CBO Releases Score of No Surprises Act

The Congressional Budget Office (CBO) has released its cost estimate of legislation (H.R. 2328) advanced by the House Energy and Commerce Committee that includes provisions aimed at protecting patients from surprise insurance gaps. The agency estimates that the No Surprises Act would increase federal revenues by $20.9 billion and reduce direct spending by $1.0 billion for a total reduction in the deficit of approximately $21.9 billion over the next decade. CBO’s analysis indicates that premiums would be reduced by around one percent compared to current law. The cost estimate anticipates that providers currently earning in-network rates above the median would see reductions to more typical amounts; the decrease in premiums driven by lower payment rates would be somewhat offset by increases in payment rates for providers currently receiving below-median payments. CBO also assumes that the legislation would create new administrative costs stemming from the independent dispute resolution (IDR) process that would be used to settle out-of-network payment disputes between providers and health plans. The report finds that the inclusion of the IDR policy would offset expected premium reductions by almost 25 percent because of the likelihood that it would result in higher payments to physicians.

E&C to Probe Private Equity’s Role in Surprise Billing

The House Energy and Commerce Committee has opened a bipartisan investigation into the impact of private equity control of health care companies on rising health care costs and surprise medical billing. Chairman Frank Pallone (D-N.J.) and Ranking Member Greg Walden (R-Ore.) have sent letters to three private equity firms – KKR, Blackstone, and Welsh, Carson, Anderson & Stowe – requesting information about how they profit from out-of-network billing practices. The firms have each acquired private physician staffing and emergency transportation companies in recent years. The lawmakers ask the private equity firms to detail their role in the staffing and management of the companies they own as well as their role in negotiations between their physician staffing companies, emergency transport companies, and insurers. The investigation was announced shortly after the New York Times reported that the firms were behind a multi-million dollar lobbying campaign against Congress’s proposed legislation to address the issue of surprise insurance gaps. The ads specifically expressed opposition to the use of benchmark payments tied to the median in-network rate for the location in which the service took place to settle reimbursement disputes between providers and insurers.

Senate Passes Autism Research, Education, Intervention Bill

The Senate passed the Autism Collaboration, Accountability, Research, Education, and Support Act of 2019 (H.R. 1058) by voice vote last week. The legislation would authorize $370 million annually through FY 2024 for research, education, and intervention programs for individuals with autism spectrum disorder. It allows program participants to receive funding throughout their lifetimes, rather than being limited to their childhood years. The bill will now be sent to the President for his signature.

Lawmakers Request FDA Data on Drug Shortages

A bipartisan group of more than 90 lawmakers have written to the FDA asking the agency to release information about what has been learned from the interagency Drug Shortages Task Force regarding the growing number of drug shortages. According to the letter, the number of drug shortages increased by 27 percent between 2017 and 2018 for a total of 186 shortages of new drugs last year – the most shortages in the last five years. The Drug Shortages Task Force convened several stakeholder listening sessions last year, followed by a public meeting and the opening of a docket for public comment. The lawmakers request details about the information obtained through this process and urge the FDA to prioritize the release of the Drug Shortages Task Force Report. The letter was led by Reps. Eliot Engel (D-N.Y.) and Brett Guthrie (R-Ky.).

Smith, Cramer Request Hearing on Insulin Legislation

Sens. Tina Smith (D-Minn.) and Kevin Cramer (R-N.D.) are urging Senate Finance Committee leadership to hold a hearing to consider their Emergency Access to Insulin Act (S. 2004). “Given the immediate impact high insulin costs have on the health and well-being of people who need insulin to survive,” the lawmakers write, “we believe Congress must take swift action to provide emergency assistance to individuals struggling to afford their prescription medications.” Their bill aims to expand access to insulin for those who cannot afford it, hold manufacturers accountable for certain insulin price increases, and promote market competition to lower the price of insulin.

Energy and Commerce Inquires on Use of Opioid Funds

Bipartisan leadership of the House Energy and Commerce Committee have sent letters to 16 of the states hit hardest by the opioid epidemic, requesting information about the use of federal funds in response to the abuse and addiction crisis. The lawmakers ask how funding from the SUPPORT for Patients and Communities Act, the Comprehensive Addiction and Recovery Act, the 21st Century Cures Act, and funding bills for fiscal years (FY) 2018 and 2019 has been deployed and prioritized, how such funds are being used to assist those with substance use disorder (SUD), and what efforts have been successful in aiding opioid use disorder (OUD) treatment, recovery, and prevention. The letters were signed by Chairman Frank Pallone, Jr. (D-N.J.), Ranking Member Greg Walden (R-Ore.), Health Subcommittee Chairwoman Anna G. Eshoo (D-Calif.), Ranking Member Michael Burgess (R-Texas), Oversight and Investigations Subcommittee Chair Diana DeGette (D-Colo.), and Ranking Member Brett Guthrie (R-Ky.) and sent to the governors of Florida, Indiana, Kentucky, Maine, Maryland, Massachusetts, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, West Virginia and Wisconsin.

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