Policy Update

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

Senate Passes SORH Reauthorization Bill

On July 24th, the Senate passed The State Office of Rural Health Reauthorization Bill of 2018 (S. 2278).  The measure, which was introduced in January by Senators Pat Roberts (R-KS) and Heidi Heitkamp (D-ND), extends the program through FY 2022 and revises the grant program for State Offices of Rural Health (SORHs) to make it mandatory for HHS to issue the grants instead of discretionary.  Hall Render and NOSORH will now encourage House leadership to hold a House vote on the Senate-passed bill or mark up the House version (H.R. 5641).

With the House on recess through Labor Day, the next legislative window for the House to advance the SORH reauthorization bill will be the September-October work period.  The House is currently scheduled to be in session then through mid-October.

Labor HHS Spending Bill Continues to Advance in Congress

On July 23rd, the House Appropriations Committee passed the FY 2019 HHS funding bill (H.R. 6470).  The bill increases SORH funding to $11 million, a million dollar increase over FY 2018. The bill has been placed on the House calendar and could be voted on as early as September when the House returns in September.

While the House is gone during August, the Senate continues work on a spending deal that includes the Labor-HHS appropriations bill (S. 3158).  The Senate bill includes $10 million in annual funding for the SORH Program.  The Senate may bundle the contentious Labor-HHS bill with the defense spending bill to gain bipartisan support.

340B Changes Considered by House

On July 11th, the House Energy and Commerce Health Subcommittee held a spirited, four-hour hearing on 340B reform. The Subcommittee set out to discuss 15 different legislative measures, looking at previously introduced 340B bills and discussion drafts authored by committee members that ranged from increased reporting requirements on how savings are spent to clarification of the program’s intent.

The Subcommittee also heard testimony from industry leaders who united around the need for greater accountability, but warned against measures that would restrict patient access to affordable drugs. Charles Daniels, pharmacist-in-chief and associate dean at the University of California, San Diego, stressed that cuts to the 340B program would negatively affect his health system’s ability to serve indigent patients.

Although the hearing was contentious at times, there was bipartisan agreement among members over clarifying the program’s intent, laying out well-defined eligibility regulations, and eliminating the risk of duplicate discounts through Medicaid’s drug rebate program. Even though there appears to be significant momentum in the House for 340B reform, it is still unlikely that a legislative measure can get the 60 votes needed to pass the Senate.

House Holds Hearing on MIPS Implementation

On July 26th, the House Energy and Commerce Health Subcommittee held a hearing continuing its review of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The Merit-based Incentive Payment System (MIPS) is part of Medicare’s two-track Quality Payment Program, which requires a hefty amount of data reporting but limits the risk of financial losses. The program replaced the deeply unpopular sustainable growth rate formula. Some experts, including the Medicare Payment Advisory Commission, have called for a complete replacement of MIPS.

All of the physicians who testified at the hearing agreed that MIPS is better than the previous system. However, the physicians also told the subcommittee that with only 42 percent of U.S. physicians participating in MIPS, doctor groups that invested heavily in health IT and care managers to raise their scores are seeing little upside. In 2019, Medicare will give high performers a boost of no more than 2%, although MACRA called for rewards of up to 7%. Other witnesses testified that some measures doctors are required to report to CMS are meaningless and sometimes irrelevant to their practices.

Chairman Michael Burgess (R-TX) said he would consider holding a hearing with HHS officials and industry stakeholders on the issue.

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