[Pages H6233-H6239]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

MEDICARE PART B IMPROVEMENT ACT OF 2017

Mr. BRADY of Texas. Madam Speaker, I move to suspend the rules and
pass the bill (H.R. 3178) to amend title XVIII of the Social Security
Act to improve the delivery of home infusion therapy and dialysis and
the application of the Stark rule under the Medicare program, and for
other purposes, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:

H.R. 3178

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Medicare
Part B Improvement Act of 2017''.
(b) Table of Contents.--The table of contents of this Act
is as follows:

Sec. 1. Short title; table of contents.

TITLE I--IMPROVEMENTS IN PROVISION OF HOME INFUSION THERAPY

Sec. 101. Home infusion therapy services temporary transitional
payment.
Sec. 102. Extension of Medicare Patient IVIG Access Demonstration
Project.
Sec. 103. Orthotist's and prosthetist's clinical notes as part of the
patient's medical record.

TITLE II--IMPROVEMENTS IN DIALYSIS SERVICES

Sec. 201. Independent accreditation for dialysis facilities and
assurance of high quality surveys.
Sec. 202. Expanding access to home dialysis therapy.

TITLE III--IMPROVEMENTS IN APPLICATION OF STARK RULE

Sec. 301. Modernizing the application of the Stark rule under Medicare.
Sec. 302. Funds from the Medicare Improvement Fund.

TITLE I--IMPROVEMENTS IN PROVISION OF HOME INFUSION THERAPY

SEC. 101. HOME INFUSION THERAPY SERVICES TEMPORARY
TRANSITIONAL PAYMENT.

(a) In General.--Section 1834(u) of the Social Security Act
(42 U.S.C. 1395m(u)) is amended, by adding at the end the
following new paragraph:
``(7) Home infusion therapy services temporary transitional
payment.--
``(A) Temporary transitional payment.--
``(i) In general.--The Secretary shall, in accordance with
the payment methodology described in subparagraph (B) and
subject to the provisions of this paragraph, provide a home
infusion therapy services temporary transitional payment
under this part to an eligible home infusion supplier (as
defined in subparagraph (F)) for items and services described
in subparagraphs (A) and (B) of section 1861(iii)(2))
furnished during the period specified in clause (ii) by such
supplier in coordination with the furnishing of transitional
home infusion drugs (as defined in clause (iii)).
``(ii) Period specified.--For purposes of clause (i), the
period specified in this clause is the period beginning on
January 1, 2019, and ending on the day before the date of the
implementation of the payment system under paragraph (1)(A).
``(iii) Transitional home infusion drug defined.--For
purposes of this paragraph, the term `transitional home
infusion drug' has the meaning given to the term `home
infusion drug' under section 1861(iii)(3)(C)), except that
clause (ii) of such section shall not apply if a drug
described in such clause is identified in clauses (i), (ii),
(iii) or (iv) of subparagraph (C) as of the date of the
enactment of this paragraph.

[[Page H6234]]

``(B) Payment methodology.--For purposes of this paragraph,
the Secretary shall establish a payment methodology, with
respect to items and services described in subparagraph
(A)(i). Under such payment methodology the Secretary shall--
``(i) create the three payment categories described in
clauses (i), (ii), and (iii) of subparagraph (C);
``(ii) assign drugs to such categories, in accordance with
such clauses;
``(iii) assign appropriate Healthcare Common Procedure
Coding System (HCPCS) codes to each payment category; and
``(iv) establish a single payment amount for each such
payment category, in accordance with subparagraph (D), for
each infusion drug administration calendar day in the
individual's home for drugs assigned to such category.
``(C) Payment categories.--
``(i) Payment category 1.--The Secretary shall create a
payment category 1 and assign to such category drugs which
are covered under the Local Coverage Determination on
External Infusion Pumps (LCD number L33794) and billed with
the following HCPCS codes (as identified as of July 1, 2017,
and as subsequently modified by the Secretary): J0133, J0285,
J0287, J0288, J0289, J0895, J1170, J1250, J1265, J1325,
J1455, J1457, J1570, J2175, J2260, J2270, J2274, J2278,
J3010, or J3285.
``(ii) Payment category 2.--The Secretary shall create a
payment category 2 and assign to such category drugs which
are covered under such local coverage determination and
billed with the following HCPCS codes (as identified as of
July 1, 2017, and as subsequently modified by the Secretary):
J1559 JB, J1561 JB, J1562 JB, J1569 JB, or J1575 JB.
``(iii) Payment category 3.--The Secretary shall create a
payment category 3 and assign to such category drugs which
are covered under such local coverage determination and
billed with the following HCPCS codes (as identified as of
July 1, 2017, and as subsequently modified by the Secretary):
J9000, J9039, J9040, J9065, J9100, J9190, J9200, J9360, or
J9370.
``(iv) Infusion drugs not otherwise included.--With respect
to drugs that are not included in payment category 1, 2, or 3
under clause (i), (ii), or (iii), respectively, the Secretary
shall assign to the most appropriate of such categories, as
determined by the Secretary, drugs which are--

``(I) covered under such local coverage determination and
billed under HCPCS codes J7799 or J7999 (as identified as of
July 1, 2017, and as subsequently modified by the Secretary);
or
``(II) billed under any code that is implemented after the
date of the enactment of this paragraph and included in such
local coverage determination or included in subregulatory
guidance as a home infusion drug described in subparagraph
(A)(i).

