08/19/2019
The August recess is currently underway, and Congress will reconvene on September 9.
Surprise billing, drug pricing, and other health care bills
In June, the House Ways and Means Committee approved several pieces of legislation related to workforce and Medicare. The Opioid Workforce Act of 2019 (H.R. 3414) would increase the number of Medicare-supported graduate medical education positions by 1,000 slots for hospitals with established, or in the process of establishing, addiction medicine, addiction psychiatry, or pain medicine programs. Another bill (H.R. 3439) would correct a technical error that would enable community hospitals to establish their own full-time residency programs and make it easier to train more residents.
The House Energy and Commerce Committee held a July markup to advance legislation to the House regarding several key health care issues, including:
• eliminating Medicaid Disproportionate Share Hospital (DSH) payments in FY 2020 and 2021 and reducing the cuts to $4 billion for FY 2022; and
• reauthorizing Title VII health professions workforce development programs (H.R. 2781) and Title VIII nursing workforce development programs (H.R. 728) for five years.
Additionally, the committee passed an amended version of its proposal to address surprise medical bills. The No Surprises Act (H.R. 3630) aims to protect patients from surprise billing and establish a benchmark payment rate to resolve surprise billing disputes between providers and insurers. Amendments approved during the markup included:
• establishing an independent dispute resolution or arbitration option for claims greater than $1,250 (effective in 2021, with the dollar amount increasing each year in line with inflation);
• specifying that the median contracted rate methodology may account for relevant payment adjustments such as higher acuity settings and the case-mix of various facilities when determining payment amounts; and
• requiring air ambulance providers to report cost data to HHS for air ambulance rides, insurers to submit claims data to HHS, and HHS and the Government Accountability Office to report to Congress on the data.
In June, the Senate Health, Education, Labor, and Pensions (HELP) Committee approved S. 1895, the Lower Health Care Costs Act, a five-part bill designed to end surprise billing, lower drug costs, improve transparency and health information exchange, and strengthen public health programs. A provision of the bill would create a benchmark payment rate tied to an area’s median in-network rate as a way to resolve surprise medical bill disputes. Duke Health Government Relations met with staff for Senator Richard Burr (R-NC) and the HELP Committee in opposition to the bill’s benchmark provisions. The Committee did not consider a proposal to adopt an independent dispute resolution. The bill now awaits action by the Senate.
On July 25, the Senate Finance Committee held a markup of draft legislation, the Prescription Drug Pricing Reduction Act, that would overhaul parts of the Medicare Part B and Part D benefits, Medicaid, and the ways in which manufacturers currently raise drug prices. The committee approved the bill by a vote of 19 to 9, with nine Republicans voting in opposition, and it now awaits action by the Senate.
The HELP and Finance Committees will likely combine drug pricing legislation, but it is unclear when a final package will be considered on the Senate floor. The House is expected to consider a drug pricing package in September.
Patient-Centered Outcomes Research Institute (PCORI)
PCORI was established in 2010 under the Affordable Care Act to fund and build the nation's capacity to conduct comparative clinical effectiveness research. Duke is ranked second in the nation for PCORI funding, with nearly $95 million supporting more than 20 projects. This research aims to improve the quality and relevance of evidence available to help patients, caregivers, clinicians, employers, insurers, and policy makers to make informed health decisions.
In June, the House Ways and Means Committee approved legislation (H.R. 3439) to extend PCORI for seven years, as well as make minor changes to PCORI’s national research priorities to include substance use, mental health, and maternal morbidity and mortality. In July, the House Energy and Commerce Committee approved legislation (H.R. 2328) to reauthorize PCORI for just three years. Duke Health Government Relations continues to advocate for a 10-year reauthorization.
Election updates for two House seats
On July 9, Greg Murphy, currently a member of the NC House and a urologist in Greenville, defeated Joan Perry, a pediatrician from Kinston, in the Republican primary election for North Carolina’s 3rd Congressional District. This district includes the Outer Banks and the coastal plain of North Carolina from the Virginia border to Wilmington. The general election is set for September 10, with Democrat Allen Thomas, Libertarian Tim Harris, and Constitution Party candidate Greg Holt.
Republican State Senator Dan Bishop will face retired Marine and Duke alumnus Dan McCready in the September 10 general election for North Carolina’s 9th Congressional District. This district’s population base is in the southern parts of Charlotte and includes rapidly growing Union County, four mostly rural counties that extend east along the South Carolina border, and parts of Bladen and Cumberland counties.