[Congressional Record Volume 158, Number 164 (Wednesday, December 19, 2012)]
[House]
[Pages H7301-H7307]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE IVIG ACCESS AND STRENGTHENING MEDICARE AND REPAYING TAXPAYERS
ACT OF 2012
Mr. BRADY of Texas. Madam Speaker, I move to suspend the rules and
pass the bill (H.R. 1845) to provide for a study on issues relating to
access to intravenous immune globulin (IVIG) for Medicare beneficiaries
in all care settings and a demonstration project to examine the
benefits of providing coverage and payment for items and services
necessary to administer IVIG in the home, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 1845
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare IVIG Access and
Strengthening Medicare and Repaying Taxpayers Act of 2012''.
TITLE I--MEDICARE IVIG ACCESS
SEC. 101. MEDICARE PATIENT IVIG ACCESS DEMONSTRATION PROJECT.
(a) Establishment.--The Secretary shall establish and
implement a demonstration project under part B of title XVIII
of the Social Security Act to evaluate the benefits of
providing payment for items and services needed for the in-
home administration of intravenous immune globin for the
treatment of primary immune deficiency diseases.
(b) Duration and Scope.--
(1) Duration.--Beginning not later than one year after the
date of enactment of this Act, the Secretary shall conduct
the demonstration project for a period of 3 years.
(2) Scope.--The Secretary shall enroll not more than 4,000
Medicare beneficiaries who have been diagnosed with primary
immunodeficiency disease for participation in the
demonstration project. A Medicare beneficiary may participate
in the demonstration project on a voluntary basis and may
terminate participation at any time.
(c) Coverage.--Except as otherwise provided in this
section, items and services for which payment may be made
under the demonstration program shall be treated and covered
under part B of title XVIII of the Social Security Act in the
same manner as similar items and services covered under such
part.
(d) Payment.--The Secretary shall establish a per visit
payment amount for items and services needed for the in-home
administration of intravenous immune globin based on the
national per visit low-utilization payment amount under the
prospective payment system for home health services
established under section 1895 of the Social Security Act (42
U.S.C. 1395fff).
(e) Waiver Authority.--The Secretary may waive such
requirements of title XVIII of the Social Security Act as may
be necessary to carry out the demonstration project.
(f) Study and Report to Congress.--
(1) Interim evaluation and report.--Not later than three
years after the date of enactment of this Act, the Secretary
shall submit to Congress a report that contains an interim
evaluation of the impact of the demonstration project on
access for Medicare beneficiaries to items and services
needed for the in-home administration of intravenous immune
globin.
(2) Final evaluation and report.--Not later than one year
after the date of completion of the demonstration project,
the Secretary shall submit to Congress a report that contains
the following:
(A) A final evaluation of the impact of the demonstration
project on access for Medicare beneficiaries to items and
services needed for the in-home administration of intravenous
immune globin.
(B) An analysis of the appropriateness of implementing a
new methodology for payment for intravenous immune globulins
in all care settings under part B of title XVIII of the
Social Security Act (42 U.S.C. 1395k et seq.).
(C) An update to the report entitled ``Analysis of Supply,
Distribution, Demand, and Access Issues Associated with
Immune Globulin Intravenous (IGIV)'', issued in February 2007
by the Office of the Assistant Secretary for Planning and
Evaluation of the Department of Health and Human Services.
(g) Funding.--There shall be made available to the
Secretary to carry out the demonstration project not more
than $45,000,000 from the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of the Social
Security Act (42 U.S.C. 1395t).
(h) Definitions.--In this section:
(1) Demonstration project.--The term ``demonstration
project'' means the demonstration project conducted under
this section.
(2) Medicare beneficiary.--The term ``Medicare
beneficiary'' means an individual who is enrolled for
benefits under part B of title XVIII of the Social Security
Act.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
TITLE II--STRENGTHENING MEDICARE SECONDARY PAYER RULES
SEC. 201. DETERMINATION OF REIMBURSEMENT AMOUNT THROUGH CMS
WEBSITE TO IMPROVE PROGRAM EFFICIENCY.
Section 1862(b)(2)(B) of the Social Security Act (42 U.S.C.
1395y(b)(2)(B)) is amended by adding at the end the following
new clause:
``(vii) Use of website to determine final conditional
reimbursement amount.--
``(I) Notice to secretary of expected date of a settlement,
judgment, etc.--In
[[Page H7302]]
the case of a payment made by the Secretary pursuant to
clause (i) for items and services provided to the claimant,
the claimant or applicable plan (as defined in paragraph
(8)(F)) may at any time beginning 120 days before the
reasonably expected date of a settlement, judgment, award, or
other payment, notify the Secretary that a payment is
reasonably expected and the expected date of such payment.
``(II) Secretarial providing access to claims information
through a website.--The Secretary shall maintain and make
available to individuals to whom items and services are
furnished under this title (and to authorized family or other
representatives recognized under regulations and to an
applicable plan which has obtained the consent of the
individual) access to information on the claims for such
items and services (including payment amounts for such
claims), including those claims that relate to a potential
settlement, judgment, award, or other payment . Such access
shall be provided to an individual, representative, or plan
through a website that requires a password to gain access to
the information. The Secretary shall update the information
on claims and payments on such website in as timely a manner
as possible but not later than 15 days after the date that
payment is made. Information related to claims and payments
subject to the notice under subclause (I) shall be maintained
and made available consistent with the following:
``(aa) The information shall be as complete as possible and
shall include provider or supplier name, diagnosis codes (if
any), dates of service, and conditional payment amounts.
