HELP Committee Leaders Release Draft Bill Targeting Health Care Priorities

Senate Health, Education, Labor, and Pensions (“HELP”) committee leaders Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) released a wide-ranging draft bill addressing health care issues such as surprise medical billing, prescription drug costs and urgent public health concerns. The proposal is separated into five main sections: 1) approaches to tackling balance or “surprise” medical billing; 2) reducing prescription drug costs; 3) increasing transparency in health care; 4) bolstering public health; and 5) improving the exchange of health IT. According to Sen. Alexander, legislation combining these proposals with ones from the Senate Finance Committee will be marked up this summer with the goal of having it reach the president’s desk by July.

For surprise medical bills, patients would be tasked with paying bills as if they are receiving in-network care when they are unexpectedly treated out-of-network in an emergency situation or at an in-network facility. The draft lays out three options to address payment disputes involving surprise medical bills. The first approach includes that an in-network facility must guarantee that all providers are considered in network. A second approach would implement an independent arbitration system for bills costing more than $750, and, for anything below that, the provider would be paid a median rate based on contracted prices in their area. A third approach would pay the provider based on the median contracted rate in the area and skips the arbitration process.

The proposal includes several measures addressing public health concerns, including combating vaccine misinformation and maternal mortality. To increase transparency in the health care system, the draft proposes to require plans to maintain updated provider directories. Plans and providers would also be required to give patients estimates of their expected out-of-pocket costs within 48 hours of a request. The draft also contains many drug pricing provisions, such as speeding low-cost generic drugs to market.

The committee is requesting comments on the discussion draft. Comments must be submitted to [email protected] by 5 PM on Wednesday, June 5, to be considered. A section-by-section summary can be found here.

House Committees Issue Bipartisan Drug Pricing Proposal

Leaders from the Ways and Means and Energy and Commerce committees released draft legislation designed to cap out-of-pocket costs in Medicare Part D on Thursday. It would also modernize incentives in the program, bringing the government’s share of catastrophic coverage from 80 percent to 20 percent over four years, gradually shifting more costs onto plans. This plan is supported by lawmakers on both sides of the aisle, as well as the administration. Stakeholders have predicted that shifting the burden to insurers would pressure them to choose lower-priced drugs in formularies and negotiate better deals with drug companies. However, the bill does not appear to shift drugmakers’ burden for covering drug costs.

Committee leaders are soliciting comments on this draft, as well as other specific questions found here, until Thursday, June 6, 2019. Comments should be send to [email protected].

Administration Releases Controversial Care Rule

Earlier today, HHS released a proposed rule to roll back protections under Section 1557 of the Affordable Care Act (“ACA”) related to sex discrimination in health care. The policy prohibited health care providers from discriminating against transgender patients. The new rule says HHS will repeal the Obama administration’s definition of sex protections in order to make its regulations “more consistent” with other agencies. HHS Director of the Office for Civil Rights Roger Severino stated this change will bring the regulations in line with what lawmakers originally intended, before the definition of gender was broadened.

HHS states that the proposed revisions will eliminate $3.2 billion in unneeded paperwork burdens associated with Section 1557 of the ACA. This proposal is part of a larger effort by the Trump administration to define gender restrictively. A fact sheet on the proposed rule can be found here.

Health-Related Bills Introduced This Week

Rep. Mark Green (R-TN) introduced H.R. 2990 to amend Title XVIII of the Social Security Act to permit states to designate without any mileage limitations facilities that are located in rural areas as critical access hospitals.

Rep. Nanette Diaz Barragan (D-CA) introduced H.R. 2951 to amend Title XVIII of the Social Security Act to provide for coverage of dental services under the Medicare program.

Sen. Michael Enzi (R-WY) introduced S. 1688 to amend the Public Health Service Act to provide for the full disclosure of billing and service information to patients. Sen. Enzi also introduced S. 1681 to educate health care providers and the public on biosimilar biological products.

Sen. Chuck Grassley (R-IA) introduced S. 1647 to amend Title V of the Social Security Act to extend funding for family-to-family health information centers.

Rep. Brian Fitzpatrick (R-PA) introduced H.R. 2915 to amend the Federal Food, Drug, and Cosmetic Act to require physicians and physician’s offices to be treated as covered device users required to report on certain adverse events involving medical devices.

Sen. Brian Schatz (D-HI) introduced S. 1618 to amend the Public Health Service Act to expand the capacity to improve health outcomes and increase access to specialized care.

Next Week in Washington

Congress will be on Memorial Day recess next week. When they return, House leaders will focus on moving a bipartisan disaster relief package that was recently passed in the Senate but failed to pass in the House after a Republican member from Texas objected to passing the measure by voice vote. This Week in Washington will return on June 7 after Congress is back to work but will publish should health care developments occur.