CMS released the 2017 Medicare Trustee’s report that provides financial data regarding the financial operations and solvency of the Hospital Insurance Trust Fund (HI) and Supplementary Medical Insurance Trust Fund (SMI). HI, otherwise known as Medicare Part A, covers hospital inpatient, home health (following hospital stays), SNF and hospice. SMI consists of Medicare Part B and Part D. According to the report, HI will run out of money in 2029, which is one year later than what was predicted last year, as national health spending continues to grow slower than expected. Since the spending rates are still lower than Medicare’s target level, the ACA-established Independent Payment Advisory Board (IPAB) is not anticipated to be activated until 2021. The 2016 trustees’ report predicted it would be triggered this year.
The House approved the “FDA Reauthorization Act of 2017” (H.R. 2430) by voice vote. The bill would reauthorize the Prescription Drug User Fee Act, the Medical Device User Fee Amendments, the Generic Drug User Fee Amendments and the Biosimilar User Fee Act, as well as modify the FDA’s drug review process. The Senate has a similar version of the bill, S. 934.
Here is a commentary from Dr. Jesse Pines about Anthem starting to deny payment for care received in the emergency department. MOCEP has been working locally and with ACEP to fight what appears to be a violation of the prudent layperson standard and so that patients avoid surprise coverage gaps.
On Wednesday, ACEP member Arjun Venkatesh, MD, MBA, attended a meeting with HHS Secretary Tom Price to discuss initiatives the agency could take on its own to reduce the regulatory burden on physicians and other health care providers. Dr. Venkatesh relayed to Sec. Price how burdensome the reporting requirements have become without adding value to patient care and how it is reducing physicians’ time spent directly with patients. As he put it to Sec. Price, it has become “death by a thousand clicks.”
On Tuesday, the House Judiciary Crime, Terrorism, Homeland Security and Investigations Subcommittee held a hearing on the “Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017” (H.R. 2851), sponsored by Rep. John Katko (R-NY). The legislation would create a new Schedule A to the Controlled Substances Act where analogues could be temporarily scheduled, add 13 synthetic fentanyls to Schedule A, expressly omits simple possession of a synthetic drug from federal enforcement, provides guidance for sentencing federal synthetic drug trafficking crimes, makes false labeling of controlled substance analogues a federal offense, and makes it easier for approved parties to conduct research on these substances.
On Wednesday, the House narrowly approved the ACEP-supported “Protecting Access to Care Act of 2017” (H.R. 1215). H.R. 1215 would apply to health care lawsuits where coverage was provided or subsidized by the federal government, including through a subsidy or tax benefit, and would not preempt certain state laws or federal vaccine injury laws. It would also limit non-economic damages to $250,000, restrict attorney contingency fees, establishes a three-year statute of limitations after the injury (or one year after the claimant discovers the injury), repeal collateral source rules, allow periodic payments of future damage awards, and prevent health care providers who prescribe or dispense an FDA-approved product from being party to a product liability or class-action lawsuit, among other things. The vote passed 218 to 210 (along party lines with 19 Republicans voting no). The Republican opposition was based mainly on their belief that this type of medical liability bill is within the jurisdiction of the states.
PHYSICIAN ASSISTANTS (Section 334.735) –
Under current law, physician assistants may only dispense drugs, medicines, devices, or therapies pursuant to a physician supervision agreement. This act removes this requirement.
Emergency Physicians: Anthem Blue Cross Blue Shield Policy Violates Federal Law
WASHINGTON ¾ The American College of Emergency Physicians (ACEP) and its Missouri Chapter today said the list of medical diagnoses developed by the health insurance giant, Anthem Blue Cross/Blue Shield (BCBS), is a clear violation of the national prudent layperson standard, which is codified in federal law including the Affordable Care Act. It’s also law in more than 30 states.
The spending bill keeps the Government open through the end of the fiscal year. It will increase spending for defense and boarder security. The Omnibus bill also includes a total of $73.5 billion ($2.8 billion increase) for HHS, which includes:
- $34 billion ($2 billion increase) for NIH;
- $7.3 billion ($22 million increase) for the CDC;
- $3.6 billion ($130.5 million increase) for SAMHSA;
- $6.4 billion ($77 million increase) for HRSA; and
- $3.7 billion (same) for CMS.
The vote proceeded without an updated analysis of its cost and impact on insurance coverage from the Congressional Budget Office (CBO), which determined the earlier iteration would cause up to 24 million individuals to lose their insurance coverage by 2026. Many experts believe the bill approved by the House yesterday will cause even more individuals to lose coverage.
The House-approved AHCA would:
- Effectively eliminate federal coverage (individual and employer) mandates by reducing to zero the penalty for failure to comply with them. To eliminate these mandates completely will require future legislation;
- Repeal most taxes established by the ACA and delays “Cadillac” tax on high-cost employer-sponsored group health plans until 2025;
- Exchanges tax subsidies to help individuals purchase health insurance with refundable, advanceable tax credits of $2,000 – $4,000 (based on age);
- Maintain the 10 Essential Health Benefits (EHBs), which includes emergency services, and several other patient protections, such as coverage for individuals with pre-existing conditions, guaranteed issue and renewability, coverage of dependents on parents’ plan up to age 26, and community rating rules. However, states could easily seek waivers to eliminate EHBs and charge different rates for insurance based on the individual’s health;
- Limit enhanced federal match payments for Medicaid to states that adopted expansion as of March 1, 2017 and eliminate enhanced federal match for those states as of Jan. 1, 2020 (except for those enrolled as of Dec. 31, 2019 who do not have a break in eligibility of more than one month);
- Convert pre-ACA Medicaid into a per-capita allotment with state option to receive block grant;
- Increase incentives to utilize Health Savings Accounts (HSAs);
- Repeal ACA Prevention and Public Health Fund;
- Establish $100 billion fund to create State Innovation Grants and Stability Program to provide financial assistance to high-risk individuals, promote access to preventive services and provide cost-sharing subsidies;
- Provide $15 billion for Federal Invisible Risk Sharing Program (reinsurance) grants to states;
- Allocate $15 billion for maternity coverage and newborn care, as well as mental health and substance use disorders; and
- Make $8 billion available to help states establish high-risk pools.
ACEP opposed the legislation because it erodes the guaranteed coverage of emergency medical care by insurance plans, does not fully protect individuals with pre-existing health conditions, and is projected to cause millions of Americans to lose their insurance coverage, among other things. As ACEP President Rebecca Parker, MD, FACEP, stated in our press release: “Access to emergency medical care is critical to all Americans, as is insurance coverage for that care. This latest version of the new health care legislation does little to improve the health of the nation and will lead to more Americans not having any form of health care coverage.” Dr. Parker was also quoted in a CBS News story: “We’re pretty concerned that the AHCA passed in the House today, in particular providing the ability for states to waive essential benefits of emergency services. People can’t choose when they’re going to have an emergency and can’t worry about whether they’re going to be covered or not.”