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Committee Releases Bipartisan Drug Pricing Bill for Thursday Markup; Parts B & D Inflation Rebates, Part D Benefit Redesign, Transparency, Increased AMP Rebate Cap Addressed

Committee Releases Bipartisan Drug Pricing Bill for Thursday Markup; Parts B & D Inflation Rebates, Part D Benefit Redesign, Transparency, Increased AMP Rebate Cap Addressed

Chairman Chuck Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) released their highly anticipated bipartisan drug pricing package – the Prescription Drug Pricing Reduction Act (PDPRA) of 2019 – ahead of a markup at 9:30am this Thursday, July 25. A description of the Chairman’s Mark is available here and a summary follows below. The bill requires rebates for Medicare Part… (Zatorski, 7/23/19) #Medicare Part D, #Drug Pricing, #Pharmacy Benefit Managers, #Prescription Drugs, #Pharmacies, #Generic Drugs

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Chronic Care Eligible for Pre-Deductible Coverage by HDHPs

Chronic Care Eligible for Pre-Deductible Coverage by HDHPs

The IRS issued a notice expanding the list of preventive services that high-deductible health plans (HDHPs) may cover before the deductible is reached. Under the notice, which is driven by President Trump’s recent Executive Order on transparency, HDHPs may provide pre-deductible coverage of a specified list of chronic care-related services, including drugs, to individuals diagnosed with certain chronic conditions. Those… (Zatorski, 7/17/19) #Cost-Sharing, #Value-Based Insurance Design

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Committee Markup of 25 Bills; Addresses Surprise Medical Billing, Drug Pricing, and Extenders

Committee Markup of 25 Bills; Addresses Surprise Medical Billing, Drug Pricing, and Extenders

The House Energy and Commerce (E&C) Committee convened a full Committee markup of legislation recently advanced by the E&C Health Subcommittee, addressing surprise medical medicals, drug pricing transparency, and public health and health care extenders. All eight health care bills were approved unanimously and reported to the House floor for a vote. Of note, the Committee approved an amendment to… (Llamas, 7/17/19) #Insurance Reform, #Chronic Diseases, #Pediatrics, #Prescription Drugs

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Agency Issues Two Rules Aimed at Easing Regulatory Burden in Long-Term Care Facilities; Prohibition on Arbitration Agreements Removed

Agency Issues Two Rules Aimed at Easing Regulatory Burden in Long-Term Care Facilities; Prohibition on Arbitration Agreements Removed

The Centers for Medicare & Medicaid Services (CMS) released two rules impacting requirements at long-term care (LTC) facilities. The releases are part of a series of steps the agency says it has taken to increase efficiency, transparency, and the safety and quality of care beneficiaries in long term care settings. Aproposed rule would make more than a dozen reforms aimed… (Cowey, 7/16/19) #Long-Term Care, #Quality, #Long-Term Care Hospitals

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Proposed Decision: Acupuncture for Chronic Low Back Pain (Comments Due: Aug. 14)

Proposed Decision: Acupuncture for Chronic Low Back Pain (Comments Due: Aug. 14)

CMS issued a proposed decision memo in response to its internally-generated National Coverage Analysis (NCA), determining that acupuncture is reasonable and necessary for the treatment of chronic low back pain (CLBP) for Medicare beneficiaries meeting stipulated parameters. CLBP is defined as an episode of low back pain that lasts three or more months. Specifically, CMS proposes to provide Medicare coverage… (Pahner, 7/15/19) #Physicians, #Coverage Decisions

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Additional Section 1332 Waiver Guidance Aims to Encourage Flexibility, Assist States

Additional Section 1332 Waiver Guidance Aims to Encourage Flexibility, Assist States

CMS released additional guidance to states to advance section 1332 State Relief and Empowerment waivers under recently-relaxed guardrails. The latest guidance follows a Request for Information (RFI) jointly issued by CMS and Treasury last spring soliciting feedback on innovative ideas states could leverage in advancing a section 1332 waiver plan. As part of the guidance, CMS released a checklist itemizing… (Pahner, 7/15/19) #Waivers, #Qualified Health Plans, #Reinsurance

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Health Subcommittee Advances 10 Bills to Full Committee on Surprise Billing, Drug Pricing, Extenders

Health Subcommittee Advances 10 Bills to Full Committee on Surprise Billing, Drug Pricing, Extenders

The House Energy and Commerce Subcommittee on Health convened a markup of 10 health care bills, including advancing H.R. 3630, the “No Surprises Act,” bipartisan legislation to address surprise medical bills. The Subcommittee also advanced H.R. 2296, the FAIR Drug Pricing Act, which requires pharmaceutical manufacturers to justify price increases above a certain threshold. The Subcommittee adopted an amendment in… (McChesney, 7/11/19) #Community Health Centers, #Drug Pricing, #Disproportionate Share Hospitals (DSH), #Pediatrics, #Hospitals, #Cost-Sharing

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Agency Estimates CY 2020 Home Health Agency Payments to Increase by 1.3 Percent under Proposed Rule

Agency Estimates CY 2020 Home Health Agency Payments to Increase by 1.3 Percent under Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) issued the calendar year (CY) 2020 home health prospective payment system and rate update proposed rule (release; fact sheet). What it is. The proposed rule affects payments to home health agencies (HHAs) beginning Jan. 1, 2020. Why it is important for you. CMS proceeds with implementation of Bipartisan Budget Act (BBA)-driven Patient-Driven… (Zatorski, 7/11/19) #Home Health, #Quality

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President Trump Signs Executive Order to Improve Kidney Care, Briefly Discusses Drug Pricing Updates; CMS Follows with Five New Kidney Care Models, Includes Proposal for Radiation Oncology Model

President Trump Signs Executive Order to Improve Kidney Care, Briefly Discusses Drug Pricing Updates; CMS Follows with Five New Kidney Care Models, Includes Proposal for Radiation Oncology Model

The federal government announced sweeping changes to the way kidney care is delivered in the United States. First, the Trump Administration outlined its overarching strategy for reforming the kidney care delivery system through its Executive Order (EO) on Advancing American Kidney Health (fact sheet). In his remarks on the EO, President Trump emphasized the need for advancing innovations in therapies… (LaRosa, 7/10/19) #Chronic Diseases, #Delivery Reform, #End-Stage Renal Disease, #Demonstration Programs, #Value-Based Purchasing, #Prevention, #Oncology

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Committee Examines Implications of Texas v. Azar; Preexisting Conditions, Medicaid Expansion, and Premium Increases Discussed

Committee Examines Implications of Texas v. Azar; Preexisting Conditions, Medicaid Expansion, and Premium Increases Discussed

Today, the House Committee on Oversight and Reform convened a hearing to examine the recent lawsuit Texas v. Azar and the potential implications for U.S. health care. Several patient witnesses testified about their experience with the Affordable Care Act (ACA) and how it provided coverage they otherwise would not have had access to. Other witnesses provided expert testimony on the… () #Legal, #Preexisting Conditions, #Single Payer

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