Following a similar initiative on the House side, leaders of the Senate Finance Committee are inviting provider input on Medicare physician payment system reform. Specifically, Chairman Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT) are requesting information on: (1) what specific reforms should be made to the physician fee schedule to ensure that physician services are valued appropriately; (2) what specific policies should be implemented that could co-exist with the current physician payment system and would identify and reduce unnecessary utilization to improve health and reduce Medicare spending growth; and (3) within the current fee-for-service system, how can Medicare most effectively incentivize physician practices to undertake the structural, behavioral, and other changes needed to participate in alternative payment models? Additional information, including a full copy of letter from Senators Baucus and Hatch to the health care provider community, is available here. Responses are due by May 31, 2013. The panel also has scheduled a May 14 hearing on "Advancing Reform: Medicare Physicians Payments."
On May 8, 2013, the House Energy and Commerce Subcommittee on Health approved by voice vote H.R. 1407, legislation to reauthorize and combine the Animal Drug User Fee Act and the Animal Generic Drug User Fee Act. TheEnergy and Commerce Committee also recently held hearings on: the Administration’s HHS budget proposal; the Center for Consumer Information and Insurance Oversight and implementation of the ACA; the lack of transparency and consumer driven market forces in U.S. health care system; and the impact of HIPAA on patient care and public safety. The House Ways and Means Health Subcommittee held a hearing on Medicare physician payment reform, and the Senate Finance Committee has scheduled a May 14 hearing on this topic. Other Senate panels also recently held hearings on health policy issues, including: a HELP Committee hearing on "Successful Primary Care Programs: Creating the Workforce We Need"’ a Homeland Security Committee hearing on “Oversight and Business Practices of Durable Medical Equipment Companies”; and a Special Committee on Aging hearing on "The National Plan to Address Alzheimer's Disease: Are We On Track to 2025?"
Key members of the Senate Health, Education, Labor, and Pensions Committee have released a bipartisan draft legislative proposal intended to improve drug distribution security. The legislation addresses, among other things: lot-level product tracing requirements for “downstream” pharmaceutical supply chain members (drug manufacturers, repackagers, wholesale distributors, and dispensers); a requirement that manufacturers serialize prescription drugs at the unit level; national licensure standards for wholesale distributors and third-party logistics providers; a requirement that members of the supply chain only transact with registered or licensed entities; and preemption of state product tracing requirements, including paper or electronic pedigree systems. The lawmakers will accept comments on the draft legislation until April 26, 2013. In a related development, the House Energy and Commerce Subcommittee on Health has scheduled an April 25 hearing on "Securing Our Nation's Prescription Drug Supply Chain,” which will focus on a House companion version of the draft “track and trace” legislation intended to secure pharmaceutical distribution.
Update: On May 8, 2013, the House Energy and Commerce Health Subcommittee approved by voice vote an amended version of its “track and trace” legislation intended to secure pharmaceutical distribution.
Earlier this month, the Senate Finance Committee held a hearing on the nomination of Marilyn Tavenner to be CMS Administrator. The Senate Health, Education, Labor, and Pensions (HELP) Committee approved the Mental Health Awareness and Improvement Act, legislation that reauthorizes and amends programs administered by both HHS and the Department of Education related to awareness, prevention, and early identification of mental health conditions. The HELP Committee also held a hearing on the effect of guaranteed issue and new insurance rating rules. A House Ways and Means Committee hearing focused on details of the President’s FY 2014 budget proposals for HHS programs. The House Energy and Commerce Committee held hearings on the ACA’s Pre-Existing Condition Insurance Program, reauthorization of FDA animal drug user fees, and “Challenges of Traditional Medicare's Benefit Design.” The Energy and Commerce Committee also plans an April 16 hearing on the fungal meningitis outbreak and whether it could have been prevented, along with an April 18 hearing on the Administration’s HHS budget proposal.
The chairmen of the House Energy and Commerce Committee and Ways and Means Committee have provided additional details regarding their proposal to repeal the current Medicare physician fee schedule sustainable growth rate (SGR) methodology and replace it with an alternative physician payment system. The update builds on comments received from the public on the panels’ February 7, 2013 outline. Among other things, the expanded proposal discusses processes to determine quality and efficiency measures that focus on evidence while being flexible and specialty-specific; recognizes the role that specialty-specific registries play in quality improvement; and addresses timely performance feedback for providers. Comments will be accepted until April 15 at email@example.com.
