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 Health Subcommittee Advances 10 Health Bills

The House Energy and Commerce Subcommittee on Health advanced 10 pieces of bipartisan, health care related legislation to the full committee last week, including H.R. 3630, the No Surprises Act. H.R. 3630 aims to hold patients harmless from surprise insurance gaps and would require insurers to keep their provider directories up to date. It would tie out-of-network payment rates to the median in-network rate for the appropriate geographic area in cases of a billing dispute between an insurer and provider. Payment amounts would be tied to a base year of 2019 rates and be indexed over time according to the consumer price index (CPI). During the markup, Reps. Raul Ruiz (D-Calif.) and Larry Bucshon (R-Ind.) spoke in support of their own surprise billing legislation, which proposes a baseball-style arbitration process similar to what is in place in New York as a back-up process to resolve payment disputes. The physician lawmakers outlined the possible unintended consequences of the No Surprises Act, including the potential to exacerbate doctor shortages. While subcommittee Chairwoman Anna Eshoo (D-Calif.) expressed interest in adding an arbitration measure to the bill, full committee Chairman Frank Pallone (D-N.J.) appeared more hesitant. He cautioned against making significant changes to the bill as it currently stands, arguing that it is already bipartisan, bicameral and would not increase health care costs. He hopes that the bill will be considered on the House floor before the August recess.

The FAIR Drug Pricing Act (H.R. 2296) would require pharmaceutical manufacturers to alert the government about forthcoming price increases and to justify the price hikes. Drug makers would be fined if they fail to report the required information. The bill was amended to include additional transparency provisions. The Community Health, Investment, Modernization and Excellence Act (H.R. 2328) would reauthorize community health centers at $4 billion annually and the National Health Service Corps (NHSC) at $310 million annually through fiscal 2024. The bill would also delay disproportionate share hospital (DSH) cuts for fiscal 2020 and 2021 and decrease the cuts in fiscal 2022 from $8 billion to $4 billion. Lawmakers stated that this measure would give them additional time to improve the DSH formula. The Territories Health Care Improvement Act (H.R. 3361) would eliminate the federal spending cap on Medicaid assistance to territories and reset the percentage levels at which they receive assistance to align with local income levels. The subcommittee also approved legislation to reauthorize funding for newborn screenings, autism research and screening, Title VIII nursing workforce programs, lifespan respite care, the Emergency Medical Services for Children Program, and other public health programs. The bills were all favorably reported by voice vote.

Update on Congressional Drug Pricing Negotiations

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) has stated he plans to unveil drug pricing legislation “very soon” alongside Ranking Member Ron Wyden (D-Ore.). His announcement followed the Trump administration’s withdrawal of its drug-rebate rule. U.S. Department of Health and Human Services (HHS) Secretary Alex Azar has stated that he will continue to work with Congress to address the issue of rising drug costs. While Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) does not believe the rebate proposal is likely to be taken up as legislation by the Senate due to its potential cost, Grassley has discussed the inclusion of a measure in the Finance package that would ask the Federal Trade Commission (FTC) to study pharmacy benefit managers (PBMs).

Finance Committee leadership are still in talks on a provision that would require manufacturers to pay back money to Medicare Part D if their prices rise faster than inflation. The lawmakers have stated that they are waiting for the Congressional Budget Office’s (CBO) analysis of their package, which could also include a cap on out-of-pocket costs for Part D seniors.

The administration will also continue to work with Sens. Grassley and Dick Durbin (D-Ill.) on the need for increased drug pricing transparency after a federal judge ruled against the White House’s push to require drug list price disclosure in television ads. The senators have introduced legislation (S. 1437) that would codify the administration’s regulation into law and could be added to a larger drug pricing and health care costs legislative package.

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