Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill
Senate Finance Committee Determines the Affordable Care Act is Increasingly Unaffordable
“According to the U.S. Department of Health and Human Services most recent rate review, 676 individual and small group plans have requested premium spikes in the double-digits. And, that’s on top of the individual market premium increases averaging 49 percent between 2013 and 2014.” The report goes on to note that the federal government’s own actuaries at Office of the Chief Actuary for the Centers for Medicare and Medicaid Services have found that the recent,”…four-year historically low rate of health spending growth, which was primarily attributable to sluggish economic recovery.”
Read More: http://www.finance.senate.gov/newsroom/chairman/release/?id=28555ac5-0649-485b-9b37-defc94ab49ff
HHS’ Million Hearts Initiative, a No-Brainer
HHS is now accepting applications for a new Affordable Care Act payment model. It appears the goal is to get more of your information electronically and get you to use standardized treatments.
“The Million Hearts initiative is a part of our efforts to promote better care and smarter practices in our health care system,” said Secretary Burwell. “It recognizes that giving doctors more one on-one time with their patients to prevent illness leads to better outcomes, and that greater access to health information helps empower patients to be active participants in their care.”
“Each patient will get a personalized risk modification plan that will target their specific risk factors. Providers will be paid for reducing the absolute risk for heart disease or stroke among their high-risk patients.” Don’t we do that anyway?
The hook here is that the “providers”:
- Have access to CDC registries to identify patients who could benefit.
- Must use the ABCS (Aspirin for people at risk, Blood pressure control, Cholesterol management, Smoking cessation) as prescribed by HHS. The provider must “Adopt a standardized treatment approach for the ABCS; protocols and algorithms can help the team help patients.”
- Use electronic health records to track patient and team progress over time and identify opportunities for improvement.
- Educate patients about heart-health habits.
- Follow up with patients between visits.
“By becoming a pledge, you allow CDC and HHS to use and share information you provide in order to further the Million Hearts® goal.”
More information: http://millionhearts.hhs.gov/aboutmh/overview.html
Contraception Legislation Illustrates Congressional Dysfunction
Two bills that say the same thing: allow birth control medications to be sold over-the-counter. This is one (of many) problems with Congress – thinking of their political party instead of the people whom they represent. Why didn’t they get together and hash out one bill?
On May 21, 2015, S. 1438, the Allowing Greater Access to Safe and Effective Contraception Act (3 pages) was introduced by Sen. Kelly Ayotte (R-NH) and referred to the Senate Finance Committee. The bill would streamline applications to the FDA for non-prescription contraceptives and notwithstanding the ACA, allow payment for such over the counter drugs to be paid for with FSA funds.
Full text: https://www.govtrack.us/congress/bills/114/s1438/text.
Not to be outdone, on Jun 9, 2015, S. 1532, the Affordability Is Access Act (9 pages) was introduced by Sen. Patty Murray (D-WA) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill (which began with several paragraphs saying how great the ACA is) would require coverage without cost-sharing for oral birth control for routine, daily use that is approved by, or otherwise legally marketed under regulation by, the Food and Drug Administration for use by women without a prescription
Full text: https://www.govtrack.us/congress/bills/114/s1532/text
Boost for Self-Pay Medicare Beneficiaries
On Jun 1, 2015, H.R. 2597, the Accelerating Innovation in Medicine Act of 2015 (AIM 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 require HHS to make a list of designated products to be directly available to self-pay patients. No Medicare claim may be submitted and an individual who consents to receive such a device is responsible for paying for it and for any related services. The benefit for the patients is the program would “promote innovation and result in increased patient access to desired products and services,” reduce administrative burdens on physicians and the government, and “would permit a window of time during which additional data may be obtained on outcomes, comparative clinical effectiveness or other data elements for possible future coverage by the Medicare program.” The physician must obtain informed consent under which the patient is informed of and accepts liability for payment for the device (and related services), and the physician or other entity is deemed to have agreed not to impose any charge under this title for such device (and for services related to furnishing the device).
Full text: https://www.govtrack.us/congress/bills/114/hr2597/text.
