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.


FY 22 Appropriations Update

Democratic appropriators in the House of Representatives released their fiscal year (FY) 2022 top-line spending allocations (i.e., the 302(b) allocations) for each of the 12 annual appropriations bills last week. The Subcommittee on Labor-Health and Human Services-Education would receive a total of $237.5 billion, an increase of $61 billion over current funding levels. The panel also continued its work to advance individual spending bills, including approving the proposed Agriculture-Food and Drug Administration (FDA) legislation, which includes $26.2 billion in funding, a more than 10% increase over current spending levels. Amongst other priorities, the bill includes increased funding for rural broadband, public health and consumer safety infrastructure, drug safety oversight, drug and device supply chain monitoring and surveillance, and FDA data infrastructure modernization. The Committee also advanced the FY 22 State and Foreign Operations bill, which includes a provision to bar federal funding for the Wuhan Institute of Virology. The Legislative Branch spending bill advanced by the panel includes funding to provide COVID-19 booster shots for members of Congress should they be recommended by the Centers for Disease Control and Prevention (CDC) in the next year. The bill’s report language also directs the Office of Attending Physician to establish a plan to distribute booster shots for congressional offices. Democrats hope to complete House passage of FY22 funding bills prior to August recess.

HHS Issues First Surprise Billing Regulation

The U.S. Department of Health and Human Services (HHS) has released the first of several expected regulations relating to the implementation of the No Surprises Act, which bans surprise out-of-network bills to patients. The interim final rule (IFR) specifies how the qualifying payment amount (QPA), which is based on a health plan’s historic median contracted rate for similar services in a particular geographic area, adjusted by the consumer price index, will be determined. The IFR discusses how to determine if services are similar and what are considered normal practices in insurer-provider contracts. The regulation also details the law’s notice and consent requirements for patients agreeing to out-of-network services. Health providers must publicly post rules prohibiting surprise billing on their website and in information to patients. The administration will create a process to review the complaints of patients who think they have received a surprise medical bill. The rule also seeks to address a policy proposed by UnitedHealthcare, under which the insurer could retroactively deny ER claims deemed to be not actual emergencies. The IFR states that this practice would not be permitted under either the No Surprises Act or the Affordable Care Act. In addition to the IFR, HHS also released a fact sheet for patients explaining their surprise billing rights and a fact sheet on how to comply with the rule’s requirements. Other provisions of the law, including the independent dispute resolution (IDR) process to settle payment disputes between insurers and providers, will outlined in future regulations. Rulemaking on arbitration must be completed by Dec. 27; the law is set to take effect Jan. 1.

PRF Reporting Portal Opened

The Provider Relief Fund (PRF) reporting portal was opened by the Health Resources and Services Administration (HRSA) last week. Providers in reporting period one have until September 30 to submit their information as a part of the required post-payment reporting process. HRSA published updated reporting requirements on June 11. Revised reporting requirements will be applicable to providers who received one or more payments exceeding, in the aggregate, $10,000 during a single Payment Received Period from the PRF General Distributions, Targeted Distributions, or Skilled Nursing Facility and Nursing Home Infection Control Distributions. A webcast is scheduled for July 8 to assist providers in understanding the reporting process.

Supreme Court to Consider Health Care Cases Next Term

The Supreme Court has announced that it will hear four health care-related cases during its next term. The high court will consider the nearly 30% cut in reimbursement for 340B drugs that occurred under the Trump administration. They will also review a Centers for Medicare and Medicaid Services (CMS) rule setting Medicare payments for disproportionate share hospitals (DSH) as well as a case to decide whether a state Medicaid program can claim part of a tort settlement for past medical expenses. Finally, the court will consider whether the Affordable Care Act allows a disparate impact claim from plaintiffs alleging disability discrimination.

House Passes Surface Transportation Reauthorization

The House of Representatives passed legislation (H.R. 3684) last week that would reauthorize surface transportation programs that are currently set to expire on September 30. Democrats intend the $760 billion measure to inform parts of the President’s broader, bipartisan infrastructure package, currently under negotiation between the Senate and White House. The bill was passed along a largely party line vote of 221-201, with only two Republicans supporting the proposal.

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