Health Policy Update 1-16-17


What’s Ahead: This Week

Inauguration

President-elect Trump will be sworn in as the 45th President of the United States on Friday, January 20.

Hearings

  • Wednesday, January 18
    • Senate Health, Education, Labor & Pensions (HELP) Committee, “Nomination of Rep. Tom Price (R-GA) to Serve as Secretary of Health and Human Services.”

Notable Policy Events

  • Tuesday, January 17
    • Center on Budget and Policy Priorities, “CEA Chair Jason Furman on Government’s Role in Fighting Poverty.” Additional information: http://bit.ly/2iMZun3
  • Tuesday, January 17 – Wednesday, January 18
    • National Institutes of Health, “Meeting of the National Advisory Committee on Aging.” Additional information: http://bit.ly/2jnoOmS 

Weekly Wrap Up: Notable Health Care Developments From Last Week

HHS Leadership

  • On January 9, Sen. Casey (D-PA) and 23 Democratic Senators sent a letter to Senate HELP Committee Chair Alexander (R-TN) and Senate Finance Committee Chair Hatch (R-UT), urging them to include outside witnesses in the Hearing of HHS Secretary Nominee Rep. Price, currently scheduled for January 18. Press release with text of letter: http://bit.ly/2jyVA25
  • On January 11, Rep. Price (R-GA) wrote a letter to HHS Office of Government Ethics, pledging to divest his interests in 43 healthcare companies within 90 days, if confirmed by the Senate for Secretary of HHS. Letter: http://bit.ly/2jz0H2g

ACA Repeal/Replace

On January 9, House Budget Committee Ranking Member Yarmuth (D-KY) and House Ways & Means Committee Ranking Member Neal (D-MA) sent a letter to the Office of Management and Budget (OMB) requesting an analysis of how the FY 2017 Budget Resolution would impact the budget. OMB Director Donovan responded the same day, estimating that the 2017 budget resolution would increase the deficit by approximately $9.5 trillion over 10 years. Ranking Members Yarmuth and Neal’s press release and letter: http://bit.ly/2jz6uoz and http://bit.ly/2jnxAS0

  • Also on January 9, Sens. Heller (R-NV) and Heinrich (D-NM) introduced the Middle Class Health Benefits Tax Repeal Act of 2017 (S. 58), which would repeal the ACA’s excise tax on high-cost employer-sponsored insurance, also known as the Cadillac Tax. Press release: http://bit.ly/2jyzPzn
  • On January 10, Senate HELP Committee Chairman Alexander (R-TN) proposed a three-step plan for concurrent, simultaneous repeal and replace of the ACA. Press release: http://bit.ly/2ihy4og
  • On January 11, House Energy & Commerce Committee launched a “Health Care Central” web portal to provide information on health care reform. Press release: http://bit.ly/2jnwRQD Portal: http://bit.ly/2jnLkvY
  • Also on January 11, Reps. DelBene (D-WA), Kind (D-WI) and Ruppersberger (D-MA) introduced the Small Business Tax Credit Accessibility Act (H.R. 432), which would expand the ACA’s tax credit for small businesses. Press release: http://bit.ly/2jnYwkD
  • On January 12, House Energy & Commerce Committee Ranking Member Pallone (D-NJ), House Ways and Means Committee Ranking Member Neal (D-MA), and House Education and the Workforce Committee Ranking Member Scott (D-VA) sent a letter to the Chairmen of their respective committees requesting public hearings on the impact of repealing the ACA through budget reconciliation. Press release: http://bit.ly/2jnKGi9 Letter: http://bit.ly/2jnHItZ
  • On January 12, House Energy & Commerce Committee released a set of graphics showcasing the ACA’s impact on the average price of premiums in several states. Press release: http://bit.ly/2jnzLow Graphics: http://bit.ly/2jnALsR
  • On January 12, Sens. Cruz (R-TX), Lee (R-UT), Rubio (R-FL), and Paul (R-KY) introduced the Obamacare Repeal Act (S. 106), which would repeal the ACA in its entirety, effective January 1, 2018. Press release: http://bit.ly/2jnT4Oo Bill text: http://bit.ly/2jnQyb1
  • On January 13, the House passed by a vote of 227-198 the FY 2017 Budget Resolution (S. Con. Res 3). The Senate previously passed the Budget Resolution on January 12 by a vote of 51-48, after voting on and failing to pass 24 of the 189 Amendments offered by both Democrat and Republican Senators. The Budget Resolution includes reconciliation instructions directing the Senate HELP Committee, Senate Finance Committee, House Ways and Means Committee, and House Energy & Commerce Committee to produce legislation that achieves at least $1 billion each in deficit reduction over 10 years (FY 2017-2026). Legislation achieving the goals is due from each Committee by January 27. Senate Budget Committee Chair Enzi (R-WY) Press release: http://bit.ly/2jyZpnN Resolution: http://bit.ly/2jz3Mj1