``(D) Payment amounts.--
``(i) In general.--Under the payment methodology, the
Secretary shall pay eligible home infusion suppliers, with
respect to items and services described in subparagraph
(A)(i) furnished during the period described in subparagraph
(A)(ii) by such supplier to an individual, at amounts equal
to the amounts determined under the physician fee schedule
established under section 1848 for services furnished during
the year for codes and units of such codes described in
clauses (ii), (iii), and (iv) with respect to drugs included
in the payment category under subparagraph (C) specified in
the respective clause, determined without application of the
geographic adjustment under subsection (e) of such section.
``(ii) Payment amount for category 1.--For purposes of
clause (i), the codes and units described in this clause,
with respect to drugs included in payment category 1
described in subparagraph (C)(i), are one unit of HCPCS code
96365 plus four units of HCPCS code 96366 (as identified as
of July 1, 2017, and as subsequently modified by the
Secretary).
``(iii) Payment amount for category 2.--For purposes of
clause (i), the codes and units described in this clause,
with respect to drugs included in payment category 2
described in subparagraph (C)(i), are one unit of HCPCS code
96369 plus four units of HCPCS code 96370 (as identified as
of July 1, 2017, and as subsequently modified by the
Secretary).
``(iv) Payment amount for category 3.--For purposes of
clause (i), the codes and units described in this clause,
with respect to drugs included in payment category 3
described in subparagraph (C)(i), are one unit of HCPCS code
96413 plus four units of HCPCS code 96415 (as identified as
of July 1, 2017, and as subsequently modified by the
Secretary).
``(E) Clarifications.--
``(i) Infusion drug administration day.--For purposes of
this subsection, a reference, with respect to the furnishing
of transitional home infusion drugs or home infusion drugs to
an individual by an eligible home infusion supplier, to
payment to such supplier for an infusion drug administration
calendar day in the individual's home shall refer to payment
only for the date on which professional services (as
described in section 1861(iii)(2)(A)) were furnished to
administer such drugs to such individual. For purposes of the
previous sentence, an infusion drug administration calendar
day shall include all such drugs administered to such
individual on such day.
``(ii) Treatment of multiple drugs administered on same
infusion drug administration day.--In the case that an
eligible home infusion supplier, with respect to an infusion
drug administration calendar day in an individual's home,
furnishes to such individual transitional home infusion drugs
which are not all assigned to the same payment category under
subparagraph (C), payment to such supplier for such infusion
drug administration calendar day in the individual's home
shall be a single payment equal to the amount of payment
under this paragraph for the drug, among all such drugs so
furnished to such individual during such calendar day, for
which the highest payment would be made under this paragraph.
``(F) Eligible home infusion suppliers.--In this paragraph,
the term `eligible home infusion supplier' means a supplier
that is enrolled under this part as a pharmacy that provides
external infusion pumps and external infusion pump supplies
and that maintains all pharmacy licensure requirements in the
State in which the applicable infusion drugs are
administered.
``(G) Implementation.--Notwithstanding any other provision
of law, the Secretary may implement this paragraph by program
instruction or otherwise.''.
(b) Conforming Amendment.--Section 1842(b)(6)(I) of the
Social Security Act (42 U.S.C. 1395u(b)(6)(I)) is amended by
inserting ``or, in the case of items and services described
in clause (i) of section 1834(u)(7)(A) furnished to an
individual during the period described in clause (ii) of such
section, payment shall be made to the eligible home infusion
therapy supplier'' after ``payment shall be made to the
qualified home infusion therapy supplier''.

SEC. 102. EXTENSION OF MEDICARE PATIENT IVIG ACCESS
DEMONSTRATION PROJECT.

Section 101(b) of the Medicare IVIG Access and
Strengthening Medicare and Repaying Taxpayers Act of 2012 (42
U.S.C. 1395l note) is amended--
(1) in paragraph (1), by inserting after ``for a period of
3 years'' the following: ``and, subject to the availability
of funds under subsection (g)--
``(A) if the date of enactment of the Medicare Part B
Improvement Act of 2017 is on or before September 30, 2017,
for the period beginning on October 1, 2017, and ending on
December 31, 2020; and
``(B) if the date of enactment of such Act is after
September 30, 2017, for the period beginning on the date of
enactment of such Act and ending on December 31, 2020'' '';
and
(2) in paragraph (2), by adding at the end the following
new sentences: ``Subject to the preceding sentence, a
Medicare beneficiary enrolled in the demonstration project on
September 30, 2017, shall be automatically enrolled during
the period beginning on the date of the enactment of the
Medicare Part B Improvement Act of 2017 and ending on
December 31, 2020, without submission of another application.
Chapter 35 of title 44, United States Code, shall not apply
to any application form used for a Medicare beneficiary who
enrolls in the demonstration project on or after such date of
enactment.''.

SEC. 103. ORTHOTIST'S AND PROSTHETIST'S CLINICAL NOTES AS
PART OF THE PATIENT'S MEDICAL RECORD.

Section 1834(h) of the Social Security Act (42 U.S.C.
1395m(h)) is amended by adding at the end the following new
paragraph:
``(5) Documentation created by orthotists and
prosthetists.--For purposes of determining the reasonableness
and medical necessity of orthotics and prosthetics,
documentation created by an orthotist or prosthetist shall be
considered part of the individual's medical record to support
documentation created by eligible professionals described in
section 1848(k)(3)(B).''.

