House Passes Medicare Advantage Bill


On June 17th, the House of Representatives passed The Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015 (H.R. 2570. The bill would establish a demonstration project allowing Medicare Advantage plans to use Value-Based Insurance Design (V-BID). The concept comes from Univ. of Michigan research. Researchers found that reducing out-of-pocket costs for some high-value medical services for certain patients can improve health outcomes and reduce disparities. It may also slow the growth of health care costs. If the bill becomes law, it would allow Medicare Advantage plans to lower co-payments and coinsurance for beneficiaries, encouraging the use of high-value, evidence-based medical services to manage chronic conditions. It prevents plans from increasing beneficiary cost sharing on any service.

The legislation was originally introduced by U.S. Reps. Diane Black (R-TN), Earl Blumenauer (D-OR) and Cathy McMorris Rodgers (R-WA). The bipartisan companion bill, the Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 (S.1396), was introduced to the Senate on May 20th by U.S. Senators Debbie Stabenow (D-MI) and John Thune (R-SD). In addition to the Capitol Hill activity, V-BID was included in a recent Centers for Medicare and Medicaid Services (CMS) Request for Information to Innovate Medicare. Numerous private and public payers have implemented V-BID programs.

House Passes Medicare Advantage Bill

On June 17th, the House of Representatives passed The Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015 (H.R. 2570, available via umhealth.me/vbid-bill). The bipartisan legislation would establish a demonstration project allowing Medicare Advantage plans to use a principle called Value-Based Insurance Design (V-BID). The concept comes from University of Michigan research that aligns patients’ out-of-pocket costs, such as copayments, with the value of health care services.

If the bill becomes law, it would allow Medicare Advantage plans to lower copayments and coinsurance for beneficiaries, encouraging the use of high-value, evidence-based medical services to better manage chronic conditions. It prevents plans from increasing beneficiary cost sharing on any service. The legislation was originally introduced by U.S. Reps. Diane Black (R-TN), Earl Blumenauer (D-OR) and Cathy McMorris Rodgers (R-WA).

The bipartisan companion bill, the Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 (S.1396), was introduced to the Senate on May 20th by U.S. Senators Debbie Stabenow (D-MI) and John Thune (R-SD). In addition to the Capitol Hill activity, V-BID was included in a recent Centers for Medicare and Medicaid Services (CMS) Request for Information to Innovate Medicare. To date, V-BID programs have been implemented by numerous private and public payers, employers, unions, and business coalitions nationwide. The accumulating evidence validates a central V-BID premise that reducing out-of-pocket costs for selected high-value medical services for certain patients can improve health outcomes, reduce disparities and potentially slow the growth of health care costs.

Mental Health Bill Reintroduced

Chairman Tim Murphy (R-PA) and Rep. Eddie Bernice Johnson (D-TX) reintroduced the Helping Families in Mental Health Crisis Act, H.R. 2646. The revamped bill builds upon the previous bipartisan version. H.R. 2646. It breaks down federal barriers to care, clarifies privacy standards, expands parity accountability, invests in services for the most difficult to treat cases, and drives evidence-based care. Rep. Murphy said, “We are moving mental health care from crisis response to recovery, and from tragedy to triumph.”

The Helping Families in Mental Health Crisis Act was first introduced in December 2013, following a yearlong investigation led by Oversight Chairman Murphy into the nation’s broken mental health system. The investigation revealed that the federal government’s approach to mental health is a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies.

As documented in a recent Government Accountability Office (GAO) report, 112 federal programs intended to address mental illness aren’t connecting for effective service delivery. Also, there is a lack of inter-agency coordination for programs supporting people with serious mental illness.

While the federal government dedicates $130 billion towards mental health each year, the mental health system is best described by its deficits. To name just a few:

  • There is a nationwide shortage of nearly 100,000 needed psychiatric beds.
  • Three of the largest mental health hospitals are criminal incarceration facilities.
  • Privacy rules frustrate physicians and family members and generate nearly 8,000 official complaints a year.
  • Only one child psychiatrist is available for every 2,000 children with a mental health disorder.
  • The leading federal mental health agency does not employ any psychiatrists.