Legislative Update

  • On January 9, the House passed the following by voice vote: the National Clinical Care Commission Act (H.R. 309), which would establish a National Clinical Care Commission to coordinate federal programs relating to metabolic syndromes; the Improving Access to Maternity Care Act (H.R. 315), which would increase data collection by HHS to help place maternal health professionals in areas of need; the Sports Medicine Licensure Clarity Act of 2016 (H.R. 302), which would expand liability coverage for sports medicine professionals; and the Protecting Patient Access to Emergency Medications Act of 2016, which would improve the Drug Enforcement Administration registration process for emergency medical services (EMS) agencies and would allow EMS professionals to administer controlled substances under a standing order. Press release: http://bit.ly/2jnMkQR
  • Also on January 9, Rep. Gosar (R-AZ) and 14 cosponsors introduced the Competitive Health Insurance Reform Act of 2017 (H.R. 372), which would amend the McCarran-Ferguson Act of 1945 to restore the application of federal antitrust laws to health insurance companies. Press release: http://bit.ly/2jyxgxn Summary: http://bit.ly/2jyAcKx
  • Also on January 9, Senate Armed Services Committee Chairman McCain (R-AZ) and Sen. Klobuchar (D-MN) introduced the Safe and Affordable Drugs from Canada Act (S. 64), which would allow individuals to safely import prescription drugs from Canada. Press release: http://bit.ly/2jytUud Bill text: http://bit.ly/2jyB818
  • On January 10, Reps. Jenkins (R-KS) and Kind (D-WI) introduced the Restoring Access to Medications Act (H.R. 394), which would allow consumers to use their health savings accounts (HSAs) and flexible health spending arrangements to purchase over-the-counter drugs. Sens. Roberts (R-KS) and Heitkamp (D-ND) introduced similar legislation in the Senate (S. 85). Rep. Jenkins’ press release: http://bit.ly/2jnOyQg
  • On January 11, Rep. King (R-IA) introduced four healthcare bills: the Tax Free Health Insurance Act (H.R. 407), which would make every health insurance policy fully tax deductible; the American Future Healthcare Act (H.R. 408), which would expand the use of HSAs; the Meaningful Use Act (H.R.409), which would repeal Stage 3 of the Meaningful Use program; and the End of Life Counseling Bill (H.R.410), which would prohibit Medicare payment for end-of-life counseling. Press releases: http://bit.ly/2jnGZZE and http://bit.ly/2jo0odd and http://bit.ly/2jnVegW
  • Also on January 11, Senate Armed Services Committee Chairman McCain (R-AZ) and Sen. Flake (R-AZ) introduced the Veterans Access, Choice, and Accountability Act (S. 86), which would continue the Veterans Choice program and allow veterans to use their Veterans Choice Card to access health care in their communities. Rep. Roe (R-TN) introduced a similar bill in the House (H.R. 369). Press release: http://bit.ly/2jnXhBF Bill text: http://bit.ly/2jo1pSt
  • On January 12, Rep. Roybal-Allard (D-CA) and 123 Democratic cosponsors introduced the Seniors Have Eyes, Ears, and Teeth Act (H.R. 508), which would expand Medicare coverage to include eyeglasses, hearing aids and dental care. Press release: http://bit.ly/2jnZPA3
  • Also on January 12, Senate Judiciary Chairman Grassley (R-IA), Sens. Casey (D-PA) and Brown (D-OH), and 25 bipartisan cosponsors introduced the Pharmacy and Medically Underserved Areas Enhancement Act (S. 109), which would allow Medicare to pay pharmacists for health care services such as health and wellness screenings, immunizations, and diabetes management. Press release: http://bit.ly/2jnS6C0
  • Also on January 12, Senate Judiciary Chairman Grassley (R-IA) and Sen. Klobuchar (D-MN) introduced the Preserving Access to Affordable Generics Act (S. 124), which would limit pay-for-delay deals between pharmaceutical manufacturers. Press release: http://bit.ly/2jnMK9G

