The following LPG Weekly Healthcare Watch provides a summary update of legislative and regulatory health care activities from March 2 – 7.  Where available, hyperlinks are included to the relevant documents. Please let us know if you have any questions or would like additional information on the items below.

LEGISLATIVE UPDATE

Senate   

  • On March 3, the HELP Committee held a hearing entitled An Emerging Disease Treat: How the U.S. Is Responding to COVID-19, the Novel Coronavirus. Chairman Lamar Alexander (R-TN) highlighted the Trump administration’s proactive steps to contain the outbreak and the expertise of public health officials behind the U.S. response. Ranking Member Patty Murray (D-WA) suggested the Trump administration has reacted to the outbreak in an unorganized, divisive manner that puts American lives at risk. Ranking Member Murray raised particular concerns with delays in diagnostic testing kits and poor leadership. Dr. Anthony Fauci, Director of the National Institutes for Allergy & Infectious Disease (NIAID), testified that any coronavirus vaccine is at least a year away from reaching the market. Witnesses included: Anne Schuchat, Principal Deputy Director, Centers for Disease Control & Prevention (CDC); Anthony Fauci, Director, NIAID, National Institutes of Health (NIH); Robert Kadlec, Assistant Secretary, Assistant Secretary for Preparedness & Response (ASPR); and Stephen Hahn, Commissioner, Food & Drug Administration (FDA).

  • On March 4, the Commerce, Science & Transportation Committee held a hearing entitled From SARS to Coronavirus: Examining the Role of Global Aviation in Containing the Spread of Infectious Disease. Chairman Ted Cruz (R-TX) claimed the federal government must leverage every resource available to protect the safety and lives of Americans. Witnesses included: Joel Szabat, Acting Under Secretary for Policy, U.S. Department of Transportation; William Ferrara, Executive Assistant Commissioner for Operations Support, U.S. Customs and Border Protection; and Stephen Redd, Director, Office of Public Health Preparedness and Response, CDC.

  • On March 5, Finance Committee Chairman Charles Grassley (R-IA) announced that he has 24 Republicans, one short of his goal, that would vote for a revised drug pricing bill, which he co-authored with Ranking Member Ron Wyden (D-OR).  Chairman Grassley also shared new cost estimate information, namely that it would reduce beneficiary out-of-pocket costs by $50 billion over the next 10 years (the previous version would have reduced such costs by $27 billion).  This change is largely due to reducing coinsurance from 25% to 20% in the initial coverage phase.  Premium savings would decrease from $5 billion to $1 billion and federal savings dropped by as much as $5 billion (to “more than $80 billion”).  An official score is expected “very soon.”

House

  • On March 3, the Veterans’ Affairs Health Oversight Subcommittee held a hearing entitled The Silver Tsunami: is VA Ready?Subcommittee Chair Julia Brownley (D-CA) noted that over the next 17 years, the U.S. Department of Veterans Affairs (VA) will double its spending on long-term care services as the largest cohort of veterans (those of the Vietnam era) grow older. Witnesses explained how the VA is preparing for this surge in utilization; however, many lawmakers suggested its efforts were insufficient. Witnesses included: Teresa Boyd, Assistant Deputy Under Secretary for Health for Clinical Operations, Veterans Health Administration (VHA); Beth Taylor, Chief Nursing Officer, VHA; Scotte Hartronft, Executive Director, Office of Geriatrics & Extended Care, VHA; Elyse Kaplan, Deputy Director, Caregiver Support Program, VHA; Nikki Clowers, Managing Director, Health Care, U.S. Government Accountability Office (GAO); Karin Wallestad, Assistant Director, Health Care, GAO; Adrian Atizado, Deputy National Legislative Director, Disabled American Veterans; and Mark Bowman, President, National Association of State Veterans Homes.

