Marilyn Singleton, M.D., J.D. summarizes health policy related bills under consideration in Congress.
Call for an Inspector General to Monitor the ACA
This bill is worth reading for the 70 reasons listed in the preamble as to why an inspector general is necessary to monitor the ACA. The list includes Obama’s broken promises, Jonathan Gruber’s admissions about the ACA, and Obama’s unilateral changes to the ACA, among other things.
On May 18, 2015, H.R. 2400, the Special Inspector General for Monitoring the ACA Act of 2014 (SIGMA Act) was introduced by Rep. Peter Roskam (R-IL) and referred to the House Appropriations, Education and Workforce and 7 other committees. On May 19, 2015, the companion bill in the Senate, S. 1368 was introduced by Sen. Pat Roberts (R-KS) and referred to the Senate Health, Education, Labor, and Pensions Committee.
The bill would establish the Office of the Special inspector General for Monitoring the Affordable Care Act to conduct, supervise, and coordinate audits and investigations of the implementation and administration of programs and activities established under, and payment system changes made by, the ACA. Places the Special Inspector General would be selected by the President with the advise and consent of the Senate and work under the supervision of the Secretary of Health and Human Services (HHS). However, the bill prohibits federal agencies involved in implementing or administering the Affordable Care Act from preventing or prohibiting the Special Inspector General from initiating, carrying out, or completing any audit or investigation.
Full text (House): https://www.govtrack.us/congress/bills/114/hr2400/text.
Full text (Senate): https://www.govtrack.us/congress/bills/114/s1368/text.
Enhancements to Medicare Benefits
On April 23, 2015, S. 1079, the Colorectal Examination and Education Now Act of 2015 (SCREEN Act) was introduced by Sen. Benjamin Cardin (D-MD) and referred to the Senate Finance Committee. The bill would (1) maintain 2015 Medicare reimbursement rates for colonoscopy; (2) eliminate Medicare beneficiary cost-sharing for colorectal cancer screening tests, for the removal of tissue or other matter during the screening test, or for a follow-up procedure; (3) reduce the physician fee and the hospital outpatient department fee to make the plan budget neutral; (4) create a demonstration project to test a payment and service delivery model to evaluate the effectiveness of a pre-operative visit before a screening colonoscopy and hepatitis C screening.
Full text: https://www.govtrack.us/congress/bills/114/s1079/text.
On April 29, 2015, S. 1131, the Medicare Diabetes Prevention Act of 2015 was introduced by Sen. Al Franken (D-MN) and referred to the Senate Finance Committee. The companion House bill, H.R. 2102 was introduced by Rep. Susan Davis (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees.
The bill would provide Medicare coverage for diabetes prevention programs to “eligible” individuals. HHS would develop the program using Centers for Disease Control and Prevention standards. Coverage does not include skilled nursing facility programs.
Full text (Senate): https://www.govtrack.us/congress/bills/114/s1131/text.
Full text (House): https://www.govtrack.us/congress/bills/114/hr2102/text.
On May 5, 2015, S. 1190, the Ensuring Seniors Access to Local Pharmacies Act of 2015 was introduced by Sen. Shelly Capito (R-WV) and referred to the Senate Finance Committee. The bill would allow any willing pharmacy serving an underserved area to become a “network pharmacy” under Medicare prescription drug coverage.
Full text: https://www.govtrack.us/congress/bills/114/s1190/text.
On May 13, 2015, H.R. 2299, to provide for site-of-service price transparency under the Medicare program was introduced by Rep. Gus Bilirakis (R-FL) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would make available to the public through a searchable website (1) the estimated payment amount for items and services rendered at hospital outpatient department or to an ambulatory surgery center; and (2) the estimated amount of beneficiary liability applicable to such an item or service.
Full text: https://www.govtrack.us/congress/bills/114/hr2299/text.
On May 14, 2015, H.R. 2325, a bill to provide for a pharmaceutical and technology ombudsman was introduced by Rep. Susan Brooks (R-IN) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would create an ombudsman within CMS to respond to complaints and grievances about Medicare-covered pharmaceutical, biotechnology, medical device or diagnostic products and issues regarding coverage or payment for such products.
