Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


E&C Gather Stakeholder Input on Surprise Billing

House Energy and Commerce Committee staff held a bipartisan briefing between health aides and stakeholders earlier this month on the issue of surprise medical bills. Participants included the Federation of American Hospitals, the American Medical Association, Families USA, and America’s Health Insurance Plans. Surprise bills are one issue that Chairman Frank Pallone (D-N.J.) hopes to address in a bipartisan manner this Congress. The House Ways and Means Committee and Education and Workforce Committee have also expressed interest in tackling surprise medical bills this year. The Senate appears to be further along in the legislative process, with a bipartisan group working to revise draft legislation released last September. Senate Health, Education, Labor, and Pensions (HELP) Committee leadership continue to await a response from the Congressional Budget Office (CBO) to their letter outlining policy options for analysis.

The Congressional Research Service (CRS) released a new report on surprise billing last week, warning lawmakers that any forthcoming federal legislation should consider existing state laws on the issue as well as the potential for litigation over payment rates. Given that fifteen states have already passed bills to address the problem of surprise medical bills, the agency recommends that Congress clarify the parameters of federal preemption of state laws. CRS suggests that Congress include an enforcement mechanism to address the violation of any potential federal legislation. According to the report, lawmakers should also expect surprise billing regulations to face legal challenges in court.

OIG To Review Use of Prior Authorization in Medicaid MCOs

The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) will begin a review of whether Medicaid managed care organizations (MCOs) are in compliance with federal requirements on prior authorization. The OIG investigation follows a letter from Sen. Bob Casey (D-Pa.), member of the Senate Finance and HELP Committees, outlining his concerns on the issue. In his letter to the OIG, Casey referenced reports of unnecessary red tape that resulted in the denial of medical and dental services as well as prescription drugs for those in need of care.

Lawmakers Release Patent Reform Framework

Lawmakers have released a bipartisan, bicameral legislative framework for reform of Section 101 of U.S. patent law, which determines patent eligibility. The framework would eliminate the requirement that any invention or discovery be both “new and useful.” Senate Judiciary Intellectual Property Subcommittee Chair Thom Tillis (R-N.C.) and Ranking Member Chris Coons (D-Del.) argue that such requirements inhibit innovation in certain areas of technology, such as medical diagnostics and personalized medicine. The framework is also backed by Rep. Hank Johnson (D-Ga.), chairman of the House Judiciary Subcommittee on Courts, Intellectual Property, and the Internet , as well as by Reps. Doug Collins (R-Ga.), and Steve Stivers (R-Ohio).

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