Congress Passes 21st Century Cures Bill

On December 7, the Senate passed the sweeping 21st Century Cures bill (H.R. 34), clearing the way for it to be signed into law. The Senate vote comes a week after House passage of the $6.3 billion medical research funding bill that makes comprehensive mental health reforms and provides funding for opioid abuse.

In addition to FDA reform and medical research funding, the measure reverses the site-neutral payment policies for off-campus hospital outpatient departments that were “mid-build” at the time the Balanced Budget Act of 2015 was signed into law. It also excludes prospective payment system-exempt cancer hospitals from similar site-neutral payment policies. The bill includes a provision that would allow for certain safety net hospitals to compare their readmission rates against each other, instead of against all hospitals. The change in calculation of penalties would kick in during fiscal year 2019.

After the bill is signed into law, ensuring the money is appropriated every year for many of its provisions will be an ongoing challenge. The White House has indicated that President Obama will sign the bill into law in a formal ceremony on December 13.

Telemedicine Bill Passed by Congress

On December 6, the House passed S. 2873, a Senate bill that promotes telemedicine. The Expanding Capacity for Health Outcomes Act (“ECHO Act”) asks HHS to study whether telemedicine could promote collaborative clinical learning and disseminate best practices among providers, primarily those in rural and underserved areas.

According to the bill sponsors, Senators Orrin Hatch (R-UT) and Brian Schatz (D-HI), the bill is intended to increase access to health care in rural areas though continuing medical education focused on telehealth technology. The bill will now go the president’s desk for signature.

Additionally, the ECHO Act would require the HHS Secretary to submit a report to Congress by December 2018 regarding the use and integration of these models by health care providers and the impact on health care provider retention as well as on the quality of, and access to, care for patients. The report directed HHS to address barriers faced by health care providers in adopting these models and ways such models have been funded by HHS over the past five years.

Bipartisan Chronic Care Bill Introduced in the Senate

On December 6, the Senate Finance Committee introduced an anticipated chronic care bill. The CHRONIC Care Act of 2016 was authored by Finance Committee Chairman Hatch and Ranking Member Ron Wyden (D-OR) and is intended to implement Medicare payment policies designed to improve management of chronic disease and improve outcomes.

The bill (S. 3504) would amend Title XVIII of the Social Security Act to expand testing of the CMS innovation center’s Value-Based Insurance Design model, ease telehealth restrictions and change how beneficiaries could be assigned to accountable care organizations, among other provisions. The legislation would also extend the Independence at Home demonstration to September 2019 and increase the cap on the total number of beneficiaries from 10,000 to 15,000.

Given the bipartisan nature of the bill and that it does not add to the deficit, the measure could move early next Congress.

MedPAC Endorses Pay Increase for Doctors, Hospitals

On December 8, members of the Medicare Payment Advisory Commission (“MedPAC”) supported draft recommendations instructing Congress to proceed with small Medicare pay increases for hospitals. Hospitals are in line for an increase of about 1.85 percent in Medicare payment rates for fiscal year 2018. Last year’s overhaul (PL 114-10) of Medicare’s payments to doctors calls for a 0.5 percent increase for calendar year 2018.

MedPAC will hold formal votes in January on its recommendations for a variety of Medicare payment rules. MedPAC is a federal advisory panel that annually makes non-binding recommendations to Congress on Medicare payment rates.

Next Week in Washington

With the House having approved a bill (HR 2028) to fund the government until April 29, the measure now moves to the Senate, which is expected to approve it over the weekend. While the House is scheduled to have a pro forma session on December 12, lawmakers will not return until Tuesday, January 3.