``(bb) The information accurately identifies those claims
and payments that are related to a potential settlement,
judgment, award, or other payment to which the provisions of
this subsection apply.
``(cc) The website provides a method for the receipt of
secure electronic communications with the individual,
representative, or plan involved.
``(dd) The website provides that information is transmitted
from the website in a form that includes an official time and
date that the information is transmitted.
``(ee) The website shall permit the individual,
representative, or plan to download a statement of
reimbursement amounts (in this clause referred to as a
`statement of reimbursement amount') on payments for claims
under this title relating to a potential settlement,
judgment, award, or other payment.
``(III) Use of timely web download as basis for final
conditional amount.--If an individual (or other claimant or
applicable plan with the consent of the individual) obtains a
statement of reimbursement amount from the website during the
protected period as defined in subclause (V) and the related
settlement, judgment, award or other payment is made during
such period, then the last statement of reimbursement amount
that is downloaded during such period and within 3 business
days before the date of the settlement, judgment, award, or
other payment shall constitute the final conditional amount
subject to recovery under clause (ii) related to such
settlement, judgment, award, or other payment.
``(IV) Resolution of discrepancies.--If the individual (or
authorized representative) believes there is a discrepancy
with the statement of reimbursement amount, the Secretary
shall provide a timely process to resolve the discrepancy.
Under such process the individual (or representative) must
provide documentation explaining the discrepancy and a
proposal to resolve such discrepancy. Within 11 business days
after the date of receipt of such documentation, the
Secretary shall determine whether there is a reasonable basis
to include or remove claims on the statement of
reimbursement. If the Secretary does not make such
determination within the 11 business-day period, then the
proposal to resolve the discrepancy shall be accepted. If the
Secretary determines within such period that there is not a
reasonable basis to include or remove claims on the statement
of reimbursement, the proposal shall be rejected. If the
Secretary determines within such period that there is a
reasonable basis to conclude there is a discrepancy, the
Secretary must respond in a timely manner by agreeing to the
proposal to resolve the discrepancy or by providing
documentation showing with good cause why the Secretary is
not agreeing to such proposal and establishing an alternate
discrepancy resolution. In no case shall the process under
this subclause be treated as an appeals process or as
establishing a right of appeal for a statement of
reimbursement amount and there shall be no administrative or
judicial review of the Secretary's determinations under this
subclause.
``(V) Protected period.--In subclause (III), the term
`protected period' means, with respect to a settlement,
judgment, award or other payment relating to an injury or
incident, the portion (if any) of the period beginning on the
date of notice under subclause (I) with respect to such
settlement, judgment, award, or other payment that is after
the end of a Secretarial response period beginning on the
date of such notice to the Secretary. Such Secretarial
response period shall be a period of 65 days, except that
such period may be extended by the Secretary for a period of
an additional 30 days if the Secretary determines that
additional time is required to address claims for which
payment has been made. Such Secretarial response period shall
be extended and shall not include any days for any part of
which the Secretary determines (in accordance with
regulations) that there was a failure in the claims and
payment posting system and the failure was justified due to
exceptional circumstances (as defined in such regulations).
Such regulations shall define exceptional circumstances in a
manner so that not more than 1 percent of the repayment
obligations under this subclause would qualify as exceptional
circumstances.
``(VI) Effective date.--The Secretary shall promulgate
final regulations to carry out this clause not later than 9
months after the date of the enactment of this clause.
``(VII) Website including successor technology.--In this
clause, the term `website' includes any successor technology.
``(viii) Right of appeal for secondary payer determinations
relating to liability insurance (including self-insurance),
no fault insurance, and workers' compensation laws and
plans.--The Secretary shall promulgate regulations
establishing a right of appeal and appeals process, with
respect to any determination under this subsection for a
payment made under this title for an item or service for
which the Secretary is seeking to recover conditional
payments from an applicable plan (as defined in paragraph
(8)(F)) that is a primary plan under subsection (A)(ii),
under which the applicable plan involved, or an attorney,
agent, or third party administrator on behalf of such plan,
may appeal such determination. The individual furnished such
an item or service shall be notified of the plan's intent to
appeal such determination''.
SEC. 202. FISCAL EFFICIENCY AND REVENUE NEUTRALITY.
(a) In General.--Section 1862(b) of the Social Security Act
(42 U.S.C. 1395y(b)) is amended--
(1) in paragraph (2)(B)(ii), by striking ``A primary plan''
and inserting ``Subject to paragraph (9), a primary plan'';
and
(2) by adding at the end the following new paragraph:
``(9) Exception.--
``(A) In general.--Clause (ii) of paragraph (2)(B) and any
reporting required by paragraph (8) shall not apply with
respect to any settlement, judgment, award, or other payment
by an applicable plan arising from liability insurance
(including self-insurance) and from alleged physical trauma-
based incidents (excluding alleged ingestion, implantation,
or exposure cases) constituting a total payment obligation to
a claimant of not more than the single threshold amount
calculated by the Secretary under subparagraph (B) for the
year involved.
