News from Congress
Lower Costs, More Transparency Act - House Committees on Energy and Commerce, Ways and Means, and Education and the Workforce
The Lower Costs, More Transparency Act, sponsored by Representatives Cathy McMorris Rodgers (R-WA), Frank Pallone (D-NJ), Jason Smith (R-MO), and Virginia Foxx (R-NC) passed through the House of Representatives by an overwhelmingly bipartisan 320-71 vote. It now awaits a vote by the Senate or consideration as part of a bicameral health extenders package in early March. If enacted, the bill would increase health care price transparency and lower overall costs for patients and employers. Families USA and 16 other organizations sent a letter to house leadership in support of the bill. The bill includes key provisions to:
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Codify the Hospital Price Transparency rule by amending the statutory basis to explicitly require disclosure of negotiated rates in dollar amounts. It would also codify the Transparency in Coverage rule.
- Apply site-neutral payment policies to off-campus hospital outpatient departments for drug administration services.
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Require off-campus hospital outpatient departments to obtain a separate national provider identifier and to use that separate identifier when billing Medicare for items and services in order to monitor for fair billing practices.
- Extend funding for the Community Health Center Fund and National Health Service Corps through 2025.
Health Care PRICE Transparency Act 2.0 - Senate Health, Education, Labor, and Pensions (HELP) Committee
Senator Mike Braun (R-IN) and Chairman of the HELP Committee Bernie Sanders (I-VT), alongside Senator Chuck Grassley (R-IA), Senator Tina Smith (D-MN), and Senator John Hickenlooper (D-CO) introduced the Health Care PRICE Transparency Act 2.0, which is a strong update to previous health care price transparency legislation considered by the HELP Committee. This bill would:
- Codify the Transparency in Coverage (TiC) rule.
- Require machine-readable files for all negotiated rates and cash prices between plans and providers.
- Expand price transparency requirements to clinical diagnostic labs, imaging centers, and ambulatory surgical centers.
- Require pricing data standards include all billing codes for services.
- Prevent pre-emption of state price transparency laws.
Value in Health Care Act of 2023 - Senate Committee on Finance
Senators Sheldon Whitehouse (D-RI), Barrasso (R-WY), Welch (D-VT), Tillis (R-NC), Cassidy (R-LA), Thune (R-SD), and Blackburn (R-TN) introduced the Value in Health Care Act of 2023 in the Senate Committee on Finance. This is a companion bill to H.R. 5013: Value in Health Care Act of 2023, which was introduced in the House in July 2023. The bill would extend incentives for providers to participate in alternative payment models and includes the following key provisions to:
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Provide a two-year extension of the 5% payment bonus for participation in advanced alternative payment models (AAPMs) created by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), as well as a scaled 3.5 - 5% payment bonus between 2025 and 2027.
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Adjust the Qualifying APM Participant (QP) threshold from a flat 75% of patients enrolled in APMs to a scaling percentage between 50% and 75% at the Secretary’s discretion. With this change, more providers could qualify for APM incentive payments.
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Eliminate distinctions between low- and high- revenue ACOs for participation in the Medicare Shared Savings Program (MSSP) that disadvantage rural and safety net providers. This is critical to improving access to care and improving health equity.
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Contracts a GAO study on ways to increase parity between APMs in traditional Medicare and Medicare Advantage so both programs are sustainable options.
The Latest from the Biden Administration
Transforming Maternal Health Model (TMaH) - CMS
The Centers for Medicare and Medicaid Services (CMS) announced the Transforming Maternal Health Model, an alternative payment model designed to improve maternal health care through a whole-person approach to pregnancy, childbirth, and postpartum care. The goal of the model is to reduce disparities in access to treatment over a 10-year implementation period, beginning with a pre-implementation period in 2025. The model will center on three main pillars: access to care, infrastructure, and workforce capacity; quality improvement and safety; and whole-person care delivery.
Biden-Harris Administration Announces New Actions to Lower Health Care and Prescription Drug Costs by Promoting Competition - The White House
The Biden-Harris Administration announced new steps toward lowering health care costs, increasing competition, and improving the quality and availability of health care. These actions include efforts to stop anticompetitive mergers and anticompetitive practices by large health care corporations through launching a cross-departmental public inquiry into corporate greed in health care, identifying anticompetitive “roll ups” that evade antitrust review, increasing ownership transparency, banning non-compete agreements, developing new payment models for doctors, and improving transparency of hospital charges.
The U.S. Playbook to Address Social Determinants of Health – The White House
The Domestic Policy Council and Office of Science and Technology Policy released a playbook outlining actions federal agencies are taking to support health through addressing social determinants of health (SDOH) and improving the social circumstances of individuals and communities. It details large-scale efforts by the Biden-Harris Administration to further their commitment to a vision of every American leading a full and healthy life within their community. The playbook focuses on three main pillars: expansion of data gathering and sharing; support for flexible funding to address social needs; and support for community backbone organizations.
Federal Independent Dispute Resolution Process Administrative Fee Final Rule - CMS
CMS released their final rule governing the administrative fee associated with filing disputes through the Independent Dispute Resolutions (IDR) process under the No Surprises Act. Over the past year, the IDR process has been inundated with thousands of disputes and as a result, CMS has sought to increase administrative fees associated with filing disputes in order to curb high administrative costs. The Final Rule establishes an administrative fee of $115 per party, as well as an IDR entity fee range of $200-$840 for single determinations and $268-$1,173 for batched determinations.