The Helping Families in Mental Health Crisis Act of 2015, H.R. 2646 would do the following:

  • Create an Assistant Secretary for Mental Health and Substance Use Disorders with mental health credentials within HHS. The assistant secretary would elevate the importance of mental health in the nation’s leading health agency, coordinate programs across different agencies, and promote effective evidence-based programs.
  • Require the Assistant Secretary for Mental Health and Substance Use Disorders to make public all federal investigations into compliance with the parity law so that families and consumers know what treatment they have rights to access.
  • Establish a National Mental Health Policy Laboratory to drive innovative models of care and develop evidence-based and peer-review standards for grant programs.
  • Dedicate funding for the Brain Research Through Advancing Innovative Neurotechnologies Initiative.
  • Require psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to appropriate post-hospital care and services.
  • Provides additional psychiatric hospital beds for those with an acute mental health crisis who need short term (less than 30 days) immediate inpatient care.
  • Support advances in tele-psychiatry to link pediatricians and primary care doctors with psychiatrists and psychologists in areas where patients don’t have access to care.
  • Require the Assistant Secretary for Mental Health and Substance Use Disorders to study and recommend a national strategy to increase the number of psychiatrists, child and adolescent psychiatrists, psychologists, psychiatric nurse practitioners, clinical social workers, and mental health peer-support specialists.
  • Include child and adolescent psychiatrists in the National Health Service Corps.
  • Authorize the Minority Fellowship Program.
  • Authorize, for the first time in federal law, the Recovery After Initial Schizophrenia Episode (RAISE), an evidence-based early intervention program.
  • Reauthorize the National Child Traumatic Stress Network.
  • Launch an early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.
  • Provide incentives to states to offer community-based alternatives to institutionalization.
  • Reauthorizes the Garrett Lee Smith Suicide Prevention Program, invest in research on self-directed violence, and authorize, for the first time in the statute, the Suicide Prevention Hotline.
  • Extend health information technology for mental health providers to coordinate care with primary care doctors using electronic medical records.
  • Establishe an inter-agency Serious Mental Illness Coordinating Committee to organize, integrate, and coordinate the research, treatment, housing and services for people with substance use disorders and mental illness.
  • Ends the decades-old prohibition on physicians volunteering at community mental health clinics and federally qualified health centers.

Congressman Murphy, a psychologist with nearly three decades experience, has been a champion for reforming the broken mental health system. He yearly introduces the bipartisan congressional resolution declaring May as Mental Health Month, to end the stigma associated with mental illness and promote public awareness of mental health. He will soon advance a similar resolution recognizing the month of June as PTSD Awareness Month. A provision in the previous version of his Helping Families in Mental Health Crisis Act was recently adopted on the House floor. Murphy offered a bipartisan amendment with Rep. Michelle Lujan Grisham (D-NM) and Rep. Earl Blumenauer (D-Ore.) to the Commerce, Justice, Science and Related Agencies Appropriations Act of 2016, to advance and expand Mental Health Courts, a successful model of collaboration between criminal justice and mental health systems for those with serious mental illness.

Senate Bill Would Expand Access to Pharmacies

The National Community Pharmacists Association (NCPA) strongly endorses The Ensuring Seniors Access to Local Pharmacies Act, S. 1190. The legislation would expand the number of pharmacies that can offer discounted copays for Medicare Part D prescription drugs. It was introduced by Senators Shelly Moore Capito (R-W.Va.), Joe Manchin (D-W.Va.), Tom Cotton (R-Ark.) and Sherrod Brown (D-Ohio).

Medicare beneficiaries in medically under-served areas would be able to access lower copays at any pharmacy that agrees to accept a drug plan’s preferred pharmacy terms and conditions. S. 1190 is a companion bill to H.R. 793, The Ensuring Seniors Access to Local Pharmacies Act, which has been introduced by Reps. Morgan Griffin (R-Va.) and Peter Welch (D-Vt.). NCPA CEO Douglas Hoey, RPh, MBA said, “Medicare beneficiaries should not be confronted with the Hobson’s choice of continuing to patronize their pharmacy at a higher cost or making a long trip to another pharmacy.”

The bill has been endorsed by the Alliance for Retired Americans, the Center for Medicare Advocacy, Families USA, Justice in Aging, the Medicare Rights Center, the National Consumers League, the National Rural Health Association, and the U.S. Pain Foundation. “Today many Medicare beneficiaries are effectively told by drug plan middlemen which pharmacy to use based on exclusionary arrangements among the pharmacy benefit manager (PBM) middlemen and, in most instances, large publicly traded chain pharmacies,” Hoey added. According to a recent Medicare study, in urban areas 54% of preferred pharmacy drug plans failed to meet the government’s threshold for reasonable access to pharmacies. In rural America the closest preferred pharmacy can be 20 miles away or more.

