POLICY BRIEFINGS

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Lawmakers Reintroduce Value in Health Care Act

Reps. Darin LaHood (R-Ill.), Suzan DelBene (D-Wash.), Kim Schrier, MD (D-Wash.), Brad Wenstrup (R-Ohio), Earl Blumenauer (D-Ore.), and Larry Bucshon, MD (R-Ind.) have reintroduced a bipartisan bill (H.R. 5013) that aims to increase participation in Accountable Care Organizations (ACOs). The Value in Health Care Act would revise Medicare’s Alternative Payment Models program to incentivize greater participation in value-based health care. The legislation would increase the percentage of shared savings beginning participants receive, modify program risk adjustment and performance metrics, strengthen technical support for participants, and extend the annual lump sum participation bonus for an additional two years.

Burgess Reintroduces GOLD CARD Act

Rep. Michael C. Burgess, MD (R-Texas) has reintroduced the Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act (H.R. 4968). The bill would exempt qualifying providers from prior authorization requirements under Medicare Advantage (MA) plans. The exemption would apply to providers who had at least 90% of prior authorization requests approved the preceding year. In related news, the Improving Seniors’ Timely Access to Care Act was advanced by the House Ways and Means Committee as a part of the Health Care Price Transparency Act last week. The measure would modernize the use of prior authorization in the MA program by establishing an electronic prior authorization process, requiring the U.S. Department of Health and Human Services to establish a process for real-time decisions for items and services that are routinely approved, and requiring MA plans to report on the extent of their use of prior authorization and their rate of approvals or denials.

Democrats Introduce Bill to Expand IRA Drug Pricing Provisions

House Democratic committee leaders introduced legislation (H.R. 4895) last week that aims to expand the impact of the Inflation Reduction Act’s drug pricing provisions. The Lowering Drug Costs for American Families Act would extend the drug price negotiation program to all Americans with private coverage, apply the law’s inflation rebates to individuals covered by private health plans, and increase the annual number of prescription drugs subject to negotiation from 20 to 50. The bill was introduced by Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-N.J.), Ways and Means Committee Ranking Member Richard E. Neal (D-Mass.), and Education and the Workforce Committee Ranking Member Robert C. “Bobby” Scott (D-Va.).

White House Releases Report on Compliance with Mental Health Parity Law

The Biden administration released a report to Congress last week on the state of compliance with the Mental Health Parity and Addiction Equity Act. It is the first time that such a report names the health insurance plans that are failing to meet the requirements of the law. Six categories of compliance problems are identified in the report, including prior authorization requirements for in-network and out-of-network inpatient services; concurrent care review for in-network and out-of-network inpatient and outpatient services; standards for provider admission to participate in a network; out-of- network reimbursement rates and how they were determined; impermissible exclusions of key treatments for mental health conditions; and adequacy standards for mental health provider networks. The report also includes examples of corrective actions plans have taken to address their deficiencies. The report was released in conjunction with a new proposed rule to strengthen the standards for health plans to meet the requirements of the mental health parity statute.

ARPA-H Launches Cancer Surgery Program

The Advanced Research Projects Agency for Health is seeking proposals for its first cancer focused program dubbed Precision Surgical Interventions (PSI). PSI aims to help all surgical procedures reach their intended goal with no errors and no need for re-operation. It will work toward developing solutions to two major surgical problems: tumor edge visualization and critical anatomy visualization. Proposer’s Day for interested researchers will open September 7.

Recently Introduced Health Legislation

H.R.4822 — To improve price transparency with respect to certain health care services, and for other purposes; Sponsor: Smith, Jason [Rep.-R-MO-8]; Committees: House - Energy and Commerce; Ways and Means; Education and the Workforce; Budget

H.R.4827 — To require applications for a health profession opportunity grant under section 2008 of the Social Security Act to contain evidence of in-demand jobs or worker shortages; Sponsor: Boyle, Brendan F. [Rep.-D-PA-2]; Committees: House - Ways and Means

H.R.4828 — To amend title XVIII of the Social Security Act to promote price transparency for imaging tests under the Medicare program; Sponsor: Carey, Mike [Rep.-R-OH-15]; Committees: House - Ways and Means; Energy and Commerce

H.R.4829 — To amend the Public Health Service Act to provide for the participation of physical therapists in the National Health Service Corps Loan Repayment program, to amend title XVIII of the Social Security Act to expand Medicare Rural Health Clinic Services and Federally Qualified Health Center Services to include physical therapy services, and for other purposes; Sponsor: DeGette, Diana [Rep.-D-CO-1]; Committees: House - Energy and Commerce; Ways and Means

H.R.4830 — To establish an interactive online dashboard to improve public access to information about grant funding related to mental health and substance use disorder programs; Sponsor: Gonzales, Tony [Rep.-R-TX-23]; Committees: House - Energy and Commerce

H.R.4832 — To amend the Indian Self-Determination Act and the Indian Health Care Improvement Act to provide advance appropriations authority for certain accounts of the Bureau of Indian Affairs and Bureau of Indian Education of the Department of the Interior and the Indian Health Service of the Department of Health and Human Services, and for other purposes; Sponsor: McCollum, Betty [Rep.-D-MN-4]; Committees: House - Natural Resources; Energy and Commerce; Education and the Workforce; Budget