  • On March 3, the Energy & Commerce Health Subcommittee held a hearing entitled Combatting an Epidemic: Legislation to Help Patients with Substance Abuse Disorders. While most bills enjoyed bipartisan support, some Republicans expressed opposition to H.R. 2482.  It is possible the committee will seek to move an opioid package in the coming weeks. The following bills were considered:

    • H.R. 1329, the Medicaid Reentry Act, to allow for medical assistance under Medicaid for inmates during the 30-day period preceding release from a public institution;

    • H.R. 2281, the Easy MAT for Opioid Addiction Act, to allow practitioners to administer up to three days of medication to a person at one time when administering narcotic drugs for the purpose of relieving acute withdrawal symptoms;

    • H.R. 2466, the State Opioid Response Grant Authorization Act, to extend the State Opioid Response Grants program;

    • H.R. 2482, the Mainstreaming Addiction Treatment Act of 2019, to eliminate the separate registration requirement for dispensing narcotic drugs in schedule III, IV, or V (such as buprenorphine) for maintenance or detoxification treatment;

    • H.R. 2922, the Respond to the Needs in the Opioid War (NOW) Act, to create a $25 billion Opioid Epidemic Response Fund (distributed over 5 five years);

    • H.R. 3414, the Opioid Workforce Act of 2019, to provide for the distribution of additional residency positions to help combat the opioid crisis;

    • H.R. 3878, the Block, Report, And Suspend Suspicious Shipments Act of 2019, to clarify the process for registrants to exercise due diligence upon discovering a suspicious order;

    • H.R. 4141, the Humane Correctional Health Care Act, to provide a consistent standard of health care to the incarcerated;

    • H.R. 4793, the Budgeting for Opioid Addiction Treatment Act, to establish a stewardship fee on the production and importation of opioid pain relievers;

    • H.R. 4812, the Ensuring Compliance Against Drug Diversion Act of 2019, to provide for the modification, transfer, and termination of a registration to manufacture, distribute, or dispense controlled substances or list I chemicals;

    • H.R. 4814, the Suspicious Order Identifying Act of 2019, to improve reporting of the distribution of controlled substances, and for other purposes;

    • H.R. 4974, the Medication Access and Training Expansion (MATE) Act of 2019, to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders;

    • H.R. 5572, the Family Support Services for Addiction Act of 2020, to establish a grant program for family community organizations that provide support for individuals struggling with substance use disorder and their families; and 

    • H.R. 5631, the Solutions Not Stigmas Act of 2019, to provide grants to medical and other health profession schools to expand or develop education and training programs for substance use prevention and treatment.

    • Witnesses included: ADM Brett Giroir, MD, Assistant Secretary for Health and Senior Advisory to the Secretary on Opioid Policy; Kimberly Brandt, Principal Deputy Administrator for Policy & Operations, Centers for Medicare & Medicaid Services (CMS); Thomas Prevoznik, Deputy Assistant Administrator, Diversion Control Division; Drug Enforcement Administration; Michael Botticelli, Executive Director, Grayken Center for Addiction, Boston Medical Center; Smita Das, Addiction Psychiatrist, Dual Diagnosis Clinic; Patty McCarthy, CEO, Faces & Voices of Recovery; Robert Morrison, Executive Director, National Association of State Alcohol & Drug Abuse Directors; Margaret Rizzo, Executive Director, JSAS Health Care, Inc; and Shawn Ryan, Chair, Legislative Advocacy Committee, American Society of Addiction Medicine.

  • On March 3, Rep. Joe Kennedy (D-MA) hosted a roundtable on mental health with Reps. Doris Matsui (D-CA), Tony Cárdenas (D-CA), Paul Tonko (D-NY), and David Trone (D-MD), as well as former Rep. Patrick Kennedy (D-RI) and stakeholders from roughly 30 groups representing patients, providers, and payers. Rep. Joe Kennedy is preparing to introduce mental health legislation.

  • On March 4, the Appropriations Departments of Labor, HHS, Education & Related Agencies Subcommittee held a hearingentitled NIH Budget Request for FY 2021. The President’s budget request proposes a 7.9% reduction in NIH funding compared to enacted FY 2020 levels. Subcommittee Chair Rosa DeLauro (D-CT) maintained that the Subcommittee “would not be pursing these cuts and intends to move forward with a continued investment in NIH.” Witnesses included: Francis Collins, Director, NIH; Anthony Fauci, Director, NIAID; Nora Volkow, Director, National Institute on Drug Abuse; Ned Sharpless, Director, National Cancer Institute; Diana Bianchi, Director, Eunice Kennedy Shriver National Institute of Child Health & Human Development; and Gary Gibbons, Director, National Heart, Lung & Blood Institute.

