HEALTH CARE BRIEFING: Surprise Billing to Ride on Omnibus Bill

A fix for unexpected medical bills will advance as part of a year-end spending package after key lawmakers reached agreement on how to address the issue earlier this month.

The text of the $1.4 trillion omnibus spending measure and $900 coronavirus stimulus package hasn’t been released yet. The House and Senate plan to vote on the measure today. Both chambers passed, and President Donald Trump signed, a single-day stopgap measure last night keeping the government open through midnight.

The legislation is based on a deal announced Dec. 11 that would ban doctors and hospitals from charging patients fees on most out-of-network care that their insurer won’t cover. It would limit patients’ financial responsibility for emergency care from providers not in their network, and would establish an arbitration process for payment disputes between insurers and providers.

Patients can incur “surprise” medical bills when they unexpectedly receive out-of-network services in an emergency or for ancillary services such as anesthesia and radiology that they didn’t know were outside their insurance plan. Out-of-network care is usually more expensive than in-network care with higher coinsurance rates or no coverage at all.

“Every American that walks into an emergency room, that gets an operation, was at risk of having some out-of-network provider. That is gone,” Rep. Donna Shalala (D-Fla.) said during a press conference last week.

The surprise-billing compromise was struck after months of negotiations and aims not to favor either insurers or providers, said an aide for Sen. Bill Cassidy (R-La.), who was part of a bipartisan group of senators that proposed legislation last year.

Debate on arbitration and mediators to oversee billing disputes had held up legislation, the aide said.

Providers wanted their billed charges to be considered by mediators, but other groups pushed for programs such as Medicare, which typically pay doctors less than private insurance, to be used as a reference.

The compromise lets providers accept a benchmark rate then seek higher reimbursement through arbitration, the aide said, Alex Ruoff and analyst Danielle Parnass report. Read more from Alex Ruoff.

What Else is in the Spending Deal: The combination spending bill and coronavirus relief measure also includes funds for virus testing, tracing and vaccine development and distribution. It provides $13 billion for nutrition assistance.

The spending package includes the long-standing Hyde amendment, which bars federal funds for most abortions, and the Helms amendment, which bars the use of foreign assistance funds for abortions. Congressional Democrats have said they want to remove the Hyde amendment from spending bills starting in fiscal 2022, when a Democrat will be in the White House. President-elect Joe Biden has said he also opposes the Hyde amendment.

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Moderna, With FDA Blessing, Begins Rollout

Moderna’s Covid-19 vaccine was cleared by U.S. regulators, the second vaccine to gain emergency authorization this month, as a historic mass immunization effort ramps up across the country.

The Food and Drug Administration’s decision to grant the authorization Friday for the shot’s use among adults means that two of the six vaccine candidates identified by Operation Warp Speed are now available to the public, a feat accomplished in less than one year. Shots from AstraZeneca and Johnson & Johnson that have also received U.S. support are expected to be submitted for review next year.

Beginning yesterday, United Parcel Service trucked the vaccine from a facility in Kentucky to a nearby airfield for flights across the U.S. Deliveries will begin today, said Wes Wheeler, chief of UPS’s healthcare unit. FedEx, which like UPS delivered the first shipments of the Pfizer vaccine last week, said in a statement its “operations are in motion” to distribute the Moderna vaccine. Read more from Anna Edney and Robert Langreth.

Front-Line Workers, Elderly Next for Vaccines: CDC Advisers: The elderly and front-line essential workers, including firefighters, teachers and grocery store workers, should be next in line for coronavirus vaccines, an advisory committee to the Centers for Disease Control and Prevention voted yesterday. The first round of vaccinations is going mostly to to health-care workers and residents of long-term care facilities.

After the so-called Phase 1B group, the third tranche, or Phase 1C, would include those ages 65 to 74, younger people with high-risk medical conditions, and other essential workers, including those who work in the construction, food service and legal fields, the CDC’s Advisory Committee on Immunization Practices recommended. A further breakdown among the third group may be provided at a later date, since multiple committee members expressed concern about how large it is — about 129 million people — and the need to further prioritize within it. Members of the committee voted 13-1 on the recommendations. Read more from Angelica LaVito.

Perna Cites Miscommunication in Supply Confusion: The general running the U.S. vaccine-distribution effort said a lag between when shots are produced and when they are cleared for shipment led to widespread confusion over how many doses states will receive this week. The chief operations officer for Operation Warp Speed, Gustave Perna, said that after doses of the Pfizer-BioNTech vaccine are manufactured, authorities have to perform a quality check. In the first week of allocations, he said, an inventory of verified shots had built up. But in the second week, new doses had to be checked, meaning states would get fewer than they had expected. Read more from John Tozzi.

London Begins Lockdown Amid Mutation: More than 16 million Britons are now required to stay at home as a lockdown came into force yesterday in London and southeast England, part of Prime Minister Boris Johnson’s attempt to control a rapidly spreading new mutation of the coronavirus. Covid-19 case rates almost doubled in London in the past week, with almost 60% of these infections attributed to the strain, officials said. So far, there is no evidence it causes higher mortality, they said. Read more from Tim Ross and Eddie Spence.

  • It’s unclear whether the more transmissible variant of the coronavirus has made its way to the U.S., according to Moncef Slaoui, chief scientific officer for Operation Warp Speed. “We don’t know,” Slaoui told CNN yesterday. “We’re looking at that.” Separately, HHS Assistant Secretary Brett Giroir questioned the threat posed by the strain, saying the coronavirus that causes Covid-19 has mutated over 4,000 times since it was discovered. Read more from Will Wade and Reade Pickert.
  • Meanwhile, Germany, Italy, Denmark, and other European nations suspended air travel with the U.K. yesterday, amid reports of the new strain. Read more.
  • Separately, two passengers flying on separate airlines were hit with proposed fines of $15,000 and $7,500, respectively, from the Federal Aviation Administration on Friday following incidents in which they refused to wear masks and allegedly assaulted flight attendants, Alan Levin reports

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What Else to Know

Becerra to Bring Scrutiny on Health Fraud, Hospital Deals: Attorneys are bracing for more enforcement actions in the health-care space in the Biden administration, with an aggressive litigator nominated to lead the Health and Human Services Department. California’s attorney general, Xavier Becerra, is expected to steer HHS to work more tightly with the Department of Justice to boost health fraud enforcement efforts. And defense attorneys also anticipate more collaboration with the Federal Trade Commission to more closely scrutinize hospital mergers. Read more from Lydia Wheeler.

Insulin, Epinephrine Discount Rule Clears Review: A rule tying health center federal grant money to patient discounts for insulin and epinephrine could be published at any time, after the White House concluded its review last week. A sign-off by the Office of Management and Budget is the final step before the rule is published in the Federal Register. The final rule is a result of an executive order President Donald Trump signed earlier this year on access to affordable life-saving medicines. Read more from Jacquie Lee.

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With assistance from Alex Ruoff and Danielle Parnass

To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Zachary Sherwood at zsherwood@bgov.com; Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com

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