Marilyn Singleton, MD, JD summarizes health care related bills introduced in the first half of March 2015.
Two Bills Unanimously Pass the House
On March 16, 2015, the bipartisan H.R. 876, Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) passed the House by a 395-0 vote and will move forward to the Senate. This bill requires that the hospital must give to Medicare beneficiaries whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification which (1) explains the individual’s status as an outpatient under observation (or any similar status) and not as an inpatient; (2) explains the reason for that classification; (3) explains the implications of that outpatient status on eligibility for Medicare coverage of items and services as well as cost-sharing requirements; (4) includes the name and title of the hospital staff who gave an oral notification and its date and time; and is signed by individual, if the notification is written, to acknowledge its receipt, or if such individual refuses to sign, the written notification is signed by the staff of the hospital who presented it.
Full text: https://www.govtrack.us/congress/bills/114/hr876/text.
On March 17, 2015, H.R. 1191, the Protecting Volunteer Firefighters and Emergency Responders Act unanimously passed the house. The bill excludes services rendered by bona-fide volunteers providing firefighting and prevention services, emergency medical services, or ambulance services to a state or local government or a tax-exempt charitable organization from the category of services subject to the employer mandate under the ACA. The bill defines “bona fide volunteer” as an employee of any government entity and any tax-exempt charitable organization whose only compensation is in the form of: (1) reimbursement for (or reasonable allowance for) reasonable expenses incurred in the performance of volunteer services, or (2) reasonable benefits (including length-of-service awards) and nominal fees customarily paid by similar entities for the services of volunteers.
Full text: https://www.govtrack.us/congress/bills/114/hr1191/text
Another Universal Health Care Proposal
This bill proposes total Command and Control by the government, including practice guidelines.
On March 2, 2015, H.R. 1200, the American Health Security Act of 2015 was introduced by Rep. Jim McDermott (D-WA) and referred to the House Armed Services, Education and the Workforce, and 3 other committees.
First and foremost this bill expresses the sense of the House of Representatives concerning recognition of health care as a human right. The bill establishes the State-Based American Health Security Program to provide every U.S. resident who is a U.S. citizen, national, or lawful resident alien with health care services. The key provisions of the bill include :
(1) Requiring each participating state to establish a state health security program.
(2) Requiring each state health security program to prohibit the sale of health insurance in that state that duplicates benefits provided under the program.
(3) Establishing the American Health Security Standards Board to: (i) develop policies, procedures, guidelines and requirements to carry out this Act; (ii) establish uniform reporting requirements and quality performance standards; (iii) provide for an American Health Security Advisory Council and an Advisory Committee on Health Professional Education; and (iv) establish a national health security budget specifying the total federal and state expenditures to be made for covered health care services.
(4) Establishing the American Health Security Quality Council to: (i) review and evaluate practice guidelines, standards of quality, performance measures, and medical review criteria; and (ii) develop minimum competence criteria.
(5) Impose on individuals: (1) a health care income tax, and (2) an income tax surcharge on amounts of modified adjusted gross income exceeding $1 million. Imposes an excise tax on securities transactions and allows an income tax credit for such taxes.
Full text: https://www.govtrack.us/congress/bills/114/hr1200/text.
File these under “None of Your Business!”
On March 2, 2015, S. 620 and H.R. 1189, its identical sister bill in the House, the Preserving Employee Wellness Programs Act” were introduced by LaMarr Alexander (R-TN) and John Kline (R-MN) and referred to the Senate Committee on Health, Education, Labor, and Pensions. The purpose of the bill is to ensure that employee wellness programs are not considered discriminatory under the Americans with Disabilities Act or the Genetic Information Nondiscrimination Act of 2008 because they offer rewards, rebates, and discounts. The bill also clarifies that the collection of information about a disease of a family member would not be an unlawful acquisition of genetic information of another family member participating in workplace wellness programs.
Full text: https://www.govtrack.us/congress/bills/114/s620/text.
On March 9, 2015, S. 679, the Quality Data, Quality Healthcare Act of 2015 was introduced by Sen. Tammy Baldwin (D-WI) and co-sponsored by Sen. John Thune (R-SD) and referred to the Senate Finance Committee. Will the goal of improving the quality of medical care, the bill would expand the use of Medicare data to (i) health care provider, (ii) health insurance issuers, (iii) employers, (iv) any organization affiliated with or representing an entity described in clause (i), (ii), or (iii), such as a medical society; (v) a public health authority (as defined for purposes of the Health Insurance Portability and Accountability Act of 1996); (vi) a State or local government agency; (vii) a research organization that certifies that it will only use the data or analyses for the public good and not for proprietary purposes; (viii) any other entity the Secretary determines appropriate to further the bill’s goals.
