This Week in Washington: House to unveil sweeping health bill
Appropriations Process Remains Top Priority
With the fiscal year set to expire on Sept. 30, time is running out for Congress to pass appropriations bills to fund the government through the new fiscal year. The House is expected to move appropriations bills for the Department of Defense, Department of Homeland Security and Department of Agriculture-Food and Drug Administration. The Senate is expected to move appropriations bills for the Department of Agriculture, Military Construction, and Veterans’ Affairs, the Department of Transportation and the Department of Housing and Urban Development. It is not yet known whether a continuing resolution will be passed to avert a government shutdown.
House Republicans Release Healthcare Package Draft
On Sept. 6, Republicans on the House Energy and Commerce, Ways and Means, and Education and Workforce committees released a draft of the Lower Cost, More Transparency Act. The legislation is a major healthcare package composed of bills advanced by the committees relating to price transparency, pharmacy benefit managers (PBMs), Medicare site-neutral payments and healthcare program funding. The proposal could change after consideration by the full GOP caucus. The package includes:
H.R. 3561, PATIENT Act of 2023
This legislation would expand hospital price transparency requirements, extend funding for the Community Health Center Fund and other programs, and implement site-neutral payments for drugs administered by physicians in off-campus hospital outpatient departments.
H.R. 4839, Hospital and ASC Price Transparency Act of 2023
This legislation would require hospitals to publicly disclose the standard charges for all items and services for at least 300 shoppable services.
H.R. 3248, Diagnostic Lab Testing Transparency Act
This legislation would strengthen price transparency of clinical diagnostic laboratory tests under the Medicare program and require providers to disclose the discounted cash price and insurer- negotiated minimum and maximum rates of tests.
H.R. 4882, Clinical Laboratory Price Transparency Act of 2023
This legislation would require providers to publicly disclose the cash and insurer-negotiated rates for clinical diagnostic laboratory tests offered by a lab included on the list of shoppable services by the Centers for Medicare and Medicaid Services (CMS).
H.R. 4828, Imaging Services Price Transparency Act of 2023
This legislation would require providers to disclose the cash price and insurer-negotiated rates for certain imaging services.
H.R. 4905, Health Insurance Price Transparency Act of 2023
This legislation would require health insurers to share cost-sharing and pricing information with patients.
H.R. 4507, Transparency in Coverage Act of 2023
This legislation would require insurers to share pricing information for healthcare services and require PBMs to share cost information with plan sponsors.
H.R. 2697, Pharmacy Benefit Manager Accountability Act
This legislation would require PBMs to disclose information regarding the rebates, fees and alternative discounts they receive from prescription drugs. It would also require PBMs to disclose drug wholesale acquisition costs and enrollee total out-of-pocket spending.
H.R. 4822, Health Care Price Transparency Act
This legislation would require PBMs to share net price data, aggregate rebate information, out-of-pocket spending and acquisition costs for all drug classes upon request by an employer.
H.R. 3282, Promoting Transparency and Health Competition in Medicare Act
This legislation would require public reporting of data from healthcare entities who share common ownership interests within the Medicare program, specifically insurers who own pharmacies, PBMs and healthcare providers.
H.R. 4883, Medicare Common Ownership Transparency Act of 2023
This legislation would require Medicare Advantage (MA) organizations to disclose common ownership of pharmacies, PBMs and providers to the Department of Health and Human Services (HHS).
H.R. 3284, Providers and Payers COMPETE Act
This legislation would require the HHS Secretary to submit an annual report to Congress detailing the impact Medicare regulations have on healthcare payer and provider consolidation.
H.R. 3839, Increasing Transparency in Generic Drug Applications Act
This legislation would improve the Food and Drug Administration’s (FDA) review process of generic drugs and allow the FDA to inform drug sponsors about differences between their application and the reference product.
H.R. 1613, Drug Price Transparency in Medicaid Act
This legislation would prohibit PBMs from using spread pricing within the Medicaid program.
H.R. 3237, to amend title XVIII of the Social Security Act to require each off-campus outpatient department of a provider to include a unique identifier on claims for items and services, and to require providers with a department to submit to the Centers for Medicare and Medicaid services an attestation with respect to each such department.
This legislation would require off-campus outpatient departments to use a unique health identifier when billing for services.
H.R. 3417, FAIR Act
This legislation would require off-campus outpatient departments to bill for services provided using a unique health identifier.
H.R. 4509, Transparency in Billing Act
This legislation would require group health plans to only pay claims submitted by hospitals that have implemented accurate billing practices, policies and procedures.
H.R. 2559, Strengthening Community Care Act of 2023
This legislation would extend funding for the Community Health Center Fund, the National Health Service Corps and the Teaching Health Center Graduate Medical Education Program.
H.R. 2550, Special Diabetes Program Reauthorization Act of 2023
This legislation would reauthorize funding for the Special Diabetes Program through calendar year (CY) 2025.
H.R. 2547, Special Diabetes Program for Indians Reauthorization Act of 2023
This legislation would reauthorize funding for the Special Diabetes Program for Indians through CY2025.
H.R. 2665, Supporting Safety Net Hospitals Act
This legislation would delay cuts to the Medicaid Disproportionate Share Hospital (DSH) payment for fiscal years (FYs) 2024-2025.
H.R. 4527, Health Data Access, Transparency, and Affordability (DATA) Act
This legislation would improve transparency of the health insurance market and ensure that plan fiduciaries can access cost and quality of care information of their plan.
H.R. 4508, Hidden Fee Disclosure Act
This legislation would clarify and strengthen employer-sponsored health plan disclosure requirements.
For more information, click here.
House Ways and Means Committee Chair Requests Information on Rural Health Disparities
On Sept. 7, House Ways and Means Committee Chairman Jason Smith (R-MO) sent a letter to stakeholders requesting their input on how to address the challenges facing patients living in rural and underserved areas when accessing healthcare services.
The Chairman noted that the committee is particularly interested in payment disparities that exist between geographic areas, payments for identical care provided in different sites of service and the long-term financial health of healthcare providers and facilities. The committee is also interested in innovative care models that could improve patient outcomes and incentives aimed at revitalizing the healthcare workforce.
Public comments will be accepted until Oct. 5. For more information, click here.
Senate HELP Committee Ranking Member Releases White Paper on AI
On Sept. 6, Senate Health, Education, Labor and Pensions (HELP) Committee Ranking Member Bill Cassidy (R-LA) released a white paper on artificial intelligence (AI) and its projected risks and benefits to society. The white paper focuses on AI’s potential role within the healthcare space and examines how AI could strengthen pharmaceutical research and development, disease detection and treatment, health data privacy and healthcare workload. The paper also examines AI’s potential impact on education and job security.
The Ranking Member is requesting that stakeholders submit feedback on the outlined topics by Sept. 22.
For more information, click here.
Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.