June 14, 2021
This Week in Health Policy for June 14
This Week (June 14 - 18)
The Senate will convene on Monday, June 14 to resume consideration of the nomination of Ketanji Brown Jackson to be U.S. Circuit Judge for the District of Columbia Circuit.
The House returns from a recess to consider, among other measures, a package of disclosure bills intended to improve corporate governance, including new disclosures related to environment & sustainability (ESG), corporate political contributions and country-by-country tax reporting.
Last Week (June 7 - 11)
Health Care Highlights
Becerra says COVID-19 Provider Relief Fund will be revamped. During an appearance on Tuesday (June 8) at the House Ways & Means Committee to discuss the president's FY22 budget proposal, HHS Secretary Xavier Becerra told lawmakers that his agency will soon release guidance on what health-care providers can do with unspent stimulus funds received through the Provider Relief Fund. "We want to make sure everybody keeps the deadlines as best as possible; we understand the need to have some flexibility," Becerra said, in questions with Rep. Ron Kind (D-WI). "So soon, this month, we will be coming out with some guidance to help people make sure that they can apply for and make good use of their monies." Becerra declined, however, to say whether the department will extend the June 30 deadline for providers to spend stimulus money received through the PRF. Becerra also suggested HHS will change how the remaining $24 billion in the PRF's relief funds will be distributed compared with the $150 billion already disbursed in the last year, saying, "We're trying to make sure we don't make the mistakes of the past."
In another exchange with Rep. Danny Davis (D-IL), Becerra said, "With the Provider Relief Fund, you would hope when any dollar is dispensed, it's because that institution, that provider has proven that it deserves to get some support from the taxpayers. We're taking a close look at the provider relief fund with the monies that still remain. We want to make sure that we're transparent in how we do this, and we want to make sure that those providers that seek funding will be accountable for any dollars they receive." Hospital groups in May asked HHS to extend the June 30 deadline and to distribute the PRF's remaining monies. Long-term care groups have complained they didn't get their fair share of the relief, Bloomberg reported. Under the Trump administration, one tranche of relief funds ($46 billion) was dedicated to providers that billed Medicare; a separate wave of $24.5 billion went to providers who reported financial losses; and $6 billion went to Medicaid providers.
HHS releases new reporting requirements for Provider Relief Fund. Following Becerra's testimony earlier in the week, on Friday (June 11), HHS released a "Post-Payment Notice of Reporting Requirements" (attached with this alert) outlining the reporting process for using PRF distributions, which supersedes previous guidance. Key updates include:
Becerra says HHS needs some legislative authority to continue covering telehealth. Also at the House Ways & Means hearing, Ranking Member Kevin Brady (TX) suggested President Biden's fiscal 2022 budget ignores a need to continue telehealth coverage after the COVID-19 public health emergency. "I hope we can work together on issues like the underserved, the poor, the rural, as well as ensuring that telehealth, which was one of the saving graces in COVID, can become permanent access and flexibility to connect our patients with their healthcare providers," Brady said. "The possibility that telehealth benefits may soon be stripped from those who relied on it to get through the COVID pandemic is another problem ignored in the Biden budget." Becerra said he does not intend to go backward on such coverage, although the department could use some help from Congress. "We look forward to working with you because some of that authority will have to come through statute. Some of that we could probably do through administrative regulation," Becerra told Rep. Mike Thompson (D-CA). "But what we do know is we can't go back to the old way of doing business. We have to take advantage of telehealth," Becerra said. The secretary also emphasized the need for broadband across the country, as well as the importance of accountability for telehealth services in Medicare and Medicaid and the need for such coverage to provided equitably.
New COVID mandatory workplace safety rules are limited to health-care employers. Under new emergency workplace rules released on Thursday (June 10) by the Labor Department, health care employers will be required to provide masks, physical barriers, social distancing and proper ventilation to ensure their employees are protected from COVID-19. The new mandatory safety rules will only apply to health care settings, which DOL estimates will cover 10.3 million workers, while all other businesses will have to follow optional safety guidelines from OSHA for their workforces. "The science tells us that health care workers, particularly those who come into regular contact with the virus, are the most at risk at this point in the pandemic. So following an extensive review of the science data, OSHA determined that a health care-specific safety requirement will make the biggest impact," Labor Secretary Marty Walsh said during a press call Thursday, Politico reported. Specifically, among other rules, the new standards mandate that health care employers provide respirators to employees working with COVID patients, establish a COVID response plan, screen employees and patients for the virus, record employee cases and provide training on COVID risks at work. Employers will not have to provide masks, social distancing or barriers to fully vaccinated workers "where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present," according to the rules. DOL said the rules will apply to "hospitals, nursing homes and assisted living facilities," and will include emergency responders and home health care workers. Analysts said the narrow scope of the long-awaited rules represented a loss for unions.
