Health Care Policy Update – Weekly Wrap-up and What’s Ahead


 What’s Ahead: This Week

 Notable Policy Events –

  • Tuesday, March 19
    • Brookings Institution, “A Conversation with Departing FDA Commissioner Scott Gottlieb on His Tenure and Policy Reforms.” Additional information: https://brook.gs/2HiLQYV
    • HHS Office of the National Coordinator for Health IT (ONC), “Health Information Technology Advisory Committee (HITAC) Meeting on Interoperability, Privacy and Security, and Patient Access.” Additional information: https://bit.ly/2HpwfXr
  • Wednesday, March 20
    • National Academies of Sciences, Engineering, and Medicine (NAM), “Report of the Committee on Medication-Assisted Treatment for Opioid Use Disorders.” Additional information: http://bit.ly/2UGYS5v
    • American Hospital Association (AHA), “Building Coordinated Networks of Care in the Digital Age: How Contemporary Market Forces are Changing Health Care.” Additional information: https://bit.ly/2VYmUJB
  • Thursday, March 21
    • Cato Institute, “Harm Reduction: Shifting from a War on Drugs to a War on Drug-Related Deaths.” Additional information: https://bit.ly/2VTkv2O
    • Bipartisan Policy Center (BPC), “Overcoming Health Care Challenges in Immigrant Communities.” Additional information: https://bit.ly/2HyAU8I
  • Friday, March 22
    • Brookings Institution, “Emerging Policy Solutions to Surprise Medical Bills.” Additional information: https://brook.gs/2Szxv07

 

Weekly Wrap-Up: Notable Health Care Developments From Last Week

 Legislative Activity –

  • On March 11, Reps. Tipton (R-CO) and Crow (D-CO) introduced the Veterans Improved Access and Care Act (H.R. 1674), which would authorize the Department of Veterans Affairs (VA) to establish a pilot program to expedite the hiring of licensed medical professionals in locations where there are shortages of available specialists. Sens. Peters (D-MI) and Gardner (R-CO) introduced companion legislation in the Senate (S. 773). Press release: https://bit.ly/2SWOnJP
  • On March 12, Reps. Kind (D-WI) and Kelly (R-PA) introduced the Personal Health Investment Today (PHIT) Act (H.R. 1679), which would allow for the use of pre-tax dollars in an individual Health Savings Account to cover expenses related to organized individual and team sports, fitness and exercise, recreation, and other physical activities. Press release: https://bit.ly/2TEwViq
  • Also on March 12, Reps. Courtney (D-CT), Thompson (R-PA), and 13 bipartisan cosponsors introduced the Improving Access to Medicare Coverage Act of 2019 (H.R. 1682), which would amend the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility (SNF) services under Medicare. Sen. Brown (D-OH) and 18 bipartisan cosponsors introduced companion legislation in the Senate (S. 753). Press release: https://bit.ly/2VTVdBw
  • Also on March 12, Rep. Bass (D-CA) introduced the Physician Assistant Education Public Health Initiatives Act of 2019 (H.R. 1685), which would authorize a demonstration to expand access to FQHCs and other underserved settings for PA clinical training and reauthorize the Primary Care Training and Enhancement grant program to direct more PA graduates to primary care practice. Press release: https://bit.ly/2T5fyC7 Bill text: https://bit.ly/2F4fihG
  • Also on March 12, Rep. Bass (D-CA) introduced the Physician Assistant Higher Education Modernization Act of 2019 (H.R. 1686), which would adjust the annual unsubsidized direct loan limit for PA students, develop a program to expand PA education programs for institutions that serve rural areas, and make HBCUs eligible to receive additional grants for PA education programs. Press release: https://bit.ly/2T5fyC7 Bill text: https://bit.ly/2u8Ockp
  • Also on March 12, Senate Aging Committee Chair Collins (R-ME) and Sen. Klobuchar (D-MN) introduced the Alzheimer’s Caregiver Support Act (S. 740), which would authorize grants to public and non-profit organizations to expand training and support services that improve caregiver health and delay long-term care facility admissions. Press release: https://bit.ly/2VY3TH5
