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PASSED: Committee Approves Health Care Legislation to Protect Seniors’ Access to Nursing Homes, Lower Drug Costs for Seniors, and Expand Drug Access for Kidney Patients

March 06, 2024

WASHINGTON, D.C. – More Americans are closer to being able to keep and use their health care in their local community, thanks to three bipartisan bills approved by the Ways and Means Committee on Wednesday. The Committee took action to stop the Biden Administration from imposing new red tape on nursing homes and stepped in to ensure access to prescription medications. 

The Committee passed legislation blocking the implementation and enforcement of a Biden Administration proposed nursing home staffing mandate that could result in nursing home closures and waiting lists for care, denying nearly 300,000 nursing home residents the care they need, especially in rural and underserved communities. The remaining two bills help Medicare Part D beneficiaries pay less for their drugs and gives these patients more control over how and where they receive life-saving medication. 

Ways and Means Committee Chairman Jason Smith (MO-08) noted in his opening statement that Americans are on the verge of losing access to certain health care services in their communities, particularly rural seniors who could be forced to find nursing home care far from friends and family as a result of closures, if the Biden Administration’s proposed nursing home staffing mandate were finalized: 

“This rule won’t result in better care for seniors – quite the opposite. If this rule takes effect, nursing homes around the country will be forced to downsize or close their doors for good. In just the last four years, over 400 nursing homes have shut down. How can we not expect more to follow, when the Administration is about to place a giant $40 billion unfunded mandate on nursing homes and seniors?

“Small nursing homes, especially those in rural and underserved areas where labor is hard to come by, will be hit hard by this proposed rule…Without access to more staff, nursing homes, particularly those in rural areas, will have no choice but to reduce the number of residents they admit or shut down all together. In total, 280,000 seniors could lose a spot in their local nursing home.

“Americans work their entire lives to ensure they will be able to receive the care they need in their old age or when they fall ill. I urge my colleagues to support these bills to protect Americans’ access to their health care benefits and options in the communities where they live.”

The Committee also approved its Views and Estimates for the FY 2025 budget. 

Protecting America’s Seniors’ Access to Care Act

Introduced by Rep. Michelle Fischbach (MN-07), H.R. 7513 blocks the Biden Administration from implementing and enforcing its proposed nursing home staffing mandate.

“I am so glad to see this bill moving forward to keep CMS from implementing this misguided nursing staff ratio rule that could hurt nursing home facilities all across Minnesota’s Seventh District,” said Rep. Fischbach (MN-07). “This administration has been insistent on moving forward with this rule, despite the fact that the industry is struggling to hire and that a report commissioned by CMS itself found that there is no single staffing level that guarantees quality care. They also know a mandated ratio could force facilities to turn away patients or even close their doors altogether. If they are not going to stop the implementation of this rule on their own, House Republicans will hold them accountable.” 

Kidney PATIENT Act

Introduced by Reps. Buddy Carter (GA-01), Carol Miller (WV-01), Terri Sewell (AL-07), and Ann Kuster (NH-02), H.R. 5074 would allow end-stage renal disease (ESRD) patients to access oral-only drugs using Medicare Part D.

  • 2024 is the last year ESRD patients will be able to access oral-only drugs, including phosphate binders, using traditional Medicare Part D drug coverage, allowing patients to access these drugs at their local trusted pharmacy. 
  • Starting in 2025, these drugs will move from Medicare Part D coverage to the ESRD payment “bundle” in 2025.
  • Dialysis providers may not invest in and provide these drugs to patients during dialysis sessions. Additionally, when a new drug enters the ESRD bundle, a bonus payment is given to dialysis providers which, in turn, increases patient costs. 
  • The bill extends patient’s ability to access oral-only drugs through Medicare Part D for the next two years. Keeping these drugs in Medicare Part D will grant patients key out-of-pocket caps and other cost sharing protections.
  • This policy would also require the Department of Health and Human Services to report on the effects of providing these drugs through Medicare Part D.

“I was thrilled to see the Kidney PATIENT Act pass out of the Ways and Means Committee today and be one step closer to becoming law. This bill will provide patients with access to oral-only kidney disease therapies through their Medicare Part D benefit until 2027. The bipartisan support from the Ways and Means Committee of the Kidney PATIENT Act shows how important it is to take care of ESRD patients across the country. I look forward to the bill continuing to move forward in the House of Representatives,” said Congresswoman Miller.

Real Time Benefit Tool Implementation Act

Introduced by Rep. Jodey Arrington (TX-19), H.R. 5712 lowers drug costs for seniors by requiring the Centers for Medicaid and Medicare Services (CMS) to roll out a digital tool allowing doctors to price shop for medicine before prescribing medicine to their patients.

  • As part of the Consolidated Appropriations Act of 2021, Congress codified a requirement for Medicare Part D prescription drug plans (PDPs) to support prescriber real-time benefit tools. 
  • Although Congress required this tool be available to prescribers, CMS has yet to issue rulemaking to fully implement this important policy.
  • The bill requires CMS to implement the prescriber real-time benefit tool by January 1, 2027.
  • Doctors will be able to determine which drug will cost the patient less under their specific insurance coverage before prescribing. 

Representative Arrington said, “For far too long, American seniors have been saddled with a convoluted and confusing process for getting the medication they need at a price they can afford. Real-time benefit tools allow Medicare beneficiaries to reduce their out-of-pocket costs and avoid surprises at the pharmacy. Seniors and taxpayers alike stand to benefit from the transparency and competition spurred by real-time benefit tools. Yet, CMS has delayed implementation of my bipartisan legislation for over three years. Enough is enough – today’s legislation sends a clear message to CMS that Congress, seniors, and the American people demand it delivers on real-time benefit tools