Marketplaces

  • On January 10, CMS released an updated Open Enrollment Snapshot showing that as of December 24, more than 11.5 million individuals signed up for 2017 coverage through the Marketplaces, an increase of 286,000 people compared to last year. Press release: http://go.cms.gov/2jJHTkn Fact sheet: http://go.cms.gov/2jJG5aS
  • On January 11, White House Council of Economic Advisors released an issue brief analyzing recent developments in the individual health insurance market. Report: http://bit.ly/2jo4pxZ
  • Also on January 11, HHS released a blog post highlighting its collaboration with several private companies to help encourage Americans to sign up for Marketplace coverage. Blog post: http://bit.ly/2jnmAUD
  • On January 12, the Treasury Department released a report on alternative work arrangements, finding that one in five 2014 Marketplace consumers was a small business owner or was self-employed, among other findings. Blog post: http://bit.ly/2jnoWCV Report: http://bit.ly/2jnnbFR

ACA Implementation

  • On January 9, HHS, the Department of Labor (DOL), and the Treasury Department jointly released Frequently Asked Questions (FAQ) outlining the current requirements for women’s preventive health services. FAQ: http://go.cms.gov/2iMNRwD
  • Also on January 9, Internal Revenue Service Commissioner Koskinen sent a letter to members of Congress providing information on the tax penalty payments paid by Americans for failing to meet the ACA’s individual mandate in tax years 2014 and 2015. Letter: http://bit.ly/2jyZhow
  • On January 11, HHS released a brief describing the ACA’s role in helping to address opioid abuse. Brief: http://bit.ly/2iMV7Zg
  • Also on January 11, CMS released guidance on standards for health plans and issuers using the HHS-administered federal external review process. The next day, CMS released additional guidance providing instructions on how to elect a federal external review process. Guidance: http://go.cms.gov/2jJDrSu and http://go.cms.gov/2jnBuu9
  • Also on January 12, CMS released FAQs providing guidance on integrating health reimbursement arrangements with group health plans. FAQ: http://go.cms.gov/2iMREdb 

Medicare

  • On January 9, CMS released a final rule establishing new conditions of participation for Medicare and Medicaid home health agencies. Press release: http://go.cms.gov/2iMWmrC Rule: http://bit.ly/2jnHQJL
  • On January 11, CMS released a proposed rule establishing special payment provisions and requirements for practitioners and suppliers to furnish prosthetics and custom fabricated orthotics. Comments are due by March 17. Press release: http://go.cms.gov/2jJIVwJ Rule: http://bit.ly/2jnA7vm
  • On January 13, CMS announced that nearly 12 million people with Medicare have saved over $26 billion on prescription drugs since 2010. Press release: http://go.cms.gov/2jntadV
  • Also on January 13, CMS released a final rule intended to streamline, expedite, and improve the Medicare appeals process. Blog post: http://bit.ly/2jnq8Gp Rule: http://bit.ly/2jnq9Kt

