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CBO Estimates Health Innovations Bill Cost to be $106 Billion

Monday, June 29, 2015  
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The Arizona Association for Home Care is a member of the National Association for Home Care and has republished this article with permission.


Originally published by NAHC on June 24, 2015


The Congressional Budget Office (CBO) this week released an estimate that the 21st Century Cures Legislation, which aims to spur medical innovations, would cost $106.4 billion over five years. The number was much higher than expected due to the fact that CBO included in its estimate the budget for the National Institutes of Health (NIH) through 2019.


Previously Congressional aides had estimated the cost of the legislation to be roughly $12 billion, but the new CBO score has caused Congress to take a fresh look at the cost of the legislation.


As previously reported, the House Energy and Commerce Committee last month released the legislation and unanimously passed it out of the Committee. The bill already faced challenges due to concerns about provisions being used to offset the cost of the legislation, particularly a provision that would delay payment to private Medicare Part D plans. CBO estimated that specific provision would offset $5 billion of

the legislation’s cost, while the total offsets amounted to $12 billion.


Of interest to home care and hospice, the legislation contains language requiring the Centers for Medicare & Medicaid Services (CMS) to conduct research supporting innovations with regards to electronic health records, interoperability, and telehealth. The bill instructs CMS to report to committees of jurisdiction in Congress on means of expanding telehealth as well as barrier to its expansion in Medicare. However, it does not require CMS to make any changes to current telehealth services. The bill also includes a section on ensuring the interoperability of health information


The bill provides $10 billion over five years for an NIH Innovation Fund, as well as $1.5 billion in additional funding under the normal appropriation for NIH. This additional funding is intended to boost the nation’s research efforts. It also directs NIH to establish a research network devoted to pediatric diseases and birth defects.


In addition to research provisions, the legislation includes proposals to improve the development and coordination of private and public efforts towards new treatments and cures, including antibiotic drugs and vaccines. With the inclusion of new drug development requirement, some lawmakers argued the legislation should provide additional resources to the Food and Drug Administration in order to carry out the requirements.


In its 2015 Legislative Blueprint for Action, NAHC provides several recommendations for Congress to ensure the appropriate use of technology in home care. The recommendations include: 1) establish telehomecare services as distinct benefits within the scope of Medicare and federal Medicaid coverage guided by the concepts embodied in the FITT Act, including all present forms of telehealth services; 2) allow for sufficient flexibility to include emerging technologies; 3) clarify that telehomecare qualifies as a covered service under the Medicare home health services and hospice benefits and provide appropriate reimbursement for technology costs; 4) eliminate the list of authorized originating sites for telehealth services by physicians so that the home residence would be a covered telehealth site; 5) ensure that all health care providers, including HHAs and hospices, have access to appropriate bandwidth so that they can take full advantage of advances in technology appropriate for care of homebound patients; and 5) include telehealth equipment and service delivery as allowable costs in home health and hospice. In addition, Congress should work with the Administration to provide financial incentives to HHAs to encourage the adoption and use of electronic health records by home care and hospice providers.


NAHC Report will continue to provide updates regarding the status of this legislation.

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