Senate Prepares for Vote-a-rama
This week, the Senate begins 50 hours of debate on the budget resolution, moving towards the repeal of the Affordable Care Act (ACA) through the budget reconciliation process. While Republicans make final policy decisions on the language and continue to discuss their repeal and replace strategy, Democrats are working on a potential string of amendment votes to the budget resolution that will force Republicans to take uncomfortable votes on popular provisions of the ACA. At the end of debate, Senators can offer an unlimited number of amendments, which are decided without debate. Wednesday’s “vote-a-rama” is an opportunity for Democrats to drag out the process and draw attention to their arguments against repeal. Some Senate Republicans have voiced concerns regarding the Republican “repeal and replace” strategy. Since Republicans can only lose two votes before the measure would be defeated, if others come forward with concerns in the week ahead passage will be difficult. The budget resolution calls for the repeal package to be ready by January 27 and Republicans aim to have it on President-Elect Trump’s desk by February 20.
Four Bipartisan Health Bills Scheduled for House Floor
House Majority Leader Kevin McCarthy (R-CA) announced the chamber may consider four health bills under suspension of the rules in the coming week. On Monday, January 9, the House is expected to consider H.R. 309, National Clinical Care Commission Act; H.R. 315, Improving Access to Maternity Care Act; H.R. 302, Sports Medicine Licensure Clarity Act of 2017; and H.R. 304, Protect Patient Access to Emergency Medications Act of 2017. H.R. 309, introduced by Rep. Pete Olson (R-TX), would establish a National Clinical Care Commission to evaluate and recommend solutions regarding better coordination and use of federal programs relating to care for people with diabetes and related metabolic syndromes and disorders. H.R. 315, introduced by Rep. Michael Burgess (R-TX), would increase data collection by the Department of Health and Human Services (HHS) to help place maternal health professionals working in the National Health Service Corps (NHSC) in appropriate geographic regions and health professional shortage areas. H.R. 302, introduced by Rep. Brett Guthrie (R-KY), ensures sports medicine professionals are covered by their malpractice insurance when providing care to their athletes or teams in other states. H.R. 304, introduced by Rep. Richard Hudson (R-NC), would amend the Controlled Substances Act to enable paramedics and other emergency medical services (EMS) professionals to continue to administer controlled substances to patients pursuant to standing orders issued by their EMS agency’s medical director. All of these bills previously passed the House of Representatives in the 114th Congress by voice votes.
HRSA Releases Final Rule on the 340B Drug Pricing Program
On January 4, the Health Resources and Services Administration (HRSA) released a final rule titled “340B Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties,” which deals with setting prices under the drug discount program. HHS reopened the rule in 2016 to gather more information and receive stakeholder feedback. The final rule sets the calculation of the 340B ceiling price and application of civil monetary penalties (CMPs) and will apply to all drug manufacturers that are required to make their drugs available to covered entities under the 340B Program. Proponents of the final rule believe the decision will prevent the drug industry from overcharging providers, while those opposed to the policy believe drug hoarding may occur. HRSA stated the “long-standing policy reflects a balance between the equities of different stakeholders and establishes a standard pricing method in the market.” The rule was published in the Federal Register on January 5 and is effective 60 days after publication.
CMS Extends Temporary Moratoria
On January 6, the Center for Medicare and Medicaid Services (CMS) published a notice titled “Medicare, Medicaid, and Children’s Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations.” The moratoria currently in place affects newly enrolling home health agencies (HHAs) in Florida, Illinois, Michigan, and Texas and Part B non-emergency ambulance suppliers in New Jersey, Pennsylvania, and Texas. Upon consultation with law enforcement and consideration of other factors and activities, CMS determined the temporary enrollment moratoria should be extended for an additional six months on HHAs for all counties in Florida, Illinois, Michigan, and Texas, as well as Part B non-emergency ground ambulance providers and suppliers for all counties in New Jersey, Pennsylvania, and Texas. The notice is effective January 29, 2017.
MedPAC Meeting This Week
On Thursday, January 12, and Friday, January 13, the Medicare Payment Advisory Commission (MedPAC) will hold a meeting to discuss Medicare policy issues and questions, as well as develop recommendations for Congress. The agenda includes the following topics:
- The Medicare Advantage program: status report;
- Status report on Part D;
- Assessing payment adequacy and updating payments for:
- hospital inpatient and outpatient services; physician and other health professionals; ambulatory surgical centers; dialysis facilities; and hospice;
- post-acute care providers; skilled nursing facility services; inpatient rehabilitation facility services; home health agencies; and long-term care hospitals;
- Implementing a unified payment system for post-acute care;
- Approaches to MACRA implementation: Balancing Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (A-APMs);
- Medicare Part B drug payment policy issues; and
- Next steps in primary care.