This Week: The government shutdown continues; Congress finishes organizing and finalizing committee members and begins to focus on the issues. Concern has been raised that the Centers for Medicare and Medicaid Innovation Center is trying to bypass Congress in health policy.

Congress

House

• Cummings Launches Drug-Pricing Investigation Prior to Hearings
• Energy and Commerce Democrats Focus on Market Stabilization Measures

Senate

• Senate Passed Medicaid Extender Legislation
• Senate Rejects Government-Wide Ban on Abortion Funding

Administration

• CMS: Proposed Payment Notice for the 2020 Coverage Year
• CMS: New Model to Lower Drug Prices in Medicare Part D and Updates to Existing Model for Medicare Advantage

Courts

• Federal Judge Blocks ACA Contraceptive Coverage Rollback

Reports

• GAO: Approaches and Challenges to Electronically Matching Patients’ Records Across Providers

Congress

House

Cummings Launches Drug-Pricing Investigation Prior to Hearings

On Jan. 14, House Oversight Committee Chair Elijah Cummings (D-MD) launched an investigation into brand drug manufacturers’ pricing practices weeks before he holds the first in a series of hearings on rising drug prices, Jan. 29. Cummings asked 12 brand drug manufacturers for information on pricing practices and research and development investments. The investigation focuses on the most expensive drugs for beneficiaries, the costliest drugs to Part D and drugs that have had the biggest price increases over the past five years. Many of those drugs treat diabetes, cancer and arthritis.

Energy and Commerce Democrats Focus on Market Stabilization Measures

On Jan. 16, the House Energy and Commerce Oversight Subcommittee Chair Diana DeGette (D-CO) announced the subcommittee is likely to hold oversight hearings on the Trump administration’s changes to the current health system. Rep. Anna Eschoo (D-CA), chair of the Energy and Commerce Subcommittee on Health, announced that Medicare for All hearings would be held only if time remains after focusing on the Affordable Care Act issues and drug pricing.

Senate

Senate Passed Medicaid Extender Legislation

On Jan. 17, the Senate passed by voice vote a bill that would extend two Medicaid provisions:

• A nearly three-month extension of spousal impoverishment rules to let married couples protect certain assets while seeking Medicaid coverage for home- and community-based services.
• Funding for a three-month extension of the Money Follows the Person demonstration that helps state Medicaid programs transition older adults and people with chronic illnesses back into their communities.

The House passed the same legislation last week, so the legislation now goes to the President to be signed into law.

Senate Rejects Government-Wide Ban on Abortion Funding

On Jan. 18, the Senate rejected a bill that would permanently ban the use of federal funding for abortions in programs such as Medicaid. The procedural vote, needed to begin debate on the No Taxpayer Funding for Abortion Act, failed 48-47, with 60 votes needed to begin debate.

Administration

CMS: Proposed Payment Notice for the 2020 Coverage Year

After considerable delay, on Jan. 17, the Centers for Medicare and Medicaid Services (CMS) issued proposed rules for the Affordable Care Act (ACA) marketplaces for 2020. The 2020 Notice of Benefit and Payment Parameters (NBPP) lays out the benefit and payment guidelines for insurers that want to sell products through HealthCare.gov and the state-run marketplaces. Normally the rule is released in the fall. 

The proposed rules include allowing midyear drug formulary changes, creating a new special enrollment period for people newly eligible for subsidies, increasing maximum out-of-pocket spending limits and reducing the user fee by half of a percentage point. The proposed rule also includes the draft application submissions calendar for qualified health plans (QHPs) interested in participating in the exchanges and an increase in ACA premiums by approximately 1% next year in order to more accurately calculate premium subsidies. Public comments on the rule are due Feb. 19.

Read the proposed rules here.

CMS: New Model to Lower Drug Prices in Medicare Part D and Updates to Existing Model for Medicare Advantage

On Jan. 18, the Center for Medicare and Medicaid Innovation (Innovation Center) at the Centers for Medicare and Medicaid Services (CMS), which tests alternative payment and service delivery models, announced a new payment model and updates to an existing model. The models are designed to enable Medicare Advantage and Part D plans, which are private plans that provide Medicare beneficiaries with medical and prescription drug coverage, expand choices for patients and add flexibility for insurers in Medicare Advantage and Medicare Part D.

Read about the Part D Payment Modernization Model here.

Read about the Value-Based Insurance Design Model (VBID) here.

Courts

Federal Judge Blocks ACA Contraceptive Coverage Rollback

On Jan. 14, a federal judge in Pennsylvania issued a nationwide injunction blocking new Trump administration rules that allow businesses to use moral and religious obligations as reasons to deny employees coverage for birth control. On Jan. 13, a federal court in California issued a similar injunction, limited to only 13 plaintiff states.

U.S. District Judge Wendy Beetlestone stopped the rule from going into effect, citing that under the Affordable Care Act (ACA), the Department of Health and Human Services (HHS) cannot provide such exemptions to employers. The Department of Justice (DOJ) is expected to appeal the ruling.

Read the nationwide injunction here.

Reports

GAO: Approaches and Challenges to Electronically Matching Patients’ Records Across Providers

The 21st Century Cures Act included a provision for the Government Accountability Office (GAO) to study patient record matching. In the report, released Jan. 15, the GAO describes (1) stakeholders’ patient record-matching approaches and related challenges, and (2) efforts to improve patient record matching identified by stakeholders.

Stakeholders the GAO interviewed, including representatives from physician practices and hospitals, noted inaccurate, incomplete or inconsistently formatted information in patients’ records that pose challenges to accurate matching using the automatic software.

From stakeholders, the GAO concluded that more could be done to improve patient record matching, and identified several efforts that could improve matching. One method is implementing common standards for recording demographic data, sharing best practices and other resources, and developing a public-private collaboration effort that could improve matching.

Read the full report here.