March 7, 2022
This Week in Health Policy for March 7
This Week (March 7-11)
This week, House Democrats leave Wednesday for their retreat in Philadelphia. But before House lawmakers leave town, they will need to pass either the FY 2022 omnibus spending package being negotiated among House and Senate appropriators and leadership or pass another continuing resolution to keep the federal government funded as the latest continuing resolution expires Friday, March 11.
Last Week (February 28-March 4)
Health Care Highlights
Health care priorities in Biden's first SOTU. On Tuesday (March 1), President Biden delivered his first State of the Union address and discussed several health care topics. On the coronavirus pandemic, Biden said the nation has "reached a new moment in the fight against COVID-19," touting new guidelines that lift mask recommendations for most Americans. Biden in his speech said that "if Congress provides the funds we need, we'll have new stockpiles of tests, masks, and pills ready "if new coronavirus variants emerge."
Biden said the American Rescue Plan has lowered health care premiums for millions of families who buy coverage on the Affordable Care Act (ACA) exchanges, adding that the provisions enhancing ACA subsidies should be made permanent. He discussed policies to cut the cost of prescription drugs, saying the U.S. should "cap the cost of insulin at $35 a month" and give Medicare the authority to negotiate lower prices for prescription drugs. In addition, Biden committed to improving nursing home quality, including plans to establish a minimum nursing home staff requirement; beating the "opioid epidemic" in part by removing "outdated rules that stop doctors from prescribing treatments," in addition to efforts to improve mental health care and maternal health care. He also touted his effort to renew the Cancer Moonshot initiative and called on Congress to fund ARPA-H, the Advanced Research Projects Agency for Health, "to drive breakthroughs in cancer, Alzheimer's, diabetes and more."
Biden issues new National COVID-19 Preparedness Plan. On Wednesday (March 2), the White House unveiled a 96-page National COVID-19 Preparedness Plan that aims to protect against and treat COVID-19, prepare for new variants, prevent economic and educational shutdowns, and continue global vaccination efforts. As part of that effort, the White House on Thursday (March 3) requested Congress authorize $22.5 billion in additional COVID-19 relief to fund, among other things, vaccines, treatments, and testing, including an additional $1.5 billion to cover coronavirus care, testing, and vaccinations for uninsured people, noting that the Provider Relief Fund and funds from the American Recue Plan are nearly depleted.
CMS Innovation Center redesigns Direct Contracting model. On Thursday (Feb. 24), the Center for Medicare and Medicaid Innovation (CMS Innovation Center) announced a redesign of the Global and Professional Direct Contracting (GPDC) Model and a transition to the re-named ACO Realizing Equity, Access and Community Health (REACH) Model. Interested provider-led organizations can submit applications for the new REACH Model from March 7 to April 22. The CMS Innovation Center also announced it is cancelling the currently paused Geographic Direct Contracting Model effective immediately. The moves follow the CMS Innovation Center's announcement on Tuesday (Feb. 22) to halt the Community Health Access and Rural Transformation (CHART) Model's Accountable Care Organizations Transformation Track and announce a new application round for the Kidney Care Choices Model set to begin January 1, 2023. The announcements collectively reflect the CMS Innovation Center's broader strategy to streamline existing models, transition more beneficiaries to ACO-type models, and enhance their focus on health equity, which includes enhanced beneficiary protections and making it easier for more providers to participate in Innovation Center models.
Biden admin to re-examine arbitration process for surprise bills. In response to a recent federal court ruling, the Biden administration is updating guidance documents related to the portions of the interim final rule that outlines the independent dispute resolution process for out-of-network payment disputes between providers and payers. The federal court on February 23 struck down part of the interim final rule that directed arbiters to prioritize the qualifying payment amount (typically the median in-network rate) for out-of-network payment disputes. The Biden administration is still considering its next legal steps. House Ways and Means Committee Republican Leader Kevin Brady (R-TX) and Chair Richard Neal (D-MA) in a statement praised the ruling for holding up the No Surprises Act "as written." However, insurer groups have criticized the court's ruling, saying it will impact affordability of health care.
CDC updates mask guidance. Last Friday (February 25), the CDC updated its mask guidance and released a new tool that enables residents to calculate the level of COVID transmission in their county. The tool newly includes other factors including hospitalizations and hospital capacity, marking a shift from previous strategies that focused solely on case count. CDC now recommends wearing a mask indoors in public is you live in or visit a high transmission county or if you have symptoms, a positive test, or exposure to someone with COVID-19. Individuals at high risk of COVID-related complications who live in or visit a medium transmission county should discuss masking with their provider. The guidelines do not change masking requirements for other settings, like public transportation and airports, and some hospitals have said they will continue to keep masking policies in place.