``(B) Annual computation of threshold.--
``(i) In general.--Not later than November 15 before each
year, the Secretary shall calculate and publish a single
threshold amount for settlements, judgments, awards, or other
payments for obligations arising from liability insurance
(including self-insurance) and for alleged physical trauma-
based incidents (excluding alleged ingestion, implantation,
or exposure cases) subject to this section for that year. The
annual single threshold amount for a year shall be set such
that the estimated average amount to be credited to the
Medicare trust funds of collections of conditional payments
from such settlements, judgments, awards, or other payments
arising from liability insurance (including self-insurance)
and for such alleged incidents subject to this section shall
equal the estimated cost of collection incurred by the United
States (including payments made to contractors) for a
conditional payment arising from liability insurance
(including self-insurance) and for such alleged incidents
subject to this section for the year. At the time of
calculating, but before publishing, the single threshold
amount for a year, the Secretary shall inform, and seek
review of, the Comptroller General of the United States with
regard to such amount.
``(ii) Publication.--The Secretary shall include, as part
of such publication for a year--
``(I) the estimated cost of collection incurred by the
United States (including payments made to contractors) for a
conditional payment arising from liability insurance
(including self-insurance) and for such alleged incidents;
and
``(II) a summary of the methodology and data used by the
Secretary in computing such threshold amount and such cost of
collection.
``(C) Exclusion of ongoing expenses.--For purposes of this
paragraph and with respect to a settlement, judgment, award,
or other payment not otherwise addressed in clause (ii) of
paragraph (2)(B) that includes ongoing responsibility for
medical payments (excluding settlements, judgments, awards,
or other payments made by a workers' compensation law or plan
or no fault insurance), the amount utilized for calculation
of the threshold described in subparagraph (A) shall include
only the cumulative value of the medical payments made under
this title.
``(D) Report to congress.--Not later than November 15
before each year, the Secretary shall submit to the Congress
a report on the single threshold amount for settlements,
judgments, awards, or other payments for conditional payment
obligations arising from liability insurance (including self-
insurance) and alleged incidents described in subparagraph
(A) for that year and on the establishment and application of
similar thresholds for such payments for conditional payment
obligations arising from worker
[[Page H7303]]
compensation cases and from no fault insurance cases subject
to this section for the year. For each such report, the
Secretary shall--
``(i) calculate the threshold amount by using the
methodology applicable to certain liability claims described
in subparagraph (B); and
``(ii) include a summary of the methodology and data used
in calculating each threshold amount and the amount of
estimated savings under this title achieved by the Secretary
implementing each such threshold.''.
(b) Effective Date.--The amendments made by subsection (a)
shall apply to years beginning with 2014.
SEC. 203. REPORTING REQUIREMENT.
Section 1862(b)(8) of the Social Security Act (42 U.S.C.
1395y(b)(8)) is amended--
(1) in the first sentence of subparagraph (E)(i), by
striking ``shall be subject'' and all that follows through
the end of the sentence and inserting the following: ``may be
subject to a civil money penalty of up to $1,000 for each day
of noncompliance with respect to each claimant.''; and
(2) by adding at the end the following new subparagraph:
``(I) Regulations.--Not later than 60 days after the date
of the enactment of this subparagraph, the Secretary shall
publish a notice in the Federal Register soliciting
proposals, which will be accepted during a 60-day period, for
the specification of practices for which sanctions will and
will not be imposed under subparagraph (E), including not
imposing sanctions for good faith efforts to identify a
beneficiary pursuant to this paragraph under an applicable
entity responsible for reporting information. After
considering the proposals so submitted, the Secretary, in
consultation with the Attorney General, shall publish in the
Federal Register, including a 60-day period for comment,
proposed specified practices for which such sanctions will
and will not be imposed. After considering any public
comments received during such period, the Secretary shall
issue final rules specifying such practices.''.
SEC. 204. USE OF SOCIAL SECURITY NUMBERS AND OTHER
IDENTIFYING INFORMATION IN REPORTING.
Section 1862(b)(8)(B) of the Social Security Act (42 U.S.C.
1395y(b)(8)(B)) is amended by adding at the end (after and
below clause (ii)) the following:
``Not later than 18 months after the date of enactment of
this sentence, the Secretary shall modify the reporting
requirements under this paragraph so that an applicable plan
in complying with such requirements is permitted but not
required to access or report to the Secretary beneficiary
social security account numbers or health identification
claim numbers, except that the deadline for such modification
shall be extended by one or more periods (specified by the
Secretary) of up to 1 year each if the Secretary notifies the
committees of jurisdiction of the House of Representatives
and of the Senate that the prior deadline for such
modification, without such extension, threatens patient
privacy or the integrity of the secondary payer program under
this subsection. Any such deadline extension notice shall
include information on the progress being made in
implementing such modification and the anticipated
implementation date for such modification.''.
SEC. 205. STATUTE OF LIMITATIONS.
(a) In General.--Section 1862(b)(2)(B)(iii) of the Social
Security Act (42 U.S.C. 1395y(b)(2)(B)(iii)) is amended by
adding at the end the following new sentence: ``An action may
not be brought by the United States under this clause with
respect to payment owed unless the complaint is filed not
later than 3 years after the date of the receipt of notice of
a settlement, judgment, award, or other payment made pursuant
to paragraph (8) relating to such payment owed.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply with respect to actions brought and penalties
sought on or after 6 months after the date of the enactment
of this Act.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Texas (Mr. Brady) and the gentleman from Wisconsin (Mr. Kind) each will
control 20 minutes.
