House Amendment to S. 1347, Electronic Health Fairness Act of 2015

S. 1347

House Amendment to the Electronic Health Fairness Act of 2015

Sponsor
Sen. Johnny Isakson

Date
December 16, 2015 (114th Congress, 1st Session)

Staff Contact
John Huston

Floor Situation

On Wednesday, December 16, 2015, the House will consider the House Amendment to S.1347, Electronic Health Fairness Act of 2015, under suspension of the rules.  The bill was introduced on May 14, 2015, by Sen. Johnny Isakson (R-GA) and passed the Senate by unanimous consent on August 5, 2015.

Bill Summary

The House Amendment to S. 1347 makes various changes to the Centers for Medicare and Medicaid Services (CMS) programs and administrative procedures to enhance services for beneficiaries. The Senate passed version of S. 1347 contains nearly identical language on providing relief to ambulatory surgical centers (ASCs) as H.R. 2570, which passed the House by voice vote on June 17, 2015. The House Amendment to S. 1347 includes nearly identical language on Medicare Advantage termination authority as H.R. 2582 and nearly identical language regarding Medicare transparency as H.R. 2505. Both bills passed the House by voice vote on June 17, 2015.

Specifically, the bill includes the following provisions:

Health IT “Meaningful Use” Exceptions—The bill amends the Health IT Meaningful Use (MU) statute to allow for a blanket hardship exception for the 2015 MU Stage 2 reporting period in order to process certain hardship applications in a more efficient manner.  The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 required that payment adjustments should be applied to Medicare eligible professionals, eligible hospitals, and critical access hospitals that are not meaningful users of Certified EHR Technology under the Medicare EHR Incentive Program. This provision was intended to incentivize providers to adopt the use of electronic health record (EHR) technology. The Act provided exceptions for health care providers if they can show that demonstrating meaningful use would result in a significant hardship.[1] S. 1347 expands this hardship provision to certain providers.

Medicare Advantage Termination Authority—The bill includes several provisions designed to ensure the integrity and viability of the Medicare Advantage (MA) program by delaying the ability of CMS to terminate MA plans solely on the basis of low quality ratings until the end of plan year 2018 in an attempt to resolve socioeconomic status issues. There are concerns that an MA plan’s performance under CMS’s five-star rating system may be impacted by factors other than the actions of the plans and providers themselves like socioeconomic factors beyond their control. Failing to account for these factors may lead some plans to score more poorly on performance measures simply because of the composition of those enrolled in their plans, not on an actual inadequacy in their performance. This provision is nearly identical to a provision within H.R. 2582, the Seniors’ Health Care Plan Protection Act of 2015, as amended, which passed the House by voice vote on June 17, 2015.

Ambulatory Surgical Center Health Records—The bill excludes ambulatory surgical center (ASC) services from being counted toward the 50 percent meaningful use eligibility threshold until certified EHR systems applicable to the ASC setting are available.  The exclusion will expire three years after the Secretary of the Department of Health and Human Services has certified such ASC EHR systems. According to the Committee, this provision resolves a burden faced by physicians practicing in ASC settings without slowing the adopting of EHR technology.[2] This provision is similar to a provision within H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015, as amended, which passed the House by voice vote on June 17, 2015.

Medicare Data Transparency—The bill also requires the Secretary of the Department of Health and Human Services to report Medicare enrollment information by zip code, and congressional district to certain congressional committees by May 1 each year. The bill also requires the Secretary to notify these committees when the required report cannot be submitted by the prescribed deadline and explain the inability to provide such report. This provision is nearly identical to a provision within H.R. 2505, the Medicare Advantage Coverage Transparency Act of 2015, as amended, which passed the House by voice vote on June 17, 2015.

Radiation Therapy Code Delay—The bill provides for a two year delay in updating Radiation Therapy codes to the new CMS International Classification of Diseases coding system (ICD-10).

Competitive Bidding for Certain Wheelchair Accessories—The bill prohibits, for one year, CMS from applying the Medicare competitive bidding to wheelchair accessories used in connection with certain[3] complex rehabilitative power wheelchairs.

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[1] See Centers for Medicare & Medicaid Services, Payment Adjustments & Hardship Information
[2] See Senate Report 114-106 at 2.
[3] See 42 U.S.C. 1395m(a)(1)(B)(ii)

Cost

There is not currently a Congressional Budget Office (CBO) cost estimate for the House Amendment to S. 1347; however, CBO estimates that enacting S. 1347, as passed by the Senate, would increase direct spending by $15 million over the fiscal year 2016 to 2025 period.

CBO estimates that enacting H.R. 2505, the Medicare Advantage Coverage Transparency Act of 2015, would not have a significant budgetary effect, because CMS already collects data on enrollment in Medicare under current law.

There is not currently a CBO estimate for H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015.

Additional Information

For questions or further information please contact John Huston with the House Republican Policy Committee by email or at 6-5539.