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<img class="alignright size-full wp-image-5645" src="https://ohioclockblog.bakerhostetlerblogs.com/wp-content/uploads/sites/27/2018/11/1200x630Washington-DC-iStock_000074771283_Blog-image_lt-blue-e1549910644100.jpg" alt="" width="438" height="230">Below is this week’s “Capitol Hill Healthcare Update,” which is posted on Mondays when Congress is in session.

GOTTLIEB, HARGAN TO TESTIFY ON 2020 HEALTH BUDGET, PROGRAMS

Outgoing FDA Commissioner Scott Gottlieb and the No. 2 official at HHS will be on Capitol Hill this week testifying on the Trump administration’s proposed budget for fiscal year 2020 healthcare programs.

Gottlieb <a href="https://www.appropriations.senate.gov/hearings/review-of-the-fy2020-budget-requests-for-the-fda">will be before</a> the Senate Appropriations subcommittee that oversees FDA’s congressional appropriations.

HHS Deputy Secretary Eric Hargan will <a href="https://budget.house.gov/legislation/hearings/department-health-and-human-services-fy-2020-budget">testify</a> Tuesday before the House Budget Committee on the department’s fiscal 2020 budget request. Committee Democrats – who have called the department’s budget “<a href="https://budget.house.gov/publications/report/hearing-department-health-and-human-services-2020-budget">cruel</a>” – are expected to question Hargan on proposed cuts to discretionary programs as well as mandatory health programs such as Medicaid.

Earlier this month, HHS Secretary Alex Azar testified before three congressional committees defending President Donald Trump’s fiscal 2020 budget for his department.

Congress is under no obligation to approve the president’s budget proposal – and lawmakers never do, regardless of who’s in the White House. Instead it’s mostly a starting point for later spending negotiations.

HOUSE DEMOCRATS TO INTRODUCE HEALTHCARE BILL THIS WEEK

[caption id="attachment_5701" align="alignleft" width="150"]<img class="size-thumbnail wp-image-5701" src="https://ohioclockblog.bakerhostetlerblogs.com/wp-content/uploads/sites/27/2018/12/Nancy_Pelosi_official_photo_portrait_111th_Congress-e1543860009569-150x150.jpg" alt="" width="150" height="150"> House Speaker Nancy Pelosi, D-Calif.[/caption]

Marking the ninth anniversary of then-President Obama signing into law the Affordable Care Act (ACA), House Speaker <a href="https://www.speaker.gov/">Nancy Pelosi</a>, D-Calif., said Democrats will <a href="https://www.speaker.gov/newsroom/32319-2/">introduce new healthcare legislation</a> Tuesday that aims to lower costs and protects patients with pre-existing conditions.

The speaker didn’t release details other than stating that the bill would “strengthen protections for pre-existing conditions [and] lower Americans’ health costs, and we will continue to fight for bold action to lower prescription drug prices.”

Many House Democrats have moved beyond partisan fights over the ACA and instead are embracing “<a href="https://jayapal.house.gov/2019/02/28/jayapal-dingell-and-more-than-100-co-sponsors-introduce-medicare-for-all-act-of-2019/">Medicare for All</a>” legislation that would create a universal, single-payer health program. Introduced by Progressive Caucus Chairwoman <a href="https://jayapal.house.gov/">Pramila Jayapal</a>, D-Wash., <a href="https://www.congress.gov/bill/116th-congress/house-bill/1384?q=%7B%22search%22%3A%5B%22hr1384%22%5D%7D&amp;s=1&amp;r=1">the bill</a> currently has 106 co-sponsors, all Democrats.

But the issue is <a href="https://www.wsj.com/articles/medicare-for-all-loses-momentum-among-democrats-11551441601">splitting</a> Democrats on Capitol Hill and among the party’s 2020 presidential contenders. Some moderate Democrats say Medicare for All is bad policy, pointing to its staggering price tag and impact on private and employer-provided health coverage.