H.R.4833 — To provide grants for the conduct of demonstration projects designed to provide education and training for eligible individuals to enter and follow a career pathway in the field of pregnancy, childbirth, or post-partum, under the health profession opportunity grant program under section 2008 of the Social Security Act; Sponsor: Moore, Gwen [Rep.- D-WI-4]; Committees: House - Ways and Means

H.R.4837 — To amend the Public Health Service Act to help build a stronger health care workforce; Sponsor: Ruiz, Raul [Rep.-D-CA-25]; Committees: House - Energy and Commerce; Ways and Means

H.R.4839 — To amend title XVIII of the Social Security Act to require certain facilities under the Medicare program to disclose certain information relating to charges and prices; Sponsor: Steel, Michelle [Rep.-R-CA-45]; Committees: House - Ways and Means; Energy and Commerce

S.2459 — A bill to amend title XVIII of the Social Security Act to ensure appropriate supervision requirements for outpatient physical therapy and outpatient occupational therapy, and for other purposes; Sponsor: Carper, Thomas R. [Sen.-D-DE]; Committees: Senate – Finance

S.2464 — A bill to amend title XXVII of the Public Health Service Act to prohibit group health plans and health insurance issuers offering group or individual health insurance coverage from imposing cost-sharing requirements with respect to diagnostic and supplemental breast examinations; Sponsor: Shaheen, Jeanne [Sen.-D-NH]; Committees: Senate - Health, Education, Labor, and Pensions

S.2465 — A bill to require the Secretary of Veterans Affairs to establish a pilot program to furnish doula services to veterans; Sponsor: Booker, Cory A. [Sen.-D-NJ]; Committees: Senate - Veterans’ Affairs

S.2474 — A bill to amend title XVIII of the Social Security Act to ensure appropriate cost-sharing for chronic care drugs under Medicare part D; Sponsor: Cornyn, John [Sen.-R-TX]; Committees: Senate – Finance

S.2476 — A bill to amend the Public Health Service Act to provide for a behavioral and mental health outreach and education strategy to reduce stigma associated with mental health among the Hispanic and Latino population, and for other purposes; Sponsor: Padilla, Alex [Sen.-D-CA]; Committees: Senate - Health, Education, Labor, and Pensions

S.2477 — A bill to amend title XVIII of the Social Security Act to provide pharmacy payment of certain services; Sponsor: Thune, John [Sen.-R-SD]; Committees: Senate – Finance

S.2481 — A bill to amend title XIX of the Social Security Act to encourage appropriate prescribing under Medicaid for victims of opioid overdose; Sponsor: Manchin, Joe, III [Sen.-D-WV]; Committees: Senate – Finance

S.2483 — A bill to amend the Public Health Service Act to provide additional transparency and consumer protections relating to medical debt collection practices; Sponsor: Murphy, Christopher [Sen.-D-CT]; Committees: Senate - Health, Education, Labor, and Pensions

S.2485 — A bill to award posthumously a Congressional Gold Medal to Henrietta Lacks, in recognition of her immortal cells which have made invaluable contributions to global health, scientific research, our quality of life, and patients’ rights; Sponsor: Van Hollen, Chris [Sen.-D-MD]; Committees: Senate - Banking, Housing, and Urban Affairs

S.2493 — A bill to require the Medicare Payment Advisory Commission (MedPAC) submit to Congress two reports on arrangements with pharmacy benefit managers with respect to prescription drug plans MA-PD plans; Sponsor: Warner, Mark R. [Sen.-D-VA]; Committees: Senate – Finance

H.R.4846 — To amend the Internal Revenue Code of 1986, title XXVII of the Public Health Service Act, and the Employee Retirement Income Security Act of 1974 to provide for oversight of pharmacy benefit manager services; Sponsor: Arrington, Jodey C. [Rep.-R-TX-19]; Committees: House - Energy and Commerce; Ways and Means; Education and the Workforce

H.R.4849 — To allow for hemp-derived cannabidiol and hemp-derived cannabidiol containing substances in dietary supplements and food; Sponsor: Blumenauer, Earl [Rep.-D-OR-3]; Committees: House - Energy and Commerce

H.R.4851 — To provide for improvements in the implementation of the National Suicide Prevention Lifeline, and for other purposes; Sponsor: Cárdenas, Tony [Rep.-D-CA-29]; Committees: House - Energy and Commerce; Ways and Means; Armed Services; Veterans’ Affairs; Oversight and Accountability

H.R.4874 — To provide for technical assistance under the health profession opportunity grant program under section 2008 of the Social Security Act; Sponsor: Kildee, Daniel T. [Rep.-D-MI-8]; Committees: House - Ways and Means

H.R.4878 — To amend title XVIII of the Social Security Act to ensure appropriate supervision requirements for outpatient physical therapy and outpatient occupational therapy; Sponsor: Lesko, Debbie [Rep.-R-AZ-8]; Committees: House - Energy and Commerce; Ways and Means

H.R.4881 — To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program; Sponsor: Malliotakis, Nicole [Rep.-R-NY-11]; Committees: House - Energy and Commerce; Ways and Means

H.R.4882 — To amend title XVIII of the Social Security Act to promote laboratory price transparency under the Medicare program; Sponsor: Miller, Carol D. [Rep.-R-WV-1]; Committees: House - Ways and Means; Energy and Commerce

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