Health Policy Report

The Week in Review

The House and Senate have adjourned for August recess. Both chambers are scheduled to reconvene for legislative business on Tuesday, September 5. The Senate will meet in “pro-forma” sessions every few days during the recess, which will effectively block President Trump from being able to make recess appointments over the break.

The Week Ahead

Next week, the Congressional Budget Office is slated to release a report on the impacts of ceasing Affordable Care Act (ACA) cost-sharing subsidy payments, as the Trump Administration has indicated it potentially may do. When Congress returns in September, they will face approaching deadlines to address federal government funding by month-end, reauthorize Children’s Health Insurance Program funding, act on expiring Medicare “extenders,” and raise the debt ceiling.

McConnell Open to Bipartisan Deal on CSR Payment

Senate Majority Leader Mitch McConnell (R-KY) signaled last week that he is open to a bipartisan deal to fund cost-sharing reduction (CSR) payment to insurers, but warned that any agreement needs to include "real reforms." While McConnell noted last week that there is "still a chance" the Senate will take back up its Affordable Care Act (ACA) repeal and replace effort, Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) are also working on "some kind of bipartisan approach" to stabilize the individual insurance market.

Several Republican senators, including Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), are expected to use the August recess to try work on their ACA replacement bills. But expectations are growing that a bipartisan approach is more likely to emerge following the GOP’s failure to coalesce around a replacement bill this summer. The Senate HELP and Finance Committees are both planning to hold hearings in September on bipartisan ideas to stabilize the insurance markets, with Sen. Alexander stating that an agreement could be reached as early as mid-September. The suggested timing implies that lawmakers are considering attaching marketplace stabilization measures to other legislation that will be moving through Congress at the end of next month, including a government funding bill, reauthorization of the Children’s Health Insurance Program (CHIP), and raising the debt ceiling.

Reps. Tom MacArthur (R-NJ) and Freedom Caucus Chairman Mark Meadows (R-NC) are also reportedly working on an individual market stabilization package that includes funding for CSRs and “very flexible 1332 waiver language” — a key demand among conservatives who have insisted that states should have more authority to opt out of ACA insurance regulations.

President Trump Declares the Opioid Crisis a 'National Emergency'

President Donald Trump last Thursday declared the opioid crisis a “national emergency,” directing the administration to use all appropriate authority to respond to the problem of opioid abuse. The President was briefed on the epidemic Tuesday by Health and Human Services (HHS) Secretary Tom Price. The emergency declaration, first recommended by the White House’s Commission on Combating Drug Addiction and the Opioid Crisis, could give the federal government additional authority to quickly free up funds to respond to the epidemic.

Among the immediate actions the Trump administration could take to address the opioid crisis: (1) approve state waivers to remove the Medicaid Institutions for Mental Diseases (IMD) exclusion, which prohibits the use of federal Medicaid funds for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds; (2) negotiate lower prices for naloxone — the drug that reverses opioid overdoses — as suggested by the Commission; and (3) distributing some of the $45 million in the Public Health Emergency Fund. Earlier last week, President Trump suggested the administration would combat the epidemic by focusing on law enforcement and security on the southern border to stop illegal drugs from entering the country.

House Panel to Begin Work on Regulatory Relief for Health Care Providers

House Ways & Means Health Subcommittee Chairman Pat Tiberi (R-OH) plans to schedule roundtables in September to discuss ideas for cutting regulations on health care providers, with legislation to cut red tape expected later this fall. The subcommittee last month asked providers to submit ideas for cutting back Medicare regulations and laws, and the roundtables are expected to provide a forum to discuss those ideas. Chairman Tiberi and providers have previously met with Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to discuss regulations they'd like to get rid of. At that time, Administrator Verma and her staff said some of the regulations could be dealt with administratively but some would need to handled legislatively.

Inspector General to Review Telehealth Reimbursement

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently announced its first review of Medicare payments for telehealth services. Telehealth services resulted in a mere $17.6 million in Medicare reimbursement in 2015, but due to strict regulations surrounding telemedicine, the OIG could discover the misuse of those services. Medicare only covers telehealth in federally defined rural health professional shortage areas, only eight types of practitioners may deliver telehealth services to Medicare beneficiaries from a qualified distant site, and CMS publishes a limited number of reimbursement codes for telehealth services. If any one of the stringent requirements are not met, doctors are not permitted to be reimbursed by Medicare for telehealth services.

Although there are several pieces of legislation that could expand Medicare coverage of telehealth services currently pending on Capitol Hill, Congressional Budget Office (CBO) scoring and concerns about cost could hold back such legislation. The Medicare Payment Advisory Commission (MedPAC) has focused much of their analysis on whether telehealth would serve as a “substitute” for or a “supplement” to existing Medicare services — a distinction that has significant implications for congressional scorekeepers. The OIG intends publish a report in 2018 including their findings and recommendations on telehealth reimbursement.