Last week Marilyn Singleton, MD, JD dissected AHCA. This week she looks at other health care related legislation under consideration on Capitol Hill.
With the firing of James Comey, hundreds of federal judges to be confirmed, the creation of a new health care bill, and tax reform, it is likely that many of these bills will sit on the back burner.
On January 9, 2017, H.R. 304, the Protecting Patient Access to Emergency Medications Act of 2017 which was introduced by Rep. Richard Hudson (R-NC), passed the House and was referred to Senate Committee on January 10th. There it sits. The bill amends the Controlled Substances Act to ensure that paramedics and other emergency medical services (EMS) professionals are able to continue to administer controlled substances, such as pain narcotics and anti-seizure medications, pursuant to standing or verbal orders when authorized by State law. Further, the bill specifies that EMS agencies are permitted to have one DEA registration, rather than having separate registrations for each EMS location, so long as certain requirements relating to the transportation and storage of controlled substances are met.
Expanded Health Savings Accounts Benefits
On January 10, 2017, H.R. 408, American Future Healthcare Act of 2017, was introduced by Rep. Steve King (R-IA) and referred to the House Ways and Means Committee. This bill amends the Internal Revenue Code, with respect to health savings accounts (HSAs), to:
- repeal the requirement that an individual making a tax deductible contribution to an HSA be covered by a high deductible health care plan;
- increase the maximum HSA contribution level; allow Medicare eligible individuals to contribute to an HSA;
- allow HSAs to be used to purchase health insurance; provide a cost-of-living adjustment for the limits on additional contributions for individuals 55 or older (catch-up contributions);
- require the cost-of-living adjustments to be indexed to the CPI medical care component (the medical care component for the Consumer Price Index for All Urban Consumers published by the Department of Labor);
- allow a rollover of HSA amounts to a Medicare Advantage Medical Savings Account (MSA).
On February 16, 2017, H.R. 1175, the Health Savings Act of 2017, was introduced by Rep. Erik Paulson (R-MN) and referred to the House Energy and Commerce and Ways and Means Committees. It’s identical sister bill in the Senate, S. 408 was introduced by Sen. Orrin Hatch (R-UT). This bill amends the Internal Revenue Code, with respect to health savings accounts (HSAs), to:
- rename high deductible health plans as HSA-qualified health plans;
- allow spouses who have both attained age 55 to make catch-up contributions to the same HSA;
- make Medicare Part A (hospital insurance benefits) beneficiaries eligible to participate in an HSA;
- allow individuals eligible for hospital care or medical services under a program of the Indian Health Service or a tribal organization to participate in an HSA;
- allow members of a health care sharing ministry to participate in an HSA; allow individuals who receive primary care services in exchange for a fixed periodic fee or payment, or who receive health care benefits from an onsite medical clinic of an employer, to participate in an HSA;
- include amounts paid for prescription and over-the-counter medicines or drugs as “qualified medical expenses” for which distributions from an HSA or other tax-preferred savings accounts may be used;
- increase the limits on HSA contributions to match the sum of the annual deductible and out-of-pocket expenses permitted under a high deductible health plan; and allow HSA distributions to be used to purchase health insurance coverage.
The bill also: (1) amends the federal bankruptcy code to exempt HSAs from creditor claims in bankruptcy, and (2) amends the Social Security Act to reauthorize Medicaid health opportunity accounts.
The bill allows a medical care tax deduction for: (1) exercise equipment, physical fitness programs, and membership at a fitness facility; (2) nutritional and dietary supplements; and (3) periodic fees paid to a primary care physician and amounts paid for pre-paid primary care services.
Full text (House): https://www.govtrack.us/congress/bills/115/hr1175/text.
Full text (Senate): https://www.govtrack.us/congress/bills/115/s403/text.
Allows HSA funds to be used for direct pay practices
On March 1, 2017, H.R. 1280, the Health Savings Account Act was introduced by Rep. Jeff Fortenberry (R-NE) and referred to the House Ways and Means Committee. This bill amends the Internal Revenue Code, with respect to health savings accounts (HSAs), to: (1) increase the maximum contribution limits for HSAs to match the sum of the annual deductible and out-of-pocket expenses permitted under a high deductible health plan, (2) allow individuals who receive primary care services in exchange for a fixed periodic fee or payment to participate in an HSA, and (3) permit HSAs to be used for fitness center memberships.
