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Health Policy Legislative Update – 8/17/2015

Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill.

President Signs Law Bringing Some Transparency to Medicare

On August 6, 2015, H.R. 876, the NOTICE Act was enacted after being signed into law by the President. This law requires a hospital to give each Medicare patient who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning to receive them which: (1) explains the individual’s status as an outpatient and not as an inpatient and the reasons why; (2) explains the implications of that status on services furnished (including those furnished as an inpatient), in particular the implications for cost-sharing requirements and subsequent coverage eligibility for services furnished by a skilled nursing facility; (3) is written and formatted using plain language and made available in appropriate languages; and (4) is signed by the individual or a person acting on the individual’s representative to acknowledge receipt of the notification, or if the individual or representative refuses to sign, the written notification is signed by the hospital staff who presented it.

Full text: https://www.govtrack.us/congress/bills/114/hr876/text.

Attempt to Codify Religious and Conscience Exemptions to the ACA

On August 4, 2015, S. 1919, the Health Care Conscience Rights Act was introduced by Sen. James Lankford (R-OK) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill’s preamble notes that the Affordable Care Act imposes “specific requirements that infringe on the rights of conscience of those who offer or purchase health coverage,” but does not offer statutory protection to those offering and purchasing health insurance who have a religious or moral objection only to specific items or services.

Accordingly, the bill provides that no provision in the ACA could:

(1)   require an individual to purchase individual health insurance coverage that includes coverage of an abortion or other item or service to which such individual has a moral or religious objection, or prevent an issuer from offering or issuing, to such individual, individual health insurance coverage that excludes such item or service;

(2)   require a sponsor (or, in the case of health insurance coverage offered to students through an institution of higher education, the institution of higher education offering such coverage) to sponsor, purchase, or provide any health benefits coverage or group health plan that includes coverage of an abortion or other item or service to which such sponsor or institution, respectively, has a moral or religious objection, or prevent an issuer from offering or issuing to such sponsor or institution, respectively, health insurance coverage that excludes such item or service;

(3)   require an issuer of health insurance coverage or the sponsor of a group health plan to include, in any such coverage or plan, coverage of an abortion or other item or service to which such issuer or sponsor has a moral or religious objection; or

(4)   authorize the imposition of a tax, penalty, fee, fine, or other sanction, or the imposition of coverage of the item or service to which there is a moral or religious objection, in relation to health insurance coverage or a group health plan that excludes an item or service pursuant to this section.

The bill also allows a civil lawsuit for violations that include compensatory damages and attorneys’ fees.

Full text: https://www.govtrack.us/congress/bills/114/s1919/text.

House Resolution Stating that the ACA Violates the Origination Clause of the Constitution

On July 29, 2015, House Resolution 392 was introduced by Rep. Trent Franks (R-AZ) and referred to the House Ways and Means Committee. The resolution expresses the sense of the House of Representatives that the enactment of the Patient Protection and Affordable Care Act of 2009, Public Law 111–148, violated article I, section 7 of the United States Constitution because it was a bill for raising revenue that did not originate in the House of Representatives. The resolution notes that “Title IX of the Senate-initiated Patient Protection and Affordable Care Act of 2009 contains 17 numbered “Revenue Provisions” to generate tax revenue to the general account in the United States Treasury; and Title IX of the substitute bill inserted into H.R. 3590 by Senate Amendment No. 2786 unquestionably raises revenue within the meaning of article I, section 7 of the United States Constitution, including without limitation an excise tax on medical devices that has no conceivable purpose other than the raising of revenue to support the operation of the Federal Government.”

Full text: https://www.govtrack.us/congress/bills/114/hres392/text.

CHANGES TO MEDICARE

Restore Pre-2009 Rules for Coverage of Mammograms

On August 4, 2015, S. 1926, the Protecting Access to Lifesaving Screenings Act (PALS Act) was introduced by Sen. Barbara Mikulski (D-MD) and referred to the Senate Finance Committee. The bill would restore Medicare coverage for screening mammography without copayment to pre-2009 recommendations, i.e., once a year versus the current once every two years. This is the sister bill to H.R. 3339 introduced by Rep Renee Ellmers (R-NC) on July 29, 2015.