Other Democrats, such as House Energy and Commerce Committee Chairman <a href="https://pallone.house.gov/">Frank Pallone</a>, D-N.J., say Medicare for All is <a href="https://reason.com/blog/2018/12/12/even-democrats-are-divided-over-medicare">politically unattainable</a>. Sen. <a href="https://www.brown.senate.gov/">Sherrod Brown</a>, D-Ohio, says Americans should be allowed to <a href="https://www.bloomberg.com/news/articles/2019-02-17/sherrod-brown-wants-medicare-buy-in-at-age-50-as-an-option-now">join Medicare before they retire</a> in a system that would run parallel to today’s group health insurance and ACA marketplace.

 HOUSE TO VOTE TODAY ON MULTIPLE MEDICAID PROVISIONS

The House is scheduled to vote <a href="https://www.majorityleader.gov/content/daily-leader-monday-march-25-2019">today</a> on <a href="https://www.congress.gov/bill/116th-congress/house-bill/1839/text?q=%7B%22search%22%3A%5B%22hr1839%22%5D%7D&amp;r=1">bipartisan legislation</a> that would allow states to provide coordinated care for children with medically complex conditions through pediatric health homes.

Introduced by Rep. <a href="https://ruiz.house.gov/">Raul Ruiz</a>, D-Calif., the legislation includes several Medicaid provisions previously introduced but not enacted, including the provision creating a state option to coordinate care for kids with medically complex conditions. The overall bill is co-sponsored by Reps. <a href="https://schrader.house.gov/">Kurt Schrader</a>, D-Ore.; <a href="https://mullin.house.gov/">Markwayne Mullin</a>, R-Okla.; and <a href="https://upton.house.gov/">Fred Upton</a>, R-Mich.

The legislation also aims to protect Medicaid recipients of home and community-based services against spousal impoverishment by renewing through September a federal provision that disregards a spouse’s income when determining Medicaid eligibility.

The bill would permit HHS to fine pharmaceutical manufacturers that overcharge Medicaid by misclassifying their prescription drugs as generics. An HHS inspector general <a href="https://oig.hhs.gov/oei/reports/oei-03-17-00100.pdf">report</a> in 2017 found 3 percent of drugs in the Medicaid program may have been misclassified, with Medicaid being overcharged $1.3 billion in 2016 for just 10 of those drugs.

The underlying bill is being considered under procedures that allow no amendments and require a supermajority for passage – a process typically reserved for noncontroversial legislation.

‘MIDDLEMEN’ PBM EXECUTIVES TO TESTIFY ON DRUG PRICING

Testimony from executives of five major pharmacy benefit managers (PBMs) will highlight a Senate Finance Committee <a href="https://thehill.com/policy/healthcare/435122-senate-panel-to-hear-from-pharmacy-middlemen-on-drug-prices">hearing</a> next month on prescription drug prices.

Both Republicans and Democrats have been critical of the middleman role that PBMs play in establishing the prices consumers ultimately pay for medicine. Some lawmakers have introduced legislation mandating that the drug discounts PBMs negotiate on behalf of large employers be passed down to consumers.

But HHS Secretary Alex Azar earlier this month in congressional testimony praised PBMs for keeping drug prices down in the Medicare Part D program.

Senior executives from Cigna Corp., Humana Inc., OptumRx Inc. and others are scheduled to testify before the committee April 9.

The committee held its <a href="https://www.finance.senate.gov/hearings/drug-pricing-in-america-a-prescription-for-change-part-i">first hearing</a> in January with academics and economists. Its <a href="https://www.finance.senate.gov/hearings/drug-pricing-in-america-a-prescription-for-change-part-ii">second hearing</a>, last month, featured senior executives from leading pharmaceutical manufacturers. Committee aides have said they also want to hear from insurers and Trump administration witnesses before turning to potential legislative solutions.

ELECTRONIC HEALTH RECORDS SUBJECT OF SENATE HEARING

[caption id="attachment_5489" align="alignleft" width="150"]<img class="wp-image-5489 size-thumbnail" src="https://ohioclockblog.bakerhostetlerblogs.com/wp-content/uploads/sites/27/2018/09/alexander-lamar-rgb-2400-3600-150x150.jpg" alt="" width="150" height="150"> Sen. Alexander Lamar, R-Tenn.[/caption]

Senate HELP Committee Chairman <a href="https://www.alexander.senate.gov/public/index.cfm/">Lamar Alexander</a>, R-Tenn., has <a href="https://www.alexander.senate.gov/public/index.cfm/2018/11/alexander-goal-is-for-electronic-health-records-to-become-what-patients-doctors-had-hoped-for">long advocated</a> the adoption of electronic health records, and his panel will hold a <a href="https://www.help.senate.gov/hearings/implementing-the-21st-century-cures-act-making-electronic-health-information-available-to-patients-and-providers">hearing</a> Tuesday on how implementation of the 21st Century Cures Act is helping make electronic information available to patients and providers.

