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.


President Previews Favored Nations Drug Clause

President Trump announced plans for an executive order to control drug costs that would align prices in the U.S. with lower prices paid abroad, known as a “favored nations” clause. The White House has not offered any further details about the executive order. However, it is unclear whether the President was referencing a previously announced international pricing index proposal. It is also unclear if the administration favors tying domestic drug prices to those in countries with similarly developed economies, or if the nation with the lowest price for each drug would be used as a benchmark.

E&C Surprise Billing Mark Up Expected This Week

The House Energy and Commerce Committee is expected to be the first House committee to consider legislation on surprise insurance gaps. Committee rules require notice of at least 36 hours in advance, and the text of any bill to be marked up must be made available three days in advance. A substitute amendment must be available 24 hours in advance. Typically the committee requires amendments to be available 2 hours in advance of consideration.

Patient Protections in Surprise Insurance Gap Legislation

Under current law, patients are to be held harmless for out-of-network emergency care at in-network facilities. However, these current law patient protections do not apply to deductibles and out-of-pocket maximums. Hart Health Strategies Inc. reviewed key legislation related to surprise insurance gaps to examine what additional patient protections are included. Specifically, our comparison chart examines when patients are “held harmless” for receiving certain out-of-network care and whether those protections extend to deductibles and out-of-pocket maximums, whether as part of emergency care (e.g., after stabilization) or other circumstances.

Finance Leadership Questions Opioid Maker Ties to Pain Advocacy Groups

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) have sent letters to several pain advocacy organizations and medical associations requesting details about their relationships with opioid manufacturers. The lawmakers are investigating the degree to which pharmaceutical companies fund the nonprofit organizations and how these ties may influence pain treatment practices and policy. The groups were asked to respond by July 29.

July 8, 2019: | Page 1 Page 2



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