The bill also allows a medical care tax deduction for periodic provider fees, including: (1) periodic fees paid to a primary care physician for a defined set of medical services or the right to receive medical services on an as-needed basis; and (2) pre-paid primary care services designed to screen for, diagnose, cure, mitigate, treat, or prevent disease and promote wellness.
Prohibits Health Savings Account payment for Some Abortions
On April 6, 2017, H.R. 2019, was introduced by Rep. Virginia Foxx (R-VA) and referred to the House Ways and Means Committee. The bill would specify that for purposes of Health Savings Accounts, an abortion is not a qualified medical expense unless: (1) the pregnancy is the result of an act of rape or incest; or (2) the woman suffers from a physical disorder, injury, or illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.
Full text: https://www.govtrack.us/congress/bills/115/hr2019/text.
Expanded Medicare Benefits
Feb 16, 2017, H.R. 1148, the Furthering Access to Stroke Telemedicine Act of 2017 (FAST Act of 2017) was introduced by Rep. Morgan Griffith (R-VA) and referred to the House Energy and Commerce and House Ways and Means Committees. It’s sister bill, S. 431 was introduced by Sen. John Thune (R-ND) and referred to the Senate Finance Committee. This bill expands access to telehealth-eligible stroke services in the Medicare program. With respect to telehealth-eligible stroke services, the term originating site means any hospital, or any mobile unit equipped with the ability to evaluate possible stroke patients while being transported to a hospital, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system, regardless of where the hospital or mobile unit is located.
Full text (House): https://www.govtrack.us/congress/bills/115/hr1148/text.
Full text (Senate): https://www.govtrack.us/congress/bills/115/s431/text.
On February 28, 2017, S. 463, the Cancer Care Payment Reform Act of 2017 was introduced by Sen. John Cornyn (R-TX) and referred to the Senate Finance Committee. This bill would establish the Oncology Medical Home Demonstration Project in the Medicare program, through which the Centers for Medicare & Medicaid Services (CMS) would make special payments to participating oncology practices that coordinate patient care and meet other specified requirements.
During the first two years of the project, CMS would pay a care coordination management fee to each such practice.
After the third, fourth, and fifth years of the project, CMS would pay a performance incentive payment to each participating practice that meets or exceeds performance standards developed by CMS.
Performance standards, assessed annually include: (1) specified measures related to patient care, resource utilization, survivorship, and end-of-life care; and (2) the patient experience of care, as reflected in surveys submitted by each practice. CMS shall also assess the extent to which a practice has used breakthrough or other best-in-class therapies.
On March 1, 2017, S. 479, the Removing Barriers to Colorectal Cancer Screening Act of 2017 was introduced by Sen. Sherrod Brown (D-OH) and referred to the Senate Finance Committee. The bill would waive coinsurance under Medicare for colorectal cancer screening test, regardless of whether therapeutic intervention is required during the screening, and regardless of the billing code.
On March 1, 2017, H.R. 1298, the CT Colonography Screening for Colorectal Cancer Act of 2017 was introduced by Rep. Brad Wenstrup (R-OH) House Energy and Commerce and Ways and Means Committees. The bill would cover screening computed tomography colonography as a colorectal cancer screening test under the Medicare program.
Full text: https://www.govtrack.us/congress/bills/115/hr1298/text.
On March 16, 2017, H.R. 1578, Donald Payne Sr. Colorectal Cancer Detection Act of 2017 was introduced by Rep. Donald Payne (D-NJ) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would provided coverage under the Medicare program for FDA-approved qualifying colorectal cancer screening blood-based tests.
On March 8, 2017, H.R. 1421, the Improving Access to Medicare Coverage Act of 2017 was introduced by Rep. Joe Courtney (D-CT) and referred to the House Energy and Commerce and Ways and Means Committees. It’s sister Senate bill S. 568, introduced by Sen. Sherrod Brown (D-OH) was referred to the Senate Finance Committee. The bill would amend title XVIII of the Social Security Act (Medicare) to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.
Full text (House): https://www.govtrack.us/congress/bills/115/hr1421/text.
Full text (Senate):https://www.govtrack.us/congress/bills/115/s568/text
On April 6, 2017, H.R. 2065, the Medicare You Can Opt Into Act of 2017 was introduced by Rep. Carol Shea-Porter (D-NH) and referred to the House Ways and Means Committee. The bill would amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States to buy into Medicare.