The following update was provided for our members by Hall Render, NOSORH Legislative Liaison:

NOSORH Makes October Hill Visits
On October 25-26, NOSORH and SORH visited Washington DC to meet with Hill leaders. The group met with House and Senate offices to discuss an upcoming SORH reauthorization bill being introduced in November and began discussions on fiscal year (FY) 2019 appropriations.

Hatch-Brady Proposal Introduced as Alternative Market Stabilization Plan
On October 24, Senate Finance chairman Orrin Hatch (R-UT) and House Ways and Means chair Kevin Brady (R-TX) proposed a bicameral agreement for ACA market stabilization. Similar to the Senate HELP Committee proposal released last week, Hatch-Brady includes two years of funding for the ACA’s cost-sharing subsidies. The Hatch-Brady plan would also waive the ACA’s individual mandate for five years. Further, employers would not be penalized through the employer mandate if coverage was not provided for the previous two years.

Both Senate proposals were introduced shortly after the White House announced that it will no longer make the ACA’s cost-sharing reduction payments. Eighteen Democratic state attorneys general sued to force the administration to keep making the payments until the courts can decide whether it is legal for the funds to be cut unilaterally. However, U.S. District Court Judge Vince Chhabria ruled last week that the administration does not have to continue making the payments.

For Republicans to pass one of these market stabilization bills, they would need to secure 60 votes in the Senate. As it stands, the Alexander-Murray bill appears to have 60 votes in the Senate, but the vote count on Hatch-Brady is unclear. The sticking point for Hatch-Brady would be that Democrats are expected to oppose any waiver of the individual mandate. Thus, it is likely that Republicans will either have to pass Alexander-Murray, with some minor modifications, or not pass anything at all.

Opioid Crisis Declared National Public Health Emergency
On October 26, President Trump officially declared the opioid epidemic a national public health emergency under federal law. The administration took action because drug overdoses are now the leading cause of death by injury in the United States, topping both traffic crashes and gun-related violence. The directive included action items, such as opioid training for prescribers and lifting a restriction in some states on inpatient treatment. However, there was no new funding announced to address the emergency.

The administration established the President’s Commission on Combating Drug Addiction and the Opioid Crisis in March of 2017. The Commission noted the fastest way to increase treatment would be to waive the prohibition on using Medicaid funds to pay for inpatient substance abuse treatment. The administration’s directive indicates it will follow the Committee’s recommendation by allowing many states to waive this prohibition. Additionally, the White House said it will extend the use of telemedicine to address the opioid epidemic by allowing for the remote prescribing of medicine used for the treatment of substance abuse and mental health.

White House, Congress Continue Scrutiny of 340B Program
On October 6, the White House Office of Management and Budget (OMB) began review of the proposed rule on 340B ceiling prices and manufacturer penalties. The 340B rule was originally proposed by HRSA in the final days of the Obama Administration and has been delayed multiple times by the Trump Administration. The rule sets penalties for manufacturers that “knowingly and intentionally” overcharge 340B providers and also includes a formula for calculating discounts.

Over the past three months, the House Energy and Commerce Committee has conducted multiple hearings on the issue and expressed repeated concerns over program growth in recent years. On October 18, the Committee held a hearing examining how 340B entities are using the program, including how much money is saved, how entities track their savings, the types of drugs purchased and prescribed within the program and how those savings are used to improve patient care.

Though the 340B program received praise for supporting many other programs through savings, Republicans raised concerns over lack of transparency and data on the program since Congress is responsible for making sure the program is running correctly. OMB is still reviewing the CY 2018 OPPS final rule that is expected to include changes to the 340B payment structure. The proposed rule had hospitals being paid 22.5% less than the average sales price for drugs acquired under the 340B program, which is a major change from the current 6% on top of the average sales price.

Rural Health-Related Bills Introduced This Week
Sen. Michael Bennett (D-CO) introduced the Medicare-X Choice Act (S.1970). The bill intends to establish a public insurance plan offered on the individual and small business health exchanges. Initially, Medicare-X would only be available in rural areas, but the goal is to have Medicare-X expand to all places by 2023.

Rep. Kristi Noem (R-SD) introduced the Rural Home Health Extension and Regulatory Relief Act. This legislation would amend title XVIII of the Social Security Act to delay application of, transition to, and limit savings for the home health groupings model under the Medicare home health prospective payment system.

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