• capitolbldg.no.cloudsHouse Energy & Commerce Mark Up Medicaid Spending Reform Bill
  • CDC Releases New Opioid Prescribing Guidelines for Chronic Pain



House Energy & Commerce Mark Up Medicaid Spending Reform Bill

Tuesday morning, the House Energy & Commerce Committee held a mark-up to consider H.R. 4725, the Common Sense Savings Act of 2016. The measure is scored to save $25 billion over 10 years and includes a number of targeted reforms to the Medicaid program. The bill would reform would alter how Medicaid eligibility is determined for persons who receive lottery winnings; eliminate enhanced Medicaid payments for prisoners; limit the ability of states to impose Medicaid “provider taxes” aimed solely at increasing Medicaid payments from the federal government; eliminate the CHIP enhanced match rate; and eliminate the Prevention and Public Health Fund that provides the HHS Secretary access to billions of taxpayer dollars for pet projects (often referred to as a “slush fund”).

Several amendments were offered by the minority, most relating to the proposed elimination the Prevention and Public Health Fund. Amendments related to the fund attempted to make the elimination of the fund contingent upon the satisfying of another political-charged requirement (such as HHS certifying that there is no risk of lead poisoning from pipes anywhere in the country or certifying that every state and locality is prepared to track and treat the Zika virus, even in locations where there are no mosquitoes). None of the amendments were approved.

As has been the case in many recent Congressional hearings, the debate was divided by party lines, with Democrats decrying the “draconian” cuts and Republicans expressing great concern for the country’s financial well-being. Many Democrats accused the bill of lacking commonsense and expressed concern that it would harm the most vulnerable within the Medicaid program. The bill was reported favorably from the committee by a roll call vote (28Y, 19N).

CDC Releases New Opioid Prescribing Guidelines for Chronic Pain

Tuesday, the Centers for Disease Control and Prevention (CDC) published prescribing guidelines to address the epidemic of deaths and overdoses attributed to opioid painkillers. The guidelines, which focus on chronic pain except for cancer and end-of-life care, arrive amid increased concern over the growing number of Americans who abuse or misuse the drugs annually. The guidelines are targeted at primary care physicians, in particular, as family doctors write the vast majority of prescriptions for opioids.

The guidelines, which are voluntary, urge primary care clinicians (which include doctors, physician assistants and nurse practitioners) to offer patients alternative treatments for chronic pain, such as non-opioid painkillers like ibuprofen and physical therapy, and to prescribe the lowest effective dosage possible to patients who do need opioid drugs and monitor the patient carefully. The agency also recommends doctors prescribe opioids only after those other therapies have failed. The CDC also recommends limiting opioid prescriptions for patients suffering short-term, acute pain to three days or less in most conditions, and says that more than seven days’ worth of opioid drugs “will rarely be needed.”

The guidelines were more than a year in the making, and the CDC encountered considerable pushback from some patient groups after a preliminary version of the guidelines was leaked last fall. The groups argued that the agency relied on weak evidence to generate its recommendations. They also feared that some patients would be denied needed pain relief, an issue they continue to press. Some groups voiced considerable opposition to the guidelines at a meeting last December of the Interagency Pain Research Coordinating Committee. The recommendations were written by CDC scientists with input from experts and include refinements based on comments from more than 160 organizations and the public.