ENA Government Relations
Supportive Changes Urged in Helping Families in Mental Health Crisis Act
The House Energy Commerce Committee’s Subcommittee on Health held a hearing on June 16 on major legislation to reform our nation’s mental health system. The bill under consideration, the Helping Families in Mental Health Crisis Act, was introduced byReps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX) and is supported by ENA and many other national health care organizations.
“The legislation identifies and works to achieve several key objective goals,” testified Dr. Jeffrey Lieberman, chairman of the Department of Psychiatry at Columbia University Collegeof Physicians and Surgeons in New York. “First, it streamlines the federalagencies working on mental health issues to ensure better coordination among the numerous agencies thatcurrently play a role in mental health care. It promotes the provision of evidence-based, science-driven treatment.It supports the research we need to develop treatments that build upon the incredible progress andadvancements we’ve made in the field in the last several decades. It increases access to much needed integratedand innovative services.”
The legislation, which was one of ENA’s Day on the Hill priorities, currently has 60 bipartisan cosponsors in the House of Representatives. A companion bill has not yet been introduced in the Senate.
Bills Introduced in House and Senate to Battle Opioid and Heroin Abuse
ENA has endorsed companion bills introduced in the House by Rep. Susan Brooks (R-IN) and Senate by Sen. Kelly Ayotte (R-NH) that take a multifaceted approach to address the prescription opioid abuse and heroin crises.
The bills (H.R. 2805/S. 1134), both of which are titled “Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015,” would give first responders greater access to life-saving toolsby establishing a grant program to provide first responders with opioid overdose reversal drugs, such as naloxone, and enhanced training in the administration of these drugs. In addition, the bills call for a coordinated drug awareness campaign with a particular focus on the links between prescription opioid abuse and heroin addiction.
U.S. Supreme Court Upholds Affordable Care Act Subsidies
On June 25, the U.S. Supreme Court ruled that individuals enrolled in the federally-run healthcare insurance marketplace, healthcare.gov, were eligible for the same subsidies available to enrollees in state-run marketplaces.
The ruling in the King v. Burwell case was a significant victory for Affordable Care Act supporters. With only 16 states running their own marketplace, the Henry J. Kaiser Family Foundation estimated that 6.4 million Americans could have lost their subsidies and faced an average 287% increase in insurance premiums if the court overturned this provision of the law. Had that occurred, it is likely that that millions would have lost their health insurance and the viability of the entire health care exchange would have been in jeopardy. That would have resulted in greater strain on emergency departments as more uninsured patients used EDs for nonemergency care.
The ruling focused on a phrase in the bill that stated that only “an Exchange established by
the State” was eligible for subsidies. On a 5-4 ruling, the court decided that the wording was vague and the intent of the overall law was to cover everyone in a government-run marketplace, not just those run by the states.
CMS Proposes Changes to Two-MidnightRule
The Centers for Medicare and Medicaid Services (CMS) recently proposed significant changes in its “two-midnight” rule. Under this rule, which went into effect in 2013, hospital patient stays that span less than two midnights are considered outpatient and billed under Medicare Part B, while stays that last more than two midnights are classified as inpatient care and billed under Medicare Part A. Inpatient status is generally preferable for patients, both because they generally incur lower out-of-pocket costs and because another CMS rule requires a patient to be admitted for three days to have access to a skilled nursing facility following a hospital visit.The current rule has been criticized by hospital groups and many health care professionals for not providing enough flexibility when determining the status of a patient.
The change proposed by CMS as part of the 2016 Hospital Outpatient Prospective Payment System rule would allow health care providers more flexibility to decide whether Medicare beneficiaries should be classified as inpatient or outpatient. For instance, the proposal would give more discretion to hospitals to admit patients undergoing certain procedures without expecting the patient to stay two nights or more.
Oregon Strengthens Nurse Staffing Law
On July 7, Oregon Governor Kate Brown signed legislation into law that gives teeth to hospital nurse staffing committees. This new legislation gives the recommendations of these nurse staffing committees the force of law, and requires that all hospitals be audited every three years for compliance. In addition, each hospital’s nurse staffing committee must be comprised of half front-line nurse caregivers and half administrators. That committee must then develop a written hospital-wide staffing plan and implement it by 2017.
Approximately 10 years ago Oregon enacted legislation creating nurse staffing committees in order to help guide hospitals when determining the proper nurse staffing levels. Unfortunately most hospitals in the state were disregarding these recommendations, which was the impetus for this new legislation.