Elijah Cummings, Powerful Chairman and Civil Rights Leader, Passes Away at Age 68

Rep. Elijah Cummings (D-Md.) passed away last week due to complications from underlying health issues. He was 68 years old. Cummings had served 12 terms in Congress and held the position of top Democrat on the House Oversight and Reform Committee since 2011. Chairman Cummings’ district includes several important health care institutions, including the Centers for Medicare and Medicaid Services’ (CMS) headquarters and Johns Hopkins Hospital. During his time in Congress, Cummings was a strong supporter of medical research, the Affordable Care Act (ACA), and improving health care access and quality for underserved populations. In his capacity as Oversight and Reform Committee chairman, Cummings launched an investigation into the prescription drug industry’s pricing practices. House Speaker Nancy Pelosi (D-Calif.) plans to rename her drug pricing package in his honor. Chairman Cummings will lie in state in National Statuary Hall on October 24. A memorial services is also scheduled for Thursday. Rep. Carolyn Maloney (D-N.Y.) will assume the position of acting chairwoman on Oversight and Reform. The Democratic Steering Committee is expected to meet soon to recommend Cummings’ permanent replacement to the full caucus. Maryland Gov. Larry Hogan (R) will announce when a special election and general election will be held.

Ways and Means Republicans Reject Surprise Billing Negotiated Rulemaking

Ranking Member of the House Ways and Means Committee Kevin Brady (R-Texas) has rejected a proposal from panel Democrats to protect patients from surprise insurance gaps using a negotiated rulemaking process. Chairman Richard Neal (D-Mass.) was hopeful that the Ranking Member would support the use of a committee of stakeholder groups and administrative agencies to determine how to resolve billing disputes between providers and payers. Rep. Brady, however, suggested that lawmakers should go “back to the drawing board” rather than pursue this negotiated rulemaking process. Brady has instead made comments in support of a policy similar to the one advanced by the Energy and Commerce Committee, which would use an independent dispute resolution (IDR) process as a backstop in certain circumstances for providers to appeal a benchmark payment rate set by legislation. In response to Rep. Brady’s comments, Chairman Neal’s office stated that they continue to work in a bipartisan manner to explore all options available to address surprise medical bills.

Senate to Consider FY 2020 Appropriations This Week

Senate Majority Leader Mitch McConnell (R-Ky.) announced his plans for the chamber to try and consider two packages of appropriations legislation for fiscal year (FY) 2020 this week. The first would encompass domestic spending across the departments of Commerce, Justice, Agriculture, Interior, Transportation, and Veterans Affairs. If the Senate succeeds in passing that package, the chamber would then begin consideration of a spending bill for the Defense, Labor, Health and Human Services, Education, State, and Energy departments. The legislative details are still being negotiated by Appropriations Chairman Richard Shelby (R-Ala.) and Ranking Member Patrick Leahy (D-Vt.). Cloture has already been filed on the House bills that will serve as the vehicles for the Senate’s appropriations work. House Democratic leadership and Senate Republican leadership, however, have yet to reach an agreement on top line spending levels. The current continuing resolution (CR) funding the federal government will expire on November 21.

Lawmakers Raise Questions on Reimbursement for Non-Opioid Treatments

Sens. Jeanne Shaheen (D-N.H.) and Shelley Moore Capito (R-W.Va.) have sent a letter to U.S. Department of Health and Human Services (HHS) leadership regarding the impact of Medicare reimbursement policy on the use of opioid-based pain management treatments. The lawmakers ask HHS and CMS to ensure that payment policies do not incentivize the use of opioids over non-opioid alternatives, and express concern about the cost disparity between opioid-based medications and non-opioid drugs in the treatment of post-surgical pain.

Grassley Investigates GME Financing, Tax-Exempt Hospitalís Billing Practices

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) has written to HHS Secretary Alex Azar requesting information on graduate medical education (GME), program financing, and what processes are in place to prevent GME fraud and abuse. His letter cites three separate reports which raise concerns about potential waste in GME program funding.

Chairman Grassley is also examining a recent report that the University of Virginia (UVA) Health System is failing to meet its legal obligations as a tax-exempt organization. In a letter to UVA Medical Center, Grassley notes that “relentless debt-collection efforts by tax-exempt hospitals” appear to be at odds with requirements that such hospitals serve community health needs, provide financial assistance, limit amounts charged for medically-necessary care, and refrain from extraordinary collection actions against patients eligible for financial assistance. He asks for additional information on UVA’s debt-collections history and processes, charity care and financial assistance offered, patients’ rights and transparency guidelines, potential overcharging, and its process for determining prices.

Lawmakers Consider Further Restrictions on E-Cigarette, Vaping Products

Vaping and the use of e-cigarette products among young adults continues to be an issue of strong bipartisan interest among lawmakers on Capitol Hill. The House Judiciary Committee advanced legislation (H.R. 3942, the Preventing Online Sales of E-Cigarettes to Children Act) that would require age verification for both the purchase and delivery of e-cigarette products. The House Energy and Commerce Committee convened a hearing on H.R. 2339, the Reversing the Youth Tobacco Epidemic Act of 2019 which would extend federal rules for tobacco sales and advertising to e-cigarettes. The bill would also increase the age to buy tobacco products to 21 and ban all flavored e-cigarettes. Principal Deputy Director of the Centers for Disease Control and Prevention (CDC) Anne Schuchat also appeared before the House Appropriations Subcommittee on Health last week to discuss vaping as a public health issue. The House Ways and Means Committee is reportedly planning to consider a federal tax on e-cigarettes.

Latest reports from the CDC estimate that the number of confirmed and probable lung injury cases resulting from the use of e-cigarette or vaping products has reached 1,479, with 33 deaths across 24 states. Approximately 16 percent of those who have become ill are under the age of 18.

FL Rep. Rooney to Retire

Florida Republican Rep. Francis Rooney announced that he will not seek reelection in 2020. Rooney was first elected to the House of Representatives in 2016 and currently serves on the Education and Workforce Subcommittee on Health, Employment, Labor, and Pensions. He is the 19th Republican lawmaker to announce his retirement from the House. Florida’s 19th congressional district is not considered a swing district.

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