CBO Scores 21st Century Cures Package

The 21st Century Cures Act will cost $106.4 billion through 2020, according to an estimate by the Congressional Budget Office (CBO). The legislation seeks to overhaul the medical drug and device research, development, and approval process. House Energy and Commerce Committee members also released a committee report last week on the legislation. Offsets for the bill are still under negotiation. Updated bill language should be available this week, and the package will likely reach the House floor after the Fourth of July holiday. H.R. 6 currently has 230 bipartisan cosponsors, notable because only 218 votes are needed for passage.

Movement on Labor-HHS-Education Appropriations

The House Appropriations Committee voted 30-21 to report out the fiscal year (FY) 2016 Labor-Health and Human Services (HHS)-Education spending bill, totaling $153.05 billion. The spending bill is a $3.7 billion reduction from current spending levels and $14.6 billion below the President’s budget request. During the markup, members on both sides of the aisle voiced discontent with the sequestration level spending caps. The bill eliminates funding for the Agency for Healthcare Research and Quality (AHRQ). It would also block any new discretionary funding for further implementation of the 2010 health care law, and rescinds some unspent funds, including $6.8 billion from the Center for Innovation at the Centers for Medicare and Medicaid Services (CMS). The National Institutes of Health (NIH) would receive an additional $1.1 billion in funding. The Centers for Disease Control and Prevention (CDC) would receive an additional $140 million in spending. The spending bill urges CMS to aid in minimizing the burden of ICD-10 implementation on doctors, such as the potential for delayed payments, and to establish a hardship exemption for those that would be harmed by the switch. Appropriators also request that CMS assist providers and hospitals in resolving issues with recovery audit contractors (RACs). They encourage CMS to find a better balance between eliminating fraud and abuse while not jeopardizing patient access to care and the financial stability of health care providers. Lawmakers want to see funds resulting from RAC audits redirected to help hospitals and providers better understand payment rules. Appropriators also suggest that they want to see a reduction in the backlog of claims at the Office of Medicare Hearings and Appeals. In response to U.S. Preventive Services Task Force (USPSTF) recommendations indicating that the benefits of mammography screening may not always outweigh the risks for women in their 40s, appropriators advise HHS to halt any changes to breast cancer screening recommendations until further research is conducted on new screening technologies. An amendment was included from Rep. Marcy Kaptur (D-Ohio) requesting that within 120 days HHS and the Department of Veterans Affairs (VA) study the rising costs of prescription drugs and examine how much the government is spending on the highest-cost and most frequently prescribed drugs in government health care programs. The Senate Labor-HHS-Education Appropriations Committee voted 16-14 to advance their own version of the FY 2016 spending bill, totaling $153.2 billion. The spending bill is a $3.6 billion reduction from current spending levels and $14.5 billion below the President’s budget request. Funding for the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act (ACA), would be eliminated. The bill also limits and monitors spending on the implementation of the ACA, blocking funding for the federal risk corridor program and discretionary funding for state-based insurance exchanges. The bill would require the administration to make public the number of employees, contractors, and activities involved in the implementation of the health care law. Total funding for HHS would be cut by $646 million for a total of $70.4 billion. NIH would receive $32 billion, a $2 billion increase over current spending levels, while CDC would receive a $251 million cut. CMS would receive a $1.15 billion cut, and committee members expressed concerns that this budget will be insufficient to allow CMS’ building space, staff, and information technology to accommodate the growing enrollment in the Medicare program. An amendment from Sen. Tom Udall (D-N.M.) was agreed to that would allocate some of the bill’s public health funds to a preventive medicine residency program. The manager’s amendment included provisions from Democratic members recognizing the therapeutic benefits of marijuana and urging the NIH to conduct more research on the drug. Language was also included commending a demonstration project for frontier clinics and encouraging the Integrative Health Council to further address mental health issues. The White House has expressed particularly strong opposition to the Labor-HHS-Education spending bills, citing their belief that spending levels deeply underfund important programs. The deadline for passing appropriations legislation is October 1, the beginning of the next fiscal year.

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