Health Policy Report – March 18, 2025

Maryland House Advances HB 1243

The Maryland House of Delegates recently voted to advance HB 1243, which creates a limited exception to current law to permit cancer patients to access specialty drugs from community oncology practices. 

During a February hearing on this bill in the House Health and Government Operations Committee, Dr. Kash Firozvi of Maryland Oncology and Hematology (MOH) testified in support of the bill. He described the benefits of medically integrated dispensing, including enhanced communication between patient and provider, improved adherence, reduced drug waste, and lower costs. “Patients deserve the freedom to choose their providers and make decisions that align with their best interests,” Dr. Firozvi said. 

The Network celebrates this win for cancer patients and looks forward to advancing this bill in the Maryland Senate. 

To watch Dr. Firozvi’s testimony, CLICK HERE.

Lawmakers Re-Introduce Legislation to Reform Radiation Oncology Reimbursement

On March 14, Senators Thom Tillis (R-NC) and Gary Peter (D-MI), and Representatives Brian Fitzpatrick (R-PA), Jimmy Panetta (D-CA), John Joyce, MD (R-PA) and Paul Tonko (D-NY) introduced S.1031/H.R. 2110, the Radiation Oncology Case Rate (ROCR) Value-Based Program Act, which would stabilize radiation oncology reimbursement in the Medicare program. Specifically, the bill seeks to realign payment, so Medicare pays for the quality of care, rather than the number of times patients visit cancer clinics.

The legislation builds on the framework of the indefinitely delayed Medicare-proposed Radiation Oncology Alternative Payment Model, maintaining the model’s episode-based payments while eliminating “outsized” cuts and “burdensome” quality requirements.

“Current reimbursement policies reward quantity over quality, making it harder for physicians to provide the tailored, high-quality care cancer patients deserve,” Senator Thom Tillis (R-NC) said in a statement. “This bipartisan bill fixes this by shifting to a fair, bundled payment model that removes incentives for longer treatments, supports innovation and ensures continued access to world-class care.”

Over 80 supporters, including The US Oncology Network, have endorsed the legislation.

To read a statement, CLICK HERE.

To read the legislation, CLICK HERE.  

To read the section-by-section, CLICK HERE.

Physician Pay Fix Excluded from Spending Package, Expected in Reconciliation Bill

On Friday, March 14, Congress advanced a Continuing Resolution (CR) spending package to fund the government and a handful of expiring health programs through September 30, 2025. Despite concerns from providers, the bill did not address the 2.93% cut to physicians’ Medicare reimbursement. 

Members of the GOP Doctors’ Caucus had vowed to use the legislation to overturn this year’s Medicare cut. Representative Greg Murphy (R-NC), Chair of the GOP Doctors Caucus, wrote in a post on X that the House speaker and majority leader had agreed to include a Medicare “doc fix” in the upcoming reconciliation bill.

Chatter has increased on reviving a bipartisan healthcare package that came together late last year. Senator Ron Wyden (D-OR), the top Democrat on the Senate Finance Committee, is attempting to revive talks on the package that would include a temporary physicians payment fix and PBM reform. However, Senate Republican leadership has not committed to anything yet. Meanwhile, Rep. Brett Guthrie (R-KY), Chair of the House Energy and Commerce Committee, has said he would “love” to see a standalone vote on a healthcare package but was unsure about the path forward. The CR does, however, extend telehealth flexibilities for Medicare beneficiaries and providers through the end of September. 

To read more, CLICK HERE and HERE.

To read more about the telehealth flexibilities, CLICK HERE.

Senate Finance Committee Holds Hearing for Dr. Mehmet Oz 

On March 14, the Senate Finance Committee held a nomination hearing to consider Dr. Mehmet Oz to be the Centers for Medicare & Medicaid Services (CMS) Administrator. In his testimony, Dr. Oz outlined the Trump Administration’s “Make America Healthy Again” campaign, expressing his interest in reducing healthcare spending by improving health, incentivizing providers, and reducing waste, fraud, and abuse in federal healthcare programs. He also noted support for using artificial intelligence (AI) to automate some provider functions and to increase pharmacy benefit manager (PBM) transparency.