The Chair recognizes the gentleman from Texas.
General Leave
Mr. BRADY of Texas. Madam Speaker, I ask unanimous consent that all
Members may have 5 legislative days in which to revise and extend their
remarks and to include extraneous material on the subject of the bill
under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BRADY of Texas. Madam Speaker, I yield myself such time as I may
consume.
I, too, want to add my thanks and appreciation to my classmate on her
years of dedication and stellar service to the United States of America
on behalf of your wonderful State. Thank you.
Some of you may remember David, the little boy in the bubble. He was
a constituent from Shenandoah, Texas, who passed away at the age of 12
after living many years of his life in a sterile environment at the
Texas Children's Hospital in Houston, Texas. His mom, Carol Ann
Demeret, is a champion for David and for other patients who were born
with immunodeficiency disease. Carol Ann is a friend and a constituent,
and has worked so hard to help those patients impacted with that
disease. For years now, Carol Ann and I and many others have been
fighting to change the law that could help patients like David.
Intravenous immune globulin, or IVIG therapy, is a vital step for
treating patients with certain life-threatening diseases. These are
patients for whom virtually every trip outside is potentially deadly.
For the 250,000 Americans with primary immunodeficiency disease, there
is no place more dangerous than going to a hospital for treatment. This
is why home IVIG treatment actually prevents people being exposed to
common illnesses that may make you and I miserable for a day or two,
but could be deadly for patients with suppressed immune systems.
Regular access to IVIG therapy means a better quality of life, less
disability, and potentially the difference between life and death.
Unfortunately, today current law excludes from Medicare coverage the
items and services necessary to administer IVIG therapy in the home,
where doctors tell us patients with compromised immune systems can
benefit the most.
The Medicare IVIG Access Act requires the Centers for Medicare and
Medicaid Services to do a couple of things. It establishes a 3-year
demonstration project to cover these items and services necessary to do
this therapy in the home. It evaluates the impact of the demonstration
project on access for these Medicare beneficiaries, analyzes the
appropriateness of implementing a new methodology for IVIG payment in
all care settings under Medicare part B, and updates a previous report
on this by the Assistant Secretary for Planning and Evaluation.
It's my intent that the required study consider the impact of lag
times with respect to data used to determine the average sales price
and make recommendations to reduce the lag time to ensure more accurate
pricing for IVIG, and to report whether home infusion saves the
Medicare program tax dollars by improving access to all care settings.
The Medicare Payment Advisory Committee recently looked at home
infusion, including the access problem for Medicare beneficiaries with
PIDD.
The June MedPAC report reported that a targeted expansion of home
infusion coverage focusing on certain drugs would have more likelihood
of savings.
Drugs with a narrow indication and precise diagnostic criteria like
IVIG for PIDD are less likely to have a woodwork effect than drugs with
broad uses or imprecise diagnostic criteria. MedPAC's report also
highlighted that fixing the part B home infusion therapy for
beneficiaries with PIDD may save money because some of the other
covered therapies for these patients are more expensive.
I expect, Madam Speaker, that the study required by this bill will
give us more information about potential savings from giving people
access to the right kind of care, reducing their exposure to germs in
other settings, and increased compliance with prescribed therapy.
There may be a lot of division and partisanship in Washington right
now, but not about this bill. I would like to thank my esteemed
colleague, Representative Doris Matsui of California, for her
leadership and tremendous hard work on this important bill. We have
here today a solid, bipartisan bill, and both the House and Senate join
together in support of Medicare IVIG access.
Madam Speaker, I will include in the Record an exchange of letters
between the Ways and Means Committee and Energy and Commerce Committee
related to this bill, and I reserve the balance of my time.
House of Representatives,
Committee on Energy and Commerce,
Washington, DC, December 11, 2012.
Hon. Dave Camp,
Chairman, Committee on Ways and Means, Washington, DC.
Dear Chairman Camp: I am writing concerning H.R. 1845, the
``Medicare IVIG Access
[[Page H7304]]
Act.'' I wanted to notify you that the Committee on Energy
and Commerce will forgo action on the bill so that it may
proceed expeditiously to the House floor for consideration.
This is done with the understanding that the Committee on
Energy and Commerce is not waiving any of its jurisdiction,
and the Committee will not be prejudiced with respect to the
appointment of conferees or its jurisdictional prerogatives
on this or similar legislation.
I would appreciate a response confirming this understanding
and ask that a copy of our exchange of letters on this matter
be included in the Congressional Record during consideration
of H.R. 1845 on the House floor.
Sincerely,
Fred Upton,
Chairman.
____
House of Representatives,
Committee on Ways and Means,
Washington, DC, December 18, 2012.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce, Washington,
Dear Chairman Upton, Thank you for your letter regarding
H.R. 1845, the ``Medicare IVIG Access and Strengthening
Medicare and Repaying Taxpayers Act of 2012,'' as amended,
which is expected to be considered on the floor this week.
I appreciate your willingness to forgo action on H.R. 1845.
I agree that your decision should not prejudice the Committee
on Energy and Commerce with respect to the appointment of
conferees or its jurisdictional prerogatives on this or
similar legislation.
I will include a copy of your letter and this response in
the Congressional Record during consideration of H.R. 1845 on
the House floor.
Sincerely,
Dave Camp,
Chairman.
