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


 What’s Ahead: This Week

Hearings/Markups –

  • Tuesday, August 1
    • Senate HELP Committee, “HHS Nomination Hearing.”
  • Thursday, August 3
    • Senate Finance Committee, “Hearing to Consider the Nominations of Gilbert B. Kaplan, of the District of Columbia, to be Under Secretary of Commerce for International Trade, United States Department of Commerce, and Matthew Bassett, of Tennessee, to be an Assistant Secretary of Health and Human Services, United States Department of Health and Human Services.”

Weekly Wrap-Up: Notable Health Care Developments From Last Week

 Appropriations –

  • On July 27, the House approved by a vote of 235-192 the Department of Defense Appropriations Act (H.R. 3219), which includes funding for four of the 12 annual Appropriations bills, including the Department of Defense, Military Construction and Veterans Affairs, Energy & Water, and the Legislative Branch. The bill now moves to the Senate for consideration. Press release: http://bit.ly/2vcyEhr

 Legislative Activity –

  • On July 24, the House passed by a voice vote seven veterans affairs bills, including the VA Procurement Efficiency and Transparency Act (H.R. 2006) and the Veterans Affairs Medical Scribe Pilot Act of 2017 (H.R. 1848). The bills now move to the Senate for consideration. Press release: http://bit.ly/2uDCTjM
  • On July 25, the House passed by a voice vote the Medicare Part B Improvement Act (H.R. 3178), which would improve the delivery of home infusion therapy and dialysis and the application of the Stark rule under the Medicare program. The bill now moves to the Senate for consideration. Press release: http://bit.ly/2uCZc9h
  • Also on July 25, Reps. Walorski (R-IN) and Delbene (D-WA) introduced the Ensuring Access to Air Ambulance Services Act (H.R. 3378), which would require reporting of certain data by providers and suppliers of air ambulance services for purposes of reforming reimbursements for such services under the Medicare program. Press release: http://bit.ly/2v4NVBj
  • On July 26, Rep. Dingell (D-MI) and 8 cosponsors introduced the Medicare Hearing Aid Coverage Act of 2017 (H.R. 3426), which would remove the exclusion of Medicare coverage for hearing aids and examinations. Press release: http://bit.ly/2v1UqVx
  • On July 27, House Energy & Commerce Committee advanced five bills related to public health, including: the Stop, Observe, Ask and Respond (SOAR) to Health and Wellness Act of 2017 (H.R. 767); the Military Injury Surgical Systems Integrated Operationally Nationwide to achieve ZERO Preventable Deaths (MISSION ZERO) Act (H.R. 880); the Firefighter Cancer Registry Act of 2017 (H.R. 931); the Action for Dental Health Act of 2017 (H.R. 2422); and the Common Sense Nutrition Disclosure Act of 2017 (H.R. 772). The bills now move to the full House for consideration. Press release: http://bit.ly/2uGOdf9
  • Also on July 27, Rep. Delbene (D-WA) and 46 cosponsors reintroduced the Birth Control Privacy Act (H.R. 3443), which would prohibit wellness program, including those offered by health insurance issuers or in connection with a group health plan, from disclosing personally identifiable information related to individuals’ use or non-use of contraceptives. Press release: http://bit.ly/2v4xAMT
  • Also on July 27, Reps. Denham (R-CA) and Valadao (R-CA) introduced the Creating Additional Residency Expansion (CARE) Act (H.R. 3451), which would expand the program for payments to teaching health centers with GME programs. Press release: http://bit.ly/2v4qeJq
  • Also on July 27, Rep. Cartwright (D-PA) introduced the Improving Care for Vulnerable Older Citizens through Workforce Advancement Act (H.R. 3461), which would develop and test an expanded and advanced role for direct care workers who provide long-term services and supports to older individuals in efforts to coordinate care and improve the efficiency of service delivery. Press release: http://bit.ly/2v4zSvt
  • Also on July 27, Rep. Lujan (D-NM) and 11 cosponsors introduced the Opioid and Heroin Abuse Crisis Investment act (H.R. 3495), which would appropriate funds for the Account for the State Response to the Opioid Abuse Crisis through fiscal year 2023. Press release: http://bit.ly/2v3RCaw
  • Also on July 27, Reps. McMorris Rodgers (R-WA) and Moulton (D-MA) introduced the Modernization of Medical Records Access for Veterans Act of 2017 (H.R. 3497), which would direct the Secretary of Veterans Affairs to carry out a pilot program establishing a secure, patient-centered, portable medical records system, that would allow veterans to have access to their personal health information. Press release: http://bit.ly/2v4J4Ad
  • Also on July 27, Reps. Higgins (D-NY), Larson (D-CT), Courtney (D-CT) and 10 cosponsors introduced the Medicare Buy-In and Health Care Stabilization Act, which would allow Americans between the ages of 50-64 the option to purchase Medicare. Press release: http://bit.ly/2uQSP2e
  • On July 28, the House passed by voice vote four bills related to veterans affairs, including the Department of Veterans Affairs Bonus Transparency Act (S. 114), the VA Senior Executive Accountability Act (H.R. 2772), the Grow our Own Directive: Physician Assistant Employment and Education Act (H.R. 3262), and the Veterans Access to Child Care Act (H.R. 95). The bills now move to the Senate for consideration. Press release: http://bit.ly/2v55Jw3 Press relese from VA Secretary Shulkin: http://bit.ly/2v4Zj04
  • Also on July 28, House Energy & Commerce Committee, Subcommittee on Oversight & Investigations Chair Murphy (R-PA) and five cosponsors introduced the Overdose Prevention and Patient Safety Act (H.R. 3545), which would protect the confidentiality of substance use disorder patient records. Press release: http://bit.ly/2vcEXl0
  • Also on July 28, Reps. Brooks (R-IN) and Murphy (D-FL) introduced the Improve Access to Care for Our Female Veterans Act (H.R. 3558), which would direct the Secretary of Veterans Affairs to make certain improvements relating to inspections of Department of Veterans Affairs medical facilities and improving care for women. Press release: http://bit.ly/2vcwtKS
  • Also on July 28, Reps. Bustos (D-IL), Crawford (R-AR), Marshall (R-KS), Evans (D-PA, and Juster (D-NH) introduced the Addiction Recovery for Rural Communities Act (H.R. 3566), which would strengthen resources to combat the heroin and opioid epidemic in rural communities across America. Press release: http://bit.ly/2vcWpWw

