Health Care Policy Update – Weekly Wrap-Up and What’s Ahead


 

What’s Ahead: This Week

Hearings –

  • Tuesday, July 11
    • Senate Committee on Veterans’ Affairs, “Pending Health Care Legislation.”

Notable Policy Events –

  • Thursday, July 6
    • National Academy of Medicine, “Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health.” Additional information: http://bit.ly/2tJ3sqg
    • American Enterprise Institute, “Unbundling the Benefit for Better Health: A Broader Role for Health Savings Accounts.” Additional information: http://bit.ly/2tIwOF3

 Weekly Wrap Up: Notable Health Care Developments From Last Week

 Legislative Activity –

  • On June 26, Sens. Sanders (I-VT), Warren (D-MA), Harris (D-CA) and Franken (D-MN) introduced the Community Health Center and Primary Care Workforce Expansion Act (S. 1441) which would provide funding for Federally Qualified Health Centers, the National Health Services Corps, Teaching Health Centers, and the Nurse Practitioner Residency Training program. Rep. Clyburn (D-SC) and 40 cosponsors introduced companion legislation in the House (H.R. 3059). Press release: http://bit.ly/2sSfdsx
  • On June 28, Senate Veterans Affairs Committee advanced by voice vote the Veterans Appeals Improvement and Modernization Act of 2017 (S. 1024), which would reform the rights and processes relating to appeals of decisions regarding claims for benefits under the laws administered by the Secretary of Veterans Affairs. The bill now moves to the full Senate for consideration. Press release: http://bit.ly/2u7vuJ0 Summary: http://bit.ly/2u7bxBO
  • Also on June 28, Sens. Cruz (R-TX), Cornyn (R-TX), Rubio (R-FL), and Young (R-IN) introduced the VA Information Technology Restructuring Act (S. 1452) which would establish within the Office of the Under Secretary for Health of the Department of Veterans Affairs the position of Chief Information Officer of the Veterans Health Administration. Press release: http://bit.ly/2smLpRt
  • Also on June 28, Sens. Donnelly (D-IN) and Murkowski (R-AK) introduced the Strengthening the Addiction Treatment Workforce Act (S. 1453) which would allow the Secretary of Health and Human Services to designate certain substance use disorder treatment facilities as eligible for National Health Service Corps Service. Press release: http://bit.ly/2to1ydT
  • Also on June 28, the House passed by a vote of 218 to 210 the Protecting Access to Care Act of 2017 (H.R. 1215) which would establish provisions governing health care lawsuits where coverage for the care was provided or subsidized by the federal government, including through a subsidy or tax benefit. The bill now moves to the Senate for consideration. Press release: http://bit.ly/2tpu1Q7
  • Also on June 28, Reps. Moulton (D-MA) and Banks (R-IN) introduced the Veterans Acquiring Community Care Expect Safe Service (ACCESS) Act (H.R. 3095) which would prohibit or suspend certain health care providers from providing non-Department of Veterans Affairs health care services to veterans. Press release: http://bit.ly/2t4Xsom
  • On June 29, House Energy & Commerce Committee Subcommittee on Health Chair Burgess (R-TX), House Ways & Means Committee Subcommittee on Health Tiberi (R-OH) and Reps. Dingell (D-MI), and Thompson (D-CA) introduced H.R. 3120, which would reduce the volume of future electronic health record-related significant hardship requests. Press release: http://bit.ly/2u8cZUJ
  • Also on June 29, Rep. Levin (D-MI) and 8 cosponsors introduced the Medicare Dental, Vision, and Hearing Benefit Act (H.R. 3111), which would provide for coverage of dental, vision, and hearing care under the Medicare program. Press release: http://bit.ly/2u8cbzb Summary: http://bit.ly/2u7TOKz Bill text: http://bit.ly/2u8cGsW
  • Also on June 29, Reps. Meehan (R-PA, DeGette (D-CO), Sewell (D-AL), Lance (R-NJ), and Kennedy (D-MA) introduced H.R. 3044, which would expand supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees under the Medicare program. Press release: http://bit.ly/2u7Xaxb
  • Also on June 29, Reps. DeGette (D-CO) and Jenkins (R-TN) introduced the Preventing Diabetes in Medicare Act of 2017 (H.R. 3124), which would reduce the occurrence of diabetes in Medicare beneficiaries by extending coverage under Medicare for medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes. Press release: http://bit.ly/2u81lt3
  • Also on June 29, Rep. Takano (D-CA) introduced the Better Workforce for Veterans Act (H.R. 3158), which would improve the authorities of the Secretary of Veterans Affairs to hire, recruit, and train employees of the Department of Veterans Affairs. Press release: http://bit.ly/2u865yB