Improving Transparency of Recovery Audit Contractors (RACs)
On May 22, 2015, H.R. 2568, the Fair Medical Audits Act of 2015 was introduced by Rep. George Holding (R-NC) and referred to the House Energy and Commerce and Ways and Means Committees. This bill imposes additional requirements on Recovery Audit Contractors (RAC). (H.R. 2156, the Medicare Audit Improvement Act of 2015 would eliminate incentive payments). The bill would require transparency of the process by requiring contractors to provide healthcare providers with:
- the names and contact information for the auditors;
- the legal authority under which the audit is conducted;
- a clear designation of the records to be reviewed under the audit;
- the dates by which records shall be submitted;
- the address to which the records shall be sent;
- identification of any errors discovered in the audit, including specification of all medical and reimbursement policies used in the audit findings;
- identification of any underpayments discovered in the audit; and
- a description of how any requested overpayment amount was calculated, including, in cases in which extrapolation was used, the extrapolation formula and a description of how the random sample was developed.
Additionally, auditors conducting medical necessity reviews must be licensed in a clinical discipline with the expertise to determine whether clinical tests and procedures were medically necessary without the benefit of examining the patient, specifically including, for medical necessity reviews of physician records, a doctor of medicine or osteopathy of the same specialty and subspecialty and with knowledge of the coverage rules being applied for the same area as the physician under review.
Full text: https://www.govtrack.us/congress/bills/114/hr2568/text.
Proposed Change to the RVRBS Review Board
On June 2, 2015, H.R. 2614, Accuracy in Medicare Physician Payment Act was introduced by Rep. Jim McDermott (D-WA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would require HHS to establish and appoint an expert outside advisory panel for purposes of providing oversight to the processes relating to the relative value scale process used under the Medicare physician fee schedule.
Full text: https://www.govtrack.us/congress/bills/114/hr2614/text.
Attempts to Bring Back the Advantage to Medicare Advantage
On May 21, 2015, H.R. 2505, the Medicare Advantage Transparency Act of 2015 was introduced by Rep. Mike Kelly (R-PA) and Rep. Ron Kind (D-WI) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would require the Secretary of Health and Human Services to submit to the Congress data on enrollment in the Medicare Part A, Part B, Part C and Part D programs by zip code, congressional district, and state. H.R. 2505 would not have a significant budgetary effect, because the Centers for Medicare and Medicaid Services collect data on enrollment in Medicare under current law.
Full text: https://www.govtrack.us/congress/bills/114/hr2505/text.
On May 21, 2015, H.R. 2506, the Seniors Health Care Protection Plan of 2015 was introduced by Rep. Vern Buchanan (R-FL) and Rep. Charles Rangel (D-NY) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would prohibit the Centers for Medicare and Medicaid Services (CMS) from terminating Medicare Advantage contracts that fail to achieve a minimum quality rating under the CMS STARS system. The system would be studied to determine the effects of socioeconomic status and dual-eligible populations on the Medicare Advantage STARS rating system before reforming such system. That prohibition would be in effect until 2019. Under current law, beginning with contracts for calendar year 2017, CMS will not renew contracts that for three consecutive years do not achieve at least three stars under the five-star rating system. Thus, enacting H.R. 2506 would permit certain plans to continue operating in 2017 and 2018 that otherwise will be terminated under current law. Those plans tend to receive slightly lower payments than other Medicare Advantage plans in the same areas, in part because they do not receive bonus payments under the five-star rating system. The Congressional Budget Office (CBO) projects that very few beneficiaries will be enrolled in plans that fail to achieve minimum quality ratings, and thus would be subject to the changes under the legislation. CBO estimates that permitting those plans to continue operating would reduce direct spending by $30 million over the 2016-2025 period.
Full text: https://www.govtrack.us/congress/bills/114/hr2506/text.
On May 21, 2015, H.R. 2507, the Increasing Regulatory Fairness Act of 2015 was introduced by Rep. Kevin Brady (R-TX) and Rep. Mike Thompson (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would expand an annual regulatory schedule for Medicare Advantage (MA) payment rates. HHS would be required to timely publish the annual MA capitation rate for each MA payment area for such year and the risk and other factors to be used in adjusting such rates.
Full text: https://www.govtrack.us/congress/bills/114/hr2507/text.
On May 29, 2015, H.R. 2579, the Securing Care for Seniors 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 would require the Secretary of Health and Human Services to revise the risk adjustment system used in the Medicare Advantage program to account for the number of chronic conditions with which a beneficiary has been diagnosed. The legislation would also require the Secretary to evaluate the effects of other changes to the risk adjustment system including using two years of diagnosis data and removing certain information related to chronic kidney disease, and report on the results of the evaluation.
