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5 surprises in the 21st Century Cures Act

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Members of the U.S. House today passed the 21st Century Cures Act health legislation package by a voice vote.

They later decided to take a recorded vote, and the package then passed 392 to 26, with just 20 Republicans and six Democrats opposing package.

Members of the Senate could vote on the package as early as next week.

The most visible section of the package would provide $4.8 billion in research funding for medical research backed by the National Institutes of Health, including Alzheimer’s research, and $500 million in funding to help the Food and Drug Administration speed up the process for approving new drugs and medical devices.

Related: 5 ways scientists could supercharge long-term care insurance

Other high-profile provisions could provide $1 billion in grants for state efforts to fight opioid abuse.

Drafters have used the popular research funding provisions and the opioid-abuse-fighting provisions as the locomotives for a train that could pull many other pieces of legislation through Congress and onto President Obama’s desk.

One difficult question to answer is what provisions will really be in the version that gets to the president’s desk, and what provisions are still in the package now.

The House Rules Committee unveiled a 996-page PDF version of the package Friday. The cures act package is not actually a bill: For procedural reasons, it’s an amendment to a Senate amendment of H.R. 34, the Tsunami Warning, Education and Research Act of 2015 bill.

The committee also posted a section-by-section summary of the cures act package. The nature of the package, and of the deliberation process on the House floor today, makes determining exactly what is in the current version difficult.

Here’s a look at five of the less-publicized provisions in the version posted Friday that might be of interest to agents and brokers interested in commercial health insurance, employee benefits or Medicare products:

Workers who could get HRA cash to buy their own coverage

The cures bill package could free employers to use health reimbursement arrangements to give workers cash the workers could use to buy their own individual health coverage. (Photo: Thinkstock)

1. Employer cash-for-coverage plans

Section 18001 could create a provision many small employers and benefits brokers have been seeking for years: A rule that would give small employers a legal, practical vehicle they could use to provide cash that workers could use to buy their own individual health coverage.

Obama administration agencies discouraged employer use of cash-for-coverage programs by ruling that those programs would amount to stand-alone health reimbursement arrangement programs, without major medical coverage attached.

A stand-alone health reimbursement arrangement program must meet all of the same coverage rules, such as paying for basic preventive services without imposing deductibles or co-payments on the patients, that a major medical plan has to meet, according to Obama administration interpretations of federal benefits laws.

Some insurers have supported that interpretation, because they believe cash-for-coverage programs could hurt the stability of the fully insured small-group health insurance market.

Related: GOP: Let small employers pay for individual health coverage

The Nashville, Tennessee-based National Federation of Independent Business found when it conducted a survey that many small employers are giving workers cash for individual coverage, anyway, without understanding that they’re violating the Obama administration interpretations.

The cures act package health reimbursement arrangement provision would let a small employer provide up to $4,950 in cash per year for individual workers who showed they had individual coverage, and up to $10,000 per year for workers who showed they had family coverage. The contribution cap would be indexed for inflation.

The cures bill package could affect Medicare provider reimbursement rates, but it could also affect enrollment reporting and welcome packets.

The cures bill package could affect Medicare provider reimbursement rates, but it could also affect enrollment reporting and welcome packets. (Photo: Centers for Medicare and Medicaid Services)

2. Medicare enrollment data

Section 17002 of the cures act package could require the U.S. Department of Health and Human Services to publish Medicare enrollment data by congressional district, ZIP code and state on an annual basis.

The department would have to publish Medicare Advantage plan, Medicare prescription drug plan and Medicare fee-for-service enrollment data.

3. Medicare welcome packages

Section 17003 of the package could require Medicare program managers to include information about the options for receiving benefits through the traditional Medicare program, the Medicare Advantage program and the Medicare Part D prescription drug program in the official Medicare eligibility notification packet.

The section would require program managers to reach out to stakeholders for their recommendations. The consultation provision could give insurers and agents a chance to weigh in.

Related: House uses Medicare changes to pay for special needs account bill

Sections in the cures bill package could lead to big mental health and substance abuse benefits changes. (Image: Thinkstock)

Sections in the cures bill package could lead to big mental health and substance abuse benefits changes. (Photo: Thinkstock)

4. Health record confidentiality

Major sections of the cures act package relate to improving mental health care and mental health care financing.

One section, Section 11002, deals with concerns over whether federal health information privacy rules are interfering with mental health care.

The section would require the Health and Human Services secretary to get the opinions of stakeholders on whether the government should change or clarify health privacy rules.

The section directs the HHS secretary to work with the U.S. Department of Health and Human Services’s Office for Civil Rights to provide clarification about situations in which providers can disclose information without patient consent “when the opportunity to object cannot practicably be provided because of the incapacity of the patient or an emergency treatment circumstance.”

5.  Insurer and plan parity compliance

Many providers and lawmakers have complained that federal enforcement of the existing federal Mental Health Parity and Addiction Equity Act benefits requirements is weak.

Section 13001 of the cures act package would require HHS to give plans more advice about how to comply with the parity requirements, including examples of plans that do and don’t comply with the standards.

The package would also let federal agencies audit plans that have been found to violate the parity standards at least five times.

In the past, some patient and provider advocates have argued that having federal agencies release detailed examples of compliant plans could encourage plan managers to game the system and develop plans that meet federal standards but do not provide real coverage parity for mental health care and other types of health care. 


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