Bills upcoming for a vote in the legislature.
Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019
This bill alters several Medicaid programs and funding mechanisms. Specifically, the bill
Marketing and Outreach Restoration to Empower Health Education Act of 2019 or the MORE Health Education Act
This bill requires the Department of Health and Human Services (HHS) to conduct outreach and educational activities regarding federally-facilitated exchanges (i.e., health insurance exchanges that are established and operated within states by HHS). The activities must inform potential enrollees of the availability of coverage and related financial assistance under the exchanges and must be provided in culturally and linguistically appropriate formats.
Protecting Americans with Preexisting Conditions Act of 2019
This bill nullifies the Department of the Treasury and the Department of Health and Human Services guidance titled "State Relief and Empowerment Waivers," published on October 24, 2018. The guidance pertains to Section 1332 waivers (also known as State Innovation Waivers or State Relief and Empowerment Waivers), which allow states to forego certain requirements of the Patient Protection and Affordable Care Act in order to implement experimental plans for health care coverage, as long as the resulting coverage meets certain statutory criteria.
The guidance, which supersedes earlier guidance from 2015, alters agency interpretation of how states may satisfy the statutory criteria for waiver approval. For example, the guidance (1) redefines acceptable coverage under such waivers to include short-term, limited-duration insurance and association health plans; (2) allows the comprehensiveness and affordability of coverage under such waivers to be assessed based on projected availability, rather than enrollment; and (3) allows the level of coverage to be assessed based on the effects over the entire course of the waiver, rather than per year.
Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act or the IMPROVE Act
This bill establishes a state Medicaid option to provide for medical assistance with respect to coordinated care provided through a health home (i.e., a designated provider or team of health-care professionals) for children with medically complex conditions. States must determine payment methodologies in accordance with specified requirements; payments also temporarily qualify for an enhanced federal matching rate.
The bill also makes a series of reductions relating to federal Medicaid expenditures. Among other changes, the bill reduces the federal matching rate for states that do not have required asset-verification programs for determining Medicaid eligibility.
Further, drug manufacturers with Medicaid rebate agreements for covered outpatient drugs must disclose drug product information. Manufacturers are subject to civil penalties for knowingly misclassifying drugs. Manufacturers are also required to compensate for rebates that were initially underpaid as a result of misclassification (whether or not such misclassification was committed knowingly).
Finally, the bill excludes specified wheelchairs and associated accessories from Medicare's competitive acquisition program (in which rates are set through a competitive bidding program rather than by an established fee schedule).
Fighting Fraud to Protect Care for Seniors Act of 2018
(Sec. 2) This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a pilot program that evaluates the feasibility of using smart card technology to address Medicare fraud. Under the program, smart card technology must be issued free-of-charge to selected Medicare beneficiaries, suppliers, and providers; such technology must support the secure, electronic authentication of beneficiary identity at points of service. In selecting program participants, the CMS must consider the risk of fraud, waste, or abuse among categories of suppliers and providers.
Empowering Seniors' Enrollment Decision Act of 2018
This bill provides statutory authority for the extension of a special enrollment period under Medicare Advantage (MA) to enrollees in certain Medicare Cost plans that are not transitioning into qualifying MA plans. Current regulations allow such enrollees (i.e., non-deemed individuals) to participate in the special enrollment period.
Comprehensive Care for Seniors Act of 2018
(Sec. 2) This bill requires the Centers for Medicare & Medicaid Services (CMS) to issue a final rule based on the provisions of a proposed rule regarding Programs of All-Inclusive Care for the Elderly (PACE) by December 31, 2018.
PACE is a program under Medicare and Medicaid that provides in-home and community services for certain individuals as an alternative to nursing home care. The proposed rule updates and revises application, enforcement, and other administrative requirements. The CMS published the proposed rule in August 2016; final action is expected in August 2019.
