DCMedical News: Monday, July 30, 2018
DCMedical News
Washington, D.C.
Monday, July 30, 2018
DCMedical News is published every day either the House or the Senate is in session.
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THE BIG STORY TODAY IN HEALTH CARE:
The House is in Recess, the Senate Not Yet, Appropriations Bills in Health Care Move Forward: The appropriations for FY2019 for the Departments of Labor, Education and Health and Human Services are moving forward, at $179.3 billion in the Senate version, $177.1 billion in the House version. For Fiscal 2018 (which ends 9/30/2018) the appropriations enacted for these departments was $177 billion. The Administration’s proposal for Fiscal 2019 was $167.4 billion. Both the Senate and House versions would provide at least $1 billion increases for the Department of HHS, and several hundred million for education, with reductions for labor. The most significant increase would be for the National Institutes of Health, a $2 billion increase over 2018 to $39.1 billion in the Senate version. Opioid grants to states, $500 million originally in FY 2017, $1 billion in 2018, would be $1.5 billion in 2019.
The draft Senate Appropriations Committee report is here, the draft House Appropriations Committee report is here. The Committee reports are among the most useful documents in interpreting appropriations, offering a “narrative” for individual appropriations “up” or “down” from the past, with comparison to Administration recommendations. Sixty votes are necessary in the Senate for passage of the Appropriations bills.
The House version of the appropriations bill has a prohibition on money going to Planned Parenthood, and has proposed eliminating Title X family planning program provisions, while the Senate bill has no such prohibitions.
The largest differences between the bills and the Administration are in the Department of Education, with the House proposing $70.8 billion, the Senate $71.4 billion, and the Administration having requested $63.2 billion, compared to expenditures of $70.9 billion in FY 2018.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Physician Pay Proposed Rule Published Friday July 27: Official publication took place Friday in the Federal Register (here) of the “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program.” Publication began the comment period “clock,” which expires at the close of business September 10. Submit comments electronically to http://www.regulations.gov, follow the ‘‘Submit a comment’’ instructions.
Vertical Healthcare Merger Review After United States v. AT&T, Inc., a feature article from the Antitrust Practice Group of the American Health Lawyers Association, here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Children of Armstrong: Following Armstrong v. Exceptional Child (2015, here), a federal court in California has denied (here) an appeal by hospitals over low MediCal payment rates. In Tulare Local Health Care District v. Cal Dep’t of Health Care Servs, decided July 20, the court said “Although Armstrong did not squarely face the precise facts of this case—whether health care providers can bring a private cause of action pursuant to California state law to enforce § 30(A)—this court understands the holding of Armstrong to be what it says: ‘the Medicaid Act precludes private enforcement of §30(A) in the courts’ and can be enforced by ‘the sole remedy Congress provided’—"the withholding of Medicaid funds by the Secretary of Health and Human Services." 135 S. Ct. at 1385.”
Cancer Hospital Prevails in Rate Matter: A different result was achieved by the H. Lee Moffitt cancer hospital, here. Section 3138 of PPACA provided that HHS should study whether the costs of cancer hospitals were higher than other hospitals, and therefore warranted higher Outpatient Prospective Payment System rates. Despite passage of the bill March 23 and March 30, 2010, HHS made no rule on such adjustments until well into 2011, with a 2012 effective date, declining to make any additional or higher payments retroactive. The court here held that HHS could not make up new effective dates for legislation. The court said the original rulemaking was understandably complex, with numerous comments and suggestions, and that “In the face of these comments, HHS punted.” The court then criticized HHS position’ that “Under HHS’s proffered interpretation, the effective date in the statute has little practical meaning: the agency has to abide by the effective date, unless it chooses to wriggle out of the effective date by its own delay—at which point it gets to choose another effective date.” The opinion (here) has a useful history of outpatient hospital payments under Medicare.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
HSA and Catastrophic Health Plan Bills, Follow Up: As reported in DCMN 7/26/2018 (here), the House passed two measures consolidating a variety of initiatives promoting and making more flexible the use of Health Savings Accounts and also promoting the role of catastrophic (“copper”) health plans. CBO reports on the bills can be found for H.R. 6199 here; for H.R. 6301, flexibility for high-deductible health plans, here; for H.R. 6305, using tax-advantaged accounts with employee onsite or retail clinics, with spousal coverage, raising contribution limits, here; for H.R. 6306, catch-up contributions, expanding expenditure eligibility, here; for H.R. 6309, to allow HSA accounts for those eligible for Medicare, here; for H.R. 6312, to allow sports and fitness expenses under tax-advantaged accounts, here; for H.R. 6313, to allow unused balances in FSAs to be carried forward, here; for H.R. 6314, to allow bronze and catastrophic (“copper”) plans to be used in conjunction with HSAs, here; and for H.R. 6317, to allow HSAs to be used in conjunction with “direct primary care service arrangements,” CBO report here.
The Cost of Health Savings Account Flexibility and Related Bills: The Joint Committee on Taxation tallied the cost of the various elements (HR 6311, here and HR 6199, here). Payment for gyms through tax deductible savings accounts would cost up to $3.8 billion over 10 years, with an additional $6.7 billion for over-the-counter medications paid through such accounts. Another $20 billion in expansion of HSA use and related measures, combined with the repeal of the medical device tax (HR 184), means the total price tag for these bills is $85-90 billion, with no offsets suggested.
Who is Uninsured? Modern Healthcare provides an infographic (here) on the current state (2017) of the uninsured. The national total: 30 million, down from 33 million in 2015, down from 50 million plus in 2010.
From Forbes, “Can Fintech Solve the U.S. Healthcare Crisis,” “[T]he Federal Reserve found that 47 percent of Americans would find it difficult to find $400 to pay for medical bills and this is shocking information because of increasing life spans and healthcare costs” and “The World Economic Forum also found that in the US, the gap in US retirement savings will balloon from around $37 trillion this year to $137 trillion by 2050; this means that the gap is growing at a rate of $3 trillion per year.”
Polling by the Bipartisan Policy Center: The Future of Health Care, presentation July 25, here; background polling here.
EVENTS & MEETINGS
July 31
10:00 a.m., Senate HELP Committee hearing, “Reducing Healthcare Costs: Decreasing Administrative Spending,” 430 Dirksen SOB.
Aug. 20
Meeting of Medicare Advisory Panel on Hospital Outpatient Program (through August 21), APCs, OPPS, the works. Evaluation of Advanced Primary Care (APC) groups; packaging of Outpatient Prospective Payment System (OPPS). Federal Register notice (5-3-2018), here.
Aug. 22
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), CAR-T cell therapies, collection of patient reported outcomes in cancer clinical studies.
Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice (6-15-2018) here.
FOR REFERENCE
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
Trial and courtesy subscriptions will end tomorrow. Subscribe now, avoid interruption of service.
July publication dates: 31.
August publication dates: prn, House adjourned, Senate may be in session, but no legislative activity is planned.
September publication dates: 4, 5, 6, 7, 12, 13, 14, 17, 18, 20, 21, 24, 25, 26, 27, 28.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com