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Casie Daugherty

March 27, 2020

We are continuing to dedicate all of our coverage to COVID-19 as the country continues to fight this pandemic.

Congress passed H.R. 748, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to respond to the epidemic in our country. H.R. 748 is intended as an economic stimulus to help our economy rebound and to provide some relief to dislocated workers, but it also includes a number of provisions to assist communities who are confronting this virus and a number of other health policies. The Senate voted unanimously 96 to 0 to approve the bill and the House voted by voice vote to approve it. The Senators who missed the vote were either infected with the disease or on a self-quarantine. You can read our daily posting about developments related to COVID-19 here and our summary of the health provisions contained in the CARES Act here.

The United States is now leading the world in confirmed cases of the coronavirus. According to Johns Hopkins University, there are now more than 86,000 confirmed cases, surpassing the number of cases in China and Italy.  Even though the U.K. lags behind the United States in terms of the outbreak, some significant figures in that country have contracted the disease. We learned this week that Prince Charles, Prime Minister Boris Johnson, and his Health Secretary Matt Hancock have all tested positive for the disease.

The Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), Dr. Anthony Fauci, is pushing an aggressive plan to begin production of a vaccine for the coronavirus while it is still being evaluated. The vaccine candidate entered a phase I clinical trial earlier this month.  Dr. Fauci is hopeful that when they enter phase II that a manufacturer will be willing to take the risk and begin production. The concern is that if you wait until the conclusion of the trials, it will take another six months to deliver the product.

The U.S. Army Corps of Engineers is seeking to convert hotels into acute alternate care facility for patients infected with the coronavirus. The agency is drafting a request for proposals for companies to step forward to offer their space for conversion into new care settings for patients. The hope is to convert 10,000 rooms in New York to help with the overcrowding in hospitals. The United States Navy is also planning to land a hospital ship in New York by Monday.

The Food and Drug Administration (FDA) has warned consumers that it has not approved any home test kits for the coronavirus. Several manufacturers have been producing tests and advertising them to consumers. The House Oversight and Reform Committee’s Subcommittee on Economic and Consumer Policy sent letters to the company manufacturing those kits asking how many tests have been sold and what they charged for them.

Yesterday was supposed to mark Opening Day for Major League Baseball.  Alas, we were not able to go to the ballparks to enjoy, but we are able to re-watch last fall’s playoffs on MASN here locally. And the Nationals are still the champs!

March 20, 2020

As coronavirus cases in the United States have surpassed 15,000 President Trump announced at a press briefing this week that he is invoking the Defense Production Act of 1950. The Defense Production Act of 1950 allows the President to mobilize and enlist American businesses to help in times of national crisis. Under the Defense Production Act of 1950, companies are required to accept and prioritize contracts from the government, the government must provide financial measures to companies including loans, loan guarantees, and purchase commitments to increase the production speed of materials, and it allows business competitors to work together to increase supply production. It is expected that the President will use the Defense Production Act to streamline and increase the development of ventilators, medical masks, hospital beds, and other health care equipment as the United States continues its battle against the coronavirus outbreak.

President Trump said at his coronavirus press briefing on Thursday that the Food and Drug Administration (FDA) would accelerate the testing of therapeutic drugs to treat the coronavirus by eliminating out-of-date rules and bureaucracy. President Trump announced that Chloroquinea drug used to treat malaria, is showing promise and that the review of the drug would be fast-tracked. Doctors in China, South Korea, and France have all reported that treatments using Chloroquine have helped, but FDA Commissioner Stephen Hahn emphasized the importance of safety in finding a vaccine and that Chloroquine needs to be first looked at in a clinical trial. Hahn also said that a vaccine would not be ready for another 12 months.

The Federal Emergency Management Agency (FEMA) is working to help coordinate the response to the coronavirus. President Trump’s emergency declaration on March 13th freed up $40 billion in funding that was reserved for supplies and personal. The agency will now be coordinating the crisis and FEMA Administrator Peter Gaynor has said he has every single federal agency and commercial partner at his disposal. Gaynor has said that the agency is working on improving supply chain management and testing availability for patients.

On the legislative front, earlier in the week, H.R. 6201 or the “Phase II” coronavirus bill passed the Senate and was signed into law. This bill responds to the coronavirus outbreak by providing paid sick leave and free coronavirus testing, expanding food assistance and unemployment benefits, and requiring employers to provide additional protections for health care workers. The Senate immediately began work on “Phase 3” with republicans releasing text of legislation (see these health care provision summaries from Senate HELP and Senate Finance committees). Democrats are now entering negotiations with republicans on what could be a final package to be voted on next week.

Reps. Mario Diaz-Balart (R-FL) and Ben McAdams (D-UT) became the first two members of congress to test positive for the coronavirus. Both members are in good condition and are in self-quarantine for the time being. At least fourteen other members of congress announced they would also self-quarantine after they were in close contact with the lawmakers including Minority Whip Steve Scalise (R-LA).

