Lynn Jenkins

Mr. Speaker, I rise today in recognition of this week as Malnutrition Awareness Week.

Malnutrition Awareness Week is a multi-organizational, multi-pronged campaign created by the American Society for Parenteral and Enteral Nutrition. This campaign seeks to educate healthcare professionals to identify and treat for malnutrition earlier. It seeks to educate consumers and patients to discuss their nutrition status with health care professionals and increase awareness of nutrition's role on patient recovery.

Every 60 seconds, 10 hospitalized patients with malnutrition go undiagnosed, and many of these patients are older adults. Yet, there are common-sense solutions that can close this care gap.

We cannot solve what we do not first measure. Unfortunately, we do not truly know the full extent of the malnutrition problem plaguing our senior population. This is because screening measures for malnutrition are not a part of our national health surveys and malnutrition is not included in the national health indicators and goals for older Americans that help shape public health programs and guide healthcare professionals. I therefore call on the U.S. Department of Health and Human Services to routinely include malnutrition screening measures in national health surveys of older adults and include malnutrition among national key health indicators and Healthy People 2030 goals for older adults.

We cannot expect older adults and their families to take steps to address malnutrition if we do not give guidance on identification of and interventions for the problem. The U.S. Department of Health and Human Services and U.S. Department of Agriculture develop new national dietary guidelines every five years, but the guidelines have never addressed the issue of older adult malnutrition. I therefore urge HHS and USDA to include dietary guidance for the prevention and treatment of older adult malnutrition and the closely aligned problem of age- related sarcopenia, the loss of strength and muscle, in the 2020 Dietary Guidelines for Americans.

We cannot advance malnutrition care and promote improved patient recovery if we do not align the identification of and interventions for malnutrition with health care quality incentive programs. Malnutrition can lead to greater risk of chronic disease, frailty, disability, and increases in healthcare costs, yet nutrition status is rarely evaluated and managed as individuals transition across care settings. I therefore call on the Centers for Medicare and Medicaid Services to include malnutrition related quality measures in Traditional Medicare quality programs as well as include measures related to malnutrition in care transition programs.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 3635) to amend title XVIII of the Social Security Act in order to improve the process whereby medicare administrative contractors issue local coverage determinations under the Medicare program, and for other purposes, as amended.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 3635, currently under consideration.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, today, I rise in support of H.R. 3635, the Local Coverage Determination Clarification Act. I introduced this legislation along with Congressman Kind, which will help ensure the Medicare coverage decisions are made by qualified health experts through a transparent process that is based on sound medical evidence.

Medicare administrative contractors, or MACs, play a critical role in ensuring that Medicare beneficiaries have access to needed care. However, the less-than-transparent process used by MACs to make coverage decisions can limit or deny patients' access to necessary care.

Specifically, the science that guides some of these decisions can be flawed, mischaracterized, or misapplied. The deliberations and decisions of the MACs, which should be based on medical science, are often conducted behind closed doors, with little opportunity for interested stakeholders to raise issues or offer alternatives. These decisions affect millions of Medicare beneficiaries and impact crucial access to innovative technologies and services.

The establishment of a clear process informed by health experts will make the local coverage determination, or LCD, process and the decisions developed by that process more sound, more transparent, and ensure accountability among MACs. These requirements are necessary to ensure that our Nation's seniors receive quality healthcare treatment.

Specifically, H.R. 3635 would improve the LCD process by requiring that carrier advisory committee meetings of the MAC are open, public, and on the record, with minutes taken and posted to the MAC's website for public inspection. The gravity of limiting or precluding coverage for both beneficiaries and practitioners heightens the need for transparency, especially when such meetings are currently closed off.

MACs would be required to include, at the outset of the coverage determination process, a description of the evidence a MAC considered when drafting a local coverage determination as well as the rationale it relies on to deny coverage.

Additionally, under current rules, local coverage determinations are essentially unreviewable once they become final. This legislation would create a process for stakeholders to request additional review of a MAC's local coverage decision from the Centers for Medicare and Medicaid Services.

It would also require the Secretary to submit a report to Congress regarding the number of requests filed with fiscal intermediaries and carriers and the number of appeals filed with the Secretary, as well as the actions in response. Additionally, the report would recommend ways to improve the usefulness and efficiency of the process as well as the communication with Medicare beneficiaries and providers.

While I am pleased that the legislation we have here today takes steps to improve the process and bring transparency to protect access for Medicare patients, we must continue to work to ensure that MACs independently evaluate the evidence of other MACs' coverage decisions. Local coverage determinations should be thoroughly evaluated by experts in each local jurisdiction.

Currently, loopholes in the process allow contractors to adopt another MAC's coverage determination without the necessary scientific rigor and meaningful engagement with stakeholders that is vital in forming the most appropriate policy. Due to regional, geographic, and population-based deficiencies, these carbon-copied LCDs may not reflect the specific geographic region they are intended to serve. Local coverage determinations should be just that--local.

Put simply, what works best for one location does not always work best for another location. Applying local coverage determinations across jurisdictions has the practical effect of establishing national coverage policies without having followed the more rigorous national coverage determination process. As such, I look forward to working with my colleagues on this issue, moving forward.

Medicare beneficiaries deserve transparency and accountability for these decisions that directly impact their access to care. These reforms are necessary to ensure that local coverage determinations do not impede a physician's medical judgment and deny patients access to medically necessary care. By changing the LCD process, Congress can ensure that medical and scientific evidence is not used selectively to deny appropriate coverage to seniors.

I want to thank Mr. Kind, who joined me in introducing this legislation.

I want to ask my colleagues for their bipartisan support of this bill as we work to improve access and care for every American.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself the balance of my time.

