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House Passes Individual Spending Bills, No Movement to End Partial Shutdown

January 18, 2019—With several federal agencies shut down since their appropriations expired Dec. 21, 2018, the House Jan. 17 approved by voice vote a continuing resolution (CR) for the unfunded federal agencies and Cabinet departments through Feb. 28 (H.J. Res 28). 

However, the vote on the six-week CR was vacated following members’ requests to record the vote. The House will hold a recorded vote on this measure the week of Jan. 21.

The House since Jan. 3 has favorably passed seven funding bills with different strategies for funding the government, including a package containing the remaining spending bills from the 115th Congress, full-year spending bills for individual agencies, and a $14 billion disaster aid bill in conjunction with a six week CR. The series of House votes follows attempts to prevent a partial shutdown by both chambers at the end of the 115th Congress [see Washington Highlights, Dec. 21, 2018].

Senate Democrats Jan. 15 asked to take up the House-passed funding bills but were blocked by Senate Majority Leader Mitch McConnell (R-Ky.), who has indicated he will not bring bills to the Senate floor unless the president says he will sign them into law.

The AAMC Jan. 17 joined a community letter to President Trump along with 280 co-signatories citing the health impacts of the government shutdown and urging the president and Congress to immediately reopen the government. While most agencies and programs within the Department of Health and Human Services are not affected by the shutdown, the Food and Drug Administration, Indian Health Service, and other health-related programs fall under the jurisdiction of different spending bills that have not yet been completed, leading to their closure.

In the letter, the community wrote, “A prolonged shutdown will continue to put the health and safety of the nation’s residents at risk. It is vital that Congress and the President work to reopen the government as soon as possible to minimize the effects of the impasse.”

The House and Senate were originally scheduled to be in a state work period the week of Jan. 21 but will instead return to Washington, D.C.

Contact:

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525
Email: trasouli@aamc.org

Christa Wagner
Legislative Analyst
Telephone: 202-828-0595
Email: chwagner@aamc.org

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MedPAC Recommends Changes to Physician Payments and Hospital Payment Updates

January 18, 2019—The Medicare Payment Advisory Commission (MedPAC) met Jan. 17-18 to approve recommendations on physician payments and hospital payment updates. The commission also discussed Medicare prescription drug pricing and performance in the Medicare Shared Savings Program (MSSP).

Physician Payments: MedPAC staff presented on payment adequacy and payment updates for physicians and other health professionals, and payment policies for advanced practice registered nurses (APRNs) and physician assistants (PAs). Staff presented three draft recommendations as a continuation from the December meeting where they were asked to bring the recommendations to a vote [see Washington Highlights, Dec. 7, 2018]. The commission unanimously passed these recommendations:

  • For calendar year (CY) 2020, Congress should increase the CY 2019 Medicare payment rates for physicians and other health professional services by the amount specified in current law;

  • Congress should require APRNs and PAs to bill the Medicare program directly, eliminating “incident-to” billing; and

  • The Health and Human Services Secretary should refine Medicare’s specialty designations for APRNs and PAs.

Hospital Payment Updates:  Commissioners unanimously voted to approve the draft recommendation to congress for fiscal year (FY) 2020 to update acute care hospitals’ base payment rates by 2% and replace Medicare’s current hospital quality programs with the new hospital value incentive program (HVIP) that provide a projected 0.8% HVIP add-on to the base payment update. Commissioners expressed reservations about the short timeline and the feasibility of implementing HVIP by FY 2020. If HVIP is not implemented, the base payment update in FY 2020 for acute care hospitals would be 2% and would not include the 0.8% HVIP add-on.

Drug Pricing: MedPAC staff presented on a broad group of policy options to address Medicare prescription drug pricing for the commission’s upcoming spring sessions. Staff highlighted both past MedPAC recommendations for Parts B and D, and potential topics to cover this spring, such as broader use of arbitration in Part D price negotiation and outcomes-based pricing.

Commissioners expressed significant interest in exploring reference pricing and implementing a Medicaid-like rebate in Medicare. However, commissioners emphasized their desire for a means to prioritize the policy options, requesting that staff evaluate the policies’ impact on spending, beneficiary access, and their overall feasibility. Several commissioners also requested that staff monitor the impact of drug prices on Part A in addition to Parts B and D.

Medicare Shared Savings Program:MedPAC staff also presented updated analysis on Medicare Accountable Care Organizations (ACOs) in the Shared Savings Program. Notably, the analysis showed that 2017 was the first year of the program that demonstrated savings to the Medicare Trust Funds. Of note, the analysis found an association between changes in assignment of beneficiaries to ACOs and changes in spending, and the impact of prospective assignment versus retrospective assignment for achieving savings for the program. Staff noted that the analysis may call into question the recent changes finalized for the program (see Washington Highlights, Dec. 21, 2018) that would push ACOs into taking on downside risk earlier in their participation (and thus less time to learn) and allowing ACOs to choose prospective or retrospective assignment annually.

