29 Jul July 29, 2019

Surprise Billing Legislation Hits Roadblocks, Leaders Look at September for Votes
Due to division within both chambers of Congress, the surprise billing legislation that has passed the relevant Committees will not be voted on prior to the August recess. The divisions are primarily between providers, who want more fee negotiating authority, and insurers, who want set reimbursement rates.  In the Senate, there are reportedly as many as 14 Senators who have put “holds” on the bill to stop it from going to the floor, prompting a rare bi-partisan statement from the lead Republican and Democratic members of the Senate Health Committee saying “The Senate does not have time before the August recess to consider the bipartisan Lower Health Care Costs Act,” pushing consideration until at least September. In the House, the Chairman of the Energy & Commerce Committee says it will be late September, at the earliest, before its surprise billing legislation will go to the floor.  Click here for the full statement from Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA).

• Doctors and hospitals are not the only ones pushing against the current Senate legislation, air ambulance companies are also publicly advocating against the policies within the bills, click here.
• The National Governors Association issued a report last week that details state strategies to cut back on surprise billing, click here.

CMS Administrator Takes On Hospitals, Supports Site-Neutral Payment Changes, Opposes Consolidation
CMS Administrator Seema Verma last week took on Medicare’s “hospital-centric payment model,” promoting the administration’s site-neutral payment policies and smacking provider consolidation.  In a speech last week, Verma condemned Democratic proposals for a public insurance option and Medicare-for-All.  Medicare or Medicaid buy-in proposals are rapidly gaining momentum among leading Democratic presidential candidates and lawmakers as the next step to cover uninsured Americans or offer cheaper plans. Last year the CMS finalized a watered-down version of a site-neutral payment rule, prompting a lawsuit from hospital groups and legislation to reverse the rule. It’s unclear whether CMS will go further in the upcoming outpatient payment rule, which is expected to be released at the end of this week. Click here to read Verma’s remarks.

Senate Committee Passes Legislation To Curb Drug Prices
In an unusual step, the Senate Finance Committee passed policies to curb rising drug prices without actual legislative language; instead, the Committee reviewed descriptions of the base bill, as well as a series of amendments, before voting to send the concept to the Senate floor. The Prescription Drug Pricing Reduction Act of 2019, approved on a 19-9 vote, will save $100 billion over 10 years through both Medicare and Medicaid changes according to an estimate by the Congressional Budget Office. The bill did not include a Trump Administration initiative to rein in the cost of physician-administered medicines that would have barred the government from establishing a system tying payments for certain drugs in Medicare Part B to an index of international prices. An amendment that would give Medicare power to negotiate prices also failed in Committee however, if the bill is taken up on the Senate Floor, it will likely be raised again. Click here to view the summaries of the bill and amendments, as well as view the contentious mark-up session.

• Meanwhile in the House, a fight between the Ways & Means Committee and the Energy & Commerce Committee is keeping Democrats from moving forward with their own drug pricing bill, click here.
• President Trump may sign an Executive Order soon that that would reduce prices of nearly all brand-name drugs covered by federal programs such as Medicare, click here.
• GOP senators are under a lot of pressure to support the newly committee passed drug reform law.  Click here.

House Passes Bi-Partisan Public Health Bills, Which Await Senate Action
The House of Representatives has overwhelming voted in favor of sending several health bills to the Senate that extend current Medicare and Medicaid programs. The bills included policies to give assistance to primary caregivers, reauthorize newborn screening programs, provide funding for Autism research, and extended the Certified Community Behavioral Health Clinic demonstration program. For more on the bills, click here and here.

20 Million Would Lose Coverage If Court Strikes Down Affordable Care Act
More than 20 million Americans would be at risk of losing their health insurance if the 5th U.S. Circuit Court of Appeals agrees with a Texas-based federal judge who declared the Affordable Care Act unconstitutional last December because Congress had eliminated an unpopular tax it imposed on people who did not buy insurance. The final word on striking down law will almost certainly come from the Supreme Court, which has twice upheld the 2010 legislation. Click here for how some states are preparing.

HHS Inspector General Looks at ACO Successes
In a new report, the HHS Office of Inspector General found that several Medicare Shared Savings Program Accountable Care Organizations have strategies that reduce spending and improve quality of care. The OIG recommended that CMS take several actions, including expand efforts to share information about strategies, adopt outcome-based measures and better align measures across programs, and identify and share information to integrate physical and behavioral health services and address social determinants of health. Click here to read the report.

• CMS has released three new case studies describing innovative programs from ACOs highlighting the Next Generation ACO Model and the Medicare Shared Savings Program, click here.

