The following update was provided for our members by Hall Render, NOSORH Legislative Liaison:
State Office of Rural Health Bill Nears Finish Line in Senate
During the week of March 19, Senate leadership hotlined (fast-tracked without debate) the State Offices of Rural Health Reauthorization Act of 2018 (S. 2278) through the Senate. Without any of the 100 members objecting, the SORH bill is now set to pass the Senate.
The Senate parliamentary procedure came weeks after the Senate Health, Labor, Education and Pensions (HELP) Committee voted to advance the bill out of committee. The bill advanced after an amendment was agreed to which increases the authorization of appropriations level to $12,500,000 for each of the fiscal years 2018 through 2022. The bill passed the committee unanimously.
Major Spending Bill Passes Congress
On March 23, President Trump signed a major $1.3 trillion spending bill into law, which keeps the government funded through September 30, 2018. The bill passed the House 256-167 and the Senate 65-32. In both bodies, the measure received the support of a majority of members from each party. In the Senate, unanimous consent was needed from all senators to waive procedural rules and set up votes before Friday’s midnight deadline.
The bill includes a total of $78 billion ($10 billion above FY 2017) for the Department of Health and Human Services. Within the HHS funding, the Centers for Medicare & Medicaid Services (“CMS”) received $4 billion in funding for administrative expenses, the Health Resources and Services Administration received $7 billion and the Substance Abuse and Mental Health Administration received $5 billion. The legislation includes nearly $4 billion in resources to combat the opioid crisis through investing in treatment, prevention and law enforcement efforts. More than $2.3 billion in funding is provided for mental health programs and other training.
Rural communities will see a $135 million increase in healthcare program funding, including $100 million for drug addiction treatment and prevention. In addition, Congress appropriated $10 million annually for the State Offices of Rural Health and $49.6 million for rural hospital flexibility grants.
Two provisions that were not included in the bill are stabilization of the ACA’s health insurance markets and providing coverage for patients with high medical costs. The first measure, known as the Alexander-Murray provision, would have reinstated government subsidies paid to health insurers. The second would have provided funding to help states set up high-risk insurance pools to provide coverage for people with high medical costs. Though the ACA stabilization proposal had already been negotiated on a bipartisan basis, Republicans wanted to include language that would ban federal funds from being used for abortions, which Democrats said was a non-starter.
House Energy and Commerce Committee Reviews Solutions to Combat the Opioid Crisis
On the week of March 19, the House Energy and Commerce Health Subcommittee wrapped up a two-day hearing examining 25 bipartisan bills addressing the opioid crisis. The legislation focused on prevention and public health solutions. Energy and Commerce Chairman Greg Walden (R-OR) stated “The unprecedented plague of opioid addiction and substance use disorder in our country requires an unprecedented response.” Legislation reviewed included Jessie’s Law, introduced by Reps. Tim Walberg (R-MI) and Debbie Dingell (D-MI), which would help ensure doctors have access to a consenting patient’s prior history of addiction in order to make fully informed care and treatment decisions.
The Poison Center Network Enhancement Act of 2018 (H.R. 5329), authored by Reps. Susan Brooks (R-IN) and Eliot Engel (D-NY), was discussed to reauthorize the important network of centers within the National Poison Data System that offer free, confidential, expert medical advice 24 hours a day, seven days a week. Oftentimes these programs serve as the primary resource for poisoning information and help reduce emergency room visits. Lawmakers also spent a lot of time debating legislation known as the Overdose Prevention and Patient Safety Act (H.R. 3545) introduced by Reps. Markwayne Mullin (R-OK) and Earl Blumenauer (D-OR). That measure would modernize substance use disorder treatment records to permit records to be shared in accordance with the Health Insurance Portability and Accountability Act for the purposes of treatment. It would also increase penalties in the event of disclosure, add breach notification requirements and provide discrimination prohibitions.
Senate Committee Hearing Assesses 340B Program
On March 15, the Senate HELP Committee held a hearing to examine the 340B drug discount program as some stakeholders have urged lawmakers to scale back its reach. HELP Committee Chairman Lamar Alexander (R-TN) said the purpose of the hearing was to learn more about the program and “how it might be improved so that hospitals and clinics can continue to provide low-income patients with help to afford their health care.” Chairman Alexander said to expect the committee to hold another 340B hearing soon, likely featuring a representative from the Health Resources & Services Administration (“HRSA”), which oversees the program.
The hearing showed a clear dividing line between Senate Democrats and Republicans on the 340B program, with Democrats advocating that savings from the program are desperately needed for the poorest populations and Republicans stating the program is being abused and needs to be reformed. Sen. Bill Cassidy (R-LA) introduced legislation for expansive changes to the 340B program, such as implementing a two-year moratorium on certain new 340B hospitals and outpatient departments and adding new reporting requirements for hospitals. By contrast, Sen. Patty Murray (D-WA) admitted that calls for transparency and accountability are appropriate, but the 28.5 percent cut CMS made last year for certain 340B drugs was “unnecessary” and fails to address skyrocketing drug costs.
House Ways and Means Committee Holds MACRA Hearing
On the week of March 19, the House Ways and Means Health Subcommittee held a hearing on implementing the Medicare Access and CHIP Reauthorization Act (“MACRA”) of 2015, which featured witnesses from CMS. Demetrios Kouzoukas, Principal Deputy Administrator and Director of the Center for Medicare, testified that the full promise of MACRA has not been realized as too few physicians and clinicians are participating in alternative payment models, and far too many clinicians find the law’s reporting requirements too burdensome. He laid out a plan to move forward on four areas of emphasis: “giving consumers greater control over health information through interoperable and accessible health information technology; encouraging transparency from payers and providers; using experimental models in Medicare and Medicaid to help patients drive value and quality throughout the entire system; and removing government burdens that impede this transformation.”
Providers and industry stakeholders have urged Congress to improve fairness and reduce burdens under the program. In the hearing, Kouzoukas urged stakeholders to work with CMS to increase innovation and submit promising ideas to the Innovation Center.
Health Care Price Transparency Working Group Created By Senators
A bipartisan group of senators are launching a working group to tackle the high price of health care. They are seeking feedback from patients, providers and insurers to help craft legislation to make health care pricing more transparent. Led by Sen. Bill Cassidy (R-LA), the group includes Sens. Todd Young (R-IN), Chuck Grassley (R-IA), Michael Bennet (D-CO), Tom Carper (D-DE) and Claire McCaskill (D-MO). The group is seeking data on what information consumers currently have about prices and out-of-pocket costs, who should ultimately be responsible for providing information to consumers and how to ensure transparency requirements don’t place unnecessary burdens on health care stakeholders.