TITLE II--IMPROVEMENTS IN DIALYSIS SERVICES

SEC. 201. INDEPENDENT ACCREDITATION FOR DIALYSIS FACILITIES
AND ASSURANCE OF HIGH QUALITY SURVEYS.

(a) Accreditation and Surveys.--
(1) In general.--Section 1865 of the Social Security Act
(42 U.S.C. 1395bb) is amended--
(A) in subsection (a)--
(i) in paragraph (1), in the matter preceding subparagraph
(A), by striking ``or the conditions and requirements under
section 1881(b)''; and
(ii) in paragraph (4), by inserting ``(including a renal
dialysis facility)'' after ``facility''; and
(B) by adding at the end the following new subsection:
``(e) With respect to an accreditation body that has
received approval from the Secretary under subsection
(a)(3)(A) for accreditation of provider entities that are
required to meet the conditions and requirements under
section 1881(b), in addition to review and oversight
authorities otherwise applicable under this title, the
Secretary shall (as the Secretary determines appropriate)
conduct, with respect to such accreditation body and provider
entities, any or all of the following as frequently as is
otherwise required to be conducted under this title with
respect to other accreditation bodies or other provider
entities:
``(1) Validation surveys referred to in subsection (d).
``(2) Accreditation program reviews (as defined in section
488.8(c) of title 42 of the Code of Federal Regulations, or a
successor regulation).
``(3) Performance reviews (as defined in section 488.8(a)
of title 42 of the Code of Federal Regulations, or a
successor regulation).''.
(2) Timing for acceptance of requests from accreditation
organizations.--Not

[[Page H6235]]

later than 90 days after the date of enactment of this Act,
the Secretary of Health and Human Services shall begin
accepting requests from national accreditation bodies for a
finding described in section 1865(a)(3)(A) of the Social
Security Act (42 U.S.C. 1395bb(a)(3)(A)) for purposes of
accrediting provider entities that are required to meet the
conditions and requirements under section 1881(b) of such Act
(42 U.S.C. 1395rr(b)).
(b) Requirement for Timing of Surveys of New Dialysis
Facilities.--Section 1881(b)(1) of the Social Security Act
(42 U.S.C. 1395rr(b)(1)) is amended by adding at the end the
following new sentence: ``Beginning 180 days after the date
of the enactment of this sentence, an initial survey of a
provider of services or a renal dialysis facility to
determine if the conditions and requirements under this
paragraph are met shall be initiated not later than 90 days
after such date on which both the provider enrollment form
(without regard to whether such form is submitted prior to or
after such date of enactment) has been determined by the
Secretary to be complete and the provider's enrollment status
indicates approval is pending the results of such survey.''.

SEC. 202. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.

(a) Allowing Use of Telehealth for Monthly End Stage Renal
Disease-related Visits.--
(1) In general.--Paragraph (3) of section 1881(b) of the
Social Security Act (42 U.S.C. 1395rr(b)) is amended--
(A) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively;
(B) in clause (i), as redesignated by subparagraph (A), by
striking ``under this subparagraph'' and inserting ``under
this clause'';
(C) in clause (ii), as redesignated by subparagraph (A), by
inserting ``subject to subparagraph (B),'' before ``on a
comprehensive'';
(D) by striking ``With respect to'' and inserting ``(A)
With respect to''; and
(E) by adding at the end the following new subparagraph:
``(B)(i) Subject to clause (ii), an individual who is
determined to have end stage renal disease and who is
receiving home dialysis may choose to receive monthly end
stage renal disease-related visits, furnished on or after
January 1, 2019, via telehealth.
``(ii) Clause (i) shall apply to an individual only if the
individual receives a face-to-face visit, without the use of
telehealth--
``(I) in the case of the initial three months of home
dialysis of such individual, at least monthly; and
``(II) after such initial three months, at least once every
three consecutive months.''.
(2) Conforming amendment.--Paragraph (1) of such section is
amended by striking ``paragraph (3)(A)'' and inserting
``paragraph (3)(A)(i)''.
(b) Expanding Originating Sites for Telehealth to Include
Renal Dialysis Facilities and the Home for Purposes of
Monthly End Stage Renal Disease-related Visits.--
(1) In general.--Section 1834(m) of the Social Security Act
(42 U.S.C. 1395m(m)) is amended--
(A) in paragraph (4)(C)(ii), by adding at the end the
following new subclauses:

``(IX) A renal dialysis facility, but only for purposes of
section 1881(b)(3)(B).
``(X) The home of an individual, but only for purposes of
section 1881(b)(3)(B).''; and

