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


What’s Ahead: This Week

Hearings –

  • Monday, September 25
    • Senate Finance Committee, “Hearing to Consider the Graham-Cassidy-Heller-Johnson Proposal.”
  • Tuesday, September 26
    • Senate Homeland Security & Government Affairs Committee, “Block Grants: How States Can Reduce Health Care Costs.”
    • House Committee on Veterans Affairs, Subcommittee on Health, “Legislative Hearing on: H.R. 93; H.R. 501; H.R. 1063; H.R. 1066; H.R. 1943; H.R. 1972; H.R. 2147; H.R. 2225; H.R. 2327; and, a draft bill to make certain improvements in VA’s Health Professionals Educational Assistance Program.”
  • Wednesday, September 27
    • Senate Veterans Affairs Committee, “What More Can Be Done to Prevent Veteran Suicide?”

 

Notable Policy Events –

  • Sunday, September 24 – Thursday, September 28
    • AHIP, “National Conferences on Medicare, Medicaid & Duals”, Additional information: http://bit.ly/2xtxMpa
  • Monday, September 25
    • National Press Club, “Mental Health & the Opioid Crisis: A Headliners Newsmakers Event.” Additional information: http://bit.ly/2wRd6nR
  • Tuesday, September 26
    • Politico, “The Doctor-Patient [and Government] Relationship.” Additional information: http://politi.co/2wF8Iba
    • Brookings Institution, “The Medicare Physician Fee Schedule and Alternative Pay Models.” Additional information: http://brook.gs/2wS2LrG
  • Wednesday, September 27
  • Friday, September 29
    • American Enterprise Institute, “Unbundling and Rebundling Health Benefits: Innovative Rethinking of Health Care Delivery and Competition.” Additional information: http://bit.ly/2wRuQ2j

 

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

 Legislative Activity –

  • On September 18, Senate Finance Committee Chair Hatch (R-UT) and Ranking Member Wyden (D-OR) introduced the Keeping Kids’ Insurance Dependable and Secure (KIDS) Act (S. 1827), which would extend funding for the Children’s Health Insurance Program for five years. Press release: http://bit.ly/2wFfKwK Bill text: http://bit.ly/2wF2Lex
  • On September 19, Sens. Grassley (R-IA), Menendez (D-NJ), Blunt (R-MO), Casey (D-PA), Gardner (R-CO), Cardin (D-MD), and Brown (D-OH) introduced the Strong Families Act of 2017 (S. 1829) which would extend the Maternal, Infant, and Early Childhood Home Visiting Program. Press release: http://bit.ly/2xnTzPn
  • Also on September 19, Sens. Nelson (D-FL), Rubio (R-FL), Casey (D-PA) and Collins (R-CO) introduced S. 1834, which would establish a National Advisory Committee on Seniors and Disasters. Press release: http://bit.ly/2wMqgSP
  • On September 21, Sens. Capito (R-WV), Manchin (D-WV), and four bipartisan cosponsors announced their intention to introduce the Protecting Jessie Grubb’s Legacy Act, which would protect the confidentiality of substance use disorder patient records. Press release: http://bit.ly/2xtWPbR Bill text: http://bit.ly/2xtNTDo

