Health-Related Provisions in CRomnibus

When signed by the President, the omnibus spending bill will provide for the following: $5.4 billion of the $6.2 billion requested by the President for Ebola response and preparedness; $30.1 billion for the National Institutes of Health (NIH), a $150 million increase, including a $25 boost for Alzeheimer’s research; $3.7 billion for program management at the Centers for Medicare and Medicaid Services (CMS); $6.9 billion for the Centers for Disease Control and Prevention (CDC), a $21 million increase; a directive to CMS to provide information about the requirement that home health agencies (HHAs) provide a face-to-face certification from a physician before home health care services for Medicare and Medicaid patients will be covered and a mandate that CMS present a plan on how rebasing is affecting HHAs, on how critical-access hospital rules impact HHAs and on how HHA requirements can be streamlined; a directive that CMS review its previous decision to cover ventricular assist devices upon receipt of new evidence; a directive that the National Institute of Allergy and Infectious Diseases (NIAID), the Biomedical Advanced Research and Development Authority (BARDA) and the CDC hold a workshop within 180 days to develop a comprehensive plan with a timeline and measurable objectives to help develop antibiotics for resistant bacteria; and a directive that CMS educate providers on how to reduce the backlog of appeals of decisions by Medicare Recovery Audit Contractors (RACs). The legislation also includes the following provisions related to the Patient Protection and Affordable Care Act (PPACA): it prohibits CMS from providing new funding to subsidize potential revenue losses by health insurers under the law’s risk corridor provision (however payments to CMS from insurers whose revenues are higher than expected could still be used to pay for insurer losses); a cut of $350 million in the Internal Revenue Service (IRS) budget could impede the agency’s activities related to the law; a provision prohibiting funds from the law’s Prevention and Public Health Fund to be used for other PPACA activities; a provision that would cut funding of the Independent Payment Advisory Board (IPAB) by $10 million; a directive that CMS report on the cost of PPACA administrative and information technology services, benefit reviews, and enrollment and market reviews; a directive that the U.S. Department of Health and Human Services (HHS) increase the transparency of abortion coverage within federal exchange health-care plans and language directing HHS to quickly respond to claims filed by health-care providers on conscience-clause violations; and an exemption for expatiate health care plans from the PPACA coverage requirements. These provisions trimming PPACA-related activities are but the opening shot by Republicans to go further next year to repeal major portions of the law, including the individual mandate and related tax credits, Medicaid expansion, employer mandate threshold of 30 hours, medical device tax, and the IPAB, etc.

Congress Considers Additional Legislation

The House sent to the President for his signature H.R. 1281, the Newborn Screening Saves Lives Reauthorization Act of 2014, legislation amending the Public Health Service Act to revise and extend through FY 2019 a grant program for screening, counseling, and other services related to heritable disorders that can be detected in newborns. The bill authorizes grants to be used to improve timeliness of newborn screening and provide training to health care professionals on the importance of timely screening and on the sharing of medical and diagnostic information with providers and families. In addition, the CDC is directed to engage in data collection, reporting and other activities to assure the quality of labs involved in such screening and HHS is directed to update the Federal Policy for the Protection of Human Subjects. The Senate sent to the President for his signature the following House-passed bill: H.R. 4771, the Designer Anabolic Steroid Control Act of 2014. The Senate is also expected to act before adjournment on the following House-passed bills: H.R. 5185, the EARLY Act Reauthorization of 2014, legislation which reauthorizes through FY 2019 the Young Women’s Breast Health Education and Awareness Requires Learning Young Act of 2009; H.R. 5059, the Clay Hunt Suicide Prevention for American Veterans Act, legislation to direct the Secretary of Defense and the Secretary of Veterans Affairs to provide for the conduct of annual evaluations of mental health care and suicide prevention programs of the Department of Defense and the Department of Veterans Affairs, to review the terms or characterization of the discharge or separation of certain individuals from the armed forces, to require a pilot program on loan repayment for psychiatrists who agree to serve in the Veterans Health Administration of the Department of Veterans Affairs; H.R. 3979, the $513.4 billion National Defense Authorization Act for Fiscal Year 2015; and H.R. 5771, legislation extending various tax provisions through December 31, 2014.

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