POLICY BRIEFINGS

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.


THIS WEEK'S BRIEFING - FEBRUARY 10, 2020

House Votes to Condemn Medicaid Block Grant Proposal


The House of Representatives passed by a vote of 223-190 a nonbinding resolution (H.Res. 826) disapproving of the Trump administration’s new Medicaid block grant proposal. No Republicans voted in support of the resolution. The guidance released on January 30 by the Centers for Medicare and Medicaid Services (CMS) would allow states to transition open-ended federal Medicaid funding to a capped amount for the Affordable Care Act’s (ACA) expansion population. The guidance would provide for greater section 1115 demonstration waiver authority for Medicaid funding, permitting states increased flexibility to administer services to able-bodied adults under the age of 65 in return for receiving federal funding for that subset of the population as either a capped total or a capped amount per beneficiary. The plan has been assailed by Democrats for its potential to result in cuts to the safety net program and undermine health care for vulnerable populations. Proponents of the proposal argue that block grants could help control rising costs and Medicaid enrollment and pave the way for state innovation. The resolution is not likely to be taken up by the GOP-controlled Senate.


House Panels to Consider Surprise Billing Proposals This Week


New bipartisan legislation to eliminate surprise insurance gaps was unveiled by leaders of the House Ways and Means Committee last week. The Consumer Protections Against Surprise Medical Bills Act of 2020 would require the establishment an independent mediated negotiation process to resolve billing disagreements between providers and payers. Arbiters would be required to consider median contracted rates used by health plans, but prohibited from considering usual and customary charges. Prior to the mediation process, both parties would enter into a 30-day period during which information about median in-network rates and typical payments is exchanged. The bill would also require plans to provide patients with an upfront cost estimate at least three days in advance of scheduled procedures. Air ambulance providers would be required to publicly report cost data to HHS, while insurers would submit to HHS claims for air ambulance services.

Ways and Means will mark up its surprise medical billing measure on Wednesday. Reps. Brad Wenstrup (D-Ohio) and John Larson (D-Conn.) have explained that their recently introduced bill (H.R. 5807) to require insurers to establish a current provider directory database and a verification process to ensure directories are up-to-date will be incorporated into the base text of the bill prior to markup. Their legislation would also require that providers notify insurers when changes to directory information occur or face a financial penalty.

In December, the House Energy and Commerce and Senate Health, Education, Labor, and Pensions (HELP) committees had negotiated a bipartisan, bicameral surprise billing plan that would use a federal benchmark payment rate to settle billing disputes while providing for an arbitration process as a backstop. Energy and Commerce Chairman Frank Pallone (D-N.J.) appeared optimistic that he could negotiate a compromise with his counterparts on the Ways and Means Committee, as long as the final bill saves taxpayer dollars and does not result in an increase in premiums.

The House Education and Labor Committee, which has jurisdiction over employer-based insurance, became the fourth congressional panel to put forth a proposal to hold patients harmless from surprise medical bills last week. The Committee plans to mark up its bipartisan legislation, which closely mirrors the Energy and Commerce and Senate HELP proposal, on Tuesday. Payment rates under the Education and Labor bill would be based on the median payment for the specified service in the particular geographic area, with the option of an independent dispute resolution (IDR) process for charges above $750. The bill also sets a benchmark payment rate for air ambulance bills. Rep. Donna Shalala (D-Fla.) has already announced that she plans to vote against the measure unless it is amended due to concerns that it would negatively impact hospitals in her district. Other lawmakers have voiced similar concerns. Rep. Shalala, alongside Reps. Phil Roe (R-Tenn.), Joseph Morelle (D-N.Y.), and Van Taylor (R-Texas), released a statement in response to the legislation introduced by Ways and Means Committee leadership, praising the bill for utilizing an IDR model to settle disputed charges.

House leadership has instructed the committees of jurisdiction to unite behind a single proposal as quickly as possible. Lawmakers hope to reach an agreement on surprise billing legislation before President’s Day so that they can pivot to the issue of prescription drug prices after the week-long recess. A final surprise billing and drug pricing package is expected to move alongside reauthorization of health care programs that expire on May 22.



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