Legislative Update – 1/18/2016


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

Other than the much-heralded but toothless repeal of the ACA, Congress hasn’t focused on health legislation. Since new laws generally add more regulations and rules, this is likely a good thing.

Giving Seniors Choice for Their Medical Care

This is a good first step to getting the government out of medical care.

On November 19, 2015, H.R. 4090, the Health Care Choices for Seniors Act was introduced by Rep. Marsha Blackburn (R-TN) and referred to the House Energy and Commerce and Ways and Means Committees. The Congressional findings are significant.

  • The Social Security Administration’s Program Operations Manual System section HI 00801.002, titled “Waiver of Hospital Insurance Entitlement by Monthly Beneficiary”, provides that an individual who does not sign up for part A of the Medicare program when the individual signs up for social security benefits will lose such benefits, regardless of the desire of the individual to not participate in the Medicare program because of religious or philosophical reasons or a preference to have private health insurance.
  • Seniors are not allowed to deduct contributions to their health savings account after the date of the entitlement of such seniors to Medicare benefits.
  • A Medicare beneficiary may only enter into a private contract with a physician for an item or service if no claim for payment under Medicare will be submitted. In the case of such contract, the physician must sign an affidavit that acknowledges such contract and that provides that the physician will not submit a claim, and will forgo reimbursement, under such title for an item or service provided to any Medicare beneficiary for a period of two years.

Accordingly, the bill would amend the Social Security Act to improve choices available to Medicare eligible seniors by permitting them to elect (instead of regular Medicare benefits) to receive a voucher for a health savings account, for premiums for a high deductible health insurance plan, or both and by suspending Medicare late enrollment penalties between ages 65 and 70. The amount of a voucher provided to an individual for a month may not exceed $200.

Full text: https://www.govtrack.us/congress/bills/114/hr4090/text

Block Grants to States for Medicaid and CHIP Programs

Several Republicans over the years have suggested block grants to minimize federal control over health care delivery. While not ideal, block grants incentivize the states to manage funds and come up with new ideas. The current funds matching scheme encourages waste, knowing that the feds will bail the states out.

On January 11, 2016, H.R. 4362, the State Health Flexibility Act of 2016 was introduced by Rep. Todd Rokita (R-IN) and referred to the House Committee on Appropriations, the House Education and the Workforce, and 6 other committees. The bill would replace the Medicaid and Children’s Health Insurance Programs with a block grant to the states. The purpose of the block grant is to allow the States maximum flexibility in providing, and financing the provision of, health-care-related items and services to indigent individuals. From 2017 to 2015, the grants would be given quarterly to equal the total amount of funds received from the federal government in 2013.

The funds could not be used for abortion unless the pregnancy is the result of rape, incest, or would be harmful to the health of patient. The states may include abortion coverage so long as they use state funds. No health care entity could be denied funds because they do not provide or refer patients for abortions. There would be no funding for health care for illegal aliens unless an emergency, i.e., (1) placing the patient’s health in serious jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily organ or part. This excludes organ transplants.

Annual publicly available reporting and audits are required and penalties would be levied for misuse of funds.

Finally, the Patient Protection and Affordable Care Act, the Health Care and Education Reconciliation Act of 2010, and Medicaid and CHIP are repealed.

Full text: https://www.govtrack.us/congress/bills/114/hr4362/text.

Another Dig at the ACA

Everyone knew that the President was not going to repeal the ACA. This bill would let the public know a key reason their insurance premiums are sky high.

On December 18, 2015, S. 2432, the Obamacare Tax Transparency Act was introduced by Sen. Tim Scott (R-SC) was introduced and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would require the disclosure of the portion of health insurance premiums that are attributable to the health insurance tax. The bill’s author notes that the Congressional Budget Office (CBO) projected that the health insurance tax will accrue $159,000,000,000 over 10 years (2016–2025) through yearly, increasing fees on most health insurance providers. According to the CBO, new fees under the ACA—including the health insurance tax—“would be largely passed through to consumers in the form of higher premiums for private coverage”. Families and small businesses are frequently unaware that their premium payments are higher due to the health insurance tax. Thus, the bill would provide consumers with a transparent account of the portion of their premium that is attributable to the health insurance tax. Such disclosure would appear on the premium statement or bill provided to the employer administering a group policy or the individual consumer.

Full text: https://www.govtrack.us/congress/bills/114/s2432/text.

Verification of Home Health Services Rendered

Fraud is rampant in the home health arena. Some of these agencies have easily hoodwinked elders who are not paying for services thus they only receive a “statement” and is “not a bill” and thus little attention is paid to the actual services rendered. It is unclear how electronics would keep fraudsters from faking the input.

On December 17, 2015, S. 2416, the Verifying Electronically the Receipt of In-Home Care For Individuals Act (VERIFI Act) was introduced by Sen. Chuck Grassley (R-IA) and referred to the Senate Finance Committee. The bill would require the use of electronic visit verification for home health services under the Medicare program and personal care services and home health services under the Medicaid program. The term “electronic visit verification system” means a system under which visits conducted as part of home health services furnished by a home health agency are electronically verified by the agency with respect to—

(i) the type of service performed;
(ii) the individual receiving the service;
(iii) the date of the service;
(iv) the location of the service is furnished;
(v) the individual furnishing the service; and
(vi) the time the service begins and ends.

No particular or uniform electronic visit verification system required. The bill also does not limit provider selection, constrain beneficiaries’ selection of a caregiver, or impede the manner in which care is furnished.

