May 2, 2022
This Week in Health Policy for May 2
This Week (May 2-6)
Senate Appropriations Committee Subcommittee on Labor, Health and Human Services, Education and Related Agencies will hold a hearing on "FY2023 Health and Human Services budget."
Last Week (April 25-29)
Health Care Highlights
Congress resumes discussions on COVID-19 relief funding while path forward on reconciliation package remains unclear. Congress was back in session this week after a two-week recess and lawmakers resumed discussions on a Senate-negotiated $10 billion COVID-19 relief bill. However, those discussions remain stalled in light of objections from both Republicans and Democrats over the Biden administration's plan to end the use of Title 42, which restricted migrants' U.S. entry amid the pandemic, on May 23. Leaders are contemplating a package that could combine the issues in a legislative package that could also potentially carry additional funding for the war in Ukraine.
Informal discussions on a scaled-down reconciliation package also continued in the background among Congressional Democrats, focusing on the potential consensus areas of: climate change, prescription drug reform, and deficit reduction. On Wednesday (April 27), Rep. Carolyn Bourdeaux (D-Ga.) and Sen. Raphael Warnock (D-Ga.) sent a letter to congressional leadership asking for the reconciliation package to also address the Medicaid expansion gap. However, the status of that — and several other Build Back Better health care provisions are uncertain — as Democratic leaders work to ensure any package has the backing of all 50 Democratic senators. And that may be no easy feat; Sen. Joe Manchin (D-WV) this week said that health care spending provisions such as those extending premium subsidy enhancements for the exchanges would need to be offset by tax increases — a move that Sen. Krysten Sinema (D-AZ) has opposed in the past
CMS finalizes 2023 MA and Part D proposed rule. On Friday (April 29), CMS issued their CY 2023 Medicare Advantage and Part D Final Rule. CMS Administrator Chiquita Brookes-LaSure in a press release said, "This rule improves the health care experience and affordability for millions of people with MA and Part D coverage, including dually eligible individuals, and provides needed support to populations often left behind." This includes a proposal to require Part D plans to apply all price concessions they receive from network pharmacies to the point of sale, so that the beneficiary can also share in the savings. Other proposals would revise the MA and Part D regulations related to marketing and communications, the criteria used to review applications for new or expanded MA and Part D plans, quality ratings for MA and Part D plans, provider network adequacy requirements, medical loss ratio reporting, special requirements during disasters or public emergencies, and regulations for Dual Eligible Special Needs Plans (D-SNPs) aimed at improving the integration of Medicare and Medicaid and reducing health disparities.
HHS issues final exchange rule. On Thursday (April 28), CMS issued the 2023 Notice of Benefits and Payment Parameters Final Rule to update regulations for individual and small group health plans. The rule finalizes CMS's proposals for federal exchange insurers to include standardized plan options for coverage sold on HealthCare.gov; establish new provider network adequacy requirements, including ensuring in-network providers meet wait time standards beginning in the 2024 plan year; and more. Click here for CMS's fact sheet.
FBI puts hospitals on alert over cyber concerns. On Wednesday (April 27), the U.S. Cybersecurity and Infrastructure Security Agency, Federal Bureau of Investigation (FBI), and the National Security Agency, along with cyber officials from Canada, the United Kingdom, Australia, and New Zealand issued a joint advisory on rising cyberattacks. The multinational advisory came one day after FBI Deputy Director Paul Abbate urged U.S. hospitals and providers specifically to work with the FBI on developing formal cyber response plans.
ICYMI: Health Care Highlights While Congress Was on Recess (April 11-22)
CMS issues SNF proposed rule. On Monday, April 11, CMS released a proposed payment rule that would decrease Medicare Part A payments for skilled nursing facilities (SNF) for fiscal year (FY) 2023 by about $320 million compared with FY 2022. The decrease largely stems from a -4.6%, or $1.7 billion, proposed recalibrated parity adjustment, which the agency delayed in the FY 2022 rule. The agency is seeking feedback on establishing minimum, staffing requirements for long-term care facilities. CMS also proposed adding an influenza vaccine coverage measure to the SNF quality reporting program, three new measures for the SNF value-based purchasing (VBP) Program, and requested information on adding a nursing home staff turnover measure to the VBP program.
Becerra extends PHE through July. On Tuesday, April 12, HHS Secretary Xavier Becerra renewed the public health emergency (PHE) through July 15. The Biden administration has committed to giving 60 days' notice before allowing the PHE to expire.
CMS issues IPPS proposed rule. On Monday, April 18, the Centers for Medicare and Medicaid Services (CMS) issued the fiscal year (FY) 2023 proposed rule for the Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospitals (LTCH) Prospective Payment System. The rule proposes to increase FY 2023 acute care hospital operating payments by about 3.2%, compared with FY 2022, however CMS estimates the net impact would be a $0.3 billion decline compared with FY 2022. Throughout the rule, CMS proposes new health equity and maternal health quality measures and issues requests for feedback on ways to better incorporate health equity data into hospital quality programs and understand how hospitals think about social determinants of health and climate change. CMS also proposes to continue suppressing certain hospital measures to account for the COVID-19 pandemic's impact, along with a handful of policies related to the COVID-19 PHE. CMS is accepting public comment until June 17.
CMS unveils strategy to advance health equity. On Wednesday, April 20, CMS unveiled a 9-point plan to advance health equity in the United States. CMS called on health care leaders to voluntarily commit to advancing health equity.
Biden unveils national drug control strategy. On Thursday, April 21, the White House unveiled a national drug control strategy that calls on states to update laws and policies to focus on harm reduction, improved data systems, and reducing the supply of illicit drugs entering the U.S.