Full text: https://www.govtrack.us/congress/bills/114/s679/text.
Increasing the Power of Health Savings Accounts
On March 2, 2015, H.R. 1196, the Health Savings Act of 2015 was introduced by Rep. Michael Burgess (R-TX) and referred to the House Energy and Commerce and Ways and Means Committees. This bill would (1) allow an additional tax deduction for amounts paid to the HSA of a taxpayer’s child or grandchild; (2) allow a rollover of HSA funds to the child, parent, or grandparent of an account holder; (3) increase the maximum HSA contribution limit; (4) allow mandatory distributions from an individual retirement account (IRA) to be paid into an HSA; (5) exempt HSAs from creditor claims in bankruptcy; and (6) expand the definition of an HSA compatible plan to include bronze, silver, and catastrophic plans on an insurance exchange.
Full text: https://www.govtrack.us/congress/bills/114/hr1196/text.
On March 11, 2015, S. 709, the Restoring Access to Medication Act of 2015 and the identical sister House bill, H.R. 1270 were introduced by Sen. Pat Roberts (R-KS) and Rep. Lynne Jenkins (R-KS) and referred to the Senate Finance Committee. The bill would repeal the amendments made by the ACA which disqualify expenses for over-the-counter drugs under health savings accounts and health flexible spending arrangements.
Full text: https://www.govtrack.us/congress/bills/114/s709/text.
Bill to Repeal the IPAB
On March 2, 2015, H.R. 1190, the Protecting Seniors’ Access to Medicare Act of 2015 was introduced by Rep. David Roe (R-TN) with well-over 100 co-sponsors and referred to the House Energy and Commerce and Rules Committees. This bill simply repeals the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board.
Full text: https://www.govtrack.us/congress/bills/114/hr1190/text.
Expanding Medicare
Although such bills seek to benefit patients, they further inculcate Medicare into the practice of medicine.
On March 3, 2015, H.R. 1221 and the identical sister bill S. 626, the Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians Act (HELLPP Act) were introduced by Rep. Renee Ellmers (R-NC) and Sen. Chuck Grassley (R-IA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill expands Medicare coverage to include podiatrists as physicians and revises the requirements for coverage of therapeutic shoes for diabetics.
Full text: https://www.govtrack.us/congress/bills/114/hr1221/text.
On March 3, 2015, H.R. 1220 and S. 626, its identical sister Senate bill, the Removing Barriers to Colorectal Cancer Screening Act of 2015 were introduced by Rep. Charles Dent (R-PA) and Sen. Sherrod Brown (D-OH) and referred to the House Energy and Commerce and Ways and Means Committees. This bill would waive coinsurance for colorectal cancer screening tests (in order to cover 100% of their cost under Medicare part B, regardless of the code billed for a diagnosis as a result of a test, or for the removal of tissue or other procedure furnished in connection with, as a result of, and in the same clinical encounter as the screening test.
Full text: https://www.govtrack.us/congress/bills/114/hr1220/text.
Increasing Medicare Access also Codifies the Expansion of the Scope of Practice of “Physician Extenders”
On March 2, 2015, H.R. 1202, the Medicare Patient Access to Hospice Act of 2015 was introduced by Rep. Lynn Jenkins (R-KS) and referred to the House Energy and Commerce and Ways and Means Committees. This bill would allow physician assistants to be considered attending physicians for the purpose of managing hospice patients.
Full text: https://www.govtrack.us/congress/bills/114/hr1202/text.
On March 6, 2015, H.R. 1342, the Home Health Care Planning Improvement Act of 2015 was introduced by Rep. Greg Walden (R-OH) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would revise conditions of and limitations on payment for home health care services. The bill allows payment for home health services to Medicare beneficiaries by: (1) a nurse practitioner, (2) a clinical nurse specialist working in collaboration with a physician in accordance with state law, (3) a certified nurse-midwife, or (4) a physician assistant under a physician’s supervision.
Full text: https://www.govtrack.us/congress/bills/114/hr1342/text.
Expanding Insurance Options under the ACA
On March 4, 2015, H.R. 1234, the Medical Freedom Act of 2015 was introduced by Rep. Tom Price, M.D. (R-GA) and referred to House Education and the Workforce and Energy and Commerce Committees. This bill (1) eliminates any restrictions the ACA placed on insurance markets; (2) repeals any limitations the ACA placed on Health Savings Accounts or Flexible Savings Accounts; and (3) allows individuals to purchase any health plan, not merely “qualified” plans as defined in the ACA.
