What’s Ahead: This Week

Notable Policy Events

  • Sunday, February 19 – Thursday, February 23
    • Healthcare Information and Management Systems Society (HIMSS), “2017 Annual Conference and Exhibition.” Additional information: http://bit.ly/2lHtJRt
  • Thursday, February 23
    • The Value Collaborative and Morning Consult, “A New Negotiation: Moving Payment for Medicines from Volume to Value.” Additional information: http://bit.ly/2lHBs2g
  • Friday, February 24
    • Center for Strategic and International Studies, “Examining the Opioid Epidemic: A Conversation with U.S. Surgeon General Dr. Vivek H. Murthy.” Additional information: http://bit.ly/2lHBcQy

Weekly Wrap Up: Notable Health Care Developments From Last Week

ACA Repeal and Replace Legislative Activity

  • On February 16, Rep. Sanford (R-SC) and five cosponsors introduced the Obamacare Replacement Act (H.R. 1072), which would repeal the ACA and replace it with expansions of Health Savings Accounts, allow for the purchase of insurance across state lines, and would provide tax deductions for the purchase of insurance. Sen. Paul (R-KY) previously introduced a similar bill in the Senate (S. 222). Press release: http://bit.ly/2m3OfYW
  • Also on February 16, House Energy & Commerce Committee Chair Walden (R-OR) and 42 cosponsors introduced the Pre-Existing Conditions Protection Act of 2017 (H.R. 1121), which would prohibit the application of pre-existing coverage exclusions and would guarantee availability of health insurance coverage in the individual and group market, contingent on legislation repealing the ACA. Press release: http://bit.ly/2m42uwJ Bill text: http://bit.ly/2m3KYc5

Other Legislative Activity

  • On February 13, Senate Special Committee on Aging Chair Collins (R-ME) and Sen. Cantwell (D-WA) introduced the Preserve Access to Medicare Rural Home Health Services Act (S. 353), which would extend the rural add-on payment in the Medicare home health benefit. Press release: http://bit.ly/2lzP4w1
  • Also on February 13, Senate Finance Committee Health Subcommittee Ranking Member Stabenow (D-MI) and Sens. Peters (D-MI), Brown (D-OH), and Franken (D-MN) introduced the Hallways to Health Act (S. 356), which would improve access to, and the delivery of, children’s health services through school-based health centers. Rep. Sarbanes (D-MD) and four cosponsors introduced a companion bill in the House (H.R. 1027). Press releases from Sen. Stabenow and Rep. Sarbanes: http://bit.ly/2lRpwH4 and http://bit.ly/2lRmIts
  • Also on February 13, Reps. Dent (R-PA), Payne (D-NJ) and Lance (R-NJ) introduced the Removing Barriers to Colorectal Cancer Screening Act (H.R. 1017), which would waive coinsurance under Medicare for colorectal cancer screening tests, regardless of whether therapeutic intervention is required during the screening. Press release: http://bit.ly/2lRt24i
  • On February 14, Sens. Portman (R-OH), Klobuchar (D-MN), Rubio (R-FL), Hassan (D-NH), and Coons (D-DE) introduced the Synthetics Trafficking & Overdose Prevention (STOP) Act (S. 372) which would require shipments from foreign countries through the postal system to provide electronic advance data when crossing the border to help stop trafficking of dangerous synthetic drugs. House Committee on Ways & Means Ranking Member Neal (D-MA) and Subcommittee on Health Chair Tiberi (R-OH) introduced a companion bill in the House (H.R. 1057). Sen. Portman’s Press release: http://bit.ly/2lzF59U Tiberi’s Press release: http://bit.ly/2lzOBKc
  • Also on February 14, Rep. Byrne (R-AL) introduced the Full Choice for Veterans Act (H.R. 1032), which expands the eligibility of veterans for hospital care and medical services provided by non-Department of Veterans Affairs medical providers under the Veterans Choice Program. Press release: http://bit.ly/2lRmylU Bill text: http://bit.ly/2lRmDWK
  • On February 15, Rep. Lawrence (D-MI) introduced the Timely Mental Health for Foster Youth Act (H.R. 1069), which would ensure that mental health screenings and assessments are provided to children and youth upon entry into foster care. Press release: http://bit.ly/2kMXnA6
  • On February 16, Sen. Isakson (R-GA) and five bipartisan cosponsors introduced the Fair Medicare Hospital Payments Act of 2017 (S. 397), which would establish a national minimum area wage index for Medicare hospital payments. House Budget Chair Black (R-TN) and 14 bipartisan cosponsors introduced a companion bill in the House (H.R. 1130). Press releases from Sen. Isakson and Rep. Black: http://bit.ly/2m3U9Jq and http://bit.ly/2lzHDop
  • Also on February 16, Senate Finance Committee Chair Hatch (R-UT) and Sen. Rubio (R-FL) introduced the Health Savings Account Act of 2017 (S. 403), which would expand Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). Reps. Paulsen (R-MN), Kelly (R-PA) and Jenkins (R-KS) introduced a companion measure in the House (H.R.1175). Sen. Hatch’s Press release: http://bit.ly/2m3Io5T Bill text: http://bit.ly/2m3MM4V
  • On February 16, Sens. Capito (R-WV), Tester (D-MT), and 5 bipartisan cosponsors introduced the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act (S. 413), which would prohibit prescription rug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. Reps. Welch (D-VT) and Griffith (R-VA) introduced a companion bill in the House (H.R. 1038). Sen. Capito’s Press release: http://bit.ly/2kNfXbj Welch’s Press release: http://bit.ly/2kNiPFa
  • Also on February 16, Senate Judiciary Chair Grassley (R-IA) and 8 bipartisan cosponsors introduced the Advancing Care for Exceptional (ACE) Kids Act (S. 428), which would authorize states to provide coordinated care to children with complex medical conditions through enhanced pediatric health homes. Press release: http://bit.ly/2kNtL5H
  • Also on February 16, Sens. Thune (R-SD), Schatz (D-HI) and Wicker (R-MS) introduced the Furthering Access to Stroke Telemedicine (FAST) Act (S. 431), which would authorize Medicare reimbursement for the use of telehealth for individuals with stroke. Rep. Griffith and 10 bipartisan cosponsors introduced a companion bill in the House (H.R. 1148). Rep. Griffith’s Press release: http://bit.ly/2m4i7o4
  • Also on February 16, Reps. Johnson (R-TX) and Walberg (R-MI) introduced the Small Business Health Fairness Act (H.R. 1101), which would amend the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs and small businesses with respect to medical care for their employees. Press release: http://bit.ly/2kNyDYh Summary: http://bit.ly/2kNo5bE
  • Also on February 16, Reps. Murphy (R-PA) and Kind (D-MI) introduced the Secondary Payer Advancement, Rationalization, and Clarification (SPARC) Act (H.R. 1122), which would provide for clarification and rationalization of Medicare prescription drug plan recovery rules for certain claims. Press release: http://bit.ly/2kNpSh7
  • Also on February 16, Rep. Johnson (R-TX) and 36 cosponsors introduced the Patient Access to Higher Quality Health Care Act of 2017 (H.R. 1156), which would repeal a ban on new construction of physician-owned hospitals. Press release: http://bit.ly/2kNeBNO
  • Also on February 16, Reps. Noem (R-SD) and Schakowsky (D-IL) introduced the Medicare Mental Health Access Act (H.R. 1173), which would provide for treatment of clinical psychologists as physicians for the purposes of furnishing clinical psychologist services under the Medicare program. Press release: http://bit.ly/2kNjcPU

