| Yesterday, the House Ways and Means Committee held a markup to advance four bipartisan health care bills that would streamline, modernize, and clarify portions of Medicare and other programs for seniors. The respective measures - each of which passed by voice vote - would: (1) increase transparency in the process by which Medicare Administrative Contractors (MACs) make local coverage determinations (LCDs); (2) launch a pilot of smart card technology to fight Medicare fraud; (3) extend the special enrollment period for seniors enrolled in Medicare Cost Plans; and (4) finalize regulations modernizing a community-based care program for seniors. Committee Democrats expressed frustration with the limited scope of the bills, while ultimately supporting their aims and voting in favor of all four. Reps. Lloyd Doggett (D-TX) and Terri Sewell (D-AL) also questioned whether testing the use of smart-card technology for beneficiaries' Medicare cards would be worth the cost; the Congressional Budget Office has not yet scored the bill. · What's next? The Committee voted to favorably report all four bills to the House floor. Two of the bills, the Comprehensive Care for Seniors Act and the Local Coverage Determination Act, have Senate versions that are currently in committee. Although these noncontroversial bills were advanced with bipartisan support, limited time left in the session may be a barrier to the bills passing both chambers. Among the highlights of each bill and discussion at yesterday's markup: · LDC Transparency - The Local Coverage Determination Act of 2017 (H.R. 3635), introduced by Reps. Jenkins and Kind, would codify the process through which MACs make LCDs and increase transparency throughout the process. The bill would require that MACs publish drafts of LCDs on their website, hold open and public meetings to review the drafts, and publish the rationale for LCDs for public examination. The bill would also establish an appeal and redetermination process by which stakeholders can dispute LCDs. An amendment (green sheet) offered by Chairman Brady made multiple substantive changes to the bill. Under the amendment, the Secretary would be required to submit an annual report to Congress detailing the usage and outcomes of the appeals process. Additionally, the amendment removed a provision that would have prohibited MACs from adopting LCDs that were developed for another geographic area without independently considering the evidence. Chairman Brady stated that the latter change was made due to concerns from Members that the prohibition would slow the LCD process and be a burden on MACs. However, Rep. Ron Kind (D-WI) raised concerns that allowing one MAC to adopt another's coverage policy without a separate evaluation essentially allows LCDs to become national coverage policy; he said he hopes the bill can be improved before a floor vote. The amendment also removed a provision establishing an ombudsman for MACs, as a similar position was already created as part of the 21st Century CURES Act. Chairman Brady's amendment was adopted by voice vote before the bill was favorably reported to the full House. · Smart Card Technology - The Fighting Fraud to Protect Care for Seniors Act of 2018 (H.R. 6690), introduced by Reps. Peter Roskam (R-IL) and Earl Blumenauer (D-OR), would establish a three-year pilot program to issue Medicare cards with smart chip technology. Committee Democrats raised questions about the costs and benefits of the program, pointing to a Government Accountability Office (GAO) report that indicated that only 2% of instances of fraud could have been prevented by the use of smart card technology, although the same report showed that smart cards could have impacted an additional 20% of cases studied. Rep. Terri Sewell (D-AL) introduced an amendment that would delay the implementation of the legislation until three years of solvency are added to the Medicare Trust Fund. The Committee voted along party lines to table Rep. Sewell's amendment. After adopting an amendment from Chairman Kevin Brady (R-TX) to include technology vendors among the stakeholders who form an advisory panel, the Committee voted by voice to advance the bill to the full House. · PACE Implementation - The Comprehensive Care for Seniors Act of 2018 (H.R. 6561), introduced by Reps. Jackie Walorski (R-IN), Lynn Jenkins (R-KS), Earl Blumenauer (D-OR), and Judy Chu (D-CA), would direct the Department of Health and Human Services (HHS) Secretary to finalize proposed Program of All-Inclusive Care for the Elderly (PACE) regulations by December 31, 2018. The rule, which was originally proposed in 2016, would allow PACE providers to customize their care teams including by contracting with primary care providers, including non-physician primary care providers. It would also reduce the number of on-site audits for PACE providers and allow core providers to update patient care plans rather than requiring the input of a patient's entire care team. Chairman Brady introduced an amendment that clarifies that the Secretary would be required to issue a final rule based on the proposed rule, rather than finalizing the rule as proposed in 2016. Chairman Brady's amendment was adopted and the bill was favorably reported by voice vote. · Enrollment Fix Codification - The Empowering Seniors' Enrollment Decision Act of 2018 (H.R. 6662), introduced by Reps. Erik Paulsen (R-MN) and Ron Kind (D-WI), would codify a regulation offering a special enrollment period (SEP) to all seniors currently enrolled in a Medicare Cost Plan. With Medicare Cost Plans being phased out, beneficiaries enrolled in such plans must find a new coverage option. The SEP will allow all seniors currently enrolled in a Medicare Cost Plan to choose a new coverage option, whether traditional fee-for-service Medicare or a Medicare Advantage Plan. The Committee voted to report an amended version of the bill to the House floor with only technical corrections. |