CMS issues new guidance on Medicare redetermination. On Thursday (March 3), CMS sent a letter to state health officials giving them 14 months, up from 12 months, to complete the Medicaid redetermination process when the public health emergency ends. When normal Medicaid and eligibility redetermination processes resume, CMS will require states to submit data each month during the 14-month period detailing their progress. CMS required states who received certain enhanced funding to suspend normal redetermination processes during the public health emergency resulting in potentially millions of individuals remaining on Medicaid even if they no longer are eligible. Many state officials have raised concerns about the impact redeterminations will have on the enrollment market.
FTC asks for comment on PBM practices. Last Thursday (February 24), the Federal Trade Commission (FTC) issued a request for information on how pharmacy benefit managers' (PBMs) business practices impact patients, pharmacies, and employers. The RFI comes shortly after the FTC voted not to probe PBMs and the impact of their drug price setting practices.
Lawmakers introduce bill to expand no-cost COVID tests. Last Friday (February 25), House Energy and Commerce Committee Chair Frank Pallone, Jr. (D-NJ) and Education and Labor Committee Chair Robert Scott (D-VA) introduced the No Surprises for COVID-19 Tests Act, which extends free COVID-19 testing made available during the public health emergency until December 31, 2023. Under the bill, insurers would be required to continue covering COVID-19 testing and other related items, such as provider office visits, urgent care, and emergency room visits, with no cost-sharing. The bill also would sunset a CARES Act provision that allowed providers to set their own "cash price" for COVID-19 tests.
Ways and Means Committee Hearing on Substance Use, Suicide Risk, and the American Health System. On Wednesday (March 2), the House Ways and Means Committee held a hearing entitled, "Substance Use, Suicide Risk, and the American Health System." During the hearing, lawmakers expressed concern about the impact of the COVID-19 pandemic on the nation's mental health and substance use. Republicans on the committee used the hearing to express concern with the Southern border control allowing fentanyl into the country and the Biden administration's prolonged shutdown and "social isolation" policies. They discussed policies to address the border and build on bills passed to stem the opioid epidemic, including the SUPPORT Act. Democrats on the committee also discussed ways to build on past legislation and find ways to increase access to care. The witnesses discussed a range of policy solutions, including making permanent certain telehealth flexibilities, such as cross state licensure and audio-only telehealth options, addressing pay parity within the mental health system and fixing reimbursement among substance use providers, removing barriers and addressing the stigma attached to medication assisted treatment for substance use, and more.
House Energy and Commerce Oversight and Investigations Subcommittee Hearing on Lessons from the Frontline: COVID-19's Impact on American Health Care. On Thursday (March 3), the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing entitled, "Lessons from the Frontline: COVID-19's Impact on American Health Care." Democrats and Republicans on the committee, along with provider witnesses, expressed concern about the levels of burnout, exhaustion, and stress impacting the health care workforce in light of the COVID-19 pandemic and the effects for patient care. Several Republicans on the committee discussed the negative ways Covid-19 vaccine mandates have impacted the health care workforce and how elective procedure delays impacted patient care. During the hearing, witnesses discussed a range of policy options to bolster and support the health care workforce, including addressing ongoing supply chain issues, support hospitals' financial viability, particularly in rural areas, address workplace violence in health care, incentivize new and former providers to enter primary care, improve physician reimbursement, support nursing staffing ratios, and more.
Reports, Studies, and Journals
Health Affairs: CMS Innovation Center Launches New Initiative To Advance Health Equity. Dora Hughes, CMO at the Centers for Medicare & Medicaid Services Centers for Medicare and Medicaid Services, outlines four ways the Innovation Center will fold "Advancing Health Equity" into its strategic objectives.
National Bureau of Economic Research: Do Higher-Priced Hospitals Deliver Higher-Quality Care? The study analyzed whether receiving care from higher-priced hospitals leads to lower mortality. It found stays at hospitals with two standard deviations higher prices is associated with a 52% increase in spending and a 1 percentage point lower mortality. "However, the relationship between higher prices and lower mortality is only present at hospitals in less concentrated markets."
National Institutes of Health: Report of the Advisory Committee on Research on Women's Health: Fiscal Years 2019—2020. NIH's Office of Research on Women's Health's biennial report provides an overview of NIH-supported research on women's health. The report finds funding for various women's health research increased between FY 2017 and 2019, including research on vaginal, uterine, and other reproductive cancers and mental health, while others, such as funding for menopause research declined.