[Congressional Record Volume 161, Number 97 (Wednesday, June 17, 2015)]
[House]
[Pages H4481-H4483]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               INCREASING REGULATORY FAIRNESS ACT OF 2015

  Mr. BRADY of Texas. Mr. Speaker, I move to suspend the rules and pass 
the bill (H.R. 2507) to amend title XVIII of the Social Security Act to 
establish an annual rulemaking schedule for payment rates under 
Medicare Advantage, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 2507

       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 ``Increasing Regulatory 
     Fairness Act of 2015''.

     SEC. 2. ESTABLISHING AN ANNUAL RULEMAKING SCHEDULE FOR 
                   PAYMENT RATES UNDER MEDICARE ADVANTAGE.

       Section 1853(b) of the Social Security Act (42 U.S.C. 
     1395w-23(b)) is amended--
       (1) in the subsection heading, by inserting ``, Annual 
     Rulemaking Schedule for Payment Rates for 2017 and Subsequent 
     Years'' after ``Rates'';
       (2) in paragraph (1)--
       (A) in subparagraph (B)--
       (i) in the subparagraph heading, by inserting ``before 
     2017'' after ``years''; and
       (ii) in the matter preceding clause (i), by inserting ``and 
     before 2017'' after ``2005''; and
       (B) by adding at the end the following new subparagraph:
       ``(C) Annual rulemaking schedule for payment rates for 2017 
     and subsequent years.--For 2017 and each subsequent year, 
     before April 1 of the preceding year, the Secretary shall, by 
     regulation and in accordance with the notice and public 
     comment periods required under paragraph (2) for such a year, 
     annually determine and announce the following:
       ``(i) The annual MA capitation rate for each MA payment 
     area for such year.
       ``(ii) The risk and other factors to be used in adjusting 
     such rates under subsection (a)(1)(A) for payments for months 
     in such year.
       ``(iii) With respect to each MA region and each MA regional 
     plan for which a bid was submitted under section 1854, the MA 
     region-specific non-drug monthly benchmark amount for that 
     region for the year involved.
       ``(iv) The major policy changes to the risk adjustment 
     model, and the 5-star rating system established under 
     subsection (o), that are determined to have an economic 
     impact.''; and
       (3) in paragraph (2)--
       (A) by inserting ``(or, for 2017 and each subsequent year, 
     at least 60 days)'' after ``45 days''; and
       (B) by inserting ``(for 2017 and each subsequent year, of 
     no less than 30 days)'' after ``opportunity''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Brady) and the gentleman from California (Mr. Thompson) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Texas.


                             General Leave

  Mr. BRADY of Texas. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on H.R. 2507 currently 
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. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I stand in support of H.R. 2507, the Increasing 
Regulatory Fairness Act. This is an important piece of legislation. 
Today, the Medicare Advantage program serves more than 16 million 
seniors throughout the country. Enrollment has increased more than 
threefold over the past decade, and it is expected to nearly double in 
the next.
  To ensure that seniors are able to continue receiving the kind of 
high-

[[Page H4482]]