(B) by adding at the end the following new paragraph:
``(5) Treatment of home dialysis monthly esrd-related
visit.--The geographic requirements described in paragraph
(4)(C)(i) shall not apply with respect to telehealth services
furnished on or after January 1, 2019, for purposes of
section 1881(b)(3)(B), at an originating site described in
subclause (VI), (IX), or (X) of paragraph (4)(C)(ii)),
subject to applicable State law requirements, including State
licensure requirements.''.
(2) No facility fee if originating site for home dialysis
therapy is the home.--Section 1834(m)(2)(B) of the Social
Security (42 U.S.C. 1395m(m)(2)(B)) is amended--
(A) by redesignating clauses (i) and (ii) as subclauses (I)
and (II), respectively, and by indenting each of such
subclauses 2 ems to the right;
(B) in subclause (II), as redesignated by subparagraph (A),
by striking ``clause (i) or this clause'' and inserting
``subclause (I) or this subclause'';
(C) by striking ``site.--With respect to'' and inserting
``site.--
``(i) In general.--Subject to clause (ii), with respect
to''; and
(D) by adding at the end the following new clause:
``(ii) No facility fee if originating site for home
dialysis therapy is the home.--No facility fee shall be paid
under this subparagraph to an originating site described in
subclause (X) of paragraph (4)(C)(ii).''.
(c) Clarification Regarding Telehealth Provided to
Beneficiaries.--Section 1128A(i)(6) of the Social Security
Act (42 U.S.C. 1320a-7a(i)(6)) is amended--
(1) in subparagraph (H), by striking ``; or'' and inserting
a semicolon;
(2) in subparagraph (I), by striking the period at the end
and inserting ``; or''; and
(3) by adding at the end the following new subparagraph:
``(J) the provision of telehealth technologies on or after
January 1, 2019, to individuals with end stage renal disease
under title XVIII by a health care provider for the purpose
of furnishing of telehealth.''.
(d) Study and Report on Further Expansion.--
(1) Study.--The Comptroller General of the United States
shall conduct a study to examine the feasibility, benefits,
and drawbacks of expanding the use of telehealth and store-
and-forward technologies under the Medicare program under
title XVIII of the Social Security Act for items and services
included in renal dialysis services, as such term is defined
in section 1881(b)(14)(B) of such Act (42 U.S.C.
1395rr(b)(14)(B)).
(2) Report.--Not later than two years after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report on the results of the study conducted
under paragraph (1).

TITLE III--IMPROVEMENTS IN APPLICATION OF STARK RULE

SEC. 301. MODERNIZING THE APPLICATION OF THE STARK RULE UNDER
MEDICARE.

(a) Clarification of the Writing Requirement and Signature
Requirement for Arrangements Pursuant to the Stark Rule.--
(1) Writing requirement.--Section 1877(h)(1) of the Social
Security Act (42 U.S.C. 1395nn(h)(1)) is amended by adding at
the end the following new subparagraph:
``(D) Written requirement clarified.--In the case of any
requirement pursuant to this section for a compensation
arrangement to be in writing, such requirement shall be
satisfied by such means as determined by the Secretary,
including by a collection of documents, including
contemporaneous documents evidencing the course of conduct
between the parties involved.''.
(2) Signature requirement.--Section 1877(h)(1) of the
Social Security Act (42 U.S.C. 1395nn(h)(1)), as amended by
paragraph (1), is further amended by adding at the end the
following new subparagraph:
``(E) Special rule for signature requirements.--In the case
of any requirement pursuant to this section for a
compensation arrangement to be in writing and signed by the
parties, such signature requirement shall be met if--
``(i) not later than 90 consecutive calendar days
immediately following the date on which the compensation
arrangement became noncompliant, the parties obtain the
required signatures; and
``(ii) the compensation arrangement otherwise complies with
all criteria of the applicable exception.''.
(b) Indefinite Holdover for Lease Arrangements and Personal
Services Arrangements Pursuant to the Stark Rule.--Section
1877(e) of the Social Security Act (42 U.S.C. 1395nn(e)) is
amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(C) Holdover lease arrangements.--In the case of a
holdover lease arrangement for the lease of office space or
equipment, which immediately follows a lease arrangement
described in subparagraph (A) for the use of such office
space or subparagraph (B) for the use of such equipment and
that expired after a term of at least one year, payments made
by the lessee to the lessor pursuant to such holdover lease
arrangement, if--
``(i) the lease arrangement met the conditions of
subparagraph (A) for the lease of office space or
subparagraph (B) for the use of equipment when the
arrangement expired;
``(ii) the holdover lease arrangement is on the same terms
and conditions as the immediately preceding arrangement; and
``(iii) the holdover arrangement continues to satisfy the
conditions of subparagraph (A) for the lease of office space
or subparagraph (B) for the use of equipment.''; and
(2) in paragraph (3), by adding at the end the following
new subparagraph:
``(C) Holdover personal service arrangement.--In the case
of a holdover personal service arrangement, which immediately
follows an arrangement described in subparagraph (A) that
expired after a term of at least one year, remuneration from
an entity pursuant to such holdover personal service
arrangement, if--
``(i) the personal service arrangement met the conditions
of subparagraph (A) when the arrangement expired;
``(ii) the holdover personal service arrangement is on the
same terms and conditions as the immediately preceding
arrangement; and
``(iii) the holdover arrangement continues to satisfy the
conditions of subparagraph (A).''.

SEC. 302. FUNDS FROM THE MEDICARE IMPROVEMENT FUND.

Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``during and after
fiscal year 2021, $270,000,000'' and inserting ``during and
after fiscal year 2021, $245,000,000''.

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

General Leave

Mr. BRADY of Texas. Madam Speaker, I ask unanimous consent that all
Members may have 5 legislative days within which to revise and extend
their remarks and include extraneous material on H.R. 3178, currently
under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?

