House Delays AHCA Vote

On April 27, House leadership delayed a vote on the American Health Care Act (“AHCA”) until at least next week. As of last night, at least 15 House Republicans remain opposed with another 20 undecided. Without Democrat support, House Republicans can only lose 22 votes.

Earlier in the week, a number of conservative groups, including the House Freedom Caucus, dropped their opposition to the ACA repeal and replace bill as a result of compromise language being added to a revised version of the AHCA. The new language allows states to seek federal waivers from complying with certain insurance protections (essential health benefits, age rating and medical underwriting under certain conditions).

However, ongoing concerns from more moderate House Republicans coupled with a lack of enthusiasm from a number of Republican governors kept the AHCA off the House floor for at least another week. Also, the Congressional Budget Office has not scored the new language that could increase the number of uninsured. Were a House bill to pass, a number of Senate Republicans have indicated it will take at least a month for the Senate to pass their version of the AHCA.

CMS Releases Proposed Pay Rule for SNFs, Rehab Hospitals

On April 27, CMS proposed an increase in federal payments to rehabilitation hospitals, skilled nursing facilities (“SNFs”) and hospices. CMS proposed increasing reimbursement to rehab hospitals by $80 million during FY 2018 in addition to eliminating a 25 percent payment penalty on facilities that don’t submit patient assessment instrument data to the agency’s data repository on time.

Similar to the inpatient hospital rule released last week, CMS used the proposed rule to seek input from the various industries on regulations it should overhaul or eliminate. HHS Secretary Tom Price and CMS Administrator Seema Verma have indicated they will review agency rules in an effort to cut unnecessary or burdensome regulations. The agency says it will not respond to the RFIs in the final FY 2018 pay rules, but it will consider the information it collects when developing upcoming rules and guidance.

House Bill Seeks to Extend Access to Physicians in Rural, Underserved Areas

Legislation was introduced in the House this week that would extend the Conrad State 30 program until 2021. The House bill would expand the number of J-1 visa waivers a state health department could request from 30 to 35 per year to work in federally designated Health Professions Shortage Areas or Medically Underserved Areas. The House bill (H.R. 2141) was introduced by Reps. Brad Schneider (D-IL) and Darrell Issa (R-CA). The bill is a companion to S. 898, which was introduced in the Senate in early April.

Health-Related Bills Introduced This Week

Sen. Shelley Moore Capito (R-WV) introduced a bill (S. 980) that would allow rural health clinics and federally qualified health centers to bill Medicare under Part B for hospice, which they currently can’t do.

Rep. Brian Fitzpatrick (R-PA) introduced a bill (H.R. 2163) to amend the Federal Food, Drug and Cosmetic Act to require physicians and physicians’ offices to be treated as covered device users required to report on certain adverse events involving medical devices.

Rep. Mimi Walters (R-CA) introduced a bill seeking to reform FDA regulations for the reclassification of previously approved low-risk medical devices. According to the Walters press release, the bill (H.R. 2144) is intended to ensure low-risk medical devices are not subject to an unnecessarily high-risk classification than is appropriate for their effective use.

Sen. Robert Menendez (D-NJ) introduced a bill (S. 986) to amend Title XVIII of the Social Security Act to permit hospitals in all-urban states to be considered Medicare dependent hospitals.

Sen. Debbie Stabenow (D-MI) introduced a bill (S. 967) that would increase access to ambulance services under Medicare and reform payments for such services.

Next Week in Washington

The House and Senate return on May 1. In addition to the possible AHCA vote in the House, funding for the federal government will need to be addressed. On April 28, Congress extended funding through May 5. The one-week extension avoids a shutdown and provides Congress time to reach an agreement on FY 17 funding through September 30.

On May 2, the House Energy and Commerce Subcommittee on Health will consider four medical device bills to potentially be included in the FDA Reauthorization Act of 2017. The bills would allow over-the-counter marketing of hearing aids (H.R. 1652), require registration of medical device servicers (H.R. 1736), establish a medical imaging approval process where contrast agent sponsors could submit supplemental applications (H.R. 2009) and create additional regulation for the inspection of medical devices (H.R. 2118).

Earlier this week, the Senate HELP Committee released the Senate version of the FDA Reauthorization Act (S. 934). The committee is hoping to mark up the legislation by the end of May.