[Congressional Record Volume 164, Number 195 (Tuesday, December 11, 2018)]
[House]
[Pages H10043-H10052]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
IMPROVING MEDICAID PROGRAMS AND OPPORTUNITIES FOR ELIGIBLE
BENEFICIARIES ACT
Mr. BARTON. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 7217) to amend title XIX of the Social Security Act to
provide States with the option of providing coordinated care for
children with complex medical conditions through a health home, and for
other purposes.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 7217
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 ``Improving Medicaid Programs
and Opportunities for Eligible Beneficiaries Act'' or the
``IMPROVE Act''.
TITLE I--ACE KIDS
SEC. 101. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A
HEALTH HOME FOR CHILDREN WITH MEDICALLY COMPLEX
CONDITIONS.
Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) is amended by inserting after section 1945 the
following new section:
``SEC. 1945A. STATE OPTION TO PROVIDE COORDINATED CARE
THROUGH A HEALTH HOME FOR CHILDREN WITH
MEDICALLY COMPLEX CONDITIONS.
``(a) In General.--Notwithstanding section 1902(a)(1)
(relating to statewideness) and section 1902(a)(10)(B)
(relating to comparability), beginning October 1, 2022, a
State, at its option as a State plan amendment, may provide
for medical assistance under this title to children with
medically complex conditions who choose to enroll in a health
home under this section by selecting a designated provider, a
team of health care professionals operating with such a
provider, or a health team as the child's health home for
purposes of providing the child with health home services.
``(b) Health Home Qualification Standards.--The Secretary
shall establish standards for qualification as a health home
for purposes of this section. Such standards shall include
requiring designated providers, teams of health care
professionals operating with such providers, and health teams
to demonstrate to the State the ability to do the following:
``(1) Coordinate prompt care for children with medically
complex conditions, including access to pediatric emergency
services at all times.
``(2) Develop an individualized comprehensive pediatric
family-centered care plan for children with medically complex
conditions that accommodates patient preferences.
``(3) Work in a culturally and linguistically appropriate
manner with the family of a child with medically complex
conditions to develop and incorporate into such child's care
plan, in a manner consistent with the needs of the child and
the choices of the child's family, ongoing home care,
community-based pediatric primary care, pediatric inpatient
care, social support services, and local hospital pediatric
emergency care.
``(4) Coordinate access to--
``(A) subspecialized pediatric services and programs for
children with medically complex conditions, including the
most intensive diagnostic, treatment, and critical care
levels as medically necessary; and
``(B) palliative services if the State provides such
services under the State plan (or a waiver of such plan).
``(5) Coordinate care for children with medically complex
conditions with out-of-State providers furnishing care to
such children to the maximum extent practicable for the
families of such children and where medically necessary, in
accordance with guidance issued under subsection (e)(1) and
section 431.52 of title 42, Code of Federal Regulations.
``(6) Collect and report information under subsection
(g)(1).
``(c) Payments.--
``(1) In general.--A State shall provide a designated
provider, a team of health care professionals operating with
such a provider, or a health team with payments for the
provision of health home services to each child with
medically complex conditions that selects such provider, team
of health care professionals, or health team as the child's
health home. Payments made to a designated provider, a team
of health care professionals operating with such a provider,
or a health team for such services shall be treated as
medical assistance for purposes of section 1903(a), except
that, during the first 2 fiscal year quarters that the State
plan amendment is in effect, the Federal medical assistance
percentage applicable to such payments shall be increased by
15 percentage points, but in no case may exceed 90 percent.
``(2) Methodology.--
``(A) In general.--The State shall specify in the State
plan amendment the methodology the State will use for
determining payment for the provision of health home
services. Such methodology for determining payment--
``(i) may be tiered to reflect, with respect to each child
with medically complex conditions provided such services by a
designated provider, a team of health care professionals
operating with such a provider, or a health team, the
severity or number of each such child's chronic conditions,
life-threatening illnesses, disabilities, or rare diseases,
or the specific capabilities of the provider, team of health
care professionals, or health team; and
[[Page H10044]]
``(ii) shall be established consistent with section
1902(a)(30)(A).
``(B) Alternate models of payment.--The methodology for
determining payment for provision of health home services
under this section shall not be limited to a per-member per-
month basis and may provide (as proposed by the State and
subject to approval by the Secretary) for alternate models of
payment.
``(3) Planning grants.--
``(A) In general.--Beginning October 1, 2022, the Secretary
may award planning grants to States for purposes of
developing a State plan amendment under this section. A
planning grant awarded to a State under this paragraph shall
remain available until expended.
``(B) State contribution.--A State awarded a planning grant
shall contribute an amount equal to the State percentage
determined under section 1905(b) (without regard to section
5001 of Public Law 111-5) for each fiscal year for which the
grant is awarded.
``(C) Limitation.--The total amount of payments made to
States under this paragraph shall not exceed $5,000,000.
``(d) Coordinating Care.--
``(1) Hospital notification.--A State with a State plan
amendment approved under this section shall require each
hospital that is a participating provider under the State
plan (or a waiver of such plan) to establish procedures for,
in the case of a child with medically complex conditions who
is enrolled in a health home pursuant to this section and
seeks treatment in the emergency department of such hospital,
notifying the health home of such child of such treatment.
``(2) Education with respect to availability of health home
services.--In order for a State plan amendment to be approved
under this section, a State shall include in the State plan
amendment a description of the State's process for educating
providers participating in the State plan (or a waiver of
such plan) on the availability of health home services for
children with medically complex conditions, including the
process by which such providers can refer such children to a
designated provider, team of health care professionals
operating such a provider, or health team for the purpose of
establishing a health home through which such children may
receive such services.
``(3) Family education.--In order for a State plan
amendment to be approved under this section, a State shall
include in the State plan amendment a description of the
State's process for educating families with children eligible
to receive health home services pursuant to this section of
the availability of such services. Such process shall include
the participation of family-to-family entities or other
public or private organizations or entities who provide
outreach and information on the availability of health care
items and services to families of individuals eligible to
receive medical assistance under the State plan (or a waiver
of such plan).
``(4) Mental health coordination.--A State with a State
plan amendment approved under this section shall consult and
coordinate, as appropriate, with the Secretary in addressing
issues regarding the prevention and treatment of mental
illness and substance use among children with medically
complex conditions receiving health home services under this
section.
``(e) Guidance on Coordinating Care From Out-of-State
Providers.--
``(1) In general.--Not later than October 1, 2020, the
Secretary shall issue (and update as the Secretary determines
necessary) guidance to State Medicaid directors on--
``(A) best practices for using out-of-State providers to
provide care to children with medically complex conditions;
``(B) coordinating care for such children provided by such
out-of-State providers (including when provided in emergency
and non-emergency situations);
``(C) reducing barriers for such children receiving care
from such providers in a timely fashion; and
``(D) processes for screening and enrolling such providers
in the respective State plan (or a waiver of such plan),
including efforts to streamline such processes or reduce the
burden of such processes on such providers.
``(2) Stakeholder input.--In carrying out paragraph (1),
the Secretary shall issue a request for information to seek
input from children with medically complex conditions and
their families, States, providers (including children's
hospitals, hospitals, pediatricians, and other providers),
managed care plans, children's health groups, family and
beneficiary advocates, and other stakeholders with respect to
coordinating the care for such children provided by out-of-
State providers.
``(f) Monitoring.--A State shall include in the State plan
amendment--
``(1) a methodology for tracking avoidable hospital
readmissions and calculating savings that result from
improved care coordination and management under this section;
``(2) a proposal for use of health information technology
in providing health home services under this section and
improving service delivery and coordination across the care
continuum (including the use of wireless patient technology
to improve coordination and management of care and patient
adherence to recommendations made by their provider); and
``(3) a methodology for tracking prompt and timely access
to medically necessary care for children with medically
complex conditions from out-of-State providers.
``(g) Data Collection.--
``(1) Provider reporting requirements.--In order to receive
payments from a State under subsection (c), a designated
provider, a team of health care professionals operating with
such a provider, or a health team shall report to the State,
at such time and in such form and manner as may be required
by the State, the following information:
``(A) With respect to each such provider, team of health
care professionals, or health team, the name, National
Provider Identification number, address, and specific health
care services offered to be provided to children with
medically complex conditions who have selected such provider,
team of health care professionals, or health team as the
health home of such children.
``(B) Information on all applicable measures for
determining the quality of health home services provided by
such provider, team of health care professionals, or health
team, including, to the extent applicable, child health
quality measures and measures for centers of excellence for
children with complex needs developed under this title, title
XXI, and section 1139A.
``(C) Such other information as the Secretary shall specify
in guidance.
When appropriate and feasible, such provider, team of health
care professionals, or health team, as the case may be, shall
use health information technology in providing the State with
such information.
``(2) State reporting requirements.--
``(A) Comprehensive report.--A State with a State plan
amendment approved under this section shall report to the
Secretary (and, upon request, to the Medicaid and CHIP
Payment and Access Commission), at such time and in such form
and manner determined by the Secretary to be reasonable and
minimally burdensome, the following information:
``(i) Information reported under paragraph (1).
``(ii) The number of children with medically complex
conditions who have selected a health home pursuant to this
section.
``(iii) The nature, number, and prevalence of chronic
conditions, life-threatening illnesses, disabilities, or rare
diseases that such children have.
``(iv) The type of delivery systems and payment models used
to provide services to such children under this section.
``(v) The number and characteristics of designated
providers, teams of health care professionals operating with
such providers, and health teams selected as health homes
pursuant to this section, including the number and
characteristics of out-of-State providers, teams of health
care professionals operating with such providers, and health
teams who have provided health care items and services to
such children.
``(vi) The extent to which such children receive health
care items and services under the State plan.
``(vii) Quality measures developed specifically with
respect to health care items and services provided to
children with medically complex conditions.
``(B) Report on best practices.--Not later than 90 days
after a State has a State plan amendment approved under this
section, such State shall submit to the Secretary, and make
publicly available on the appropriate State website, a report
on how the State is implementing guidance issued under
subsection (e)(1), including through any best practices
adopted by the State.
``(h) Rule of Construction.--Nothing in this section may be
construed--
``(1) to require a child with medically complex conditions
to enroll in a health home under this section;
``(2) to limit the choice of a child with medically complex
conditions in selecting a designated provider, team of health
care professionals operating with such a provider, or health
team that meets the health home qualification standards
established under subsection (b) as the child's health home;
or
``(3) to reduce or otherwise modify--
``(A) the entitlement of children with medically complex
conditions to early and periodic screening, diagnostic, and
treatment services (as defined in section 1905(r)); or
``(B) the informing, providing, arranging, and reporting
requirements of a State under section 1902(a)(43).
``(i) Definitions.--In this section:
``(1) Child with medically complex conditions.--
``(A) In general.--Subject to subparagraph (B), the term
`child with medically complex conditions' means an individual
under 21 years of age who--
``(i) is eligible for medical assistance under the State
plan (or under a waiver of such plan); and
``(ii) has at least--
``(I) one or more chronic conditions that cumulatively
affect three or more organ systems and severely reduces
cognitive or physical functioning (such as the ability to
eat, drink, or breathe independently) and that also requires
the use of medication, durable medical equipment, therapy,
surgery, or other treatments; or
``(II) one life-limiting illness or rare pediatric disease
(as defined in section 529(a)(3) of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 360ff(a)(3))).
``(B) Rule of construction.--Nothing in this paragraph
shall prevent the Secretary from establishing higher levels
as to the
[[Page H10045]]
number or severity of chronic, life threatening illnesses,
disabilities, rare diseases or mental health conditions for
purposes of determining eligibility for receipt of health
home services under this section.
``(2) Chronic condition.--The term `chronic condition'
means a serious, long-term physical, mental, or developmental
disability or disease, including the following:
``(A) Cerebral palsy.
``(B) Cystic fibrosis.
``(C) HIV/AIDS.
``(D) Blood diseases, such as anemia or sickle cell
disease.
``(E) Muscular dystrophy.
``(F) Spina bifida.
``(G) Epilepsy.
``(H) Severe autism spectrum disorder.
``(I) Serious emotional disturbance or serious mental
health illness.
``(3) Health home.--The term `health home' means a
designated provider (including a provider that operates in
coordination with a team of health care professionals) or a
health team selected by a child with medically complex
conditions (or the family of such child) to provide health
home services.
``(4) Health home services.--
``(A) In general.--The term `health home services' means
comprehensive and timely high-quality services described in
subparagraph (B) that are provided by a designated provider,
a team of health care professionals operating with such a
provider, or a health team.
``(B) Services described.--The services described in this
subparagraph shall include--
``(i) comprehensive care management;
``(ii) care coordination, health promotion, and providing
access to the full range of pediatric specialty and
subspecialty medical services, including services from out-
of-State providers, as medically necessary;
``(iii) comprehensive transitional care, including
appropriate follow-up, from inpatient to other settings;
``(iv) patient and family support (including authorized
representatives);
``(v) referrals to community and social support services,
if relevant; and
``(vi) use of health information technology to link
services, as feasible and appropriate.
``(5) Designated provider.--The term `designated provider'
means a physician (including a pediatrician or a pediatric
specialty or subspecialty provider), children's hospital,
clinical practice or clinical group practice, prepaid
inpatient health plan or prepaid ambulatory health plan (as
defined by the Secretary), rural clinic, community health
center, community mental health center, home health agency,
or any other entity or provider that is determined by the
State and approved by the Secretary to be qualified to be a
health home for children with medically complex conditions on
the basis of documentation evidencing that the entity has the
systems, expertise, and infrastructure in place to provide
health home services. Such term may include providers who are
employed by, or affiliated with, a children's hospital.
``(6) Team of health care professionals.--The term `team of
health care professionals' means a team of health care
professionals (as described in the State plan amendment under
this section) that may--
``(A) include--
``(i) physicians and other professionals, such as
pediatricians or pediatric specialty or subspecialty
providers, nurse care coordinators, dietitians,
nutritionists, social workers, behavioral health
professionals, physical therapists, occupational therapists,
speech pathologists, nurses, individuals with experience in
medical supportive technologies, or any professionals
determined to be appropriate by the State and approved by the
Secretary;
``(ii) an entity or individual who is designated to
coordinate such a team; and
``(iii) community health workers, translators, and other
individuals with culturally-appropriate expertise; and
``(B) be freestanding, virtual, or based at a children's
hospital, hospital, community health center, community mental
health center, rural clinic, clinical practice or clinical
group practice, academic health center, or any entity
determined to be appropriate by the State and approved by the
Secretary.
``(7) Health team.--The term `health team' has the meaning
given such term for purposes of section 3502 of Public Law
111-148.''.
TITLE II--OTHER MEDICAID
SEC. 201. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING
DEMONSTRATION.
(a) General Funding.--Section 6071(h) of the Deficit
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
(1) in paragraph (1)--
(A) in subparagraph (D), by striking ``and'' after the
semicolon;
(B) in subparagraph (E), by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following:
``(F) subject to paragraph (3), $112,000,000 for fiscal
year 2019.'';
(2) in paragraph (2)--
(A) by striking ``Amounts made'' and inserting ``Subject to
paragraph (3), amounts made''; and
(B) by striking ``September 30, 2016'' and inserting
``September 30, 2021''; and
(3) by adding at the end the following new paragraph:
``(3) Special rule for fy 2019.--Funds appropriated under
paragraph (1)(F) shall be made available for grants to States
only if such States have an approved MFP demonstration
project under this section as of December 31, 2018.''.
(b) Funding for Quality Assurance and Improvement;
Technical Assistance; Oversight.--Section 6071(f) of the
Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is
amended by striking paragraph (2) and inserting the
following:
``(2) Funding.--From the amounts appropriated under
subsection (h)(1)(F) for fiscal year 2019, $500,000 shall be
available to the Secretary for such fiscal year to carry out
this subsection.''.
(c) Technical Amendment.--Section 6071(b) of the Deficit
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by
adding at the end the following:
``(10) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.''.
SEC. 202. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF
HOME AND COMMUNITY-BASED SERVICES AGAINST
SPOUSAL IMPOVERISHMENT.
(a) In General.--Section 2404 of Public Law 111-148 (42
U.S.C. 1396r-5 note) is amended by striking ``the 5-year
period that begins on January 1, 2014,'' and inserting ``the
period beginning on January 1, 2014, and ending on March 31,
2019,''.
(b) Rule of Construction.--
(1) Protecting state spousal income and asset disregard
flexibility under waivers and plan amendments.--Nothing in
section 2404 of Public Law 111-148 (42 U.S.C. 1396r-5 note)
or section 1924 of the Social Security Act (42 U.S.C. 1396r-
5) shall be construed as prohibiting a State from
disregarding an individual's spousal income and assets under
a State waiver or plan amendment described in paragraph (2)
for purposes of making determinations of eligibility for home
and community-based services or home and community-based
attendant services and supports under such waiver or plan
amendment.
(2) State waiver or plan amendment described.--A State
waiver or plan amendment described in this paragraph is any
of the following:
(A) A waiver or plan amendment to provide medical
assistance for home and community-based services under a
waiver or plan amendment under subsection (c), (d), or (i) of
section 1915 of the Social Security Act (42 U.S.C. 1396n) or
under section 1115 of such Act (42 U.S.C. 1315).
(B) A plan amendment to provide medical assistance for home
and community-based services for individuals by reason of
being determined eligible under section 1902(a)(10)(C) of
such Act (42 U.S.C. 1396a(a)(10)(C)) or by reason of section
1902(f) of such Act (42 U.S.C. 1396a(f)) or otherwise on the
basis of a reduction of income based on costs incurred for
medical or other remedial care under which the State
disregarded the income and assets of the individual's spouse
in determining the initial and ongoing financial eligibility
of an individual for such services in place of the spousal
impoverishment provisions applied under section 1924 of such
Act (42 U.S.C. 1396r-5).
(C) A plan amendment to provide medical assistance for home
and community-based attendant services and supports under
section 1915(k) of such Act (42 U.S.C. 1396n(k)).
SEC. 203. REDUCTION IN FMAP AFTER 2020 FOR STATES WITHOUT
ASSET VERIFICATION PROGRAM.
Section 1940 of the Social Security Act (42 U.S.C. 1396w)
is amended by adding at the end the following new subsection:
``(k) Reduction in FMAP After 2020 for Non-Compliant
States.--
``(1) In general.--With respect to a calendar quarter
beginning on or after January 1, 2021, the Federal medical
assistance percentage otherwise determined under section
1905(b) for a non-compliant State shall be reduced--
``(A) for calendar quarters in 2021 and 2022, by 0.12
percentage points;
``(B) for calendar quarters in 2023, by 0.25 percentage
points;
``(C) for calendar quarters in 2024, by 0.35 percentage
points; and
``(D) for calendar quarters in 2025 and each year
thereafter, by 0.5 percentage points.
``(2) Non-compliant state defined.--For purposes of this
subsection, the term `non-compliant State' means a State--
``(A) that is one of the 50 States or the District of
Columbia;
``(B) with respect to which the Secretary has not approved
a State plan amendment submitted under subsection (a)(2); and
``(C) that is not operating, on an ongoing basis, an asset
verification program in accordance with this section.''.
SEC. 204. DENIAL OF FFP FOR CERTAIN EXPENDITURES RELATING TO
VACUUM ERECTION SYSTEMS AND PENILE PROSTHETIC
IMPLANTS.
(a) In General.--Section 1903(i) of the Social Security Act
(42 U.S.C. 1396b(i)) is amended by inserting after paragraph
(11) the following:
``(12) with respect to any amounts expended for--
``(A) a vacuum erection system that is not medically
necessary; or
``(B) the insertion, repair, or removal and replacement of
a penile prosthetic implant (unless such insertion, repair,
or removal and replacement is medically necessary); or''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply with respect to items and services furnished on
or after January 1, 2019.
[[Page H10046]]
SEC. 205. MEDICAID IMPROVEMENT FUND.
Section 1941(b)(1) of the Social Security Act (42 U.S.C.
1396w-1(b)(1)) is amended by striking ``$31,000,000'' and
inserting ``$9,000,000''.
SEC. 206. PREVENTING THE MISCLASSIFICATION OF DRUGS UNDER THE
MEDICAID DRUG REBATE PROGRAM.
(a) Application of Civil Money Penalty for
Misclassification of Covered Outpatient Drugs.--
(1) In general.--Section 1927(b)(3) of the Social Security
Act (42 U.S.C. 1396r-8(b)(3)) is amended--
(A) in the paragraph heading, by inserting ``and drug
product'' after ``price'';
(B) in subparagraph (A)--
(i) in clause (ii), by striking ``; and'' at the end and
inserting a semicolon;
(ii) in clause (iii), by striking the period at the end and
inserting a semicolon;
(iii) in clause (iv), by striking the semicolon at the end
and inserting ``; and''; and
(iv) by inserting after clause (iv) the following new
clause:
``(v) not later than 30 days after the last day of each
month of a rebate period under the agreement, such drug
product information as the Secretary shall require for each
of the manufacturer's covered outpatient drugs.''; and
(C) in subparagraph (C)--
(i) in clause (ii), by inserting ``, including information
related to drug pricing, drug product information, and data
related to drug pricing or drug product information,'' after
``provides false information''; and
(ii) by adding at the end the following new clauses:
``(iii) Misclassified or misreported information.--
``(I) In general.--Any manufacturer with an agreement under
this section that knowingly (as defined in section 1003.110
of title 42, Code of Federal Regulations (or any successor
regulation)) misclassifies a covered outpatient drug, such as
by knowingly submitting incorrect drug category information,
is subject to a civil money penalty for each covered
outpatient drug that is misclassified in an amount not to
exceed 2 times the amount of the difference, as determined by
the Secretary, between--
``(aa) the total amount of rebates that the manufacturer
paid with respect to the drug to all States for all rebate
periods during which the drug was misclassified; and
``(bb) the total amount of rebates that the manufacturer
would have been required to pay, as determined by the
Secretary, with respect to the drug to all States for all
rebate periods during which the drug was misclassified if the
drug had been correctly classified.
``(II) Other penalties and recovery of underpaid rebates.--
The civil money penalties described in subclause (I) are in
addition to other penalties as may be prescribed by law and
any other recovery of the underlying underpayment for rebates
due under this section or the terms of the rebate agreement
as determined by the Secretary.
``(iv) Increasing oversight and enforcement.--Each year the
Secretary shall retain, in addition to any amount retained by
the Secretary to recoup investigation and litigation costs
related to the enforcement of the civil money penalties under
this subparagraph and subsection (c)(4)(B)(ii)(III), an
amount equal to 25 percent of the total amount of civil money
penalties collected under this subparagraph and subsection
(c)(4)(B)(ii)(III) for the year, and such retained amount
shall be available to the Secretary, without further
appropriation and until expended, for activities related to
the oversight and enforcement of this section and agreements
under this section, including--
``(I) improving drug data reporting systems;
``(II) evaluating and ensuring manufacturer compliance with
rebate obligations; and
``(III) oversight and enforcement related to ensuring that
manufacturers accurately and fully report drug information,
including data related to drug classification.''; and
(iii) in subparagraph (D)--
(I) in clause (iv), by striking ``, and'' and inserting a
comma;
(II) in clause (v), by striking ``subsection (f).'' and
inserting ``subsection (f), and''; and
(III) by inserting after clause (v) the following new
clause:
``(vi) in the case of categories of drug product or
classification information that were not considered
confidential by the Secretary on the day before the date of
the enactment of the IMPROVE Act.''.
(2) Technical amendments.--
(A) Section 1903(i)(10) of the Social Security Act (42
U.S.C. 1396b(i)(10)) is amended--
(i) in subparagraph (C)--
(I) by adjusting the left margin so as to align with the
left margin of subparagraph (B); and
(II) by striking ``, and'' and inserting a semicolon;
(ii) in subparagraph (D), by striking ``; or'' and
inserting ``; and''; and
(iii) by adding at the end the following new subparagraph:
``(E) with respect to any amount expended for a covered
outpatient drug for which a suspension under section
1927(c)(4)(B)(ii)(II) is in effect; or''.
(B) Section 1927(b)(3)(C)(ii) of the Social Security Act
(42 U.S.C. 1396r-8(b)(3)(C)(ii)) is amended by striking
``subsections (a) and (b)'' and inserting ``subsections (a),
(b), (f)(3), and (f)(4)''.
(b) Recovery of Unpaid Rebate Amounts Due to
Misclassification of Covered Outpatient Drugs.--
(1) In general.--Section 1927(c) of the Social Security Act
(42 U.S.C. 1396r-8(c)) is amended by adding at the end the
following new paragraph:
``(4) Recovery of unpaid rebate amounts due to
misclassification of covered outpatient drugs.--
``(A) In general.--If the Secretary determines that a
manufacturer with an agreement under this section paid a
lower per-unit rebate amount to a State for a rebate period
as a result of the misclassification by the manufacturer of a
covered outpatient drug (without regard to whether the
manufacturer knowingly made the misclassification or should
have known that the misclassification would be made) than the
per-unit rebate amount that the manufacturer would have paid
to the State if the drug had been correctly classified, the
manufacturer shall pay to the State an amount equal to the
product of--
``(i) the difference between--
``(I) the per-unit rebate amount paid to the State for the
period; and
``(II) the per-unit rebate amount that the manufacturer
would have paid to the State for the period, as determined by
the Secretary, if the drug had been correctly classified; and
``(ii) the total units of the drug paid for under the State
plan in the period.
``(B) Authority to correct misclassifications.--
``(i) In general.--If the Secretary determines that a
manufacturer with an agreement under this section has
misclassified a covered outpatient drug (without regard to
whether the manufacturer knowingly made the misclassification
or should have known that the misclassification would be
made), the Secretary shall notify the manufacturer of the
misclassification and require the manufacturer to correct the
misclassification in a timely manner.
``(ii) Enforcement.--If, after receiving notice of a
misclassification from the Secretary under clause (i), a
manufacturer fails to correct the misclassification by such
time as the Secretary shall require, until the manufacturer
makes such correction, the Secretary may--
``(I) correct the misclassification on behalf of the
manufacturer;
``(II) suspend the misclassified drug and the drug's status
as a covered outpatient drug under the manufacturer's
national rebate agreement; or
``(III) impose a civil money penalty (which shall be in
addition to any other recovery or penalty which may be
available under this section or any other provision of law)
for each rebate period during which the drug is misclassified
not to exceed an amount equal to the product of--
``(aa) the total number of units of each dosage form and
strength of such misclassified drug paid for under any State
plan during such a rebate period; and
``(bb) 23.1 percent of the average manufacturer price for
the dosage form and strength of such misclassified drug.
``(C) Reporting and transparency.--
``(i) In general.--The Secretary shall submit a report to
Congress on at least an annual basis that includes
information on the covered outpatient drugs that have been
identified as misclassified, the steps taken to reclassify
such drugs, the actions the Secretary has taken to ensure the
payment of any rebate amounts which were unpaid as a result
of such misclassification, and a disclosure of expenditures
from the fund created in subsection (b)(3)(C)(iv), including
an accounting of how such funds have been allocated and spent
in accordance with such subsection.
``(ii) Public access.--The Secretary shall make the
information contained in the report required under clause (i)
available to the public on a timely basis.
``(D) Other penalties and actions.--Actions taken and
penalties imposed under this paragraph shall be in addition
to other remedies available to the Secretary including
terminating the manufacturer's rebate agreement for
noncompliance with the terms of such agreement and shall not
exempt a manufacturer from, or preclude the Secretary from
pursuing, any civil money penalty under this title or title
XI, or any other penalty or action as may be prescribed by
law.''.
(2) Offset of recovered amounts against medical
assistance.--Section 1927(b)(1)(B) of the Social Security Act
(42 U.S.C. 1396r-8(b)(1)(B)) is amended by inserting ``,
including amounts received by a State under subsection
(c)(4),'' after ``in any quarter''.
(c) Clarifying Definitions.--Section 1927(k)(7)(A) of the
Social Security Act (42 U.S.C. 1396r-8(k)(7)(A)) is amended--
(1) by striking ``an original new drug application'' and
inserting ``a new drug application'' each place it appears;
(2) in clause (i), by inserting ``but including a drug
product approved for marketing as a non-prescription drug
that is regarded as a covered outpatient drug under paragraph
(4)'' after ``drug described in paragraph (5)'';
(3) in clause (ii), by striking ``was originally marketed''
and inserting ``is marketed''; and
(4) in clause (iv)--
(A) by inserting ``, including a drug product approved for
marketing as a non-prescription drug that is regarded as a
covered
[[Page H10047]]
outpatient drug under paragraph (4),'' after ``covered
outpatient drug''; and
(B) by adding at the end the following new sentence: ``Such
term also includes a covered outpatient drug that is a
biological product licensed, produced, or distributed under a
biologics license application approved by the Food and Drug
Administration.''.
(d) Exclusion of Manufacturers for Knowing
Misclassification of Covered Outpatient Drugs.--Section
1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b)) is
amended by adding at the end the following new paragraph:
``(17) Knowingly misclassifying covered outpatient drugs.--
Any manufacturer or officer, director, agent, or managing
employee of such manufacturer that knowingly misclassifies a
covered outpatient drug under an agreement under section
1927, knowingly fails to correct such misclassification, or
knowingly provides false information related to drug pricing,
drug product information, or data related to drug pricing or
drug product information.''.
(e) Effective Date.--The amendments made by this section
shall take effect on the date of the enactment of this Act,
and shall apply to covered outpatient drugs supplied by
manufacturers under agreements under section 1927 of the
Social Security Act (42 U.S.C. 1396r-8) on or after such
date.
TITLE III--MEDICARE
SEC. 301. EXCLUSION OF COMPLEX REHABILITATIVE MANUAL
WHEELCHAIRS FROM MEDICARE COMPETITIVE
ACQUISITION PROGRAM; NON-APPLICATION OF
MEDICARE FEE-SCHEDULE ADJUSTMENTS FOR CERTAIN
WHEELCHAIR ACCESSORIES AND CUSHIONS.
(a) Exclusion of Complex Rehabilitative Manual Wheelchairs
From Competitive Acquisition Program.--Section 1847(a)(2)(A)
of the Social Security Act (42 U.S.C. 1395w-3(a)(2)(A)) is
amended--
(1) by inserting ``, complex rehabilitative manual
wheelchairs (as determined by the Secretary), and certain
manual wheelchairs (identified, as of October 1, 2018, by
HCPCS codes E1235, E1236, E1237, E1238, and K0008 or any
successor to such codes)'' after ``group 3 or higher''; and
(2) by striking ``such wheelchairs'' and inserting ``such
complex rehabilitative power wheelchairs, complex
rehabilitative manual wheelchairs, and certain manual
wheelchairs''.
(b) Non-Application of Medicare Fee Schedule Adjustments
for Wheelchair Accessories and Seat and Back Cushions When
Furnished in Connection With Complex Rehabilitative Manual
Wheelchairs.--
(1) In general.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services shall not,
during the period beginning on January 1, 2019, and ending on
June 30, 2020, use information on the payment determined
under the competitive acquisition programs under section 1847
of the Social Security Act (42 U.S.C. 1395w-3) to adjust the
payment amount that would otherwise be recognized under
section 1834(a)(1)(B)(ii) of such Act (42 U.S.C.
1395m(a)(1)(B)(ii)) for wheelchair accessories (including
seating systems) and seat and back cushions when furnished in
connection with complex rehabilitative manual wheelchairs (as
determined by the Secretary), and certain manual wheelchairs
(identified, as of October 1, 2018, by HCPCS codes E1235,
E1236, E1237, E1238, and K0008 or any successor to such
codes).
(2) Implementation.--Notwithstanding any other provision of
law, the Secretary may implement this subsection by program
instruction or otherwise.
The SPEAKER pro tempore (Mr. Simpson). Pursuant to the rule, the
gentleman from Texas (Mr. Barton) and the gentleman from Texas (Mr.
Gene Green) each will control 20 minutes.
The Chair recognizes the gentleman from Texas (Mr. Barton).
General Leave
Mr. BARTON. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
insert extraneous materials in the Record on the bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BARTON. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, we are here today, the culmination of a 6-year journey.
The IMPROVE Act is a combination of three bills. One bill is a bill
that allows Medicare to follow the patient; another bill is a bill for
spousal impoverishment, to prevent that; and the third bill, and the
primary bill in this package, is a bill that we call the ACE Kids Act.
Mr. Speaker, there are, luckily, not a large number, about 2 million
children in this country, who have multiple complex medical conditions
that are life-threatening. These are the sickest of the sick of our
young population. About 500,000 of these children are Medicaid
eligible. In other words, their families qualify for low-income health
insurance called Medicaid.
Mr. Speaker, under current law, the parents of these children have to
create the healthcare network on a case-by-case basis for their child.
They also cannot seek healthcare across State lines that is covered by
Medicaid. So current law makes it very difficult on these sickest-of-
the-sick children.
The ACE Kids Act changes that, Mr. Speaker. It allows the creation of
a medical home that can cross State lines, that can coordinate care.
It is optional. The States do not have to participate in this
program. The parents of the child do not have to participate in this
program. But if they do wish to participate, you create a health home
for the child wherein everything is coordinated.
In the pilot programs that have been run using this model, you get
better quality healthcare at lower cost. We think the pilot programs
show that, over time, if we adopt this model and if the States adopt it
and the families adopt it, we get a lot better healthcare at a lower
cost. So this is a win-win, Mr. Speaker.
As I said, we have worked on this for 6 years. It is a bipartisan
bill. In the last Congress, we had a majority of the Congress that
sponsored the bill. In this Congress, we have more than 130 cosponsors
on a bipartisan basis.