 ACA Repeal and Replacement Activity –

  • On June 26, Congressional Budget Office (CBO) released its analysis of the Better Care Reconciliation Act (BCRA) of 2017, finding that 22 million more people would be without health insurance coverage under the BCRA than under current law in 2026 and that the bill would result in deficit savings of $321 billion over the period from 2017-2026. White House Press Release: http://bit.ly/2u3Dfj2 Analysis: http://bit.ly/2u3OxDQ
  • Also on June 26, National Governors Association (NGA) sent a letter to Senate Majority Leader McConnell (R-KY) requesting that Congress give governors time to review and react to any health care legislation before proceeding, to “ensure that the bill does not adversely harm the people we were elected to serve.” Letter: http://bit.ly/2u3vAky
  • Also on June 26, National Association of Medicaid Directors (NAMD) released a statement noting that “Medicaid is complex and therefore demand thoughtful and deliberate discussion about how to improve it…While NAMD does not have consensus on the mandatory conversation of Medicaid financing to a per capita cap or block grant, the per capita growth rates for Medicaid in the Senate bill are insufficient and unworkable.” Statement: http://bit.ly/2u3P7Bk
  • On June 27, Senate Finance Committee Ranking Member Wyden (D-OR) sent a letter to CBO Director Hall requesting that the CBO perform an additional analysis of the bill that would analyze its effects over a 20-year period, rather than the customary 10-year window. In response, CBO released an analysis finding that Medicaid spending would be about 35 percent lower in 2035 compared with spending projections under current law. Press release: http://bit.ly/2u3SMPB Letter: http://bit.ly/2u3CtTa Analysis: http://bit.ly/2u3Ey1a
  • Also on June 27, Sen. Paul (R-KY) sent a letter to Senate Majority Leader McConnell (R-KY) outlining a list of “policy” priorities” he feels would improve the health care system and insurance markets.” Press release: http://bit.ly/2tv2z4h Letter: http://bit.ly/2tuEOJz
  • Also on June 27, Democrats from the House Committee on Oversight & Government Reform released state-by-state reports describing the effects of the Better Care Reconciliation Act on children with disabilities. Press release: http://bit.ly/2tuMhIQ Reports: http://bit.ly/2tupvAL
  • Also on June 27, House Energy & Commerce Committee Pallone (D-NJ) and Senate HELP Committee released a report describing the Trump Administration and Congressional Republicans’ “intentional sabotage of the individual insurance markets to justify passage of Trumpcare.” Press release: http://bit.ly/2u4i4NU Report: http://bit.ly/2u3Qa4w
  • Also on June 27, House Energy & Commerce Committee Ranking Member Pallone (D-NJ) and Ways & Means Committee Ranking Member Neal (D-MA) sent a joint memo to health care reporters providing selected highlights of the CBO report on the Better Care Reconciliation Act. Memo: http://bit.ly/2u76IZa
  • On June 28, Sen. Shaheen (D-NH) and 20 cosponsors introduced the Marketplace Certainty Act (S. 1462) which would amend the Patient Protection and Affordable Care Act to improve cost-sharing subsidies. Press release: http://bit.ly/2sVd1R2
  • Also on June 28, Sen. Ernst (R-IA) introduced the Health Equity and Access for Returning Troops and Servicemembers (HEARTS) Act (S. 1461), which would provide for the eligibility of certain former members of the Armed Forces who are medically retied and who are entitled to hospital insurance benefits under Medicare part A by reason of previous entitlement to Social Security disability insurance benefits to enroll in the TRICARE program regardless of whether such members decline enrollment under Medicare part B. Press release: http://bit.ly/2tJ06n9
  • On June 29, Senate HELP Committee Ranking Member Murray (D-WA) and Senate Finance Committee Ranking Member Wyden (D-OR) released a joint report on the impact of repealing Medicaid expansion on the states hit hardest by the opioid crisis. Press release: http://bit.ly/2u6TTOC Report: http://bit.ly/2u7ezGk
  • On June 30, Senate Finance Committee Ranking Member Wyden (D-OR) sent a letter to Chair Hatch (R-UT) requesting full committee consideration of the Better Care Reconciliation Act and a return to regular order on the Senate floor. Press release: http://bit.ly/2u7RH9D Letter: http://bit.ly/2u7MYF1
  • Also on June 30, Senate HELP Committee Ranking Member Murray (D-WA), Senate Finance Committee Ranking Member Wyden (D-OR), and Senate Special Committee on Aging Ranking Member Casey (D-PA) sent a letter to HHS Secretary Price urging him to reveal the details of ongoing discussions with the Department and Republican Senators to gain support for the BCRA. Press release with text of letter: http://bit.ly/2tIH2Fm
  • Also on June 30, Sen. Cardin (D-MD) introduced the Keeping Health Insurance Affordable Act (KHIAA) (S. 1511), which would bring stability to the individual insurance market, make insurance coverage more affordable, lower prescription drug prices, and improve Medicaid. Summary: http://bit.ly/2tJ2vOv Bill text: http://bit.ly/2tJ6ue6
  • Also on June 30, Sen. Sasse (R-NE) sent a letter to President Trump urging him to adopt a two-step strategy of repealing and then replacing the ACCA, if an agreement is not reached by the day members return from the Fourth of July recess. Press release: http://bit.ly/2u81n3T

