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October 06, 2023

Three U.S. House Committees Reach Consensus on Hospital and PBM Legislation

In early September 2023, the House Energy and Commerce, Ways and Means, and Education and the Workforce Committees announced a bipartisan agreement on a healthcare transparency legislation package. This bipartisan legislation was approved several months ago, suggesting that the full House may soon pass it, possibly within this month. The bill, which has garnered support from Republicans, also carries the endorsement of the leading Democrat on the Energy & Commerce Committee and incorporates several provisions proposed by other Democrats. Key components of the legislation include:

  1. Banning Medicaid Managed Care Organizations from spread pricing Introducing Medicaid spread pricing rules that could significantly impact specific clinics.
  2. Equalizing payments for physician-administered pharmaceuticals at off-campus outpatient departments, potentially resulting in a nationwide reduction in hospital payments by an estimated $20 million to $30 million annually.
  3. Postponing Medicaid Disproportionate Share Hospital  cuts until the end of 2025, yielding a cost savings of $16 billion for hospitals over a two-year period (unless Congress intervenes, DSH cuts will take effect on November 18, 2023).
  4. Implementing various enhancements to price transparency requirements, including doubling penalties, with potential fines of up to $10 million.

The Senate has not yet adopted a stance on these provisions. For a detailed breakdown of the bill, access: