SUPPORT for Patients and Communities Act - H.R.6 (Preview)
Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act . The bill modifies Medicaid, Medicare and other health care programs to help prevent opioid substance use disorder and provide better access to treatment for the disorder. Among its provisions, it expands both Medicare and Medicaid to cover medication-assisted treatment for substance use disorders, expands the use of telehealth services in the treatment of substance use disorders or co-occurring mental health disorders, requires prescriptions for controlled substances under Medicare Part D to be transmitted electronically, and creates financial incentives for the development of non-opioid pain treatments. The measure is expected to be considered under a structured rule that makes in order only specified amendments.
SUMMARY: This bill modifies Medicaid, Medicare and other health care programs to help prevent opioid substance use disorder and provide better access to treatment for the disorder, including by expanding both Medicare and Medicaid to cover medication-assisted treatment for substance use disorder.
Among its other Medicaid provisions, it increases access to Medicaid benefits for incarcerated youth and young adults who have aged out of foster care, and requires all state Medicaid programs to operate pharmacy programs that identify people at high risk of abusing controlled substances and to subsequently set reasonable limits on which prescribers and pharmacies those beneficiaries may use.
And among its other Medicare provisions, it expands the use of telehealth services in the treatment of substance use disorders or co-occurring mental health disorders, requires prescriptions for controlled substances under Medicare Part D to be transmitted electronically, allows new non-opioid analgesic drugs to receive a higher reimbursement from Medicare for five years (rather than three) as a financial incentive to develop such non-opioid pain killers, and creates financial incentives to use post-surgical injections as a pain treatment alternative to opioids in ambulatory surgical centers by increasing their Medicare reimbursement rate.
The measure also includes provisions intended to offset the cost of the bill's various provisions by encouraging certain efficiencies within Medicare and Medicaid. Overall, the Congressional Budget Office estimates that bill would reduce deficits by $1.2 billion over 10 years.
Medicaid Provisions
Medicaid, the federal health care program for low-income families and children, pregnant women, the elderly and people with disabilities, ends up covering about four in 10 people who seek treatment for opioid use disorder and carries about 21% of the cost of substance use disorder treatment, according to a Kaiser Family Foundation report.
BACKGROUND:
The nation's opioid crisis has been building since the 1990s, when drug companies began promoting slow-release opioid pain medication they said was less likely to cause addiction. Doctors embraced the opportunity to prescribe medications that could relieve pain with less addiction risk, and started prescribing opioids for individuals who suffered from chronic pain in addition to those who needed pain relief for a brief time, such as after surgery.
Because no monitoring for abuse or addition occurred, however, a growing number of patients became addicted, while unused medication was subject to being sampled and abused by others (often for recreational use) leading them to become addicted. Addicted individuals, when unable to obtain prescribed medications, also frequently began seeking illicit opioids such as heroin and fentanyl, which are far more powerful and dangerous.
According to the Centers for Disease Control (CDC), 151 Americans die every day from an opioid overdose. The CDC says that more than 630,000 people died from drug overdoses from 1999 to 2016, with 66% of the more than 63,600 drug overdose deaths in 2016 involving an opioid (five times higher than in 1999). Estimates of the economic cost of the opioid crisis vary, with health care research organization Altarum in November 2017 estimating a $95 billion cost for 2016, and the White House's Council of Economic Advisors that month estimating a $500 billion cost in 2015 when accounting for the broader societal cost of premature deaths from overdose.
This bill is one of a series of bills being considered this week to address the nation's opioid and drug abuse crisis.
Compilation Bill
Various House committees have reported more than 60 bills to respond to the opioid and drug abuse crisis — the vast majority of which have been considered under suspension of the rules. This bill (HR 6) comprises 17 bills that were individually reported by the Energy and Commerce and Ways and Means committees, as well as provisions to offset the projected costs of the measure.
According to press releases from the two committees, "HR 6 will serve as the underlying vehicle for the majority of House-passed bills to combat the opioid crisis to move over to the Senate." It is expected that most of the opioid-related bills passed by the House last week and this week will be added to HR 6 before it is transmitted to the Senate.
Access for Medicaid Beneficiaries
The bill retains or expands access to Medicaid for certain beneficiaries and establishes a demonstration project to expand substance use disorder treatment programs.
It requires Medicaid programs to suspend rather than terminate coverage for youth who are incarcerated. Specifically, for individuals who are under 21 years of age and eligible for Medicaid prior to incarceration or during incarceration, the state must redetermine their eligibility prior to their release and, if they meet the requirements, restore eligibility upon release. The state cannot require a new application for Medicaid from the individual before redetermining eligibility. Reinstated eligibility for incarcerated youth applies to juveniles who are incarcerated beginning one year after enactment.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 1925. CBO estimates they would increase direct spending by $75 million over the 2018-28 period.)
Under the Affordable Care Act (ACA; PL 111-148), foster youth, who age out of foster care at 18, are able to retain Medicaid coverage until age 26, regardless of their income. The bill explicitly extends this eligibility across state lines for foster youth who are 18 on or after Jan. 1, 2023. It also requires the Health and Human Services Department (HHS) to issue guidance to states on best practices for ensuring access to Medicaid coverage for former foster youth up to age 26 and for raising awareness regarding Medicaid coverage options for such youth.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 4998. CBO estimates they would increase direct spending by $171 million over 10 years.)
Demonstration Project
The bill establishes a demonstration project to increase the treatment capacity of Medicaid substance use disorder treatment and recovery providers.
The demonstration project must include an ongoing assessment of the behavioral health treatment needs of the state and support the recruitment, training and technical assistance for Medicaid substance use disorder treatment providers.
The project must improve reimbursement for, and expansion of, the number or capacity of treatment providers who can dispense drugs needed to manage withdrawal, who are authorized to dispense narcotic drugs to patients for maintenance treatment or detoxification, and who are qualified under state law to provide substance use disorder treatment or recovery services. It also must improve reimbursement for, and expansion of, Medicaid providers to address neonatal abstinence syndrome; pregnant women, postpartum women and infants; adolescents and young adults between ages 12 and 21; and Native American and Alaskan Native individuals.
At least 10 states would receive planning grants for the first 18 months of the demonstration project. States selected for the project must be geographically diverse, and preference would be given to those where the prevalence of substance use disorder is higher than the national average. The bill provides $50 million for the planning grants.
From the states that receive planning grants, no more than five would actually conduct the three-year demonstration project, with federal funds covering 80% of the qualified sums spent by states on eligible activities under the demonstration project.
Starting in 2020, the Centers for Medicare and Medicaid Services (CMS) must report to Congress on the states conducting the demonstration project. with the initial report will also detail which states were selected and why. After an interim report a final report would be due by Oct. 1, 2024, that evaluates the project and describes the extent to which states achieving project goals, the strengths and limitations of the project, and a plan for sustaining the project.
(The above demonstration project provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5477. CBO estimates they would increase direct spending by $256 million over 10 years.)
Federal Payments for Certain Health Homes
The bill extends the federal enhanced matching grant from eight quarters to 10 quarters for health homes offering services to individuals with substance use disorders who are Medicaid beneficiaries.
States that have provisions focused on substance use disorder in their state plans on or after Oct. 1, 2018, may request the extended time for the federal matching grant. States that receive the extension must report to HHS on the quality of the health care provided, beneficiary access to the care, and the total health care expenditures for the affected individuals.
HHS must make the best practices of states with substance use disorder plans available on the Centers for Medicare and Medicaid Services website by Oct. 1, 2020.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5810. CBO estimates they would increase direct spending by $509 million over 10 years.)
Drug Management
The bill requires all state Medicaid programs, beginning Jan 1, 2020, to operate pharmacy programs that identify people at high risk of abusing controlled substances, and to subsequently set reasonable limits on which prescribers and pharmacies those beneficiaries may use in order to best manage the individual's prescription drug use. States would be given explicit authority to make such determinations.
Specifically, at-risk individuals would be restricted to no more than three physicians and no more than three pharmacies for the prescribing and dispensing of controlled substances. If a pharmacy has multiple locations that share real-time electronic data, all locations would be treated as a single pharmacy. The pharmacy program must permit individuals with multiple residences, or individuals displaced by natural disasters, to access other physicians and pharmacies through a waiver process.
States must notify at-risk individuals before placing them in the pharmacy program, and also notify the physicians and pharmacies that can prescribe and fill prescriptions for the individual. Identified individuals would initially be enrolled in the pharmacy program for a year, and must be assessed for re-enrollment at least 30 days before the end of the enrollment period. Individuals who are receiving hospice or palliative care, treatment for cancer, or who are residents of long-term care facilities could not be considered at risk.
The measure establishes beneficiary appeals and protections similar to those under Medicare, and it requires a series of reports and reviews on the status of the expanded programs. It requires HHS to provide guidance on transitioning the at-risk population between fee-for-service Medicaid and managed care, and from Medicaid to Medicare.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5808. CBO estimates they would increase direct spending by $13 million over 10 years.)
Drug Review Requirements
The bill places new requirements on states regarding Medicaid drug review and utilization requirements.
Beginning Oct. 1, 2019, states must have in place "safety edits" that identify when a Medicaid beneficiary is prescribed opioids or morphine in excess of the state's limitation, or when an individual is concurrently prescribed opioids and benzodiazepines or anti-psychotics. States must have in place a program to monitor anti-psychotic medications prescribed to children and must report to HHS annually on activities carried out under that program, especially with regard to children in foster care. States must also have in place a process to identify fraud and abuse of controlled substances by beneficiaries, health care providers and pharmacies.
Individuals who are receiving hospice or palliative care, treatment for cancer, or who are residents of long-term care facilities are exempt from the drug review safety edits. HHS could waive the safety edits for a particular state during a natural disaster or similar emergency.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5799. CBO estimates they would increase direct spending by $5 million over 10 years.)
Medication-Assisted Treatment
The bill requires states to provide medication-assisted treatment (MAT) for substance use disorder under Medicaid starting Oct. 1, 2020, and ending Sept. 30, 2025. (MAT is the use of FDA-approved drugs to treat substance use disorder.) MAT is defined in the measure as including counseling services and behavioral therapy.
States may apply for a waiver from the requirement to provide medication-assisted treatment on the grounds that statewide there are not enough providers of the treatment.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5810. CBO estimates that requiring states to provide medication-assisted treatment, together with extending the grant (see above) would increase direct spending by $509 million over 10 years.)
Neonatal Abstinence Syndrome
Infants who were exposed to drugs in the womb may experience neonatal abstinence syndrome (NAS) once they are born. Symptoms can include seizures, feeding difficulties, sweating and vomiting. These infants may also be premature and require specialized care in a neonatal intensive care unit. The number of children in the United States born with the syndrome has quadrupled in the past 15 years, according to a 2016 CDC report. The report showed the highest rates of infants born with NAS in Maine, Vermont and West Virginia, where the rates were greater than 30 per 1,000 births.
Infants can be exposed to drugs in the womb because pregnant women use prescription medications to manage pain, because they use illicit drugs, or even when they use medication to help treat an opioid addiction. The long-term prognosis for infants with NAS has not been thoroughly studied, both because recognition of the problem is relatively recent and because separating the outcomes associated with NAS and the outcomes due to socioeconomic factors is difficult. However, infants born with NAS often experience vision problems, motor development problems, and behavioral and cognitive problems.
The bill requires HHS, within a year of enactment, to issue guidance to improve care for infants with neonatal abstinence syndrome and their families. The guidance must include the types of services that states may cover under Medicaid and best practices for prevention, screening, treatment, plans of safe care and post-discharge services for parents with substance use disorders and babies with NAS. HHS must also recommend available financing options under Medicaid and the Children's Health Insurance Program for parents with substance use disorders, infants with NAS and home visiting services.
Within a year of enactment, the Government Accountability Office (GAO) must report to Congress on gaps in coverage for pregnant women with substance use disorder under the Medicaid program and gaps in coverage for postpartum women with substance use disorder who were covered by Medicaid during pregnancy.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5789. CBO estimates that these provisions would have no effect on direct spending.)
Medicare Provisions
In July 2017 the HHS Inspector General issued a report warning against the over-prescription of opioids to Medicare beneficiaries enrolled in Medicare Part D (Medicare's prescription drug plan). According to the OIG report, one in three Part D beneficiaries received an opioid prescription in 2016, about 500,000 beneficiaries received high amounts of opioids, and nearly 90,000 beneficiaries were at serious risk from opioids either because of the "extreme" amounts they were receiving or because they were doctor shopping to obtain multiple prescriptions.
While Medicare will pay for prescription opioids, the program currently does not pay for most treatment plans to address opioid abuse.
Access for Medicare Beneficiaries
The bill expands Medicare to cover FDA-approved medications that treat opioid use disorder, as well as the dispensing and administration of those medications. It also expands Medicare to cover substance use counseling, individual and group therapy, toxicology testing and other items and services that HHS determines are appropriate. It does not, however, cover meals or transportation.
Under the measure, to be eligible the opioid treatment program providing the services must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA), must be accredited by an accrediting body approved by SAMHSA, and must meet any additional conditions HHS finds necessary for the health and safety of patients and the efficient and effective furnishing of treatment services.
Beginning on or after Jan. 1, 2020, the federal government would pay 100% of a bundled payment for opioid use disorder treatment services.
(The above provisions were originally reported by the Way and Means Committee by voice vote as HR 5776. CBO estimates they would increase direct spending by $250 million over 10 years.)
Access to Telehealth
Telehealth services are provided to Medicare beneficiaries from a health care facility by means of an interactive audio and video telecommunications system that permits real-time communication between the patient and a health care practitioner at a distant health care facility. Medicare covers telehealth services only under specific, limited circumstances, primarily for beneficiaries in rural, underserved communities.
The bill expands the use of telehealth services in the treatment of substance use disorder or co-occurring mental health disorder, starting Jan. 1, 2020, and it provides $3 million for these services.
Specifically, HHS is authorized to waive certain requirements currently placed on telehealth services with regard to the health care facility from which the patient originates the telehealth sessions and the geographic limitations in place for use of the service. These limitations are waived only for services HHS determines are most commonly furnished to patients with substance use disorders or mental health disorders that co-occur with substance use disorders.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5603. CBO estimates they would increase direct spending by $11 million over 10 years.)
Drug Management
The bill includes provisions to reduce opioid use by promoting the development and use of other drugs and therapies to manage pain.
Pass-Through Payments
The bill requires HHS to create a pass-through payment extension under Medicare to encourage the development of non-opioid drugs for post-surgical pain management.
Specifically, it extends from three to five years Medicare's so-called pass-through status for new non-opioid analgesics drugs under which the manufacturer would receive a higher reimbursement from Medicare for the drug. To qualify, a new non-opioid alternative must demonstrate a substantial clinical improvement compared to the benefits of drugs already available on the market.
(Existing rate-setting policies at the Centers for Medicare & Medicaid Services encourage providers to prescribe opioids, which are relatively cheap. Meanwhile, non-opioid pain medications are cost-prohibitive for hospitals and physicians, resulting in stagnation of research and innovation in non-opioid pain management options. Many experts believe that extending the separate reimbursement period will spur innovation by allowing manufacturers of new non-opioid drugs to obtain higher reimbursement for a longer period of time.)
(The above provisions were originally reported by the Way and Means Committee by a 34-17 vote as HR 5809. CBO estimates they would increase direct spending by $180 million over 10 years.)
Initial Visit Opioid Screening
When individuals first become eligible for Medicare they are given a physical examination called The Initial Preventive Physical Examination (IPPE) or "Welcome to Medicare Preventive Visit." Medicare pays for that initial examination for beneficiaries within the first 12 months of when the beneficiary's Medicare Part B coverage begins.
The bill requires doctors, as part of a new Medicare beneficiary's initial physical examination, to review the individual's use of prescription opioids and to screen for potential risk factors for opioid addiction.
Under the measure, Medicare physicians must also provide information to patients about non-opioid alternatives for the treatment and management of chronic pain. These requirements would apply to initial examinations conducted on or after Jan. 1, 2020.
The measure clarifies that both the pain assessment and the screening would only apply to an individual with a current opioid prescription for chronic pain.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5798. CBO estimates they would increase direct spending by $5 million over 10 years.)
Post-Surgical Injections
The bill creates financial incentives to use post-surgical injections as a pain treatment alternative to opioids by increasing the Medicare reimbursement payment rate for such treatments in ambulatory surgical centers (ASCs).
(ASCs are modern health care facilities focused on providing same-day surgical care, including diagnostic and preventive procedures. They generally provide patients with a more convenient alternative to hospital-based outpatient procedures, along with a strong track record of quality care and positive patient outcomes.)
Specifically, for the 2020-2023 period the Medicare reimbursement rate for certain analgesic injections in ASCs would be frozen at 2016 levels — which is higher than the current rate.
The measure requires HHS to conduct a study and submit to Congress a report on the extent to which the procedures are effective at preventing the need for opioids. It also requires GAO to collect data and report on the cost differential between the procedures performed in a hospital operating room compared to an office setting within a hospital.
(The above provisions were originally reported by the Way and Means Committee by a 36-14 vote as HR 5804. CBO estimates they would increase direct spending by $108 million over 10 years.)
Electronic Prescriptions
According to the Centers for Disease Control, 27% of those at the highest risk of overdose are prescribed painkillers by more than one physician. Experts contend that requiring electronic prescriptions for controlled substances can help eliminate duplicative prescriptions that fuel the opioid epidemic, reduce the costs and inefficiencies of paperwork, and prevent patients from doctor shopping and acquiring fraudulent paper prescriptions.
The bill requires prescriptions for controlled substances covered under Medicare Part D to be transmitted electronically, starting on Jan. 1, 2021.
Exceptions include when the prescriber and dispenser are the same entity, when a prescription cannot be submitted electronically, when the prescriber has received a waiver, or when a prescription is issued by a practitioner prescribing a drug under a research protocol. It also exempts pharmacies from electronic prescribing requirements if the patient is in hospice care or is a resident of a skilled nursing facility.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 3528. CBO estimates they would decrease direct spending by $255 million over 10 years.)
Drug Management Programs
Medicare Part D, which provides prescription drug coverage, already encourages prescription drug plan sponsors to offer drug management programs. These programs may specify extra requirements for coverage or limits on certain drugs. For example, the plan may require a physician to get approval from the sponsor before prescribing a drug and it may limit the amount of drug or the period of time for which the drug is covered. The plan may require that a patient first try one drug before trying another (perhaps newer and more expensive, or perhaps more potentially addictive), and it may encourage the use of generic versions. Drug management programs can also include medication therapy management, which seeks to coordinate medications for different conditions that may be prescribed by different physicians. Under this aspect of drug management, the medical team seeks to ensure that drug interactions are accounted for and that there is no duplication of medications.
The bill requires Medicare Part D prescription drug plan sponsors to provide drug management and medication therapy management programs for at-risk beneficiaries starting on or after Jan. 1, 2021.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5675. CBO estimates they would decrease direct spending by $60 million over 10 years.)
Other Health Care Provisions
The bill includes provisions to facilitate research and development of nonaddictive pain treatments, assist in the detection of fentanyl and synthetic opioids, and authorize additional health care professionals to be able to administer medication-assisted treatment for substance use disorder.
Nonaddictive Pain Therapy
The bill directs the FDA to hold at least one public meeting to address the challenges and barriers of developing nonaddictive medical products that could treat pain or addiction, with HHS to subsequently issue or update existing guidance on ways that new non-addictive treatments for pain and addiction could be brought to market for patients.
Under the measure, the HHS guidance must include information on how the FDA, in seeking to develop non-addictive alternatives to treat pain or addiction, could apply existing laws that provided for expedited approval of drugs for serious or life-threatening diseases or conditions, and the methods for evaluating acute and chronic pain.
(The above provisions were originally reported by the Energy and Commerce Committee by a 31-23 vote as HR 5806. CBO estimates these provisions would have no effect on direct spending.)
Synthetic Opioid Surveillance
The bill establishes a grant program and appropriates $15 million for each year through FY 2023 to support the establishment or operation of public health laboratories to detect fentanyl, its analogues and other synthetic opioids.
HHS must develop the safety standards under which the labs will operate, including standards for safely handling and testing synthetic opioids; reference materials, quality control standards and instrumentation calibration protocols; and procedures for encountering and reporting new synthetic opioid formulations. The labs that are awarded grants must work with law enforcement agencies and public health authorities in testing seized drugs and providing diagnostic testing for non-fatal exposures of emergency personnel.
It also establishes a pilot program for point-of-use testing of illicit drugs for dangerous contaminants, authorizing $5 million a year through FY 2023 for the program. Under the program, five state or local agencies would test for dangerous contaminants to illicit drugs at the points where they are used. HHS must establish metrics to evaluate the program's success and report to Congress on the results.
