HealthCare Roundtable e-News – June 16, 2021


Roundtable Joins Effort to Protect Patients from Surprise Bills

Last week, the Roundtable continued federal advocacy efforts to end surprise medical bill by signing a group letter to the Biden Administration asking them to prioritize regulations that ensure patient are protected from surprise bills while also lowering costs. The letter, which was signed by nearly 50 organizations, was sent to HHS officials Thursday, June 10. Please do not hesitate to reach out to Roundtable Senior Policy Advisor, Andrew MacPherson, with questions.

See full letter here.

White House OMB Reviewing Interim Final Rule on Surprise Billing Legislation

The White House Office of Management and Budget (OMB) is currently reviewing an interim final rule that will double down on surprise medical billing in emergencies. Known as “Requirements Related to Surprise Billing; Part 1”, the rule covers several key provisions of the No Surprise Act, including the formula for the critical “qualified payment amount” and guidance on informed consent, two topics that have fueled continuous debate with lawmakers.

The pace at which the administration has been able to move the rule along is surprising many who believed that CMS would have a difficult time meeting some of its earlier deadlines. Loren Adler, associate director of USC-Brookings Schaeffer Initiative for Health Policy, said that he was impressed the rule is moving along so quickly but emphasized that it won’t go into effect until January of next year. (InsideHealthPolicy)

The No Surprise Act, which the interim rule is based on, aims to limit what providers can charge patients for regarding in-network rates for services done in an out-of-network setting or for treatment done by an out-of-network doctor in an in-network setting. The bill also includes baseball-style arbitrations for cases where an independent dispute resolution is required.

The dispute resolution process is expected to go into effect Jan. 1, 2022, if the bill passes, but other key regulatory decisions must be made first, including the methodology the health plan must use for a qualified payment amount (QPA) in the individual, small group, and large group markets, and the information that plans must share with providers when making a QPA determination.

Becerra Says HHS Looking to Constrain Non-ACA Plans

Last week, HHS Secretary Xavier Becerra told lawmakers at a Senate Appropriations hearing that the agency is considering actions to constrain non-ACA compliant health plans, a step that advocates say is necessary to protect customers and keep marketplaces from becoming oversaturated.

Several lawmakers questioned Becerra on the steps the agency is considering, including Sen. Tammy Baldwin (D-Wis.), who asked Becerra why HHS has been slow to act on non-compliant plans, particularly at a time “when Americans can access comprehensive coverage at an affordable price,” Baldwin said. The senator also argued that many of the non-compliant plans in the marketplace often engage in misleading marketing practices that appear aimed at confusing consumers, particularly during open enrollment and the current special enrollment period. (InsideHealthPolicy)

Becerra confirmed that HHS is “looking at some things” to address these plans, but said that a key component of the agency’s approach is to ensure that whatever strategic action is taking could withstand a legal challenge. Becerra did not provide additional insights into the agency’s potential moves; however, he has suggested in the past that the Biden administration may look to reinstate an Obama-era rule that let short-term plans run for no longer than three months. This approach received support from Sen. Chris Murphy (D-CT), who has advocated for the reversal of the Trump policy that blocked the rule and said he was looking forward “to hearing more about HHS’ plans as soon as possible.” (InsideHealthPolicy)

States Step Up to Tackle Lowering Drug Costs, Regulate PBMs Post-Pandemic

Slow federal action on the lowering of drug costs is leading many states all over the U.S. to look at pharmacy benefit manager regulation as a means of approving drug cost legislation at the local level. States are also considering laws targeting insulin costs, general cost-sharing requirements, and drug importation from Canada, despite resistance from the Canadian government.

According to the National Conference of State Legislatures, at least 46 states have considered PBM restrictions this year with a few, including Tennessee, Nevada, and Oregon, looking to ban “white bagging,” audit protections for pharmacists, licensure requirements, and reporting requirements for certain cost and pricing information. Additionally, 31 states, including Alabama, Oklahoma, Kentucky, and Texas, have set their sights on capping monthly out-of-pocket insulin costs. (InsideHealthPolicy)

In Colorado, local legislators drafted a bill that would create a prescription drug affordability board, which could review prices of medications sold in the state to consumers and set payment limits. Under the bill, drugs would qualify for an affordability review under various triggers, including when prices increase by more than 10% per year or exceed either $30,000 a year for brand-name drugs or $100 per month for generics per person. Colorado is also one of several states that have approved laws on drug importation from Canada, where officials are currently reviewing bids from contractors to work on bringing the project to life.

InsideHealthPolicy: Home and Community-Based Services Provisions Unlikely To Be In Bipartisan Infrastructure Proposal

A bipartisan infrastructure proposal from Congress is unlikely to include home- and community-based services investments, a GOP aide confirmed to Inside Health Policy Monday. President Joe Biden proposed to spend $400 billion to bolster Medicaid home care in his infrastructure blueprint. He has indicated that he hopes to pass bipartisan infrastructure legislation, and also suggested last month that he doesn’t want to compromise on including caregiving investments in the bill.

After ending infrastructure compromise talks with a group of Republican senators, Biden switched to discussions with a bipartisan group of 20 senators. Ten members of that group reached a tentative deal on Thursday (June 10), and that deal doesn’t appear to include HCBS funding. The senators want to focus on core infrastructure, and HCBS doesn’t fall under that umbrella, the GOP aide said. The House Problem Solvers Caucus has also released an infrastructure proposal that doesn’t mention HCBS or caregiving infrastructure investments.

The news comes after a Senate Finance Committee hearing on Thursday where senators from both parties expressed support for increasing HCBS funding, though Finance Committee ranking Republican Mike Crapo (R-ID) suggested Biden’s current proposal might need to be reworked to receive bipartisan support.

HCBS stakeholders told Inside Health Policy recently that they remained optimistic about getting the $400 billion passed in some way, though they acknowledged that’s most likely to happen if the infrastructure bill goes to reconciliation. Advocates said they think the funding could be passed outside of the infrastructure bill as well.