The U.S. Navy is activating two hospital ships, the USNS Mercy and the USNS Comfort, to the Bay Area and to New York to help combat the coronavirus and alleviate hospitals. At full strength both ships can provide up to 1,200 doctors, nurses, and other medical specialists. The ships will be boarded by U.S. Navy medical personnel and be filled with medical supplies and equipment. The USNS Mercy is based in San Diego and is ready for activation immediately while the USNS Comfort which will be going to New York is currently in a maintenance period that will delay its activation.

It is International Day of Happiness, so we hope you enjoy your “quarantini” to help celebrate!

March 17, 2020

*In the wake of the ongoing coronavirus activities we are writing a special edition of Healthcare Today to keep you up-to-date on the ongoing news*

At the White House Coronavirus Task Force briefing yesterday, President Trump laid out new guidelines for all Americans to slow the spread of the coronavirus. The president said that even if you are young and healthy, Americans should work from home when possible, avoid gathering in groups of 10 or more people, avoid eating/drinking in bars and restaurants, and avoid non-essential travel and social visits. These guidelines are in place for the next fifteen days, at that point the administration will reassess if these guidelines need to be in place. These additional guidelines came after the Centers for Disease Control (CDC) recommended Sunday night against any gathering greater than 50 people for the next eight weeks. In Washington DC, Mayor Muriel Browser announced as of 10 pm Monday all bars and restaurants will become grab-and-go, takeout, or delivery-only and no eating inside bars or restaurants will be allowed.

After Republican opposition, the House passed a revised coronavirus bill by unanimous consent that clears the bill for Senate action. The revised coronavirus package included some amendments to the small business tax credit sections and amended language regarding Medicaid reimbursement. We are hearing that the House is unlikely to return to Washington until the next Coronavirus stimulus package is ready for a vote.

Senate Minority Leader Chuck Schumer spoke on the Senate floor today outlining what he and Senate Democrats believe should be included in the next package to address the Coronavirus. They are proposing at least $750 billion in federal funding to combat coronavirus and the current economic crisis. Federal funds would work to fix hospital and treatment capacity issues; expand unemployment insurance and increase Medicaid funding; guarantee everyone can afford coronavirus testing; address public health and economic needs for Native Americans; provide Immediate loan payment forbearance for all Federal loans, student loans, mortgages, small business loans and others, and moratoriums on evictions and foreclosures; and deliver immediate help to small businesses. On the Republican side, it is being reported that Senate Majority Whip John Thune was asking members to submit ideas to leadership for the additional stimulus package, and Senator Mitt Romney (R-UT) has put together a proposal of direct payments to American families and student debt relief. In other Senate news, the Senate Health, Education, Labor, and Pensions Committee postponed a hearing on the Coronavirus that was scheduled for Wednesday per public health officials’ recommendations.

The first human trial to prevent against the Coronavirus began today. The first test will take place at the Kaiser Permanente Washington Health Research Institute in Seattle and the trialists will receive shots that were co-developed by the National Institutes of Health and Moderna Inc. testing for side effects of the shots. Public health officials expect it to take at least a year to a year and half before a vaccine is ready for widespread public use, but this is seen as an important step in pursuing that goal.

As you can see, while much of Washington is working remotely, they are still working. We will continue to see considerable actions taken by the Federal government to address this crisis.