[[Page H6236]]

There was no objection.
Mr. BRADY of Texas. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, improving and strengthening Medicare for the long term
is a major priority for the American people and Members of Congress on
both sides of the aisle; but as we pursue this larger goal, we should
not pass up opportunities to make smart, focused improvements that will
help Medicare beneficiaries today. That is exactly what the Medicare
Part B Improvement Act will do.
I introduced this bill with Ways and Means Ranking Member Richard
Neal, Health Subcommittee Chairman Pat Tiberi, and Ranking Member
Sander Levin. This legislation delivers targeted, immediate reforms to
make Medicare work better for the American people, and it includes
solutions from roughly one dozen Members of Congress on both sides of
the aisle.
The Medicare Part B Improvement Act takes action on three primary
goals: first, expanding access to high-quality care; second, improving
efficiency in the delivery of care so that patients can better receive
the care they need when they need it; and, third, easing administrative
burdens on healthcare providers so they can spend less time on
paperwork and more time with patients.
Importantly, H.R. 3178 extends and improves Medicare home infusion
services, which allow patients to receive personalized care in the
comfort of their own home.
This legislation also extends an ongoing Medicare pilot program, the
IVIG demonstration program, that allows patients with weakened immune
systems to receive care in their homes.
This demonstration program carries a lot of meaning for me. I
introduced it in 2012 as a direct response to the challenges facing
patients with immunodeficiency diseases.

{time} 1345

As I learned from Carol Ann Demaret, a constituent and friend of mine
whose son David suffered from severe combined immunodeficiency disease,
life with a severely weakened immune system can be an incredible
struggle. For children especially, it can be a daily fight just to
survive.
Allowing these vulnerable patients to receive treatment from the
safety of their own home cannot only improve the quality of care, it
can greatly enhance their quality of life. It can give a kid a real
chance to be a kid.
In addition to these important provisions, this bill contains
numerous solutions that will lower healthcare costs and increase access
to high-quality, coordinated care for beneficiaries.
More than that, the bill is an excellent example of what we can
accomplish through regular order. This legislation was approved
unanimously by the Ways and Means Committee on July 13. It demonstrates
how, working together, we can solve real challenges facing patients,
families, and healthcare providers in our communities.
I would like to thank all the Ways and Means members on both sides of
the aisle who helped craft the solutions in this bill. I would also
like to recognize Chairman Walden and Ranking Member Pallone of the
Energy and Commerce Committee for their leadership and hard work in
helping us move this bill forward.
The Medicare Part B Improvement Act takes targeted action to make
Medicare work better for the American people. I urge all of my
colleagues to join me in supporting its passage.
Madam Speaker, I reserve the balance of my time, and I ask unanimous
consent that the gentleman from Ohio (Mr. Tiberi), chairman of the
Health Subcommittee, be permitted to control the remainder of the time.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. NEAL. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I stand in support of H.R. 3178, the Medicare Part B
Improvement Act of 2017.
I am pleased that Chairman Brady, along with Health Subcommittee
Chairman Tiberi, Ranking Member Levin, and I worked in a bipartisan
manner to draft this legislation. It brings together a number of
important measures to improve Medicare part B. I encourage all of our
colleagues to support it.
As I said during the bipartisan Ways and Means Committee markup of
H.R. 3178, I hope the committee will be able to hold more meetings like
this. This is what the American people want and expect from their
Members: to get things done in a bipartisan manner.
The bill before us today is pretty straightforward. It makes
important changes to Medicare part B in a number of ways. It includes a
commonsense transitional policy for home infusion services, cosponsored
by Mr. Tiberi and Mr. Pascrell.
Our colleagues Mr. Bishop and Mr. Mike Thompson are cosponsors of
language to streamline Medicare rules to improve access to medically
necessary prosthetics and orthotics.
Mr. John Lewis cosponsored language to help dialysis facilities
improve backlogs so they can more efficiently treat end-stage renal
disease.
Ms. DelBene and Mr. Mike Thompson are cosponsors of a bill that
allows telehealth so patients can receive dialysis in the comfort of
their own home.
Finally, the measure includes clarification language to Stark laws
that Mr. Kind led to provide more certainty for Medicare providers.
Our colleagues on both sides of the aisle worked hard on these bills,
and I am pleased we can move them forward in a bipartisan manner.
Madam Speaker, I encourage my colleagues to support H.R. 3178, and I
reserve the balance of my time.
Mr. TIBERI. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I stand in this Chamber today in strong support of
H.R. 3178, a package of bipartisan policies centered on improving care
for Medicare beneficiaries across several areas.
In particular, H.R. 3178 includes a bill that I introduced with my
friend and colleague from New Jersey, Mr. Bill Pascrell, that provides
a temporary transitional payment for home infusion providers.
The 21st Century Cures Act created a new reimbursement benefit for
home infusion therapies beginning in 2021. This new temporary
transitional payment will bridge the potential gap in care for
beneficiaries, and home infusion providers will continue to administer
these therapies without going bankrupt.
This legislation includes other good public policies that further
encourage giving seniors the choice to receive more care in the comfort
of their own homes, as well as expanding access to providers,
particularly in rural and in needy areas.
I would like to thank my colleagues on the Ways and Means Committee
for their support. I would also like to thank my colleagues on the
Energy and Commerce Committee for their commitment to working on this
issue, especially Michael Burgess, as well as Chairman Emeritus Fred
Upton, who helped pave the way for these policies with the passage of
the 21st Century Cures Act.
Madam Speaker, I would like to conclude with a commitment that this
is not an end for policies encouraging care--especially drug infusion--
in the home for patients who choose to do so. We look forward to
working with the administration and clarifying current rules to ensure
we successfully implement both this legislation and future policies to
ensure inclusion of payment for all drugs needed by the home infusion
patient community.
Madam Speaker, I reserve the balance of my time.
Mr. NEAL. Madam Speaker, I yield 3 minutes to the gentleman from
California (Mr. Thompson).
Mr. THOMPSON of California. Madam Speaker, I thank the gentleman for
yielding.
Madam Speaker, I rise in strong support of this legislation, and I
want to thank all my colleagues who worked in a bipartisan manner to
make it happen.

