy and Commerce and Ways and Means Committees. The bill calls for bundled payments for integrated care furnished during an “episode of care” for “applicable conditions” involving a hospitalization, to an individual entitled to/enrolled in Medicare part A (Hospital Insurance) and enrolled for benefits under Medicare part B (Supplementary Medical Insurance), but not enrolled under Medicare part C (Medicare+Choice Program) or in a PACE (Programs of All-Inclusive Care for the Elderly) program. A qualified entity may select one or more applicable conditions for bundled payments.
“Applicable conditions” means any of the following procedures furnished as part of inpatient hospital services:
(1) Hip/Knee joint replacement,
(2) Lumbar spine fusion,
(3) Coronary artery bypass graft,
(4) Heart valve replacement,
(5) Percutaneous coronary intervention with stent,
(6) Colon resection.
“Applicable services” means the following items and services:
(1) Acute care inpatient services,
(2) Physicians’ services delivered in and outside of an acute care hospital setting,
(3) Outpatient hospital services,
(4) Post-acute care services, including home health services, skilled nursing services, inpatient rehabilitation services, and inpatient hospital services furnished by a long-term care hospital.
An “episode of care” means 3 days prior to hospital admission, the duration of the inpatient admission, and the 90 days following the discharge of the applicable beneficiary from such hospital.
Proposed Expansions to Medicare Coverage
On June 10, 2015, S. 1549, the Care Planning Act of 2015 was introduced by Sen. Mark Warner (D-VA) and referred to the Senate Finance Committee. The bill would require Medicare and Medicaid to cover advanced illness planning and coordination services furnished to an eligible individual with progressive illness, including Alzheimer’s disease, by a hospice or other provider through an interdisciplinary team. The coverage would apply to those enrolled in Medicare part A (Hospital Insurance) and part B (Supplementary Medical Insurance), but not enrolled under Medicare part C (Medicare+Choice). The bill also requires the Center for Medicare and Medicaid Innovation to test service models to pay for advanced illness care “while preserving or enhancing quality of care.”
On June 12, 2015, H.R. 2759, the Mental Health Access Improvement Act of 2015 was introduced by Rep. Christopher Gibson (R-NY) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would require Medicare part B to cover marriage and family therapist and mental health counselor services.
On June 12, 2015, H.R. 2748, the Help Extend Auditory Relief (HEAR) Act of 2015 was introduced by Rep. Matthew Cartwright (D-PA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would require Medicare to cover aural rehabilitation services, hearing aids as durable medical equipment, audiology rehabilitation services, and related hearing services.
On June 23, 2015, H.R. 2846, the Planning Actively for Cancer Treatment (PACT) Act of 2015 was introduced by Rep. Lois Capps (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would provide Medicare coverage for cancer care planning and coordination services. The bill’s preamble notes, “shortcomings in providing cancer care, resulting in a lack of shared decision-making, inadequate management of cancer symptoms, and insufficient monitoring and treatment of late effects of cancer and its treatment, relate in part to the inadequacy of Medicare payments for such planning and coordination services.”
Proposed Changes to Medicare Oncology Payments
On June 25, 2015, H.R. 2895, the Medicare Patient Access to Cancer Treatment Act of 2015 was introduced by Rep. Mike Pompeo (R-KS) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would equalize Medicare reimbursement in hospital outpatient departments and physicians’ offices for cancer care services. The preamble of the bill notes that the Medicare payments for chemotherapy administered in hospital outpatient settings have more than tripled since 2005 (from $90 million to $300 million) while payments to physician community cancer clinics have actually decreased by 14.5 percent. Additionally, the Medicare physician fee schedule rate in 2015 for CPT Code 96413 (Chemo, iv infusion, 1 hr), the most common drug administration code billed by oncology practices, is $136 but the payment rate for the same service under the Medicare hospital outpatient prospective payment system (HOPPS) fee schedule in 2012 is 100 percent higher at $285.
The June 2013 report of the Medicare Payment Advisory Commission highlighted the large disparities in payment in outpatient settings and noted that the payment variations across settings should be addressed quickly due to the fact that current disparities have created incentives for hospitals to buy physician practices, driving up costs for the Medicare program and for beneficiaries. In 2015, MedPAC reaffirmed their recommendation that “Medicare should begin to move towards site-neutral payments where there is clear overlap in the services provided.” The purpose of the bill is to “ensure the future of community cancer care by equalizing the Medicare reimbursement for the same service provided to a cancer patient regardless of whether the service is delivered in the hospital outpatient department or physician’s office.
On June 11, 2015, S. 1566, the Cancer Drug Coverage Parity Act of 2015 was introduced by Sen. Mark Kirk (R-IL) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would require group and individual health insurance plans to cover oral anticancer drugs on terms (1) no less favorable than the coverage for anticancer medications that are intravenously administered or injected by a health care provider; and (2) not subject to any prior authorization, step therapy, dollar or durational limit, copayment, deductible or coinsurance that does not apply to such provider-administered anticancer medication.
Full text Senate bill: https://www.govtrack.us/congress/bills/114/s1566/text
Full text (identical House bill): https://www.govtrack.us/congress/bills/114/hr2739/text