March 13, 2020

President Trump has announced a 30-day travel ban on individuals traveling from the 26 European countries of the Schengen Area. The President subsequently issued a Presidential Proclamation on the travel ban. The travel ban is effective beginning March 13th at 11:59 pm, the United Kingdom and Ireland are exempt from the ban, and American citizens and permanent residents abroad are not impacted. The Trump administration has also announced a number of measures that they hope will increase testing for the coronavirus. The Food and Drug Administration (FDA) will authorize New York state to authorize public and private labs to start testing, authorize labs to run tests using Roche’s high-volume platform, and create a new hotline for labs if they have problems validating a test, can’t receive authorized tests, or have issues validating a test. The Department of Health and Human Services (HHS) has put Assistant Secretary for Health Brett Giroir in charge of coordinating testing efforts within HHS’ agencies. It is also expected that President Trump will declare a national emergency today that will invoke the Stafford Act and allow more federal aid for states and municipalities.
As of this morning, both House Speaker Nancy Pelosi and Treasury Secretary Steve Mnuchin were close to a deal on a coronavirus bill. It is expected that the bill will include: free coronavirus testing for everyone including the uninsured that needs a test, increased unemployment insurance, paid emergency leave, increased federal funds for Medicaid, provide clarification for Medicare telehealth services, and enhance food security initiatives for student meals, the Supplemental Nutrition Assistance Program, and seniors’ nutrition and food banks. A vote in the House of Representatives is expected on the bill today. The Senate will be in session next week to consider the bill.
The Centers for Disease Control Director (CDC) Robert Redfield and Director of the National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci both testified on Capitol Hill this week. Redfield faced criticism for lawmakers for the lack of availability of tests and the missteps in the area of testing. Under tough questioning from Rep. Katie Porter (D-CA), Redfield promised that the CDC would pay for coronavirus testing. Dr. Fauci admitted in hearings that the current testing system for the coronavirus was failing and that improvements needed to be made.
The World Health Organization has declared the coronavirus a global pandemic. There are now more than 118,000 cases in 114 countries and more than 4,300 people have lost their lives. D.C. Public schools will close beginning Monday through April 1st and Maryland public schools will be closed from March 16th-27th. The NCAA has officially cancelled the men’s and women’s basketball tournament, and the NBA, NHL, MLB, PGA, and MLS have all suspended play due to the spread of the coronavirus.
In other news, CMS and the HHS Office of the National Coordinator for Health Information Technology issued rules this week that would implement interoperability and patient access provisions of the 21st Century Cures Act. These rules will allow patients to download their health records using third-party apps and hope to give patients more control of their healthcare.
The Energy and Commerce Health Subcommittee marked-up several health bills this week. Thirteen bills that were approved through the committee including H.R. 5534, the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, that seeks to provide extended months of Medicare coverage of immunosuppressive drugs for kidney transplant patients; H.R. 3935, The  Protecting Patients Transportation to Care Act, that seeks to provide for the continuing requirement of Medicaid coverage of nonemergency transportation to medically necessary services; and H.R. 4801, the Healthy Start Reauthorization Act of 2019, that would reauthorize the Healthy Start Program.
The Centers for Medicare and Medicaid Services launched a new model this week that seeks to lower the out-of-pocket expenses for insulin. This is a voluntary model that – if insurers and insulin manufacturers agreed to participate – would allow participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs for insulin to a maximum $35 copay per thirty-day supply throughout the benefit year. Sanofi and Eli Lily have both announced they will participate, while Novo Nordisk is currently reviewing the model.
We will have a full moon tonight on Friday the 13th. That won’t happen again until 2049. This week also brought us the weird combination of changing clocks, full moon, and Friday the 13th all in the same week!

March 6, 2020

There are now at least 200 known cases of the coronavirus in the United States across twenty states. President Trump has signed an $8.3 billion emergency funding package earlier today that would provide $7.76 billion to federal, state and local agencies to combat the coronavirus and authorizes an additional $500 million in waivers for Medicare telehealth restrictions.

Telehealth advocates praised the waiver of Medicare’s geographical restrictions on telehealth during a public health emergency.  The bill also loosens restrictions on the use of a telephone to deliver care, as long as that phone has audio-visual capabilities.  The waiver is limited to seniors and providers who have established an existing relationship within the past three years. Also, the provision would not apply to seniors who became Medicare-eligible within the last three years.

The package provides $826 million for vaccines and treatments for the National Institute of Allergy and Infectious Diseases, $300 million to purchase vaccines from the drug industry once they’ve been approved, $950 million in grants to states that seeks to limit the stress on state health departments, another $100 million to community health centers, $300 million for the Center for Disease Control (CDC) to respond to international disease outbreaks, $435 million to the State Department for global health programs, and $3.1 billion to purchase medical supplies.

America’s Health Insurance Plans, a major health insurance trade group, made a commitment to cover testing for the coronavirus. They said they would begin relaxing policies and they could also potentially waive co-pays. The CDC has also updated its guidance on testing for the virus allowing clinicians to use their judgement to determine if a patient should be tested or not.

In other news, the Supreme Court agreed on Monday to hear a challenge to the Affordable Care Act that will likely occur this fall. The Justices will review the Texas vs. United States Affordable Care Act court decision that ruled the entire law was invalid, however that ruling allowed the law to remain in place as the appeals process continues. It is likely that they will hear the arguments beginning in October of 2020 and a decision on the case won’t be made until the spring or summer of 2021. The Supreme Court’s decision is a win for Democrats who hope a focus on health care will help them in the 2020 election as it did in the 2018 midterm elections.

The Food and Drug Administration (FDA) has provided an update on the agencies evaluation of the regulatory pathways for cannabidiol (CBD) products this week in a report to Congress. The report said that the FDA still needs more data, more safety information, and is worried about the number of people that are using multiple CBD products. The FDA also expressed concerns that widespread use of CBD could lead to less clinical research. CBD businesses were upset with the report as they were hoping the report would provide more regulatory clarity.

This week, Representatives Diana DeGette (D-CO) and Larry Bucshon (R-IN) along with Senators Michael Bennet and Richard Burr (R-NC) introduced the Verifying Accurate Leading-Edge IVCT Development (VALID) Act. This bicameral, bipartisan legislation seeks to expand our countries diagnostic testing capabilities and help our response to public health threats. The bill would propose a major revamp of the FDA proposal for a precertification program, create a new product category for diagnostic and lab tests that would be under FDA review and approval, and create a new system for labs and hospitals to submit their tests electronically to the FDA for approval.

It is National Oreo Cookie Day today, so we hope you enjoy some Oreos for dessert!

