Pharmacist Provider Status Legislation: Projections
Pharmacist Provider Status Legislation: Projections
Objective To compare legislation at the federal level that would recognize pharmacists as health care providers under Medicare Part B with similar state-level efforts in an attempt to identify the strengths and weaknesses of these options and forecast outcomes.
Summary The current primary care provider shortage poses a significant threat to public health in the United States. The effort to achieve federal provider status for pharmacists, currently in the form of identical bills introduced in January 2015 into the U.S. House of Representatives and the U.S. Senate as the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314), would amend the Social Security Act to recognize pharmacists as health care providers in sections of Medicare Part B that specify coverage and reimbursement. This action has budgetary implications owing to the compensation that would accrue to pharmacists caring for Medicare beneficiaries. Passage of these bills into law could improve public health by sustainably increasing access to pharmacists' patient care services in medically underserved areas. In this article, the legislation's strengths and weaknesses are analyzed. The resulting information may be used to forecast the bills' fate as well as plan strategies to help support their success. Comparison of the bills with existing, state-level efforts is used as a framework for such policy analysis.
Conclusion While the current political climate benefits the bills in the U.S. Congress, established legislative precedents suggest that parts of H.R. 592/S. 314, specifically those regarding compensation mechanisms, may require negotiated amendment to improve their chances of success.
In January 2015, Members of Congress introduced the "Pharmacy and Medically Underserved Areas Enhancement Act" into both the U.S. House of Representatives and the U.S. Senate. H.R. 592, was referred to the House Committees on Energy & Commerce and Ways & Means. S. 314 was sent to the Senate Finance Committee. The language in these bills is identical to that introduced into the House of Representatives during the last Congress as H.R. 4190.
The bills seeks to amend title XVIII of the Social Security Act, requiring Medicare to cover pharmacists' services, as allowed by state law, that would be otherwise covered if provided by a physician or to a medically underserved population. The language also specifies reimbursement parameters: "The amounts paid shall be equal to 80 percent of the lesser of the actual charge or 85 percent of the fee schedule … if such services had been furnished by a physician." Such changes would have a profound and important impact on pharmacy practice, primary care access, and public health. However, this session of Congress has just begun, and the fate of the legislation at this time is unclear.
Can analysis forecast whether the bills will pass? Health policy analysis literature highlights the importance of identifying and evaluating multiple alternatives as guidance toward selecting a proposal with high chances of success. Analysts must weigh and balance high-yield and high-risk policy components. For the purposes of this analysis, high-yield components are those most beneficial to the cause and/or most desired by the legislation's supporters. High-risk components are those most likely to draw contention and opposition. Do H.R. 592/S. 314 strike this balance?
An in-depth policy "research analysis" is beyond the scope of this commentary and of less use now that the bills have left their development stages. Instead, a "basic analysis" focusing on bill language and political landscape may prove more useful for forecasting efforts. Certainly, a positive impact coupled with minimum risk improves a bill's chances for acceptance. What analytical steps will help to determine whether H.R. 592/S. 314 are so built?
Given the importance of precedent in law making and interpretation, comparing the proposed amendments to existing pieces of legislation with known outcomes seems appropriate. The political climate on Capitol Hill is undeniably different from that in most state legislatures. Still, a comparative policy analysis of statelevel bills is likely to reveal relevant parallels and further illuminate potential strengths and weaknesses of federal efforts. More importantly, with no previous federal provider status bills to study, state-level legislation represents the only currently available point of reference and analysis.
Massachusetts recently introduced two pharmacist provider status bills; SB484 was killed in committee, and HB2060 continues through the legislative process. On January 1, 2014, California enacted a landmark provider status law. Here are three exemplary bills – one failed, one in process, and one successful—with which to make comparisons for H.R. 592/S. 314 analysis. Table 1 summarizes analytical comparisons between bills.
Abstract and Introduction
Abstract
Objective To compare legislation at the federal level that would recognize pharmacists as health care providers under Medicare Part B with similar state-level efforts in an attempt to identify the strengths and weaknesses of these options and forecast outcomes.
Summary The current primary care provider shortage poses a significant threat to public health in the United States. The effort to achieve federal provider status for pharmacists, currently in the form of identical bills introduced in January 2015 into the U.S. House of Representatives and the U.S. Senate as the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314), would amend the Social Security Act to recognize pharmacists as health care providers in sections of Medicare Part B that specify coverage and reimbursement. This action has budgetary implications owing to the compensation that would accrue to pharmacists caring for Medicare beneficiaries. Passage of these bills into law could improve public health by sustainably increasing access to pharmacists' patient care services in medically underserved areas. In this article, the legislation's strengths and weaknesses are analyzed. The resulting information may be used to forecast the bills' fate as well as plan strategies to help support their success. Comparison of the bills with existing, state-level efforts is used as a framework for such policy analysis.
Conclusion While the current political climate benefits the bills in the U.S. Congress, established legislative precedents suggest that parts of H.R. 592/S. 314, specifically those regarding compensation mechanisms, may require negotiated amendment to improve their chances of success.
Introduction
In January 2015, Members of Congress introduced the "Pharmacy and Medically Underserved Areas Enhancement Act" into both the U.S. House of Representatives and the U.S. Senate. H.R. 592, was referred to the House Committees on Energy & Commerce and Ways & Means. S. 314 was sent to the Senate Finance Committee. The language in these bills is identical to that introduced into the House of Representatives during the last Congress as H.R. 4190.
The bills seeks to amend title XVIII of the Social Security Act, requiring Medicare to cover pharmacists' services, as allowed by state law, that would be otherwise covered if provided by a physician or to a medically underserved population. The language also specifies reimbursement parameters: "The amounts paid shall be equal to 80 percent of the lesser of the actual charge or 85 percent of the fee schedule … if such services had been furnished by a physician." Such changes would have a profound and important impact on pharmacy practice, primary care access, and public health. However, this session of Congress has just begun, and the fate of the legislation at this time is unclear.
Can analysis forecast whether the bills will pass? Health policy analysis literature highlights the importance of identifying and evaluating multiple alternatives as guidance toward selecting a proposal with high chances of success. Analysts must weigh and balance high-yield and high-risk policy components. For the purposes of this analysis, high-yield components are those most beneficial to the cause and/or most desired by the legislation's supporters. High-risk components are those most likely to draw contention and opposition. Do H.R. 592/S. 314 strike this balance?
An in-depth policy "research analysis" is beyond the scope of this commentary and of less use now that the bills have left their development stages. Instead, a "basic analysis" focusing on bill language and political landscape may prove more useful for forecasting efforts. Certainly, a positive impact coupled with minimum risk improves a bill's chances for acceptance. What analytical steps will help to determine whether H.R. 592/S. 314 are so built?
Given the importance of precedent in law making and interpretation, comparing the proposed amendments to existing pieces of legislation with known outcomes seems appropriate. The political climate on Capitol Hill is undeniably different from that in most state legislatures. Still, a comparative policy analysis of statelevel bills is likely to reveal relevant parallels and further illuminate potential strengths and weaknesses of federal efforts. More importantly, with no previous federal provider status bills to study, state-level legislation represents the only currently available point of reference and analysis.
Massachusetts recently introduced two pharmacist provider status bills; SB484 was killed in committee, and HB2060 continues through the legislative process. On January 1, 2014, California enacted a landmark provider status law. Here are three exemplary bills – one failed, one in process, and one successful—with which to make comparisons for H.R. 592/S. 314 analysis. Table 1 summarizes analytical comparisons between bills.
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