HHS OIG Report Examines States’ Oversight of Opioid Prescription and Use
A report released looks at the policies created in Nebraska, Nevada, New Hampshire, Tennessee, Texas, Utah, Washington State, and West Virginia to slow the Opioid Epidemic. The report looked at oversight of Opioid prescribing and use in these states. It did not make any recommendations, but instead compared the strategies used by each state. Click here for the full report.

• Records show that by 2006, as the death rate accelerated across the country, a handful of obscure generic-drug manufacturers were selling the bulk of opioid pills flooding the country. Click here for the Washington Post investigative report.

Some States Are Looking to Cap Medicaid Funding
Many Republican states have begun the process of shifting their payments from the federal government for Medicaid towards block-grant funding. This limits the amount that a state can receive for their Medicaid programs to an amount set by the federal government, or in some cases by the state. Currently, Medicaid is an open-ended entitlement program, which guarantees that any person who meets the criteria for the program will receive it’s benefits. With block-grant funding, states would be forced to engage in enrollment freezes or cutbacks. Click here for a Pew report on the subject.

States Are Grappling With How to Pay For Long-Term Care
As the U.S. population ages, paying for long-term care will be a challenge since half of all people 65 and over will need such care at some point. Ninety percent of Americans have no long-term care insurance, and a year long stay in a long-term facility can cost more than $90,000 per year on average. More and more of these payments are falling on Medicare and Medicaid, as states look for ways to fund this care. Click here for a Pew Trusts article on the subject.

GAO: More Oversight Needed To Guard Against Nursing Home Abuse
Such incidents more than doubled from 430 in 2013 to 875 in 2017. The largest increase was seen in severe cases, though the GAO report noted these tend to still be rare. The watchdog agency also found gaps in CMS oversight that can lead to delays or missed referrals of complaints, and also that CMS has not issued guidance on what facilities should include when self-reporting incidents of abuse to state agencies. HHS agreed with GAO’s six recommendations and noted how it would implement new changes. The report comes as the Senate Finance committee investigates the industry. At a hearing last week, Iowa Senator Chuck Grassley said the Finance Committee should revisit programs of the Elder Justice Act, provisions passed as part of Obamacare to prevent elder abuse. Click here for the GAO report.

House Subcommittee Hearing Sheds Light On JUUL’s Targeting of Children
The vaping company JUUL Labs has come under increasing scrutiny over the last year for the popularity of its nicotine vaping devices among children. JUUL has ardently defended itself, touting the company’s efforts to slow this vaping epidemic. The House Government Oversight Subcommittee hearing last week revealed the troubling tactics that JUUL used in its efforts to sell vaping products to children and teens.  The revelations included JUUL’s partnership with schools that allowed for its direct advertising to children, its presentations to students (in one teen’s testimony, he claimed that a JUUL representative told his 9th grade class that JUULs were “totally safe”), and its use of social media to target children. Click here for the Subcommittee memorandum. Click here for a New York Times article detailing the hearings.

• U.S. Food and Drug Administration last week announced the launch of its first e-cigarette prevention TV ads educating kids about the dangers of e-cigarette use, click here.

As Income Inequality Grows, So Does Health Inequalities
A study out of the University of California determined that from 1993 to 2017, as income inequality grew higher, health equity decreased. It is significant to note that it attributed only 10 to 20 percent of the health inequity to healthcare services, with the rest primarily resulting from social determinants of health. It raises the question of the importance of investing in affordable housing and nutrition to improve overall health. For the entire study click here.

Physical Activity Gender Gap 
According to a recent Lancet study 31.7% of women are considered inactive, while only 23.4% of men were not meeting the same recommendations. The gender gap begins at a young age, when girls face the stereotypes of playing certain sports or participating in certain physical activities. The report also evaluated how effective multimedia interventions can be to increase physical activity, particularly in young girls. Yet, unless these interventions can drastically change current trends, the WHO goal to reduce inactivity by 10% by 2025 is unlikely to be reached.  To review the full study, click here.

Some States Have Begun to Allow Mental Health Days for Students
In a win for mental health advocates, Oregon and Utah have passed legislation that allows students to take mental health days off of school just as they would take sick days. As depression and anxiety, among other mental health problems are on the rise for children and teenagers, advocates and hope that this will help curb the ongoing mental health crisis. For the full report, click here.

The Bathroom Scale “Is Not Everything”
Carrying extra belly fat — that is, having an “apple” body shape — was tied to higher mortality risk for postmenopausal women, researchers reported. Compared with women of normal weight as defined by BMI category — and possessing no central obesity as measured by waist circumference — those with normal weight who did have central obesity had about 30% increased risk for all-cause mortality. Click here for the report.