Pending Trade Legislation Would Extend Medicare Sequestration

The House and Senate are considering trade legislation that would be financed in part by $700 million from extended Medicare sequestration authority – much to the consternation of the health care provider community.

By way of background, under the “Protecting Access to Medicare Act of 2014” (PAMA), Congress “front-loaded” the Medicare reimbursement cuts under the Budget Control Act’s sequestration authority for FY 2024 to capture all of the sequestration savings during the first half of FY 2024, which fell into PAMA’s 10-year budget scoring window. Specifically, the 2% annual cap on Medicare provider payment cuts was raised to 4% for the first six months of FY 2024, and then was scheduled to drop to 0% for the second half of FY 2024.

Under trade legislation approved by the House Ways and Means Committee and the Senate Finance Committee (the Trade Adjustment Assistance Act), the sequester on Medicare spending would be extended to the second half of FY 2024, but the cap would be set at 0.25%. The Congressional Budget Office estimates that this provision would raise $700 million. The full House and Senate have not yet approved the bills, but it suggests that lawmakers are getting increasingly comfortable with using future Medicare sequestration to fund Medicare and non-Medicare programs.

House Approves "Ensuring Patient Access and Effective Drug Enforcement Act"

On April 21, 2015, the House of Representatives approved H.R. 471, the Ensuring Patient Access and Effective Drug Enforcement Act of 2015. The bipartisan legislation would clarify the Controlled Substances Act to establish consistent enforcement standards intended to protect against diversion while promoting patient access to medically-necessary controlled substances. 

Two Health Policy Laws Enacted, Additional Bills Advance

On August 8, 2014, President Obama signed into law the following two bills approved by the Senate in July:

  • H.R. 4631, the Autism CARES Act, to continue federal research, early identification and intervention, and education related to autism; and
  • H.R. 3548, the Improving Trauma Care Act, to include in the Public Health Service Act definition of trauma injuries caused by thermal, electrical, chemical, or radioactive force.

In addition, prior to beginning the August recess, the House of Representatives approved the following bills:

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Bipartisan Health Bills Advance

This week the House is scheduled to consider five bipartisan public health bills addressing traumatic brain injuries, newborns, trauma patients, and individuals with autism. Specifically, the House is expected to vote on the following:

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Full Energy and Commerce Committee Approves Three Bipartisan Health Bills

On June 10, 2014, the full House Energy and Commerce Committee approved by voice vote three bipartisan public health bills:

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House Panel Approves Bipartisan SGR Reform Bill

On July 23, 2013, the House Energy and Commerce Health Subcommittee approved legislation to repeal the Medicare physician fee schedule SGR formula and replace it with a period of stable payment followed by reimbursement linked to quality of care. In the first phase, the legislation would set the fee schedule update for each of years 2014 through 2018 at 0.5%. During this time, the current law payment incentives, such as the PQRS and the EHR Incentive Program will continue. After that 5-year period, providers will receive an annual update of 0.5%, but an additional update adjustment would be based on quality performance under a new Update Incentive Program (UIP). Eligible professionals could choose at any time to opt-out of the fee-for-service program and participate in alternative payment models. The bill also requires the Secretary to implement a system for the periodic reporting by physicians of data on the accuracy of relative values for physician services, such as data relating to service volume and time; the Secretary could provide incentive payments to providers for reporting this data. The bill also directs Medicare to identify improperly valued services to reduce net physician fee schedule expenditures by 1% per year for 2016 through 2018 (not budget neutral).  The full Committee is expected to vote on the legislation later this week.

House Panel Approves Changes to Medicare Secondary Payer (MSP), Medical Loss Ratio Rules

On September 20, 2012, the House Energy and Commerce Committee approved by voice vote H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act. The legislation would make a series of procedural changes to MSP rules intended to “speed up the process of returning money to the Medicare Trust Fund while reducing costly legal barriers for both large and small employers.” The panel also approved on a 16-14 vote H.R. 1206, the Access to Professional Health Insurance Advisors Act. The legislation would amend the Affordable Care Act’s (ACA) health insurance medical loss ratio (MLR) rules to exclude from the calculation of the MLR certain commissions paid to independent insurance brokers and agents. H.R. 1206 also would require HHS to defer to a state's determinations as to whether enforcing the MLR requirement will destabilize their respective individual or small group health insurance markets. Neither bill has been considered by the full House to date.

