This Week in Washington: Still No Speaker in the House; NIH Director Nominee has Hearing; FDA Seeking Feedback on Innovative Drug Clinical Trial Design.
On Oct. 19, the House Energy and Commerce Committee Subcommittee on Health held a legislative hearing and considered 23 bills concerning Medicare payment for providers. The witnesses were:
- Meena Seshamani, M.D., Ph.D., Director of the Centers for Medicare and Medicaid Services Center for Medicare
- Leslie Gordon, MPP, Director of Health Care at the Government Accountability Office
- Paul Masi, MPP, Executive Director of the Medicare Payment Advisory Commission
- Steven Furr, M.D., FAAFP, President-Elect of the American Academy of Family Physicians
- Debra Patt, M.D., Ph.D., MBA, Executive Vice President of Texas Oncology
- Joe Albanese, MPP, Senior Policy Analyst of Paragon Health Institute
- Matthew Fiedler, Ph.D., Joseph A. Pechman Senior Fellow in Economic Studies at the Brookings Institution Brookings Schaeffer Initiative on Health Policy
The bills discussed in the hearing are:
H.R.__, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program
This legislation would extend a policy to increase the work geographic index for Medicare physician payments to 1.00 for any locality where the index would be less than 1.00.
H.R.__, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program and to improve the accuracy of geographic adjustment factors under such a program
This legislation would extend a policy to increase the work geographic index for Medicare physician payments to 1.00 for any locality where the index would be less than 1.00 and would include reforms to improve the accuracy of geographic data adjustment factors.
H.R. 2377, the Saving Access to Laboratory Services Act
This legislation would direct the Centers for Medicare and Medicaid Services (CMS) to use statistical sampling of private-payer rates when establishing Medicare reimbursement amounts for clinical diagnostic tests.
H.R.__, To amend title XVIII of the Social Security Act to revise the phase-in of clinical laboratory test payment changes under the Medicare program
This legislation would delay changes to how clinical laboratories are paid under the Medicare program until Jan. 1, 2025.
H.R.__, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models
This legislation would extend incentive payments for participation in eligible alternative payment models through 2026 and would establish a 5-year cap on payment incentives for qualifying participants.
H.R.__, the Improving Seniors Timely Access to Care Act of 2023
This legislation would require Medicare Advantage plans with prior authorization requirements to establish an electronic prior authorization program.
H.R. 1352, the Increasing Access to Biosimilars Act of 2023
This legislation would create a new pilot program to evaluate the benefits of providing more shared savings payments to biosimilar providers under Medicare.
H.R.__, the Provider Reimbursement Stability Act of 2023
This legislation would increase the Physician Fee Schedule (PFS) budget neutrality threshold, set a limitation on year-to-year conversion fact (CF) variance and require the Secretary of the Department of Health and Human Services (HHS) to update prices and rates for direct cost inputs for practice expense (PE) relative value units (RVUs).
H.R. 5526, the Seniors’ Access to Critical Medications Act of 2023
This legislation would make permanent a CMS waiver that allows Medicare patients to receive medications through the mail and allows family members and caregivers to obtain medications on the patient’s behalf.
H.R. 1406, the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act
This legislation would allow cardiopulmonary rehabilitation services to be furnished via telehealth from a beneficiary’s home permanently.
H.R. 2583, the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2023
This legislation would allow nurses and physician assistants to supervise and administer Medicare cardiac rehabilitation care programs.
H.R.__, To amend title XVIII of the Social Security Act to exempt certain practitioners from MIPS payment adjustments under the Medicare program based on participation in certain payment arrangements under Medicare Advantage
This legislation would allow practitioners who participate in certain Medicare Advantage payment arrangements to be exempted from MIPS reporting requirements and adjustments.
H.R. 4402, To amend title XI of the Social Security Act to clarify manufacturer transparency reporting requirements for certain transfers used for educational purposes
This legislation would clarify that manufacturers of a covered drug, device, biological or medical supply will not be required to submit information regarding educational materials that directly benefit patients.
H.R. 3674, the Providing Relief and Stability for Medicare Patients Act of 2023
This legislation would increase the non-facility practice expense relative value units for certain Medicare services.
H.R.__, To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals
This legislation would modify the physician self-referral exemptions related to Physician-Owned Hospitals (POHs) for certain rural hospitals.
H.R.__, the Fewer Burdens for Better Care Act of 2023
This legislation would require the HHS Secretary to provide a 30-day public comment period for stakeholders to provide feedback on quality and efficiency measures that should be considered for removal.