Patients and providers in my district and across the country will
benefit from these important improvements, and I am proud to support
them.
Two provisions come from bipartisan bills that I have worked on for a
number of years. The first helps patients get the devices they need
while keeping fraudulent providers out of Medicare. The change we are
debating today

[[Page H6237]]

will ensure that any documentation created by device experts will be
included in a patient's medical record to support the physician's
directions.
The second provision that I authored comes from the comprehensive
telehealth packages that I have been working on with Representative
Black and our colleagues from the Energy and Commerce Committee, Mr.
Welch and Mr. Harper. This change will allow for virtual visits and
remote patient monitoring for kidney failure patients living at home.
Letting these patients utilize telehealth ensures that they can access
the services they need from the setting that they prefer: their homes.
This bill is another step forward in the expansion of telehealth, but
we can do a lot more. Our telehealth bills offer a menu of options for
moving forward. Policies like paying for telestroke services or adding
telehealth to the Medicare Advantage program have bipartisan support
among both Houses, as well as a broad coalition of support from
stakeholders.
We know they save money. I have worked on telehealth for decades.
When I was in the California State Senate, I wrote the State's first
telehealth legislation to bring critical services to folks enrolled in
the State Medicaid program. That was in 1996. Now it is 2017, and we
still haven't passed, in Congress, comprehensive telehealth legislation
that would expand access for Medicare beneficiaries.
It is long past time for Congress to come to the conclusion that
California reached long ago: telehealth saves money, and it saves
lives. I am optimistic that the passage of this bill is just a small
sample of what is to come in regard to telehealth in the future.
Mr. TIBERI. Madam Speaker, I yield 2 minutes to the gentleman from
Texas (Mr. Burgess), chairman of the Health Subcommittee of the Energy
and Commerce Committee and a leader on healthcare issues.
Mr. BURGESS. Madam Speaker, I thank the gentleman for yielding.
Madam Speaker, I rise in support of H.R. 3178, the Medicare Part B
Improvement Act of 2017.
This bill represents a series of bipartisan reforms from the
Committees on Energy and Commerce and Ways and Means that will provide
targeted reforms to improve access to care for Medicare beneficiaries.
Home infusion patients are oftentimes our Nation's sickest and most
vulnerable, and maintaining access to these services in home settings
has proved invaluable in ensuring that patients can continue to
effectively receive the care that they need.
Under last year's 21st Century Cures Act, we took the necessary steps
to ensure that taxpayers and beneficiaries were no longer overcharged
on the acquisition and dispensing costs associated with home infusion.
Additionally, we took complementary steps to recognize the unique
education needs associated with receiving infusion in the home.
However, as my subcommittee learned in a hearing on this issue just
last week, there is still more that must be done to integrate these two
policies without jeopardizing access to patient care. Therefore,
today's bill creates a bridge to connect these critical policies and to
resolve the issue.
Additionally, H.R. 3178 takes an additional needed step to protect
home health services by expanding opportunities for individuals to
receive home dialysis. Access to services like home infusion and home
dialysis has had a significant impact in my home State of Texas, and I
am encouraged by today's bill, as it will build upon these additional
successes for Texans and all Americans.
I would like to thank Chairman Brady, Chairman Tiberi, and Chairman
Walden for their leadership on the bill. They rose to the challenge to
address these tough policy decisions. This bill is a product of their
hard work, as well as the hard work of all the staff involved at the
subcommittee and full committee level, and I thank them as well.
Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from New
Jersey (Mr. Pascrell).
Mr. PASCRELL. Madam Speaker, I rise today in support of H.R. 3178,
the Medicare Part B Improvement Act.
I am pleased that the bill before us today includes legislation that
I introduced with my good friend Pat Tiberi from Ohio, the Medicare
Part B Home Infusion Services Temporary Transitional Payment Act.
Listening to Mr. Tiberi and Mr. Neal, I believe what they say should
resonate across the Hill. This can't be one and done. Bipartisanship is
something that should be contagious, particularly as we are talking
about a healthcare event which is important and may mean life or death
to many of our citizens.

Home infusion is an essential treatment option for individuals
suffering from many, many debilitating diseases like cancer, congestive
heart failure, multiple sclerosis, and rheumatoid arthritis. The 21st
Century Cures Act, which became law last year, correctly adjusted
payments for home infusion drugs and would establish a new home
infusion nursing benefit within Medicare beginning in 2021.
However, we have heard concerns that the payment adjustment going
into effect before the nursing benefit is implemented could jeopardize
access to home infusion in the interim. The bill that Congressman
Tiberi from Ohio and I introduced would address that concern by
creating a temporary nursing benefit until the new permanent benefit
can be implemented.
Madam Speaker, I urge my colleagues to support H.R. 3178.
Mr. TIBERI. Madam Speaker, I yield 2 minutes to the gentlewoman from
Kansas (Ms. Jenkins), a valuable member of our Health Subcommittee of
the Ways and Means Committee.
Ms. JENKINS of Kansas. Madam Speaker, I rise today in support of H.R.
3178, the Medicare Part B Improvement Act of 2017, which includes my
legislation, the Dialysis Certification Act.
Kansas currently ranks among the top three longest wait times for
dialysis center surveys. The lack of manpower at the State
administrative agency that contracts with CMS for these surveys has
left some clinics waiting 2 years for a certification. This bill gives
dialysis providers the opportunity to receive surveys and
certifications from a CMS-approved third-party accreditor, much like
hospitals are able to do now.

