Bipartisan Telehealth Bill Introduced
Includes Provision Proposed by Hall Render
On February 3, Sens. Brian Schatz (D-HI) and Roger Wicker (R-MS) introduced legislation to expand the use of telemedicine and remote patient monitoring (“RPM”) under Medicare to increase cost savings and quality care. The Creating Opportunities Now for Necessary and Effective Care Technologies (“CONNECT”) for Health Act (S. 2484) helps providers meet the goals of the Medicare Access and CHIP Reauthorization Act (“MACRA”) and the Merit-Based Incentive Payment System (“MIPS”) by eliminating Medicare’s location-based reimbursement restrictions and allowing telehealth and RPM to be basic benefits under Medicare Advantage. It also allows hospitals to provide telehealth or remote patient monitoring technologies to Medicare patients without violating the Civil Monetary Penalties Law. The measure is one of two proposals included in a letter Hall Render sent to the House Energy and Commerce Subcommittee on Health as it started to prepare the 21st Century Cures legislation in 2014.
The CONNECT for Health Act establishes a bridge program that enables doctors participating in MIPS to apply for waivers that would exempt them from limitations Medicare imposes on telehealth coverage. Providers participating in alternative payment models would be automatically exempt from Medicare telehealth restrictions. It would also expand coverage of RPM technologies for patients with chronic conditions to non-hospital facilities, including community health centers, rural health clinics, dialysis facilities and telestroke evaluation and management sites. According to an Avalere analysis, the major provisions of the legislation could generate $1.8 billion in savings over 10 years.
House Energy and Commerce Committee Seeks Feedback on Site-Neutral Payment Policies
On February 5, House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Ranking Member Frank Pallone (D-NJ) sent a letter to health care stakeholders seeking feedback on policy changes regarding site-neutral payments, including the changes in reimbursement rates to hospital off-campus outpatient departments that were part of the Bipartisan Budget Act of 2015. In a release, Upton and Pallone said they are seeking information on “policies which would potentially amend or expand the site-neutral provision.” They also asked for “proposals on how to pay for those suggestions which would lead to an increase in cost for beneficiaries.”
Comments to the committee are due February 19, 2016. If you are interested in providing the committee with feedback, please contact John Williams using the information below or your regular Hall Render attorney.
House Democrats Release Mental Health Legislation
On February 2, a group of Democrats on the House Energy and Commerce Committee introduced a mental health reform bill to serve as an alternative to the measure previously introduced by Rep. Tim Murphy (R-PA). The Comprehensive Behavioral Health Reform and Recovery Act of 2016 (H.R. 4435) removes several of the policies in Murphy’s bill, including financial incentives for states with assisted outpatient treatment laws that allow judges to mandate treatment for people with mental illnesses. It also makes fewer changes to HIPAA and proposes regulations that clarify when it is appropriate for providers to share limited mental health information. In addition, the legislation would repeal Medicaid’s 190-day lifetime cap on psychiatric hospital stays, provide $20 million for mental health first aid training and create a range of other grant programs to establish assertive community treatment programs to help in reducing hospitalizations, homelessness and arrests among people with mental illnesses.
Murphy’s bipartisan Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646) includes a series of provisions addressing mental illnesses, such as lifting Medicaid restrictions for inpatient psychiatric care and establishing an assistant secretary for mental health position. The legislation would also change HIPAA privacy protections for people with mental illnesses to allow family members access to patients’ medication lists and other health information.
Panel Calls for Targeted DSH Payments to Safety Net Hospitals
On February 1, the Medicaid and CHIP Payment and Access Commission (“MACPAC”) issued a report to Congress recommending that HHS ensure that disproportionate share hospital (“DSH”) funds are better targeted to safety net hospitals. The report stated that one-third of DSH payments are made to hospitals that don’t serve a particularly high share of Medicaid and other low-income patients.
Congress intended that DSH payments would support the hospitals that serve the greatest share of Medicaid and other low-income patients, but the MACPAC report showed this isn’t necessarily the case. According to the report, the scheduled reduction of Medicaid DSH allotments of 16 percent in fiscal year 2018 and up to 55 percent in fiscal year 2025 makes targeting payments crucial. The report didn’t make any recommendations as to how HHS should better target the funding.
CMS Creates Panel to Address Rural Health
On February 2, CMS acting Administrator Andy Slavitt announced that the agency will develop a rural health council to review regulations for their impact on health care providers in rural settings and make recommendations for rural-focused policies. The panel, which will include regional health officers, is intended to improve access to care in rural areas, support the rural health care economy and ensure the agency’s innovation programs appropriately fit rural markets. CMS recently announced additional funding for an expansion of the National Rural ACO Consortium to support the growth of 23 rural ACOs that serve half a million Medicare beneficiaries across the country. The agency will also begin to test new models for integrated health care in geographically isolated areas using telemedicine, swing beds and other forms of care delivery through the Frontier Community Health Integration Project. Slavitt said the council will seek input into CMS’s 2016 agenda at one of the agency’s Rural Health Open Door forums.
Health-Related Legislation Introduced This Week
Rep. Diane Black (R-TN) introduced the Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) to create a national minimum Area Wage Index (“AWI”) of 0.874 for Medicare reimbursement of inpatient and outpatient health care services. The new base AWI would ensure that hospitals in rural and underserved areas with lower average wages do not receive lower reimbursement rates and smaller profit margins.
Sen. Michael Bennet (D-CO) introduced S. 2498 to establish a pilot program to improve care for the most expensive Medicare fee-for-service beneficiaries. The program would promote comprehensive and effective care management services to reduce Medicare costs.
Next Week in Washington
The Senate returns on Monday, February 8. The House returns on Tuesday, which is the same day as the New Hampshire primary and the release of the president’s annual budget proposal. Committees in both chambers will hold hearings next week examining proposed HHS funding for FY 2017.
Next week will also see a number of other health-related events, including the Senate Health, Education, Labor and Pensions Committee markup of S.1622, the FDA Device Accountability Act of 2015; S.2030, the Advancing Targeted Therapies for Rare Diseases Act of 2015; and S.849, the Advancing Research for Neurological Diseases Act of 2015. The House Energy and Commerce Health Subcommittee will hold a hearing on Medicaid and CHIP’s federal medical assistance percentage.