HHS poised to rescind Trump-era rule on insulin and epinephrine. HHS and the Office of Management and Budget moved ahead with plans to rescind a Trump administration rule that would have required certain 340B community health centers to give all their insulin and epinephrine discounts to patients or lose federal grants. A notice on retraction of the rule was approved on Monday (June 7) for publication in the Federal Register. HHS under President Biden had delayed the effective date of the rule, originally set for January, until July 20 to give agency officials more opportunity to review it. Trump administration HHS officials had argued that the insulin rule would benefit patients who struggle to pay for expensive medicines, but the health centers contended that they already pass on those savings and the rule was only an administrative burden. Earlier this year, the National Association of Health Care Centers said the rule would "adversely impact Community Health Centers" and make it harder for low-income patients to afford the medications, Fox Business reported.
HHS preparedness nominee testifies at Senate HELP. At a hearing of the Senate Health, Education, Labor & Pensions (HELP) Committee on Tuesday (June 8), the Biden administration's nominee for HHS Assistant Secretary for Preparedness and Response (ASPR) said her top priority is to "be ready for the next public health emergency." Dawn O'Connell said that if confirmed, her main three goals will be to deliver the U.S. "quickly out of the current pandemic," "restore and maintain the public health emergency capacity that has been severely strained by the pandemic," and prepare for the next crisis, Politico reported. As part of that, O'Connell said she expects to spend time and resources on the Strategic National Stockpile, including diversifying the medical supplies in warehouses and securing a domestic manufacturing base for them. "ASPR should have been one of the first slots filled by this administration," said Ranking Member Richard Burr (R-NC), adding he wished "this hearing had been held months ago." Burr said he wanted O'Connell to work with the committee to "see what mistakes were made and how to learn from them, to make it more clear that the ASPR is in charge, that you have the tools you need, and that when the next pandemic comes … that ASPR is ready to stand up and take the lead." Miriam Delphin-Rittmon, the nominee for HHS Assistant Secretary for Mental Health and Substance Use, also testified, saying she intended to address the regression in opioid use that occurred during the Covid-19 pandemic. More than 87,000 people died from drug overdoses in the 12 months ending September 2020, the most of any year on record, according to data from the Centers for Disease Control and Prevention. Many of the overdoses were related to powerful synthetic opioids. Testimony from the hearing is posted here.
Blum returns to CMS as deputy administrator. Jonathan Blum, who previously served in the Obama administration's Centers for Medicare & Medicaid Services as principal deputy administrator, has rejoined CMS in the same position, it was reported on June 8. During his first stint at CMS, Blum oversaw the release of Medicare physician payment data and the development of value-based payment strategies. A former staff member at the Senate Finance Committee under former Chairman Max Baucus (D-MT), Blum served as an executive vice president at CareFirst BlueCross BlueShield after leaving the Obama administration, as well as a principal at the consulting firm Health Management Associates. "A tireless public servant and health policy expert, [Blum] brings invaluable experience to CMS as we navigate the COVID-19 pandemic, serve the individuals that rely on CMS for health coverage, and work to advance health equity," CMS Administrator Chiquita Brooks-LaSure said in a statement.
Richardson named chief of staff to Brooks-LaSure at CMS. The Biden administration has chosen Erin Richardson, a lobbyist at the Federation of American Hospitals, as chief of staff to CMS Administrator Chiquita Brooks-LaSure, Politico reported on Tuesday (June 8), citing sources. Richardson previously worked at former President Obama's White House Domestic Policy Council, as well as the House Ways and Means Committee, like Brooks-LaSure herself. The Biden administration has not yet offered nominees to head up the Medicare, Medicaid and private insurance offices.
Reports & Studies
New HHS data shows record number of Americans with ACA health coverage. On Saturday (June 5), HHS released a report showing that a record 31 million Americans have health coverage through the Affordable Care Act. The report also showed reductions in uninsured rates in every state since the ACA's coverage expansions took effect, and that the numbers of people served by the health Marketplaces and Medicaid expansion have reached record highs. 11.3 million people had enrolled in ACA exchange plans as of February 2021, while 14.8 million newly eligible people had enrolled in Medicaid through the ACA's expansion of eligibility as of December 2020. The report also found that between 2010 and 2016, the overall number of non-elderly uninsured adults in the U.S. decreased by 41 percent, falling from 48.2 million to 28.2 million. California, Kentucky, New York, Oregon, Rhode Island, Washington, and West Virginia have reduced their uninsured rate by at least half from 2013 to 2019 through enrollment in Marketplace coverage and expansion of Medicaid to adult populations. HHS Secretary Xavier Becerra said via Twitter, "The historic numbers released today speak to the success of the Affordable Care Act and our country's need for quality, affordable health care. The President's American Rescue Plan was a leap forward, and we at HHS will continue to advance the fight for health security."