  • Also on March 12, Sens. Smith (D-MN), Moran (R-KS), Murphy (D-CT), and Wicker (R-MS) introduced the Cancer Drug Parity Act (S. 741), which would stop insurers from charging more for prescribed oral cancer medicine than traditional IV chemotherapy. Rep. Higgins (D-NY) and 17 bipartisan cosponsors introduced companion legislation in the House (H.R. 1730). Press release: https://bit.ly/2Hym5mB Bill text: https://bit.ly/2S2b5Ak
  • Also on March 12, Senate HELP Committee Ranking Member Murray (D-WA), Sen. Duckworth (D-IL) and 9 Democratic Senators introduced the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act (S. 758), which would lift the prohibition in current law preventing women who receive their health coverage through government-sponsored plans from obtaining legal health care services. Companion legislation was introduced in the House by Reps. Lee (D-CA), Schakowsky (D-IL), and DeGette (D-CO) (H.R. 1692). Press release: https://bit.ly/2O8jXU3
  • On March 13, Sens. Peters (D-MI) and Gardner (R-CO) introduced the Telehealth Innovation and Improvement Act (S. 773), which would require the Department of Health and Human Services (HHS) to allow eligible hospitals to test telehealth services through the Center for Medicare and Medicaid Innovation (CMMI). Press release: https://bit.ly/2Je2bjw
  • Also on March 13, Senate Veterans Affairs Committee Ranking Member Tester (D-MT) and 23 bipartisan cosponsors introduced the Commander John Scott Hannon Veterans Mental Health Care Improvement Act (S. 785), which seeks to bolster VA’s mental health workforce and increase rural or hard-to-reach veterans’ access to VA care while making sure that veterans have access to alternative and local treatment options like animal therapy, outdoor sports, yoga, and acupuncture. Press release: https://bit.ly/2W06ArS Bill text: https://bit.ly/2TE6qtq
  • On March 14, Reps. Sewell (D-AL), Katko (R-NY), Torres Small (D-NM), and Davis (R-IL) introduced the Resident Physician Shortage Act (H.R. 1763), which would increase the number of Medicare-supported residency positions by 3,000 per year for five years. Press release: https://bit.ly/2TNID9E Bill text: https://bit.ly/2Y1IDlx
  • Also on March 14, Rep. Payne (D-NJ) and 11 bipartisan cosponsors introduced the Colorectal Cancer Detection Act of 2019 (H.R. 1765), which would extend Medicare coverage to include FDA-approved blood-based colorectal cancer screening tests. Press release: https://bit.ly/2UEsgJw
  • Also on March 14, Rep. Matsui (D-CA) and 34 bipartisan cosponsors introduced the Excellence in Mental Health and Addiction Expansion Act (H.R. 1767), which would ensure that the Certified Community Behavioral Health Centers that were established through the Excellence in Mental Health and Addiction Act will be funded for two additional years. Sens. Stabenow (D-MI) and Blunt (R-MO) introduced companion legislation in the Senate (S. 824). Press release: https://bit.ly/2JiXHbg
  • Also on March 14, Rep. Carter (R-GA) and 5 bipartisan cosponsors introduced H.R. 1781, which would provide the Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) with access to certain drug payment information, including rebates. Sens. Cortez Masto (D-NV), Cornyn (R-TX), Cassidy (R-LA), and Carper (D-DE) introduced companion legislation in the Senate (S. 801). Press release: https://bit.ly/2uaElLc Bill text: https://bit.ly/2ua1SvN
  • Also on March 14, Sens. Shaheen (D-NH) and Collins (R-ME) introduced the Expanding Access to Diabetes Self-Management Training Act (S. 814), which would improve access to diabetes outpatient self-management training services. Press release: http://bit.ly/2JlUDuZ
  • Also on March 14, Senate Finance Committee Chair Grassley (R-IA) and Sens. Klobuchar (D-MN), Lee (R-UT), and Durbin (D-IL) introduced the Short on Competition Act (S. 844), which would allow for the expedited approval of generic prescription drugs and temporary importation of prescription drugs in the case of marginally competitive drug markets and drug shortages. Press release: http://bit.ly/2CwVvr1

