With help from Dan Goldberg, Sarah Owermohle and Renuka Rayasam.
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— Lawmakers in Montana are frantically negotiating to try and keep Montana’s Medicaid expansion in the final days of its legislative session and bumping up on a crucial deadline today.
— Texas state lawmakers are trying to improve the quality of their nursing homes, which rank as the worst in the nation.
— House Energy and Commerce staff held a briefing with stakeholders on surprise medical bills, a hot-button issue both parties and chambers want to tackle this year.
** A message from Johnson & Johnson: Nurses change lives, and that changes everything. Johnson & Johnson has been a proud advocate of nurse professionals for over 120 years. Their creativity, innovation, and healing touch change patients’ lives – and the world. Visit https://nursing.jnj.com to learn more. **
Good morning, and happy Monday PULSE, where your guest host (email@example.com) feels compelled to admit she’s never seen “Game of Thrones” (but hope all you fans out there enjoyed).
MONTANA GOV. SAYS REPUBLICANS PLAYING ‘RUSSIAN ROULETTE’ WITH HEALTH CARE — Republicans in the Montana Senate on Saturday voted down legislation to continue its Medicaid expansion, setting up a frantic negotiation in the session’s final days. The Montana House easily passed a bill at the end of March that funds the expansion of insurance to 96,000 residents and would add new work requirements to the program.
Gov. Steve Bullock, a Democrat, accused Republicans of playing “Russian roulette with the health care of nearly 10 percent of our population.” The transmittal deadline in Montana is today, which means that if the legislation doesn’t clear the Senate by the end of the day it will take a two-thirds vote to clear the chamber.
HOW WE GOT HERE — Bullock signed a four-year Medicaid expansion into law in 2015. He wanted to keep the program going beyond 2019 but needed a way to pay for the state’s share of the cost. But voters defeated a ballot measure in November that would have raised tobacco taxes to pay for Montana’s expansion. That forced Bullock, a term-limited Democrat, to find common ground with Republicans who control the legislature before the program expires in June.
TEXAS TAKES ON NURSING HOME INDUSTRY — Texas has some of the worst nursing homes in the country. But as Congress starts to look at some industry reforms, state lawmakers in Texas are trying to improve the dismal quality.
Lawmakers have introduced bills that would require written consent before a patient is given antipsychotic medication, which some nursing homes overuse to control residents. They’re also looking at requiring more stringent background checks for employees. The filed legislation in Texas comes on top of previous reforms over the last two sessions. But facilities say that unless Medicaid pays them more, reforms will be hard to institute and nursing homes will close. More for Pros.
On Capitol Hill, the Senate Finance Committee is investigating nursing home safety and oversight, and the panel has held one hearing so far on the topic, where Chairman Chuck Grassley (R-Iowa) warned that “Congress’ work in this area isn’t done.”
E&C STAFF, STAKEHOLDERS MEET ON SURPRISE BILLS — House Energy and Commerce Committee staff is examining surprise medical bills, which hit insured patients. The committee held a bipartisan briefing April 5 with health aides and stakeholders, according to attendees. Participants included the Federation of American Hospitals, the American Medical Association, Families USA and America’s Health Insurance Plans.
Congressional interest is intensifying. Two other panels in the House have expressed interest in tackling the often high-cost bills: Ways and Means, as well as Education and Labor (which held a hearing earlier this month). Meanwhile, the Senate is much further along than the House in crafting a bill, as a bipartisan working group hammers out a revised version of a draft from September. And Senate Health Committee leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) sent options to congressional scorekeepers last month for their analysis, though a Senate aide said they haven’t yet heard back from CBO.
NEW JERSEY GOV. SIGNS AID-IN-DYING BILL — Gov. Phil Murphy (D) approved legislation to let patients with less than six months left to live obtain medication to end their own lives, a seven-years-long quest for the lead sponsor of the bill, our POLITICO New Jersey colleague Sam Sutton reports.
National context: New Jersey is the eighth state to allow aid-in-dying, joining states like California and Vermont. Similar legislation recently fell one vote shy in the Maryland Senate and is being debated in Nevada. In New York, where legislation has stalled for several years, Gov. Andrew Cuomo signaled last week that if the legislature passed an aid-in-dying bill, he’d sign it. More here.
