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Eli Greenspan is Manager of Government Relations, ML Strategies, in the firm’s Washington, DC office. Prior to joining ML Strategies, Eli was a legislative correspondent for US Senator Martin Heinrich (D-NM), where his experience included health care, education, child welfare, social security, food assistance, and poverty issues specifically as they relate to the Affordable Care Act, Medicare, and Social Security.

Congress is in session this week with six important health care hearings, including hearings on Medicare fraud, mental health, and Stark reform. Meanwhile, the Administration continues to put forth new proposed rules and guidance that will impact many stakeholders between now and the end of the year. We cover this and more in this week’s health care preview, which you can find by clicking here.

This week, Congress returns from recess to another four-week work period. The dynamics of the next four weeks might be in flux now that President Trump has nominated Brett Kavanaugh to the U.S. Supreme Court. Other issues to monitor include the suspension of risk adjustment payments and the fall out from the Kentucky Medicaid waiver ruling. We cover all this and more in this week’s preview, which you can find here. 

This week, focus turns to the Senate as the House overwhelmingly passed its opioid package known as H.R. 6 last week (see our previous coverage here). The Senate will look to combine its various proposals into one package for floor consideration and what passes will provide a timeline for reconciling the House and Senate packages. In other news, the Senate will spend time in the HELP and Finance Committee on drug pricing. With Secretary Azar set to testify, we look for signals that the Administration is moving forward with any aspect of its drug pricing blueprint. We cover this and more in this week’s preview, which you can find here.

Welcome to the third week of this four week stretch. This week, the House will continue to vote on a number of proposals to address the opioid crisis. Last week the House passed over 30 bills on opioids, most of which were non-controversial and reached bipartisan support. However, the bills considered this week are expected to have spending tied to them and could therefore be more controversial.  We cover this and more in this week’s health care preview, which you can find here.

This week the Senate Finance Committee will mark up its opioid package. Additionally, the HELP Committee will hear from Secretary Azar on the Administration’s effort to lower prescription drug prices. For our complete review and what else to watch for this week, click here.

In a previous blog, we reviewed pending and approved 1115 waivers in 11 states. These reviews provide an overview of 1115 waiver applications, including a focus on work requirements, lock-outs, changes in coverage structures, repealing the Medicaid IMD exclusion, and other behavioral health initiatives.  As we continue to monitor these applications, we’ve created a new site to track 115 waivers and will be continuing to update this site with additional state waiver requests and approvals.

On April 30, 2018, Ohio became the latest state to submit an 1115 waiver to include work requirements for certain Medicaid beneficiaries. The waiver application requires individuals in the Group VIII category – those with income level of 0-138% of the federal poverty level (FPL) – to meet the Work and Community Engagement requirement to maintain their Medicaid eligibility. These requirements will closely mirror existing SNAP and Able-Bodied Adults without Dependents (ABAWD) requirements. There are at least fifteen exemptions to the work requirements outlined in the 1115 waiver request.

If the individual is not exempt, they will need to work or participate in a community engagement activity for a minimum of 20 hours per week, or 80 hours averaged monthly. These activities include education and training activities, job search or readiness programs, or the Work Experience Program, which supports beneficiaries in meeting work activity requirements through private or government entities.

Lastly, Ohio is requesting a federal match for supportive services such as transportation to help eligible beneficiaries in meeting the work and community engagement goals. If there is no federal match, the State would consider granting beneficiaries a good cause exemption. To date, Ohio is the only state with a submitted 1115 waiver including work requirements that is pursuing federal match for supportive services to help beneficiaries meet the work requirement.

A complete summary of the Ohio 1115 waiver application is found here.

You can view our complete waiver summary and links to state-by-state summaries by clicking here.

This week, the House is set to vote on Right to Try legislation which has gained the support of FDA Commissioner Scott Gottlieb. In the Senate, the HELP Committee will review the Pandemic and All-Hazards Preparedness and Advancing Innovation Act, or PAHPA, along with rural health care issues, which the Senate Finance Committee also happens to be looking at this week. On the Administration’s side, several agencies took steps forward consistent with the President’s agenda on drug pricing. How this plays out over the next several months will be relevant to all stakeholders in this space. We cover this and more in this week’s preview, which can be found here.

This week, the House Energy & Commerce Committee will hold its second round markup of opioid-related legislation. While they remain on pace for passage by Memorial Day, the timing will be determined by how smooth the markup this week goes. Additionally, Ways & Means is also considering a markup of four large packages of opioid legislation. Anything the House passes will have to go to the Senate. In other words, the June work period seems more likely for significant action in this space.

Additionally, the Administration is moving ahead with its drug pricing initiative. While the initial reaction was skepticism, the Administration would not have put the initiative in writing if they didn’t mean it. As the key players continue discussing the various proposals, understanding where the Administration has the authority to act and how it could impact what you do is key to staying ahead of any proposals that gain traction. We cover this and more in this week’s health care preview, which you can find here.

On Tuesday, May 8th, the House held three hearings related to combating the opioid epidemic. The first hearing came out of the Energy and Commerce (E&C) Subcommittee on Oversight and Investigations, which examined opioid distribution and diversion by the pharmaceutical industry. The second hearing came out of the E&C Subcommittee on Health, which examined the current statutory restrictiveness on the medical profession’s ability to coordinate substance use disorder (SUD) treatment due to prohibitions on certain patient information disclosure. The third hearing came out of the House Judiciary Committee and examined best practices in international and domestic enforcement on drug traffickers in curbing the supply of opioids across the U.S. Continue Reading Congress Holds Hearings and Proposes Legislation to Combat Vexing Opioid Crisis