Mr. KIND. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise in strong support of H.R. 1845. It's a
combination of two strong, bipartisan commonsense bills before the
House today. I want to thank the gentleman on the Ways and Means
Committee, Mr. Brady, for his support of this important legislation.
As one of the coauthors of the SMART Act, one of the bills that have
been combined today, with Representative Tim Murphy, and as an original
cosponsor of the Medicare IVIG Access Act, I'm glad these two
bipartisan bills have been combined and brought to the floor for
consideration and hopefully passage later today.
The SMART Act had 139 bipartisan cosponsors; the Medicare IVIG Access
Act, with 65 bipartisan cosponsors, are perfect examples of, at times,
Democrats and Republicans joining forces and getting something done
around this place. And hopefully that spirit will continue in the days
to come with the difficult decisions that face this body.
I would like to thank my good friend Tim Murphy for his leadership
and hard work in moving the SMART Act through the Energy and Commerce
Committee. I'd also like to recognize the extraordinary, broad
stakeholder coalition that has worked so hard to help get the SMART Act
on the floor today, particularly the American Association For Justice
and the MARC Coalition.
Finally, I want to thank Representative Brady and Doris Matsui for
their tireless efforts on behalf of the Medicare IVIG Access Act. Their
legislation is a step toward ensuring all seniors with primary
immunodeficiency diseases are able to access life-saving IVIG drugs in
their own home.
But let me just take a few minutes to discuss the need for the SMART
Act. The SMART Act reforms the badly broken Medicare secondary payer
system. For background, the Medicare secondary payer system requires
Medicare to recoup the cost of hospital and doctor bills for a senior
if her injuries are the responsibility of a private insurer or some
other third party. So far so good. Making sure Medicare doesn't pay for
injuries caused by another third party is good policy to help keep
Medicare solvent.
The problem is that under the current system, seniors and parties
that want to settle a claim often cannot determine how much they owe
Medicare. That often results in the settlements collapsing. The result
is that seniors are denied settlements to compensate for their
injuries, and the Medicare trust fund is never reimbursed. That's bad
for seniors, and it's bad for the Medicare program. We're talking about
cases where seniors are trying to give money back to the government and
the government simply won't say how much they owe it. It's outrageous
that seniors can't even give money back to Medicare that the government
is owed because the system is broken down.
At a time when Congress is considering cuts to the Medicare benefits
and provider payments, we need to at least make sure that Medicare is
getting the money seniors want to send it.
The SMART Act will improve the Medicare secondary payer system by
making the government work more efficiently, reducing unnecessary
burdens and waste, and speeding the repayment of amounts owed to the
Medicare trust fund. The best way to demonstrate the need for the
legislation is with a few examples of the current system's unfairness
and outright absurdity.
{time} 1340
I have a handful of demand letters here sent by CMS to seniors asking
to be repaid $1.59, or $2.81, or $4.82, or even $36.75. Those amounts
CMS has sought to recoup from seniors is far less than the amount it
actually costs CMS to pursue these claims. That's penny wise and a
pound foolish.
The SMART Act makes sure CMS is only pursuing Medicare secondary
payment claims that will recoup at least the cost that it takes CMS to
pursue these claims. That's commonsense reform.
This bill makes financial sense for Medicare, but it will also make a
meaningful difference for seniors who are awaiting settlements that are
held up by Medicare's process today.
In fact, I heard the story of one gentleman who fell on a retailer's
handicapped ramp while using a walker. Now, Mr. Law cut his left hand;
he hit his head on the fence alongside the ramp. He and the retailer
discussed the medical charges, and they agreed to settle for $2,000.
It took 18 months and eight written exchanges with CMS to resolve
this simple MSP claim, which delayed settlement of the claim by the
same 18 months. Plus, Mr. Law actually passed away during the extended
timeframe.
We can do better for seniors. We can get Medicare the money it's owed
a lot faster. This legislation would accomplish that.
These are just a few of the examples of why the SMART Act is needed.
The toll this broken system takes on seniors and the burden it imposes
on businesses is unacceptable.
I urge my colleagues to vote for H.R. 1845 to support this
commonsense reform, including the IVIG program.
And, Madam Speaker, since this may be the last time I'll have a
chance to address you in the chair, I too want to echo the sentiments
of so many of our colleagues, to congratulate you on such a
distinguished career here in the House.
You did well in representing your constituents back home in Missouri.
We'll miss you as a colleague, someone who tried hard to work on
finding bipartisan, commonsense solutions to the challenges facing our
Nation. And, of course, we wish you all the best in your future
endeavors.
I reserve the balance of my time.
Mr. BRADY of Texas. At this time, I yield 2 minutes to the chairman
of the Health Subcommittee, a longtime fighter for patients and those
on Medicare, the gentleman from California (Mr. Herger).
Mr. HERGER. I thank my friend from Texas.
Madam Speaker, I rise today in strong support of H.R. 1845, as
amended, the Medicare IVIG Access and Strengthening Medicare and
Repaying Taxpayers Act of 2012.
This legislation would create a 3-year demonstration project to
provide up to 4,000 Medicare beneficiaries suffering from primary
immunodeficiency diseases with in-home coverage of IVIG. Medicare
beneficiaries with PIDD need the biologic IVIG to boost their immune
system so they can fight off infection and maintain a high quality of
life.
Medicare currently offers comprehensive coverage of IVIG treatments
in the physician's office and hospital setting, but not when IVIG is
administered in the home. This flawed payment policy encourages
Medicare beneficiaries to receive care in the most costly settings.
