Ways and Means Stalled on Surprise Billing Measure

House Ways and Means Committee Chairman Richard Neal (D-Mass.) stated that his panel has yet to reach an agreement on a method of payment to settle billing disputes between insurers and providers and may not mark up a bill to address the issue of surprise insurance gaps until late October. He also told reporters last week that Ways and Means is not discussing the inclusion of policies to impact air ambulances in their surprise billing legislation. While the House Energy and Commerce Committee’s bill also excludes air ambulances, the Senate Health, Education, Labor, and Pensions (HELP) legislation would tie their out-of-network charges to the median rate of a geographic area. According to Chairman Neal, Ways and Means is still developing timelines for several pieces of major legislation, including drug pricing and surprise billing.

HELP Committee Chairman Lamar Alexander (R-Tenn.) plans to meet with Sen. Bill Cassidy (R-La.) this week to further discuss HELP’s surprise billing legislation. Sen. Cassidy is pushing for the addition of an independent dispute resolution (IDR) process under which arbiters would be required to base their payment decisions on commercially reasonable rates.

In other related news, the House Energy and Commerce Committee has opened an investigation into the impact of private equity control of health care companies on rising health care costs and surprise medical billing.

FY 2020 Appropriations Remain In Flux

The House of Representatives plans to consider a clean continuing resolution (CR) this week in an effort to avoid a federal government shutdown at the end of the fiscal year (FY) on September 30. The short-term spending bill is expected to extend current government funding into late November or early December.

The Senate Appropriations Committee approved spending allocations for all 12 subcommittees last week, along with the Defense and Energy and Water Development spending bills. While appropriators had planned to vote on the Labor-Health and Human Services-Education and State-Foreign Operations bills as well, proceedings were postponed due to abortion-related disputes regarding Title X grant funding and the Mexico City policy. The 302(b) top-line spending caps for FY 2020 were decided without input from House appropriators, who have already advanced the majority of their panel’s spending bills, by a party-line vote of 16-15. Agriculture-FDA will receive $23.1 billion, Labor-HHS-Education will receive $187.7 billion, and Military Construction-VA will receive $105.5 billion. Ranking Member Patrick Leahy (D-Vt.) stated that it was “unacceptable” that the Labor-HHS-Education measure would only receive a one percent increase over FY 2019 levels.

Lawmakers Push to Restrict E-Cigarettes

Sen. Mitt Romney (R-Utah) has written to U.S. Department of Health and Human Services Secretary Alex Azar questioning whether a recall by the Food and Drug Administration (FDA) of e-cigarettes is appropriate in light of the mysterious, vaping-related illness that has sickened approximately 380 people and resulted in at least six deaths across the country. Sen. Romney urges both the FDA and the Centers for Disease Control and Prevention (CDC) to “report to Congress and to the public any new findings related to the investigation into severe pulmonary disease, or other diseases, stemming from the use of e-cigarettes.”

A bipartisan group of senators led by Dick Durbin (D-Ill.) met with FDA Acting Commissioner Ned Sharpless on the issue of e-cigarettes last week. The lawmakers, including Sens. Lisa Murkowski (R-Alaska), Maggie Hassan (D-N.H.), Mitt Romney (R-Utah), Patty Murray (D-Wash.), Jeff Merkley (D-Ore.), Mazie Hirono (D-Hawaii), and Richard Blumenthal (D-Conn.), praised the agency for announcing its intention to ban flavored vaping products. They urged the FDA to remove both e-cigarette flavors and illegal vaping devices from the market as quickly as possible. According to Secretary Azar, the number of children reported to have used e-cigarettes increased to 5 million in 2018 from 3.6 million the previous year.

Senate Finance Members Request Change to DIR Policy

A bipartisan group of senators has written to leadership at the U.S. Department of Health and Human Services (HHS) asking the administration to broaden Medicare’s definition of direct and indirect remuneration (DIR). The lawmakers cite an analysis from the Centers for Medicare and Medicaid Services (CMS) that pharmacies experienced a 45,000 percent increase in DIR fees between 2010 and 2017. They characterize this increase as “an untenable trend for pharmacies” that causes higher prices for beneficiaries at the pharmacy counter and suggest that HHS “redefine ‘negotiated price’ to include all pharmacy price concessions at the point-of-sale and establish a broader definition of ‘price concession’” in time for the 2021 plan year.

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