The Congressional legislative agenda is jam packed with legislation that must pass before September 30th. This includes reauthorizing pandemic preparedness legislation, addressing Medicaid Disproportionate Hospital Payments (DSH) payment cuts, and reauthorizing funding for community health centers and other programs. Committees in both the House and Senate have also introduced bills with unfavorable provisions, like site-neutral payments and 340B payment reforms. All while the looming deadline for critical health care funding is swiftly approaching, Congress has reached deadlock and they will only have 11 legislative days to advance all the must-pass legislation. Keep reading to get the latest update on the Hill.

Problematic Congressional Health Care Legislation Under Consideration
A series of House and Senate bills are being considered that could negatively impact providers and cut payments for services.

  • HELP committee: Primary Care and Health Workforce Expansion Act:
    • Prohibits hospitals from charging facility fees in the commercial market for all services in off-campus Hospital Outpatient Departments (HOPDs) and many services in on-campus HOPDs. Additionally, it would limit providers from changing more than the Qualifying Payment Amount (QPA) for items and services provided in an office setting.
  • House Ways & Means: Healthcare Price Transparency Act:
    • Cut Medicare payments for drug administration services at off-campus HOPDs.
  • House Education & Workforce: Transparency in Billing Act:
    • Require off-campus HOPDs to be assigned a separate health identifier and include it on all claims for services billed to commercial group health plans.
  • House Energy and Commerce: PATIENT Act of 2023:
    • Cut Medicare payments for drug administration services at off-campus HOPDs, require off-campus HOPDs to be assigned a separate health identifier and codify the Hospital Price Transparency Rule.

Critical Legislation
Without Hill action, many critical health care provisions and funding streams are set to expire by September 30th, including:

  • Fiscal Year (FY) 2024 government funding – including appropriations for programs under the HHS.
  • The delay in cuts to Medicaid Disproportionate Share Hospital (DSH) payments, which would go in effect on October 1st without Congressional action.
  • PAHPA.
  • Authorization and funding for Community Health Centers (CHCs).
  • Primary care and healthcare workforce programs – including Graduate Medical Education (GME) programs.
  • The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.

The PAHPA Tension is Palpable
Several bills have been filed (S. 2333), (H.R. 4421), (H.R. 4420), to reauthorize PAHPA. PAHPA seeks to advance national security by funding public health and medical preparedness programs. Despite the need to reauthorize this legislation, legislators disagree on the best approach. HELP committee chairman, Bernie Sanders, added provisions, including one requiring drug manufacturers to notify the FDA in advance of drug and device shortages. House Republicans moved to slash funding for the program and disagree that PAHPA is the right vehicle for drug shortage provisions. There is no word yet on the timing of floor consideration for the House bills before cross-chamber consideration.