Biden proposes sweeping mental health changes

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Jul 25, 2023 View in browser   By Ben Leonard and Daniel Payne Presented by Driving the Day Neera Tanden, White House domestic policy adviser, says that more Americans need access to mental health care. | AP Photo/Andrew Harnik BIDEN ACTS ON MENTAL HEALTH PARITY — The Biden administration is proposing to boost a 2008 law that established so-called mental health parity by establishing more stringent requirements for health plans. It’s a significant expansion of health insurers’ responsibilities under the law. The proposed rule, announced Tuesday, would: — Mandate that insurers analyze the outcomes of their coverage to ensure there's equivalent access to mental health care, including provider networks, prior authorization rates and payment for out-of-network providers, and take action to get in compliance — Establish when health plans can’t use prior authorization or other tactics to make it more difficult to access mental health and substance use treatment — Require additional insurers to comply with the 2008 law Pointing to rising rates of mental health issues and suicide, White House domestic policy adviser Neera Tanden said in a press call that not enough Americans are able to access mental health care. She added that insurers make it harder to access mental health care in-network, forcing patients to pay out of pocket. “This rule will stop the industry evasion that has led millions of people to pay for care even when they have insurance,” Tanden said. The teeth: A senior administration official granted anonymity to speak about the plans said that fines could be in store for violators. “[This] is saying to insurance companies that you need to be working to build networks for mental health services that are adequate,” the official said. The official added that the action means insurers couldn’t have so-called “ghost networks” that have many providers on paper but few that treat patients. If insurers’ out-of-network reimbursement looks significantly different for mental health than it does for physical health, the payers would need to make payment changes, the official said. What’s next: The administration will take comments from the public for 60 days. WELCOME TO TUESDAY PULSE. Do you have thoughts on the new proposed rule? Send me your takes, tips and scoops at bleonard@politico.com, and reach our usual host, Daniel, at dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, your host Ben talks with Alice Miranda Ollstein, who explains how the culture wars are more prominently featuring into this year’s appropriations process as Republicans are riding on must-pass appropriations bills to advance an agenda on health issues — and preparing for spending fights over abortion, trans care and more. Listen to today’s Pulse Check podcast   A message from PhRMA: Research and development of cancer medicines after their initial FDA approval can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. Read the new report.   In Congress Legislators will race this week to complete unfinished business before their August recess. | Patrick Semansky/Associated Press HEALTH POLICY IN FOCUS — Today kicks off what will be a jam-packed week in health policy as lawmakers rush to tackle a number of issues before their August recess. Even more hearings and markups are likely to be scheduled before the recess, which begins at the end of this week and runs through early September. It starts with House floor votes scheduled on legislation that would sanction Chinese lawmakers who fail to combat foreign opioid traffickers and a bill that aims to make the organ donation and distribution process more efficient. Then, Wednesday, the House Foreign Affairs Committee will mark up legislation that would provide global aid to fight tuberculosis, and the House Rules Committee is scheduled to meet on the FDA spending bill. The Senate Finance Committee will also mark up legislation aimed at reining in pharmacy benefit managers, which run drug benefit programs for health insurers. What won’t happen on Wednesday: Senate HELP Committee Chair Bernie Sanders (I-Vt.) is delaying a scheduled markup Wednesday on primary care legislation, saying committee members intend to have a “major piece of bipartisan legislation ready by the first week of September.” The bill had run into criticism from Republicans, who argued the authorized funding was too high. Sen. Bill Cassidy (R-La.), ranking member of the Health, Education, Labor and Pensions Committee, called for the markup to continue this week. Thursday will be a hearings bonanza before lawmakers head out of town: — The Senate Appropriations Committee will mark up its version of the Labor-HHS spending bill. — DEA Administrator Anne Milgram will testify before a House Judiciary subcommittee. — Rahul Gupta, director of the Office of National Drug Control Policy, will testify before the House Oversight Committee. — A House judiciary subcommittee will hold a hearing on gender-affirming care. — The Joint Economic Committee will hone in on the economic impacts of diabetes. — The House Oversight Committee’s select subcommittee on the pandemic will hold a hearing on