February 28, 2020

President Trump has placed Vice President Mike Pence in charge of the federal government’s response to the Coronavirus. Department of Health and Human Services (HHS) Secretary Alex Azar was initially tasked with leading the response, but Pence will lead the task force and has added the State Department’s top AIDS official, Deborah Birx, who has run that office since 2014 to join the team. Congressional leadership began discussions around supplemental funding to address the outbreak this week. We are hearing negotiators are seeking anywhere from $4 billion to $8.5 billion. This is a much higher number then the initial $1.25 billion in new funds that the administration requested, but President Trump has said he is willing to increase his budget request if lawmakers were willing to allocate more money. The Centers for Disease Control and Prevention announced this week that they had identified the first coronavirus case in the United States of unknown origin. In previous cases, patients had either travelled to China or had contact with other patients that had the disease.

Energy and Commerce Chairman Frank Pallone’s (D-NJ) bill that seeks to curb youth use of e-cigarettes passed in the House of Representatives today. The bill would ban all flavored tobacco products and impose a tax on e-cigarettes that seeks to reduce youth use of e-cigarettes. The bill ultimately passed despite opposition from 17 Democrats and the majority of Republicans over concerns of banning menthol cigarettes and that the legislation could lead towards a black market for vaping products.

HHS Secretary Alex Azar had a busy week on the hill this week testifying before for committees on both President Trump’s fiscal year 2021 budget and the Coronavirus. Much of the hearings centered around the administration’s response to the spread of the coronavirus and the amount of supplemental funding the administration will seek to deal with the virus. Secretary Azar did promise to work with congressional committees to find a solution end surprise medical bills, noted increased investments to deal with the opioid crisis, highlighted the decline in drug overdose deaths for the first time in decades, and touted the administration’s approach to transform rural health care.

Walmart has decided to expand and increase its investments in low-cost health care centers. Traditionally Walmart stores have had vision and pharmacy centers, but its new health care centers will also allow patients to receive a $30 medical checkup, a $25 teeth cleaning, or talk with a counselor for $1 a minute. They currently have two health care centers with plans to open a third center this summer. These centers could allow Walmart to compete with CVS and Walgreens that have moved into the clinic space and allow patients in rural areas more access to care.

We hope you enjoy your fried fish for dinner on this National Tartar Sauce Day and your tagalongs, samosas, thin mints, and do-si-dos for dessert on this Girl Scout Cookie Weekend!

February 21, 2020

The outbreak of coronavirus (COVID-19) continues to dominate the news. The number of new cases appears to be slowing, although there is concern whether new cases are slowing or if it is a matter of how cases are being confirmed by health officials in China. Health officials in Japan are exploring how the disease is being spread after a cruise ship docked in Yokohama was quarantined with over 600 passengers testing positively for the disease.

Congress is also digging in deeper over the outbreak; Representatives John Garamendi (D-CA) and Vicky Hartzler (R-MO) have introduced a bill (H.R. 4710) to require the Department of Defense (DoD) to only purchase American-made raw materials, medicines, and vaccines for U.S. troops. There is a growing concern about the fact that China manufactures most of the therapies Americans consume. The bipartisan duo plans to advance their bill as part of the Defense Authorization bill. There is also a hearing scheduled March 3rdin the Senate Health, Education, Labor, and Pensions (HELP) Committee featuring officials from the Centers for Disease Control (CDC), National Institutes of Health (NIH), Food and Drug Administration (FDA) about steps the federal, state and local governments are taking to prevent the spread of this disease.

Sanofi Pasteur is getting in the game to develop a vaccine for coronavirus, joining Johnson & Johnson, Inovio, and Moderna in the race to develop a preventative measure to combat the disease. Reynolds American is infecting fast growing tobacco plants with coronavirus to see if they can unlock some clues about how to develop a vaccine.

The Trump administration’s plans to impose work requirements in the Medicaid program took a step back at the end of last week. A federal appeals court in Washington upheld a lower court’s ruling in March that voided the Department of Health and Human Services (HHS) approval of the state of Arkansas plan to impose work requirements in their state’s Medicaid program. The decision is likely to be appealed to the Supreme Court although HHS did not immediately comment on the decision.

The Medicare Advantage program is proving to be more popular with senior citizens. The plan experienced a 9.4% spike in enrollees this year, making the total covered population by the program 24.4 million seniors. Seven states (California, Minnesota, Florida, Hawaii, Oregon, Pennsylvania, and Rhode Island) have over 40% of their seniors enrolled in the program. Minnesota is the leading the pace with nearly 60% of their seniors covered by Medicare Advantage. The Congressional Budget Office (CBO) attributes Medicare Advantage to the growing Medicare spending. CBO noted that Medicare spending is going to be $22 billion higher than originally projected with most of that growth coming from the Medicare Advantage program.

Senator Grassley is more optimistic about the chances of his drug pricing bill passing the Senate. In fact, the senator tweeted a classic missive about his bill on Valentine’s Day. The latest Republican senator to support the bill is his fellow Iowan Senator Joni Ernst (R-IA) becoming the 12th Republican senator to publicly back the bill. Senator Grassley believes he needs at least 25 Republican senators for Majority Leader Mitch McConnell (R-KY) to feel comfortable with the bill on the Senate floor.