{time} 1400

Those third-party organizations must demonstrate their standards are
as good as or better than the standards used by CMS, and the Secretary
must approve them.
I toured several clinics in my district last year, and I was
frustrated to learn that a state-of-the-art clinic, necessary to fill a
need in Topeka for ESRD patients, has been waiting 2 years for an
initial survey, and a clinic in Pittsburg, Kansas, has been waiting for
250 days. Without these clinics, patients are forced to find clinics
much further away, which, depending on the access to transportation,
can be a barrier to treatment. That is unacceptable, and this problem
will be easily solved by this provision.
I want to thank my cosponsor, Congressman John Lewis, the Energy and
Commerce Committee and the Ways and Means Committee chairmen for
quickly moving this bill to the House floor for action. This provision
will allow dialysis clinics across America to more easily obtain a
survey so they may serve patients that depend on their care.
Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentlewoman from
Washington (Ms. DelBene), who is a coauthor of this legislation.
Ms. DelBENE. Madam Speaker, I would like to thank the chair and the
ranking member for working with me to include a proposal in this bill
that I developed with Congresswoman Black, Congressman Thompson, and
Congressman Meehan modernizing Medicare and harnessing the promise of
telehealth to improve care for patients nationwide.
Allowing patients with end-stage renal disease to receive dialysis at
home can dramatically improve their health outcomes and quality of
life. This is something I have heard consistently from providers in my
home State of Washington, like the Northwest Kidney Centers, who do
incredible work to help patients receive dialysis at home when it is
medically appropriate.
Advances in telehealth hold great potential to extend this treatment
option to more Americans, particularly in rural communities, but there
are still too many barriers to the use of cutting-edge technologies in
Medicare.

[[Page H6238]]

There is a great need to update our laws to reflect these innovations
and reimburse telehealth appropriately; otherwise, we won't just be
denying access to healthcare today, we could be preventing the next
frontier of innovations from even getting off the ground.
Without the long-term visibility of Medicare coverage, startups and
entrepreneurs might never get the funding they need to develop new
technologies and bring them to market. It is essential that we unlock
the full potential of telehealth. By doing so, we can improve patient
care, promote health, defeat heartbreaking diseases, and save lives.
That is why I am so glad we are taking this step today.
Thank you again to the committee for working with me on this
important bill, and I hope it is the first of many victories as we work
together to expand telehealth.
I urge my colleagues to vote ``yes.''
Mr. TIBERI. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Tennessee (Mrs. Black), a valuable member of the Health Subcommittee of
the Committee on Ways and Means and who, as you have already heard from
previous speakers, has an important provision in this bill and who,
more importantly, brings her valuable training as a nurse who practiced
before she came to Congress.
Mrs. BLACK. Mr. Speaker, I thank my colleague for yielding me time on
this very important issue.
I also want to thank my colleagues for working with me on this--Mr.
Meehan, Mr. Thompson, and Ms. DelBene--for working on a really
important piece of legislation that is included in this package, which
will improve the quality of life for seniors on Medicare across the
country.
As has previously been said, I am a nurse. I have worked in the field
for over 45 years, and I am proud to sponsor a bill that enhances
patient care for those patients who are suffering from end-stage renal
disease.
You know, we have made tremendous advances in technology over the
last decade, and now it would be almost something we couldn't have
thought of 45 years ago. Physicians can remotely monitor patients in
their dialysis treatments through telehealth to reduce the number of
medical visits that are necessary, to ensure that the treatment is
efficient and effective, and to also catch signs of complications
early, which would cause not only a decrease in quality of care for the
patient, but also a cost.
Telehealth provides patients an important component in the comfort of
their own homes--think about being sick and having to get in the car to
travel--while physicians now have a new tool to treat their patients'
whole health.
Our seniors deserve access to this innovative care, and it can save
money. It can help to ensure that Medicare can be there for seniors who
most need the care.
So I urge my colleagues to take a vote for your constituents and for
Medicare beneficiaries across the country and support this bill.
I also look forward to continuing this work. This is certainly not
the end of what we can do for our patients who are homebound and need
care in the home. I will continue this work with Members on both sides
of the aisle, which is being done now, for our Nation's seniors to have
access to these kinds of innovative telehealth technologies that will
improve care and also, more importantly, help to lower the cost of
treatment.
I urge passage of this amendment.
Mr. NEAL. Mr. Speaker, I yield 1 minute to the gentlewoman from
California (Ms. Matsui), whose husband served with great distinction as
a member of the Ways and Means Committee.
Ms. MATSUI. Mr. Speaker, I rise today in support of H.R. 3178, the
Medicare Part B Improvement Act, and, specifically, a provision to
extend the IVIG demonstration project that Chairman Brady and I worked
on together.
I have long been a champion of those impacted by primary
immunodeficiency diseases, which include more than 300 rare genetic
diseases, all of which keep the immune system from functioning
properly. A mild infection can cause serious problems and even death
for these patients.

