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.


Senate GOP Releases COVID Proposal

Last week, Senate Republicans introduced a series of bills that comprise the latest pandemic relief plan known as the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act. While the $1 trillion stimulus package was drafted through negotiations between Senate Republicans and the White House, internal disagreements remain about the total scope of additional federal spending.

The legislation includes $306 billion in emergency coronavirus relief funding, with $16 billion in grants to states for testing, contact tracing, and surveillance and $20 billion for vaccine, therapeutic, and diagnostic development. It would establish state stockpiles of medical products and items needed during a public health emergency with technical assistance provided by the federal government. HEALS also includes $53 million for the Cybersecurity and Infrastructure Security Agency (CISA) to protect federal networks engaged in COVID-19 vaccine research and development against hackers. The legislation would create tax credits to incentivize domestic manufacturing of personal protective equipment (PPE), with the goal of reaching 100 percent domestic sourcing within five years. It would also establish a congressional review board to examine the long-term solvency of the Medicare trust fund. The board would be tasked with drafting bipartisan legislation to restore trust fund solvency, with the bill receiving fasttrack consideration in each chamber. The HEALS Act would extend and make changes to the Paycheck Protection Program (PPP), adding $60 billion for small business loans. Businesses with fewer than 300 people would be permitted to apply for a second PPP loan if they can show revenue losses of 50 percent or more since the pandemic began. The HEALS Act includes a second tranche of stimulus payments to individuals which would be structured in the same way as the previous payments distributed in March. The plan would cut enhanced unemployment aid to $200 a week – down from the $600 a week that expired on July 31. The HEALS Act also includes the liability protections championed by Majority Leader Mitch McConnell (R-Ky.). The bill would shield entities from COVID-19-related lawsuits through October 1, 2024 as long as they make “reasonable” efforts to follow public health guidelines and do not commit acts of “gross negligence” or “intentional misconduct.” Medical liability claims that arise from virus-related care would be moved to federal courts. In negotiating with congressional Democrats, McConnell has stated his insistence that the liability changes be included wholesale in the next aid package.

While Democrats are demanding significantly more funding than was included in the HEALS Act, there has also been some intra-party push back against the package from certain Senate Republicans who have signaled that they will not support the plan because of concerns about deficit spending. Negotiations on the next broad pandemic relief package continued over the weekend but remain stalled as lawmakers of each party blame each other for failing to bridge the differences between the HEALS Act and House Democrats’ $3.5 trillion Heroes Act, which was passed two-months ago. The main points of contention remain the liability shield provisions, extension of supplemental unemployment payments, and the level of aid to state and local governments. The two sides were unable to reach an agreement on a short-term extension of the enhanced $600-a-week supplemental unemployment benefit and the moratorium on evictions, which expired as of Friday. McConnell has moved to force debate this week on a clean, temporary extension of unemployment insurance, but Democratic leadership have said they will only support a short-term extension if agreement on a comprehensive package appears imminent. House Speaker Nancy Pelosi (D-Calif.) has promised that Congress will not adjourn for August recess without a deal.

House Passes Second FY21 Minibus

The House of Representatives passed, by a vote of 217-197, its second appropriations minibus (H.R. 7617) last week. The $1.3 trillion package would fund Defense, Commerce, Justice, Science, Energy and Water Development, Financial Services and General Government, Homeland Security, Labor, Health and Human Services, Education, Transportation, Housing, and Urban Development for fiscal year 2021 (FY21). The bill includes $210 billion in emergency funding to respond to the coronavirus pandemic, and lawmakers adopted an amendment that would require several federal agencies to establish and keep up to date a list of 300 to 400 medications necessary during a public health emergency. The GOPcontrolled Senate is not expected to consider the legislation, which has received a veto threat from President Trump. The White House’s veto statement cites a provision in the bill that would prohibit the administration from enforcing a conscience rule permitting health care providers to refuse care because of religious or moral objections.

HHS Surprise Medical Billing Report Calls for Passage of Legislative Fix

The U.S. Department of Health and Human Services (HHS) released a report last week calling on lawmakers to pass legislation to address surprise medical billing. The report describes the issue of surprise billing and the actions that have been taken by the administration to increase price transparency, but does not recommend whether a fix should use independent dispute resolution (IDR) or set a payment rate to settle out-of-network billing disputes between providers and payers. HHS has said that the three main surprise billing proposals being debated in Congress would meet their criteria of protecting patients from out-of-network charges from providers not chosen by the patient. White House officials have stated their support for the inclusion of a surprise billing measure in the next coronavirus response package. No such provision is included in the latest Senate GOP proposal or in the House Heroes Act. Following the release of the HHS report, bipartisan leadership of the House Energy and Commerce Committee, House Education and Labor Committee, and Senate Health, Education, Labor, and Pensions (HELP) Committee released joint statements endorsing quick passage of a surprise billing fix. Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.), and Michael Bennet (D-Colo.), who previously introduced the STOP Surprise Medical Bills Act, have also echoed their support for inclusion of a fix in the next COVID response bill.

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