Full text: https://www.govtrack.us/congress/bills/114/hr2325/text.
On May 14, 2015, S. 1349, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) was introduced by Sen. Benjamin Cardin (D-MD) and referred to the Senate Finance Committee. This is the Senate companion bill to H.R. 876 that passed the House on March 16, 2015. This requires hospitals to notify Medicare beneficiaries that they are classified under observation status rather than inpatients.
Full text: https://www.govtrack.us/congress/bills/114/s1349/text.
On May 18, 2015, H.R. 2404, the Treat and Reduce Obesity Act of 2015 was introduced by Rep. Erik Paulsen (R-MN) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would expand the health care providers (from primary care practitioners, i.e., primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine) qualified to furnish intensive behavior therapy to include (1) physicians who are not primary care physicians; (2) any other appropriate health care providers (including physician assistants, nurse practitioners, or clinical nurse specialists, clinical psychologists, registered dietitians or nutrition professionals; and (3) evidence-based, community-based lifestyle counseling programs approved by the Secretary. The services would be covered only if the patient was referred by a primary care practice setting. Obesity medication would be covered by Medicare Part D if the patient is overweight (defined as a body mass index (BMI) ≥ 30 kg/m2) and has one or more related comorbidities.
Full text: https://www.govtrack.us/congress/bills/114/hr2404/text.
On May 20, 2015, H.R. 2461, a bill to improve access to, and utilization of, bone mass measurement benefits under part B of the Medicare program was introduced by Rep. Michael Burgess, M.D. (R-TX) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would establish minimum payments for osteoporosis tests.
Full text: https://www.govtrack.us/congress/bills/114/hr2461/text.
On May 21, 2015, H.R. 2519, the Audiology Patient Choice Act was introduced by Rep. Lynn Jenkins (R-KS) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would (1) revise the coverage of audiology services to treat as physicians qualified audiologists authorized by the state and acting within the scope of their license to furnish such services. (2) allow Medicare beneficiaries to choose a qualified audiologist without regard to any requirement to be under the care of (or referred by) a physician or other health care practitioner, or that services be provided under the supervision of a physician or other health care practitioner.
Full text: https://www.govtrack.us/congress/bills/114/hr2519/text.
On May 21, 2015, H.R. 2488, the Medicare Beneficiary Preservation of Choice Act of 2015 was introduced by Rep. Keith Rothfus (R-PA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would restore the second Medicare enrollment and disenrollment opportunities that were repealed by the ACA.
Full text: https://www.govtrack.us/congress/bills/114/hr2488/text.
Telemedicine Encouraged
On April 28, 2015, H.R. 2066, the Telehealth Enhancement Act of 2015 was introduced by Rep. Gregg Harper (R-MS) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would:
- In order to incentivize hospitals to lower their excess readmission rates, HHS would make additional payments to a hospital that is a proportion of the savings from better-than-expected performance;
- Authorize an Accountable Care Organization to include coverage of telehealth and remote patient monitoring services as supplemental health care benefits to the same extent as a Medicare Advantage plan is permitted to provide such coverage of such services as supplemental health care.
- Recognize telehealth services and remote patient monitoring in the national pilot program on payment bundling.
- Amends the Communications Act of 1934 to specify additional health care providers to which universal telecommunications service support must be provided.
- Requires Federal Communications Commission rules for enhancing health care provider access to advanced telecommunications and information services to disregard provider location.
- Give states the option under Medicaid to provide coordinated care for enrollees with high-risk pregnancies and births and miscellaneous provisions to coordinate care of Medicaid recipients.
Full text: https://www.govtrack.us/congress/bills/114/hr2066/text.
More Micromanaging of Physicians
Several states currently require continuing education in pain management principles as a condition of licensure. This bill appears to be another tool in increasing federal control over the practice of medicine.