THE NATION’S FIRST PUBLIC OPTION — This could be the week that Washington becomes the first state in the union to approve a public option, a progressive goal that has eluded many other Democratic-controlled legislatures. The bill, WA SB 5526 (19R) , currently is sitting with the state Senate, which already backed the concept but must concur with an updated version of the legislation that passed the House. The legislation has until Wednesday to pass.
Medicare Advantage provider to pay $30M to settle upcoding allegations, DOJ announces. California-based Sutter Health and several affiliated entities agreed Friday to resolve accusations that they submitted inaccurate information about their beneficiaries’ health, which reportedly resulted in plans and providers being overpaid.
Of note: Sutter officials said the settlement reflects the company’s decision to resolve the dispute. Neither Sutter nor its affiliated medical foundations admit to any liability, POLITICO’s Victoria Colliver reports. The Department of Justice concurred that there wasn’t a determination of liability in the case.
WHAT REBATE RULE? CONGRESSIONAL ADVISERS RECOMMEND BOOSTING THEM IN MEDICAID — The Medicaid and CHIP Payment and Access Commission recommended last week that Congress lower costs by eliminating Medicaid’s rebate cap, even as the administration is seeking to remove the pass-throughs from the system entirely. Medicaid rebates are currently capped at 100 percent of a drug’s average manufacturer price and usually come in handy when a medicine’s list price sharply rises — in the fourth quarter of 2015, 18.5 percent of drugs hit the cap.
…The congressional advisory panel estimated that removing the limit entirely could save the federal government $15 billion to $20 billion over 10 years. But they also noted that manufacturers could raise launch prices for new drugs or shift the expected costs to other parts of the system like commercial plans — contributing to the high list prices the White House is looking to tamp down on with its rebate rule.
ICYMI: WHITE HOUSE MOVES TO TIGHTEN CONTROLS ON REGULATORS — The White House said Thursday that agencies must submit non-binding guidance documents to its budget office for review, a significant move to curb what industry and many Republicans see as backdoor rulemaking, reports POLITICO’s Victoria Guida. The memo from acting OMB director Russell Vought could have a sweeping impact on FDA, which has already issued 50 guidance documents this year including the signature plan from former Commissioner Scott Gottlieb to restrict flavored e-cigarette sales — a guidance that relies on manufacturers and retailers to self-regulate. Read more here.
Nobel prize-winning neuroscientist dies over the weekend. Paul Greengard, 93, helped unlocked new information into how brain cells relay information, providing key insights into Parkinson’s disease, schizophrenia, bipolar disorder and drug addiction. He, along with two other researchers, won a Nobel Prize in 2000, The New York Times reports.
President Trump’s renewed calls to gut Obamacare are facing a harsh political reality: the health care law has become increasingly popular over time, Paige Winfield Cunningham writes in The Washington Post.
Stanford is investigating a professor over interactions with the scientist who received backlash for helping make the world’s first genetically edited babies, reports Pam Belluck of The New York Times.
Also in The New York Times, Jennifer Steinhauer reports on the effort to stem the estimated 20 suicide deaths every day among veterans.
Treatment centers and medical staff trying to curb the Ebola epidemic are coming under attack, Julia Steers and Gabriele Steinhauser write in The Wall Street Journal.
Shareholders approved the $74 billion Bristol-Myers Squibb and Celgene merger. Damian Garde and Adam Feuerstein report on the road ahead in Stat.
** A message from Johnson & Johnson: Nurses change lives, and that changes everything. Johnson & Johnson has been a proud advocate of nurse professionals for over 120 years. Every day, their creativity, innovation, and healing touch change patients’ lives – and the world. Nurses are the backbone of our healthcare system, and our critical partners on the front lines of care. Throughout history, we’ve seen how nurse-led innovation in patient care has profoundly changed human health and believe supporting and recognizing nurses as leaders and innovators is one of the most effective ways of empowering them as critical change-makers. Today, Johnson & Johnson is working to elevate the visibility and impact of nursing innovation that is changing the trajectory of health for humanity. Visit https://nursing.jnj.com to learn more. Nurses change lives. And that changes everything. **