 ACA Repeal and Replacement Activity –

  • On July 24, Reps. Griffith (R-VA), Jordan (R-OH), Meadows (R-NC), and Perry (R-PA) submitted an amendment to the Make America Secure Appropriations Act of 2018 (H.R. 3219) which would abolish the Budget Analysis Division of the Congressional Budget Office (CBO) and transfer its duties to the Office of the Director. On July 26, the House voted against the amendment by a vote of 116-309. Press release: http://bit.ly/2uXhEvL Amendment: http://bit.ly/2uCPd3Q
  • On July 25, the Senate approved by a vote of 51-50 a motion to proceed to debate on the American Health Care Act (H.R. 1628). Press release from Majority Leader McConnell (R-KY): http://bit.ly/2uXrNZv Press releases from Sens. Murkowski (R-AK) and Collins (R-ME): http://bit.ly/2uX9yn6 and http://bit.ly/2uE26wM Press releases from Sens. Heller (R-NV), Capito (R-WV) and Portman (R-OH): http://bit.ly/2uXr9Lt and http://bit.ly/2uXl81t and http://bit.ly/2uXmbyh
  • Also on July 25, the Senate voted down by a vote of 43-57 the first amendment in the nature of a substitute, the Better Care Reconciliation Act. Press release: http://bit.ly/2tyHHpLSection-by-section: http://bit.ly/2uD5isA Updated BCRA text: http://bit.ly/2vFSuid)
  • Also on July 25, the Senate Parliamentarian provided additional guidance on several portions of the Better Care Reconciliation Act, finding that provisions such as the change to age rating and allowing small businesses to establish association health plans violate Senate reconciliation rules. On July 27, the Senate Parliamentarian further determined that portions of section 207 of the BCRA, which provides greater flexibility for states to use section 1332 waivers, are not permissible under Senate Rules. Press release: http://bit.ly/2uGnvTL
  • Also on July 25, Reps. Welch (D-VT), Schrader (D-OR) and 87 Democratic Representatives sent a letter to House Speaker Ryan (R-WI) outlining a bipartisan path to improving the ACA aimed at changes to the individual insurance market. Press release with text of letter: http://bit.ly/2uX3ieU
  • Also on July 25, House Energy & Commerce Committee Ranking Member Pallone (D-NJ) and Ways & Means Committee Ranking Member Neal (D-MA) sent a letter to HHS Secretary Price and to McKinsey requesting additional information regarding HHS’ analysis of the ‘Consumer Freedom’ amendment and expressing concern regarding HHS’ “lack of transparency about how this study was conducted.” Press release: http://bit.ly/2uXwIcZ Letter: http://bit.ly/2uX5CCE
  • On July 26, the Senate rejected a substitute amendment, the Obamacare Repeal Reconciliation Act (ORRA), by a vote of 45-55. The ORRA would have repealed key provisions of the ACA with a two-year effective date.
  • Also on July 26, a bipartisan group of 10 Governors sent a letter to Senate Majority Leader McConnell (R-KY) and Minority Leader Schumer (D-NY) urging them to “work with governors of every party to develop solutions that will make health care coverage more available and affordable for all Americans.” Press release: http://bit.ly/2uFu21a Letter: http://bit.ly/2uFodk1
  • Also on July 26, CBO released an analysis of the projected impact of the Senate’s so-called ‘skinny bill,’ as requested by Senate Democrats. Although bill text for the skinny bill has not yet been released, CBO estimated that the expected provisions of the bill, a repeal of the individual and employer mandate and the medical device tax – would result in 16 million more uninsured by 2026 and $142 billion in savings from $2017-2026. Analysis: http://bit.ly/2uFug89