As Washington continues to grapple with the cost of insulin as part of the drug pricing debate, FDA finalized its definition of “biological product” clarifying a protein as a polypeptide with a specific sequence, ultimately allowing for the transition of applications for insulin, human growth factor, fertility treatments and other products to licensed biologics starting March 23. This will in turn open up possible biosimilar and interchangeable competition for insulin.

We want to give a big thanks to all the hospital employees, nurses, doctors, and other healthcare professionals on this National Caregivers Day.

February 14, 2020

The World Health Organization has officially named the Coronavirus Disease announcing it will be called COVID-19.  The “co” stands for “corona”, “vi” for “virus” and “d” for “disease”, while “19” was for the year, as the outbreak was first identified on December 31st, 2019. Coronavirus cases in the United States have risen to 15 and an American in Wuhan, China died from the virus. At least twenty-five public health laboratories in the United States announced they’ve been unable to test for cases of the coronavirus originating in Wuhan because the test kits that have been distributed by the Centers for Disease and Control (CDC) are delivering inconclusive results. The CDC is currently working with the labs to fix the issue and labs are sending all clinical specimens to the CDC as a backup measure.

Both the House Education and Labor Committee and the House Ways and Means Committee marked up legislation this week seeking to fix the issue of surprise billing. The House Education and Labor Committee legislation passed through the committee with bipartisan support but had members of the committee oppose the legislation due to its use of a benchmark rate and the legislation’s impacts on doctors. The House Education and Labor Committee’s legislation would limit cost-sharing for patients to their insurance plan’s in-network rate and prohibit doctors outside their patients’ networks from billing them directly for more than the same in-network rate. Under this plan, doctors would need to accept a benchmark rate for bills under $750 and go through arbitration in disputes over bills higher than $750. Some of the Education and Labor Committee members favored the House Ways and Means legislation that passed through committee this week with bipartisan support.

The Ways and Means Committee legislation has the support of doctors’ groups and it would ask payers and providers to settle their disputes privately or go to third-party mediators for settlements. The leaders of the House Energy and Commerce, House Education and Labor, and House Ways and Means Committees are expected to try to work out their differences and come up with final legislation soon.

President Trump also weighed in on surprise billing this week. Trump thanked the House Ways and Means and Education and Labor Committees for their work and asked them to work with the House Energy and Commerce Committee and Senate Health Education Labor and Pension Committees to send a bipartisan bill to his desk.

Senate Finance Chairman Chuck Grassley (R-IA), Ranking Member Ron Wyden (D-OR), Sen. Todd Young (R-IN), and Sen. Ben Cardin (D-MD) have started to probe the U.S. Organ Procurement and Transplantation Network (OPTN). A number of inspector general audits and news reports have raised questions about the agencies abilities with reports indicating thousands of available organs were not used and questioning of whether patient safety standards were met. The group of senators sent a letter to the United Network for Organ Sharing (UNOS) that oversees the OPTN requesting an expansive amount of data.

A bipartisan bill led by Sen. Bill Cassidy (R-LA), Sen. Jeanne Shaheen (D-NH), and Sen. Tammy Baldwin (D-WI) was introduced this week that seeks to close the orphan drug loophole that currently gives certain profitable drugs shelter from competition. Currently, drug companies are allowed to get seven years of market exclusivity if they can prove to the Food and Drug Administration (FDA) that the new drug they developed needs exclusivity to be economically viable. The bill will allow the FDA to remove this market exclusivity if the company fails to prove that the drug would be economically unviable when facing competition encouraging more market competition and allowing cheaper options to come on the market sooner.

We wish you all a Happy Valentine’s day and hope you enjoy your time with your loved ones!

February 7, 2020

Last Friday, President Trump announced a travel ban on immigrants who pose a risk of transmitting the coronavirus. The executive order bans entry into the United States for all foreign nationals who were physically present within China during the 14-day period immediately preceding their entry to the United States unless they’re immediate relatives of U.S. citizens or permanent residents. The executive order seeks to stop the virus from spreading, but Ron Klain, who led the Obama Administration’s Ebola response efforts, told a House Foreign Affairs subcommittee that the travel ban won’t stop the spread of the virus. Jennifer Nuzzo, an associate professor and senior scholar at the Johns Hopkins Center for Health Security, agreed and said at the hearing that the virus is spreading too quickly for the travel ban to be effective. Klain believes the focus needs to be on people who have visited the Hubei province in the past 14 days. The White House declined to send administration officials to testify.

It was a busy week in surprise billing. House Ways and Means Committee Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) released text of the Committee’s bipartisan plan to stop surprise medical bills. The Ways and Means Committee plan centers on a pseudo-mediation model to fix the issue of surprise medical bills and for the first time seeks to require patients to receive a true and honest bill in advance of scheduled procedures. The committee plans to hold a mark-up of the legislation next week. House Energy and Commerce Committee Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) and Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) released a statement today in support of the bipartisan legislation that they released last year. Their legislation would allow health plans and providers to submit billing disputes over $750 to outside arbiters and bar air ambulances from billing patients the difference between the charged and the allowed amount. The House Education and Labor Committee is also expected to release new bipartisan legislation today and hold a mark-up on that bill next week.

