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Federal Health Policy Updates for the Week of September 9, 2019

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The Headlines

Welcome back from the August recess! Congress returned from its month-long district work period to a long legislative to-do list and only 37 legislative days until the end of the calendar year. Read on for what the next few months might hold. 

  1. The House and Senate have just two more weeks to agree on how to fund the federal government before the new fiscal year begins October 1.
  2. Results are in from the September 10 special election for North Carolina’s 3rd and 9th Congressional Districts.
  3. Congress has surprise billing and drug pricing among its top health priorities to address before the end of the year.
  4. A House health subcommittee held a hearing on maternal health, and a Duke Health OB-GYN physician weighed in.
  5. The Department of Health and Human Services (HHS) proposed payment rules for outpatient care and the physician fee schedule and finalized a payment rule for inpatient care.

The Details

1.  FY 2020 appropriations stall
Before the August recess, the president signed into law a budget deal that raised the Budget Control Act’s budget caps for two years and suspended the federal debt limit through July 2021. In other words, Congress enacted legislation that set topline spending levels for defense and non-defense discretionary spending for FY 2020, avoiding across-the-board cuts that would have significantly lowered federal spending.
 
In July, the House approved 10 of its 12 appropriations bills for FY 2020, including the Labor-HHS-Education spending bill that would provide a $2 billion increase for the National Institutes of Health. Based on the budget deal’s new spending totals, the House now needs to adjust how much it had appropriated for both defense and non-defense discretionary spending.
 
The Senate Appropriations Committee had not approved any of its 12 appropriations bills for FY 2020 until last week, passing two spending bills before encountering partisan disagreements over abortion policy, border wall funding, and overall spending levels for non-defense programs.
 
This week, the House will likely pass a continuing resolution through mid-November that would fund the government at current levels and give Congress more time to finalize funding for FY 2020 after it starts on October 1.

2. Two new members of the US House
NC State Senator Dan Bishop won the congressional seat for the 9th District, beating Democratic challenger Dan McCready by roughly two percentage points in a special election on September 10. Representative-elect Bishop will be sworn in this week in the US Capitol along with NC State House Representative Greg Murphy, who defeated his Democratic opponent Allen Thomas in a special election for the 3rd District.

3. Surprise billing and drug pricing
In July, the House Energy and Commerce Committee approved legislation that would prohibit balance billing for emergency services; require written and oral notice about the provider’s network status when scheduling appointments; establish a minimum payment standard set at median contracted geographic rates; and provide $50 million in grants for states developing or maintaining an all-payer claims database.  The Senate Health, Education, Labor and Pensions Committee also approved legislation to prevent surprise medical bills, reduce drug prices, increase transparency, and strengthen public health.
 
The House Ways and Means and Education and Labor Committees as well as the Senate Finance Committee also have jurisdiction over surprise billing and may act in the fall. Additionally, House Speaker Nancy Pelosi is expected to release a comprehensive drug pricing plan this week. Our office continues to monitor legislative developments and will continue to share updates.

4. House hearing on maternal health
Last week, the House Energy and Commerce Subcommittee on Health held a hearing entitled, “Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care,” and heard from expert witnesses on the importance of funding and supporting research and interventions to improve maternal health. Prior to the briefing, Dr. Sarahn Wheeler, Assistant Professor of Obstetrics and Gynecology -- Maternal-Fetal Medicine Division, shared with the office of Rep. GK Butterfield (D-NC) some of the qualitative work about women’s experiences with employment and barriers to presentation for prenatal care during pregnancy. 
 
Legislation discussed included:
H.R. 1897, the Mothers and Offspring Mortality and Morbidity Awareness Act
H.R. 1551, the Quality Care for Moms and Babies Act
H.R. 2902, the Maternal Care Access and Reducing Emergencies Act
H.R. 2602, the Healthy MOMMIES Act

5. Regulatory updates
Over the summer, the Centers for Medicare and Medicaid Services (CMS) finalized a rule for the FY 2020 Inpatient Prospective Payment System that increased operating payment rates by 3.1% and increased new technology add-on payments from 50 percent of estimated costs of the case to 65 percent, including for CAR T-cell therapies, among other things. The final rule goes into effect on October 1, 2019.
 
CMS also proposed rules for the 2020 Outpatient Prospective Payment System, proposing to increase payment rates by 2.7% and require hospitals disclose their payer-negotiated rates, and the 2020 Physician Fee Schedule that would develop a new unblended approach to paying for and documenting Evaluation and Management visits and bundle payment for the treatment of opioid use disorder, among many other things. Comments on these proposed rules are due September 27, and a final rule will be issued by November 1 with the effective date beginning January 1, 2020.

Upcoming committee hearings