Contact:

Kate Ogden
Physician Payment & Quality Specialist
Telephone: 202-540-5413
Email: kogden@aamc.org

Andrew Amari
Hospital Policy and Regulatory Specialist
Telephone: 202-828-0554
Email: aamari@aamc.org

Phoebe Ramsey, J.D.
Sr. Regulatory Analyst - Quality & Payment Policy
Telephone: 202-448-6636
Email: pramsey@aamc.org

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House Oversight Committee Initiates Investigation on Drug Pricing

January 18, 2019—House Oversight and Reform Committee Chair Elijah Cummings (D-Md.) Jan. 14 sent letters to 12 drug companies requesting detailed information and documents on the companies’ drug pricing practices. 

According to Cummings, “The goals of this investigation are to determine why drug companies are increasing prices so dramatically, how drug companies are using the proceeds, and what steps can be taken to reduce prescription drug prices.”

Specifically, the letters ask for more information on communications on price increases, investments in research and development, and corporate strategies to preserve market share and pricing power.

The committee will hold a Jan. 29 hearing on prescription drug price increases. No witnesses have been announced yet, but it is expected to include drug company executives and patients affected by rising drug prices.

Contact:

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org

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AAMC Submits Comments on Proposed Objectives for Healthy People 2030

January 18, 2019—The AAMC Jan. 17 submitted  comments to the Department of Health and Human Services regarding the proposed core, development, and research objectives for Healthy People 2030.  These objectives represent the nation’s critical public health priorities to improve the health and well-being of all Americans through multisector collaboration and evidence-based intervention. 

In its comments, the AAMC provided recommendations on several of the proposed measures as summarized below:

  • Core Objectives – Achieving Health Equity: The AAMC supports the inclusion of core objectives that address health disparities and/or achieving health equity where population-level data has been collected and tracked and are focused on the reduction of disease burden. The AAMC recognizes the socioeconomic factors that affect health and remains committed to advancing solutions in academic medicine that address systemic inequalities in communities.     

  • Developmental Objectives – Clinical Prevention and Population Health Content and Training: The AAMC supports the inclusion of the proposed education-related objectives and is committed to continued participation in the Healthy People Curriculum Task Force to collect data on the integration of population health topics in medical education. Additionally, the AAMC remains engaged with its interprofessional colleagues to promote team-based approaches through didactic and experiential training for future health professionals.

  • Research Objectives– Workforce Development and Pipeline Programs: The AAMC supports the inclusion of research objectives to assess the capacity of the physician workforce and evaluate the impact of pipeline programs to advance quality, equitable health care for an increasingly diverse U.S. population. Further research on the impact of these efforts can be informed by the AAMC’s robust data warehouse and participant data from the Robert Wood Johnson Foundation Summer Health Professions Education Program that engages 1,000 college students yearly through traditional health care and public health experiences.

Contact:

Malika Fair, M.D., M.P.H.
Sr. Director, Health Equity Partnerships & Program
Telephone: 2027784773
Email: mfair@aamc.org

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On the Hill

January 18, 2019—Subcommittee assignments for key House committees were announced this week for both parties. The House Appropriations Committee Jan. 15 announced its Subcommittee Chairs and Ranking Members for Democrats and Republicans. Rep. Rosa DeLauro (D-Conn.) will Chair the Labor, Health and Human Services, Education, and Related Agencies Subcommittee with Rep. Tom Cole (R-Okla.) as Ranking Member.

The House Energy and Commerce Committee Democrats and Republicans announced their Subcommittee rosters. Rep. Anna Eshoo (D-Calif.) will Chair the Health Subcommittee with Rep. Michael Burgess (R-Texas) as Ranking Member.

The House Ways and Means Committee Democrats and Republicans announced Jan. 16 their Subcommittee rosters. Rep. Lloyd Doggett (D-Texas) will Chair the Subcommittee on Health with Rep. Devin Nunes (R-Calif.) as Ranking Member. 

Rep. Tom Marino (R-Pa.) Jan. 17 announced his resignation from the House of Representatives. The Congressman, just elected to his fifth term in the 12th District of Pa., will leave office Jan. 23. Pennsylvania Gov. Tom Wolf (D) will schedule a special election to fill the remainder of Marino’s term.


On the Agenda


Jan. 24-25: MACPAC Public Meeting
1300 Pennsylvania Ave. NW, Washington, D.C.
The Medicaid and CHIP Payment Advisory Commission (MACPAC) will hold a public meeting to discuss a variety of topics, including Medicaid Disproportionate Share Hospital allotment reductions.

Jan. 29: Oversight and Reform Hearing on Prescription Drugs
TBD
The House Committee on Oversight and Reform will hold a hearing titled “Prescription Drug Price Increases.”

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.


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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org