State of the Union: Public Policy Panel · State of the Union: Public Policy Panel ... Title

The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.Copyright © 2018 The Sequoia Project. All Rights Reserved.

State of the Union: Public Policy Panel

Moderator: Mark J. Segal, PhD – Principal, Digital Health Policy Advisors

Presenter: Lindsay Austin – Principal, Troutman Sanders Strategies

The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.

Administration Activity: 2018

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This administration . . . [is] not interested in incremental steps. We want to lay down bold new rules of the road, [provide] better value to patients, and make real progress . . . over the next several years

We’re not interested in micromanaging how . . . interoperability and patient usability are achieved. We are . . . setting out simple goals: Patients ought to have control of their records in a useful format, period. When they arrive at a new provider, they should have a way of bringing their records, period. That’s interoperability—the what, not the how.

HHS Secretary Alex Azar, 3/16/2018National Association of Community Health Centers

Focus: Interoperability, Patient Access, APIs, Data Liquidity


• MyHealthEData/Blue Button 2.0

o Launched in March 2018 with White House Office of Innovation and CMS

• Increased focus: HIPAA right of access via open (HL7 FHIR®) APIs

• CMS created role of Chief Health Informatics Officer (CHIO)

• ONC Health IT Advisory Committee: Last met on October 17

• TSP has engaged with CMS and ONC leaders

• CMS Annual Hospital Rule (April proposed/August final): TSP comments

o EHR Incentive Program/Meaningful Use now “Promoting Interoperability Program”

o 2015 ONC certification required in 2019: enhanced interoperability and APIs

o RFI on use Conditions of Participation to encourage interoperability

• CMS Physician Payment Proposed Rule (July): TSP comments

o Aligned with hospital rule: interoperability and patient access, burden reduction

Administration Activity

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• Trusted Exchange Framework & Common Agreement (TEFCA): TSP comments

o ONC released draft TEF January 2018–principles, terms & conditions for framework:

required by 21st Century Cures and highly relevant to TSP and related initiatives

o Draft US Core Data for Interoperability (USCDI)–expanding standard data for exchange

o Extensive stakeholder comments under review by ONC

o Pending: Revised TEF for public comment, funding opportunity announcement for

Recognized Coordinating Entity (RCE), proposed and final Common Agreement

• ONC Proposed Rule on 21st Century Cures Interoperability: TSP will comment

• Received at OMB Sept. 17 and under review

• Information Blocking: “reasonable and necessary exceptions”

• Updates to certification: information blocking, “open APIs without special effort,” real-world testing

• TEFCA: meaning of sign-on

• ONC EHR Reporting Program: TSP Comments Oct. 11

• CMS Proposed Rule on Interoperability and Patient Access

• Received at OMB Sept. 21 and under review

• Expected focus: API-based access to payer data

Administration Activity

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Legislation

• VA Mission Act

• Opioids Package

• FY2019 Appropriations

Activity

• Health Care Innovation Caucus

• Newly formed VA Health IT

subcommittee

115th Congress Activity

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• S. 2372 VA Mission Act signed into law by President Trump on June 6, 2018

o Bill creates a new Veteran Community Care Program giving improved access to healthcare and removes previous restrictions

o Sec 132. Improving Information Sharing with Community Providers: clarifies current law regarding EHR info sharing with non-VA providers

Why should we care about VA Mission

Act?

• Now allows VA to adjust its electronic

data sharing to an “informed opt-out”

option for veteran patients

• No longer requires signed

authorization to share records with

community providers, such as those

using eHealth Exchange

TSP worked with Members and

committees to advise on this language

and continues to act as resource

VA Mission Act

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• H.R. 6 The SUPPORT for Patients and Communities Act, “The Opioids Package”, signed into law

• 600 page package combines over 50 different bills addressing the national opioid crisis

• Non-partisan achievement for this congress and the Administration

• Opioids will be a continued policy focus and expect more legislation to be introduced

• Health IT Related Provisions include:

• Improvements to PDMPs, where providers are required to check a patient’s history before prescribing,

allows states to access and share data more easily, and improves efficiency of PDMPs

• Creates a pilot program to test payments to behavioral health providers adopting certified EHR technology

• Includes “Jessie’s Law” which requires HHS to develop best practices for displaying substance

use disorder treatment information in EHRs

• Advances electronic prescribing of controlled substances and electronic prior authorization under

Medicare Part D

• Requires Comprehensive Opioid Recovery Centers to operate a “secure, confidential, and interoperable” EHR

Opioids Package

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FY2019 LHHS bill signed into law Sept. 28

o Funds agencies including HHS, CDC, CMS, ONC,

FDA, etc.

o Congress provided $60.4M for ONC, which is level

with its FY18 budget but $21M over the President’s

FY19 budget request

o LHHS bill includes key Patient Matching Report

Language, an on-going mission for health IT

stakeholders

TSP advocated for the Patient Matching report language

with industry stakeholders and will continue to support

Why does the Approps process matter?

o Annual funding is critical for agencies to plan, hire, and

manage. Helps agencies perform their “missions”

such as implementing the 21st Century Cures Act and

other programs

Patient Matching Language

“The Committee is aware that one of the most significant

challenges inhibiting the safe and secure electronic exchange

of health information is the lack of a consistent patient data

matching strategy. With the passage of the HITECH Act, a

clear mandate was placed on the Nation’s healthcare

community to adopt electronic health records and health

exchange capability. Although the Committee continues to

carry a prohibition against HHS using funds to promulgate

or adopt any final standard providing for the assignment

of a unique health identifier for an individual until such

activity is authorized, the Committee notes that this limitation

does not prohibit HHS from examining the issues around

patient matching. Accordingly, the Committee encourages the

Secretary, acting through the Office of the National Coordinator

for Health Information Technology and CMS, to provide

technical assistance to private-sector led initiatives in

support of a coordinated national strategy for industry and

the federal government that promote patient safety by

accurately identifying patients to their health information.”

