On Tuesday evening, Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) announced an agreement on a five-year extension of the Children’s Health Insurance Program (CHIP), though full details of the deal remain scarce. With the program facing a funding deadline of September 30, the deal is welcome news for states, program administrators, and the 9 million children who depend on this coverage. Legislative text has not yet been released, but the proposal is expected to maintain the 23 percent increase in the federal matching rate that was provided under the Affordable Care Act for an additional two years, phasing it down for 2020, and finally fully eliminating the increase in 2021. However, committee leaders and GOP leadership in the House of Representatives have not indicated if they support this approach. Other unanswered questions remain as to how the bill will be paid for and what other expiring programs may be attached to the legislation to be extended along with CHIP.
See the video by ACEP’s Associate Executive Director of Public Affairs, Laura Wooster, for a short brief about what ACEP is doing for you.
The federal court system took a step in the right direction Thursday when it was announced that the Centers for Medicare & Medicaid Services (CMS) needs to further explain a regulation that impedes emergency physicians from receiving reasonable payment for out-of-network services.
ACEP filed suit against the federal government in May 2016 in response to the Government’s refusal to address concerns ACEP set forth regarding a CMS regulation for out-of-network emergency physician payment, which outlines the “greatest of three” options.
As written, ACEP believes this rule, which originated from the ACA in 2010, opened the door for insurers to use black box methods to determine physician payment without providing any means to verify the data. In November 2016, ACEP then filed a Motion for Summary Judgment asking the Court to rule in its favor on this issue.
On Thursday, the U.S. District Court for the District of Columbia partially granted ACEP’s Motion and denied the Government’s counter motion. More importantly, it remanded the matter back to the federal agencies for further explanation of the ruling, saying that comments had previously been submitted during the regulation’s development expressing “concerns … for example, that the methods it used to set payments were not transparent and could be manipulated by insurers. Many of these commenters proposed using a transparent database to set payments instead. The Departments all but ignored these comments and proposals.”
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.