Under this demonstration project, Medicare part B would cover the
home administration costs, including the trained medical professional
who administers the biologic, allowing up to 4,000 beneficiaries with
PIDD to receive IVIG treatments in their home. Importantly,
beneficiaries who receive IVIG
[[Page H7305]]
in their home can avoid the risk of infection inherent in alternative
treatment settings.
The HHS Secretary would be required to issue a report to Congress
detailing the impact this demonstration project had on beneficiary
access to care, and whether or not CMS should permanently change its
IVIG coverage policy. According to CBO, the costs of this one-time
demonstration are fully offset by permanently reforming Medicare's
secondary-payer rules as detailed in the SMART Act.
The SMART Act will help ensure that taxpayers will not be stuck with
a Medicare bill for incidents caused when another party is liable or
negligent. The SMART Act also makes important changes so that the
arcane Medicare rules would no longer be an impediment for parties
resolving their differences and reaching settlement.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. BRADY of Texas. Madam Speaker, I yield another minute to the
gentleman from California.
Mr. HERGER. Madam Speaker, we need to protect the Medicare trust
funds, and we need to have an efficient, consistent, and clear process
to resolve these claims; and the SMART Act does exactly that.
I urge my colleagues to join me in support of this important
legislation.
Mr. KIND. Madam Speaker, I want to thank my good friend, the
gentleman from California, for his support of H.R. 1845, in particular,
the SMART Act, and congratulate him, as well, on his distinguished
career since he will be retiring at the end of this session of Congress
as well.
At this time I yield as much time as she may consume to the
gentlewoman from California (Ms. Matsui), the principal author of the
Medicare IVIG Act.
Ms. MATSUI. I'd like to thank my colleague for yielding.
I also want to say, Madam Speaker, thank you for your many wonderful
years of service and our friendship. We'll miss you in this Chamber,
and we wish you well.
Madam Speaker, I rise in strong support of H.R. 1845, the Medicare
IVIG Access Act. I'd like to thank Congressman Brady for his hard work
and his leadership on this legislation, as well as Congressman Kind for
the leadership on the SMART Act provisions of this important
legislation.
Primary Immunodeficiency Diseases or, as we call it, PIDDs, is a
group of diseases that cause a person's immune system to be unable to
function properly. Unlike most of us who are able to fight common
infectious diseases, patients with untreated PIDD can become seriously
ill from a simple cold virus or even a cut on their arm.
Patients with PIDD are generally treated with intravenous
immunoglobulin, or IVIG, a complex drug that provides them a temporary
immune system. Every 3-4 weeks, patients receive an IV treatment for
about 2-4 hours per treatment. To maintain a healthy immune system,
they must have this treatment for the rest of their lives.
People with commercial insurance typically receive care in any of
three settings: hospital outpatient departments; a physician's office;
or at home, administered by a nurse. For many patients, receiving their
care at home is optimal, as it greatly reduces the risk of infection.
However, for Medicare beneficiaries with PIDD, the program pays for
home infusion of IVIG but does not cover nursing services and supplies.
As you can imagine, a 74-year-old Medicare recipient on a fixed income
is not capable of paying the several hundred dollars a month necessary
for the nurse to provide IVIG infusions in their homes. As a result,
many patients are forced to receive their treatment in a hospital
setting, oftentimes increasing the likelihood of infection, pneumonia,
and an expensive stay in a hospital billed to Medicare.
Madam Speaker, this does not make sense for the patient or for
Medicare, and that's why Congressman Brady and I introduced the
Medicare IVIG Access Act.
Madam Speaker, this legislation is budget-neutral and fully paid for.
H.R. 1845 creates a 3-year demonstration project capped at 4,000
patients, in which the nursing services and supplies associated with
home infusion of IVIG will be covered for Medicare beneficiaries with
PIDD.
I believe that this project will mirror the results of studies of
patients with commercial insurance that found increased compliance,
fewer infections and overall savings for patients infused at home
versus the hospital.
Madam Speaker, patients with rare genetic diseases should not see
their access to care diminish when they become eligible for Medicare.
H.R. 1845 fixes the gap in Medicare coverage that unfairly restricts
patients' access to IVIG and disrupts their continuity of care.
I strongly encourage my colleagues to vote for this critically
important legislation.
{time} 1350
Mr. BRADY of Texas. Madam Speaker, I am pleased to yield 5 minutes to
the lead author and champion of the SMART Act, one of our health care
leaders, Mr. Murphy of Pennsylvania.
Mr. MURPHY of Pennsylvania. I thank the gentleman.
Madam Speaker, may I add my accolades to your work for the people of
Missouri, particularly my ancestors who founded Murphy's Settlement,
now Farmington, in your district. You've done them well.
Four years ago, Lorraine Babich of Washington County, Pennsylvania,
then age 73, suffered injuries so severe from a car accident that she
will never fully recover. After the accident, Lorraine underwent a very
difficult surgery. She was transferred to a rehabilitation facility,
where she contracted Methicillin-resistant Staphylococcus Aureus,
otherwise known as MRSA. Sadly, Lorraine's condition has worsened. She
now suffers from dementia and must receive 24/7 care at a nursing home.
The physical pain in Lorraine's life is multiplied by the emotional
pain of recent years. A year after the accident, Lorraine lost her
husband; then, last year, her only child passed away.
