August 9, 2021
This Week in Health Policy for August 9
This Week (August 9 - 13)
The Senate plans to take up the Democrats' $3.5 trillion, fiscal 2022 budget reconciliation bill next week, following completion of the bipartisan infrastructure package, which could come Monday or Tuesday if there is an agreement to limit debate. A motion to proceed to the bill will be followed by up to 50 hours of debate, culminating in what is likely to be a late-night marathon "vote-a-rama" of amendment votes. It is possible the House could interrupt its August recess to come back to Washington and vote on the Senate-passed budget blueprint. The budget resolution, when passed in identical form by both chambers, unlocks the 51-vote budget reconciliation mechanism, and House and Senate committees will work to flesh out their assigned pieces in September and October.
Last Week (August 2 - 6)
Health Care Highlights
CMS finalizes hospital inpatient payment rule. On Monday (August 2), the Centers for Medicare & Medicaid Services (CMS) issued their FY2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. The final rule includes a 2.5% increase for inpatient stays in 2022 along with a 1.1% increase for long-term care hospitals. In a press release announcing the rule, CMS said that they are "taking action to drive value-based, person-centered care, and promote sustainability and readiness to respond to future public health emergency in our nation's hospitals." In the rule, CMS finalized a proposal to repeal a requirement that would have required hospitals to disclose their median payer-specific negotiated charge with Medicare Advantage (MA) plans, however the agency noted that it remains committed to price transparency efforts. CMS also adopted new quality metrics, including a maternal morbidity structural measure and a measure requiring hospitals to track and report COVID-19 vaccination status for health care personnel. CMS noted in the rule that it will address comments on proposals related to disproportionate share hospital (DSH) payments, organ acquisition costs, and payments to hospitals for direct graduate medical education (GME) and indirect medical education in subsequent regulations. For more information see the associated Fact Sheet, Press Release, and Final Rule.
Finance committee plans bipartisan mental health effort. On Thursday (August 5), Senate Finance Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) launched an effort to develop bipartisan legislation to address barriers to mental health care in the U.S. The senators asked committee members in a letter for input on issues related to the behavioral health workforce, access for underserved communities, enforcement of mental health parity laws, and expanded access to telehealth. "Drafting policies designed to improve access to behavioral health care, enhance care quality, and combat disparities, while controlling costs, is an enormous task that will be balanced with the importance of acting with urgency," the letter states. The Finance leaders asked for members to submit proposals by August 31, 2021.A separate request for public- and private-sector stakeholder input will be announced later this month.
FDA aiming to grant Pfizer shot full approval. The Food and Drug Administration (FDA) said in a statement that it is taking an "all-hands-on-deck approach" to expedite the process of granting full approval to Pfizer's COVID-19 vaccine, and is targeting early September for full approval. Agency spokesperson Abby Capobianco said the FDA is "identifying additional resources such as personnel and technological resources from across the agency and opportunities to reprioritize other activities, in order to complete our review to help combat this pandemic surge." Capobianco noted that the urgency is in part due to some American's hesitance to get the shot until it has full approval, adding that "FDA staff will conduct a thorough review process, while balancing the incredible sense of urgency necessary." Pfizer submitted the application for full approval in early May. Also this week, Moderna indicated it is close to applying for full federal approval of its COVID-19 shot, following the completion of a late-stage study.
CDC issues ban of eviction. On Tuesday (August 3), the Centers for Disease Control and Prevention issued a new ban on evictions in COVID-19 hot spots until October 3, following criticism from the President's own party for allowing the previous eviction moratorium to expire over the weekend. The White House initially argued that the CDC couldn't issue another extension due to legal barriers, with Biden later saying that the new order would at least "give some additional time" for them to get $45 billion in funding to people who are behind on their rent, as inevitable legal challenges play out. CDC Director Dr. Rochelle Walensky pointed to the threat posed by the Delta variant and said: "It is imperative that public health authorities act quickly to mitigate such an increase of evictions, which could increase the likelihood of new spikes in SARS-CoV-2 transmission. Such mass evictions and the attendant public health consequences would be very difficult to reverse."
Hearings and Mark-ups
On Tuesday (August 3), the Senate Health, Education, Labor and Pensions (HELP) Committee advanced four bills out of the committee:
Reports, Studies, and Journals
Congressional Budget Office: Senate Amendment 2137 to H.R. 3684, the Infrastructure Investment and Jobs Act, as Proposed on August 1, 2021. The Congressional Budget Office estimates that over the 2021—2031 period, enacting Senate Amendment 2137 to H.R. 3684 would decrease direct spending by $110 billion, increase revenues by $50 billion, and increase discretionary spending by $415 billion. On net, the legislation would add $256 billion to projected deficits over that period.
Centers for Disease Control and Prevention: Prescription Opioid Use Among Adults With Chronic Pain: United States, 2019. In 2019, 22.1% of U.S. adults with chronic pain used a prescription opioid. Uninsured adults had a lower prevalence of prescription opioid use (12.1%) than adults with private coverage (19.9%), Medicare (28.2%), or Medicaid or other forms of public coverage (28.4%).
National Bureau of Economic Research: "Economic Consequences of Hospital Closures." Researchers examined over 100 rural hospital closures spanning 2005—2017 to quantify the effects on the local economy. They found sharp and persistent reductions in employment, but these localize to health care occupations and are largely driven by areas experiencing complete closures.
Kaiser Family Foundation: "COVID-19 Vaccine Breakthrough Cases: Data from the States." Authors reviewed the websites and other official state sources for all 50 states and D.C. to see which are providing data on COVID-19 breakthrough cases, hospitalizations, and deaths, how regularly, and what those data may tell us.