IHA Daily Briefing: June 13

Wednesday, June 13, 2018

IHA Advocacy Alert: REMC Act of 2018
New 340B Legislation (the "SERV" Act) Introduced
Congress Focuses on Opioid Crisis
CMS Issues Opioids Roadmap
CDC Alert: Outbreak of Hepatitis A Virus Infections

IHA Advocacy Alert: REMC Act of 2018
U.S. Representatives Lynn Jenkins (R-KS), Ron Kind (D-WI), and Terri Sewell (D-AL) have introduced bipartisan legislation, supported by IHA, that would establish a new rural facility designation under the Medicare program – Rural Emergency Medical Center (REMC).

The Rural Emergency Medical Center Act of 2018 (H.R. 5678) would allow critical access hospitals (CAHs) and prospective payment system hospitals with 50 inpatient beds or fewer to convert to 24/7 emergency department care and outpatient services in rural areas and receive enhanced reimbursement rates.

While it's unlikely that Congress will move H.R. 5678 in the current session before the mid-term elections, it's important to lay the groundwork with the Illinois Congressional Delegation for potential action in 2019.

IHA members are asked to contact your member of Congress and request their support of H.R. 5678. To send an email message to your U.S. Representative, click here.

Specifically, the bill would require that a hospital stop providing inpatient services should it choose this new designation, and would be required to transport patients to an inpatient hospital if needed.  An REMC would be classified as a hospital for the purposes of the 340B Drug Pricing Program and be an "originating site" for Medicare-covered telehealth services. Additionally, an REMC could provide post-acute care in a separately licensed skilled nursing facility unit.

New 340B Legislation (the "SERV" Act) Introduced
Yesterday, U.S. Representative Doris Matsui, (D-CA) introduced the Stretching Entity Resources for Vulnerable (SERV) Communities Act, which includes several provisions addressing the 340B Drug Pricing Program, such as:

  • Reversing the 28 percent payment cut (approximately) to 340B eligible hospitals that was implemented on Jan. 1, 2018 by the Centers for Medicare & Medicaid Services;
  • Enhancing the integrity of the 340B program; and
  • Clarifying language that allows hospitals to use savings under the 340B program to expand community services.

A one-page summary of the legislation is available by clicking here.

Congress Focuses on Opioid Crisis
The U.S. House Tuesday began its two-week vote-a-thon on dozens of bills aimed at addressing the opioid crisis. Most of the 39 bills scheduled for votes this week and dozens more next week are modest and bipartisan.

They include measures creating grants to help hospitals open opioid treatment centers with a wide range of services; awarding grants to hospitals and emergency departments to develop, implement, enhance or study alternative pain management protocols and treatments that limit the use and prescription of opioids in EDs; allowing the government to repay up to $250,000 in student loans for those who work as a substance use order treatment professional in areas with severe problems; establishing a database of the nation’s efforts to combat the opioid epidemic; and requiring the Dept. of Health and Human Services to develop and disseminate best practices on the prominent display of substance use disorder history in health records of patients who previously provided this information to a healthcare provider.

Meanwhile, the U.S. Senate Finance Committee on Tuesday unanimously passed its Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018. The bill aims to ensure Medicare and Medicaid beneficiaries receive better education, prevention and treatment about pain and addiction; let Medicare beneficiaries know about non-opioid treatments for pain; and expand and clarify how Medicaid can treat those with an addiction.

CMS Issues Opioids Roadmap
On Monday, the Centers for Medicare & Medicaid Services (CMS) published its Opioids Roadmap. The roadmap visually outlines CMS’ existing three-pronged approach to combat the opioid epidemic by:

  • Preventing new opioid use disorder cases;
  • Treating patients dependent or addicted to opioids; and
  • Utilizing nationwide data to target prevention and treatment activities.

In a blog post, CMS said that six out of every 1,000 Medicare beneficiaries suffer from opioid use disorder. The department reiterated that it is working to ensure that beneficiaries are not inadvertently put at risk of misuse by:

  • Monitoring prescription opioid trends;
  • Strengthening controls at the time of opioid prescriptions; and
  • Encouraging healthcare providers to promote a range of safe and effective pain treatments, including alternatives to opioids.

Meanwhile, the Substance Abuse and Mental Health Services Administration published an update to its Opioid Overdose Prevention Toolkit. It provides information and links to resources to prevent opioid-related overdoses and deaths for community members, first responders, prescribers, patients, and families.

CDC Alert: Outbreak of Hepatitis A Virus Infections
The Centers for Disease Control and Prevention (CDC) recently released a Health Alert Network advisory on its investigation of hepatitis A outbreaks among those reporting drug use and/or homelessness and their contacts. From January 2017 through April 2018, the CDC received more than 2,500 reports of hepatitis A infections associated with person-to-person transmission from multiple states. Of the more than 1,900 reports for which risk factors are known, more than 1,300 (68 percent) of those infected reported drug use (injection and non-injection), homelessness or both.

The advisory provides guidance to assist in identifying and preventing new infections for public health departments, healthcare facilities and programs providing services to affected populations. Among other actions, the CDC recommends that healthcare providers:

  • Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms;
  • Encourage those who have been exposed recently to hepatitis A virus and who have not been vaccinated to be administered one dose of single-antigen hepatitis A vaccine or immune globulin as soon as possible, within two weeks after exposure;
  • Consider saving serum samples for additional testing to assist public health officials in the investigation of transmission;
  • Ensure all those diagnosed with hepatitis A are reported to the health department in a timely manner;
  • Encourage hepatitis A vaccination for homeless individuals in areas where hepatitis A outbreaks are occurring; and
  • Encourage hepatitis A vaccination for those who report drug use or other risk factors for hepatitis A.