quality care they receive under the program, the Centers for Medicare 
and Medicaid Services, known as CMS, is expected to pay about $156 
billion to more than 3,600 Medicare Advantage plans just this year. 
That is nearly 30 percent of all Medicare spending, by the way.
  Typically, every year CMS sends out what is called the rate notice to 
plans and Medicare Advantage companies that details the various payment 
rates and benefit changes the agency plans to make for the following 
year. This notice follows the standard rulemaking process of other 
payment systems. That is, a draft notice is published, the public has a 
certain amount of time to submit comments and questions, and then the 
agency publishes a final notice based on that feedback.
  Right now, this current process takes about 45 days. Do you know how 
many days are currently allotted for public comment? The answer: A mere 
15 days--15 days for thousands of plans and millions of stakeholders to 
submit comments on proposed changes to a program that amounts to one-
third of all Medicare spending.
  I could almost understand this if the rate notice were a short and 
concise document, easy to understand, and simple to implement, but of 
course it is not. The rate notice has grown from around 16 pages in 
2006 to nearly 150 pages this year. That is over a ninefold increase. 
All the while, the time for the public comment period has remained the 
same. This means less and less time for plans and Congress to conduct 
the necessary review so we can provide CMS with the kind of feedback 
that would better help the agency assess the impact of their proposed 
changes. This is important because without accurate feedback, CMS could 
inadvertently move forward with a proposed change to the Medicare 
Advantage program that might negatively impact these seniors who depend 
on these plans for access to essential medical care.
  The legislation before us is simple and straightforward. All it 
proposes to do is extend the public notice period from 45 days to 60 
days, which would mean an extension of the comment period from 15 to 30 
days. This is a commonsense, good government fix we can make that will 
give plans more time to understand the changes that Medicare proposes, 
offer constructive feedback, and make the Medicare Advantage program 
overall more responsive to senior needs.
  I want to thank Mr. Thompson of California, who is a key member of 
our Committee on Ways and Means, and Mr. Pitts, the chairman of the 
Health Subcommittee on Energy and Commerce, for their thoughtful and 
very helpful work on this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. THOMPSON of California. Mr. Speaker, I yield myself such time as 
I may consume.
  Mr. Speaker, I would like to thank Mr. Brady. It was a pleasure 
working with him on this piece of legislation.
  I rise in support of H.R. 2507. Every year, as was pointed out, the 
Centers for Medicare and Medicaid Services publishes its Medicare 
Advantage call letter and rate notice that outlines all the payment 
rates and the changes for nearly 2,000 plans that serve our most 
vulnerable population.
  About 10 years ago the call letter and rate notice were less than 20 
pages long. Since then, enrollment in Medicare Advantage has nearly 
tripled. Medicare Advantage policies have become more complex, and the 
call letter and the rate notice has grown nearly tenfold. They run 
about 150 to 200 pages.
  The same time, the time between the publishing of the draft notice 
and the final notice, which is currently 45 days, has remained 
unchanged. During this 45-day period, in which there are only 15 days 
to comment on the proposed changes in the program, the plans, Members 
of this body and our staff are expected to review 150 pages of 
regulatory changes and understand the impacts of the proposed policy 
changes on those programs that provide essential medical care to over 
one-third of Medicare beneficiaries.
  As we all know, and as we have all experienced every February and 
March, this does not lend itself to an efficient, effective, nor 
transparent process. Moreover, it deprives CMS of thoughtful, 
constructive feedback that is necessary to improve a program that our 
seniors love and rely on. This bill is a simple, straightforward 
measure that will improve the current process by expanding the current 
cycle from 45 to 60 days, which will give plans, stakeholders, Members, 
and our staff 30 full days--double the current time allowed--to analyze 
and provide feedback on the draft call letter and rate notices.
  This is a no-cost, good government, bipartisan bill that will make 
the process more transparent, more fair, and more advantageous for the 
beneficiaries whom we serve. Therefore, I strongly urge my colleagues 
to join me in supporting this important piece of legislation.
  I reserve the balance of my time.
  Mr. BRADY of Texas. Mr. Speaker, I yield 2 minutes to the gentleman 
from Georgia (Mr. Carter), a key new member of the House of 
Representatives who understands the importance of Medicare Advantage.
  Mr. CARTER of Georgia. Mr. Speaker, one of the things I always strive 
for in my personal and professional life is always trying to do things 
better. As I tell my staff, there is no such thing as standing still. 
If you are not moving forward, then you are moving backward. We can all 
continue to get better at what we do.
  That is the goal of H.R. 2507, the Increasing Regulatory Fairness Act 
of 2015. As part of an annual rulemaking process, the Centers for 
Medicare and Medicaid Services update payments to the Medicare 
Advantage program. With the current structure of this annual process, 
health insurers are given little time to submit comments to the new 
payment rates or even determine whether the payment adjustment is 
beneficial to Medicare Advantage enrollees.
  With H.R. 2507, health insurers will have additional time to analyze 
whether the payment adjustments for Medicare Advantage plans are 
justified and overall beneficial. I believe we must always try to get 
better every day. This includes our work as civil servants. H.R. 2507 
will provide a better environment for CMS and health insurers to create 
the best payment rate agreement regarding Medicare Advantage plans. By 
providing more time for comments and the finalizing of rates, Medicare 
Advantage enrollees will receive a better calculated benefit for their 
plans.

  I urge my colleagues to support this bill.
  Mr. THOMPSON of California. Mr. Speaker, I concur with the statements 
previously made by my colleagues and thank both Mr. Brady and Mr. Pitts 
for working with me on this legislation. As I have stated before, this 
is a simple, no-cost bill that will improve the current process and the 
Medicare Advantage program for our seniors. I urge my colleagues to 
support H.R. 2507.
  I yield back the balance of my time.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself the balance of my 
time.
  Mr. Speaker, I join with Congressman Thompson. I appreciate so much 
his work in this area in a bipartisan way on a bill that not only 
bridges both parties but a number of committees in this Congress and 
really just provides a commonsense way to make sure the public, 
Congress, and others can comment, and to make sure these rules really 
benefit the seniors who are receiving Medicare Advantage. I urge strong 
support for this bill.
  I yield back the balance of my time.
  Mr. PITTS. Mr. Speaker, the bill before us today expands an annual 
regulatory schedule for Medicare Advantage (MA) payment rates so that 
stakeholders have the necessary time to review and provide feedback to 
ensure seniors continue to have access to quality, low-cost plans of 
their choosing.
  H.R. 2507, the Increasing Regulatory Fairness Act of 2015, was 
introduced by my colleague, Representative Kevin Brady (TX), Chairman 
of the Health Subcommittee of Ways and Means, and I cosponsored along 
with Mike Thompson (CA), Pete Sessions (TX), and Kyrsten Sinema (AZ). 
This bipartisan, commonsense legislation will facilitate greater 
understanding and collaboration between industry stakeholders and 
regulators, and will offer a greater opportunity for public input in 
the establishment of policies affecting the MA and Part D plans.
  Since 2006, when the Medicare Modernization Act's official 
implementation, and the Medicare Advantage/Part D call letter and rate