 ACA Implementation –

  • On June 27, CMS released an updated county-by-county analysis of current projected issuer participation in the health insurance Marketplaces, finding that 49 counties are projected to have no issuer participation in 2018. Press release: http://go.cms.gov/2u7w4Xd Map: http://bit.ly/2u71H2T
  • On June 28, CMS published a document providing instruction on cost-sharing reduction (CSR) reconciliation discrepancy files that issuers will send to CMS for the 2016 benefit year. Document: http://go.cms.gov/2t5erH9
  • On June 30, CMS released a summary report on transitional reinsurance payments and permanent risk adjustment transfers for the 2015 benefit year. Report: http://go.cms.gov/2tQCJIi
  • On June 30, CMS sent a letter to Minnesota Governor Dayton informing him that it has completed a preliminary review of the state’s application for a section 1332 waiver, and found it to be complete, and marking the beginning of the federal public notice process and 180-day federal decision-making period. Comments are due by July 30. Letter: http://go.cms.gov/2tQIVA7 Waiver Application” http://go.cms.gov/2tQ7Nb3

Medicare –

  • On June 29, CMS released a proposed rule updating payment policies for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). CMS proposes to increase the base rate by $1.76 to $233.31 in calendar year 2018. The proposed rule also includes a request for information welcoming continued feedback on the Medicare program. Comments are due by August 28. Press release: http://go.cms.gov/2u7mcwo Fact sheet: http://go.cms.gov/2u7mGCR Final rule: http://bit.ly/2u7uXXm

 Medicaid –

  • On June 27, HHS Office of Inspector General (HHS-OIG) released a report on Medicaid’s Transformed Medicaid Statistical Information System (T-MSIS), finding that early implementation challenges have resulted in delays in implementation. Summary with link to report: http://bit.ly/2u7wUTx
  • On June 29, CMS posted a final rule to implement changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs to reflect changes to the way states adjudicate eligibility for Medicaid and CHIP. Fact sheet: http://go.cms.gov/2u7fcj3 Final rule: http://bit.ly/2u7iF12
  • Also on June 29, CMS announced a funding opportunity for round two of the Zika Health Care Services Program, which provides up to $6.45 million in Medicaid funding to support prevention activities and treatment services for health conditions related to the Zika virus. Applications are due by July 10. Notice: http://bit.ly/2tyjsLG
  • On June 30, CMS released guidance announcing its intention to provide states with targeted enforcement discretion in complying with the Medicaid Managed Care final rule. Guidance: http://bit.ly/2ty9iKQ

 New Payment and Delivery System Reform Models –

  • On June 26, CMS posted materials from a June 15 webinar on shared savings methodology in the Medicare-Medicaid Accountable Care Organization model. Webinar materials: http://bit.ly/2tqcSXA
  • On June 28, CMS released a list of participating skilled nursing facilities (SNF) for the third quarter of 2017 for the Comprehensive Care for Joint Replacement (CJR) model. List: http://bit.ly/2tqc3h9
  • Also on June 28, CMS posted a Frequently Asked Questions (FAQ) document on the Coordinated Care Reward available through the Next Generation ACO model. FAQ: http://bit.ly/2tmjQM5

