Dec. 21 Government Funding Deadline Approaches

Negotiations are stalled between lawmakers and the White House on funding several major federal agencies ahead of the December 21 deadline to avoid a partial government shutdown. President Trump and congressional Democrats appear to be at an impasse, with neither party willing to compromise over funding for a boarder wall. Senate Democrats have agreed to $1.6 billion for border security, but the President has demanded at least $5 billion. Republicans are discussing options for another short-term continuing resolution (CR), and the President is reportedly considering making a proposal to Democratic leaders to delay the spending fight until next year. While the U.S. Department of Health and Human Services (HHS) is already funded, the Food and Drug Administration (FDA) receives its annual appropriations through one of the unfunded spending bills. The House is scheduled to hold its next votes on December 19 and plans to stay in session until it completes its work for the 115th Congress.

Lame-Duck Health Bills Passed Last Week

The House of Representatives passed the Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act (H.R. 7217) last week by a vote of 400-11. The IMPROVE Act is a bipartisan package of bills pertaining to the Medicaid program and aimed at improving care for children with complex medical conditions. It includes a new penalty for pharmaceutical manufacturers that knowingly misclassify branded products as generics to reduce their Medicaid rebate payments. The overcharge language was adopted from Sen. Chuck Grassley and Sen. Ron Wyden’s Right Rebate Act of 2018 (S. 3702). Grassley and Wyden are hopeful the bill will be approved by the Senate before the end of the lame-duck session. The IMPROVE Act incorporates H.R. 3325, the Advancing Care for Exceptional (ACE) Kids Act, H.R. 5306, the Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources (EMPOWER) and Care Act, and H.R. 7149, the Protecting Married Seniors from Impoverishment Act.

The House also passed S. 2465, the Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2018, which would reauthorize the Sickle Cell Disease Prevention and Treatment Demonstration Program; S. 3029, the PREEMIE Reauthorization Act of 2018, to continue research and education programs aimed at preventing preterm births; H.R. 1318, the Preventing Maternal Deaths Act of 2017, to expand federal efforts to track and prevent maternal mortality; and H.R. 6615, the Traumatic Brain Injury Program Reauthorization Act of 2018, to reauthorize the CDC’s traumatic brain injury initiatives and establish a national concussion surveillance system. S. 2465, S. 3029, and H.R. 1318 have been passed by the Senate and will now head to the President’s desk for his signature.

The Senate passed the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (S. 2076) by voice vote last week. This legislation would provide more resources for state and local public health officials to increase early detection and diagnosis of Alzheimer’s disease and to provide support for people living with Alzheimer’s and their caregivers.

W&M Releases Revised Tax Package, Red Tape Health Care Bills

House Ways and Means Committee Chairman Kevin Brady (R-Texas) released a revised lame-duck tax package last week. The revised legislation is an amendment to the original version of the bill that was released on November 26. The bill would delay or repeal several ACA taxes, including the medical device tax, which would be postponed until 2025. The ‘Cadillac’ tax on high cost health plans would be delayed until 2023, and the law’s fee on health insurers would be delayed until 2022. The tax on indoor tanning services would be permanently repealed.

Republican members of the panel also released a series of health care bills as a part of the Committee’s Medicare Red Tape Relief Project. The bills are aimed at increasing access to care in rural areas and improving the efficiency of the Medicare program. H.R. 7248, the Reducing Administrative Burden and Becoming Increasingly Transparent Act, would give Medicare providers a vehicle to submit comments to the Centers for Medicare and Medicaid Services (CMS) every year on how to reduce administrative burden in each Medicare payment system. H.R. 7253, the Remove Extraneous Measures that Obstruct Value and Efficiency (REMOVE) Act, would codify all measure removal factors for hospital and post-acute care (PAC) quality measures, including the newest measure removal factor #8 that weighs the benefits of a measure against the costs of reporting the measure. H.R. 7247, the Incentivizing Shared Risk in Medicare Advantage Act, would clarify that a Medicare Advantage (MA) organization may establish a waiver process to exempt physicians that engage in financial risk arrangements with the plan. H.R. 7249, the Better Prior Authorization Notification Act, would require notification to providers and beneficiaries that will be impacted by prior authorization. H.R. 7250, the Prior Authorization Improvement Act, would require a study on the feasibility of existing technologies that can help streamline and reduce the burden of prior authorization requests in MA plans. H.R. 741, the Rural Hospital Regulatory Relief Act of 2017, permanently extends the application by CMS of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals (CAHs) and small rural hospitals. H.R. 5507, the Critical Access Hospital Relief Act repeals the 96-hour physician-certification requirement for inpatient CAH services under Medicare.

E&C, W&M Agendas Take Shape

Rep. Frank Pallone (D-N.J.), Chairman of the House Energy and Commerce Committee for the 116th Congress, stated in an interview last week his plans to investigate the Trump administration’s management of the 2018 ACA open enrollment period, which saw a decline in sign-ups. Pallone also plans to pursue an ACA-stabilization measure, similar to a bill he introduced this Congress with the future Chairman of the Ways and Means Committee Richard Neal (D-Mass.) and likely Education and Workforce Chairman Bobby Scott (D-Va.). The legislation (H.R. 5155) would block the Trump administration’s expansion of short-term insurance plans. While protections for pre-existing conditions and ACA stabilization are also at the top of the agenda for Ways and Means, Rep. Neal commented last week that he would also be open to holding hearings on “Medicare for All” in the 116th Congress.

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