  • On March 4, the Homeland Security Committee held a hearing entitled Confronting the Coronavirus: Perspectives on the Response to a Pandemic Threat. Chairman Bennie Thompson (D-MS) called the hearing to discuss how the federal government can empower state and local governments to respond efficiently to the outbreak, prepare hospitals and health care providers for a potential surge in demand, and protect the lives of Americans. He raised concerns that the Trump administration has downplayed the threat, overstated how close scientists are to developing a vaccine, and silenced public health officials. Witnesses included: Ngozi O. Ezike, Director, Illinois Department of Public Health; Tom Inglesby, Director, Center for Health Security, Johns Hopkins University Bloomberg School of Public Health; and Julie Louise Gerberding, Co-Chair, Commission on Strengthening America’s Health Security, Center for Strategic & International Studies.  

  • On March 5, the House Science, Space & Technology Hearing held a hearing entitled Beyond Coronaviruses: Understanding the Spread of Infectious Diseases and Mobilizing Innovative Solution. Witnesses included: Suzan Murray, Program Director, Smithsonian Global Health Program, Smithsonian’s National Zoo & Conservation Biology Institute; John Brownstein, Chief Innovation Officer, Boston Children’s Hospital, Professor, Harvard Medical School; Peter Hotez, Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine; and Tara Kirk Sell, Senior Scholar, Johns Hopkins Center for Health Security, Assistant Professor, Johns Hopkins Bloomberg School of Public Health.

  • On March 5, the Veterans’ Affairs Technology Modernization Subcommittee held a hearing entitled Getting It Right: Challenges with the Go-live of Electronic Health Record Modernization (EHRM). Witnesses included: Melissa Glynn, Assistant Secretary for Enterprise Integration, Office of Enterprise Integration, VA; Richard Stone, Executive in Charge, VHA; Robert J. Fischer, Director, Mann-Grandstaff VA Medical Center; John Windom, Executive Director, Office of Electronic Health Record Modernization; David Case, Deputy Inspector General, Office of Inspector General, VA; and Travis Dalton, President, Cerner Government Services.

  • On March 5, bipartisan Energy & Commerce Committee leaders sent a letter to FDA Commissioner Stephen Hanh, MD, seeking a briefing on how the agency receives and tracks information relating to temporary withdrawal of generic drugs from the market. Forty-four states filed a complaint last May alleging that some companies are engaging in this practice to increase reimbursements.

  • Staff for the Committees on Education & Labor, Energy & Commerce, and Ways & Means continue to meet with the hopes of reconciling their surprise medical billing legislation with the goal of moving a unified by bill before May 22.

  • House Democrats are expected to release an ACA “fix” bill next week.

REGULATORY UPDATE

  • On March 4, the FDA issued industry guidance on the “Deemed To Be Licensed” provision of the Biologics Price Competition and Innovation (BPCI) Act of 2009, which allows certain drugs (such as insulin) to be regulated as biologics instead of small molecule drugs. 

  • On March 2, the Supreme Court announced it will consider Texas v. Azar, the lawsuit challenging the constitutionality of the Affordable Care Act (ACA), this year.  The court is expected to hear arguments and decide the case in its next term, which starts in October and ends in June 2021, meaning a ruling is not likely before the November 3rd election.

  • On March 2, CMS released the April 2020 ASP Drug Pricing File, containing updated payment amounts that will be used to pay for certain Part B covered drugs for the second quarter of 2020.

  • On March 5, CMS released the April 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS), that includes a list of drugs, biologicals and biosimilars that are approved for pass-through status effective April 1, 2020.

  • On March 9, President Trump will deliver a speech at “HIMSS20,” the Healthcare Information and Management Systems Society's annual health information technology conference.

CORONAVIRUS UPDATE

  • On March 2, CMS Administrator Seema Verma joined the White House’s coronavirus task force.

  • On March 2, New York Gov. Andrew Cuomo (D) announced that insurers in the state will be required to waive cost-sharing associated with coronavirus testing, including emergency room, urgent care, and office visits.

  • On March 2, the CDC and FDA announced plans to allow certain, industrial respirators that have not been approved by the FDA be used in health care settings.