Mr. Speaker, in closing, I am proud to stand here today in support of this commonsense legislation that creates transparency and accountability to the local coverage determinations process and will help ensure that Medicare patients receive the medical care they need.

Mr. Speaker, I hope everyone will join me in voting for this legislation on the House floor today as we work to improve access and care for every American, and I yield back the balance of my time.

Mr. Speaker, pursuant to House Resolution 1012, I call up the bill (H.R. 6199) to amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous materials on the bill under consideration.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I am pleased to come to the floor today to speak in support of the Restoring Access to Medication and Modernizing Health Savings Account Act of 2018.

This legislation makes a variety of simple but much-need changes to health savings accounts, or HSAs, rules to ensure that folks have more access and choice when using their HSAs.

This bill contains five separate bipartisan pieces of legislation that passed the Ways and Means Committee earlier this month. It includes a bipartisan policy by Mr. Roskam and Mr. Thompson that would allow HSA-eligible plans to offer a certain amount of first-dollar coverage in their plan design without losing their HSA-eligibility. This allows HSA plans to offer coverage for valuable services like telehealth or primary care appointments without a deductible.

The bill permits patients with HSAs to access the innovative and patient-centered direct primary care arrangements with HSA plans, provisions championed by the bipartisan team of Mr. Paulsen and Mr. Blumenauer.

The bill also allows coverage for certain medical services from a retail or onsite clinic and permits contributions to an HSA if their spouse has a health FSA, which is prohibited today.

Another commonsense provision in the bill allows rollovers from other tax-advantaged health accounts to be able to fund HSAs. These proposals were included in Mr. Kelly and Mr. Blumenauer's bipartisan legislation.

Additionally, this bill contains the PHIT Act, introduced in a bipartisan manner by Mr. Jason Smith and Mr. Kind, that would allow certain qualified fitness expenses to be eligible items that can be paid for with tax-advantaged dollars, offsetting a portion of their costs and promoting healthy activity.

Lastly, this legislation repeals the Affordable Care Act's unnecessary barriers when it comes to using tax-advantaged health accounts to purchase over-the-counter medicines, something that I have been pleased to work on with my good friend Congressman Kind for the last several years, and I am encouraged that the bipartisan duo of Representatives Meng and Paulsen have also joined us in introducing the underlying legislation.

In addition to expanding access for over-the-counter medication, the bill also allows for feminine hygiene products to be considered a qualified medical expense.

Since the passage of the Affordable Care Act, Americans have had to seek prescriptions in order to use their health savings and flexible spending accounts on safe and effective over-the-counter medicines. This legislation would end the need for those prescriptions.

It doesn't make any sense to require the millions of American families that use HSAs and FSAs to manage their healthcare needs to go to the doctor in order to access over-the-counter medicines for things like basic pain management and cold and allergy symptoms.

Nobody benefits from this nonsensical policy that requires consumers to jump through unnecessary hoops and increases the burdens on the healthcare system, all while providing no medical benefit. Over-the- counter medicines are often the frontline treatment for many common illnesses and for maintenance of chronic diseases, and they should be treated as medically reimbursable healthcare therapies, just as prescription medications.

Mr. Speaker, I am pleased the House is considering H.R. 6199, which gives individuals and families more control over their healthcare spending and increases their options when it comes to health savings accounts.

Today marks a nice opportunity to pass bipartisan legislation to simply make it easier for consumers to meet their basic medical needs. These are commonsense, simple, bipartisan solutions, and I urge my colleagues to support this legislation.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from South Carolina (Mr. Rice), a distinguished member of the House Ways and Means Committee.

Mr. Speaker, I appreciate my friend's point of view on the other side of the aisle. Mr. Kind and I have worked really hard on this legislation for many years. I want to, for the Record, just remind folks that this bill is simply allowing people to keep more of their hard-earned money.

Letting people keep their own money is not government spending that needs to be offset. Each of these bills contained in this package were authored with our Democratic colleagues without an offset. Each of these bills went through committee, with bipartisan support, without an offset. It is ironic that Democrats want to, all of a sudden, claim to be fiscally conservative.

This is the same Democratic Party that passed the stimulus in 2009. Remember, that bill added nearly $800 billion to the deficit.

Mr. Speaker, I yield 3 minutes to the gentleman from Pennsylvania (Mr. Kelly), a real leader on these issues on the House Committee on Ways and Means.

Mr. Speaker, I yield 3 minutes to the gentleman from Kansas (Mr. Estes), my friend and colleague.

Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. Roskam), who has provided great leadership in this area.

Mr. Speaker, I yield 2 minutes to the gentleman from Minnesota (Mr. Paulsen), who has worked tirelessly in this area.

Mr. Speaker, I yield myself the remainder of my time.

Mr. Speaker, we have heard my friends on the other side of the aisle suggest here, this afternoon, this bill might, in some way, hurt people with preexisting conditions. However, we know that is simply not true. This bill doesn't touch preexisting conditions. It doesn't raise costs or premiums on families. And it doesn't take away anyone's choice of a healthcare plan.

Millions of Americans use tax-advantage healthcare accounts to save and pay for healthcare expenses. In fact, there are twice as many Americans with an HSA than those who get coverage on the Affordable Care Act's exchanges. Almost 22 million people had an HSA in 2017, and there is only about 10 million people enrolled on the exchanges in 2018. Forty-four percent of all civilian workers had access to a health flexible spending arrangement in 2017.

The provisions in this bill allow more things to be paid for out of these accounts, like over-the-counter drugs, feminine products, and fitness activities. This means people are paying less because they are able to use pre-tax dollars or take a deduction for their contribution.

As a reminder, the policies in the bill are all bipartisan. We have worked together to write and advance them.

This bill helps middle class families afford their healthcare expenses, and I hope my colleagues will continue to support this legislation.

Mr. Speaker, I yield back the balance of my time