Finally, the measure directs the Centers for Disease Control and Prevention to expand its drug surveillance program to all states and U.S. territories, to increase data collection on synthetic opioids, and to use information from other sources. It authorizes $10 million a year through FY 2023 for these activities.
(The above provisions were originally reported by the Energy and Commerce Committee by voice vote as HR 5580. CBO estimates these provisions would have no effect on direct spending.)
Medication-Assisted Treatment Waivers
Current law allows qualified physicians to administer medication-assisted treatment (MAT) for substance use disorder without first obtaining a Drug Enforcement Administration (DEA) registration. This waiver of DEA registration allows physicians to treat at first 30 patients at a time, and then 100 patients in subsequent years if the doctor applies for the expansion. Nurse practitioners and physician assistants may receive waivers to treat 30 patients at a time.
The bill removes, in certain cases, the wait period of one year before a qualified physician can apply to treat 100 patients at a time. The physician must either meet certain existing regulatory requirements or must provide medication-assisted treatment using covered medications in a qualified practice setting.
It allows clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives to administer medication-assisted treatment without a DEA waiver (under current law, only qualified physicians, nurse practitioners and physician assistants may do so). It also extends by two years, until Oct. 1, 2023, the period for which clinical nurse specialists, certified registered nurse anesthetists or certified nurse midwives may administer MAT without a DEA waiver.
(The above provisions were originally introduced as HR 3692, which was not reported by either committee. CBO estimates these provisions would increase direct spending by $395 million and decrease revenues by $66 million over 10 years, for a net deficit increase of $461 million over 10 years.)
Offsets
Medical Loss Ratio Incentive
A state may outsource its Medicaid program to a managed care organization (MCO) that accepts a set per member per month payment for these services. MCOs usually pay for and provide services, either directly or through contracts with third party providers, and the organizations themselves are often nonprofit or not-for-profit organizations. If a state chooses to require a medical loss ratio (MLR; the ratio of Medicaid revenue that must be spent on medical care rather than salaries, marketing, administration and profit) for its MCOs, regulations require an MLR of 85%. If the insurers spends less than 85% on medical care, states must collect remittances of the difference and must return a share of the remittance to the federal government.
The bill provides an incentive to states to encourage them to adopt the 85% MLR requirement for their Managed Care Organizations by specifying that the state would retain a larger share of the remittance from the organizations who don't meet the MLR requirement.
In their explanatory materials, the committees state that this provision "is projected to achieve efficiencies in federal Medicaid spending compared to current law because states are incentivized to collect rebates from MCOs that do not adhere to a reasonable MLR."
CBO estimates that these provisions would decrease direct spending by $2.6 billion over 10 years.
Extend Medicare ESRD Secondary Payer Rules
Medicare beneficiaries often have a private or other public health care plan in addition to Medicare coverage. Most of the time Medicare is the primary payer (meaning it pays first) for covered services, although in some cases the non-Medicare coverage pays first; this is called the Medicare secondary payer program (MSP). Under current law, for people with end stage renal disease who have employer health coverage, Medicare is the secondary payer for 30 months.
The bill extends for three months, from 30 to 33 months, the time that employer health plans must be the primary payer for Medicare beneficiaries with end stage renal disease, beginning Jan. 1, 2020.
CBO estimates that these provisions would decrease direct spending by $344 million and decrease revenues by $54 million over 10 years, for a net decrease in the deficit of $290 million over 10 years.
Prescription Drug Coverage Reporting
Currently, employer and union health care plans must report to Medicare enrollment information regarding certain employees, while other group health plans that offer prescription drug benefits are not required to do so.
Starting Jan. 1, 2020, the bill requires that all non-Medicare group health plans whose coverage is primary (making Medicare the secondary payer) report to HHS and Medicare Part D plan sponsors their coverage of Medicare beneficiaries.
CBO estimates that these provisions would decrease direct spending by $45 million over 10 years.
CBO Cost Estimate
The Congressional Budget Office estimates that the bill's direct spending and revenue provisions would reduce net deficits by $1.2 billion over 10 years. As of press time, however, CBO had not completed its estimate of how the measure would affect spending subject to appropriation.