  • On March 2, ASPR Assistant Secretary Robert Kadlec was tapped to lead the HHS response effort. Assistant Secretary for Health ADM Brett Giroir will serve as Kadlec’s deputy, and both will report to HHS Secretary Alex Azar.

  • On March 2, FDA Commission Hahn predicted that by March 6, U.S. labs would have the resources to perform nearly 1 million diagnostic tests. However, public health experts noted this figure is misleading because it far exceeds the number of samples that could reasonably be processed in the coming weeks. 

  • On March 3, Vice President Mike Pence announced the CDC is broadly expanding who can be tested for the virus. Specifically, CDC has released new guidance that permits any American to be tested, as long as a doctor suspects the patient has COVID-19. Previously, CDC required patients to show specific symptoms in an attempt to manage testing demand.

  • On March 3, President Trump, Vice President Pence, and the coronavirus task force met with executives from the pharmaceutical industry. Reportedly, the President was focused on how quickly vaccines and treatments could reach American patients. When asked by a reporter after the meeting whether be believes federal funds should be directed to drug manufactures, the President responded “Some of the companies are so rich they can actually loan money to the federal government. They don't need money. They need time.” 

  • On March 3, President Trump donated $100,000 of his salary to the HHS Office of the Assistant Secretary for Health to aid the coronavirus response effort.

  • On March 3, the World Health Organization (WHO) announced coronavirus has so far killed about 3.4% of those diagnosed with illness worldwide (90,893 reported cases and 3,110 deaths), up from previous estimates of or 2-3%. On March 4, President Trump disputed the accuracy of WHO’s assessment and suggested the actual figure is below 1%.

  • On March 3, former FDA Commissioner Scott Gottlieb wrote an op-ed in the Wall Street Journal about the strategies to contain the outbreak.

  • On March 4, the House voted 415-2 to pass a $8.3 billion supplemental funding package. The deal allocates $826 million to NIAID for development of a vaccine, treatment, and tests. After several days of debate on whether to include a provision to ensure treatments and vaccines, if developed, are affordable to all Americans, lawmakers settled on dedicating $300 million to help Americans purchase vaccines and treatments. In addition, the FDA would receive $61 million to speed up their review of new therapies and respond to possible drug and device shortages. States and local governments would receive $950 million, which would be used in part to fund quarantines. Another $3.1 billion would be spent on purchasing medical supplies for the Strategic National Stockpile and $100 million would go towards community health centers.  

  • On March 4, CMS announced plans to contain the spread of the coronavirus by increasing infection control precautions in nursing homes, hospitals, dialysis facilitates, and hospices. The Agency has a list of facilities it will prioritize for inspections.

  • On March 6, President Trumped signed into law an $8.3 billion emergency supplemental funding bill relating to the coronavirus outbreak.  The bill will foster vaccine development ($826 million) and purchasing once the vaccine is developed ($300 million), research and equipment stockpiles ($3.1 billion) and provide money to states ($950 million) and health professionals to help contain the outbreak.   Lastly, the measure loosens regulations on Medicare reimbursement for telehealth. The Senate passed the bill on March 5 (96-1) after the House passed the bill on March 4 (415-2).  A summary of the bill can be found here.

  • On March 5, the Alliance of Community Health Plans (ACHP) and America’s Health Insurance Plans (AHIP) announced its members will pay for physician-ordered coronavirus testing.

  • On March 5, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for coronavirus-related services.  The agency also issued an additional HCPCS code that labs can use to bill for coronavirus diagnostic tests not made by CDC. 

  • On March 6, the House Ways & Means Chairman Richard Neal (D-MA) requested a meeting with eight major health insurers on March 10 to discuss their plans to cover coronavirus-related testing and treatment without burdening patients with high out-of-pocket costs.  Chairman Neal cited concerns from constituents about potentially large medical bills associated with seeking care for the virus.  The insurers invited to the meeting include: Humana, Anthem, HCSC, Blue Cross Blue Shield of Massachusetts, Cigna, UnitedHealth, Aetna and Kaiser Permanente.

  • Reports suggest the Trump administration and some lawmakers are considering developing a stimulus package to boost the economy amid the outbreak.  

