Bill Serves as End-of-Year Health Omnibus

Rep. Tom Price Chosen as HHS Secretary; Seema Verma to CMS

Senate Finance Committee Chronic Care Legislation Introduced

Announced Cabinet and Leadership Positions in Trump Administration


Cures Bill Serves as End-of-Year Health Omnibus

With few legislative vehicles moving through the lame-duck Congress this year and the year-end funding bill being a short-term continuing resolution with few additional provisions, H.R. 34, the legislative vehicle for the 21st Century Cures Act, has taken on the role of end-of-year health omnibus bill. Buoyed by support from the White House, the House of Representatives passed H.R. 34 by a vote of 392 to 26 on November 30th and the Senate approved the legislation on December 7th by a vote of 94 to 5. President Obama is expected to sign the bill within the next week.

H.R. 34 is the latest iteration of the 21st Century Cures Act and contains many of the provisions from the earlier H.R. 6 bill, which passed the House in 2015 but languished in the Senate. While the bill’s focus on the Food and Drug Administration, National Institutes of Health, and its support for faster drug and medical device discoveries and approvals has received the most attention, the bill also includes other Congressional health priorities.

Mental health reform is included in H.R. 34 by incorporating the Helping Families in Mental Health Crisis Reform Act, based on H.R. 2646, legislation championed by Rep. Patrick Murphy (R-PA), that would establish an Assistant Secretary for Mental Health and Substance Abuse as well as improve the Substance Abuse and Mental Health Services Administration. The legislation authorizes additional funding for state and local mental health and substance abuse treatment efforts. It also includes provisions pertaining to law enforcement and keeping the mentally ill out of the criminal justice system that were championed in the Senate.

The legislation also includes provisions for hospitals related to incorporating socioeconomic status into the hospital readmissions program and addresses issues for long-term care hospitals and hospital outpatient departments that are under construction. Beneficiary assignment will also be improved for providers participating in ACOs in the Medicare Shared Savings Program.

Finally, the bill includes other fixes as well, including retroactively delaying implementation of competitive bidding until January for durable medical equipment and allowing physical therapists to use locum tenens providers. Among the Medicare Advantage provisions in the legislation, beneficiaries with end stage renal disease will be able to enroll in Medicare Advantage plans.

Rep. Tom Price Chosen as HHS Secretary; Seema Verma to CMS

President-elect Donald Trump has chosen Rep. Tom Price (R-GA) as his nominee for Secretary of the Department of Health and Human Services. Rep. Price, a six-term Congressman, currently serves as Chairman of the House Budget Committee, through which he oversaw the 2015 repeal bill of the Affordable Care Act through the budget reconciliation process that was ultimately vetoed by President Obama. Rep. Price, an orthopedic surgeon, has long been critical of the Affordable Care Act. Price introduced his own legislation to repeal and replace the Affordable Care Act (H.R. 2300, the Empowering Patients First Act) and he also served on the House Republican’s Task Force on Health Care Reform convened by Speaker Paul Ryan, which released a report earlier this year. While Rep. Price has his own ideas for repealing and replacing the Affordable Care Act, as Secretary, expect House Republicans to still be in the driver’s seat for how to repeal and replace the law. However, as Secretary, Price is in a strong position to effect regulatory changes to the law and modify administrative policy to begin to undo parts of the law, such as requirements and fees on insurers and providers.

In addition, Seema Verma has been selected to lead the Centers for Medicare and Medicaid Services. Verma is a health care consultant who worked with Vice President-elect and Indiana Governor Mike Pence on Indiana’s Medicaid expansion waiver as well as with other states. While it has been noted that Verma lacks experience with Medicare, the announcement of her appointment signals that much of her work will likely focus on Medicaid reform, particularly as it relates to the Affordable Care Act. In particular, waivers for Medicaid will likely proliferate under her leadership, as Republican Governors have sparred with the Obama Administration over issues such as work requirements and cost sharing for Medicaid enrollees. Verma’s focus on Medicaid reform aligns with Congressional Republicans’ interest in the issue, which has included a Medicaid reform task force led by Rep. Brett Guthrie (R-KY) that is expected to release a summary of its findings and recommendations in the coming weeks.

Senate Finance Committee Chronic Care Legislation Introduced

On December 6th, Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D- OR), along with the Committee’s Chronic Care Working Group leads Sen. Johnny Isakson (R-GA) and Sen. Mark Warner (D-VA), introduced S. 3504, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. This legislation is the culmination of the Committee’s year and a half effort to solicit and develop proposals to improve the care provided to Medicare beneficiaries with chronic conditions, whose cost of care makes up a significant portion of Medicare spending.

While the sponsors of the bill had sought to attach it to a year-end legislative vehicle, the shifting legislative landscape, with the recently passed Continuing Resolution instead of an omnibus appropriations bill and the beginning of efforts to repeal and replacement of the Affordable Care Act instead of improving it, stymied hopes of advancing the CHRONIC Care Act in the 114th Congress. However, the bipartisan bill is a significant policy marker for the provisions included in it, and two provisions related to Medicare Advantage were included in
H.R. 34, the 21st Century Cures Act.

The CHRONIC Care Act would expand the use of telehealth in ACOs, Medicare Advantage, and for treating strokes. It would also improve care coordination in ACOs and allow Medicare Advantage to tailor benefits to beneficiaries with chronic diseases. Furthermore, the bill would extend the Independence at Home Model and expand the use of home dialysis services.

The sponsors of the CHRONIC Care Act will likely pursue passing this legislation during the 115th Congress.