 ACA Market Stabilization & Reform –

  • On September 18, the Congressional Budget Office (CBO) released a statement announcing that it is “aiming to provide a preliminary assessment of the Graham-Cassidy bill by early next week.” The same day, Democratic Congressional leaders wrote to CBO Director Hall requesting a “comprehensive CBO analysis” of the Graham-Cassidy bill, arguing such a review is essential before Congress votes on the bill. CBO Statement: http://bit.ly/2wBNsmA Letter: http://bit.ly/2wBMuXu
  • On September 19, 15 Republican governors urged congress to back the Graham-Cassidy bill, noting that “adequately funded block grants to the states, along with maximum flexibility and control, is the best option on the table.” Letter: http://bit.ly/2wMtwO3
  • Also on September 19, 10 bipartisan governors, including Govs. Sandoval (R-NV) and Walker (R-AK) sent a letter urging Congress “not to consider the Graham-Cassidy-Heller-Johnson amendment and renew support for bipartisan efforts to make health care more available and affordable for all Americans.” Letter: http://bit.ly/2wEJxpg
  • Also on September 19, Senate HELP Committee Chair Alexander (R-TN) formally ended his Committee’s work on legislation to shore up the individual marketplaces, noting that he has “not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted.” Press release: http://bit.ly/2xnx4d5 Press release from Ranking Member Murray: http://bit.ly/2xolb70
  • Also on September 20, Washington State Governor Inslee (D) and Insurance Commissioner Kreidler sent a letter to members of the Washington State Congressional Delegation urging them to oppose the latest version of legislation to repeal and replace the ACA, arguing that it “will harm the people of Washington State and seriously undermine our health insurance market.” Letter: http://bit.ly/2wLM6Gg
  • On September 21, National Association of Medicaid Directors issued a statement calling for Congress to carefully consider the impacts of the Graham-Cassidy proposal to repeal and replace the ACA, raising concerns that the legislation would undermine state innovation efforts and would “fail to deliver on our collective goal of an improved health care system.” Statement: http://bit.ly/2wMstO9
  • On September 24, Senate Finance Committee released an updated draft of the Graham-Cassidy bill, which provides additional funding to Alaska, Arizona, Kentucky and Maine and allows more flexibility for states to roll back some of the ACA’s insurance regulations. Bill text: http://bit.ly/2wRtQLB
  • Also on September 24, Senate Finance Committee Ranking Member Wyden (D-OR) and 10 Democratic members of the Finance Committee sent a letter to Chair Hatch (R-UT) requesting the committee meet in a large hearing room “in keeping with the extraordinary importance of the hearing and with the committee’s usual practice on matters of such intense public interest. Press release: http://bit.ly/2wRyzNh Letter: http://bit.ly/2wRGkTg

ACA Implementation –

  • On September 19, Minnesota Governor Dayton (D) sent a letter to HHS Secretary Price expressing concern about the Administration’s waiver review process; Minnesota is currently awaiting approval on a section 1332 waiver that would allow it to establish a state-based reinsurance program. Letter: http://bit.ly/2wEGI7N
  • Also on September 19, CMS sent a letter of completeness to Iowa regarding their 1332 waiver application, which seeks to waive certain requirements related to health plan coverage, premium tax credits, cost sharing reductions, and special enrollment periods in order to implement the Iowa Stopgap Measure for 2018. Comments are due by October 19. Letter: http://bit.ly/2wGWWNK Waiver: http://bit.ly/2wtE09e
  • On September 20, CMS released an updated Health Insurance Exchanges Issuer County Map, which shows that nationwide no counties are expected to be bare, but 1,524 counties are expected to only be covered by one issuer. Press release: http://go.cms.gov/2xnCG7i Map: http://go.cms.gov/2xohmib
  • On September 22, CMS approved Minnesota’s 1332 waiver application, allowing the state to establish a state-based reinsurance program. Letter: http://go.cms.gov/2wRkFe5

Medicare –

  • On September 22, Senate Finance Committee Chair Hatch (R-UT) sent a letter to CMS Administrator Verma urging her not to finalize the recently developed Home Health Groupings Model in its calendar year 2018 Medicare Home Health Prospective Payment System proposed rule, until the agency can fully validate the impact these reforms will have on Medicare spending. Press release: http://bit.ly/2wMhXqa Letter: http://bit.ly/2wMmKbl

 New Payment and Delivery System Models –

  • On September 20, CMS published a Request for Information (RFI) seeking feedback on a new direction for the CMS Innovation Center to better promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes. RFI: http://bit.ly/2xnR6V1
  • Also on September 20, CMS posted the 2016 shared savings and quality data summary for the Comprehensive Primary Care Initiative, finding that 97 percent of practices were eligible for shared savings in 2016 based on quality requirements, and, on average, there was about $51 million in net savings and $5 million in gross savings. Data Summary: http://bit.ly/2xnOgzu