Full text: https://www.govtrack.us/congress/bills/114/s1926/text.

Bill to Give Physician Extenders More Authority

On July 29, 2015, H.R. 3355 was introduced by Rep. Lynn Jenkins (R-KS) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs covered by Medicare.

Full text: https://www.govtrack.us/congress/bills/114/hr3355/text.

Medicare Coverage of Hearing Aids, Glasses, and Dental Care

On July 29, 2015, H.R. 3308, the Seniors Have Eyes, Ears, and Teeth Act was introduced by Rep. Alan Grayson (D-FL) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would expand Medicare coverage to include eyeglasses, hearing aids, and dental care.

Full text: https://www.govtrack.us/congress/bills/114/hr3308/text.

Prescription Drug Program Operated by Medicare

On July 29, 2015, S. 1884, the Medicare Prescription Drug Savings and Choice Act of 2015 was introduced by Sen. Dick Durbin (D-IL) and referred to the Senate Finance Committee. The bill would amend Medicare Part D (Voluntary Prescription Drug Benefit Program) to provide for: (1) establishment of one or more Medicare operated prescription drug plan options; and (2) an appeals process for denials of benefits under a Medicare operated prescription drug plan.

Full text: https://www.govtrack.us/congress/bills/114/s1884/text.

MISCELLANEOUS

Health Savings Account to Cover Fitness Club Memberships

On July 29, 2015, H.R. 3404, was introduced by Rep. Matt Salmon (R-AZ) and referred to the House Ways and Means Committee. The bill would allow fitness facility memberships and classes to be treated as a medical expense for purposes of using Health Savings Account funds. The Facility cannot be (1) a private club owned and operated by its members; (2) offer golf, hunting, sailing, or riding facilities; (3) a facility where health and fitness is incidental to its overall function. The facility must be fully compliant with the State of jurisdiction and Federal anti-discrimination laws.

Full text: https://www.govtrack.us/congress/bills/114/hr3404/text.

Federal Control Over Childhood Vaccinations

On August 4, 2015, S. 1921, the Vaccinate America’s Children through Complete Information & Education Act of 2015 was introduced by Sen. Christopher Murphy (D-CT) and referred to the Senate Finance Committee. The bill would require States participating in medical assistance programs to adopt uniform administrative procedures with respect to nonmedical exemptions for State immunization requirements.

The prerequisites for granting a nonmedical exemption from State immunization requirements are the following:

(A)    A parent or guardian seeking a nonmedical exemption must discuss the consequences of non-vaccination with the child’s pediatrician or other primary care provider and that the discussion is noted in the medical record.

(B)    A parent or guardian seeking a nonmedical exemption read and sign a form that discusses the risks of non-vaccination and submits the form to the State.

(C)    A parent or guardian seeking a nonmedical exemption submits to the State a notarized letter describing the parent’s or guardian’s reasons for seeking the exemption.

(D)    All nonmedical exemptions from State immunization requirements shall only be granted for a 1-year period and shall be required to be renewed annually if a parent or guardian of a child wants the exemption to continue for another year.

Full text: https://www.govtrack.us/congress/bills/114/s1921/text

A Bill to Defund Planned Parenthood

On August 3, 2015. S. 1917, a bill to prohibit the provision of Federal funds to an entity that receives compensation for facilitating the donation of fetal tissue derived from an abortion was introduced by Sen. Susan Collins (R-ME) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would defund Planned Parenthood and its affiliates who facilitate donation of fetal tissue derived from abortion. Nothing in the bill would reduce overall Federal funding available in support of women’s health. The bill also directs the Attorney General to investigate has engaged in any illegal activity pertaining to fetal tissue products.

Full text: https://www.govtrack.us/congress/bills/114/s1917/text.

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