  • Also on July 26, House Energy & Commerce Committee Ranking Member Pallone (D-NJ) sent a letter to the U.S. Government Accountability Office requesting an investigation into Department of Energy Secretary Perry’s “potential misuse of appropriated taxpayer fund when he wrote an opinion piece for an Ohio newspaper critical of the Affordable Care Act.” Press release: http://bit.ly/2uG4HUO Letter: http://bit.ly/2uFLOkE
  • On July 27, House Speaker Ryan released a statement affirming that the House is “willing” to go to Conference with the Senate to develop a comprehensive effort to repeal and replace the ACA from the narrow legislation under consideration. Press release: http://bit.ly/2v533i0
  • Also on July 27, Senate Budget Committee released bill text for the “skinny” amendment in the nature of a substitute, known as the Health Care Freedom Act; the bill would have repealed the individual and employer mandates and delays the tax on medical devices, among other changes. On July 28, the Senate rejected this amendment by a vote of 49-51. Majority Leader McConnell Press release: http://bit.ly/2v5dXo2 Bill text: http://bit.ly/2v4aeHq
  • Also on July 27, CBO released an analysis of the Health Care Freedom Act, finding that it would result in 16 million more uninsured Americans in 2026 and would reduce the federal deficit by $180 billion. Analysis: http://bit.ly/2v4EEcd
  • Also on July 27, Rep. Schakowsky (D-IL) introduced the Protecting Consumers from Unreasonable Rates Act (H.R. 3450), which would provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates. Sens. Feinstein (D-CA) and Duckworth (D-IL) introduced a companion bill (S. 1667) in the Senate. Press releases: http://bit.ly/2v4B41M and http://bit.ly/2v5d7aN
  • On July 28, House Energy & Commerce Committee Ranking Member Pallone (D-NJ), Ways & Means Committee Ranking Member Neal (D-MA), Education & the Workforce Committee Ranking Member Scott (D-VA), and Budget Committee Ranking Member Yarmuth (D-KY) sent a letter to the Chairmen of their respective committees expressing their willingness to work together to strengthen the ACA. Press release: http://bit.ly/2vcS9GJ Letter: http://bit.ly/2vcJUKB

ACA Implementation –

  • On July 24, Massachusetts released for public comment a proposed section 1332 waiver to support commercial insurance market stability through a premium stabilization fund, a small business health care tax credit, and to revive the state’s employer shared responsibility program. Proposal: http://bit.ly/2uXsdz2
  • On July 26, Internal Revenue Service (IRS) published final regulations on the health insurance premium tax credit, finalizing longstanding proposed rules originally issued in July 2014 largely without change. Notice: http://bit.ly/2uGRRpd
  • Also on July 26, CMS posted an update to the Health Insurance Exchanges Issuer County Map. Press release: http://go.cms.gov/2v4RwPA
  • On July 27, CMS released a proposed rule on methodology for Medicaid Disproportionate Share Hospital (DSH) allotment reductions set to begin in fiscal year 2018. Comments are due by August 28. Guidance: http://bit.ly/2uGp30a