FY2019 Appropriations

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House Health Care Innovation Caucus

o Reps. Mike Kelly (R-PA), Ron Kind (D-WI), Markwayne

Mullin (R-OK), and Ami Bera (D-CA)

o Caucus seeks to advance innovative policies that

improve the quality of care and lower costs for

consumers

TSP presented to Caucus staffers at Ways & Means

Committee roundtable this year with HIMSS

o Caucus issued RFI

TSP responded to RFI in July with a focus the health

technology innovation section

Why should we care about this Caucus?

• Bipartisan forum to inform policymakers focused on

health IT priorities, opportunity to educate. Will host

roundtables and discussions

House Veterans Affairs Committee

o Formed the Subcommittee on Technology

Modernization in July

o Co-chaired by Reps. Jim Banks (R-IN) &

Conor Lamb (D-PA)

o Will oversee VA’s EHR modernization efforts and

other health IT policies impacting veterans

o Held first hearing in September on the role of the

Interagency Program Office in VA EHR

modernization

Why should we care about this subcommittee?

• Opportunity for TSP to advise and educate

policymakers and staff on initiatives with VA and

DOD

115th Congress Activity Cont.

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• Countdown = 12 days

• House of Representatives

• Senate

• Committee Outlook

2018 Midterm Elections – November 6

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• 435 House seats up for reelection

• Current breakdown:

o 235 Republicans

o 193 Democrats

o 7 vacancies (2 D, 5 R)

• Democrats need to net 23 seats for a 218

majority

• Since 1950, sitting President’s party has

averaged a loss of 24 House seats in

midterm elections

• Over 70 new members expected from

resignations, retirements, etc.

• Key retirements and departures;

o Speaker Paul Ryan (R-WI)

o Marsh Blackburn (R-TN) – Vice Chair

E&C Health

o Gene Green (D-TX) – Ranking

Member E&C Health

o Tim Walz (D-MN) – Ranking Member

Veterans’ Affairs

o Diane Black (R-TN), Greg Harper (R-

MS), Beto O’Rourke (R-TX), and Pat

Tiberi (R-OH) – All Health IT

Supporters

U.S. House of Representatives

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• 35 seats up for reelection

o Republicans defending 9 seats

o Democrats defending 26 seats

• Current breakdown:

o 51 Republicans

o 49 Democrats (w/ 2 Independents)

• Competitive Races:

• R: AZ, TN, NV, and possibly TX

• D: ND, FL, IN, MO, MT, and possibly WV

• Departures: Hatch, Corker, Flake, Cochran, Sessions, Franken, McCain

U.S. Senate

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“We gave four good pollsters the same raw data. They had four different results.”

-Nate Cohn, NYT Correspondent on 2016 election

House

o FiveThirtyEight Forecaster: Democrats

have 6 in 7 chance (85.2%) chance of

winning control of the House

o Cook Political Report: 30 seats currently

considered a “toss-up” (1 D and 29 R)

Senate

o FiveThirtyEight Forecaster: Republicans

have 4 in 5 chance (81.3%) keeping

control of the Senate

o Cook Political Report: 9 seats currently

considered a “toss-up” (4 D and 4 R)

1 D rated leans R (ND)

What do the Polls Say?

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Kaiser Family Foundation: Health care is top issue for Democrat/Independent voters, and

immigration and the economy are the main issues for Republican voters. Issues bring voters to the

polls and turnout matters!


• Lame Duck Session, Post Election

o CR Expires Dec 7 (7/12 Approps bills)

o Nominations: Judicial, UN, AG, others

o Tax Package

o Farm Bill

o Immigration/Wall Funding

• 116th Congress

o President’s Budget Request

o FY2020 Appropriations

o Trade Deals

o Politics!

Lame Duck & Beyond…

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Leadership Votes will likely happen in Lame Duck

Committee Assignments likely early 116th

Energy and Commerce Committee – Greg Walden (R-OR)/Frank Pallone (D-NJ)

Subcommittee on Health – Michael Burgess (R-TX)/Gene Green (D-TX) (Eshoo/Pallone)

Ways & Means – Kevin Brady (R-TX)/Richard Neal (D-MA)

Subcommittee on Health – Peter Roskam (R-IL)/Sander Levin (D-MI) (Mike Thompson)

VA Committee – Phil Roe (R-TN)/Tim Walz (D-MN) (Mark Takano)

Subcommittee on Tech Modernization – Jim Banks (R-IN)/Conor Lamb (D-PA)

HELP Committee – Lamar Alexander (R-TN)/Patty Murray

(D-WA)

Finance Committee – Orrin Hatch (R-UT) (Crapo/Grassley)

/Ron Wyden (D-OR)

VA Committee – Johnny Isakson (R-GA)/Jon Tester (D-MT)

Other Committees to watch:

o Appropriations

o Oversight

o Armed Services

o Commerce (privacy)

Congressional Committee Outlook

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Key House Committees Key Senate Committees


Public Policy Panel

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Jamie Ferguson

Kaiser Permanente

Vice President of Health

Information Technology &

Policy

Sam Burch

HIMSS

Senior Director,

Congressional Affairs

Jitin Asnaani

CommonWell Health Alliance

Executive Director

The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.Copyright © 2018 The Sequoia Project. All Rights Reserved.

QUESTIONS?

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Documents

State of the Union: Public Policy Panel · State of the Union: Public Policy Panel ... Title