ACA Repeal

  • On February 13, Sens. Hassan (D-NH), Carper (D-DE), Brown (D-OH), Klobuchar (D-MN) and Gillibrand (D-NY) sent a letter to HHS Secretary Price urging against changes to the ACA that would increase health insurance costs for older Americans. Press release with text of letter: http://bit.ly/2lLXAs8
  • On February 16, House Republicans released a blueprint for replacing the ACA, which provides for individual tax credits, adjusted based on age, an expansion of health savings accounts, provision of State Innovation Grants for high-risk pools or reducing consumer out-of-pocket costs, and an overhaul of the Medicaid program through per capita caps and a repeal of the ACA’s eligibility expansion. Blueprint: http://bit.ly/2lQYN1m


  • On February 15, CMS issued a proposed rule to stabilize the ACA’s Marketplaces, which proposes to expand re-enrollment verification for special enrollment periods, shorten the open enrollment period for plan year 2018, return network adequacy review to the states, and provides additional flexibility for issuers in calculating actuarial value. Comments are due by March 7. Press release: http://go.cms.gov/2kJGOpw Proposed rule: http://bit.ly/2lzCAEq
  • On February 17, CMS released a proposed bulletin announcing new rate filing deadlines, a revised list of key dates for insurers for 2017, and an addendum to its 2018 letter to federally-facilitated Marketplace issuers incorporating new certification dates. Comments are due by March 7. Bulletin: http://go.cms.gov/2lzL7r0 Key dates: http://go.cms.gov/2lzL6mW Letter: http://go.cms.gov/2lzGOMA
  • Also on February 17, Senate Finance Committee Ranking Member Wyden (D-OR) and HELP Committee Ranking Member Murray (D-WA) sent a letter to HHS Secretary Price noting concern regarding the Trump Administration’s decision to remove consumer information and resources from Healthcare.gov. Letter: http://bit.ly/2lzIVzW