HHS issues call-to-action on climate change. On Friday, April 22, HHS invited health care industry stakeholders, including U.S. hospitals and pharmaceutical companies, to voluntarily pledge to reduce greenhouse gas emissions by 50% by 2030 and develop climate resilience plans. HHS said it plans to release additional climate-readiness resources and technical assistance guides in the coming months and pledge forms are due by June 3.
CMS issues Medicare enrollment proposed rule. On Friday, April 22, CMS issued a proposed rule to update Medicare enrollment and eligibility standards. Among other things, the proposed rule would establish five new special enrollment periods for beneficiaries and implement two provisions included in the Consolidated Appropriations Act: ensuring coverage begins as soon as a month of enrolllment and enables eligible kidney transplant recipients to enroll in a Medicare Part B immunosuppressive drug coverage.
The Senate Health, Education, Labor & Pensions Committee hearing on "FDA User Fee Agreements: Advancing Medical Product Regulation and Innovation for the Benefit of Patients, FDA Center Directors." On Tuesday (April 26), the Senate Health, Education, Labor & Pensions (HELP) Committee held a hearing entitled, "FDA User Fee Agreements: Advancing Medical Product Regulation and Innovation for the Benefit of Patients, FDA Center Directors." The hearing was the second of two the committee has held on Food and Drug Administration (FDA) user fee agreements, which authorize the FDA to collect user fees from drug and device manufacturers and requires congressional reauthorization every five years. During the hearing, committee members discussed a range of topics related to the Prescription Drug User Fee Amendments (PDUFA VII), Generic Drug User Fee Amendments (GDUFA III), Biosimilar User Fee Amendments (BsUFA III), and the Medical Device User Fee Amendments (MDUFA V), which would authorize new user fees for their respective industries for fiscal years 2023—2027. Witnesses at the hearing included FDA center directors who answered questions on ways the latest agreements would improve FDA's ability to provide access to safe and effective drugs and medical devices, as well as related topics.
The House Energy and Commerce Committee's Subcommittee on Health hearing on "Communities in Need: Legislation to Support Mental Health and Well-being." During the hearing, lawmakers discussed 19 bipartisan bills that address mental health care in the United States. Lawmakers paid particular attention to bills that addressed pediatric mental health issues, the mental health workforce, and law enforcement response to mental health crises. Committee members heard from two panels: One consisting of representatives from the Biden administration and another panel of experts, including representatives from behavioral health provider groups and state mental health and alcohol and drug use directors. Panelists provided updates on federal agency efforts to address mental health and shared their support for various programs included in the legislation discussed during the hearing. The hearing is one of a series of hearings occurring across committees of jurisdiction on mental health care and marks the next stage in the Subcommittee's effort to advance a comprehensive mental health package.
House Ways and Means Committee and House Energy and Commerce Committee hold separate hearings on the Department of Health and Human Services' FY 2023 Budget. During the hearings, Department of Health and Human Services Secretary Xavier Becerra answered lawmakers' questions on President Biden's recent FY 2023 budget request. Topics discussed during the hearings ranged widely and included mental health, the rise in fentanyl overdose deaths, funding to establish a new climate change office, the COVID-19 pandemic and rolling back Title 42, and more. During the House Energy and Commerce Committee hearing, Becerra expressed his support for Cures 2.0 and authorizing language for the Advanced Research Projects Agency for Health (ARPA-H). Meanwhile, Republicans on the House Ways and Means Committee took aim at the budget request for not adequately addressing rising health care costs and asked whether the administration has a plan to prevent looming Medicare Trust Fund insolvency. Becerra said the administration is focused on reducing costs in Medicare through value-based care and suggested congressional action is needed to improve the Medicare Trust Fund's financial viability.
House Appropriations Committee holds hearing on "Meeting Veterans' Full Needs: Update on Women's Health, Mental Health, Homelessness, and Other Programs." During the hearing, lawmakers heard from representatives from several VA offices on President Biden's FY 2023 budget request for the Department of Veterans Affairs (VA). Topics discussed during the hearing included funding levels for programs aimed at gender-specific care and women's health, mental health and suicide prevention, substance use disorder and treatment, and homelessness, the VA's Whole Health program, and more.
House Committee on Veterans' Affairs (VA) holds hearing on "U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2023." During the hearing, lawmakers heard from two panels, the first featuring VA Secretary Denis McDonough and the second featuring representatives from veterans' advocacy groups. Topics discussed during the hearing included President Biden's FY 2023 budget request for the VA, the VA's response to the COVID-19 pandemic, House-passed legislation to treat veterans exposed to toxins during their service, technology investments to improve care, veteran mental health and suicide prevention programs, and more.
Reports, Studies, and Journals
HHS Office of Inspector General. Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care. The report found 13% of prior authorization requests denied by Medicare Advantage Organizations in 2019 likely would have been approved under traditional Medicare. The report calls on Medicare officials to strengthen oversight of Medicare Advantage plans.
Health Affairs. Trends In Hospital Prices Paid By Private Health Plans Varied Substantially Across The US. The study compared commercial health plan payment rates for hospital care with Medicare rates from 2012 to 2019. The study found while average commercial-to-Medicare price ratios were largely stable during the time period, payment trends varied widely by hospital referral region and aggregate spending could have been $39 billion lower in 2019 if the growth rate for hospital referral region commercial price ratios were tied to the national average.
JAMA. Trends in Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders, 2006—2019. The study found self-reported cigarette smoking fell from 50.7% in 2006 to 37% in 2019 among individuals with a major depressive episode and substance use disorders. The authors state that additional efforts are needed to further reduce smoking prevalence among this population.