Full text: https://www.govtrack.us/congress/bills/114/hr2579/text.
More Chipping Away at the ACA
On June 2, 2015, H.R. 160, the Protect Medical Innovation Act of 2015, sponsored by Erik Paulsen (R-MN) was sent from the House Ways and Means Committee to the full House for consideration. This bill would amend the Internal Revenue Code to repeal the excise tax on medical device manufacturers and importers.
Full text: https://www.govtrack.us/congress/bills/114/hr160/text
May 13, 2015, H.R. 2306, the Obamacare Marriage Penalty Elimination Act was introduced by Rep. Glenn Grothman (R-WI) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would eliminate the marriage penalty in health insurance premium tax credits. That is, the credit allowed would be the sum of the two credits determined under this section separately with respect to each spouse.
Full text: https://www.govtrack.us/congress/bills/114/hr2306/text.
On June 10, 2015, H.R. 2711, the No Subsidies Without Verification Act was introduced by Rep. Diane Black (R-TN) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would disallow the health plan premium assistance tax credit or cost-sharing reduction under the ACA until their income information and eligibility are verified. Requirements for such verification are: (1) completion of a manual or electronic review of the information required of an applicant for enrollment in a plan, and (2) resolution of any inconsistency of such information with records of the Departments of the Treasury or Homeland Security (DHS) or the Social Security Administration.
Full text: https://www.govtrack.us/congress/bills/114/hr2711/text.
Payment Incentive to Upgrade Radiology Services
On May 21, 2015, H.R. 2550, the Medical Imaging Modernization Act of 2015 was introduced by Rep. Cathy McMorris Rodgers (R-WA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would provide a Medicare payment incentive for the transition from traditional x-ray imaging to digital radiography and other Medicare imaging payment provision. By 2017, payment for traditional x-ray services would be reduced by 20 percent. After 2023, further reductions would take place.
Full text: https://www.govtrack.us/congress/bills/114/hr2550/text.
Human Trafficking Training Program
On May 21, 2015, S. 1446, the “SOAR [Stop, Observe, Ask, and Respond] to Health and Wellness Act of 2015 was introduced by Sen. Heidi Heitkamp (D-ND) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would instruct HHS to establish a pilot program to be known as “Stop, Observe, Ask, and Respond to Health and Wellness Training” to provide training to health care providers and other related providers to address human trafficking in the health care system. The program would have the following training objectives:
- identify potential human trafficking victims;
- implement proper protocols and procedures for working with law enforcement to report, and facilitate communication with such victims, in accordance with all applicable Federal, State, local, and tribal requirements, including legal confidentiality requirements for patients and health care providers;
- implement proper protocols and procedures for referring such victims to appropriate social or victims service agencies or organizations;
- provide such victims care that is coordinated; victim centered; culturally relevant; comprehensive; evidence based; gender responsive; age appropriate, with a focus on care for youth; and trauma informed.
Such a program could be integrated with programs regarding victims of domestic violence, dating violence, sexual assault, stalking, child abuse, child neglect, child maltreatment, and child sexual exploitation.
Full text: https://www.govtrack.us/congress/bills/114/s1446/text.
Expansion of TeleMedicine
On May 22, 2015, S. 1465, the Furthering Access to Stroke Telemedicine Act (FAST Act) was introduced by Sen. Mark Kirk (R-IL) and referred to the Senate Finance Committee. Sen. Kirk was recently a stroke victim. The bill would expand access to stroke telehealth services under the Medicare program. Medicare would pay for services related to the evaluation or treatment of an acute stroke that are provided within the evidence-based window of treatment. The site of service would be the location of the patient.
Full text: https://www.govtrack.us/congress/bills/114/s1465/text.
Grace Period for ICD-10
On June 4, 2015, H.R. 2652, the Protecting Patients and Physicians Against Coding Act of 2015 was introduced by Rep. Gary Palmer (R-AL) and referred to the House Energy and Commerce and on Ways and Means Committees. The bill would provide a 2-year grace period in transitioning from the use of ICD-9 to ICD-10 during which physicians and other health care providers submitting claims and other documents using ICD–10 are not penalized for errors, mistakes, and malfunctions relating to the transition to such code set.
Full text: https://www.govtrack.us/congress/bills/114/hr2652/text.