RULES AT THE WHITE HOUSE OFFICE OF MANAGEMENT & BUDGET (OMB)

Pending Review

HHS-CMS

  • Conditions for Coverage for End-Stage Renal Disease Facilities—Third Party Payments (CMS-3337-P); Proposed Rule; Received 6/6/2019

  • International Pricing Index Model for Medicare Part B Drugs (CMS-5528-P); Proposed Rule; Received 6/20/2019

  • Medicare Coverage of Innovative Technologies (CMS-3372-P); Received 7/30/2019

  • Medicaid & CHIP Managed Care (CMS-2408-F); Final Rule; Received 9/26/2019

  • Interoperability and Patient Access (CMS-9115-F); Final Rule; Received 9/26/2019

  • Strengthening the Program Integrity of the Medicaid Eligibility Determination Process (CMS-2421-P); Proposed Rule; Received 12/20/2019

  • Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value Based Payments (VBP) for Drugs Covered in Medicaid (CMS-2482-P); Proposed Rule; Received 12/27/19

  • Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals; the Long-Term Care Hospital Prospective Payment System; and FY 2021 Rates (CMS-1735); Proposed Rule; Received 1/30/20

  • Strengthening Oversight of Accrediting Organizations (AO) and Preventing AO Conflict of Interest, and Related Provisions (CMS-3367); Proposed Rule; Received 2/18/20

  • FY 2021 Skilled Nursing Facility (SNFs) Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1737); Proposed Rule; Received 2/24/20

  • FY 2021 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1729); Proposed Rule; 2/24/20

  • FY2021 Hospice Wage Index, Payment Rate Update, and Quality Reporting Requirements (CMS-1733); Proposed Rule; Received 3/3/20

  • FY 2021 Inpatient Psychiatric Facilities Prospective Payment System Rate and Quality Reporting Updates (CMS-1731); Proposed Rule: Received 3/4/20

HHS-IHS

  • CY 2020 Reimbursement Rates; Notice; Received 3/2/20

HHS-OIG

  • Civil Monetary Penalties Law Notice of Proposed Rulemaking; Proposed Rule; Received 1/23/20

HHS-ONC

  • 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program; Final Rule; Received 10/28/2019

HHS-HRSA

  • Reimbursement of Travel and Subsistence Expenses toward Living Organ Donation Program Eligibility Guidelines; Notice; Received 11/8/2019

REPORTS 

Government Accountability Office (GAO) 

  • On March 3, GAO posted a report entitled Science & Tech Spotlight: Coronaviruses. The two-page “spotlight” provides an overview of previous coronavirus outbreaks, how coronaviruses functions, current diagnostics, and research on vaccines and therapeutics. GAO reports that COVID-19 has an estimated mortality rate of around 3% and is believed to spread rapidly.

HHS Office of Inspector General (OIG)

  • On March 2, OIG posted a report entitled NIH Had Information Technology Control Weaknesses Surrounding Its EHR System. OIG found that the Clinical Research Information System (CRIS), which contains the EHR data for patients in NIH’s Clinical Center, may be at risk of unauthorized access, use, disclosure, disruption, modification, or destruction. While OIG notes that NIH has certain controls in place to secure EHR information, they conclude that security policies and practices have not always been operating effectively to preserve the security, confidentiality, integrity, and availability of CRIS. In response, OIG made three recommendations to improve EHR security. 

  • On March 2, OIG posted a report entitled CHI St. Vincent Infirmary: Audit of Outpatient Outlier Payments. OIG conducted an audit on St. Vincent to determine whether outpatient outlier payments received by St. Vincent were based on properly billed claims. From July 1, 2014 through June 30, 2016, OIG found that St. Vincent did not properly bill 103 claims, resulting in improper outlier payments totaling $581,136. OIG recommends that St. Vincent return any improper outlier payments and improve procedures and provide education to ensure claims billed to Medicare are accurate.

  • On March 3, OIG published a report entitled CMS Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the ACA. The audit aimed to conclude whether CMS obligated and disbursed funds for its federal marketplace contracts in compliance with appropriations law and federal requirements. OIG found that CMS correctly obligated and expended funds for 62 of the 74 contracts reviewed. OIG estimates the remaining 12 contracts in which CMS did not obligate and expend funds in manner consistent with federal law resulted in Antideficiency Act violations totaling $164.6 million ($155.9 million related to the federal marketplace) and expenditure violations totaling $22.4 million ($18.3 million related to the federal marketplace). OIG made four recommendations to remedy the situation. 

