United States: Capitol Hill Healthcare Update - September 10, 2018

Last Updated: September 12 2018
Article by Christian B. Jones

This week's "Capitol Hill Healthcare Update" includes the latest on a pending Senate vote on opioid legislation as Congress races to enact a response to the crisis before the November election; the Senate votes to expand Sunshine Act disclosure requirements; and a key House Republican backs requiring drug manufacturers to include prices in their ads; and more. (Note: Congress is in recess today and Tuesday in observance of Rosh Hashanah. The House and Senate will reconvene Wednesday for legislative business.)


The Senate this week is scheduled to vote on legislation to address the opioid crisis after lawmakers reached a bipartisan agreement on a package of more than 70 individual proposals, including expanding access to medication-assisted treatment and funding to spur research on nonaddictive painkillers.

Senate HELP Committee Chairman Lamar Alexander, R-Tenn., negotiated the agreement, which includes legislation previously approved by five Senate committees. Senate leaders want to avoid an open amendment process on the Senate floor, which led to the behind-the-scenes work by Alexander that intensified during the last several weeks.

The Senate bill would give the U.S. Postal Service new tools to block mail delivery of fentanyl and other illicit drugs, expand telehealth coverage for treatment options and allow the FDA to require opioids to be prescribed in shorter-duration blister packs of three or seven days rather than 30-day supplies.

It also includes language by Judiciary Committee Chairman Chuck Grassley, R-Iowa, to expand Sunshine Act reporting to include payments by prescription drug and medical device manufacturers to nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives. Sen. Claire McCaskill, D-Mo., unsuccessfully sought to add patient groups to the Sunshine reporting requirement.

The House approved a separate opioid measure in June, including changes to Medicare and Medicaid reimbursement rules that would allow for coverage of inpatient drug rehab services and non-opioid pain management drugs. The Senate is expected to include the House language and its provisions as one bill, which could help speed passage as lawmakers race to finalize the legislation before Congress adjourns ahead of the November elections.


Rep. Michael Burgess, R-Texas, urged House appropriators last week to agree to Senate-approved language targeting $1 million for HHS to develop regulations that would require pharmaceutical manufacturers to include pricing information in consumer advertising.

Burgess is the chairman of the House Energy and Commerce Health Subcommittee. He signed a letter to House Appropriations Committee leaders with Rep. Gene Green, D-Texas, the ranking Democrat on the Health Subcommittee.

The funding is included in the Senate's version of the fiscal 2019 HHS funding bill. House and Senate leaders are trying to negotiate a final HHS bill paired with funding for the Pentagon before the end of the current fiscal year on Sept. 30.

HHS Secretary Alex Azar has touted the pricing idea for months, but so far, House Republicans have been silent on the issue. With Azar actively lobbying lawmakers for the provision and now receiving public backing from key Republicans like Burgess, the funding is likely to be included in the final bill.


The Senate last week unanimously approved legislation that would permit pharmacists to tell patients that paying for certain prescription drugs with cash would be less expensive than using insurance.

The House Energy and Commerce health subcommittee approved by voice vote a separate version of the legislation, which would prohibit pharmacist "gag clauses" in contracts between pharmacies and pharmacy benefit managers.

Introduced by subcommittee member and former pharmacist Rep. Buddy Carter, R-Ga., the legislation would prohibit gag clauses in employer and individual health insurance plans, as well as in Medicare Advantage and Part D prescription drug plans. The Senate-passed bill would apply only to Medicare plans, but the Senate plans a separate vote this week to expand the ban to drug plans providing employee benefits and insurance exchange coverage.

HHS Secretary Alex Azar has called the clauses "unconscionable."


With the deadline to pass fiscal 2019 appropriations bills three weeks away, congressional leaders are scrambling to approve nine spending bills in three separate legislative packages, including funding for HHS, FDA and other health agencies.

Any spending bill not approved by Oct. 1 would need to be added to a stopgap funding bill to avoid a partial government shutdown. Temporary spending measures likely would extend current-year funding levels and programs to December, when lawmakers will convene for a post-election session to try to finalize spending.

House and Senate negotiators are close to finishing a bill that would include funding for the veterans' health system, which is expected to be enacted this month. Other conference committees are working on spending packages that include funding for FDA and funding for HHS and its related healthcare agencies.


Republican leaders on the House Ways and Means Committee fired off three letters to CMS last week urging the agency to relieve administrative and regulatory burdens for Medicare providers.

Written by committee Chairman Kevin Brady, R-Texas, and Health Subcommittee Chairman Peter Roskam, R-Ill., the letters said CMS Administrator Seema Verma could cut red tape for hospitals, post-acute care providers, and physicians and ancillary services.

The committee has held several hearings during a yearlong examination of regulatory burdens faced by providers.

Brady and Roskam urged CMS to reduce regulatory burdens for hospital conditions of participation, co-location of providers, skilled nursing facility consolidated billing, hospital-quality star ratings and hospice audits.


The House on Wednesday is scheduled to vote on a series of bipartisan healthcare bills, including one on how Medicare administrative contractors make local reimbursement decisions.

The bills are being considered expedited rules that require two-third votes for approval — a procedure typically reserved for legislation that enjoys wide bipartisan support.

One bill by Reps. Lynn Jenkins, R-Kan., and Ron Kind, D-Wis., would provide transparency and consistency for providers by codifying requirements that Medicare administrative contractors must follow when making local coverage determinations. The transparency would include open meetings for stakeholders, timely feedback to public comments and a reconsideration process.

Also scheduled for floor votes is legislation by Reps. Erik Paulsen, R-Minn., and Kind to codify existing regulations that ensure certain Medicare beneficiaries have time to make decisions about their Medicare coverage. Another bill, by Reps. Peter Roskam, R-Ill., and Earl Blumenauer, D-Ore., would create a three-year pilot program to test the use of smart card technology in Medicare.

All three bills won approval last week in the House Ways and Means Committee.

The House is also scheduled to vote on legislation by Rep. Jackie Walorski, R-Ind., that would retroactively suspend the Affordable Care Act's employer mandate, change the definition of full-time employee under the mandate and push out until 2023 the implementation of the ACA's 40 percent tax on "Cadillac" health plans. The bill has drawn opposition from Democrats and isn't likely to be considered in the Senate.

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