[[Page H4483]]

notice were around 16 pages long, a two-week comment period may have 
been adequate. Today, however, that document has grown to nearly 150 
pages--and the comment period--still just 15 days--is simply not enough 
time for plans that now serve one-third of the Medicare population to 
analyze and gather substantive comments on increasingly complex policy 
changes. This bill would increase that comment period to 30 days, a 
strong step towards regulatory fairness for the successful Medicare 
Advantage/Part D programs.
  Expanding this comment period allows for a fair amount of time in 
which both stakeholders, as well as Members of Congress and Committees, 
have sufficient time to understand the policy implications and 
formulate comments, if they so choose. More time equals better, more 
thoughtful policies.
  Mr. Speaker, by approving this legislation, we will be giving 
seniors, insurance plan providers and other interested stakeholders 
adequate time to comprehend and provide comments on proposed changes to 
Medicare Advantage plans.
  This is an important and necessary legislative change and I urge all 
of my colleagues to support H.R. 2507.
  Mr. ENGEL. Mr. Speaker, I rise in opposition to, specifically, the 
provision of H.R. 2570 that pays for the Value Based Insurance Design 
for Better Care Act. If this bill passes with its current pay-for in 
place, it will do so at the detriment of Americans who rely on home 
infusion therapies.
  ``Infusion therapy'' refers to the administration of medication 
directly into the bloodstream through a needle or catheter. A patient 
will undergo infusion therapy when his or her disease or infection 
cannot be adequately treated by oral medications. Infusion therapy is 
used to treat cancers, congestive heart failure, immune deficiencies, 
multiple sclerosis, rheumatoid arthritis, gastrointestinal diseases, 
and other conditions.
  The administration of infusion therapies is significantly more 
involved than that of oral medications. Infusion therapy entails 
specialized equipment, supplies, and professional services, including 
sterile drug compounding, care coordination, and patient education and 
monitoring.
  Currently, Medicare fully covers infusion therapy when it is 
administered in a hospital, doctor's office or nursing home. However, 
Medicare's coverage of infusion therapy in the home is fractured and 
does not adequately cover the services needed to provide infusions in 
the home.
  Not only does this coverage gap force patients into expensive 
institutional settings, but it also puts patients at risk of developing 
additional infections in these environments. What's more, this coverage 
gap prevents patients from receiving the treatment they need in the 
most comfortable setting possible: their homes.
  Although Medicare does not presently pay for the services that are 
essential for a patient to receive infusion therapies at home, 
providers have been able to offer a limited set of home infusion drugs 
to Medicare beneficiaries via Medicare Part B DME coverage, as the 
reimbursement they receive for home infusion drugs is substantial 
enough to cover the services necessary to administer those drugs.
  If H.R. 2570 passes in its current form, this will no longer be the 
case.
  The demonstration program that this legislation creates is financed 
by modifying the reimbursement structure for infusion drugs under the 
Medicare Part B durable medical equipment benefit. This change will 
perpetuate the coverage gap that prevents Medicare from covering the 
indispensable service component of home infusion therapy.
  In addition, the drug reimbursement that providers receive will no 
longer be significant enough to capture home infusion services as it 
does currently. As a result, it will become exceedingly difficult for 
providers to offer Medicare beneficiaries infusion therapy in their 
homes.
  I want to emphasize that I do not oppose changing the manner in which 
home infusion drugs are paid for. On the contrary, I have introduced 
H.R. 605, the Medicare Home Infusion Site of Care Act, with Congressman 
Pat Tiberi. Our bill, which has garnered cosponsors from both sides of 
the aisle, would explicitly cover the services that must be provided to 
administer infusion drugs at home.
  I ask that my colleagues think about the patients who depend on home 
infusion therapies. If we allow H.R. 2570 to pass in its current form, 
we simultaneously deny patients the ability to receive life-saving 
therapies in their homes, forcing them into institutional settings that 
will come at a cost to the Medicare program and, most importantly, to 
patients' quality of life.
  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. 2507, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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