As part of the Cures law, Congress called for accelerated implementation of electronic health information, and HHS last month proposed two rules on digital health records. The committee will review those proposed regulations, which include ensuring patients have more control over their records.

Witnesses include Ben Moscovitch, project director of health information technology at the Pew Charitable Trusts; Lucia Savage, chief privacy and regulatory officer at Omada Health Inc.; Dr. Christopher Rehm, chief medical informatics officer at LifePoint Health; and Mary Grealy, president of the Healthcare Leadership Council.

SENATORS REINTRODUCE ONCOLOGY ‘ORAL PARITY’ LEGISLATION

Senators earlier this month reintroduced <a href="https://smithsenate.app.box.com/s/o26k8p1x2eezrbkl00auhivbksz7i9jl">bipartisan legislation</a> that would require insurance companies to cover orally administered cancer drugs in the same way as traditional intravenous chemotherapy.

Introduced by Sens. <a href="https://www.smith.senate.gov/HomePage">Tina Smith</a>, D-Minn., and <a href="https://www.moran.senate.gov/public/index.cfm/">Jerry Moran</a>, R-Kan., the bill would prevent insurers from covering oral and self-administered medicines at cost-sharing rates that differ from those for intravenous chemotherapy. The legislation would not mandate that health plans provide chemotherapy coverage but would apply to plans already covering chemotherapy.

Forty-three states and the District of Columbia have passed “oral parity” laws that stop insurers from charging more for prescribed oral cancer medicine than for intravenous chemotherapy. The senators’ <a href="https://www.moran.senate.gov/public/index.cfm/news-releases?ID=7536379A-A50E-47FD-9DC7-A7DBA9ABFED9">bill</a> would expand that requirement to group and individual plans governed under federal laws.

More than 25 percent of all oncology treatments under development are oral drugs, according to a <a href="https://www.ajmc.com/journals/supplement/2016/improving-patient-access-to-critical-therapies-in-the-age-of-cost-sharing/in-office-dispensing-of-oral-oncolytics-a-continuity-of-care-and-cost-mitigation-model-for-cancer-patients">study</a> by the National Community Oncology Dispensing Association.


SENATORS PRESS HHS ON SUNSHINE ACT COMPLIANCE

The bipartisan leaders of the Senate Finance Committee last week <a href="https://www.grassley.senate.gov/news/news-releases/grassley-wyden-press-hhs-cms-physician-payment-sunshine-act-compliance">wrote</a> to both the HHS inspector general and CMS about physician-owned distributorships’ compliance with federal disclosure laws.

[caption id="attachment_5630" align="alignleft" width="101"]<img class="size-full wp-image-5630" src="https://ohioclockblog.bakerhostetlerblogs.com/wp-content/uploads/sites/27/2018/11/Grassley-1.jpg" alt="" width="101" height="117"> Sen. Chuck Grassley, R-Iowa[/caption]

Senate Finance Committee Chairman <a href="https://www.grassley.senate.gov/">Chuck Grassley</a>, R-Iowa, and Sen. <a href="https://www.wyden.senate.gov/">Ron Wyden</a>, D-Ore., warned that physician-owned distributorships may not be reporting doctor ownership in entities that supply drugs or medical devices to their practices. The arrangements are suspect because they could violate anti-kickback laws, the senators wrote.

Failure to disclose physician ownership interests and related payments would violate the Physician Payment Sunshine Act, which Grassley authored.

The senators asked the inspector general to respond to a series of questions, including whether its office has conducted a detailed review and audit of the CMS Sunshine Act database to determine whether physician-owned distributorships are reporting physician ownership or investment interest.