CBO Works to Score Surprise Insurance Gap Legislation

The Congressional Budget Office (CBO) scored a number of legislative proposals to prevent surprise insurance gaps last week, according to congressional staff. Several bipartisan groups in both the House and Senate have released legislation to address surprise medical bills in recent months. The CBO has sent its preliminary budget estimates to lawmakers, but the full estimates are not yet public. The agency examined a bill from a Senate working group led by Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.). CBO found that their proposal, which includes a provision to allow payment disputes to be settled through arbitration, would save $17 billion over the next decade. CBO found that the bipartisan proposal from Senate Health, Education, Labor, and Pensions (HELP) Committee leadership to pay providers based on the median contracted rate would save $25 billion over the next decade. The provisions contained in the HELP draft bill to use arbitration for bills of more than $750 would save $20 billion over the next 10 years, but would cost $1 billion in administrative costs, while the panel’s network matching policy would save $9 billion. Chairman Lamar Alexander (R-Tenn.) plans to convene a hearing next week and to markup the Lower Health Care Costs Act of 2019 later in the month in hopes of passing a bill before August recess. According to Alexander, the committee has received over 400 comments on the draft bill to lower health care costs and is working to review and incorporate the feedback into a final package. HELP’s legislation is expected to be combined with prescription drug pricing legislation from the Senate Finance Committee before being brought for a vote on the Senate floor.

Senators Release List of Under-Performing Nursing Homes

Sens. Bob Casey (D-Pa.) and Pat Toomey (R-Pa.) have released a confidential list obtained from the Centers for Medicare and Medicaid Services (CMS) documenting approximately 400 “under-performing” nursing homes across the nation with “persistent records of poor care.” The list is comprised of candidates for the Special Focus Facility (SFF) initiative. According to Casey and Toomey, CMS declined to make the list public. Agency officials have stated that the same data is available on the Nursing Home Compare website. The list was released along with a report providing additional background and context information.

House Dems Request Info on Direct Enrollment

Democratic leadership of the House Energy and Commerce and Ways and Means committees have written to Administrator of the Centers for Medicare and Medicaid Services (CMS) Seema Verma questioning the administration’s decision to allow more consumers to enroll in Affordable Care Act (ACA) coverage directly through insurance broker websites. Chairmen Frank Pallone (D-N.J.) and Richard Neal (D-Mass.) express concerns that expanding the enhanced direct enrollment process could confuse consumers, lead to individuals being unnecessarily charged more for coverage, or result in the steering of consumers to short-term, limited-duration plans that do not have to comply with all of the 2010 health care law’s consumer protections. The lawmakers ask for a list of CMS-approved direct enrollment entities, direct enrollment-related consumer complaints, and whether the agency has taken any direct enrollment enforcement action against insurance brokers no later than June 18.

House to Begin Consideration of $1 Trillion in Spending Bills this Week

The House plans to begin consideration of a package of five FY 2020 appropriations bills totaling almost $1 trillion in spending, according to notice from the House Rules Committee. H.R. 2740 would combine the spending bills covering Defense, Labor-Health and Human Service-Education, State and Foreign Operations, Energy and Water Development, and the Legislative Branch. It will be the first FY 2020 spending bill and one of several minibuses to be considered this year on the House floor; Majority Leader Steny Hoyer (D-Md.) has said that he hopes all 12 appropriations bills will be passed by the end of the month to prevent a government shutdown at the end of the fiscal year on Sept. 30. The House Rules Committee will meet Monday and Tuesday to set the terms for floor debate. Lawmakers will begin debate on the bill Wednesday, and a vote is expected the week of June 17.

Finance Drug Pricing Proposal Expected June 19

The Senate Finance Committee hopes to release bipartisan drug pricing legislation by June 19, according to Chairman Chuck Grassley (R-Iowa). The package has not yet been finalized but is expected to include reforms to Medicare Parts B and D and the Medicaid program. Both Grassley and Ranking Member Ron Wyden (D-Ore.) have expressed support for a Part D out-of-pocket cap. The committee is also considering extending the administration’s proposal to require rebates to be passed directly to consumers. Grassley has stated that, if the issue of drug pricing is not addressed this month, it will be difficult to pass legislation before the end of the year.

Trump Administration Personnel Updates

Peter Urbanowicz, Chief of Staff to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar, announced that he will be leaving the department in June. Deputy Chief of Staff Brian Harrison will be promoted to the chief of staff position. Harrison has held the position of deputy chief of staff since Azar’s confirmation. Harrison worked in the office of the Deputy Secretary at HHS during the George W. Bush administration and has also held positions at the Social Security Administration, the Department of Defense (DOD), and the Office of the Vice President at the White House.

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