AHCA Remains Stalled in House

In an effort to breathe life into the stalled American Health Care Act (“AHCA”), Trump administration officials, members of the House Freedom Caucus and House Republican leadership spent the week discussing fixes to the AHCA. The discussions focused largely on allowing states to decide if they want to continue the ACA’s insurance mandates. However, lawmakers left town for the Easter recess without making any real progress.

While there is no new legislative text, the new proposal centers around allowing states waivers to opt out of or modify some of the ACA’s more popular provisions, including essential health benefits and coverage for pre-existing conditions. The potential changes would likely be paired with greater flexibility and funding for state-sponsored high-risk pools. To that end, the House Rules Committee adopted an amendment this week that creates a $15 billion Federal Invisible Risk Sharing Program that is intended to help states reduce premiums by reimbursing health insurance issuers for high-cost individuals beginning in 2018.

The changes were an attempt to attract members of the House Freedom Caucus who came out against the AHCA two weeks ago. While appeasing the most conservative members of the House may increase the odds of the bill passing the lower chamber, it makes Senate passage under reconciliation more difficult. Senate Majority Leader Mitch McConnell (R-KY) will have to make changes to win over the moderate Republicans needed to reach the 50-vote threshold for passage. Timing is also an issue as the Senate wants to move onto tax reform after the Easter recess and use the FY 2017 reconciliation bill as the vehicle.

Senate HELP Committee Holds FDA-Related Hearings

The Senate Health, Education, Labor and Pensions (“HELP”) Committee held two FDA-related hearings this week. On April 5, FDA Commissioner nominee Scott Gottlieb spent almost three hours answering questions during his nomination hearing. Gottlieb expressed that dealing with the opioid abuse, enacting the 21st Century Cures Act in a timely fashion and bringing down drug costs are three of the top challenges facing FDA. Despite committee Democrats concerns over Gottlieb’s potential conflicts of interest, the nomination is expected to move forward as Republicans expressed strong support. A committee vote is expected on Gottlieb’s nomination the last week of April.

On April 4, the committee held its third hearing on FDA user fee agreements. Chairman Lamar Alexander (R-TN) said he hopes to move quickly to reauthorize the user fee agreements negotiated by FDA and the drug and device industry so that FDA won’t be forced to send layoff notices to FDA employees at the end of July. The HELP Committee and the House Energy and Commerce committee continue to target May as the timeline for committee passage.

Telehealth Bill Introduced in the Senate

Leaders of the Senate Finance Committee introduced a bipartisan bill that would allow more Medicare dollars to flow into telemedicine. Among other provisions included in the chronic care legislation, the bill would provide ACOs more flexibility to provide telehealth services and allow beneficiaries receiving dialysis treatments at home to do their monthly check-in with their doctor by way of telehealth, rather than traveling to the doctor’s office or hospital. The bill would also expand the availability of telehealth to ensure individuals who may be having a stroke receive the right diagnosis and treatment.

The bill stems from the Senate Chronic Care working group, which originally introduced this bill at the end of last Congress. Last week, Sen. Gardner (R-CO) introduced a different telehealth bill (S. 787) that would require HHS to allow eligible hospitals to test telehealth services through the Center for Medicare and Medicaid Innovation.

Health-Related Bills Introduced This Week

Rep. Jackie Speier (D-CA) introduced a bill (H.R. 2066) intended to prevent abusive billing of ancillary services to Medicare. According to the press release, the Promoting Integrity in Medicare Act (“PIMA”) would prevent physicians in certain specialties from referring patients to ancillary medical services in which they have an ownership interest and that are offered in their offices. PIMA would prohibit self-referral for advanced imaging, anatomic pathology, radiation therapy and physical therapy.

Rep. Tom Reed (R-NY) introduced the Rural Hospital Access Act (H.R. 1955) that seeks to make permanent the extension of the Medicare-dependent hospital program and the increased payments under the Medicare low-volume hospital program. A companion version was introduced in the Senate by Sens. Charles Grassley (R-IA) and Chuck Schumer (D-NY).

Rep. Marsha Blackburn (R-TN) introduced a bill to amend the Public Health Service act to limit the liability of health care professionals who volunteer to provide health care services in response to a disaster.

Rep. Pete Olson (R-TX) introduced a bill that intends to align physician supervision requirements under Medicare for radiology services performed by advanced level radiographers with state requirements.

Rep. Ryan Costello (R-PA) introduced a bill to amend the Federal Food, Drug and Cosmetic Act to provide clarity with respect to the regulation of diagnostic imaging devices for use with contrast agents.

Sen. Bill Cassidy introduced a bill (S. 830) to amend Title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity. Among other provisions, the bill would give CMS authority to improve Medicare beneficiary access to benefits for intensive behavioral counseling by allowing types of providers to offer this benefit.

Sen. John Thune (R-SD) introduced a bill that would clarify that health care services provided by certain sports medicine professionals who provide medical services in a secondary state outside the state of licensure can be covered by the health professional’s medical malpractice insurance provider.

Next Week in Washington

After seven consecutive weeks in session, the House and Senate will be out the next two weeks for the Easter work period. While House leadership has told members to be prepared to return to Washington if a deal is reached on the AHCA, no such deal is expected.