On February 17, CMS announced the award of approximately $20 million to 11 organizations for the first year of a five-year program intended to provide training and education about the Quality Payment Program to clinicians in individual or small group practices. CMS intends to invest up to an additional $80 million over the remaining 4 years. Press Release: http://go.cms.gov/2lfhhpa


On February 13, U.S. Government Accountability Office (GAO) released a report on combatting fraud and abuse in Medicaid personal care services, recommending that CMS improve its data collection processes to enable improved oversight, decision making, external reporting, and monitoring processes. Summary with link to report: http://bit.ly/2m3DCFB

New Payment and Delivery Models

  • On February 15, HHS issued a final rule delaying the effective date of the final rule for the Episodic Payment Models, the Cardiac Rehabilitation Incentive Payment Model, and changes to the Comprehensive Joint Replacement (CJR) model, from February 18 to March 21. Final rule: http://bit.ly/2kS5SdX
  • On February 17, CMS announced a second round of payer solicitations for a January 1, 2018 start in the Comprehensive Primary Care Plus model. Interested payers must submit their proposals by April 3. Announcement: http://bit.ly/23xXKQo

Drug Prices

  • On February 14, Senate Judiciary Chair Grassley (R-IA) and Sens. McCain (R-AZ) and Klobuchar (D-MN) sent a letter to HHS Secretary Price urging him to use his statutory authority to fast track the importation of prescription drugs from Canada under certain circumstances. Press release: http://bit.ly/2lRmPFl Letter: http://bit.ly/2lRlnTo
  • On February 17, HHS Office of Inspector General (OIG) released an online portfolio of recent relevant work relating to drug pricing and reimbursement in HHS programs. Online Portfolio: http://bit.ly/2lfisoL


  • On February 14, Sens. Wicker (R-MS), Tester (D-MT), Grassley (R-IA), and Heitkamp (D-ND) led a group of 37 bipartisan Senators in a letter to HHS Secretary Price emphasizing the importance of rural healthcare providers and their critical role in rural communities. Press release: http://bit.ly/2lLS9cO Letter: http://bit.ly/2lM2Vje
  • Also on February 14, Rep. DeGette (D-CO) sent a letter cosigned by 161 Democratic Representatives to House Speaker Ryan (R-WI) expressing concern for efforts made by Congressional Republicans to undermine the Title X family planning program. Press release: http://bit.ly/2lM9br0 Letter: http://bit.ly/2lM3vxe
  • Also on February 14, HHS released a report on trends in enrollment, eligibility and take-up for employer-sponsored insurance by state Medicaid expansion status from the years 2008-2015, finding that the enrollment rate in private coverage was 2.7% higher in states that expanded Medicaid than in states that did not. Report: http://bit.ly/2m4hevA
  • Also on February 14, Centers for Disease Control and Prevention (CDC) released a report on health insurance estimates for 38 selected states in 2016 National Health Interview Survey Data, estimating that 8.8% of Americans (28.2 million) were uninsured in 2016. Report: http://bit.ly/2kOWIkY
  • On February 15, House Energy & Commerce Ranking Member Pallone (D-NJ), Health Subcommittee Ranking Member Green (D-TX), and Oversight & Investigations Subcommittee Ranking Member DeGette (D-CO) sent a letter to President Trump expressing concern that the Administration’s hiring freeze may jeopardize the National Institutes of Health’s ability to carry out its mission of advancing scientific knowledge to improve human health. Press release: http://bit.ly/2m3Z7Ww Letter: http://bit.ly/2m44uF4
  • Also on February 15, CMS released projections of national health expenditure data for 2016 through 2025, estimating that national health spending growth is projected to average 5.6 percent annually over the period. Press release: http://go.cms.gov/2lzGLAi Data: http://go.cms.gov/2lzLhi1 Health Affairs Article: http://bit.ly/2lzz6ls
  • Also on February 15, U.S. Government Accountability Office (GAO) released a report finding that some Veterans Health Administration medical facilities did not follow all required procedures, and some skipped required inspections. Summary with link to report: http://bit.ly/2lrFQkN
  • On February 16, HHS announced a $5.5 million settlement agreement with Memorial Healthcare Systems due to potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. Press Release: http://bit.ly/2kQGO7h
  • Also on February 16, HHS issued final rules delaying the effective dates of two recent final rules. The first, on substance use disorder patient record data sharing was delayed from February 17 to March 21, the second, Possession, Use, and Transfer of Select Agents and Toxins was pushed from February 21 to March 21. Final rules: http://bit.ly/2lbQsSO and http://bit.ly/2kxskwN
  • On February 17, CDC released a report finding that in 2013, 18% of office-based primary care physicians worked in patient-centered medical home practices. Report: http://bit.ly/2lzKoWZ