Bill Would End Specialty Tier Cost Sharing

Reps. David B. McKinley R-WV and Lois Capps D-CA introduced a bill that would counteract a trend in today’s health insurance market: moving vital medications into specialty tiers with high cost sharing. The Patients’ Access to Treatments Act (PATA) of 2015 would limit cost-sharing requirements for medications placed in a specialty tier. Specialty tiers commonly require patients to pay a percentage of the cost of the drug co-insurance, which can range from 25% to 50% or higher, resulting in hundreds and even thousands of dollars a month in out-of-pocket costs. New and innovative medications often fall into these tiers.

For people with arthritis, many of these new medications are biologics – a true innovation for people with autoimmune forms of the disease, such as rheumatoid arthritis. These complex medications, made from living organisms, use the body’s immune system to fight the condition, and even halt its progression in some cases. “Cost sharing for a prescription medication should not be so large that it inappropriately restricts or interferes with medically-necessary use of medications,” says Ann Palmer, president and CEO of the Arthritis Foundation. Cost sharing for some arthritis drugs can exceed $1,500 a month.

Bill Seeks to Change the Definition of a Full Time Employee

The House of Representatives passed the Save American Workers Act (H.R. 2575), which would change the definition of “full-time” work under the Affordable Care Act’s employer mandate from 30 to 40 hours per week. However, the White House has promised to veto it. The bill would raise the threshold for full-time status to 40 hours per week, decreasing the number of employees to whom employers are required to provide insurance.

Bill Would Extend Coverage to the Undocumented

Senator Ricardo Lara (D-Huntington Park/Long Beach) introduced Senate Bill 1005, the Health For All Act. The bill would give undocumented residents access to the Covered California exchange and Medi-Cal. The Affordable Care Act (ACA) excludes undocumented immigrants from the Covered California exchange. An estimated three to four million people in the state will remain uninsured in spite of ACA, and almost a million of those will be undocumented residents ineligible for coverage. “Excluding people from access to care hurts the health of our communities, and does not reflect California values,” said Lara. The estimated annual tax contribution of undocumented immigrants in California is $2.7 billion and 92% of this population live in working families. For more information, visithttp://www.senate.ca.gov/lara.

Bill Would Establish Collection of Health Cost Data

Assembly member Roger Hernández (D – West Covina) announced the introduction of AB 1558. This bill would ensure public access to comprehensive and uniform information on healthcare costs and prices via a website while protecting patient confidentiality and respecting providers of care. All-payer claims databases have been established in several states including Maine, Colorado, Massachusetts, Connecticut and Kansas.

Delaying the Individual Mandate Would Reduce the Deficit

A House bill to delay Obamacare’s individual mandate would save $35 billion dollars, according to the Congressional Office. In July, the House passed H.R. 2668, which would delay the application of the individual health insurance mandate and the employer health insurance mandate for one year. The Congressional Budget Office (CBO) and the Joint Committee on Taxation estimate that enacting H.R. 2668 would reduce federal deficits by roughly $36 billion from 2014 to 2018 and by roughly $35 billion from 2014 to 2023. For more information, visit http://www.cbo.gov/publication/44551

Bill Would Expand HSAs & FSAs

Senate Finance Committee Ranking Member Orrin Hatch (R-Utah) and Senator Marco Rubio (R-Fla.) introduced the Family and Retirement Health Investment Act of 2013 to strengthen and expand health savings accounts (HSAs) and flexible spending arrangements (FSAs). Companion legislation was introduced in the House by U.S. Rep. Erik Paulsen (R-Minn.).

Hatch, whose Committee has jurisdiction over health care policy said, “Over the years, these plans have grown in popularity, and it’s well past time Congress act to improve them. Streamlining these popular health care products…will provide millions of families, workers, and retirees the opportunity to put away tax-free savings to pay for their personal medical costs. It’s smart policy to increase access to quality and affordable health care for consumers at an affordable price and I hope to see this bill enacted into law.”

The legislation would do the following:
• Allow a husband and wife to make catch-up contributions to the same HSA.
• Remove the onerous new restrictions on the use of HSA and FSA dollars for the purchase of over-the-counter drugs.
• Clarify the use of prescription drugs as preventive care that will not be subject to an HSA-eligible plan deductible.
• Reauthorize the use of Medicaid health opportunity accounts.
• Promote wellness by expanding the definition of qualified medical expenses to encourage more exercise and better nutrition.
• Allow seniors enrolled in Medicare Part A to continue contributing to their HSAs.
• Allow for the purchase of low-premium health insurance and long-term care insurance with HSA dollars.

Last Updated 11/13/2019

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