Lorraine's story is heartbreaking and tragic, and it's depressing to
learn Medicare is working against Lorraine's interests. In the fall of
2010, Lorraine's family and the automobile insurer for the other driver
in the accident reached a monetary settlement. The insurer agreed to
pay Lorraine's medical bills, and Lorraine would also collect damages.
First, Lorraine's health insurer--Medicare--had to be repaid, but the
Centers for Medicare and Medicaid Services won't tell Lorraine or the
auto insurer how much is owed to the Medicare trust fund. The insurance
company wants to reimburse Medicare and provide Lorraine with a
settlement, but CMS's complicated bureaucracy is standing in the way.
There are thousands of cases just like Lorraine's in congressional
districts across the country. But we now have a chance to fix this
problem and make sure Lorraine and her family receive what they are
rightfully owed by passing H.R. 1845, which includes a bipartisan bill
I introduced with Congressman Ron Kind.
Our bill, the Strengthening Medicare and Repaying Taxpayers Act, or
the SMART Act, will recoup billions of dollars owed by insurance
companies to the Medicare trust fund quickly and eliminate waste within
CMS. The SMART Act, which has nearly 140 bipartisan cosponsors and the
support of trial lawyers, patient advocates, defense attorneys, and the
U.S. Chamber of Commerce, requires that Medicare provide settling
parties with accurate information about the total costs of medical
bills when the parties announce a settlement is near.
The Congressional Budget Office has looked at our bill and found it
will save billions in Medicare. The current Medicare Secondary Payer
bureaucracy is causing seniors to have their Social Security checks
garnished and their Medicare coverage denied, through no fault of their
own. Our bill fixes these issues and ensures bureaucracy does not stand
in the way of a settlement.
Right now, insurers are walking away from settlements because of the
flaws in the Medicare Secondary Payer statute. When those settlements
break down, seniors get nothing and the taxpayers are not repaid. By
enacting this legislation, Congress can help Lorraine and thousands of
senior citizens who are needlessly suffering because Medicare isn't
operating effectively and efficiently.
I want to thank Chairmen Upton and Camp, Ranking Members Waxman and
[[Page H7306]]
Levin, and Congressman Kind for their support on this legislation. I
want to extend a special thanks to their respective staffs for their
hard work, particularly Robert Horne and Brad Grantz. Without them,
this legislation wouldn't be moving forward.
This is good government and saves taxpayers' money. I urge its
adoption.
Mr. KIND. I yield such time as he may consume to my very good friend,
the gentleman from New Jersey, one of the leaders in the Energy and
Commerce Committee, Mr. Pallone.
Mr. PALLONE. I want to thank the gentleman from Wisconsin.
Madam Speaker, I rise to lend my support to H.R. 1845, as amended.
This bill combines two pieces of legislation: H.R. 1845, which provides
a demonstration for the coverage of home infusion of intravenous immune
globulin, or IVIG, and H.R. 1063, which makes improvements to the
Medicare Secondary Payer process, or MSP. However, I would like to note
my concerns about the process.
Our committee acted on H.R. 1063, and I commend the chairman for his
efforts to ensure it was a bipartisan product, but we did not act on
the IVIG legislation, which is every bit as important to our Members as
the MSP. So it's my hope that in the future we can avoid situations
like this.
The Medicare Secondary Payer provisions of this bill will reduce the
burdens of the secondary payer process for beneficiaries and other
stakeholders. Most importantly, the legislation will do so in a way
that ensures that we're also protecting taxpayer dollars and the
Medicare trust fund. I do worry, however, that the MSP bill does not
include administrative funding for the Centers for Medicare and
Medicaid Services, or CMS, to implement these new changes.
One of the primary complaints I hear about MSP is that stakeholders
are currently frustrated because the process does not move fast enough.
But here we are, legislating new responsibilities on top of an already
slow process--with no funding. This will simply burden the agency and
make it more difficult to get to resolution on secondary payer cases in
a timely fashion. So I hope that at some future date we can provide a
reasonable sum to the agency to allow them to be better equipped to
speed this process along.
One additional point on MSP: the new process we've established for
resolving disputes of claims posted on the Web portal is not intended
to supplant the ordinary appeals process for MSP activities. I believe
that is clear in the language, but I want to note that there should be
no ambiguity. This bill does not supplant existing appeals rights.
In addition to MSP changes, this bill also provides for a 3-year
demonstration related to IVIG. IVIG is a blood-derived treatment that
helps strengthen the immune systems of immune-deficient patients and
prevents paralysis in some autoimmune diseases and neuropathies.
Currently, Medicare beneficiaries may receive home infusion of IVIG as
a part B benefit; however, the equipment, nursing services, and
supplies necessary for the home infusion are not reimbursed.
Congresswoman Matsui has been a clear leader on this issue and it's
to her credit that it's included in this package today. She's worked so
tirelessly on this IVIG issue, and I'm hopeful that this demonstration
project she has championed will both save money for the Medicare
program and improve access to needed services for this vulnerable
population. I thank her for her leadership on behalf of these patients.
I also want to thank Chairman Upton for working on these two issues
with us, and I look forward to the next Congress, where, hopefully,
we'll find additional areas of common ground to work on.
Mr. KIND. I have no further speakers. I encourage my colleagues to
support H.R. 1845, and I yield back the balance of my time.
