Following a week-long recess, the House this week is expected to vote on a Medicaid legislative package comprising policy proposals widely supported by both sides of the aisle.
The legislation would give states the option to establish Medicaid health homes to help coordinate care for children with complex medical conditions — an identical proposal to that in the Advancing Care for Exceptional (ACE) Kids Act, supported by America’s Essential Hospitals. The package also includes bills to:
- provide $20 million in additional funding for the “Money Follows the Person” demonstration program, which helps Medicaid beneficiaries with disabilities and chronic conditions transition from institutionalized to community-based care settings;
- maintain until Sept. 30 the spousal income disregard when determining Medicaid eligibility for recipients of home and community-based services; and
- extend funding for the certified community behavioral health clinic demonstration program under Medicaid, which expands access to community-based addiction and behavioral health services.
Lowering Health Care, Rx Drug Costs
Meanwhile, the House Committee on Energy and Commerce Subcommittee on Health will hold a March 27 mark up of a dozen bills aimed at lowering health care and prescription drug costs.
Half the bills focus on lowering prescription drug prices, including one to prohibit “pay-for-delay” patent settlements and one to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission access to drug pricing data to advise Congress on proposals to lower prescription drug prices. The other half of the bills in the mark-up aim to stabilize the Affordable Care Act (ACA) insurance marketplace, including a bill to protect patients with pre-existing conditions.
House Democrats to Unveil ACA Legislation
House Democrats also are expected to introduce legislation to bolster insurance reforms under the ACA. The legislation would expand the availability of benefits, such as subsidies, to help lower the cost of health coverage, while ending insurance changes implemented by the Trump administration
House and Senate Tackle Surprise Billing
The Senate Committee on Health, Education, Labor, and Pensions (HELP) is moving forward in its work on balance billing, or surprise medical bills. A bipartisan group of senators, led by Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH), is expected to release surprise billing legislation by mid-April. This comes after Cassidy and members of the bipartisan Senate health care price transparency working group last fall released a discussion draft related to surprise bills.
Meanwhile, HELP Committee Chair Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) are working with the Congressional Budget Office to conduct a financial analysis of various policy proposals to mitigate surprise billing. The proposals explore several options to establish a payment rate for providers when delivering out-of-network care, including introducing an arbitration process between plans and providers, creating a base payment defined by a percentage of the Medicare rate, and, possibly, bundling provider charges in a single payment.
In the House, the Committee on Education and Labor will hold a hearing the first week of April to gather information on surprise billing practices; the hearing will not examine specific legislation.