President’s FY 2020 Budget –

 ACA and Individual Market –

  • On March 11, CMS released a public list of third-party entities approved to use an enhanced direct enrollment pathway for insurance coverage through the federally-facilitated exchange. List: https://go.cms.gov/2SyEB0x
  • On March 12, CMS released guidance on 1332 State Relief and Empowerment Waiver Concepts, including state-specific premium assistance, adjusted plan options, account-based subsidies, and risk stabilization strategies. Guidance: https://go.cms.gov/2u5YP7D
  • On March 13, House Energy & Commerce Committee Chair Pallone (D-NJ), Health Subcommittee Chair Eshoo (D-CA), and Oversight & Investigations Subcommittee Chair DeGette (D-CO) launched an investigation into the practices of short-term, limited duration insurance (STLDI) health plans and brokers by requesting documents and information from 12 companies that sell or assist consumers in enrolling in such plans. Press release with links to letters: https://bit.ly/2TFScaL

 Medicare and Medicaid –

  • On March 11, CMS and Centers for Disease Control and Prevention (CDC) announced a free online training course in infection prevention and control for nursing home staff in long-term care settings. Fact sheet: https://go.cms.gov/2TxBtac
  • On March 12, Senate Finance Committee Ranking Member Wyden (D-OR) sent a letter to CMS Administrator Verma, calling on CMS to identify additional steps that can be taken to ensure that children in Medicaid and CHIP receive all recommended vaccines. Press release: https://bit.ly/2Hkrcrz Letter: https://bit.ly/2TaC8Jw
  • Also on March 14, CMS released new state tools and guidance that provide standard monitoring metrics and recommended research methods for section 1115 demonstrations that test new approaches to Medicaid eligibility and coverage policies. Press release: https://go.cms.gov/2JfcEeg CMS Administrator Verma blog: https://go.cms.gov/2TDCm17 Guidance: https://bit.ly/2TMQep4
  • Also on March 14, Arkansas released February 2019 enrollment data on the Arkansas Works Program. The data show that, of the 10,584 individuals disenrolled from the Medicaid program since the rollout of the state’s work requirements, only 1,889 have reapplied for coverage in 2019. Data: https://bit.ly/2Fgw12I
  • On March 15, CMS approved Ohio’s 1115 waiver to add a work requirement as a condition of eligibility to the state’s Medicaid program. Approval: https://bit.ly/2W6igt7
  • Also on March 15, Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2019 Report to Congress, which focuses on hospital payment policy – specifically disproportionate share hospital (DSH) and upper payment limit (UPL) supplemental payments. Press release: https://bit.ly/2T2VbFK Report: https://bit.ly/2HxaAfo
  • Also on March 15, Medicare Payment Access Commission (MedPAC) released its March 2019 Report to Congress, which makes payment policy recommendations for nine provider sectors in FFS Medicare and reviews the status of the Medicare Advantage and Part D programs. Press release: http://bit.ly/2TRvrAI Fact Sheet: http://bit.ly/2TUWJGm Report: http://bit.ly/2JmN5YT

 Payment and Delivery System Reform –

  • On March 12, CMS posted materials from the February 27 and March 7 overview webinars of the Emergency Triage, Treat, and Transport (ET3) model. Materials: https://bit.ly/2U1nOnT
  • On March 14, CMS posted materials from the February 21 notice of funding opportunity and application review webinar on the Maternal Opioid Misuse (MOM) model. Materials: https://bit.ly/2FapMwi

 Drug and Medical Device Prices and Regulation –

  • On March 12, Senate Finance Committee Chair Grassley (R-IA) and Ranking Member Wyden (D-OR) invited executives from five PBMs – Cigna, CVS Caremark, Humana, OptumRx, and Prime Therapeutics – to testify before a committee hearing on April 3. Press release with links to letters: https://bit.ly/2FeNYid
  • On March 14, CMS updated its Drug Spending Dashboards with data for 2017, which shows that, from 2013 through 2017, prescription drug spending grew 10.0 percent in Part B, 14.8 percent in Medicaid, and 10.6 percent in Part D. Press release: https://go.cms.gov/2T8rumO Dashboards: https://go.cms.gov/1T0FBWD
  • Also on March 14, FDA released additional guidance for industry on strategies that can support the development of precision medicines as well as guidance on risk-based monitoring through the incorporation of more computerized systems for effective oversight. Press release: https://bit.ly/2Y1iT8U Precision medicine guidance: https://bit.ly/2Ff31IL Risk-based monitoring guidance: https://bit.ly/2Jguy0s

 Substance Use and Mental Health –

  • On March 11, National Institutes of Health (NIH) released a study finding that nearly one-third of youths ages 10 to 12 years screen positive for suicide risk during ER visits. Press release: https://bit.ly/2EV7eQk
  • On March 12, HHS Office of Inspector General (OIG) released a fact sheet on West Virginia’s oversight of opioid prescribing and monitoring of opioid use. The fact sheet, along with information from 7 additional states, will be summarized in a report to CMS. Fact sheet: https://bit.ly/2T8GoJy
  • On March 13, Substance Use and Mental Health Services Administration released a report on Mediation-Assisted Treatment (MAT) in the criminal justice system. Report: http://bit.ly/2JhopRy
  • On March 13, FDA announced a draft compliance policy with respect to e-cigarette regulation, refocusing FDA’s attention to preventing the access and appeal of nicotine products to kids. Press release: https://bit.ly/2VWpMqk
  • Also on March 13, Senate Finance Committee Ranking Member Wyden (D-OR) penned a letter to the American Academy of Pain Medicine (AAPM), inquiring about potential ties between the organization and opioid manufacturers. Press release: https://bit.ly/2Y1YUHs Letter: https://bit.ly/2Ckq6HY

 Health Data and IT –

  • On March 12, HHS launched an app to help patients prepare and organize questions and other helpful information prior to medical visits. The Question Builder app is available on the App Store and Google Play. Press release: https://bit.ly/2TNSkVA

 Veterans and Military Health –

  • On March 12, VA announced a precision medicine partnership with Sanford Health to provide free screening and improve patient care for cancer survivors. Press release: https://bit.ly/2TENg6x
  • On March 14, House Veterans’ Affairs Committee Chair Takano (D-CA) penned a letter to VA Secretary Wilkie notifying him that the Committee is expanding the scope of its investigation into the potential influence of the on VA beyond the “Mar-a-Lago Three.” Press release with text of letter: https://bit.ly/2Y8VsL8
  • On March 15, VA highlighted research finding that veterans with multiple mental health conditions are seeing positive outcomes after receiving care in a VA outpatient mental health clinic. Press release: https://bit.ly/2XZGFlW Study: https://bit.ly/2Y2I62H

 Misc. –

  • On March 14, the Presidential Advisory Council on HIV/AIDS announced 9 new members. Press release: https://bit.ly/2u8u3uW