Full text: https://www.govtrack.us/congress/bills/114/s2416/text

More Quality Measure and Pay-for-Performance

On January 12, 2016, S. 2438, the Medicaid and CHIP Quality Improvement Act of 2016 was introduced by Sen. Sherrod Brown (D-OH) and referred to the Senate Finance Committee. The bill’s purpose is to establish a nationwide systematic method of reporting on and improving quality of care as well as comparing the quality between the different type of delivery systems, i.e., fee-for-service, managed care, primary care case management in the Medicaid and CHIP programs. The bill would establish federal quality measures for such programs. It would also establish performance bonuses for significant achievement in Medicaid and CHIP quality performance. The total amount available over three years is $500,000,000. As a condition of receiving a Medicaid quality performance bonus under this subsection, a State shall agree to designate at least 75 percent of the bonus funds paid to the State under this subsection for a fiscal year for the development and operation of quality-related initiatives that will directly benefit providers or managed care entities.

Full text: https://www.govtrack.us/congress/bills/114/s2438/text.

Mental Health and Eligibility to Purchase Guns

President Obama’s executive order regarding reporting mental health may make this look like child’s play.

On January 5, 2016, H.R. 4315, the Mental Health Access and Gun Violence Prevention Act of 2016 was introduced by Rep. Sheila Jackson Lee (D-TX) and referred to the House Energy and Commerce and Ways and Means Committees. The bill’s preface asserts that Approximately 1 in 4 American adults have a mental illness and nearly half of all adults in America will develop at least one mental illness during their lifetime. Thus, the bill authorizes the appropriation of $500,000,000 for fiscal year 2017 to the Attorney General of the United States, the Secretary of Health and Human Services, and the Commissioner of Social Security to carry out programs (1) to increase access to mental health care treatment and services; and (2) to encourage and assist the reporting of relevant disqualifying mental health information to the National Instant Criminal Background Check System.

Full text: https://www.govtrack.us/congress/bills/114/hr4315/text.

Standards for Gene Therapy

As gene therapy and genetic engineering gain popularity and the President unveiling of his “precision medicine” initiative, it was inevitable that the federal government would step in.

January 12, 2016, S. 2443, the Advancing Standards in Regenerative Medicine Act was introduced by Sen. Tammy Baldwin (D-WI) and referred to the Senate Health, Education, Labor, and Pensions Committee. This bill amend the Federal Food, Drug, and Cosmetic Act to mandate that the Health and Human Services Secretary, in consultation with stakeholders, including regenerative medicine product manufacturers and clinical trial sponsors, contract manufacturers, academic institutions, standard setting organizations, the National Institute of Standards and Technology, and other relevant Federal agencies, as appropriate, shall facilitate establishment of a public-private Standards Coordinating Body in Regenerative Medicine and Advanced Therapies. This coordinating body would establish standards for the development, evaluation and review of regenerative medicine products.

For purposes of this bill, regenerative medicine and advanced therapies includes cell therapy, gene therapy, gene-modified cell therapy, therapeutic tissue engineering products, and human cell and tissue products, and combination products using any such therapies or products. No additional funds would be allocated for this coordinating body.

Full text: https://www.govtrack.us/congress/bills/114/s2443/text.

An Attempt to Determine Why Patients Don’t Take Their Meds

The statistics about patients’ nonadherence to medications are impressive. One reason – not cited by Congress is the staggering cost. As physicians, we can certainly help by not over-prescribing.

On December 18, 2015, H.R. 4292, the Synchronization & Nonadherence Correction (SYNC) Act of 2015 was introduced by Rep. Kristi Noem (R-SD) and referred to the House Energy and Commerce and Ways and Means Committees. The Congressional findings are of interest:

(1) Between one-half and two-thirds of patients with chronic diseases in the United States do not take medications as prescribed.

(2) Low rates of medication adherence result in higher health care costs, reduced effectiveness of health care treatments and regimens, negative health effects for patients, and tens of thousands of deaths on an annual basis.

(3) Medication adherence may be lowest among patients with chronic diseases.

(4) Improving medication adherence would reduce unnecessary hospital admissions and emergency room visits.

(5) Nonadherence is estimated to cost the United States health care system over $100,000,000,000 each year.

(6) Improving medication adherence could improve patient health outcomes, reduce health care costs, and lead to productivity gains.

The bill would provide for research and the testing of innovative health care delivery models to improve medication adherence. The agencies involved are the Secretary of Health and Human Services, acting through the Agency for Healthcare Research and Quality, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, the Director of the National Institutes of Health, and the Director of the Centers for Disease Control and Prevention, and in coordination with the Patient-Centered Outcomes Research Institute, The following models of synchronization shall be tested under this subsection:

(A) Model 1: Synchronization (synchronization of prescription drug medications and medication reconciliation phone calls or electronic communication with enrollees prior to filling prescriptions).

(B) Model 2: Synchronization and compliance-based packaging.

(C) Model 3: Synchronization and ongoing pharmacist counseling at the patient’s request and review of the appropriateness of the medication regimen and any barriers to medication adherence.

The model under this subsection shall only pertain to first fills for maintenance drugs treating chronic diseases such as cardiovascular disease, hypertension, diabetes, autoimmune diseases, chronic obstructive pulmonary disease (COPD), and mental health conditions.

Full text: https://www.govtrack.us/congress/bills/114/hr4292/text.

Clarification of Physician Independent Contractor Status

On December 8, 2015, S. 2371, the Physician Shortage Minimization Act of 2015 was introduced by Se. Jonny Isakson (R-GA) and referred to the Senate Finance Committee. The bill would amend the Internal Revenue Code to clarify the treatment of locum tenens physicians as independent contractors to alleviate physician shortages in underserved areas.

Full text: https://www.govtrack.us/congress/bills/114/s2371/text

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