Daily on Healthcare, sponsored by SBEC: Back to life? Deal struck on surprise billing ban

By | December 9, 2019

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BACK TO LIFE? DEAL STRUCK ON SURPRISE BILLING BAN: Members of Congress announced changes to their surprise billing legislation this weekend as they attempt to deliver what Republican Sen. Lamar Alexander is calling a “Christmas present” to patients.

The bill, which lawmakers had hoped to pass ahead of the August recess, was floundering due to lobbying efforts by private-equity doctor staffing firms and a push from a large swath of lawmakers who wanted the measure to include arbitration, a provision to set up an independent arbiter to resolve billing disputes.

The push won over. Congressional leaders announced Sunday that the move to set rates, known as “benchmarking,” would remain in the bill, but for certain claims insurers or healthcare providers could turn to arbitration to intervene. Senior aides haven’t released precise details yet on how the mechanism would be triggered.

Despite the many differences in Congress, and the impeachment inquiry in the House, Congress is making it clear this is one area for which they’re willing to put aside their differences.

Sweetening the deal even further, the Lower Health Care Costs Act includes early $ 20 billion for five years of funding for the nation’s 1,400 community health centers, as well as measures to lower drug prices. And let’s not forget it contains a measure aimed at the vaping issue by increasing the legal age to buy tobacco products from 18 to 21.

The deal will potentially will be attached to a spending bill due Dec. 20. There’s not yet a guarantee that the package will pass, but the latest change boosts the chances that Congress will be able to check this issue off its list for 2019.

Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at dailyonhealthcare@washingtonexaminer.com. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.

THE SENATE DRUG PRICING BILL ALSO GETS A FACELIFT: The Senate Finance Committee has changed the bipartisan bill, which has support from the White House, so that it will fund other healthcare priorities, including Medicaid for Puerto Rico. It also lets seniors pay the cost of their drugs over the course of the year, instead of all at once at the pharmacy counter. It’s not clear drug pricing will go ahead this year, though, as senators still don’t have a commitment from Mitch McConnell to bring the bill to the floor.

Meanwhile, over in the House: The Lower Drug Costs Now Act from Nancy Pelosi to let the government negotiate the price of up to 250 drugs is getting a vote this week. And Republicans are ramping up against the bill Monday by introducing a measure of their own, which largely takes from the Finance Committee bill and which they are daring Democrats to support.

SUPREME COURT WON’T REVIEW KENTUCKY ULTRASOUND LAW: The Supreme Court’s decision means that a 6th Circuit ruling, to allow the law to go into effect, will remain in place.

The law in Kentucky, known as the Ultrasound Informed Consent Act, requires doctors who perform the ultrasound to show and describe the images to patients, and to play the sound of the heartbeat. Women are allowed to look away and to ask for the sounds to be turned off. Doctors who don’t comply can be fined and referred to Kentucky’s medical licensing board.

SEEMA VERMA TRIED TO CHARGE TAXPAYERS $ 47K FOR STOLEN JEWELRY: Centers for Medicare and Medicaid Services Administrator Seema Verma filed a $ 47,000 claim for lost property in August 2018, Politico reported, after her baggage was stolen from a rental car in San Francisco. When it happened, Verma was nearby giving a speech and ended up losing tens of thousands of dollars’ worth of jewelry. A Health and Human Services spokesperson said the department pays a “discounted rate based on age for the items that were lost,” and added, “It’s perfectly appropriate that the administrator filed a personal property loss claim for goods stolen while on work travel and this is not an unusual practice for federal employees.” Even though Verma filed a $ 47,000 claim, HHS gave her just $ 2,852.40.

GOP DEMANDS ANSWERS FROM INSURERS ABOUT HIGH INSULIN PRICES: Energy and Commerce Committee Republicans are demanding answers from insurers, including Blue Cross Blue Shield, Cigna, and Anthem, for information regarding the list prices of insulin versus negotiated prices. They point out that while list prices of insulin products have increased over the past 10 years, the net prices that manufacturers get has stayed the same or decreased.

FDA WARNS UMBILICAL CORD BLOOD PRODUCT MANUFACTURER: The Food and Drug Administration has issued a warning to Liveyon, a company that claims its products derived from umbilical cord blood “may aid in the regeneration of bone, muscle, cartilage and release a host of reparative growth factors and proteins,” through the “miraculous nature of stem cell science.” An FDA inspection of the Liveyon Labs and Liveyon LLC facility in May found that umbilical cord donors were not properly vetted per the FDA’s tissue guidelines.

In the past year, 17 people have been hospitalized after being injected with similar products derived from umbilical cord blood. It is also worth noting that the FDA has sent similar letters to 20 stem cell manufacturing companies in violation of the same guidance as Liveyon.

The Rundown

Washington Post Democrats leveraged Trump’s fixation on Space Force to pursue parental-leave victory for federal workers

The New York Times Two new drugs help relieve sickle-cell disease. But who will pay?

The Sacramento Bee Dental patients face years of debt, inflated bills with ‘out-of-pocket’ credit cards

The Wall Street Journal Black voters back Medicare for All, not so much the candidates pushing it

Tampa Bay Times An autistic child melts down. An officer makes a decision. A family suffers the consequences.


MONDAY | Dec. 9

10 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Advancing Comprehensive Primary Care in Medicaid.” Details.

TUESDAY | Dec. 10

9 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Examining Pharmaceutical Patent Practices & Their Impact on Drug Prices.” Details.

10 a.m. 2123 Rayburn. Health Energy and Commerce’s Oversight and Investigations Subcommittee hearing on “Securing the U.S. Drug Supply Chain: Oversight of FDA’s Foreign Inspection Program.” Details.

10:30 a.m. 2322 Rayburn. Health Energy and Commerce’s Health Subcommittee to hold hearing on “Proposals to Achieve Universal Health Care Coverage.” Details.


10 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Modernizing the Stark Law and Anti-Kickback Statute to Promote Value-Based Care.” Details.