H.R. 5395, the SURS Extension Act
This legislation would extend the Quality Payment Program-Small Practice, Underserved, and Rural support program for fiscal years (FYs) 2024-2029.
H.R.__, To amend title XVIII of the Social Security Act to promote provider choice using real-time benefit information
This legislation would require prescription drug plan (PDP) sponsors to provide patients real-time information related to formularies and benefit information within one year of enactment.
H.R. 5555, the DMEPOS Relief Act of 2023
This legislation would require the HHS Secretary to provide certain adjustments to Medicare payment for items and medical equipment that were included in round 2021 of the Durable Medical Equipment, Prosthetics/Orthotics and Supplies (DMEPOS) competitive bidding program.
H.R. 4104, the Preserving Patient Access to Home Infusion Act
This legislation would allow nurse practitioners and physician assistants to establish and review home infusion plans of care and require CMS to pay home infusion providers for drugs administered to patients on a daily basis.
H.R. 4878, the EMPOWER Act
This legislation would remove direct supervision requirements for physical therapy assistants and occupational therapy assistants and would require the U.S. Government Accountability Office (GAO) to analyze how the Medicare Part B 15 percent payment differential for services provided by therapy assistants has affected access to therapy services.
H.R.__, the Telehealth Privacy Act of 2023
This legislation would prohibit the HHS Secretary from making a physician’s or practitioner’s address of residence publicly available if they choose to provide telehealth services from that address.
H.R.__, To amend title XVIII of the Social Security Act to allow for the use of alternative measures of performance under the Merit-based Incentive Payment System under the Medicare program
This legislation would grant MIPS reporting flexibility to physicians who perform the majority of their work in a facility-based setting.
For more information, click here.
On Oct. 18, the House Ways and Means Committee held a roundtable with officials from the Departments of Health and Human Services, Labor and Treasury, regarding the implementation of the No Surprises Act.
On Sept. 19, the committee held a hearing to discuss the ability of small practices to access the system for arbitration, and other issues including network restrictions, payment reductions and dispute resolution process delays.
For more information, click here.
On Oct. 18, Reps. DelBene (D-WA), Miller (R-WV), Cardenas (D-CA) and Bucshon (R-IN) sent a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure urging CMS to expand access and coverage of home dialysis for Medicare patients with acute kidney injury (AKI).
For more information, click here.
On Oct. 18, the Senate Finance Committee held a hearing regarding “ghost networks” and common deceptive marketing practices that target Medicare Advantage (MA) beneficiaries during the Annual Open Enrollment period. The witnesses were:
- Christina Reeg, Senior Health Insurance Information Program Director at the Ohio Department of Insurance
- Cobi Blumenfeld-Gantz, Co-Founder and Chief Executive Officer of Chapter
- Krista Hoglund, ASA, MAAA, Chief Executive Officer of Security Health Plan
During the hearing, committee Chairman Ron Wyden (D-OR) stressed the importance of eliminating MA “ghost networks.”
In addition, the Chairman and Sens. Bennet (D-CO) and Tillis (R-NC) introduced the Requiring Enhanced and Accurate Lists (REAL) of Health Providers Act. The bill would require MA plans to maintain accurate and updated provider directories and would protect patients from paying for care obtained at providers that were incorrectly listed as being in-network.
For more information on the hearing, click here.
For more information on the bill, click here.
On Oct. 18, the Senate Health, Education, Labor and Pensions (HELP) committee held a hearing on the nomination of Monica Bertagnolli to be Director of the National Institutes of Health (NIH).
In his questioning of Dr. Bertagnolli, Chairman Bernie Sanders (I-VT) focused on reducing the cost of prescription drugs, which is not in the purview of the NIH. Ranking Member Bill Cassidy (R-LA) asked if Dr. Bertagnolli would apply Reasonable Pricing Clauses to NIH contracts.
The committee will vote on whether to send Dr. Bertagnolli’s nomination to the Senate floor on Oct. 25.
For more information, click here.
On Oct. 19, Sens. John Thune (R-SD), Maggie Hassan (D-NH) and Marsha Blackburn (R-TN) introduced the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Disease (IMD) Options Act, a bill to make permanent the Medicaid option for states to treat adults with substance use disorders in facilities larger than 16 beds. This legislation comes several weeks after Congress allowed the SUPPORT Act to expire. Without this state plan amendment pathway, states are bound to the so-called IMD exclusion where they cannot use federal funds to pay for a patient’s behavioral health treatment at a hospital, nursing home or other facility that has more than 16 beds.
The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, included a state plan option in Medicaid that allowed federal Medicaid funds to be used for patients in IMD with substance use disorder.
For the text of the legislation, click here.
Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.