The House of Representatives agreed to a resolution that disapproves of a recent Trump Administration policy that seeks to allow states to set limits on Medicaid benefits and drug lists. The new program will allow states to seek Section 1115 waivers to receive defined payments for adults that are covered by the Affordable Care Act’s Medicaid expansion. The vote was mostly along party lines with one Democrat voting with Republicans. Democrats refer to this policy as block-granting the Medicaid program and argued that they oppose any plan to weaken the Affordable Care Act’s expansion of Medicaid, while Republicans support the President’s proposal and believed this resolution was partisan and political.

The Centers for Medicare and Medicaid Services (CMS) issued proposed changes to Medicare Advantage and Medicare Part D that seek to modernize and strengthen the two programs. The proposed rule would implement the 21st Century Cures Act requirement to give all beneficiaries with End Stage Renal Disease the option to enroll in a Medicare Advantage plan starting in 2021. The changes also seek to lower beneficiary cost sharing on the most expensive prescription drugs by allowing beneficiaries to compare their out-of-pocket payments for different prescription drugs under Part D plans. CMS is also proposing updates to methodologies used to pay Medicare Advantage plans and Part D sponsors that are expected to increase revenue by 0.93%.

President Trump focused much of his State of the Union speech on health care, spending close to 15 minutes on health-related issues. The President mentioned a number of priorities including a push for bipartisan legislation to reduce drug costs, praise for his administration’s introduction of association health plans, and bipartisan support for investments in fighting kidney disease, HIV, and improvements in the opioid epidemic. The President also attacked Democrats on legislation that would give free health care to illegal immigrants and promised to never let socialism destroy American healthcare, giving us a possible preview of his reelection strategy.


It is National Wear Red Day, so we hope you enjoy sporting your Santa Claus costume!

January 31, 2020

The World Health Organization declared the Coronavirus a public health emergency of international concern. The organization hopes that this will allow the agency to give more help to countries to stop the spread of the virus. The White House announced the formation of a Coronavirus Task Force that will be led by Health and Human Services Secretary Alex Azar. The Task Force will seek to monitor, contain, and mitigate the spread of the virus. Senators have stated that there could be a potential need for supplemental funding to deal with spread of the virus, and the House Energy & Commerce Committee is planning a hearing on the virus next week

This week, the Centers for Medicare and Medicaid Services introduced the Healthy Adult Opportunity program. This initiative allows states to set limits on Medicaid benefits and drug lists. The new program will allow states to seek Section 1115 waivers to receive defined payments for adults that are covered by the Affordable Care Act’s Medicaid expansion. The capping of Medicaid spending is a major change from how the program is currently financed with a shift from open-ended matching to states to a capped amount of federal dollars to states for the program. This proposed change will likely face legal challenges from opponents who view this as executive overreach.

In surprise billing news this week, House Majority Leader Steny Hoyer (D-MD) said that he hopes a surprise billing deal can be moved as early as mid-February if committee leaders are able to come up with a consensus on the final bill. House Education and Labor Committee Chairman Bobby Scott (D-VA), who chairs one of the committees with jurisdiction over the matter, said this week that he plans to mark-up new surprise billing legislation in the next two weeks. House Ways and Means Committee Chairman Richard Neal (D-MA) announced that his committee will lay out language for legislation to tackle surprise medical bills next week and plan to have a mark-up on the legislation on February 12th. The Ways and Mean plan centers on a mediation model to fix the issue and has the support of Ranking Member Kevin Brady.

Yesterday, a bill passed in the House that would extend the government’s ability to categorize new, illicit types of fentanyl as illegal until 2021. The bill would extend the Justice Department’s temporary power to place fentanyl-like substances on the list of the most-strictly controlled drugs for fifteen months. The Senate version of the bill has already passed paving the way for President Trump to sign the bill into law.

Whether you are a 49’ers fan, a Chiefs fan, or neither, we hope you enjoy the Super Bowl this weekend.

January 24, 2020

The Supreme Court this week denied a motion to fast-track a review of the Texas vs. United States Affordable Care Act court decision. A group of attorneys general filed a petition asking the Supreme Court to fast-track a review of Texas vs. United States so that it could be considered this term. The Supreme Courts decision is a loss for Democrats who hoped that the decision could be heard before the election. Democrats remain hopeful that the Supreme Court will review the case by next term which begins in October, but it is likely that the case will not be heard until after the 2020 election.

