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Week of July 5-9

Congress is out this week. The next This Week in Health Policy will be on July 16.

Week of June 28-July 2

Health Care Highlights

Democrats begin preparing health care expansion proposals despite lack of consensus. Democratic leaders are moving ahead with proposals to expand health care coverage as part of a future budget reconciliation package despite a lack of consensus on what should be prioritized and slim majorities in both chambers. House Budget Chair John Yarmuth (D-KY), who is readying a budget resolution to provide reconciliation instructions for potential proposals in the coming weeks, said this week that one idea being pushed by House progressives — lowering the age to qualify for Medicare — only "has about 75% support in the caucus." Progressives are also pushing to add dental, vision, and hearing coverage to Medicare, which also has the support of Senate Budget Chairman Bernie Sanders (I-VT) and Senate Majority Leader Chuck Schumer (D-NY).

Separately, House Energy and Commerce Chair Frank Pallone (D-NJ) said this week his committee is crafting a bill aimed at extending "guaranteed coverage" to people in the 12 states that have not decided to expand Medicaid under the Affordable Care Act (ACA). Pallone did not offer details on how that would be achieved, however some Democrats are proposing a new tier of ACA marketplace plans available to people who fall in the so-called "coverage gap," making too much to qualify for Medicaid but too little to qualify for subsidies. Another idea from Rep. Lloyd Doggett (D-TX) would allow counties and other local governments to expand Medicaid in a hyperlocal fashion and President Biden's budget calls for creating a federal public-run health insurance option in holdout states that would offer free coverage modeled after Medicaid benefits.

Such expansion proposals, however, may not pass muster under budget reconciliation rules due to a requirement preventing proposals from increasing the deficit beyond a ten year budget window. The only major health proposal President Biden has officially included in his American Families Plan and budget proposals is the least divisive: making permanent the enhanced subsidies provided through a recent COVID-19 relief package, boosting marketplace subsidies and ensuring no one would pay more than 8.5% of their income for coverage.

Nunes and Guthrie to lead Healthy Future Task Force. On Wednesday (June 30), House Republican Leader Kevin McCarthy announced the formation of the Healthy Future Task Force, led by Ways and Means Health Subcommittee Republican Leader Devin Nunes (R-CA) and Energy and Commerce Health Subcommittee Republican Leader Brett Guthrie (R-KY). "Our goal is to bring together the best ideas that we can implement in order to make health care more affordable, promote innovation for new treatments, and increase health care choices for all Americans. Republicans are united in preventing Democrats' goal of a government takeover of health care, which will lead to fewer cures, less choices, and worse health care," said Nunes and Guthrie. The Task Force plans to "craft legislative proposals that Republicans can advance after retaking the majority."

CMS issues payment parameters rule enhancing ACA. On Monday (June 28), the Biden administration issued the third installment of the 2022 notice of benefit and payment parameters proposed rule, which includes several provisions aimed at rolling back Trump-era flexibilities and enhancing protections under the ACA Among other things, the proposed rule:

• Extends the annual open enrollment period by a month, from November 1 through January 15;
• Creates a new special enrollment period (SEP) for people at or below 150% of the federal poverty level (FPL), aimed at benefiting consumers who lose Medicaid coverage;
• Strengthens requirements for navigator organizations to assist consumers in understanding their coverage opportunities under the ACA and facilitate greater access;
• Reverses Trump-era regulations that allow states to exit their insurance marketplaces and instead rely on private brokers and agents for enrollment, and a rule requiring separate billing for non-Hyde abortion services; and
• Proposes new interpretations for 1332 innovation waiver guardrails around comprehensiveness, affordability, coverage and deficit-neutrality.

Comments are due on July 28. See fact sheet and press release for more information.

Tri-agencies issue first part of surprise billing regulation. On Thursday (July 1) the Departments of Health (HHS), Labor and Treasury, and the Office of Personnel Management, issued "Requirements Related to Surprise Billing; Part I," an interim final rule implementing the first of several requirements in title I (the "No Surprises Act") of division BB of the Consolidated Appropriations Act, 2021. The regulations will take effect for health care providers and facilities January 1, 2022. For group health plans, health insurance issuers, and FEHB Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after January 1, 2022. Among other provisions, the final rule:

• Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.
• Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.
• Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.
• Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

Comments will be due 60 days after it is placed in the Federal Register. See consumer fact sheet, payer fact sheet, and press release for more information.

CMS issues ESRD payment rule making changes to ETC model. On Thursday (July 1), the Biden administration issued their ESRD prospective payment system proposed rule, including modifications to the End-Stage Renal Disease (ESRD) Treatment Choices Model aimed at encouraging dialysis providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic states. According to the press release, this makes the model "the agency's first CMS Innovation Center model to directly address health equity," which has been stated as a priority of the administration and the CMS Administrator Chiquita Brooks-LaSure specifically. Among other items, the rule is seeking comment on plans to modernize its quality measurement enterprise, including clarifying the definition of digital quality measures, standardizing the data required for collection, and developing a common portfolio of measures for potential alignment across payers. Comments are due August 31. See fact sheet and press release for more information.

CMS issues home health rule expanding value-based purchasing. On Monday (June 28), the Biden administration issued their CY 2022 Home Health Prospective Payment System proposed rule, which included a proposal to expand the Home Health Value-Based Purchasing (HHVBP) Model nationwide. The model — currently underway in nine states — aims to determine whether payment incentives for providing better quality of care with greater efficiency would improve the quality and delivery of home health care services to people with Medicare. The rule also proposes to make permanent changes to the home health Conditions of Participation (CoP) that were implemented during the COVID-19 Public Health Emergency (PHE), among other items. Comments are due August 27. See fact sheet and press release for more information.

Daniel Tsai tapped to lead CMCS. Daniel Tsai was tapped this week to lead the Center for Medicaid and CHIP Services (CMCS). Tsai most recently served as Assistant Secretary for MassHealth and Medicaid Director for the Commonwealth of Massachusetts. According to the announcement, "Tsai will lead the Center's efforts in addressing disparities in health equity and serving the needs of children, pregnant people, parents, seniors, and individuals with disabilities who rely on these essential programs."

Reports, Studies, and Journals

Centers for Disease Control and Prevention: Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic - United States, March-April 2021. Among more than 26,000 public health workers, 53% reported symptoms of at least one mental health condition in the past 2 weeks. Symptoms were more prevalent among those who were unable to take time off or worked ≥41 hours per week.

Peterson-KFF Health System Tracker: Ground ambulance rides and potential for surprise billing. This brief describes ambulance use, ownership type, the share of ground ambulance rides with a potential for surprise bills, and state or local policies aimed at reducing surprise bills for ground ambulances.

Bipartisan Policy Center: Positioning America's Public Health System for the Next Pandemic. The COVID-19 pandemic has made clear that the nation's safety, health, and economic prosperity are dependent on a robust public health system. Federal public health agencies and state and local public health departments have long been severely underfunded.

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