Mr. BRADY of Texas. I yield myself such time as I may consume.
In closing, I want to thank my counterpart, Doris Matsui, for her
great work on this issue. I so appreciate the leadership and
partnership of Mr. Kind and Mr. Murphy in combining these two important
health care bills in order to both provide safer, more affordable
access to care for those with compromised immune deficiencies, as well
as finding ways to save money with the important Medicare program and
the SMART Act.
I want to thank Andrew Wankum of my staff for his excellent work on
this bill, Dan Elling, staff director of the Ways and Means
Subcommittee on Health, as well as Jennifer Safavian for her leadership
on the Ways and Means Committee. But I especially want to thank my
constituent friend, Carol Ann Demaret, the mom of David, for her
decades of hard work on behalf of these patients. And I appreciate so
much Marcia Boyle, the founder of the Immune Deficiency Foundation, and
all those patients who for years have come up here asking for this help
and change.
=========================== NOTE ===========================
December 19, 2012 on Page H7306 the following appeared: I want
to thank Dan Elling, staff directorof the Ways and Means
Subcommittee on Health, as well as Jennifer Safavian for her
leadership on the Ways and Means Committee.
The online version should be corrected to read: I want to thank
Andrew Wankum of my staff for his excellent work on this bill, Dan
Elling, staff director of the Ways and Means Subcommittee on
Health, as well as Jennifer Safavian for her leadership on the
Ways and Means Committee.
========================= END NOTE =========================
Today, this Congress, Republicans and Democrats alike, join together
in providing that help and that access. I urge support for this bill
and yield back the balance of my time.
Mr. WAXMAN. Madam Speaker, I am pleased that we are bringing this
bill to the floor today. This bill combines two pieces of legislation,
H.R. 1845 which provides a demonstration for the coverage of home
infusion of intra venous immune globulin (IVIG) and H.R. 1063, which
makes improvements to the Medicare Secondary Payer process.
H.R. 1063 was developed and reported by the Energy and Commerce
Committee as a bipartisan effort. I commend Chairman Upton's
willingness to work with us to achieve a solution. I believe we have a
good balance assembling this package of improvements to the current
process.
Under current law, Medicare is a secondary payer to certain group
health plans and non-group health plans regardless of state law or plan
provisions. These plans include auto or other liability insurance, no-
fault insurance, and workers' compensation plans. But even though it is
legally a secondary payer, it pays medical claims for Medicare
beneficiaries--even if they may have other entities with a legal
responsibility--and then recovers its expenditures so seniors and
persons with disabilities are able to get the services they need. Then
the appropriate claims are settled after the fact. The goal of the
Medicare Secondary Payer bill is to reduce the burdens of the secondary
payer process for beneficiaries and other stakeholders and help to have
timely settlements, but to do so in a way that makes sure we are also
protecting taxpayer dollars and the Medicare trust fund.
I do regret that we were unable to include administrative funding for
the Centers for Medicare and Medicaid Services (CMS) to implement these
new changes. Stakeholders are currently frustrated because the process
does not move fast enough; adding new responsibilities on top of an
already slow process--with no new funding--is going to burden the
agency and make it more difficult to meet the stakeholders' desired
time frame for resolution. I hope that at some future date we can
provide a reasonable sum to speed this process along.
I would like to clarify one additional point regarding the changes in
this bill. The new process we have established for resolving disputes
of claims posted on the web portal is not intended to supplant the
ordinary appeals process for MSP activities. I believe that is clear in
the language, but I want to note there should be no ambiguity.
I am also pleased that a bill Congresswoman Matsui has been a clear
leader on is included in this package today. She has worked tirelessly
on this IVIG issue, and I am hopeful that this demonstration project
she has championed will save both save money for the Medicare program
and improve access to needed services for this vulnerable population. I
thank her for her leadership on this issue.
I thank Chairman Upton for working on these two issues with us, and
our colleagues on the Ways and Means Committee who worked to bring
these bills to the floor, and I look forward to next Congress where
hopefully we will find additional areas of common ground to work on.
Mr. REICHERT. Madam Speaker, I rise today to express my support for
H.R. 1845. Title II addresses a set of issues involving the employers
and the casualty insurance industry and the Medicare Secondary Payer
(MSP) law.
However, this is not the only set of MSP issues that impact workers'
compensation that also needs to be addressed. My legislation, H.R.
5284, the Medicare Secondary Payer and Workers' Compensation Settlement
Agreement Act, is cosponsored by Representative Mike Thompson and has
bipartisan support.
This legislation aims to resolve the delays by the Centers for
Medicare and Medicaid Services (CMS) in reviewing workers' compensation
settlements to determine the appropriate set-aside amount to be
maintained by Medicare beneficiaries to pay for future medical costs in
which Medicare may have an interest.
[[Page H7307]]
H.R. 5284 creates a system of certainty and allows the workers'
compensation settlement process to move forward while eliminating
millions of dollars in administrative costs. It will help create clear
and consistent standards, currently lacking in the process, to address
workers' compensation issues. Most importantly, it will benefit all
parties involved--injured workers, employers, insurers and CMS.
I am hopeful that the House of Representatives will be able to move
H.R. 5284 towards enactment.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Texas (Mr. Brady) that the House suspend the rules and
pass the bill, H.R. 1845, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. BRADY of Texas. Madam Speaker, on that I demand the yeas and
nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
____________________