Congress has a full agenda in lame-duck session
The 116th Congress still has two months to tackle some pressing problems facing the nation and the industry, most notably, the continued surge in COVID-19 cases. Though lawmakers failed to pass another major stimulus package after months of negotiations before the election, talks are likely to resume.
Senate Majority Leader Mitch McConnell (R-Ky.) said he wants to get another stimulus bill passed before the end of the year. But House Speaker Nancy Pelosi (D-Calif.) on Nov. 6 said she’s not willing to accept a more scaled-back COVID-19 stimulus package like the one McConnell has failed to pass twice.
“It doesn’t appeal to me at all,” Pelosi said.
Congress is also facing down a deadline to fund the federal government on Dec. 11. Both Pelosi and McConnell have said they want to pass new appropriations bills instead of doing a shortterm extension of current spending authority. Funding for several Medicare and Medicaid programs, including delays to disproportionate-share hospital payment cuts, expires the same day.
Proponents of banning surprise medical bills have viewed the healthcare extenders package as a potential vehicle for reform, but it’s unclear whether House committee chairs with jurisdiction over the issue can reconcile their differences and agree on legislation.
A FEDERAL JUDGE last week ordered a UnitedHealth Group subsidiary to revamp how it processes behavioral health claims after the insurer wrongfully denied mental health and substance use disorder treatment coverage to tens of thousands of its members.
Chief Magistrate Judge Joseph Spero wrote that United Behavioral Health manipulated internal guidelines to deny mental health coverage so it could “protect its bottom line.” The company then lied to state regulators and its own executives overseeing the guidelines, and deliberately attempted to mislead the court,
Spero wrote in the Nov. 3 court filing in U.S. District Court in San Francisco.
To remedy the “pervasive and long-standing” Employee Retirement Income Security Act violations and prevent them from happening again, United Behavioral Health, or UBH, must reform its claims processing so that coverage is based on generally accepted standards of care. It must implement a training program for all personnel involved in clinical coverage, under the oversight of a court-appointed independent monitor. The judge also ordered UBH to reprocess the more than 67,000 claims in question.
UnitedHealth Group said in a statement that it has increased coverage through clinician-developed, evidence-based guidelines over the last several years, as it has expanded its provider network and boosted digital platforms. “We are focused on ensuring our members get the quality, compassionate care they need,” the company said.
This case is indicative of a larger problem, the lawyers representing the plaintiffs claim. For-profit insurers have been discriminating against mental health patients for years, largely without government scrutiny, said D. Brian Hufford, who leads Zuckerman Spaeder’s health insurance practice.
Spero’s order stems from a March 2019 ruling in favor of more than 50,000 plaintiffs who claimed that UBH’s coverage decisions were being made based
● on intentionally flawed guidelines.
THE VETERANS Health Administration is developing processes to 3D-print its own medical devices.
The agency struck a deal to purchase 3D printers, software and other printing materials from 3D Systems. The company will also work with the VHA to set up a manufacturing program that complies with regulations from the Food and Drug Administration. The VHA and 3D Systems did not disclose financial details of the agreement in their announcement.
For many health systems across the U.S., 3D-printing capabilities have helped them create face masks, test kit swabs and ways to adapt and repair breathing machines amid COVID-19.
Half of respondents in Modern Healthcare’s May Power Panel survey of top healthcare CEOs cited 3D printing as a technology with significant potential to support their COVID-19 response.
The VHA’s new contract builds on a collaboration it kicked off with 3D Systems in the early days of the pandemic. The VHA used 3D printing to create surgical face masks and address a shortage of personal protective equipment, as well as printing nasopharyngeal swabs used for COVID-19 testing.
When a hospital moves into a manufacturing role in lieu of simply purchasing devices, it adds new responsibilities. They need to follow established guidances, such as those from the FDA, with 3D printing to ensure they’re setting up good quality-control procedures for the devices they create. The VHA will collaborate with 3D Systems on developing quality and regulatory management practices as part of the contract.
The organizations plan to work together to design medical devices and, when needed, take them through FDA clearance. 3D Systems initially will manage regulatory paperwork to file applications with the FDA and set up a quality management process; eventually, they ● will train VHA staff to do those tasks.