 Mental Health and Substance Abuse –

  • On September 19, Senate Banking Committee Ranking Member Brown (D-OH) and Sen. Donnelly (D-IN) sent a letter to Federal Reserve Chair Yellen urging her to explore and devote resources to supplement federal government efforts to combat the nation’s opioid epidemic. Press release with text of the letter: http://bit.ly/2wHDBfd
  • Also on September 19, Rep. Cummings (D-MD) and 50 members of the House sent a letter to President Trump urging him to declare the opioid epidemic a national emergency and immediately negotiate lower prices to get the opioid reversal drug naloxone into the hands of law enforcement and first responders across the country. Press release: http://bit.ly/2wHuF9J Letter: http://bit.ly/2wHoGl5
  • Also on September 19, the Centers for Disease Control & Prevention (CDC) published a study on the opioid epidemic’s impact on life expectancy in the U.S., finding that while decreased death rates due to chronic diseases increased life expectancy by 2.25 years, opioid-related deaths offset that increase by about 2.5 months. Article: http://bit.ly/2xqV3bx
  • On September 20, the Food and Drug Administration (FDA) published a statement on the agency’s continued efforts to promote the safe adoption of medication-assisted treatment (MAT) for opioid addiction, including requiring changes to MAT drug labels to increase safety. Statement: http://bit.ly/2xnIMVi
  • On September 21, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a report that reveals that out of the 19.9 million adults that needed substance use treatment in the past year, only 10.8 percent (2.1 million) received treatment at a specialty facility. Press release: http://bit.ly/2wJmpGj
  • Also on September 21, National Academy of Medicine released a report describing the opioid crisis, and providing recommendations to clinicians in helping to counter the epidemic. Report: http://bit.ly/2xsSIN8

 Prescription Drugs –

  • On September 20, Co-Chairs of the Congressional Diabetes Caucus, Reps. DeGette (D-CO) and Reed (R-NY) released key findings from recent meetings with top prescription drug stakeholders on the rising price of insulin, and announced their intention to work with the Food and Drug Administration on developing lower cost, biosimilar versions of insulin. Press release: http://bit.ly/2wM43UW Report: http://bit.ly/2wMpk0P  Letter to FDA: http://bit.ly/2wM423k

Health IT –

  • On September 18, HHS Office of the National Coordinator for Health IT (ONC) released a blog post highlighting how health information technology is helping patients and provider to better treat and manage HIV. Blog post: http://bit.ly/2xtGFPW
  • On September 19, ONC released a blog post requesting public comment on the Interoperability Standards Advisory, a catalog of the standards and implementation specifications that can be used to meet interoperability needs in healthcare. Comments are due by November 20. Blog post: http://bit.ly/2xtb4gY
  • On September 21, ONC announced two changes to improve its electronic health record Certification Program: it will now allow 30 of the 55 certification criteria to be “self-declaration only”, and will exercise greater discretion for randomized surveillance of certified health IT products. Blog post: http://bit.ly/2xtptK1
  • On September 19, Agency for Healthcare Research and Quality (AHRQ) released its 2016 Health Information Technology Annual Report, which describes research performed, projects administered, and grants awarded by the agency in 2016. Report: http://bit.ly/2xtJal5
  • On September 20, House Energy & Commerce Chair Walden (R-OR) and Subcommittee Chair Murphy (R-PA) sent a letter to HHS Secretary Price requesting information about the lingering effects of a malware strain known commonly as “NotPetya,” and raising concerns about the potential consequences of cyber threats to the healthcare sector. Press release: http://bit.ly/2wMndKs Letter: http://bit.ly/2wLNRDo

Veterans Health –

  • On September 22, U.S. Government Accountability Office (GAO) released a report describing the Veteran Health Administration’s (VHA) processes for developing and releasing national policy and recommending that VHA clarify and improve access to its national policy and guidance documents, and ensure alignment of local and national policy. Summary with link to report: http://bit.ly/2xtg2KD

