To establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the copayments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures.
Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015
(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act (SSAct) with respect to criteria for qualifying as a meaningful user of electronic health records (meaningful EHR user). For any payment year after 2015 any patient encounter of an eligible professional occurring at an eligible ambulatory surgical center shall not be treated as one in determining whether an eligible professional qualifies as a meaningful EHR user.
(Sec. 3) HHS shall establish a three-year demonstration program to test the use of value-based insurance design methodologies under the eligible Medicare Advantage (MA) plans offered by MA organizations under Medicare part C.
"Value-based insurance design methodology" is one for identifying specific prescription medications, and clinical services payable under Medicare, for which copayments, coinsurance, or both would improve the management of specific chronic clinical conditions because of the high value and effectiveness of such medications and services for such specific chronic clinical conditions, as approved by HHS.
HHS may expand the duration and scope of the demonstration program to an appropriate extent if specified requirements are met.
(Sec. 4) Payment amounts are prescribed for infusion drugs and biologicals furnished through durable medical equipment (DME) on or after January 1, 2017.
(Sec. 5) It is the sense of Congress that HHS:
(Sec. 6) $220 million shall be available to the Medicare Improvement Fund during and after FY2020.
(Sec. 7) DME competitive acquisition programs shall not cover infusion drugs and biologicals.
Placed on the Union Calendar, Calendar No. 117.
Read twice and referred to the Committee on Finance.
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Mr. Brady (TX) moved to suspend the rules and pass the bill, as amended.
Considered under suspension of the rules. (consideration: CR H4479-4481)
DEBATE - The House proceeded with forty minutes of debate on H.R. 2570.
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Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H4479-4480)
On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H4479-4480)
Motion to reconsider laid on the table Agreed to without objection.
The title of the measure was amended. Agreed to without objection.
Received in the Senate and Read twice and referred to the Committee on Finance.