Thanks to the IVIG demo, Medicare beneficiaries with immunodeficiency
diseases are now able to receive in-home IVIG therapy, meaning they can
avoid community settings of care, which can be very important to people
with compromised immune systems.
I am pleased that this provision was included in the Medicare Part B
Improvement Act. I urge support of this important bill.
Mr. TIBERI. Mr. Speaker, I reserve the balance of my time.
Mr. NEAL. Mr. Speaker, I yield 4 minutes to the gentleman from Texas
(Mr. Doggett).
Mr. DOGGETT. Mr. Speaker, as so often happens here, this bill bears a
somewhat grander title than its contents. Medicare part B certainly
does need improvement. While I support putting into statute what is
already administrative practice, extending a demonstration project that
appears to be working and the other provisions that my colleagues have
worked on in this bill, I think much more should have happened.
It is especially ironic that, at the very moment we are considering
this bill, the United States Senate across the hall is proposing to
eliminate healthcare coverage for millions of Americans. Certainly,
this Republican repeal effort does far more harm to far more people
than we can collectively undo here in the House with this rather modest
piece of legislation.
And there is one glaring omission from today's Medicare Improvement
Act, one subject that the Republican leadership of the House Ways and
Means Committee fears. It fears not only doing something about this
problem, it fears about even understanding the extent of the problem,
and it certainly fears having any public hearings to explore this
subject. That is the menace that is affecting millions of people across
this country: pharmaceutical price gouging.
This bill fails to address any aspect of soaring pharmaceutical costs
of part B medications. For almost a year, a number of us, House
Democrats on the Ways and Means Committee, have called on the chairman
to at least schedule a hearing about all aspects, all categories of
soaring pharmaceutical prices that not only mean financial ruin for too
many families, but also burden Medicare and most any type of taxpayer-
financed healthcare initiative.
Government-approved monopolies for drug manufacturers are being
exploited by charging the sick and dying whatever they might pay for a
little more life, for a little more comfort at monopoly prices.
Under longstanding existing law--it has been there before this
Congress ever got together--pharmaceutical companies are at least
required to provide average sales price data on part B Medicare drugs.
Three years ago, the Office of the Inspector General at the Department
of Health and Human Services found that at least one-third of the more
than 200 manufacturers of part B drugs had not submitted any of this
average sales price data for some of their products, and an additional
45 manufacturers had not been required to report any data. The
Inspector General found that inaccuracies in these average sales price
filings may affect taxpayer-financed Medicare payments.
Last month, the nonpartisan Medicare Payment Advisory Commission came
before the House Ways and Means Committee and gave its report on
Medicare. It noted that this problem on average sales price data
continues, and that it has not been addressed by Congress, as the
Inspector General had recommended.
The Republican majority has refused to do anything about this
problem. It has blocked an amendment that I offered in committee that
simply implemented the recommendation of the Inspector General and of
MedPAC to get that average sales price data and to ensure that all part
B manufacturers report that data or are penalized at a reasonable
level. It would simply have ensured compliance with existing law to
protect program integrity and to protect the taxpayer interest. And you
can be sure that if the Republicans didn't want to know what the prices
were, they certainly didn't want to do anything about the soaring
prices and the impact on American families.
So I support the bill, but this is a missed opportunity that we
should have employed to address a critical problem.

[[Page H6239]]

Mr. TIBERI. Mr. Speaker, I yield myself as much time as I may
consume.
As the previous speaker said, he supports the bill, which I am
pleased to hear that, but as the chairman has said, as the ranking
member has said, this is just the beginning. This is just the
beginning, and we can't let the perfect be the enemy of the good in
this piece of legislation because there is very important bipartisan
legislation that is meaningful to people in a home today somewhere in
Ohio or Massachusetts where home infusion is really important or
dialysis is really important.
I am pleased that the ranking member from Massachusetts has been so
helpful on this bill, and I reserve the balance of my time.
Mr. NEAL. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I want to thank the staff for their hard work on this
bill, including Amy Hall, Sarah Levin, Melanie Egorin from the
Democratic staff; Emily Murry and Nick Uehlecke from the Republican
staff; Jessica Shapiro from the House Legislative Counsel's office; Ira
Burney, Jennifer Druckman, and Lisa Yen from CMS; and the staff of the
Congressional Budget Office, Tom Bradley, Rebecca Yip, and Lara
Robillard. I want to thank them all for their very, very hard work.
We have this rare opportunity, this rare moment where we have broad
agreement on this legislation, and I hope all Members of the House can
find their way to be supportive of this legislation, and I hope the
path of bipartisanship that we have chosen here can serve as a reminder
of what we can get done.
Mr. Speaker, I yield back the balance of my time.
Mr. TIBERI. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I just say ``ditto'' to the gentleman from Massachusetts
(Mr. Neal), whom I have a great relationship with, for all the words
about the staff. In particular, I also want to thank Abby Finn from my
staff, and Emily Murray and her team; but it has been a pleasure
working with the gentleman from Massachusetts' team as well, and Mr.
Levin, the ranking member of the Health Subcommittee.
Mr. Speaker, this is a good step in the right direction and the first
step in expanding access to high-quality care and improving efficiency
and delivery of care so seniors can better receive the care they need
where they need it, which is so incredibly important. I really
appreciate the comments of the ranking member.
And again, I want to remind everybody what the chairman said, that
this is just the beginning, and hopefully this will be a template to
much more bipartisan support for the remainder of this year.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Simpson). The question is on the motion
offered by the gentleman from Texas (Mr. Brady) that the House suspend
the rules and pass the bill, H.R. 3178, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.

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