Senate Plans Scrambled on Health Reform

Senate Majority Leader Mitch McConnell (R-KY) once again delayed proceedings on Republican plans for health care reform. While McConnell is still considering whether to hold a vote on a bill to repeal and replace the ACA or a repeal-only measure, Republicans remain at odds over Medicaid, overall coverage numbers, lowering premiums and cutting regulations.

Adding to their difficulty is a Congressional Budget Office (“CBO”) report released on July 19 that estimates a repeal-only bill would cut the deficit by $473 billion over a decade but could result in 32 million people becoming uninsured. The following day, CBO released an estimate on the repeal and replace bill, known as the Better Care Reconciliation Act, that shows it would cut the deficit by $420 billion but leave up to 22 million people uninsured. The Senate recessed for the week on Thursday night unclear as to which path, if any, Republicans will pursue when they return next week.

House Examines 340B Program

On July 19, the House Energy and Commerce Oversight Subcommittee held a hearing on the 340B program. While members expressed support for the 340B program, the committee highlighted concerns for it that include: 1) the growth of 340B far exceeding HRSA’s limited oversight; 2) HRSA’s oversight reveals high levels of non-compliance; 3) hospitals receiving duplicate discounts; 4) hospitals diverting 340B drugs to ineligible patients; and 5) covered entities not maintaining 340B databases.

A number of members called for program integrity reforms for 340B. Additionally, some members were critical of CMS’s proposed Hospital Outpatient rule from July 14. In the rule, CMS is proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through 340B at the average sales price minus 22.5 percent rather than average sales price plus 6 percent. See the CMS fact sheet detailing the OPPS rule from last Friday.

House Committee Advances FY 2018 Spending Plans

On July 19, House Appropriators passed their funding proposal for the Labor-HHS-Education fiscal year (“FY”) 2018 spending bill. The bill includes a total of $77.6 billion for HHS, a decrease of $542 million below the FY 2017 enacted level but $14.5 billion above the president’s budget request. The committee funded HRSA at $5.8 billion, which is almost $400 million below the FY 2017 level.

Within the HRSA account, $300 million was provided for the Children’s Hospital Graduate Medical Education program, the same as the 2017 enacted level. The committee also had level funding for rural health programs, which included $18.5 million for telehealth. Within the report language, the committee encouraged HHS to establish a Telehealth Center of Excellence to test the efficacy of telehealth services in both urban and rural geographic areas.

The Senate is working on a slower timeline as the subcommittees have only recently begun consideration of FY 2018 spending levels. Of the various spending bills, the Labor-HHS bill is almost always the most difficult for Congress to pass due to partisan policy riders and spending levels. The slower Senate pace will most likely lead to the Labor-HHS funding bill to be wrapped into an omnibus spending package.

Health-Related Bills Introduced This Week

House Energy and Commerce Health Subcommittee Chairman Michael Burgess (R-TX) introduced a bill (H.R. 3263) that would extend the Medicare independence at home medical practice demonstration program from five to seven years. The bill would also allow providers to enroll additional beneficiaries in the demonstration.

Rep. Gregg Harper (R-MS) introduced a bill (H.R. 3224) that would amend Title XVIII of the Social Security Act to clarify reasonable costs for critical access hospital payments under Medicare.

Rep. Devin Nunes (R-CA) introduced a bill (H.R. 3236) that would amend Titles XI and XVIII of the Social Security Act to improve provider and supplier cost reporting of ambulance services under Medicare.

Rep. Lynn Jenkins (R-KS) introduced a bill (H.R. 3331) that would amend Title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology.

Next Week in Washington

The House and Senate return July 24. Next week is the final week the House is scheduled to be in session prior to the August break, but the Senate is still scheduled to be in session the first two weeks of August.

On July 25, the Senate is tentatively scheduled to hold a motion to proceed on health care reform. Majority Leader McConnell has indicated that if Republicans lose by one vote, they will re-vote upon Senator McCain’s (R-AZ) return to Washington following treatment for a brain tumor. On July 26, the House Energy and Commerce Health Subcommittee will hold a hearing on Medicare special needs plans legislation. Last week, the Ways and Means Committee marked up the Medicare SNP bill (H.R. 3168).