[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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