Health Policy Report (1/21)
January 21, 2020The Week in Review
It was a historic week in the chambers of Congress last week that saw action on both impeachment and the United States-Mexico-Canada Agreement (USMCA). The Senate passed implementing legislation for the USMCA after several committees approved President Donald Trump’s signature trade pact on a bipartisan basis last week. Following passage of the USMCA measure, Senators were sworn in as jurors for the impeachment trial by Chief Justice John Roberts.
On the House floor, lawmakers cleared a bill (text; amendments) out of the Education and Labor Committee that seeks to deter worker age discrimination. The Protecting Older Workers Against Discrimination Act would amend the Age Discrimination in Employment Act to bolster federal age-discrimination protections in the workplace by easing the standard of proof requirements for these claims. House lawmakers also passed a Congressional Review Act resolution that would overturn a Department of Education Rule relating to “Borrower Defense Institutional Accountability.” Both measures are considered dead-on-arrival in the GOP-controlled Senate after the Trump administration issued veto threats last week.
The Week Ahead
The Senate has begun its historic impeachment trial against President Trump after officially receiving two articles of impeachment from the House last week. Senators will consider two charges, including abuse of power and obstruction of Congress, laid forth by the House in its articles. The full trial will begin in earnest today, with House managers and White House defense lawyers set to present their respective cases.
In the House, lawmakers have adjourned for the Martin Luther King Jr. Day district work period. The lower chamber will resume legislative business on Monday, Jan. 27.
HHS, ONC Release Health IT Roadmap through 2025
Last Wednesday, the Department of Health and Human Services (HHS) released a draft of its 2020-2025 Federal Health IT Strategic Plan. The draft strategic plan, developed by the Office of the National Coordinator for Health Information Technology (ONC), emphasizes efforts to facilitate software access to health data and building an interoperable health IT infrastructure throughout the industry. It also reinforces the Administration’s strategic priorities around transparency, reflecting other HHS efforts that hold that increasing product and price transparency for patients will decrease system costs and improve outcomes. “Federal partners will continue to play a role in ensuring that patients get access to their electronic health information and have the full transparency that they need to shop for care,” wrote National Coordinator Donald Rucker, M.D. in a cover note. “The Plan will decrease provider burden and open up entirely new business models throughout the health app economy.”
Three of the plan’s four overarching goals are focused in improving health IT’s role in directly serving patients. The four goals are: 1) promote health and wellness; 2) enhance the delivery and experience of care; 3) build a secure, data-driven ecosystem to accelerate research and innovation; and 4) connect health care and health data through an interoperable health IT infrastructure. The plan largely follows the same script as a pair of proposed rules, one from the Centers from Medicare and Medicaid Services (CMS) and the other from ONC, that crack down on so-called “information blocking,” promote interoperability, and create a framework for application programming interface (API) development. API development is central to much of the plan, facilitating all of the major goals with the secure and accurate transfer of health information between various systems. Amid complaints from some industry groups, it is notable that the administration has not appeared to change direction with the release of HHS’ 2020-2025 strategic plan.
CMS Seeks Input on Implementing New Health Home Benefit
The Centers for Medicare and Medicaid Services (CMS) released a request for information (RFI) last Thursday on coordinating care from out-of-state providers for medically-complex children, as required by the Medicaid Services Investment and Accountability Act of 2019 (H.R. 1839). The bill, which amended the Social Security Act, created a new optional Medicaid health home benefit of covering health home services for Medicaid-eligible children with medically-complex conditions. To smooth the process and develop best practices for achieving coordinated care under such circumstances, the law requires CMS to issue guidance on coordinated care for medically-complex children given by providers across state lines and requires an RFI to inform the guidance.
Once published in the Federal Register, the RFI will be open for comment for sixty days. The RFI has a scheduled publication date of January 21, 2020, meaning the comment period will likely close on March 21, 2020. The responses will inform a guidance to state Medicaid directors, which is required to be published by October 1, 2020. In particular, the agency wishes to hear from children and their families, states, providers, managed care plans, and advocates. The RFI summarizes the qualifying chronic conditions, mandatory health home services, and qualifying providers and health care teams.
Hospitals Sue to Halt Site Neutral Payment Policy for 2020
The American Hospital Association, Association of American Medical Colleges, and several hospital systems sued the Trump Administration over the site-neutral payment policy last Monday, arguing that the pay cuts are outside of the Centers for Medicare and Medicaid Services’ authority because they aren’t budget neutral as required by law. Although a federal judge ruled last September that the administration had exceeded its authority in 2019 by implementing the site-neutral payment policy for off-campus hospital clinics, the administration decided to include the policy in its final 2020 Hospital Outpatient Prospective Payment System rule. The administration appealed the ruling in December but agreed to relinquish the payments it owed hospitals for 2019.
The lawsuit is the latest in a string of actions hospitals have taken to halt the policy. Hospitals attempted to preemptively stop the policy for 2020, but their request was denied by a federal court and they were forced to wait until they submitted claims from 2020 to claim standing in the case. Hospital advocates have reported they would lose $760 million in 2020 under the policy, although CMS estimated the 2020 changes would cut copays for Medicare beneficiaries and slash federal spending by $800 million this year.
FTC Commissioner Endorses Medicare Drug Negotiation
Last Thursday, a Republican member of the Federal Trade Commission voiced support for allowing Medicare to directly negotiate the price of prescription drugs at an event held by the Council for Affordable Health Coverage, breaking from the traditional conservative view on the subject. Christine Wilson, a business executive appointed to the FTC by President Trump in 2018, noted that she may “touch a third rail” with her support, but explained that the “federal government … is essentially a price-taker, and that seems like a problem.” Commissioner Wilson also appeared to endorse the Democratic drug pricing proposal passed through the House last month, saying she’d like to see the idea expanded. She acknowledged, however, that the bulk of health care cost regulations lie beyond the FTC’s jurisdiction and expressed frustration with anticompetitive behavior within the pharmaceutical industry more broadly.
Her remarks highlight the ongoing divide in Washington over which strategies should be used by the administration to rein in drug costs. Although President Trump originally campaigned on the concept of Medicare negotiation, his administration and Republican members of Congress have consistently opposed the idea. White House aides have labeled Democrats’ drug-negotiation bill “hyper-partisan,” and Trump has pledged to veto the proposal in the unlikely event it passed Congress.