We have had a hearing in the committee of jurisdiction, the Committee
on Energy and Commerce. We have had a markup in subcommittee. We have
had a markup in full committee. Now, Mr. Speaker, we are bringing it to
the floor.
We hope the House, later today, will vote affirmatively to pass this
on suspension and send it to the Senate. We have preconferenced it with
the Senate, and we have every reason to believe, if the House passes it
today, the Senate will take it up expeditiously and pass it, and this
is a bill that will become law.
Mr. Speaker, I reserve the balance of my time.
Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I rise today in support of H.R. 7217, the IMPROVE Act.
This legislation contains several important policies related to
Medicaid and Medicare.
First, I am a proud original cosponsor of the ACE Kids Act, and I am
happy to see it included in H.R. 7217. The ACE Kids Act aims to improve
care coordination for children with complex medical conditions served
by Medicaid.
The legislation creates a Medicaid health home, State optional,
specifically targeted for this population of children. It also requires
the Secretary to issue best practices on coordinating out-of-State care
for children with complex medical conditions.
Mr. Speaker, I thank the sponsors of the ACE Kids Act, Representative
Castor and Congressman Barton, both members of the Energy and Commerce
Committee, for championing this issue for so many years.
The IMPROVE Act also provides new funding for the Money Follows the
Person, the MFP, program. The MFP program helps individuals transition
from institutional care to care in their community, where they can live
more independent lives.
MFP also helps support States' home and community-based services
infrastructure. Without this extension funding, we would start to see
many of these MFP programs end in short order.
Mr. Speaker, I urge support for the program, which provides thousands
of Americans with the choice to receive services in their home or
community rather than in an institution.
{time} 1245
The committee will continue to work on providing long-term funding to
the MFP program in the next Congress.
I also voice my support for the extension of spousal impoverishment
protections until April 2019. These protections will help ensure that a
person can maintain enough income and assets to meet their basic living
expenses while still allowing for their spouse to receive long-term
care in their home or community under Medicaid.
The expiration of this policy would lead to people losing their long-
term care services and the unnecessary institutionalization of people
currently
[[Page H10048]]
receiving services in their homes or communities. The committee will
continue to work on a long-term solution in the next Congress.
Mr. Speaker, I urge my colleagues to support passage of H.R. 7217,
the IMPROVE Act, and I reserve the balance of my time.
Mr. BARTON. Mr. Speaker, I yield 3 minutes to the gentleman from
Oregon (Mr. Walden), who is the current chairman of the Energy and
Commerce Committee.
Mr. WALDEN. Mr. Speaker, I thank Mr. Barton for his great leadership
on the ACE Kids Act. I know this has been something he has been
dedicated to for many years, and I am glad we could get this worked out
and to the floor today. In fact, Mr. Speaker, these bills add to the
129 that the Energy and Commerce Committee has passed across this House
floor.
Mr. Speaker, 92 percent of those bills have been bipartisan. I don't
think the American people know that, because when we get along and do
things, it doesn't get much coverage. But most of our work, 92 percent
of our bills have been bipartisan, plus these today. 28 of those
measures have become law.
I rise in strong support of this bipartisan H.R. 7217, which includes
a number of different policies to improve and bolster the Medicaid and
Medicare programs for vulnerable patients across our country, Mr.
Speaker.
I recognize Joe Barton and our colleague, Kathy Castor from Florida,
who I know is going to speak in a moment. They have just worked
relentlessly on the ACE Kids Act. This is an important bill, and it is
included in this package and one I am proud the House will advance
forward today.
They both should be commended for their work because, you see, Mr.
Speaker, the ACE Kids Act is bipartisan. It is cost-effective
legislation. It provides children and their families the treatment and
coordinated care they so desperately need and deserve.
Representative Barton, former chairman of the committee, has long
been a champion on this issue, and, again, I thank him for his tireless
efforts to advocate for improving care for our Nation's sickest
children.
This bill also extends two key Medicaid programs: the Money Follows
the Person Demonstration Program and the spousal impoverishment rules
in Medicaid, both of which were due to expire or be out of money by the
end of the year.
I am disappointed we weren't able to secure a longer term extension
of these programs. I know many of my colleagues share that
disappointment. Both sides negotiated in good faith, though, on how to
pay for an extension, and I hope that the bipartisan work on the long-
term bill will continue early in the new Congress. Today, we are moving
forward with a 3-month extension to prevent these programs from
expiring.
Finally, this package includes a small but critically important
Medicare fix to ensure disabled seniors have access to necessary
mobility devices, and that is fully offset and paid for.
Further boosting our efforts to advance public health, we have four
other bills before us today. Collectively, these bills reauthorize
several important programs, promote safe motherhood, and improve
patient care.
Lastly, we will consider H.R. 6140. That is the Advanced Nuclear Fuel
Availability Act. This bill, as you already know, Mr. Speaker, directs
the Secretary of Energy to establish a program to make high-assay, low-
enriched uranium available for use in the first-of-a-kind advanced
nuclear reactor designs. This fuel will enable the development and
deployment of a new generation of innovative nuclear technologies.
Nuclear energy is the largest source of emissions-free electricity in
the United States, so a strong U.S. nuclear energy policy can ensure a
reliable, clean U.S. energy sector for years to come and provide
American families and businesses with affordable energy.
In closing, Mr. Speaker, I thank Ranking Member Pallone, Mr. Green,
and the other members of the Energy and Commerce Committee. I urge my
colleagues to support passage of all of these bills, especially H.R.
7217, on behalf of patients in Oregon and all across our country.
Mr. GENE GREEN of Texas. Mr. Speaker, I yield 5 minutes to the
gentlewoman from Florida (Ms. Castor), a cosponsor of the ACE Kids Act
and a great member of our Energy and Commerce Committee.
Ms. CASTOR of Florida. Mr. Speaker, I thank Congressman Green for
being an outspoken advocate for his constituents, but especially for
affordable healthcare for all Americans, especially children. It has
been a privilege serving with him.
Mr. Speaker, on behalf of the families with children with complex
medical needs all across America, I rise to urge approval of the
IMPROVE Act, which includes a bill that I have been working on for a
number of years with Representative Joe Barton called the ACE Kids Act.
We drafted the Advancing Care for Exceptional Kids Act a few years
ago with the simple but important goal of putting families and children
first. The bill authorizes the creation of cost-saving and time-saving
health homes where specialized care is coordinated in a high-quality
setting.
Mr. Speaker, the children with complex medical conditions and their
families are heroic.
Caroline West in Tampa, Florida, has a rare genetic condition, also
cerebral palsy and a seizure disorder. She can't walk. It is very
difficult for her to speak, but she is able to attend school part-time
and enjoys the life of a typical teenager, in many respects.
Lucy Ferlita is the only living person in the United States with
early onset myopathy with areflexia, respiratory distress, and
dysphagia. Very little is known about this disease, but what we know is
that it is very difficult for her to eat. She has to have a feeding
tube, a ventilator to breath, and nursing care 24 hours a day, and yet
she is a bright and social 6-year-old.
Jaden Velasquez has a congenital heart defect. He was born with it.
The left side of his heart is severely underdeveloped. He has undergone
numerous surgeries, yet he is a loving and happy 10-year-old, loves
swimming, and is enjoying life.
Lakota Lockhart, with congenital central hypoventilation syndrome, a
central nervous system disorder, causes him to not be able to breathe
every time he tries to sleep.
I met these children in Tampa, Florida, at St. Joseph's Children's
Hospital. They have the world-renowned Chronic-Complex Clinic that was
started 16 years ago by a passionate pediatric doctor named Dr. Daniel
Plasencia. The ACE Kids Act is modeled after the work being done at St.
Joe's by the professionals at the Chronic-Complex Clinic and the 700
kids and families they currently serve and other children's hospitals
all across the country.
The families have shared with us how difficult it is to get quality
healthcare. It is oftentimes so fragmented and uncoordinated that they
have to go from one office to another, and maybe the specialist is in
another State. That is why we put together the ACE Kids Act, to help
coordinate care in a single setting to help give these kids a better
quality of life, and the ACE Kids Act will do just that.
The bill provides an incentive to States to establish health homes to
better coordinate care for kids with medical complexities. It also
directs HHS to provide guidance to States on best practices relating to
providing care across State lines.
As so many of these families know all too well, coordinating care
across State lines can be burdensome, so that is the aim of the ACE
Kids Act: to lift that burden.
In addition to Congressman Joe Barton, who has worked diligently for
so many years to get this over the finish line, I thank all of the
families with children with complex medical challenges. They deserve
credit for moving this bill forward, coming to Congress, and helping to
explain the importance of coordinating care.