Medicaid/CHIP

  • On January 11, Senate Finance Committee Chairman Hatch (R-UT), House Energy & Commerce Chairman Walden (R-OR), House Energy & Commerce Committee Oversight and Investigations Subcommittee Chairman Murphy (R-PA) and House Energy & Commerce Committee Health Subcommittee Chairman Burgess (R-TX) sent a letter to the Medicaid and CHIP Payment and Access Commission (MACPAC), requesting it analyze the optional Medicaid eligibility and benefit categories that states have chosen to cover, and spending for those categories. Press release: http://bit.ly/2jnsB3F Letter: http://bit.ly/2jnsR2D
  • Also on January 11, CMS released an FAQ providing information on the delivery of family planning services and supplies to Medicaid beneficiaries. FAQ: http://bit.ly/2jJT6l1
  • On January 12, HHS released a report finding that nearly 900,000 Puerto Ricans may lose health coverage due to Medicaid funding shortfalls in the territory. Report: http://bit.ly/2jJORFR
  • Also on January 12, CMS released an FAQ describing health services initiatives under the Medicaid program and how they can be used to improve health outcomes. FAQ: http://bit.ly/2jo3q0W
  • On January 13, CMS released a bulletin describing strategies to support dual eligible beneficiaries’ access to durable medical equipment, prosthetics, orthotics and supplies. Bulletin: http://bit.ly/2jnqA7z
  • Also on January 13, North Carolina Senate Leader Berger and House Speaker Moore announced the North Carolina Legislature had filed a federal complaint to halt North Carolina Governor Cooper’s actions to expand Medicaid in the state. On January 14, the U.S. District Court for the Eastern District of North Carolina granted the Legislature a temporary retraining order. Senate Leader Berger’s press release: http://bit.ly/2jo2IR5

New Payment and Delivery System Models

  • On January 10, CMS released its payment methodology for the Comprehensive Primary Care Plus (CPC+) program. Methodology: http://bit.ly/2jnlWq8
  • On January 12, CMS announced the Pennsylvania Rural Health Model, which establishes all-payer global budgets for participating rural hospitals and will be jointly administered by Pennsylvania and CMS. Press release: http://go.cms.gov/2iMWW8P Fact sheet: http://go.cms.gov/2iMWLKD

Health IT

  • On January 11, ONC released a report on patient-generated health data, highlighting continued opportunities and challenges. Report: http://bit.ly/2jnT9l9
  • Also on January 11, ONC released a fact sheet on permitted uses and disclosures of protected health information for health oversight activities. Fact sheet: http://bit.ly/2jo0fGG
  • On January 12, ONC announced the Phase 2 winners of the Consumer Health Data Aggregator Challenge and the Provider User Experience Challenge, which are both aimed to spur the development of apps allowing consumers to easily aggregate their health data. Press release: http://bit.ly/2iN0c43
  • Also on January 12, CMS released a blog post highlighting its work in using health IT and data to support primary care practices. Blog post: http://bit.ly/2jnmzjt 

Misc.

  • On January 9, Government Accountability Office (GAO) released a report finding that state and local staff would benefit from increased HHS communication and support during public health emergencies. Summary with link to report: http://bit.ly/2jnFfzx
  • Also on January 9, GAO released a report finding that the Indian Health Service has limited, inconsistent oversight over the quality of care at its facilities. Summary with link to report: http://bit.ly/2jnsC7z
  • On January 11, Centers for Disease Control and Prevention (CDC) released the Healthy People 2020 Midcourse Review, which provides a snapshot of progress towards meeting targets halfway through the 10-year initiative. Report: http://bit.ly/2jnT8xQ
  • Also on January 11, HHS released a Request for Information (RFI) seeking responses from health care delivery organizations about current challenges they care facing and potential solutions as they seek to become “learning health care systems.” Responses are due by February 28. RFI: http://bit.ly/2jnXcOp
  • Also on January 1, Food and Drug Administration (FDA) posted an agenda of its planned 2017 new and revised guidance. Agenda: http://bit.ly/2j4JSeS
  • On January 12, HHS released a brief describing a number of challenges facing the Puerto Rican health care system. Brief: http://bit.ly/2jJT6Bf
  • On January 13 HHS released a final rule on the confidentiality of substance use disorder patient records, which seeks to facilitate information exchange among providers. Rule: http://bit.ly/2jz0wnG
  • Also on January 13, CDC released a report finding that Americans living in rural areas have higher death rates and suffer more preventable deaths from the leading causes of mortality, compared to people living in urban areas. Report: http://bit.ly/2jyVHe7
  • Also on January 13, FDA released a discussion paper outlining a possible approach to laboratory developed test (LDT) oversight, which provides both CMS and FDA with regulatory authority. Discussion paper: http://bit.ly/2iJeHs2