On May 20, 2015, S. 1392, Safer Prescribing of Controlled Substances Act was introduced by Sen. Edward Markey (D-MA) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would require continuing education for practitioners who prescribe controlled substances. As a condition of granting or renewing the registration of a covered practitioner under this part to dispense, or conduct research with, controlled substances in schedule II, III, IV, or V, the practitioner must complete a training program approved by HHS. The program must “expose covered practitioners to” (1) best practices for pain management, including alternatives to prescribing controlled substances and other alternative therapies to decrease the use of opioids; (2) responsible prescribing of pain medications, as described in Federal prescriber guidelines for nonmalignant pain; (3) methods for diagnosing, treating, and managing a substance use disorder, including the use of medications approved by the Food and Drug Administration and evidence-based nonpharmacological therapies; (4) linking patients to evidence-based treatment for substance use disorders; and (5) tools to manage adherence and diversion of controlled substances, including prescription drug monitoring programs, drug screening, informed consent, overdose education, and the use of opioid overdose antagonists.
The Substance Abuse and Mental Health Services Administration must establish at least one training module that is available to applicants online – free of charge. Five years after the start of the program HHS must evaluate if the program changed prescribing patterns of controlled substances.
Full text: https://www.govtrack.us/congress/bills/114/s1392/text.
The Feds Want to Micromanage Hospital Nursing Care
On April 29, 2015, H.R. 2083, the Registered Nurse Staffing 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 companion bill in the Senate, S. 1132 was introduced by Sen. Jeff Markey (D-OR) and referred to the Senate Finance Committee.
The bill would require each Medicare participating hospital to implement a hospital-wide staffing plan for nursing services furnished in the hospital to ensure that the “unique characteristics of patients and hospital unites” are addressed and that “safe, quality patient care consistent with specified requirements” is delivered. The bill specifies civil monetary and other penalties for violation of the requirements of this Act and provides whistleblower protections against discrimination and retaliation involving patients or employees of the hospital for their grievances, complaints, or involvement in investigations relating to such plan.
Full text (House): https://www.govtrack.us/congress/bills/114/hr2083/text.
Full text (Senate): https://www.govtrack.us/congress/bills/114/s1132/text.
Residency Positions
On April 30, 2015, S. 1148, the Resident Physician Shortage Reduction Act of 2015 was introduced by Sen. Bill Nelson (D-FL) and referred to the Senate Finance Committee. The companion bill, H.R. 2021 was introduced by Rep. Joseph Crowley (D-NY) and referred to the House Energy and Commerce and Ways and Means Committees.
The bill would direct HHS to increase the resident limit for each qualifying hospital for fiscal years 2017 to 2021. The increase in residency positions will affect calculation of payments for direct graduate medical education costs. The bill would generally set the aggregate number of increases in the resident limit to 3,000 per year in each of FY2017-FY2021, of which 1,500 in each such fiscal year shall be used for full-time equivalent residents training in a shortage specialty residency program. The bill also requires a study on the physician workforce and strategies to increase diversity in the health professions.
Full text (Senate): https://www.govtrack.us/congress/bills/114/s1148/text.
Full text (House): https://www.govtrack.us/congress/bills/114/hr2124/text.
Bipartisan Reform of Recovery Audit Contractors (RAC): No Incentive Payments
On April 30, 2015, H.R. 2156, the Medicare Audit Improvement Act of 2015 was introduced by Rep. Sam Graves (R-MO) and co-sponsored by Adam Schiff (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The mission of the recovery audit contractors (RACs) under the Medicare program is to identify underpayments and overpayments and recoup overpayments. Currently RAC auditors receive incentive payments. The bill would prohibit incentive payments and provide a set fee. Additionally, payments would be reduced on a sliding scale to auditors with high rates of denials being overturned. Finally, a determination of whether inpatient hospital services or inpatient critical access hospital services furnished to an individual are reasonable and necessary shall now be based solely on information available to the admitting physician at the time of the inpatient admission of the individual for such services, as documented in the medical record.
Full text: https://www.govtrack.us/congress/bills/114/hr2156/text.