I also thank Chairman Walden, Ranking Member Pallone, Chairman
Burgess, and Ranking Member Green for their support, and our stalwart
partners: Representatives Herrera Beutler, Eshoo, and Reichert.
Thank you to America's children's hospitals, the March of Dimes, the
American Academy of Pediatrics, and thanks to the professional staff at
the committee for your dedication to these families, especially Rachel
Pryor, Samantha Satchell, Tiffany Guarascio, and Josh Trent and Caleb
Graff on the Republican side.
[[Page H10049]]
Additionally, this bill would not be where it is without the stellar
work of Representative Barton's staffers: Krista Rosenthall, Gable
Brady, Sophie Trainor, and Jeannine Bender, and my LD, Elizabeth Brown.
Passage of this bill will be a gift to so many families during this
holiday season and beyond, so I urge my colleagues here in the House
and then over in the Senate to pass the ACE Kids Act contained within
the IMPROVE Act.
Mr. BARTON. Mr. Speaker, before I yield to Dr. Burgess, I echo what
Congresswoman Castor just said about the staffs that have worked so
hard. We couldn't have done this bill without all the individuals she
just named.
I also thank her. When she said I have been tireless, she makes me
look like a snail, and she is the rabbit working every day to make this
possible.
Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr.
Burgess), the distinguished subcommittee chairman of the Health
Subcommittee, my good friend.
Mr. BURGESS. Mr. Speaker, I rise in support of H.R. 7217. This is a
bipartisan Medicaid package that moves forward House priorities with
responsible offsets. The Energy and Commerce Committee has been working
to draft and perfect the legislation before us, and it is encouraging
to see this reach the House floor.
Not only does this package include a new program to improve access to
care, it reauthorizes important and effective programs from which
Americans benefit each and every day. Title I of this package is based
upon Representative Joe Barton and Representative Kathy Castor's ACE
Kids Act.
But I do want to assure families that have children with chronic
illnesses that this legislation is intended to help them, if they want
help, to obtain care coordination services. However, I also want to
clarify that this legislation is not intended to limit families or
their physicians from selecting their provider of medical services.
There is nothing in this legislation that restricts the child's
family and their physician from deciding who is the best provider
amongst those accepting Medicaid and qualified to offer the medical
services. The Center for Medicare and Medicaid Services has provided
assurances that current freedom-of-choice rules will apply to new care
coordination activity.
As a doctor, I know that many children with chronic illnesses have a
strong relationship with their doctors and with other members of their
healthcare team. I want to make certain that this new law will help
families coordinate their care without affecting the relationship that
families have with their current medical care providers or with other
providers in their communities from whom they may wish to receive their
care.
This package also extends funding for the Money Follows the Person
Demonstration, an effort that was led by my Energy and Commerce
Subcommittee on Health Vice Chair Brett Guthrie and Representative
Debbie Dingell from Michigan.
This Medicaid demonstration was established in 2005 for individuals
in States across our Nation, including Texas, to receive long-term care
services in their homes or other community settings rather than
institutions such as nursing homes. The funding for this program has
already expired, and a funding extension is already overdue. While it
would have been nice to extend this for longer, it was essential to get
this extension across the floor.
A 3-month extension for the protection for Medicaid recipients of
home and community-based services against spousal impoverishment was
also included. This effort was championed by Representatives Fred Upton
and Debbie Dingell.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. BARTON. Mr. Speaker, I yield an additional 30 seconds to the
gentleman from Texas.
Mr. BURGESS. Mr. Speaker, in an effort to be fiscally responsible,
this legislation includes several offsets to make this package, on net,
a saver.
While it is largely a Medicaid package, there is one small but
important Medicare provision. This provision excludes complex medical
rehabilitative wheelchairs from Medicare's Competitive Acquisition
Program. Currently, these chairs are not included, but because the
statute did not provide the same clear exemption that power wheelchairs
received, there is fear that this unintended omission can lead to them
being included.
Mr. Speaker, I thank the gentleman for the additional time, and I
include my full statement in the Record.
Mr. Speaker, I rise today in support of H.R. 7217, a bipartisan
Medicaid package that propels forward House priorities with responsible
offsets. The Energy and Commerce Committee has been working diligently
to draft and perfect the legislation before us, and it is encouraging
to see this package reach the House floor. Not only does this package
include an exciting new program to improve access to care, it
reauthorizes important and effective programs from which Americans
benefit each and every day.
Title I of this package is based upon Rep. Joe Barton and Rep. Cathy
Castor's ACE Kids Act. I want to ensure families who have children with
chronic illnesses that this legislation is intended to help them, if
they want help, to obtain care coordination services. However, I want
to clarify that this legislation is not intended to limit families and
their physicians from selecting the provider of medical services. There
is nothing in this legislation that restricts the child's family, and
their physician, from deciding who is the best provider among those
accepting Medicaid and qualified to offer the medical services. CMS has
provided assurances that current ``freedom of choice'' rules will apply
to new care coordination activity. As a physician, I know that many
children with chronic illnesses have a strong relationship with their
physician and with other providers. I want to make sure that this new
law will help families coordinate their care without affecting the
relationship that families have with their current medical care
providers or with other providers in their communities from whom they
may want to receive such care from.''
This package also extends funding for the Money Follows the Person
demonstration, an effort led by my E&C Subcommittee on Health Vice
Chair, Brett Guthrie, and Rep. Debbie Dingell. This Medicaid
demonstration, which was established in 2005, has enabled eligible
individuals in states across our nation, including Texas, to receive
long-term care services in their homes or other community settings,
rather than in institutions such as nursing homes. The funding for this
program has already expired, and a funding extension is already long
overdue. While we would have like to extend the funding for longer, it
was essential that we get an extension across the floor, even if a
small one.
A 3-month extension for the Protection for Medicaid Recipients of
Home and Community-Based Services Against Spousal Impoverishment
program is also included. This effort was championed by Representatives
Fred Upton and Debbie Dingell. Our seniors are among our most
vulnerable citizens, and it is programs like this one that help to
protect them from financial ruin.
In an effort to be fiscally responsible, this legislation includes
several offsets that make this package on net a saver, which is
something that Energy & Commerce insists upon and is critically
important.
While this is largely a Medicaid Package, there is one small but
important Medicare provision. This provision excludes manual Complex
Rehabilitative wheelchairs from Medicare's Competitive Acquisition
Program. Currently, these chairs are not included but because statute
did not provide the same clear exemption that power wheelchairs
received, there is fear this unintended omission could lead them to
being included. This provision also delays the application of
competitive bid pricing with CRT accessories used with a CRT manual
chair for 18 months. This mirrors a similar protection last provided by
Congress for power wheelchairs in the 21st Century Cures Act.
This package contains must-pass provisions that the Energy and
Commerce Committee have long fought to pass. The provisions included in
this legislation will improve access to care for Medicaid and Medicare
beneficiaries, which is a laudable and important goal. Not only are
these provisions imperative, but they are responsibly offset. I would
particularly like to thank Energy and Commerce Committee staffer Caleb
Graff, who has spent countless hours negotiating to get this package to
the floor. I support this legislation, and I urge my fellow members and
our friends in the Senate to do so as well.
Mr. GENE GREEN of Texas. Mr. Speaker, I yield 3 minutes to the
gentlewoman from Michigan (Mrs. Dingell), another member of the Energy
and Commerce Committee.
{time} 1300
Mrs. DINGELL. Mr. Speaker, I thank my colleague, Ranking Member Gene
Green, for yielding me the time.
[[Page H10050]]
I rise in support of H.R. 7217, the IMPROVE Act, and I thank Chairman
Walden, Ranking Member Pallone, and Representatives Upton and Guthrie
for their leadership in negotiating this important bill and for
bringing it to the floor today.
I also thank and acknowledge my dear friend Joe Barton for all of his
leadership on the ACE Kids Act and congratulate him on his retirement.
Joe has been a great friend to John and me over the years, and he will
be dearly missed in the next Congress. Getting the IMPROVE Act signed
into the law by the end of the year will be a fitting tribute to his
decades of service in the Congress.
Ranking Member Green has also been critical to so many measures.
Texas has had two valuable public servants.
Improving long-term care has been one of my top priorities since
coming to Congress, and our system is completely broken. We need a
broader overhaul of long-term care financing, and we also need to build
off existing programs to make sure we are doing everything we can to
ensure that we are enhancing the opportunities for independent living
and supporting aging with dignity.
I am proud to have authored two important provisions in the IMPROVE
Act that extend critical programs that are about to expire.
