Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


White House Unveils Price Transparency Regulations

On Friday, the White House unveiled new health care price transparency regulations in fulfillment of President Trump’s June 24 Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. The final rule would require hospitals to publicly disclose the cost of specific items and services in an easily-accessible manner. The rule covers provisions originally included in the Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) proposed rule and is effective starting January 1, 2021. The negotiated rates for the 300 most common services that can be scheduled in advance would have to be published, along with how much the hospital would be willing to accept if the patient pays cash. The information would be updated each year. Under a separate proposed policy put forward by the Centers for Medicare and Medicaid Services (CMS), most employer-based group health plans and health insurance issuers offering group and individual coverage would be required to disclose price and cost- sharing information with plan participants through an online tool that allows policyholders to get real-time, personalized estimates of their out-of-pocket costs for all covered services and items. Plans would also have to make available to the public the negotiated rates for in-network providers and the maximum amounts paid for out-of-network providers. The proposed rule has a comment period of 60 days. The sweeping changes face stiff pushback from the health care industry and a coalition of major hospital groups, who quickly announced that hospitals will sue to block the changes.

Congress to Vote on CR This Week

Congress will vote on a stopgap spending measure this week to extend government funding through December 20. The current continuing resolution (CR) funding the federal government will expire on November 21. House Majority Leader Steny Hoyer (D-Md.) has stated that the short-term spending bill should be “relatively clean,” while the White House has indicated that the patch will be signed by President Trump as long as it does not contain any restrictions on funding for border wall construction. Congressional leadership and top appropriators have yet to reach an agreement on top-line figures for fiscal year (FY) 2020 spending bills. Hoyer announced that lawmakers should be prepared to postpone a recess scheduled to begin December 13 if a government funding deal has not yet been reached.

E&C Advances Tobacco, Maternal Mortality, and Citizens Petition Legislation

The House Energy and Commerce Subcommittee on Health advanced four pieces of public health legislation to the full panel last week. The bills include the Reversing the Youth Tobacco Epidemic Act (H.R. 2339), which would raise the minimum age to buy tobacco products to 21. It would also ban some flavored tobacco products. During the markup, Republicans raised concerns that the legislation would eliminate consumer choice for law-abiding adults while not doing enough to address the causes of the emerging lung illness impacting e-cigarette users. Some GOP panel members also objected to the bill’s lack of an exception to the change in purchasing age for members of the military. The panel also advanced the STOP GAMES Act (H.R. 2387), which would make changes to prevent the citizens petition process from being used to prevent generic drug competition from coming to market. Republicans expressed worry that the bill could impact legitimate citizens petitions but indicated that they could support the bill with some modifications. The subcommittee also passed two pieces of legislation aimed at improving maternal health. The Helping MOMS Act (H.R. 4996) would give states the option to cover pregnant and postpartum women for a year instead of 60 days. The Maternal Health Quality Improvement Act (H.R. 4995) would combine the provisions of the Excellence in Maternal Health Act, to authorize grants to identify, develop, and disseminate maternal health quality best practices, support training for health professionals, and authorize grants for operating innovative, evidence-based programs that deliver integrated services to pregnant and post-partum women, and the Rural Moms Act, to provide funding for the establishment of rural obstetric networks for improving outcomes in birth and maternal morbidity. The E&C full committee plans to consider H.R. 2339, H.R. 4996, and H.R. 4995 during a scheduled mark up on November 19; it is unclear when the full committee will consider H.R. 2387 (related to citizen petitions).

Cornyn, Durbin Continue to Push for Passage of Drug Pricing Legislation

Two bipartisan pairs of lawmakers again failed in their attempt to pass drug pricing legislation by unanimous consent last week. Sens. John Cornyn (R-Texas) and Richard Blumenthal (D-Conn.) pushed their bill (S. 1416) that would empower the federal government to prevent brand manufacturers from using the patent system to block generic competition from coming to market, while Sens. Dick Durbin (D-Ill.) and Chuck Grassley (R-Iowa) sought to pass legislation (S. 1437) that would require drug makers to disclose the cost of their products in direct-to-consumer (DTC) advertising. The DTC advertising bill was blocked by Sen. Pat Toomey (R-Pa.), who has expressed concern about the legislation’s potential to mislead consumers or deter them from seeking care, and about unfairly targeting only a single stakeholder in the health care system – drug manufacturers. Senate Minority Leader Chuck Schumer (D-N.Y.) blocked the patent bill, saying that he does not oppose the legislation but citing Republican opposition to clearing broader health care bills that would have a larger impact on lowering costs, such as proposals to allow Medicare to negotiate drug prices or the Finance Committee’s drug pricing package. Sen. Cornyn has said that he will repeat his attempt to pass his bill weekly, “if not more often,” while Sen. Blumenthal appealed to Majority Leader Mitch McConnell (R-Ky.) to bring the legislation to the floor himself.

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