Republicans expressed their support for Oz, while Democrats highlighted skepticism over his financial ties to health companies, previous criticism of fee-for-service Medicare, and a recent GOP plan to reduce Medicaid spending. 

Ahead of the hearing, Senator Elizabeth Warren (D-MA), a member of the Senate Finance Committee sent a letter to Dr. Oz, urging him to divest from any companies that stand to benefit as a result of his role at CMS and recuse himself from matters involving former employers or clients. In an agreement with the Office of Government Ethics, Oz previously confirmed that he would end investments and resign from advisory roles at several companies within his first 90 days.

Dr. Oz is expected to receive a favorable vote in the Senate Finance Committee and advance to a floor vote in the Republican-controlled Senate.

To read more, CLICK HERE.

Senate HELP Committee Holds Hearing for NIH Nominee Dr. Jay Bhattacharya

The Senate Committee on Health, Education, Labor and Pensions (HELP) voted to advance Dr. Jay Bhattacharya’s nomination as Director of the National Institute of Health (NIH).

During his HELP Committee hearing, Bhattacharya was pressed by several Senators over recent funding cuts to the NIH. Dr. Bhattacharya responded by promising that scientists would have access to the funding they need. Dr. Bhattacharya will now advance to a full Senate vote, where he is expected to secure confirmation.

The HELP Committee also recently held a hearing for Marty Makary, nominee for Commissioner of the Food & Drug Administration (FDA). Makary’s hearing was very similar to Dr. Bhattacharya’s as he too faced scrutiny over his controversial opinions on the COVID-19 lockdowns. When asked about the abrupt cancelation of a meeting between FDA officials to discuss the next influenza vaccine strains or about the layoffs at NIH, Makary quickly distanced himself.

To watch the hearing, CLICK HERE.

To read more about Bhattacharya’s hearing, CLICK HERE.

To read more about Makary’s hearing, CLICK HERE.

HHS Moves to Limit Public Comments on Proposed Rules

The Department of Health and Human Services (HHS) issued a statement rescinding a long-standing

policy where healthcare issue regulations, including policies concerning benefits, grants, and funding, will no longer be subject to public comment. The statement, officially published on March 3, announced the re-alignment of procedures for the issuance of rules and regulations as established under the Administrative Procedures Act (APA).  

Stating that the rulemaking requirements impose extra requirements and do not align with HHS’ operational efficiencies, the department’s notice exempts “matters relating to agency management or personnel or to public property, loans, grants, benefits, or contracts” from comment procedures, unless required by law. This is not anticipated to impact longstanding comments on rulemaking such as the yearly Medicare Physician Fee Schedule, which comes out each summer.

As public commenting periods enable stakeholder feedback concerning health policy to the executive branch, the impact of this policy reversal is uncertain. However, health policy experts note that this policy change likely won’t apply to Medicare, a program that has its own legal requirements.

To read about RFK Jr. rescinding public commentary requirements for HHS rulings, CLICK HERE.

To read the official policy statement, CLICK HERE.

United Healthcare Pledges to Cut 10% of Prior Authorizations

In a notice to providers on March 1, United Healthcare announced that it would cut prior authorization requirements by 10% in 2025.

This comes as AI algorithms used by Optum Home & Community have come under scrutiny. In 2023, two families sued the insurer, alleging the algorithm developed by NaviHealth was used to wrongfully deny post-acute care, resulting in the death of two United Healthcare Medicare Advantage members. An Optum spokesperson said the tool is not used to make coverage decisions but rather a guide to help inform providers, families, and other caregivers about what sort of assistance and care the patient may need.

United Healthcare says that this is part of an effort to modernize the prior authorization process and simplify the healthcare experience for members and healthcare professionals. Back in 2023, the company eliminated 20% of prior authorization requirements and in 2024, introduced a gold card program that allows some providers to skip prior authorization services.

To read the statement, CLICK HERE.

To read more about the release, CLICK HERE.