The first is a 3-month extension of the Money Follows the Person
program. This very successful program provides grants to States to
cover transitional services for individuals who voluntarily wish to
leave a nursing home or other institution and transition to a community
care setting. Money Follows the Person is a win for both beneficiaries
and taxpayers, because the program has demonstrated significant savings
over the years while bringing a real benefit to people's lives.
I am also pleased that legislation I authored with the gentleman from
Michigan (Mr. Upton), my good friend, the Protecting Married Seniors
from Impoverishment Act, is also included in this bill. Extending
spousal impoverishment protections for seniors in Medicaid is just
common sense. Nobody should be forced to spend down all of their
resources and have to go bankrupt just to get the care they need.
But these are only partial victories. Both programs are extended for
3 months. This is enough to keep these important programs alive for
now, but all of us have a lot of work to do when we come back in the
new year.
Let me be clear: I will continue to fight for long-term extensions of
both programs in the next Congress, and I am confident that we can get
that done with the Democratic majority. These programs clearly have
bipartisan support, and they do so much good for so many people.
Once again, congratulations to my two dear friends from Texas for
their leadership. I urge my colleagues to join me in support of this
bill.
Mr. BARTON. Mr. Speaker, I thank the gentlewoman from Michigan for
her kind words. I appreciate the nice gift I got yesterday from her and
her husband, his new book, ``The Dean.'' I look forward to reading it
over Christmas.
Mr. Speaker, I yield 1 minute to the distinguished gentleman from
Kentucky (Mr. Guthrie).
Mr. GUTHRIE. Mr. Speaker, I rise in support of my legislation, the
EMPOWER Care Act, which is included in H.R. 7217. It will ensure that
Medicaid beneficiaries can receive the best long-term care possible in
their communities or in their own homes.
The EMPOWER Care Act will extend the Medicaid Money Follows the
Person program, which allows certain Medicaid beneficiaries, such as
the elderly or individuals with disabilities, to transition from a
healthcare facility to receiving care in their own homes. It does not
force patients to leave a facility if they don't want to.
My home State of Kentucky is currently working to transition 50
individuals from healthcare facilities back into their own communities,
empowering these individuals who have chosen to receive care in their
community.
I thank my friend, Congresswoman Debbie Dingell, for working with me
on this bipartisan bill. I look forward to working with her to make the
Money Follows the Person program permanent in the future.
Mr. GENE GREEN of Texas. Mr. Speaker, I yield 3 minutes to the
gentleman from Vermont (Mr. Welch), another good member of our Energy
and Commerce Committee.
Mr. WELCH. Mr. Speaker, I extend my congratulations as well to Mr.
Barton. It has been a pleasure working with you, sir. Thank you. Also,
to Mr. Green, thank you very much for all your service. What an
incredible career both of you have had.
My colleagues have talked about the underlying bill, and I am in
agreement with what everyone has said.
I wanted to focus attention on an aspect of the bill that was
sponsored by my colleague Kurt Schrader and me, and that is a provision
that addresses abusive practices of drug manufacturers who
intentionally misrepresent their brand drugs as a generic in order to
avoid providing a larger discount to the Medicaid program.
My colleagues, whatever our position on the best way to deliver
healthcare, one thing we know is the case: It is too expensive. Whether
it is taxpayers footing the bill, consumers, or employer-sponsored
healthcare plans, it is too expensive. And one of the reasons is rip-
off pharma practices.
This is a situation where, oftentimes, brand-name drugs try to keep
generics off the market. But this is a case where a brand name tried to
pretend they were a generic in order to get a lower price.
I will give an example. In 2016, Mylan misclassified the EpiPen as a
generic drug instead of a brand drug, and that allowed them to charge
Medicaid a higher price for the drug. Mylan ended up paying $465
million in a settlement to Health and Human Services, but the estimated
malfeasance cost Medicaid--which is to say, taxpayers--more than $1
billion.
Simultaneously, Mylan was raising its list price on EpiPen, which
parents have to have for their kids who have an allergic reaction, from
$103 to $608 over 7 years, a 500 percent increase.
Mylan is not alone. This practice of unrelenting drug price hikes is
tried and true for manufacturers.
So I am very pleased that we have included in this bill an end to
this abusive practice. We have to make healthcare affordable.
Representative Schrader and I, with this provision, are taking a
small step. With the help of our Congress and the passage of this very
good bill, we will be taking one more step in dealing with the cost
crisis in our healthcare system.
Mr. BARTON. Mr. Speaker, I yield 1 minute to the gentleman from
Michigan (Mr. Upton), the former full committee chairman and the
current subcommittee chairman of the Energy Subcommittee.
Mr. UPTON. Mr. Speaker, I stand in support of this legislation today.
I thank my colleague Debbie Dingell. The two of us helped cosponsor
the spousal impoverishment bill, which is part of this bill. There was
no objection to that, and I am delighted that we are getting it done.
But I want to particularly take this time and just thank Joe Barton
for his leadership on the ACE Kids Act.
All of us come here to this House for particular causes that really
grab our interest and attention. Joe Barton has been so good--some
would say like a dog to a Frisbee--in getting the ACE Kids Act to the
House floor. This bill is going to save lives.
It was bipartisan. Frankly, I wanted to move it as part of the 21st
Century Cures Act, but we didn't have a CBO score. We couldn't get it
done.
We had plenty of meetings over the last couple of years on this, and
here it is. We are going to get it done. Hopefully, the Senate is going
to get it done, and we are going to get it to the President's desk.
This is probably the last time that Joe Barton is actually managing a
bill on the House floor, and it is appropriate that this is his bill,
that it is his engine that is moving this train that really is going to
make a difference for families across the country. So I say thank you,
Joe Barton.
Mr. GENE GREEN of Texas. Mr. Speaker, I yield 3 minutes to the
gentleman from Oregon (Mr. Schrader), a colleague from our committee.
Mr. SCHRADER. Mr. Speaker, I rise today in support of H.R. 7217, the
IMPROVE Act.
I appreciate all the work that has been done on this bill over the
years.
[[Page H10051]]
From improving care for kids with complex medical conditions to
strengthening community-based, long-term care services for the disabled
community, there is a lot to support in this bill.
I want to highlight one portion of the bill that my colleague and
good friend Peter Welch alluded to a few moments ago. A few years ago,
families were shocked when the drug company Mylan raised the price on
EpiPen, a common generic drug used to treat allergies in emergency
situations, by more than 400 percent.
While patients were facing this sticker shock for a drug necessary to
keep them alive, investigators in the Department of Health and Human
Services and in our own House and Senate committees were doing some
digging of our own.
In the course of their investigation, they found that not only was
the manufacturer of EpiPen ripping off patients and their families,
they were ripping off the American taxpayer, too. By misclassifying
their drug as a generic when it was actually a brand drug, Medicaid was
being overcharged for years.
Further investigations by HHS found that hundreds of other drugs were
also misclassified, and Medicaid was overcharged by more than $1
billion in the 4 years between 2012 and 2016. By passing this bill
today, we can put an end to this waste and abuse in our Medicaid
system.
Under this bill, if a drug company knowingly misclassifies their
brand drug as a generic, CMS will have the power to fine that drug
company double the normal rebate they would have had to pay the
government. The bill strengthens CMS and congressional oversight of the
program to prevent this from ever happening again.
I thank Mr. Welch, and Senators Wyden and Grassley, for their active
work on this one, as well as Mr. Barton, Mr. Green, Chairman Walden,
and Mr. Pallone for including it in this great reform package.
Mr. Speaker, I urge all Members to support the bill.
Mr. BARTON. Mr. Speaker, I yield 1 minute to the gentleman from
Florida (Mr. Bilirakis).
Mr. BILIRAKIS. Mr. Speaker, I rise in support of H.R. 7217, the
IMPROVE Act, which includes several important Medicaid provisions,
including the ACE Kids Act. I have been a cosponsor of the ACE Kids Act
since its first introduction.
Mr. Speaker, in the Tampa area, we have St. Joseph's Children's
Hospital. They run a Chronic-Complex Clinic for children. This medical
home is a great model that the ACE Kids Act is trying to build on.
This integrated care model, where the care is built around the needs
of the patient, has made a huge difference in the lives of so many
children. I am excited that, finally, we have reached the finish line
on the ACE Kids Act.
I thank former full committee chairman and also, I guess--well, I am
not sure, but he is a great guy. Yes, he is vice chairman of the
committee. I thank him for all of his hard work on the ACE Kids and the
IMPROVE Acts. I also thank my colleague Kathy Castor for being
relentless. The two of them are relentless on behalf of our children.
I thank all the children that came up and advocated for this bill as
well.
So, in any case, we are going to get this done. We couldn't do it
without these two, so thank you very much.
Mr. GENE GREEN of Texas. Mr. Speaker, how much time do I have left?
The SPEAKER pro tempore. The gentleman from Texas (Mr. Green) has
4\1/2\ minutes remaining. The gentleman from Texas (Mr. Barton) has
6\1/2\ minutes remaining.
Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I think this is how we need to work together, and this
is a good example of not only inter-State but also inter-party, to be
able to solve these three problems that this bill corrects. I hope the
next Congress will continue that effort of Republicans and Democrats
talking to each other, Texans talking to Oklahomans, which is sometimes
tough, to work together for the people we represent.
Mr. Speaker, I yield back the balance of my time.
Mr. BARTON. Mr. Speaker, I yield 1 minute to the distinguished
gentleman from Georgia (Mr. Carter), a strong supporter.
Mr. CARTER of Georgia. Mr. Speaker, I rise today in support of the
IMPROVE Act. My colleagues on the Energy and Commerce Committee and I
have been working to address a number of the issues that culminated
under this legislation.
For instance, the ACE Kids Act, an effort championed by
Representative Barton, would make strides in addressing the challenges
of children with medically complex conditions.
It sets standards for health home qualifications, so as to ensure
better coordinated care for children in need.
It updates and streamlines the coordinated care provisions for health
homes for children, so that they will have the system and framework in
place to properly respond and work with health systems and
professionals.
Additionally, it overhauls the data collection requirements for
providers and updates the State reporting requirements, so as to
maintain a more comprehensive network of care for children with complex
medical conditions.
Mr. Speaker, this legislation is a culmination of a lot of hard work
by my colleagues, particularly Representative Barton and the staff of
the Energy and Commerce Committee, and represents a commonsense step
forward in assisting needy children. I urge my colleagues to support
this legislation.
{time} 1315
Mr. BARTON. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Washington (Ms. Herrera Beutler), one of the tireless supporters of
this bill from day one, who herself has a medically complex special
needs child, who went through the nightmare of having to create her own
network for her child, and who has been a cosponsor since day one.
Ms. HERRERA BEUTLER. Mr. Speaker, I thank Chairman Barton for his
leadership on this.
I am so excited that we are here today to celebrate this. I have
spent months of my life in a NICU for my own medically complex child,
and I have stood bedside-to-bedside with many a family as they have
faced the reality of having a sick kid and they have hit hard economic
times. I can put too many faces and names to the reality that little
kiddos often can't get the care they need, and today we are taking a
step to fix it. I am so excited about this.
One in 25 children in the U.S. is medically complex. That means they
have diagnoses like cancer or end-stage renal disease or congenital
heart disease or other diagnoses that require consistent critical
medical care. They need the expertise.
Out of those 3 million medically complex kiddos, 2 million of them
rely on Medicaid, which means what we do with Medicaid significantly
impacts them.
They are also less expensive than the other folks on Medicaid, so we
can go a long way to make sure of getting them care.
So in order to enhance the critical care for these 2 million kiddos,
the ACE Kids Act would create networks, anchored by children's
hospitals, to help coordinate care, allowing families to seamlessly
pursue the best doctors and facilities, even if it takes them out of
State, and that is the key.
Right now under Medicaid, you can get stuck in your ZIP Code. So
maybe there is a specialist for your child's rare disease in another
State. Well, if you are on Medicaid, you are limited.
We are breaking open that limitation today to allow those kiddos to
cross State lines and pursue the best doctors regardless of where they
are. This just makes sense.
Here is the great thing: the efficiency and the better coordination
is going to improve outcomes, number one, that is the best thing. But
the next best thing is this is even going to save money, because we are
not going to build that expertise in every single community, we are
going to get those kids where they need to go.
It is really going to cut down on duplication and it is going to
increase efficiency and it is going to be the right thing. So this is a
win-win proposition. I am so excited about this.
Mr. Speaker, I urge my colleagues to vote ``yes.''
[[Page H10052]]
And, again, Mr. Speaker, I thank the chairman and Ms. Castor for
their leadership here.
Mr. BARTON. Mr. Speaker, I yield 1 minute to the gentleman from New
York (Mr. Zeldin).
Mr. ZELDIN. Mr. Speaker, I thank Mr. Barton for yielding the time.
Mr. Speaker, today I rise to speak in support of language that was
added to the IMPROVE Act that would protect access to critical
equipment for individuals with disabilities.
In November of 2014, the Centers for Medicare and Medicaid Services
issued a rule stating that accessories used on complex rehabilitative
wheelchairs would no longer be part of the fixed fee schedule and would
be subject to competitive bidding pricing, decreasing access to
customized wheelchairs and accessories relied on by adults and children
with disabilities.
My language included in this legislation will include a commonsense
clarification to ensure those in the Medicare Program do not have to go
through the difficulty of adjusting to the new rules and pricing
arbitrarily set by CMS. This will ensure that they have reliable and
consistent access to the equipment they need.
Mr. Speaker, I urge my colleagues to protect those with disabilities
and their access to the resources they rely on.
Mr. BARTON. Mr. Speaker, may I inquire how much time I have
remaining?
The SPEAKER pro tempore. The gentleman from Texas has 2\1/2\ minutes
remaining.
Mr. BARTON. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, before I close, I want to set the record straight on one
thing. There has been a report that this bill, the ACE Kids Act,
expands Medicaid. That is factually incorrect.
The children that qualify for the ACE Kids Act are already covered by
Medicaid.
There is no expansion. We do not create a new program. We do not
expand an existing program. We do not change the definitions.
We simply make it possible, if this bill becomes law, for parents of
children that qualify and that are already covered under Medicaid, they
can choose a healthcare home for their child, and that healthcare home
can cross State lines. But as Dr. Burgess pointed out, it is not
coercive. The States don't have to participate in the program, the
families don't have to participate in the program. It is all voluntary.
But the pilot programs that have been done on this model, they save
money and they give better care. It has been proven.
CBO has scored this over time that it saves money, but we put pay-
fors in the bill. If it did cost some extra money, it would be paid
for. There is a 2-quarter, 6-month increase in the FMAP, the Federal
matching that the Federal Government gives to States that choose to
participate. I think it is about 15 percent extra money for 6 months.
That is the only cost.
Now, to close, I am going to read a list, and Congresswoman Castor
read a lot of these, but these are the national groups that support our
bill: the Adult Congenital Heart Association, America's
Essential Hospitals, American Academy of Pediatrics, American
Association of Child & Adolescent Psychiatry, American Board of
Pediatrics, American College of Cardiology, American College of
Surgeons, American Heart Association, American Psychological
Association, American Society of Echocardiography, American Thoracic
Society, Amicus Therapeutics, Association of American Medical Colleges,
Association of Medical School Pediatric Department Chairs, Autism
Society, Autism Speaks, ChildServe, Children's Cause for Cancer
Advocacy, Children's Hospital Association, Epilepsy Foundation, Family
Voices, Foundation to Eradicate Duchenne, International Pediatric
Rehabilitation Collaborative, March of Dimes, Mended Little Hearts,
MomsRising, National Association for Children's Behavioral Health.
There are about seven or ten more.
Mr. Speaker, I want to thank the staff, especially Krista Rosenthall,
Jeannine Bender, committee staff Caleb Graff, Josh Trent, and Ryan
Long. And, again, I thank Kathy Castor and Gene Green.
Mr. Speaker, this has been a bipartisan effort. I ask for a strong
``yea'' vote.
Mr. Speaker, I yield back the balance of my time.
Mr. SMITH of Texas. Mr. Speaker, I believe it is important to make
very clear with this legislation that CMS should not waive any Medicaid
state plan requirements that would limit the freedom to choose
qualified Medicaid providers who can provide medical services to
children with chronic conditions. Nothing in this bill modifies section
1902(a)(23) of the Social Security Act--related to freedom of choice
requirements. Children and their families or guardians retain the right
to elect care from a provider or supplier who is qualified and eligible
to receive Medicaid payment for the services. It is the intent of this
legislation to permit and guarantee the family, in consultation with
their physician, in all instances, to be permitted to select the best
provider/supplier who can meet the patient's needs. While I support
this legislation to provide care coordination for these children, the
ultimate choice of the who will provide direct medical services must
remain with the family.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Texas (Mr. Barton) that the House suspend the rules and
pass the bill, H.R. 7217.
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. BARTON. Mr. 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 motion will be postponed.
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