Local Coverage Determination Clarification Act of 2017
This bill amends title XVIII (Medicare) of the Social Security Act to revise the process by which Medicare administrative contractors (MACs) issue and reconsider local coverage determinations (LCDs) that: (1) are new, (2) restrict or substantively revise existing LCDs, or (3) are otherwise specified in regulation. (MACs are private insurers that process Medicare claims within specified geographic areas.)
Before such an LCD may take effect, the MAC issuing the determination must, with respect to each geographic area to which the determination applies:
Upon the filing of an applicable request by an interested party with regard to the reconsideration of a specified LCD, the MAC that issued the determination shall:
An interested party may appeal a reconsideration decision to the Centers for Medicare & Medicaid Services (CMS).
The CMS shall appoint a Medicare Reviews and Appeals Ombudsman to carry out specified duties with regard to LCDs.
This bill amends the Internal Revenue Code to suspend the employer mandate for health insurance coverage until January 1, 2019.
The bill amends the Patient Protection and Affordable Care Act to delay for one year, until after December 31, 2020, the implementation of the excise tax on high cost employer-sponsored health coverage (commonly referred to as the Cadillac tax).
Ambulatory Surgical Center Payment Transparency Act of 2018 or ASC Payment Transparency Act of 2018
(Sec. 2) This bill requires the expert outside advisory panel that reviews the Medicare prospective payment system for hospital outpatient department services to include at least one ambulatory surgical center representative.
(Sec. 3) The bill also requires the Centers for Medicare & Medicaid Services to specify the criteria used to exclude certain procedures from the list of covered surgical procedures that may be performed in an ambulatory surgical center under Medicare.
Improving Seniors Access to Quality Benefits Act
(Sec. 2) This bill requires the Centers for Medicare & Medicaid Services to report on how the inclusion of quality percentage increases in Programs of All-Inclusive Care for the Elderly affects certain payment calculations under Medicare Advantage.
Palliative Care and Hospice Education and Training Act
This bill amends the Public Health Service Act to require the Department of Health and Human Services (HHS) to provide support for Palliative Care and Hospice Education Centers. These centers must improve the training of health professionals in palliative care and establish traineeships for individuals preparing for advanced education nursing degrees, social work degrees, or advanced degrees in physician assistant studies in palliative care.
HHS may provide support to schools of medicine, schools of osteopathic medicine, teaching hospitals, and graduate medical education programs for training physicians who plan to teach palliative medicine.
HHS must: (1) provide Palliative Medicine and Hospice Academic Career Awards to individuals to promote their career development; (2) support entities that operate a Palliative Care and Hospice Education Center; (3) support advanced practice nurses, social workers, physician assistants, pharmacists, chaplains, or students of psychology pursuing an advanced degree in palliative care or related fields; and (4) award grants to schools of nursing, health care facilities, or programs leading to certification as a nurse assistant to train individuals in providing palliative care.
The Agency for Healthcare Research and Quality must provide for a national education and awareness campaign to inform patients, families, and health professionals about the benefits of palliative care.
The National Institutes of Health must expand national research programs in palliative care.
Title VIII Nursing Workforce Reauthorization Act of 2017
This bill amends the Public Health Service Act to extend through FY2022 support for nursing workforce programs and grants.
Eligibility for advanced nursing education grants is expanded to include education programs for clinical nurse leaders and all combined registered nurse and graduate degree programs. (Clinical nurse leaders are advanced generalist clinicians who apply research and coordinate care in order to improve outcomes for patients.) To be eligible for these grants, clinical nurse specialist programs must provide registered nurses with full-time clinical nurse specialist education that qualifies the nurses to provide a full range of care.
Programs for loan repayment and scholarships for nurses, loans for nursing faculty, and geriatric care education are extended through FY2022. Grants for increasing nursing workforce diversity are also extended through FY2022.
Nurse education, practice, and quality grants are extended through FY2022 and eligibility is expanded to include nurse-managed health clinics.
Grants for nursing career ladder programs are expanded to: (1) promote career advancement for individuals to become registered nurses or advanced education nurses; and (2) support internships and residency programs to encourage mentoring and the development of specialties.