BakerHostetler

SURPRISE BILLING PROGRESS DRIVES THE WEEK

Legislation to address surprise medical bills is moving forward this week, as two House committees mark up their own plans to protect patients.

After progress stalled at the end of last year, the House Ways and Means Committee jump-started it by announcing it would move forward with its proposal. The committee plans to take up the bipartisan bill Wednesday.

Tuesday, the Education and Labor Committee will enter the fray with its own bill. Chairman Bobby Scott, D-Va., and Ranking Member Virginia Foxx, R-N.C., released the proposal last week.

The key point of contention among the different plans is the mechanism used to resolve billing disputes. The Ways and Means approach relies on independent arbitration when insurers and providers cannot negotiate a solution on their own. A bipartisan agreement by the House Energy and Commerce and Senate Health, Education, Labor and Pensions committees uses a benchmark payment rate. The new Education and Labor proposal appears to hew more closely to the Energy and Commerce approach.

House leaders want to work out the differences among the plans by May or earlier, ahead of a self-imposed deadline when several federal health programs expire. It’s not yet clear how they might reach that consensus, but policymakers do believe they will ultimately succeed.

BUDGET HEARINGS BEGIN

The White House on Monday released its $4.8 trillion fiscal year 2021 budget, and Congress will immediately begin hearings on agencies’ requests.

The Senate Finance Committee on Thursday will review the budget for the Health and Human Services Department with Secretary Alex Azar. The budget proposes a 10 percent decrease in spending for HHS, among other significant cuts to domestic spending.

Azar is likely to use the opportunity to voice the administration’s support for the Finance Committee’s bipartisan bill to address prescription drug costs – and to press President Trump’s eagerness for a deal on the issue. In his State of the Union address last week, Trump praised Chairman Chuck Grassley, R-Iowa, for his work on drug prices. Trump did not offer the full-throated endorsement of the Finance Committee bill that Grassley might have hoped for, but pushed for Congress to find bipartisan agreement.

Drug pricing reforms are included among more than a dozen health policy priorities highlighted by the White House, also including combating drug abuse and the opioid epidemic, advancing kidney health, and eliminating HIV in America.

The blueprint document includes an “allowance” for bipartisan drug proposals, and says the administration supports “legislative efforts to improve the Medicare Part D benefit by establishing an out-of-pocket maximum, improving incentives to contain costs, and reducing out-of-pocket expenses for seniors” as well as “changes to bring lower-cost generic and biosimilar drugs to patients.”

Despite the administration’s push, compromise appears elusive on a comprehensive measure to lower prescription costs. As Trump spoke about the issue in his speech, Democratic lawmakers chanted “H.R. 3! H.R. 3!” – referencing House-passed legislation that aims to require pharmaceutical manufacturers to negotiate prices directly with the government.

Stakeholders will also be watching for any signals from Azar on any upcoming movement on the administration’s health policy proposals – perhaps most notably the International Pricing Index, which would tie drug prices to their prices in other countries. Republicans, including Grassley, are wary of the model, which is ready to be advanced by HHS whenever Trump decides to do so.

Congress is under no obligation to approve the president’s budget – and lawmakers never do, regardless of who is in the White House. Instead, the budget is a blueprint and opportunity to propose policies highlighting an administration’s priorities.

Indeed, Democrats began criticizing Trump’s new budget before it was even released midday Monday.

APPROPRIATORS MULL CORONAVIRUS FUNDING

House appropriators are urging the Trump administration to work with them on emergency funding to prepare for and prevent a major coronavirus outbreak in the United States.

While only 12 American cases have been detected and officials believe the risk of a pandemic is currently low, lawmakers want the country to be prepared for the worst. Appropriations Chairwoman Nita Lowey, D-N.Y., and HHS Subcommittee Chairwoman Rosa DeLauro, D-Conn., wrote to Secretary Alex Azar urging the administration to transmit a request to Congress for emergency supplemental appropriations.

They expressed support for his decision to declare a public health emergency, but are seeking more information and resources. Azar on Friday was hesitant on the need for additional funding, saying that agencies and state and local governments currently have what they need and that there are too many unknowns.

Lawmakers are also concerned about supply chain impacts of the virus. Sens. Marco Rubio, R-Fl., and Chris Murphy, D-Conn. – both appropriators themselves – wrote to Food and Drug Administration Commissioner Stephen Hahn seeking to ensure that the FDA is able to protect pharmaceuticals and other medical supplies from China in light of the outbreak.

CMMI GUARDRAILS BILL INTRODUCED IN HOUSE

Bipartisan members of the House’s two principal healthcare committees last week introduced legislation aiming to increase accountability and transparency in the Centers for Medicare and Medicaid Innovation.

Reps. Terri Sewell, D-Ala., Adrian Smith, R-Neb., Tony Cardenas, D-Calif., and John Shimkus, R-Ill., wrote the legislation to place “guardrails” around the innovation center created by the Affordable Care Act. CMMI was created to design and test new payment models in government health programs to lower costs and improve outcomes.

Health industry stakeholders generally support CMMI and its goals. But they also have concerns about the innovation center’s broad reach and authority. Those concerns accelerated in 2016 when CMMI rolled out a plan to slash physician reimbursement for drugs in Medicare Part B – it was called a demonstration project, but it required the participation of essentially every provider in Part B. After intense blowback to the proposal, it was eventually scrapped.

More recent CMMI ideas have also generated concern and criticism, including the International Pricing Index, which would tie drug prices to their prices in other countries.

“The Innovation Center has been a critical component of Congress’ mission to deliver value-based health care focused on positive outcomes, especially in rural and underserved communities where health care providers struggle to take on the financial risks required to innovate patient care. It is essential that Congress ensures that CMMI functions as intended, to improve the quality and efficiency of care delivered, and incorporates greater opportunity for public input,” Sewell said.

BROAD BIPARTISAN SUPPORT FOR MEDICARE ADVANTAGE

Hundreds of lawmakers signed on to annual letters from the Hill to the Centers for Medicare and Medicaid Services in support of the Medicare Advantage program.

Forty percent of eligible Medicare beneficiaries are enrolled in Medicare Advantage, which uses private insurance plans and includes additional benefits such as prescription, vision and dental coverage. Lawmakers typically send letters each year to express support and outline their vision for the program.

A letter led by Reps. Tony Cárdenas, D-Calif., Brett Guthrie, R-Ky., Earl Blumenauer, D-Ore., and Mike Kelly, R-Penn., was signed by 338 House members. Sens. Mike Crapo, R-Idaho, and Catherine Cortez Masto, D-Nev., led a letter signed by 64 senators. According to AHIP, 402 members of Congress signing letters supporting Medicare Advantage is the largest number ever.

“Medicare Advantage offers affordable, high-quality care coordination, disease management programs, out-of-pocket spending limits, access to community-based programs, additional supplemental benefits such as vision and dental coverage, and often prescription drug coverage for no additional premium. The program also serves vulnerable and underserved populations that have special needs and chronic conditions and provides supports for seniors at critical times of their life,” the House lawmakers wrote.

CMS will finalize rates and updates to the program for 2021 in early April.

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