The following update was provided for our members by Hall Render, NOSORH Legislative Liaison:
House Introduces Rural Health Reauthorization Bill
On April 26, House Energy and Commerce members Markwayne Mullin (R-OK) and Kurt Schrader (D-OR) introduced the State Offices of Rural Health Reauthorization Act of 2018. The bill (H.R. 5641) is the companion bill to S. 2278 which was passed in March by the Senate Health Education Labor and Pensions Committee. The Senate bill, which was introduced by Senators Roberts (R-KS) and Heitkamp (D-ND), has been cleared for full Senate passage. The next step for H.R. 5641 will be a mark-up before the Energy and Commerce Committee.
Congress Tackles Opioid Epidemic
The Senate Finance Committee held in April to address opioid and substance-abuse disorders in Medicare, Medicaid and other HHS-related programs. The hearing addressed how the programs can adapt and be improved to address the crisis, as well as what the Trump administration and Congress can do to fight the opioid crisis together. The Committee, through feedback from stakeholders and its members, identified areas of bipartisan support. These include the need to evaluate access to and utilization of non-opioid treatment options for managing pain; enhancing data-sharing to promote appropriate health care interventions and strengthen program integrity; and ensuring evidence-based care is available for patients to identify and treat opioid use disorders.
On April 24, the Senate HELP Committee held a markup for a number of opioid-related bills. Legislation that passed the Senate committee includes: S. 2680, the “Opioid Crisis Response Act of 2018”; S. 2315, the “Over-the-Counter Drug Safety, Innovation, and Reform Act”; S. 2597, the “Children’s Hospital GME Support Reauthorization Act of 2018”; and S. 382, the “Firefighter Cancer Registry Act.” The following day, the House Energy and Commerce Committee advanced a 60-bill package that touches on everything from FDA approval of pain medicines to how government programs pays for addiction treatment. Congress hopes to pass comprehensive opioid reform before Memorial Day.
MedPAC Recommends Cut to Urban Off-Campus Hospital Pay
The Medicare Payment Advisory Commission (MedPAC) recommended Congress to cut pay by 30 percent for certain off-campus emergency departments in urban areas. Off-campus stand-alone emergency departments that are within six miles of an on-campus hospital emergency department would be subject to the cuts. To support this recommendation, MedPAC claims these off-campus facilities have lower patient severity and standby costs than on-campus emergency departments therefore the Medicare payments are askew. In contrast, MedPAC supported the recommendation to allow isolated rural stand-alone emergency departments, or those that are more than 35 miles away from another emergency room, to bill standard outpatient prospective payment fees and Congress provide annual payments to assist with fixed costs.
Additionally, the payment advisers discussed a recommendation to make the four current value-based payment programs into a single initiative. This new initiative would judge hospitals on readmissions, mortality, spending, and how patients’ rate their stay. Depending on performance, two percent of a hospital’s Medicare payments would be withheld or earned back. This plan was cited as a good way to simplify hospital reporting programs and move to outcome-based measures. However, the Commission also raised several concerns such as questions on how to weigh the categories, if two percent is enough of an incentive, etc. MedPAC will continue discussions on this recommendation in the fall.
Rural Health Related Bills Introduced in April
Rep. Collin Peterson (D-MN) introduced H.R. 5498 to amend title XVIII of the Social Security Act to extend the floor on the area wage index under the inpatient prospective payment system to certain sole community hospitals and to amend the Public Health Service Act to provide eligibility for certain sole community hospitals to discounted drug prices under the 340B drug pricing program.