 Veterans Healthcare –

  • On June 26, Senate Committee on Veterans’ Affairs Chair Isakson (R-GA), Senate Armed Services Committee Chair McCain (R-AZ), and Senate Appropriations Committee Subcommittee on Veterans Affairs Chair Moran (R-KS) sent a letter to VA Secretary Shulkin and Department of Defense Secretary Mattis praising the VA’s recent announcement that it will transition to the same electronic health record system as the defense department. Press release: http://bit.ly/2u6UDDx Letter: http://bit.ly/2u7yRiP
  • Also on June 26, VA Midwest Health Care Network and the Air Force Medical Operations agency announced a collaborative Tele-ICU agreement that will allow Air Force patients at 5 military treatment facilities to use VA’s Tele-ICU capabilities through its centralized support center in Minneapolis. Press release: http://bit.ly/2tgIFd2
  • On June 27, VA released finalized plans that lay the framework for providing emergency mental health coverage to former service members with other-than-honorable administrative discharges. Press release: http://bit.ly/2tTpjbf

 Mental Health and Substance Abuse –

  • On June 26, the Department of Health and Human Services (HHS) announced the availability of $195 million in a new funding opportunity for community health centers to expand access to mental health and substance abuse services focusing on the treatment, prevention, and awareness of opioid abuse. Applications are due by July 26. Press release: http://bit.ly/2tkGapG
  • Also on June 26, Rep. Kennedy (D-MA) and 10 cosigners sent a letter to HHS Secretary Price requesting a status report on HHS’ obligations under the 21st Century Cures Act to convene a stakeholder meeting on mental health parity. Press release: Letter: http://bit.ly/2u7TyLw
  • Also on June 26, Sens. Portman (R-OH) and Klobuchar (D-MN) sent a letter to the Drug Enforcement Agency (DEA) requesting that the agency provide additional information in an effort to support first responders on the frontlines in the fight against synthetic opioids. Press release with text of letter: http://bit.ly/2u884TO

 Drug Development and Prices –

  • On June 26, Food and Drug Administration (FDA) published a statement on the importance of the Drug Quality and Security Act and its role in overseeing the safety of compounded drugs. Press release: http://bit.ly/2snwBSG
  • Also on June 26, GAO published a report finding that the FDA’s reliance on generic drug user fees has increased and surpassed many of its performance goals, and recommending that the FDA make a plan for the fees it doesn’t spend in the same year they’re collected. Report: http://bit.ly/2t2e9AS
  • On June 27, FDA announced two new steps to increase competition in the market for prescription drugs and to facilitate the entry of lower-cost alternatives: it will publish a list of off-patent, off-exclusivity branded drugs without approved generics and will implement a new policy to expedite the review of generic drug applications where competition is limited. Press release: http://bit.ly/2sWSLNj
  • On June 29, FDA announced a plan to eliminate the agency’s existing orphan designation request backlog and to ensure continued timely response to all new requests for designation with firm deadlines. Press release: http://bit.ly/2tJ7wXt

Misc. –

  • On June 26, U.S. Government Accountability Office (GAO) published a report finding that federal efforts to increase the physician workforce may not be sufficient to meet needs, particularly in rural areas and primary care. Report: http://bit.ly/2snK0tR
  • On June 27, House Energy & Commerce Committee Chair Walden (R-OR) and Subcommittee on Oversight & Investigations Chair Murphy (R-PA) sent a letter to National Institutes of Health Director Collins requesting information about NIH-sponsored emergency medical research allegedly being conducted without informed consent. Press release: http://bit.ly/2u70ysl Letter: http://bit.ly/2u767GZ
  • Also on June 27, HHS released a request for nominations for members to the National Advisory Council for Healthcare Research and Quality. Nominations are due by August 27. Notice: http://bit.ly/2u814pW
  • Also on June 27, CDC released data on vaccination coverage among adults aged 65 and older in 2015. Data brief: http://bit.ly/2u86DEL
  • On June 28, HHS released a notice soliciting written comments on the proposed framework of Healthy People 2030. Comments are due by September 29. Notice: http://bit.ly/2u82GzP
  • Also on June 28, Centers for Disease Control and Prevention (CDC) published its 40th annual report on trends in the health of the nation. Press release: http://bit.ly/2snD3Je Report: http://bit.ly/2sSoAIS
  • On June 30, Senate Finance Committee Ranking Member Wyden (D-OR) sent a letter to the HHS Office of Government Ethics requesting information about CMS Administrator Verma’s compliance with her ethics agreement. Press release: http://bit.ly/2u6JUZR Letter: http://bit.ly/2u6YnF6
  • Also on June 30, CMS announced the award of $15 million in funding to the Genesee County Healthy Start Program to help families affected by lead exposure in Flint, MI. Press release: http://bit.ly/2tyhj2n
  • Also on June 30, CMS published 2015 Open Payments data, along with newly submitted and updated payment records for the 2013 and 2014 reporting periods. Press release: http://go.cms.gov/2tQtQhH Data: http://bit.ly/2jTrfye