House E&C Committee Releases Draft of New Medicare Doc Fix Legislation

The House Energy and Commerce Committee released draft legislative language which would implement proposed changes to the current Medicare physician payment sustainable growth rate (SGR) system. On June 5th the House Energy and Commerce Health Subcommittee has scheduled a hearing to take testimony on the proposal. House Republicans are expected to insist that the cost of the legislation be offset (the Congressional Budget Office estimates the cost as $139 billion over 10 years); however the form such offsets will take is not included in the current draft. Of note, the House Ways and Means Committee did not co-sponsor the initiative as was the case for two previous efforts to outline possible changes to repeal the current sustainable growth rate formula and replace it with a system based on quality measures and new payment models. The E&C draft bill would: repeal the SGR and provide an unspecified period of stable payments in the first phase; provide payments based on quality-of-care measures in a second phase; and introduce “efficiency of care” adjustments in a third phase.

Medicare Part A Solvency Extended 2 Years

The Medicare trustees released their annual reports including an estimate that the current Part A Hospital Insurance trust fund will remain solvent without change through 2025, but will become insolvent in 2026. In general, the Medicare actuaries assumed that recent lower-than-expected spending increases would extend Part A solvency for another two years from the insolvency date reported last year. The Part B Supplemental Program report included an estimate that the standard Part B premium will not increase in 2014 over this year’s premium of $104.90 a month. Of note, the trustees said the estimates assumed that Congress will not act to override the projected 25% cut in physician payment amounts scheduled to begin in 2014. If Congress does enact a doc fix for 2014, Part B costs are projected to grow by 6.3% annually over the next five years.

CMS Authorizes Data Release for Fraud Prevention

CMS gave notice that the disclosure to health plans of identifiable provider and beneficiary information contained in 23 agency health databases will be allowed when it “is deemed reasonably necessary by CMS to prevent, deter, discover, detect, investigate, examine, prosecute, sue with respect to, defend against, correct, remedy, or otherwise combat fraud, waste, or abuse….” Such actions will be coordinated by the CMS Data Sharing and Partnership Group.

Medicare Coverage for Anti-Nausea Therapy

CMS released a final decision memo stating that Medicare will cover certain “reasonable and necessary” oral anti-nausea and vomiting therapies for beneficiaries undergoing chemotherapy.

Upcoming Hearings and Markups on Health-Related Legislation

House Education and the Workforce Committee: will hold a hearing on the President’s Fiscal Year 2014 Budget Proposal for the U.S. Department of Health and Human Services; 10:00 a.m., 2175 Rayburn Bldg.; June 4

House Energy and Commerce Committee: will hold a hearing on Medicare physician payment overhaul legislation; 10:00 a.m., 2123 Rayburn Bldg.; June 5.

House Appropriations Committee, Agriculture, Rural Development, FDA, and Related Agencies Subcommittee: consideration and markup of FY 2014 Agriculture Appropriations Bill. 9:30 a.m., 2362-A Rayburn Bldg.; June 5.

House Appropriations Committee, Defense Subcommittee: will mark up the FY 2014 Defense Appropriations Bill. 11:00 a.m., H-140 Capitol, June 5. This Mark Up is CLOSED.

Senate Appropriations Defense Subcommittee: will hold hearings on proposed FY 2014 appropriations for agencies, programs and activities under its jurisdiction. 10 a.m., 192 Dirksen; June 5.

Senate Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee: will hold hearings on proposed fiscal 2014 appropriations for agencies, programs and the activities under its jurisdiction. 10 a.m., 138 Dirksen; June 5.

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