vaccine mandates   A message from PhRMA:   NDAA LATEST — Senate leaders are looking to avoid controversial issues like abortion in a bid to pass its defense policy bill before summer recess, POLITICO’s Connor O’Brien reports. Democratic leaders hope to keep together a bipartisan consensus that’s kept the sprawling legislation on track after the House passed its version filled with conservative priorities. Senate Majority Leader Chuck Schumer wants to avoid measures related to the Pentagon’s policy to provide leave and travel reimbursement for troops who cross state lines to seek abortions and restrictions on transgender medical care. The issue has held up military promotions due to Sen. Tommy Tuberville’s (R-Ala.) blockade over the policy. Schumer has offered an abortion vote as an olive branch, but Tuberville has said that’s insufficient. Adding abortion language — either through a GOP effort to restrict the policy or Democratic counterproposals to codify it — would make it nearly impossible for the Pentagon policy bill to achieve the votes needed to clear the Senate. Sen. Roger Wicker of Mississippi, the top Republican on the Armed Services Committee, predicted that the abortion policy debate won’t happen as part of the defense bill.   JOIN 7/26 FOR A TALK ON THE NEW ENERGY ECONOMY: Join POLITICO's lively discussion, "Powering a Clean Energy Economy," on July 26 to explore the effectiveness of consumer-targeted policies to boost sustainability and create clean energy jobs. How are the Inflation Reduction Act's provisions faring? Which strategies truly sway consumer behavior? Hear from featured speaker, Rep. Debbie Dingell (D-Mich.), among other experts. Don't miss this insightful event — register today and be part of the conversation driving America's clean energy future! REGISTER NOW.     Public Health TB OUTBREAK — The CDC and multiple state health departments are investigating a tuberculosis outbreak that officials suspect is related to contaminated bone and tissue products shipped to hospitals and dental offices in at least seven states, federal and state officials confirmed on Monday. POLITICO’s Alice Miranda Ollstein and Lauren Gardner report that Aziyo Biologics announced a recall earlier this month of its bone matrix products — bone repair products made from human tissue that are typically used in orthopedic and spinal surgeries — after two patients who received transplants became infected and one died. The company said samples from the donor lot tested negative for the bacteria at an independent lab. The CDC said the cases appear to be connected to a single Aziyo product ViBone, a bone-forming material. “We are taking immediate action to safeguard patients by implementing a full product recall as we work with the CDC to investigate this event,” Randy Mills, the company’s president and CEO, said in a press release earlier this month. The company didn’t immediately respond to requests for further comment. CDC officials told POLITICO that at least 36 patients have had surgical or dental procedures using the products, and they’re working with medical providers and state health departments to test and treat patients for tuberculosis, including those who are asymptomatic. CDC officials are also investigating whether any medical providers contracted the disease from patients during surgery or follow-up care over the last few months. The CDC didn’t disclose the number of tuberculosis cases they’ve identified or which states are affected.   A message from PhRMA: A new report showcases the vital role of post-approval R&D in nine critical oncology treatments. This research can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. See how post-approval R&D in cancer is at risk.   Names in the News Yolanda Lawson will become the president of the National Medical Association. She’s the founder of MadeWell OBGYN and an associate attending at Baylor University Medical Center. Mona Miller will step down as CEO of the American Society of Human Genetics in November. David Bixby will return to law firm Lewis Roca’s health care team. He was previously chief legal officer at Banner Health.  What We're Reading STAT explores the impact of hospital gardens. Healthcare Dive reports on a review finding that private equity ownership worsens quality and increases costs. The Wall Street Journal reports on an artificial intelligence startup that claims to have AI writing medical records, but humans still do much of the work.   JOIN 7/27 FOR A TALK ON WOMEN LEADERS IN THE NEW WORKPLACE: In the wake of the pandemic, U.S. lawmakers saw a unique opportunity to address the current childcare system, which has become increasingly unaffordable for millions of Americans, but the initial proposals went nowhere. With the launch of the Congressional Bipartisan Affordable Childcare Caucus in May, there may be a path to make childcare more affordable. Join Women Rule on July 27 to dive into this timely topic and more with featured speakers Rep. Nancy Mace (R-S.C.), Rep. Ro Khanna (D-Calif.) and Reshma Saujani, Founder & CEO of Moms First and Founder of Girls Who Code. REGISTER HERE.       Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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