The World Health Organization declared that the Wuhan coronavirus outbreak is not yet a global health emergency. The outbreak has now spread from China to at least five other countries and at least seventeen people have passed away due to the respiratory disease. The Centers for Disease Control (CDC) has begun screening travelers at major U.S. airports and has placed staff overseas to work alongside the ministers of health in China and Thailand. The CDC has also asked the Food and Drug Administration (FDA) to authorize emergency use of a newly developed diagnostic test to detect the Wuhan coronavirus. The FDA has authorized emergency use in past outbreaks of Zika and Ebola and the authorization allows the CDC to share this test with local and state health officials. The Senate Health, Education, Labor, and Pensions and Foreign Relations Committee hosted a briefing today for all senators with top administration health officials from the CDC, the State Department, and Centers for Medicaid and Medicare Services (CMS) around the coronavirus situation.

We are hearing that the CMS is planning to issue a letter next week regarding Medicaid block-grant guidance. CMS Administrator Verma is expected to issue a letter that will explain how states can seek 1115 waivers to receive defined payments for adults that are covered by Obamacare’s Medicaid expansion. Capping Medicaid spending will likely face legal challenges from opponents who view this as executive overreach.

There is a bipartisan push in the Senate to hold e-cigarette companies accountable for the youth vaping crisis. There was bipartisan legislation introduced this week by Senators Jeanne Shaheen (D-NH), Lisa Murkowski (R-AK), Richard Durbin (D-IL), Mitt Romney (R-UT), Tammy Baldwin (D-WI) and Susan Collins (R-ME) that would require e-cigarette manufactures to pay higher user fees to the FDA to help fund the agencies oversight of the e-cigarette industry. Under this bill the tobacco industry’s yearly fees to the FDA would increase from $712 million to $812 million. Companion legislation will be introduced in the House by Representative Cheri Bustos (D-IL). In other vaping news, over fifty lawmakers led by House Energy and Commerce Oversight Subcommittee Chairwoman Diana DeGette (D-CO) sent a letter to Human Health and Services Secretary Alex Azar calling on the agency to revise its guidance and issue new rules that would ban the sale of flavored nicotine products.

The Environmental Protection Agency (EPA) weakened its request to find out more about companies use of ethylene oxide in sterilizing medical equipment after pushback from the FDA. The FDA claimed jurisdiction over the use of the cancer-causing chemical and requested deletion of the entire discussion around ethylene oxide. The EPA removed the entire section dealing with low ethylene oxide volumes from the final version of its advanced notice of proposed rulemaking but did include a more general question regarding the cost and feasibility of the practice that could result in lower emissions of the toxic chemical.

It is National Beer Can Appreciation Day and National Peanut Butter Day so enjoy your peanut butter and jelly sandwich for dinner with your cold beer (in moderation).

January 17, 2020

Thousands of healthcare leaders and executives convened in San Francisco for the annual J.P. Morgan Health Care Summit this week. Centers for Medicare Services (CMS) Administrator Seema Verma was the keynote speaker for the event and spoke to attendees in a moderated question and answer session. Verma expressed her continued support to realign financial incentives and provide innovation in states to ensure costs are under control, the administrative burdens in providing value-based care, and the need to look at technology and innovation to solve our healthcare problems.

Kate Goodrich, the Chief Medical Officer at CMS, is resigning from her role at CMS to take a position at health insurer Humana. Goodrich played a central role at CMS and has led the quality measurement and value-based incentives group since 2012. Goodrich will now be working on improving outcomes for patients at Humana. Goodrich isn’t the only Administration official headed to Humana, as Mona Siddiqui is leaving her post as the Chief Data Officer at HHS to focus on initiatives at Humana to improve patient safety and quality of care.

House Speaker Nancy Pelosi said this week that the House will address the surprise billing issue once they return from the recess break. The leaders of the House Energy and Commerce Committee and the House Ways and Means Committee are both working on legislation to fix the surprise billing issue.  The Energy and Commerce plan has the support of Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) and Energy and Commerce Ranking Member Greg Walden (R-OR), and would allow health plans and providers to submit billing disputes over $750 to outside arbiters and bar air ambulances from billing patients the difference between the charge and the allowed amount. The Ways and Means plan has the support of Chairman Richard Neal and Ranking Member Kevin Brady (R-TX) and centers on a mediation model to fix the issue.

The House Energy and Commerce Health Subcommittee held a hearing this week on the future of cannabis policy for the new decade. Currently, researchers that want to study marijuana need to get approval from the Drug Enforcement Agency and can only use marijuana grown at the University of Mississippi. There was bipartisan support from the Subcommittee that an expansion of these research opportunities was needed. Critics of the current process noted that this system doesn’t reflect the diversity of marijuana strains currently on the market.

There is a bipartisan push for the Food and Drug Administration to allow hemp-derived cannabidiol (CBD) to be lawfully marketed as a dietary supplement. House Agriculture Chairman Colin Peterson (D-MN), Rep. James Comer (R-KY), and Rep. Brett Guthrie (R-KY) introduced legislation this week that would amend the Federal Food, Drug, and Cosmetic Act to change the way the FDA regulates hemp-derived CBD. The bill calls for flexibility in allowing hemp-derived CBD to be marketed in dietary supplements and require a study and report from the U.S. Department of Agriculture.

We hope you all enjoy the long weekend and take some time to remember Dr. Martin Luther King Jr’s legacy and lasting impact on our country.