Full text: https://www.govtrack.us/congress/bills/114/hr1234/text.
On March 10, 2015, H.R. 1348, the Health Insurance Freedom Act of 2015 was introduced by Rep. Renee Ellmers (R-NC) and referred to House Energy and Commerce and Ways and Means Committees. This bill would allow health insurance issuers to offer qualified health plans with alternative health benefits so individuals can opt out of minimum essential health benefits
Full text: https://www.govtrack.us/congress/bills/114/hr1348/text.
Mar 3, 2015, H.R. 1218, the Personal Health Investment Today Act (PHIT Act) was introduced by Rep. Charles Boustany, M.D. (R-LA) and referred to the House Ways and Means Committee. This bill would allow tax deductions as “medical care” for costs of certain “qualified” physical activities, fitness, and exercise. “Qualified” expenses are those for (1) membership at a fitness facility; (2) participation or instruction in a program of physical exercise or physical activity (including videos and books); and (3) equipment for use in a program (including a self-directed program) of physical exercise or physical activity. The deduction is limited to $1,000 for individuals, $2,000 for joint or head of household filers.
Full text: https://www.govtrack.us/congress/bills/114/hr1218/text.
An Inadvertent Move toward National Medical Licensing
On March 10, 2015, S. 689, the Sports Medicine Licensure Clarity Act was introduced by Sen. John Thune (S-SD) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill provides that if a covered sports medicine professional provides covered medical services to an athlete, an athletic team, or a staff member of an athlete or athletic team in a secondary State, such services shall be deemed to have been provided in the primary State for the following purposes: (1) Determining the medical professional liability insurance of that professional; and (2) Determining the civil and criminal malpractice liability of that professional. Full text: https://www.govtrack.us/congress/bills/114/s689/text.
SGR Update
On March 19, 2015, H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act of 2015 was introduced by Rep. Michael Burgess (R-TX) and referred to the House Energy and Commerce and Ways and Means Committees. The legislation also would raise physician pay by 0.5% in the second half of 2015 and then each year from 2016 through 2019 while shifting Medicare reimbursement from fee-for-service to pay- for-performance. Medicare’s incentive programs for electronic health records, quality reporting, and the so-called value-based modifier would be merged to reduce their administrative burden on physician practices. A bipartisan, bicameral group is modifying the bill with the following proposals:
(1) Repeal the SGR.
(2) Extend Children’s Health Insurance Program (CHIP) through September 2017.
(3) Extend funding for various health programs to low income Medicare and Medicaid recipients.
(4) Other Medicare Reforms. This legislation includes two bipartisan Medicare bills: (1) Medicare DMEPOS Competitive Bidding Improvement Act (HR 284), which makes modifications to the Medicare durable medical equipment, prosthetics, orthotics, and supplies competitive acquisition program and (2) The Protecting Integrity in Medicare Act (HR 1021), which strengthens Medicare’s ability to fight fraud and builds on existing program integrity policies.
(5) Savings. The policies that reduce the legislation’s cost include the following:
(i) Income-related Premium Adjustment. Starting in 2018, this policy would increase the percentage that beneficiaries pay toward their Part B and D premiums in two income brackets (roughly 2 percent of beneficiaries): for individuals with income between $133.5-160K ($267-$320K for a couple), the percent of premium paid increases from 50 percent to 65 percent. For those with income between $160-214K ($320- $428K for a couple), the percent increases from 65 percent to 75 percent.
(ii) Medigap Reform. The proposal limits first dollar coverage on certain Medigap plans by prohibiting plans from covering the Part B deductible. Change applies only for future retirees starting in 2020.
(iii) Increase Levy Authority on Payments to Medicare Providers with Delinquent Tax Debt. This provision will permit the IRS to impose a levy of up to 100 percent on tax delinquent Medicare service providers.
(iv) Hospital Update. Under current law, hospitals will receive a 3.2 percentage point adjustment in addition to their base payment rate in FY18. This policy would phase-in this update incrementally and prohibit CMS from collecting a recoupment from 2010.
(v) Additional Medicaid DSH Savings. Currently, reductions in state DSH allotments are scheduled to begin in FY2017. This policy would delay Medicaid DSH changes until FY2018 and extend the policy through 2025.
(vi) 1 Percent Market Basket Update for Post-Acute Providers. This policy replaces the market basket update in 2018 with a one percent update for long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), home health providers (HH), and hospice providers.
Full text: https://www.govtrack.us/congress/bills/114/hr1470/text.
