{"id":2070,"date":"2021-07-26T18:41:44","date_gmt":"2021-07-26T18:41:44","guid":{"rendered":"https:\/\/thornrun.com\/health-policy-report-7-26\/"},"modified":"2023-08-08T21:25:36","modified_gmt":"2023-08-08T21:25:36","slug":"health-policy-report-7-26","status":"publish","type":"post","link":"https:\/\/thornrun.com\/health-policy-report-7-26\/","title":{"rendered":"Health Policy Report (7\/26)"},"content":{"rendered":"\n

Capitol Hill Update<\/strong><\/p>\n\n\n\n

Senators will reconvene for legislative business this week as negotiations on the bipartisan infrastructure framework<\/a>\u00a0continue. The bipartisan “G20” group has expressed optimism that they will settle on a final agreement and produce legislative text by the end of today, followed by another procedural vote to try and advance the bill at some point this week. The two sides have reportedly agreed to further delay the Trump administration’s Medicare rebate rule to help offset some of the plan’s costs, but it is not yet clear whether Senators have resolved a lingering disagreement over transit funding. With an ambitious agenda of clearing both the Biden-endorsed infrastructure deal and a budget resolution prior to the end of the summer, it is likely that the Senate will nix part of its August state work period to free up additional floor time. <\/p>\n\n\n\n\n\n\n\n

In the House, Members\nwill convene today to begin a busy week of appropriations activity. Lawmakers\nwill look to clear at least seven funding measures for fiscal year (FY) 2022\nnext week by way of a “minibus” containing the spending bills\nfor Labor-HHS-Education<\/a>, Ag-FDA<\/a>, Energy-Water<\/a>, Interior-Environment<\/a>, Military Construction-VA (MilCon-VA<\/a>), Transportation-HUD (T-HUD<\/a>), and Financial Services and General\nGovernment (FSGG<\/a>). The bills for C<\/a>ommerce-Justice-Science<\/a>, State-Foreign Operations<\/a>, and Legislative Branch<\/a> are also on the schedule for this week,\nbut there is no word on when the Defense<\/a> and Homeland Security<\/a> bills will be taken up as of now. With\nrespect to the August schedule, Majority Leader Steny Hoyer (D-MD) stated that\nMembers will leave Washington for the month-long district work period as\nplanned. However, he suggested that lawmakers could get called back for votes\ndepending on when the Senate clears the infrastructure deal and budget\nresolution <\/p>\n\n\n\n

CMS Proposes Hospital\nOPPS and ASC Payment Rates with a Focus on Transparency <\/strong><\/p>\n\n\n\n

On Monday, the Centers\nfor Medicare and Medicaid Services (CMS) proposed its calendar year (CY) 2022\nHospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical\nCenter (ASC) payment rates (text<\/a>; fact sheet<\/a>; press release<\/a>). The rule discusses proposed updates and\nrequirements for the Hospital Outpatient Quality Reporting (OQR) Program and\nthe ASC Quality Reporting (ASCQR) Program, Hospital Price Transparency\nrequirements, and design of the Radiation Oncology (RO) Model. CMS also\nincluded a Request for Information (RFI) focused on health equity standards,\nquality measures and reporting requirements, and payment policies for Rural\nEmergency Hospitals (REHs). Thorn Run\u2019s analysis<\/a> of the rule expands on proposed changes,\nwhich include limits on telehealth utilization for mental health. <\/p>\n\n\n\n

If finalized, the rule\nwould crackdown on hospital transparency by implementing fines that could\namount to $2 million over the course of a year, depending on the hospital\u2019s\nsize. The policy would likely see far-reaching impacts, considering that less than six percent<\/a> of hospitals are compliant with federal price\ndisclosure requirements. This, and other accountability measures in the\nproposal, come on the heels of President Biden\u2019s recent Executive Order on Competition<\/a>. “As President Biden made clear in his\nexecutive order promoting competition, a key to price fairness is price\ntransparency,” HHS Secretary Xavier Becerra said in a statement. <\/p>\n\n\n\n

Additionally, CMS\nproposed to halt the previous Administration\u2019s phase-out of the inpatient-only\n(IPO) list. Under previous longstanding CMS regulations, Medicare payments were\nonly available for services on the IPO list if they were performed in an\ninpatient setting. In December 2020, CMS finalized a rule to eliminate the list\nover a three-year period, permitting Medicare payments for these services if\nalso performed in an outpatient setting. At this time, several patient advocacy\nand hospital groups argued against ending the inpatient-only list, as it could\npotentially push high-risk procedures into an outpatient setting and lower\nhospital payments if treatment shifted to lower-cost settings. After hearing\nthese concerns from stakeholders, CMS announced on Monday that it is halting\nthe elimination of the IPO list and is soliciting comments on whether the\nagency should maintain the longer-term strategy of eliminating the list. <\/p>\n\n\n\n

Manufacturers,\nDistributors to Reach $26B Opioid Settlement<\/strong><\/p>\n\n\n\n