January 10, 2020

The Supreme Court ordered the Trump Administration and the states challenging the Affordable Care Act to respond by today at 4:00 pm to an appeal filed to the Supreme Court. The appeal was filed by a group of Attorneys General who asked the Supreme Court to review a December decision by a federal appeals court that ruled the Affordable Care Act’s (ACA) individual mandate penalty unconstitutional.

The House Energy and Commerce Committee’s Health Subcommittee discussed a number of healthcare measures this week. The Subcommittee hearing focused on H.R. 5534, a bill that would remove the 36-month limit on Medicare coverage for transplant recipients. Medicare covers dialysis for all people who need it, but not all people who have received a kidney transplant are eligible to stay covered for the immunosuppressant drugs on which they rely to prevent their new kidney from being rejected. Also discussed in the hearing were H.R. 3935, a bill that would require Medicaid to cover non-emergency – but medically necessary – transportation like public transit, taxis, and van services, and H.R. 2477, a bill that directs the federal government to provide advance notice to individuals approaching Medicare eligibility about basic Medicare enrollment rules, filling a long-standing gap in education for older adults and people with disabilities.

The Bipartisan Policy Center released a poll this week that indicated healthcare will remain a top issue heading into the 2020 elections. Healthcare was polled as the most important issue overall for Democrats and Independent voters and the third most important for Republican voters. Among those polled there was a preference for improving the current system over repealing the Affordable Care Act or adopting a Medicare-for-all single-payer system.

The New England Journal of Medicine released a study that found the “hotspotting” program created by the Camden Coalition of Healthcare Providers did not live up to the promise of its potential. The model hoped to reduce spending and improve health care services for the sickest and most expensive patients. The program focused on health care workers identifying those patients and invested resources to coordinate their care. The program gained national recognition and interest from Federal officials. The study concluded that hospital readmission rates were no lower among patients randomly assigned to the Coalition’s program than among those who received usual care.

The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced that Brad Smith will replace Adam Boehler as the Director of the Center for Medicare & Medicaid Innovation (CMMI) at CMS and Senior Advisor to HHS Secretary Azar for Value-Based Transformation. Smith previously served as CEO of Aspire Health that he founded with former U.S. Senate Majority Leader Bill Frist (R-TN) and worked for Tennessee Gov. Bill Haslam and Sen. Bob Corker (R-TN).

For those of you like the one of us that has yet to take down their Christmas tree, we want to remind all of you to take care of your indoor foliage on this National Houseplant Appreciation Day.

January 3, 2020

The Food and Drug Administration (FDA) finalized its enforcement policy on unauthorized flavored cartridge-based e-cigarettes. Manufacturers will have 30 days to take flavored vape cartridges with the exception of menthol off the market. Open tank systems that are used more by adults will still be allowed to be sold in vape shops as long as steps to prevent youth access are taken by manufacturers. The Administration believes this guidance will both prevent teen use and allow e-cigarette use for adults who want to reduce or quit the use of combustible cigarettes. The guidance has faced criticism from lawmakers and public health organizations who believe that the partial ban doesn’t go far enough and that there are still loopholes that will allow teenagers to still buy products from vape shops.

The nursing home industry believes that an expected recommendation from the Medicare Payment Advisory Commission (MedPAC) will harm providers. At its December meeting, MedPAC recommended the elimination of the base payment rate update for fiscal year 2021 in skilled nursing facilities as they believe this would lower spending and not impact access to services. Mark Parkinson, President and CEO of the American Health Care Association, said in a statement that these recommendations are not the answer and that skilled nursing facilities are currently struggling to keep their doors open.

The Centers for Medicare and Medicaid Services (CMS) announced the Affordable Care Act (ACA) enrollment numbers remained stable in 2019. 8.3 million people enrolled dropping from around 8.5 million enrollees a year ago. CMS noted that the decline is due to a number of factors including a strong economy, the expansion of Medicaid in Maine, and Nevada switching to a state-based exchange.

A federal appeals court upheld the Department of Health and Human Services (HHS) methodology to administer the ACA risk-adjustment program reversing a lower court decision on the matter. The use of statewide average premiums was previously deemed “arbitrary and capricious” by a district court in New Mexico. The Tenth Circuit ruled that the program must be budget neutral and that using the statewide average was allowed. New Mexico Health Connections who brought the challenge could appeal the case directly to the Supreme Court, but it is unclear if they would hear the case.

House Energy and Commerce Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) along with Senate Health Education Labor and Pension Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) expanded its bipartisan investigation into physician staffing companies and insurers role in surprise billing legislation. The leaders of the two committees sent letters to companies including Anthem Inc., Cigna Corp., UnitedHealth Group Inc., and CVS Health Corp. as part of its probe into the practice of surprise billing. The leaders are asking for assistance from the companies understand why surprise billing occurs and the policies and practices that help protect individuals from surprise billing.

It is JRR Tolkien’s birthday so enjoy re-reading the Hobbit or Lord of the Rings this weekend in his honor!