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.


Sanders, Marshall Release Health Care Workforce Package

Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Bernie Sanders (I-Vt.) and panel member Roger Marshall (R-Kan.) have reached an agreement on a health care workforce package that would provide a significant funding increase for the nation’s community health centers. The Bipartisan Primary Care and Health Workforce Act includes an almost $2 billion annual increase in mandatory funding for community health centers – totaling $5.8 billion annually for three years. The bill would triple mandatory funding for the National Health Service Corps, from $310 million to $950 million annually for three years, while also providing $1.5 in mandatory funding over the next five years to the Teaching Health Centers Graduate Medical Education program. The package provides $1.2 billion in mandatory funding for two-year registered nursing program grants and authorizes or reauthorizes discretionary funding for other nursing workforce programs. The bill would ban hospitals from certain anti-competitive contracting clauses in negotiations with commercial insurance companies, and would restrict hospitals from charging facility fees for services that do not occur on a hospital campus. The legislation does not have the support of HELP Committee Ranking Member Bill Cassidy (R-La.), who argues that the bill “lacks full Hyde [Amendment] protections and drastically increases spending without a plan to pay for it.” Cassidy has expressed support for the package being advanced in the House of Representatives which contains lower funding amounts. Chairman Sanders has said that he is still working to improve the spending offsets contained in the agreement. Sen. Marshall stated that the bill would be “fully paid for by combatting the enormous waste, fraud, and abuse in the health care system, making it easier for patients to access low-cost generic drugs, and holding pharmacy benefit managers (PBMs) accountable, among other provisions,” while his staff has specified to reporters that the deal would be partly paid for with PBM reforms advanced by the HELP and Finance committees earlier this year. The Bipartisan Primary Care and Health Workforce Act is scheduled to be marked up by the HELP Committee on Thursday. It likely can be passed out of Committee without any additional Republican votes, but it will require further bipartisan support to pass on the Senate floor. Funding for community health centers and authorization for other programs expires at the end of the month.

Transparency Bill Expected to Advance in the House

The House is set to vote this week on the Lower Costs, More Transparency Act (H.R. 5378). The package is focused on increasing transparency in the hospital, insurer, and PBM industries. It includes many provisions previously advanced by the Energy and Commerce, Ways and Means, and Education and the Workforce committees, drawing much from the PATIENT Act, to provide patients with timelier and more accurate information about the cost of health care procedures and services. It also increases funding for community health centers and the Teaching Health Center Graduate Medical Education Program. The legislation is backed by both Chair Cathy McMorris Rodgers (R-Wash.) and Ranking Member Frank Pallone (D-N.J.) of the Energy and Commerce Committee, Ways and Means Committee Chairman Jason Smith (R-Mo.), and Education and the Workforce Chair Virginia Foxx (R-N.C.). However, the top Democrats on the Ways and Means and Education and the Workforce panels did not join in introducing the bill.

Update on Government Funding Negotiations

The Senate voted to expedite debate on a fiscal year (FY) 2024 funding bill (H.R. 4366) for the departments of Veterans Affairs, Agriculture, Transportation, and Housing and Urban Development last week. Thirty-seven Republicans joined Senate Democrats in backing the measure, which contains $100 billion more in spending than supported by Republicans in the House of Representatives. It also lacks several border security and anti-abortion provisions being sought by GOP members of the House. After passing the three-bill spending package, the Senate then plans to vote on a stopgap spending bill containing $24 billion in aid to Ukraine and $16 billion in disaster funding.

Republicans in the House announced on Sunday that they had reached a deal on a continuing resolution (CR) to fund the federal government through October 31. The CR would trigger a 1% cut to current spending levels. The cut would not be applied equally across the budget; the Department of Defense and Veterans Affairs would not see any spending reductions, while the rest of the government would see an immediate 8% cut until the end of October. The proposal was negotiated by Main Street Caucus members Dusty Johnson (R-S.D.), Stephanie Bice (R-Okla.) and Kelly Armstrong (R-N.D.) and Freedom Caucus members Scott Perry (R-Pa.), Chip Roy (R-Tex.) and Byron Donalds (R-Fla.). If the House passes the CR deal, the Senate will need to respond by either passing the package or sending an amended version back to the House. The latter is more likely given the House agreement is not bipartisan and unlikely to be signed into law by the White House.

HELP Chair Sanders Agrees to Confirmation Hearing for NIH Nominee

Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Bernie Sanders (I-Vt.) has committed to holding a confirmation hearing next month on the nomination of Dr. Monica Bertagnolli to serve as Director of the National Institutes of Health. Sanders’ statement followed an announcement by the Biden administration that it had secured an agreement from biotech company Regeneron to limit the list price of a next-generation monoclonal antibody treatment for COVID-19 to equal to or less than the price in other major countries. Chairman Sanders had previously pledged to oppose all administration health nominees until the White House took unilateral action to cut drug prices.

Senators Ask DEA to Extend Virtual Prescribing Flexibilities

Abipartisan group of senators have written to the Drug Enforcement Administration (DEA) urging the agency to maintain access to care in its telemedicine prescribing policies. The lawmakers ask DEA to extend COVID-era flexibilities permitting the virtual prescribing of controlled substances for new patients beyond November 2023, and to extend the 30-day supply allowed for the prescription of controlled substances before a patient must see their doctor in person. The letter expresses concerns about the ability of patients to obtain in-person appointments within 30 days of starting a new medication, and “the potential consequences to their health of starting a new medication and abruptly ending it should they not be able to obtain such an appointment.” The lawmakers also recommend that DEA establish a special registration process to enable providers to prescribe controlled substances without an in-person visit. The letter was signed by Sens. Mark Warner (D-Va.), John Thune (R-S.D.), Catherine Cortez Masto (D-Nev.), Shelley Moore Capito (R-W. Va.), Sheldon Whitehouse (D-R.I.), and Dan Sullivan (R-Alaska).

Romney Announces Decision to Not Seek Reelection

Sen. Mitt Romney (R-Utah) announced that he will not seek a second term in the U.S. Senate last week. Romney cited his age, 76, as the reason for his decision, calling for support for a new generation of leaders “to make the decisions that will shape the world they will be living in.” Romney currently serves on the Foreign Relations Committee, Health, Education, Labor and Pensions Committee, the Homeland Security and Governmental Affairs Committee, and the Budget Committee. Romney told reporters that he does not plan to endorse anyone to replace him next year.

Challenges to the No Surprises Act Continue

The Texas Medical Association and other medical providers filed a brief last week in the U.S. Court of Appeals for the Fifth Circuit arguing that federal agencies rewrote the law to favor health insurers in their implementation of the No Surprises Act (NSA). “What insurers could not obtain through the legislative process, the federal Departments implementing the NSA have given them through rulemaking,” the plaintiffs state. The providers express opposition to the administration’s decision to direct independent dispute resolution entities to give primary consideration to the qualifying payment amount (QPA) as they work to settle billing disputes, and challenge the underlying method laid out to calculate the QPA.

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