House Committee Approves Health Legislation

On July 28, 2010, the House Energy and Commerce Committee approved a variety of health policy bills, including the following: H.R. 903, the “Dental Emergency Responder Act of 2010” (amended); H.R. 1745, the “Family Health Care Accessibility Act of 2010” (amended); H.R. 2923, the “Combat Methamphetamine Enhancement Act of 2010”, H.R. 3199, the “Emergency Medic Transition Act of 2010” (amended); H.R. 3470, the “Nationally Enhancing the Wellbeing of Babies through Outreach and Research Now Act of 2010” (amended); H.R. 5710, the “National All Schedules Prescription Electronic Reporting Reauthorization Act of 2010” (amended); H.R. 5756, the “Training and Research for Autism Improvement Nationwide Act of 2010” (amended); and H.R. 5809, the “Safe Drug Disposal Act of 2010” (amended). The legislation now awaits action by the full House.  

Generic Drug Competition

The Senate Judiciary Committee has approved S. 369, the Preserve Access to Affordable Generics Act, which generally would prohibit brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market. As approved by the Committee, the bill would allow certain settlement agreements between drug companies if they enhance competition, and it would establish penalties for violations of the act. 

House Panel Approves Bill to End Insurance Anti-Trust Protections

The House Judiciary Committee has passed H.R. 3596, the Health Insurance Industry Antitrust Enforcement Act of 2009. H.R. 3596 would prohibit companies that provide health and medical malpractice insurance from price fixing, bid rigging, or allocating markets while providing coverage for health insurance or medical malpractice claims. The Congressional Budget Office (CBO) estimates that the legislation would have no significant effect on the premiums that private insurers would charge for health insurance, in part because state laws already bar the activities that would be banned under federal law. 

Medical Isotopes Production

On October 21, 2009, the House Commerce Committee approved H.R. 3276, the American Medical Isotopes Production Act. The legislation is intended to provide the Department of Energy with new authority and funding to assist private sector projects to establish a steady domestic supply of the medical isotope molybdenum-99.  

Senate Panel Approved HHS Appropriations Bill

On August 4, 2009, the Senate Appropriations Committee approved an amended version of H.R. 3293, legislation to fund the Departments of Labor, HHS, and Education for FY 2010, which begins October 1, 2009. The bill, which was cleared by the full House on July 24, 2009, now awaits consideration by the full Senate. 

Whistleblower Protection, Improper Payments Legislation Advances

The Senate Homeland Security and Governmental Affairs Committee has approved S. 372, the "Whistleblower Protection Enhancement Act of 2009." Among other things, the Committee-approved bill would: clarify that federal employees are protected for disclosure of waste, fraud, or abuse made as part of an employee's job duties; clarify that whistleblowers may disclose evidence of censorship of scientific or technical information under the same standards that apply to other disclosures; and create a “Whistleblower Ombudsman” in every Inspector General office.  The panel also approved S.1508, the "Improper Payments Elimination and Recovery Act,” which would strengthen requirements for federal agencies to report and correct overpayment errors.  The bills now await consideration by the full Senate.

Senate HELP Committee Approves Bill; Finance Committee Stalls

On July 15, 2009, the Senate Committee on Health, Education, Labor, and Pensions (HELP) approved its health reform plan, the Affordable Health Choices Act,” on a party-line 13-to-10 vote. The major features of the legislation are summarized in a previous posting. Note that the HELP Committee does not have jurisdiction over Medicare or Medicaid; provisions impacting those programs will be included in the Senate Finance Committee health reform bill. A group of Finance Committee members are still meeting to agree on a bipartisan bill, but panel members are no longer predicting when the details of a compromise package may be released. After Finance Committee action, the two Committee packages then will be combined for consideration by the full Senate, likely sometime in the fall.

Sept. 2, 2009 update: The HELP Committee has finally released the version of the health reform bill adopted by the panel on July 15, 2009.


