February 11, 2019.

Senators Tackle Surprise Medical Bills; Medical Groups Caution Against Capping Payments
Led by Sens. Bill Cassidy, M.D. (R-LA) and Michael Bennet (D-CO), a group of bipartisan Senators sent letters asking for detailed information from providers and insurers regarding surprise medical billing practices as they draft legislation to halt the highly publicized practice. This request serves as a follow up to input they received for draft legislation, the Protecting Patients from Surprise Medical Bills Act, released in September 2018. Additionally, physician and clinician groups sent a letter to Senate Health Committee members urging them to avoid setting caps on payments to physicians to stop surprise billing. They offer suggestions and issues to keep in mind as they develop the bills saying, “Physicians and other providers are limited in their ability to help patients avoid these unanticipated costs because they, too, may not know in advance who will be involved in an episode of care…” Click here for the Senate letter, and here for the medical groups’ letter.

House and Senate Introduce Identical Bills to Allow Medicare to Negotiate Drug Prices
Sen. Sherrod Brown (D-OH) and Rep. Lloyd Doggett (D-TX) introduced companion bills that would permit Medicare to negotiate prices for prescription drugs and license generic copies of pharmaceuticals when the manufacturer will not agree on a price with CMS. The Medicare Negotiation and Competitive Licensing Act would empower Medicare to negotiate directly with manufacturers for drug prices, which is currently prohibited as well as strip the companies of their exclusive rights to a drug if those negotiations failed. Doggett is chairman of the Ways and Means Health Subcommittee. Brown is on the Senate Finance Committee. To view the bill, click here.

Bipartisan Bills Introduced to Improve Access to Rural Health Care
Reps. Terri Sewell (D-AL) and Adrian Smith (R-NE), who both represent rural Congressional Districts, introduced two bills aimed at improving rural access to healthcare last week. One bill, H.R. 1041, would repeal the Medicare rule that requires Critical Access Hospitals to discharge or transfer patients within 96 hours after being admitted. The second, H.R. 1052, would permit physician assistants to directly bill Medicare in order to expand their role as medical providers in underserved communities. Click here for H.R. 1041 and here for H.R. 1052.

  • The Critical Access Hospital Coalition advises policy makers on the needs of CAHs to ensure resources are available for rural health care for generations to come, click here.

Out-of-Pocket Costs for Insurance Rising Steadily
Even though the unisured rate is statistically unchanged since 2016 at 12.4-percent, the out-of-pocket costs for insurance as a percentage of income has risen since 2010, according to a new survey from the Commonwealth Fund. Of people who were insured continuously throughout 2018, an estimated 44 million were underinsured because of high out-of-pocket costs and deductibles at about 5 percent of their annual incomes. Additionally, the survey found that more than half of uninsured adults and insured adults who have had a coverage gap reported that they had had problems paying medical bills or were paying off medical debt over time. Click here for the full survey results.

Bipartisan Senators Introduce Bill to Increase GME Slots
Sens. Bob Menendez (D-NJ), John Boozman (R-AR) and Senate Minority Leader Chuck Schumer (D-NY) have introduced legislation, the Resident Physician Shortage Reduction Act, that would add 15,000 additional Medicare-funded residency slots over five years. The bill would incrementally increase the slots by 3,000 per year from 2021 through 2025, given to hospitals in the following order: hospitals in states with new medical schools or new branch campuses, followed by those training more residents than are supported by their current GME cap, then hospitals affiliated with Veterans Affairs medical centers, hospitals that emphasize training in a community-based setting or in outpatient departments, those not located in a rural area but which operate an approved rural track program, and finally all other hospitals. To view more from the lead sponsor along with a section-by-section of the bill, click here.

Opioid Avoidance: When the Cure Is Worse than the Disease
As many as 18 million patients rely on opioids to treat long-term pain that is intractable but not necessarily associated with terminal illness. In 2016, seeking to curb opioid misuse, the CDC introduced guidelines outlining a maximum safe dosage and strongly urging doctors to avoid prescribing for chronic pain unless death is imminent. As a result, thousands of pain medication recipients have had their doses reduced or eliminated. But this attempt to save people from addiction is leaving many patients in perpetual pain — and thus inadvertently ruining, or even ending, lives. Click here for the NY Times report.

Five Million a Year Expected to Sign-Up for Association Health Plans Over the Next Decade
According to a joint report by the Congressional Budget Office and Joint Committee on Taxation, about five million Americans are anticipated to enroll in association health plans each year over the next ten years under the Administration’s new rules. These plans allow for small businesses and individuals to pool together to buy health insurance by geography or industry to obtain healthcare coverage as if they were a single large employer. Most of the people in these pools will migrate from the ACA plans which could cause premiums in the marketplace to rise by roughly 3 percent. The report also asserts that about one million people would have otherwise been uninsured if the rules were not in place. To read the report, click here.

  • Democrats request GAO review of whether the Administration’s recent guidance that loosens restrictions on ACA waivers are subject to the Congressional Review Act, potentially allowing lawmakers to overturn it, click here.

FDA Makes Moves to Bar Tobacco Sales at Certain Retailers 
The Food and Drug Administration has filed complaints seeking No-Tobacco-Sale Orders for certain Walgreens and Circle K stores for repeated violations of restrictions on the sale and distribution of tobacco products, including sales of cigars and menthol cigarettes to minors. The orders are among the strongest actions the agency can take and signal a willingness to take on big retailers that violate state laws governing tobacco and e-cigarette products. The NTSO is focused on a Walgreens in Miami and a South Carolina Circle K that each had more than five violations over 36 months. To read more from the FDA, click here.

HIPAA Enforcement Yields Record Fines
The HHS’ Office for Civil Rights (OCR) concluded an all-time record year in Health Insurance Portability and Accountability Act (HIPAA) enforcement activity, according to a new report.  In 2018, OCR settled 10 cases and was granted summary judgment in a case before an Administrative Law Judge, together totaling $28.7 million from enforcement actions. This total surpassed the previous record of $23.5 million from 2016 by 22 percent. Click here for the HHS report.

World Health Organization Looks to Reclassify Marijuana to Allow More Medicinal Use
The WHO’s Committee on Drug Dependence last month made a recommendation that marijuana and its components should be moved out of the most restrictive international schedule of controlled substances – Schedule IV, where narcotics like heroin are classified. The Committee contends that the reclassification would drive more medical use and research of the drug. The recommendations, issued to WHO’s Secretary-General in January, will eventually come up for a vote by the U.N. Commission on Narcotic Drugs, which next meets in March. Member countries are not obligated to follow WHO’s guidelines, the U.S. as a member country is unlikely to follow suit. Click here for more from Forbes.

Eating a Vegan Diet Can Improve Gut Health and Help Lose Weight
New research being conducted in collaboration with scientists from the Czech Republic and the US concluded that eating a plant-based diet could be beneficial for gut health.  The research studied various hormones related to weight and digestion. In response to the growing obesity epidemic, the study showed that a plant-based diet can help a person feel fuller and manage their weight. To read the full study, click here.

New Study: Women’s Brains Are Younger Than Men’s
According to new research from the Washington University School of Medicine, brain metabolism slows as individuals age, but the process in which this occurs may be different between men and women. Study participants, aged 20 to 82, underwent PET scans to collect and analyze brain metabolism data. The data suggested that the female metabolic brain age was about 3.8 years younger compared to males, and the male metabolic brain age was 2.4 years older compared to females leading to the conclusion that men begin adulthood about three years older than women. Click here to read more on the study.

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