  • On March 4, OIG posted a report entitled Medicare Hospital Provider Compliance Audit: Saint Francis Health Center. The audit is part of OIG’s series of hospital compliance audits. OIG found that Saint Francis complied with Medicare billing requirements for 49 of the 100 inpatient claims reviewed. OIG estimates the remaining 51 non-compliant claims resulted in overpayments of $707,118 for calendar years 2015-2016. During this period, OIG calculates that Saint Francis received overpayments of at least $5.5 million; therefore, they recommend for the hospital to refund this amount to Medicare. 

UPCOMING HEARINGS

Senate

  • None of note

House 

  • Appropriations Labor, HHS, Education & Related Agencies Subcommittee

    March 10, 10:00 a.m., 2358-C Rayburn House Office Building

    CDC Budget Request for FY 2021

    Witnesses include: Ileana Arias, Associate Deputy Director for Public Health Science & Surveillance; Sherri Berger, Chief Strategy Officer & Chief Operating Officer; and Robert Redfield Director, CDC.

  • Homeland Security Emergency Preparedness, Response & Recovery Subcommittee

    March 10, 2:00 p.m., 310 Cannon House Office Building

    Community Perspectives on Coronavirus Preparedness and Response

    Witnesses include: Ken Cuccinelli, Acting Deputy Secretary, U.S. Department of Homeland Security (DHS) and Gary Rasicot, Acting Assistant Secretary, Countering Weapons of Mass Destruction Office, DHS.

OTHER HEALTH POLICY NEWS 

  • On March 2, the U.S. Department of Justice (DOJ) announced Sandoz has admitted to fixing prices on a least five generic drugs between 2013 and 2015, accounting for over $500 million in revenue. Sandoz has agreed to pay a $195 million criminal penalty.

  • On March 3, JAMA published a study concluding that net prices of branded drugs in the U.S. increased by 60% between 2007 and 2018, whereas list prices climbed by 159%. The study also estimates that the average Medicaid drug discount increased from 40% to 76% during this period. Discounts to other payers increased from 23% to 51%.

  • On March 3, the DOJ joined a whistleblower lawsuit charging Mallinckrodt of violating the False Claims Act Medicaid by knowingly underpaying Medicaid rebates due as a result of large increases in the price of its drug Acthar 

  • On March 4, U.S. District Judge James Boasberg overturned Medicaid work requirements in Michigan, citing a recent U.S. appeals court decision that invalided work requirements in Arkansas and Kentucky as justification. Judge Boasberg is also scheduled to rule on the validity of work requirements in Indiana.

  • On March 4, the Supreme Court heard oral arguments for Russo v. June Medical Services LLC, which challenges a Louisiana law that requires doctors who perform abortions to have admitting privileges to a nearby hospital. The lawsuit makes the first major abortion case that has reached the Supreme Court since Justices Brett Kavanaugh and Neil Gorsuch were confirmed.

  • On March 4, FasterCures of the Milken Institute named Esther Krofah as its executive director. Prior to joining the Milken Institute in 2018, Krofah was the director of public policy at GlaxoSmithKline and deputy director of the HHS Office of Health Reform.

  • On March 5-6, the Medicare Payment Advisory Commission (MedPAC) held a public meeting on the following topics:

    • Addressing Medicare Shared Savings Program Vulnerabilities;

    • The Role of Specialists in Alternative Payment Models and Accountable Care Organizations;

    • Realigning Incentives in Medicare Part D;

    • Redesigning the MA Quality Bonus Program; 

    • Mandated report: Impact of Changes in the 21st Century Cures Act to Risk Adjustment for MA Enrollees;

    • Improving Medicare’s End-Stage Renal Disease Prospective Payment System; and

    • Separately Payable Drugs in the Hospital Outpatient Prospective Payment System.

  • On March 6, President Trump announced that Rep. Mark Meadows (R-NC) will become the new White House chief of staff.  Mick Mulvaney, the acting White House chief of staff for the last 14 months, will become envoy to Northern Ireland.  Meadows was first elected to Congress in 2012 and formed the conservative Freedom Caucus with Rep. Jim Jordan (R-OH) in 2014.