Status of House Tri-Committee Bill

As previously reported, on June 17, 2009, the chairmen of the three House committees that share jurisdiction over health policy released a “discussion draft” of their comprehensive health reform plan. A revised version of the bill, the America's Affordable Health Choices Act of 2009 (H.R. 3200), was unveiled on July 14, 2009. In short, the legislation would: create a public health insurance plan to compete with private insurers; expand access to insurance include low-income subsidies, creation of a health insurance exchange, Medicaid expansion, and private insurance market reforms; impose mandates for individuals to purchase insurance and employers to contribute to health care costs (with certain exceptions); and make extensive Medicare and Medicaid policy changes affecting virtually every type of health care entity. On July 17, 2009, the Ways and Means Committee approved H.R. 3200, followed the same day by House Education and Labor Committee approval of an amended version of the legislation. The third House committee with jurisdiction -- Energy and Commerce -- began consideration of the legislation on July 17. Energy and Commerce Committee markup has been suspended, however, while Chairman Henry Waxman negotiates with more conservative Democratic members of the panel concerned with the costs of the bill and other features of the legislation, such as regional disparities in payment levels. Eventually the work of the three committees will be melded into one bill for a House vote, followed by reconciliation with the Senate package later in the year.

Senate HELP Committee Approves Health Reform Legislation

On July 15, 2009, the Senate Committee on Health, Education, Labor, and Pensions (HELP) approved its health reform plan, the “Affordable Health Choices Act,” on a party-line 13-to-10 vote. In addition to significant insurance reforms, including a public health plan option, the legislation addresses a variety of other health policy issues, such as health care quality, health care workforce issues, preventive care, chronic care management, and a regulatory approval process for follow-on biologicals. The major features of the legislation are outlined below.

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Tobacco Regulation

On May 20, 2009, the Senate Health, Education, Labor and Pensions (HELP) Committee approved an amended version of S. 982, the "Family Smoking Prevention and Tobacco Control Act,” which would provide the FDA with certain authority to regulate tobacco products.  

False Claims Act Enforcement

On March 5, 2006, the Senate Judiciary Committee approved an amended version of S.386, the "Fraud Enforcement and Recovery Act." Among other things, the bill would “clarify” that the False Claims Act was intended to extend to any false or fraudulent claim for government money or property, whether or not the claim is presented to a government official or employee, whether or not the government has physical custody of the money, and whether or not the defendant specifically intended to defraud the government. 

House Panel Approves Tobacco Regulation and Other Health Measures

On March 4, 2009, the House Energy and Commerce Committee approved the following health policy bills: H.R. 1256: Family Smoking Prevention and Tobacco Control Act; H.R. 1259, the Dextromethorphan Distribution Act of 2009; H.R. 1246, the Early Hearing Detection and Intervention Act of 2009; H.R. 1253, the Health Insurance Restrictions and Limitations Clarification Act of 2009; H.R. 20, the Melanie Blocker Stokes Mom's Opportunity to Access Health Education, Research, and Support for Postpartum Depression Act; H.R. 479, the Wakefield Act (addressing emergency medical services for children); H.R. 577, the Vision Care for Kids Act of 2009; H.R. 756, the National Pain Care Policy Act of 2009; H.R. 914, the Physician Workforce Enhancement Act of 2009; and H.R. 307, the Christopher and Dana Reeve Paralysis Act. The legislation now moves to the full House for further consideration. 

Committee Markups

On September 10, 2008, the Senate Finance Committee approved an amended version of S. 1070, the “Elder Justice Act of 2008.”  The legislation includes a number of provisions aimed at protecting residents of nursing facilities, including a requirement that crimes occurring in federally-funded long-term care facilities be reported to law enforcement agencies; increased funding for training of long-term care ombudsmen and surveyors investigating allegations of abuse, neglect, and misappropriation of property in long-term care facilities; notification and planning requirements in the event of an impending nursing facility closure; and incentives for individuals to train for employment as direct care providers in long-term care facilities. The panel also approved an amended version of S. 1577, the “Patient Safety and Abuse Prevention Act of 2008,” which would, among other things, expand requirements for background checks employees of long-term care facilities with direct patient access. Separately, on September 11, the Senate Judiciary Committee approved S. 2838, the "Fairness in Nursing Home Arbitration Act"; which would render unenforceable pre-dispute arbitration agreements between long-term care facilities and residents. The House Judiciary Committee approved its version of the measure, H.R. 6126, on July 30, 2008

Older Entries

July 29, 2008 — Health IT Legislation

July 29, 2008 — Nursing Home Arbitration

July 29, 2008 — False Claims Act Amendments

July 29, 2008 — Animal Drug User Fees

July 9, 2008 — Health IT Legislation Approved by House Panel

July 9, 2008 — Labor-HHS Appropriations Approved by Senate Committee

July 8, 2008 — Animal Drug User Fees

June 19, 2008 — Elder Justice Act