January 16, 2015

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In This Issue
Forty Hours Heads to the Senate
Two Weeks In and Still Plowing Through
NARAB II Update
Moving On
Regulatory Review
HUPAC Round Up
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Two Weeks In and Still Plowing Through

The 113th Congress was the least productive session in modern memory, but based on the past two weeks, the 114th Congress looks like it is trying to win the opposite record. With a unified Republican Congress, the House and Senate have been working together to push forward quite a lot of their priority agenda items in these first few weeks.

The medical device tax is the next big item on the healthcare chopping block for Congress. This Tuesday, Senator Orrin Hatch (R-UT) introduced S. 149, the Medical Device Access and Innovation Protection Act. The bill would repeal the 2.3% excise tax on medical products levied on manufacturers that was included in the PPACA. This repeal would be retroactive to December 31, 2012. The bill would cost the federal government $29 billion in lost revenue, but Chairman Hatch said he would first focus on passing the bill then look for any possible pay-fors to make up the lost revenue. Joining Hatch as original bipartisan co-sponsors on S. 149 were Senators Richard Burr (R-NC), Bob Casey (D-PA), Dan Coats (R-IN), Joe Donnelly (D-IN), Al Franken (D-MN), Amy Klobuchar (D-MN), Rob Portman (R-OH), Jeanne Shaheen (D-NH), and Pat Toomey (R-PA). Given the bipartisan support, this bill has a good chance of passing. Assuming all 54 Republicans vote along with the five original Democratic co-sponsors in favor, then Chairman Hatch only needs one more vote to reach the magic number of 60. To move this issue forward in the lower chamber, Representative Erik Paulsen (R-MN) introduced companion legislation in the House on Tuesday, H.R. 160, the Protect Medical Innovation Act of 2015.

Newly-elected Louisiana Senator Bill Cassidy joined Chairman Hatch in introducing his own slew of PPACA-repeal bills this week. S. 157, the “No Obamacare Mandate Act,” is a more comprehensive package that would also repeal the medical device tax, as well as the employer mandate and the individual mandate. Another bill by Senator Cassidy, S. 158, would extend the “if you like your plan you can keep it” pledge, by allowing “grandmothered” group health plans to continue to be offered through 2018.

Following up on their 412-0 vote last week for H.R. 22, which exempts veterans from counting towards employer totals in their employer mandate applicability counts, this week the House passed H.R. 33 to exempt firefighters from any employer mandate count. The bill passed by a vote of 401-0 and gives municipalities greater flexibility by not requiring them to provide coverage to those firefighters working more than 30 hours a week and also provides a statutory clarification to follow the IRS announcement last year that volunteer first responders would not be counted towards the employer mandate.

Also introduced this week was H.R. 290, the Creating Access to Rehabilitation for Every Senior (CARES) Act, by Representative Jim Renacci (R-OH-16). This bill would eliminate the three-day inpatient hospital stay requirement for Medicare beneficiaries who are in need of skilled nursing facility services. Eliminating the requirement would get at the “observation status” issue and prevent seniors from being denied treatment or facing extensive bills, which first require that the patient spend three days as an admitted patient in a hospital before they are eligible for nursing services. Renacci also introduced H.R. 289, the Better Efficiency and Administrative Simplification Act, which would give seniors the option to receive their Medicare Summary Notice electronically instead of by mail.

Finally, in healthcare related congressional news, hearings and investigations are in the works to examine the Sustainable Growth Rate (SGR) formula and the failure of one of the 23 healthcare co-ops. Next Wednesday and Thursday, the House Energy and Commerce Health Subcommittee will hold a two-day hearing on the SGR. The current patch is set to expire on March 31 and both parties have expressed interest in finding a long-term solution to prevent the annual need for a patch. Without a patch, Medicare physicians could be on the hook for a double-digit decrease in their reimbursement rates. And Iowa Senator Chuck Grassley is probing the Administration about CoOportunity Health. The state of Iowa has taken over the co-op, which with 120,000 members, is the second largest in the country, since the co-op does not have adequate funds to pay its claims. Last month the Centers for Medicare and Medicaid Services announced that it would not provide any additional funding to the co-op.

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