Today, the Obama Administration released its proposed federal budget for fiscal year 2014. As widely reported, the budget incorporates an offer the President made to Congress in December 2012 to achieve nearly $1.8 trillion in additional deficit reduction over the next 10 years, including $401 billion in health savings (the Administration observes that this level of cuts would “provide more than enough deficit reduction to replace the damaging cuts required by the Joint Committee sequestration”).
Virtually all provider types – and drug manufacturers – would be impacted by the budget provisions, if adopted as proposed. The budget proposal is certainly subject to change during the legislative process, particularly as the House and Senate leadership pursue alternative budget frameworks, and indeed, gridlock could prevent significant action on entitlement reform this year. Nevertheless, the proposals bear careful monitoring because they could eventually be included in any long-elusive “grand bargain” to reform the Medicare program and reduce the federal debt.
Highlights of the Administration’s Medicare and Medicaid proposals include the following:Continue Reading...
On March 26, 2013, President Obama signed into law H.R. 933, a continuing resolution that averts a government shutdown by funding the government through the remainder of fiscal year 2013 (through September 30, 2013). The funding bill is subject to the sequestration order triggered by the Budget Control Act, although funding was increased for a limited number of HHS programs (including funding for community health centers and certain National Institutes of Health activities). The funding bill keeps in place the 2% Medicare provider cuts triggered under the Budget Control Act’s sequestration provisions. It also authorizes the Food and Drug Administration to continue collecting industry user fees to fund agency operations.
Recent Congressional hearings have addressed a number of health policy issues. For instance, the House Energy and Commerce Committee held a series of hearings on health information technologies, covering the Administration’s perspectives on innovation and regulation (including a discussion of the Administration’s policies on regulation of mobile medical apps), how innovation benefits patients, and “harnessing wireless innovation.” http://energycommerce.house.gov/press-release/three-day-hearing-series-produces-much-needed-certainty-patients-providers-and-innovators. Separately, a Health Subcommittee hearing focused on Medicare and Medicaid entitlement reform. In addition, the Senate Finance Committee held a hearing on health care delivery reform, focusing on the Center for Medicare and Medicaid Innovation efforts.
On March 20, 2013, the Senate Committee on Health, Education, Labor, and Pensions approved an amended version of S. 330, a bill to amend the Public Health Service Act to establish safeguards and standards of quality for research and transplantation of organs infected with human immunodeficiency virus (HIV). Among other things, the bill would remove the ban on research of organ transplantation from HIV-positive donors to HIV-positive recipients. If such research shows that these transplants can be conducted safely, the bill authorizes organ donation standards to be updated accordingly. The panel also approved an original bill to reauthorize the Animal Drug User Fee Act and Animal Generic Drug User Fee Act.
On March 4, 2013, the House gave final approval to H.R. 307, the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, after approving amendments adopted by the Senate on February 27, 2013. The legislation reauthorizes programs intended to strengthen the nation's preparedness infrastructure and support development of medical countermeasures to respond to chemical, biological, radiological, and nuclear attacks. The legislation now awaits the President’s signature.
There have been many Congressional health policy hearings recently, with more scheduled. Highlights include the following:
- House Ways and Means Committee. Recent hearings have examined traditional Medicare’s benefit design and tax-related provisions in the ACA, and on March 15, the Health Subcommittee is holding a hearing on the Medicare Payment Advisory Commission's annual March Report to the Congress.
- House Energy and Commerce Committee. The Health Subcommittee has reviewed innovative ways to fight health care fraud and abuse, and the panel has scheduled hearings on the impact of the ACA on jobs (March 13) and health insurance premiums (March 15). A March 18 hearing will focus on “Saving Seniors and Our Most Vulnerable Citizens from an Entitlement Crisis.”
- Senate Hearings. The Finance Committee held a hearing on the status of CMS delivery reform efforts. A Health, Education, Labor and Pensions Committee hearing examined animal drug user fees. The Commerce Committee has reviewed transparency in the individual health insurance market. An Aging Committee hearing focused on ways to strengthen Medicare.
Due to continuing budget gridlock in Washington, sequestration has been triggered – meaning automatic cuts to a wide range of federal programs, including Medicare payments to providers and health plans. While the Centers for Medicare & Medicaid Services has not yet announced detailed plans for implementing the sequester requirements for its programs, this Alert answers some basic questions about sequestration and how it will impact the Medicare program. Among other things, the Alert addresses what Medicare spending is impacted by sequestration, when the Medicare cuts start, and how long sequestration will last.
