Hall Render Meets with Energy and Commerce Committee Staff on Telemedicine Initiative

On July 15, Hall Render attorneys John Williams, Jeff Short and Michael Batt met with professional staff at the House Energy and Commerce Committee to discuss what steps Congress can take to remove the legislative and regulatory barriers that currently impede the advancement of telemedicine and telehealth technology. The meeting was in follow up to a letter sent by a coalition of health systems organized by Hall Render in response to a request for comment from Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-PA) and Ranking Member Frank Palone (D-NJ).

The letter calls on Congress to: 1) revise the electronic health records Stark Law exception and Anti-Kickback safe harbor so hospitals can provide telemedicine equipment to physicians; 2) remove all geographic restrictions on the traditional Medicare coverage of telehealth services, require comparable coverage in Medicaid State plans and require comparable coverage for Medicare Part C plans; and 3) add an exclusion under the Civil Monetary Penalties Law that will allow hospitals and other providers to make home health monitoring equipment, services and similar technology available to patients at the time of discharge at no cost.

These proposals are intended to avoid the more contentious issues surrounding telemedicine, like cross-border medical licensing and physician credentialing, in order to gain broad bipartisan support. The committee staff expressed significant interest in these ideas and asked the coalition to return in September for further discussions. The coalition plans to lobby for their inclusion in the 21st Century Cures legislation that the Energy and Commerce Committee expects to move through Congress next year.

CBO Reduces Health Spending Projection

On July 15, the Congressional Budget Office (“CBO”) released its annual 25-year budget outlook, which lowers the projection for federal spending on health programs by one-tenth of a percentage point to 8% of the gross domestic product by 2039. The outlook projects that long-term debt will rise due to future federal spending on entitlement, Affordable Care Act (“ACA”) insurance subsidies and expansion of the Medicaid program.  CBO noted the budget shortfall will approach levels not seen in the U.S. since World War II.

CBO also projects that the ACA’s Independent Payment Advisory Board (“IPAB”) will remain dormant for the next decade thanks to the relatively slow growth in Medicare spending.  The IPAB, which has not yet been appointed, is required to direct Medicare cuts if spending growth exceeds a set target, but CBO’s latest outlook predicts that won’t happen over the next 10 years. On a somewhat positive note, CBO found the Medicare spending slowdown should contribute to long-term stabilization of the Medicare Part A Hospital Insurance Trust Fund.

HRSA Intends to Proceed with Guidance on 340B Drug Discounts

The Health Resources and Services Administration (“HRSA”) announced this week that it will issue “further interpretive rules or guidance” on 340B and orphan drug purchases by providers, which comes in the wake of a 2013 HRSA rule on drug discounts for safety-net providers that was vacated by a federal district court earlier this year.  In the meantime, a 340B proposed rule remains under review by the White House. That rule is expected to address areas such as hospital eligibility criteria, eligibility of off-site hospital facilities and compliance requirements for contract pharmacy arrangements.

House Reps Introduce Bill to Protect Home Health Care Access

Reps. Greg Walden (R-OR) and Tom Price (R-GA) introduced a bill intended to protect access to home health care services for seniors. The legislation (H.R. 5110) would repeal the Obama administration’s proposed Medicare payment cuts to home health agencies, which are scheduled to begin January 1, 2015 and reduce payments by 3.5% each year until 2017.

If passed, the bill would achieve savings by putting into place a value-based purchasing program that rewards home health agencies providing high value care to their patients while reducing payments to agencies that don’t meet certain performance measures and quality standards, which includes hospital readmission rates for Medicare home health beneficiaries.

Bills Introduced This Week

Rep. Mike Coffman (R-CO) introduced a bill (H.R. 5113) that would amend Title XIX of the Social Security Act to end the increased federal funding for Medicaid expansion with respect to inmates’ hospital care under the ACA and apply those savings towards a 2015 Medicare Advantage stabilization program.

Rep. John Lewis (D-GA) introduced a bill (H.R. 5102) that would amend Title XVIII of the Social Security Act to repeal the requirement for employer disclosure of information on health care coverage of employees who are Medicare beneficiaries.

Next Week in Congress

The House and Senate return Monday, July 21 and Tuesday, July 22 for a full week of work.  On July 23, Rep. Boustany (R-LA), Chairman of the Committee on Ways and Means’ Subcommittee on Oversight, will hold a hearing on the integrity of the administration of the ACA’s Premium Tax Credit. Government Accountability Office staff will be the only witnesses at the hearing.