 Hurricanes –

  • On September 19, HHS Secretary Price declared a public health emergency in Puerto Rico and the U.S. Virgin Islands due to Hurricane Maria. Press release: http://bit.ly/2wMja0H
  • Also on September 19, HHS Office of Civil Rights released a bulletin providing a limited waiver of HIPAA sanctions and penalties for public health emergency areas. Bulletin: http://bit.ly/2wMn49R
  • On September 21, CMS announced it would waive certain Medicare, Medicaid, and CHIP requirements to ensure that sufficient healthcare items and services are available. CMS Press release: http://go.cms.gov/2wMnmgN Waiver: http://go.cms.gov/2wMjaOf
  • On September 21, House Energy & Commerce Committee Ranking Member Pallone (D-NJ) and House Ways & Means Committee Ranking Member Neal (D-MA) sent a letter to HHS Secretary Price requesting the agency grant additional leeway for the upcoming open enrollment seasons for both Medicare and the Marketplaces due to historic damage inflicted by hurricanes in a number of states. Press release: http://bit.ly/2wM9kvT Letter: http://bit.ly/2wM6HdD

 Misc. –

  • On September 18, HHS released a report summarizing research on approaches used as part of regulatory impact analyses to value changes in time use. Summary with link to report: http://bit.ly/2wLU4PI
  • On September 19, Health Resources and Services Administration (HRSA) announced the award of $342 million in funding to 55 states, territories, and nonprofit organizations through the Maternal, Infant, and Early Childhood Home Visiting Program. These funds allow awardees to continue to provide voluntary, evidence-based home visiting services to women during pregnancy, and to parents with young children up to kindergarten entry. Press release: http://bit.ly/2xnNK4a
  • Also on September 19, Centers for Disease Control and Prevention (CDC) published a report on the characteristics of visits to primary care physicians by adults diagnosed with hypertension, finding that wide variations in demographics and geography identified may help inform state and local policies aimed at controlling hypertensions. Report: http://bit.ly/2xnIs8V
  • Also on September 19, a bipartisan group of 70 Senators sent a letter to Senate HELP Committee Chairman Alexander (R-TN) and Ranking Member Murray (D-WA) calling for immediate action to extend critical funding for community health centers before funding runs out at the end of September. Letter: http://bit.ly/2wHqvid
  • On September 20, HRSA announced the availability of the Health Center Program Compliance Manual, a comprehensive, streamlined, and web-based guidance document to assist health centers in understanding and demonstrating compliance with Health Center Program requirements. Notice: http://bit.ly/2xtCSBO
  • Also on September 20, Senate Judiciary Committee Chair Grassley (R-UT) sent a letter to CMS Administrator Verma requesting a description of all statutory and other barriers that prevent the public release of hospital inspection reports. Press release: http://bit.ly/2wM6FCb Letter: http://bit.ly/2wM5kLU
  • Also on September 20, Ranking Members from the Senate Finance, HELP, and Homeland Security & Governmental Affairs Committees, and the House Energy & Commerce and Ways & Means Committees sent a letter to HHS Inspector General Levinson requesting that his office review HHS Secretary Price’s adherence to federal regulations and HHS policies and procedures for travel. Press release: http://bit.ly/2wMpgxX Letter: http://bit.ly/2wMNN6g
  • On September 21, CDC published an early release of selected estimates based on data from the January to March 2017 National Health Interview Survey, which shows data on a number of healthcare indicators, including vaccines, health insurance coverage, smoking, physical activity, alcohol consumption, obesity, and the prevalence of certain disease. Release: http://bit.ly/2wJUyWn
  • On September 22, AHRQ released a Compendium of U.S. Health Systems, the nation’s first publicly available database that gives researchers, policymakers, and health care administrators a snapshot of the nation’s health systems. Summary with link to compendium and corresponding summary reports: http://bit.ly/2wMgrEs