Local government\nlawyers announced Tuesday that they are finalizing a $26 billion settlement\nwith drugmaker Johnson & Johnson and distribution companies\nAmerisourceBergen, Cardinal Health, and McKesson. The three wholesalers also\nagreed to a $1.1 billion settlement in New York this past week. Full details\nfor the $26 billion settlement could be publicized as soon as this week, and each\nstate will have 30 days to opt-in (local governments will then have an\nadditional five months). Under the settlement agreement, AmerisourceBergen,\nCardinal Health, and McKesson will contribute $21 billion over 18 years, and\nJohnson & Johnson would pay the remaining $5 billion over nine years. The\nsettlement total will decrease if governments decline to participate. <\/p>\n\n\n\n

If approved, the\nfunding will be allocated towards treatment and mitigation efforts for those\nimpacted by opioid addiction, and Johnson & Johnson will agree to no longer\nmanufacture opioids. However, impacted parties and experts are skeptical that\nthe money will trickle down where it is needed most. Pennsylvania would receive\n$1 billion from the settlement, and Philadelphia would only receive a projected\n$5 to $8 million. Philadelphia\u2019s district attorney has already come out against\nthe settlement, calling it a \u201csellout.\u201d West Virginia\u2019s attorney general also\nopposes the deal, arguing that the $26 billion is based on population, not the\nseverity of the crisis. <\/p>\n\n\n\n

Purdue Pharma is\nhaving more difficulty reaching a settlement. The company tried to file for\nbankruptcy in an attempt to settle about 3,000 lawsuits for aggressive opioid\nmarketing to the tune of $4.5 billion. The plan would block the Sackler family\nand their associates from future suits, which proved to be a sticking point for\nthe U.S. Department of Justice, which condemned the proposed bankruptcy\nsettlement.<\/p>\n\n\n\n

States Look to the\nWhite House as Delta Surges <\/strong><\/p>\n\n\n\n

As the Delta variant\ncontinues to upset COVID-19 case rates across the country, local health\nagencies are focusing on getting their populations vaccinated. In Mississippi,\nholding one of the country\u2019s lowest vaccination rates, thirteen hospitals have\nrun out of ICU capacity. Other states struggling to get their populations\nvaccinated are experiencing spikes in Delta cases. The Centers for Disease\nControl (CDC) Director Rochelle Walensky said that Delta accounts for 83\npercent of new cases as the country falls behind President Biden\u2019s 70 percent\nvaccination goal. Many state officials are now turning towards the\nadministration for guidance when asked if they are considering renewed\nmask-wearing mandates and other restrictions. Some public health researchers\nare hoping that vaccine rates will increase once the Food and Drug\nAdministration (FDA) grants vaccines full approval. \u201cWith over 300M doses given\nin the U.S., there is ample safety & efficacy evidence,\u201d Dr. Zeke Emanuel,\nan oncologist who served on President Biden\u2019s Covid-19 transition team, tweeted\non July 6. \u201cMoving from emergency authorization to full approval will help\nincrease vaccine uptake.\u201d The Kaiser Family Foundation in June found<\/a> <\/a>that 31 percent of unvaccinated adults would\nbe more likely to get the vaccine once it receives full approval. <\/p>\n\n\n\n

Formally approving COVID-19 vaccines, which are currently approved under emergency use authorization (EUA), would also give state and local governments and institutions the greater legal authority to require vaccinations. So far, the topic of COVID-19 vaccine mandates has been met with resistance. Some states, venues conducive to large gatherings, and employers have already begun to implement requirements, while over 20 state legislatures have passed bills banning restrictions on unvaccinated people. FDA is projected to grant full approval for Pfizer\u2019s vaccine in January of 2022, though acting FDA Commissioner Janet Woodcock expects to see a decision before then. <\/p>\n\n\n\n

Meanwhile, the consequences of COVID-19 are creating new questions begging for an answer. A new study<\/a> found that nearly one-in-ten COVID-19 patients are seeking treatment for post-acute sequelae of SARS-CoV-2 infection (PASC), or \u201cLong-COVID.\u201d In children, this medical phenomenon is often found in the form of multi-system inflammatory syndrome (MIS-C). The National Institutes of Health (NIH) last week launched a $40 million study<\/a> to examine Long-COVID and MIS-C last week. Alok Patel, a pediatrician at Lucile Packard Children\u2019s Hospital Stanford notes that \u201cEven though even though covid itself\u2014the acute infection\u2014presented less severe in children, long covid is very debilitating, isolating and scary for families.\u201d As adolescent case numbers rise, Congressional lawmakers are asking for answers as physicians continue to speculate and research how to identify and treat the condition. According to many Congressional Democrats, the answer lies in authorizing vaccines for children under12-years-old. However, FDA is not expecting that EUA until winter, after children are back in school <\/p>\n","protected":false},"excerpt":{"rendered":"

Capitol Hill Update Senators will reconvene for legislative business this week as negotiations on the bipartisan infrastructure framework\u00a0continue. The bipartisan “G20” group has expressed optimism that they will settle on a final agreement and produce legislative text by the end of today, followed by another procedural vote to try and advance the bill at some […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,7],"tags":[],"acf":[],"yoast_head":"\nHealth Policy Report (7\/26) - thornrun<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/thornrun.com\/health-policy-report-7-26\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Policy Report (7\/26) - thornrun\" \/>\n<meta property=\"og:description\" content=\"Capitol Hill Update Senators will reconvene for legislative business this week as negotiations on the bipartisan infrastructure framework\u00a0continue. 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