The Chairmen of the House Ways and Means Committee and House Energy and Commerce Committee are inviting comments on the outline of a proposal to permanently repeal the sustainable growth rate (SGR) formula for updating Medicare physician fee schedule payments and institute other payment reforms. The lawmakers are considering a three-phase proposal. In the first phase, the SGR formula (which Congress has repeatedly overridden to avoid sharp reimbursement cuts) would be repealed, which would eliminate an estimated 25% across-the-board rate cut in 2014 and any future SGR cuts. In its place, the plan would provide an unspecified “period of predictable, statutorily-defined payment rates.” In phase two, the plan would link payment to performance on physician-endorsed measures of quality of care, while in phase three, physicians could earn additional payments based on efficiency of care. The Committees also are considering addressing several other related issues, including gainsharing, medical liability reform, Independent Payment Advisory Board repeal, and private contracting/balance billing. Comments will be accepted on the plan until February 25, 2013 at SGRComments@mail.house.gov.
The full House of Representatives has passed three health policy bills recently cleared by the House Energy and Commerce Committee. On February 4, 2013, the House approved H.R. 297, the Children’s Hospital Graduate Medical Education (GME) Support Reauthorization Act of 2013 (which provides support to children’s hospitals for pediatric medical residency programs), and H.R. 225, the National Pediatric Research Network Act of 2013 (to allow the National Institutes of Health to fund pediatric research networks to conduct research on conditions and diseases affecting children. In addition, on February 12, 2013, the House approved H.R. 235, the Veteran Emergency Medical Technician (EMT) Support Act, which would provide funding to states with EMT shortages to streamline licensing requirements for military veteran EMTs. The bills now await Senate action.
House Energy and Commerce subcommittees have held hearings on “Influenza: Perspective on Current Season and Update on Preparedness” and on “SGR: Data, Measures and Models; Building a Future Medicare Physician Payment System.” On the Senate side, the Senate Health, Education, Labor, and Pensions Committee voted to approve H.R. 307, the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (which was approved by the House last month), and S. 252, “The Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Act.” In addition, the Finance Committee held a hearing on ACA health insurance exchanges.
A bipartisan group of Senate Finance Committee members has released a report summarizing recommendations solicited from public and private sector health care stakeholders for improving efforts to address Medicare and Medicaid waste, fraud, and abuse. During the new session of Congress, the Senators intend to review and consider the proposals and recommendations submitted by approximately 150 individual health care professionals, corporate stakeholders, and associations and work to develop administrative recommendations and potential legislative actions. In general, the stakeholder recommendations focus on five areas: improper payments, beneficiary protection, audit burden, data management, and enforcement . Recommendations include, for example, eliminating duplication in federal and state Medicare/Medicaid anti-fraud programs, improving the efficiency of the various CMS audit contractors, and creating an advisory panel to provide clinical input as part of contractor oversight.
On February 14, 2013, the House Energy and Commerce Health Subcommittee is holding a hearing entitled “SGR: Data, Measures and Models; Building a Future Medicare Physician Payment System.”
On January 22, 2013, the House of Representatives approved H.R. 307, the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, by a bipartisan vote of 395 to 29. The legislation would reauthorize programs intended to strengthen the nation's preparedness infrastructure and support development of medical countermeasures to respond to chemical, biological, radiological, and nuclear attacks. The legislation now awaits Senate action.
The House Energy and Commerce Committee approved three health policy bills on January 22, 2013, versions of which were passed by the full House during the last Congress. Specifically, the panel voted to approve: H.R. 297, the Children’s Hospital Graduate Medical Education (GME) Support Reauthorization Act of 2013 (which provides support to children’s hospitals for pediatric medical residency programs); H.R. 225, the National Pediatric Research Network Act of 2013 (to allow the National Institutes of Health to fund pediatric research networks to conduct research on conditions and diseases affecting children); and H.R. 235, the Veteran Emergency Medical Technician (EMT) Support Act (which would provide funding to states with EMT shortages to streamline licensing requirements for military veteran EMTs).
The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on January 24, 2013 to assess the state of America’s mental health system. In addition, the HELP Subcommittee on Primary Health and Aging held a January 29 hearing entitled “30 Million New Patients and 11 Months to Go: Who Will Provide Their Primary Care?”