 Medicare –

  • On July 24, the Medicare Payment Advisory Commission (MedPAC) released its June 2017 Data Book which provides data and information on health care spending and the Medicare program. Data book: http://bit.ly/2uCXLaV
  • Also on July 24, House Ways & Means Committee, Subcommittee on Health Chair Tiberi (R-OH) announced a new initiative called the Medicare Red Tape Relief Project, through which the Committee is seeking feedback from providers on how to lower costs, improve quality, and encourage more innovation in Medicare. Submissions are due by August 25. Press release: http://bit.ly/2uCSxvQ
  • Also on July 24, the Centers for Medicare & Medicaid Services (CMS) released a Market Saturation and Utilization Data Tool that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas. Press release: http://go.cms.gov/2v1RZSU
  • On July 25, CMS issued a proposed rule that would update payment rates and the wage index for home health agencies serving Medicare beneficiaries in 2018 and proposes a redesign of the payment system in 2019. The proposed rule also includes a request for information to “welcome feedback on positive solutions for program simplification, flexibility, and innovation.” Comments are due by September 25. Press release: http://go.cms.gov/2v4Rvvd Fact sheet: http://go.cms.gov/2v4W2xE Proposed rule: http://bit.ly/2v5roV0
  • Also on July 25, CMS released guidance on annual redeterminations for Medicare Part D low-income subsidy deemed status. Guidance: http://bit.ly/2v59xgT
  • On July 28, CMS posted an extension of a temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and NJ, as applicable, to prevent and combat fraud, waste, and abuse. Notice: http://bit.ly/2v51FMx

 Medicaid –

  • On July 28, CMS released a new pediatric measure set as part of the Core Quality Measures Collaborative (CQMC), intended to help align quality measures between public and private payers. Fact sheet: http://go.cms.gov/2v4SCuF CQMC: http://go.cms.gov/2v5mVSd

 New Payment and Delivery System Models –

  • On July 26, CMS posted materials for a New Care Redesign Program (CRP), a new voluntary program within the Maryland All-Payer Model that advances efforts to redesign and better coordinate care in Maryland. Materials: http://bit.ly/2v5cgqG
  • On July 28, CMS posted final year 1 and preliminary year 2 savings reports for the Financial Alignment Initiative for Medicare-Medicaid Enrollees. Reports: http://bit.ly/2v5qO9A

 Health IT –

  • On July 25, Office of the National Coordinator for Health IT (ONC) announced a change in the notification process for the availability of test tools and test procedures for the testing of health IT under the ONC Health IT Certification Program. Notice: http://bit.ly/2uH4ZdS
  • Also on July 25, HHS announced the launch of a revised consumer web tool, called the HIPAA Breach Reporting Tool, that highlights recent breaches of health information. Press release: http://bit.ly/2v5aDJz
  • On July 27, Food and Drug Administration (FDA) announced it would seek applicants for a pilot program allowing digital health developers to be pre-certified as quality coders. Notice: http://bit.ly/2v55jpu

 Mental Health and Substance Abuse –

  • On July 25, HHS announced $1.6 million in 16 awards to public and private nonprofit entities across the nation to address the primary and/or secondary prevention of prescription and illegal opioid misuse by women across the lifespan. Press release: http://bit.ly/2v50bSg
  • On July 26, U.S. Government Accountability Office (GAO) published a report on the status of federal efforts and key issues for preventing illicit drug use, including the federal government’s progress in achieving strategy goals. Report: http://bit.ly/2v4AReY
  • Also on July 26, Substance Abuse and Mental Health Services Administration (SAMHSA) published a report finding that opioid misuse among adults aged 50 or older in 2014 was higher than 2002. Press release: http://bit.ly/2v4ZmJb

 Drug Prices –

  • On July 26, FDA published guidance regarding questions and answers to generic drug user fee amendments of 2012. Notice: http://bit.ly/2v4UGTF

Veterans Health –

  • On July 25, the Department of Veterans Affairs (VA) published a final rule prohibiting a community residential care facility from employing an individual who has been indicted in a court of law of certain crimes. Final rule: http://bit.ly/2v1Z4CP

Misc. –

  • On July 26, House Energy & Commerce Committee Ranking Member Pallone (D-NJ) and House Committee on Foreign Affairs Ranking Member Engel (D-NY) sent a letter to President Trump, urging him to immediately staff up the Centers for Disease Control and Prevention (CDC), and warning that not doing so creates a “grave risk to global health and national security.” Press release: http://bit.ly/2uDgiUw Letter: http://bit.ly/2uDeuuL
  • On July 26, HHS awarded approximately $7 million through two workforce development programs to combat the Zika virus and to meet the health care needs of people living in Puerto Rico, American Samoa, and the U.S. Virgin Islands. Press release: http://bit.ly/2v546i6
  • On July 27, HHS released a report describing the importance of partnerships in medical product research and development. Report: http://bit.ly/2v5z8q0
  • On July 28, FDA announced a new comprehensive plan for tobacco and nicotine regulation that will serve as a multi-year roadmap to better protect kids and significantly reduce tobacco-related disease and death. Press release: http://bit.ly/2v51lgv
  • Also on July 28, CDC published a report finding that many disparities in health and well-being are rooted in early childhood. Report: http://bit.ly/2v4tl3Y