IHA Daily Briefing: May 17

Friday, May 17, 2019
U.S. House Passes Healthcare Legislation
Congress Reviews Efforts to Prevent Surprise Billing
Measles Outbreak Continues
Briefly Noted

U.S. House Passes Healthcare Legislation
The U.S. House of Representatives passed the Strengthening Health Care and Lowering Prescription Drug Costs Act (H.R. 987) yesterday. The healthcare package includes several bills to address high prescription drug prices as well as bills targeting actions by the Trump Administration to roll back certain aspects of the Affordable Care Act (ACA).

Included in the healthcare package were two bills sponsored by members of the Illinois delegation:

  • The Protecting Consumer Access to Generic Drugs Act (H.R. 1499), introduced by Rep. Bobby Rush (IL-1), which would make it illegal for brand and generic manufacturers to enter into agreements in which the brand manufacturer pays the generic manufacturer not to bring a product to market; and
  • H.R. 1010, introduced by Rep. Lauren Underwood (IL-14), which would block the Administration’s rule expanding access to short-term, limited-duration health insurance plans.

“IHA applauds Rep. Underwood’s dedication to ensuring all Illinoisans have access to quality, affordable healthcare. Her legislation takes needed action to protect patients from insurance plans that do not offer adequate protection over the long term, especially if a patient is diagnosed with a serious condition or illness. Illinois hospitals appreciate Rep. Underwood’s ongoing leadership to make sure vital protections included in the Affordable Care Act are not rolled back,” said IHA President and CEO A.J. Wilhelmi in a press release from Rep. Underwood.

Also included in the healthcare package is the IHA-supported CREATES Act (H.R. 965), which would prevent brand manufacturers from blocking access by generic manufacturers to brand drug samples needed to test the efficacy of cheaper alternatives.

The prescription drug bills included in the healthcare package (H.R. 987) are bipartisan; however, the legislation targeting the ACA was backed by Democrats, making the combined package dead on arrival in the Senate.

A statistical brief released from the Agency for Healthcare Research and Quality reports that “the average total prescribed medicine expenditure for persons who obtained at least one outpatient prescription medication increased by $458, from $1,497 in 2009 to $1,955 in 2016, a 30.6% increase.” The brief says, “In every year from 2009 to 2016, both average total and out-of-pocket expenditures for prescribed medicines were consistently higher for the elderly than the non-elderly. For example, in 2016, the elderly had $3,288 average total expenditures, compared with $1,539 for the non-elderly, a difference of $1,749. In the same year, the elderly paid out of pocket an average of $401, compared with $188 for the non-elderly, a difference of $213.”


Congress Reviews Efforts to Prevent Surprise Billing
Momentum continues to build in support of federal legislation to protect patients from surprise medical bills after receiving emergency or planned care which could reasonably be expected to be in-network. Earlier this week, the U.S. House Energy and Commerce Committee released a bipartisan discussion draft proposal and on Wednesday Ranking Member of the Senate Finance Committee Ron Wyden (D-OR) introduced legislation to enhance price transparency. Yesterday, a group of bipartisan Senators introduced the STOP Surprise Medical Bills Act. Additional proposals are expected to be released in the coming weeks, including one from the Senate Health, Education, Labor and Pensions Committee.

Last week, the White House released principles on surprise billing, which it wants Congress to use when drafting legislation. The Administration also underscored its commitment to taking action to advance price transparency and protect patients from surprise medical bills.

According to a press release, the STOP Surprise Medical Bills Act, introduced yesterday by Sens. Bill Cassidy, M.D. (R-LA) and Michael Bennet (D-CO), prevents balance billing in three scenarios:

  • Emergency services:  The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of the patient being treated at an out-of-network facility or by an out-of-network provider.
  • Non-Emergency services following an emergency service at an out-of-network facility: This bill would protect patients who require additional healthcare services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
  • Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.

The legislation would allow providers and plans to appeal a payment amount through use of an independent dispute resolution process – or arbitration. “This process would entail the plan and provider submitting offers to an independent dispute resolution entity that has been certified by the Secretaries of HHS and the Department of Labor. This entity would make a final decision based upon commercially-reasonable rates for that geographic area,” the press release said.

Other proposals being considered in Congress to protect patients from surprise billing include the use of a “bundled” bill, in which the hospitals and payers would negotiate a price for emergency department services. Another proposal that has been circulated is tying payments for emergency services and out-of-network care to a percentage of Medicare rates.

The American Hospital Association released a set of principles to help inform the ongoing federal policy debate.


Measles Outbreak Continues
The Illinois Dept. of Public Health (IDPH) reports that from Jan. 1 to May 10, 839 individual cases of measles have been confirmed in 23 states, with many states still experiencing outbreaks. In Illinois, there have been seven cases in 2019 to date.

IDPH says that only 6% of the U.S. cases were internationally imported; the rest are a result of secondary transmission. Among all cases, 90% were either unvaccinated, or had unknown vaccine status.

IDPH offers the following recommendations and action items:

  • Healthcare personnel should have documented evidence of measles immunity or be offered two doses of measles, mumps, and rubella (MMR) vaccine;
  • Healthcare facilities should maintain lists of immunity status of all healthcare personnel;
  • Healthcare facilities and providers are encouraged to enhance efforts to ensure their patient populations have received on time, age-appropriate MMR vaccine.

For more information from IDPH about measles, see their webpage.


Briefly Noted
The Centers for Medicare & Medicaid Services (CMS) has posted the electronic clinical quality measure (eCQM) specifications info for the 2020 reporting period for Eligible Hospitals and Critical Access Hospitals, and the 2020 performance period for Eligible Professionals and Eligible Clinicians. These updated eCQMs are to be used to electronically report 2020 clinical quality measure data for CMS quality reporting programs. Measures will not be eligible for 2020 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program. Read more here.