August 1, 2022
This Week in Health Policy for August 1
This Week (August 1-5)
The House is out next week, but House Speaker Nancy Pelosi (D-CA) said she will call House members back to vote on the reconciliation bill, if necessary. The Senate has one more week on the schedule before the August recess and plans to take up the Inflation Reduction Act.
Last Week (July 25-29)
Health Care Highlights
Democrats reach a deal on reconciliation package. In a surprise development, Senator Joe Manchin (D-WV), Senate Majority Leader Chuck Schumer (D-NY), and President Biden July 27 announced a deal on a $740 billion reconciliation bill — the Inflation Reduction Act — intended to be voted on in the Senate next week that includes climate/energy, health, and tax components and achieves $300 billion in deficit reduction. The announcement followed Senator Manchin apparently backing away from talks over a broader bill two weeks ago. A joint release from Senators Schumer and Manchin said the bill includes $369.75 billion in Energy Security and Climate Change programs and "will finally allow Medicare to negotiate for prescription drugs and lower health care costs for millions of Americans." A statement by president Biden said "with this agreement, we have a chance to make prescription drugs cheaper by allowing Medicare to negotiate lower prices and we can lower health insurance costs for 13 million Americans, by an average of $800 a year, for families covered under the Affordable Care Act [ACA]." The revised legislative text was submitted to the Parliamentarian for review and the full Senate plans to consider it next week. Speaker Nancy Pelosi (D-CA) announced support for the proposal and the expectation is the House, which is scheduled to leave for the August recess at the end of the week, would reconvene to approve a Senate-passed bill.
The bill includes two key health care pieces intended to reduce the price of prescription drugs and expand the enhanced ACA subsidies (currently set to expire at the end of 2022) for three years. The drug pricing provisions include enabling Medicare to negotiate the price of some high-cost, single-source prescription drugs; imposing inflationary rebates; capping out-of-pocket costs at $2,000 per year; and, redesigning the Part D program, among other items. Sen. Schumer also said this week that they will add insulin-affordability measures to the legislation, although it is unclear which provisions will be added and if they will withstand scrutiny by the Senate parliamentarian. Previous iterations of the bill included a $35 cap on monthly insulin costs and established a separate negotiation category for insulin products.
House passes telehealth bill. On Wednesday (July 27), the House passed the Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) by a wide bipartisan margin of 416-12, sending the legislation to the Senate where its fate is less certain. The bill extends Medicare telehealth flexibilities through 2024, including: removal of geographic and originating requirements; expansion of eligible telehealth practitioners; reimbursement for federally qualified health centers and rural health clinics; delay of in-person requirements for mental health services; allowing for audio-only telehealth; and use of telehealth to satisfy certain Medicare face-to-face requirements. The White House also issued a Statement of Administration Policy in support of the bill, saying it would "build on the experience and best practices learned during the pandemic, and modernize our health care system to expand access to quality, affordable care, especially in rural and underserved communities."
CMS releases Maternity Care Action Plan. On Tuesday (July 26), the Centers for Medicare and Medicaid Services (CMS) announced the release of its Maternity Care Action Plan to Implement the Biden-Harris Maternal Health Blueprint and launch of an industry wide Call to Action. According to the announcement, "the action plan takes a holistic and coordinated approach across CMS to improve health outcomes and reduce inequities for people during pregnancy, childbirth, and the postpartum period. CMS' implementation of the action plan will support the Biden-Harris Administration's broad vision and call to action to improve maternal health." HHS also announced on Tuesday that they approved the extension of Medicaid and Children's Health Insurance Program (CHIP) coverage for 12 months after pregnancy in Connecticut, Massachusetts, and Kansas. 18 states and D.C. have now been approved for the extended coverage, made possible by a new state plan opportunity established by the American Rescue Plan Act, and nine others are awaiting approval.
HHS reinstates health care nondiscrimination rules. On Monday (July 25), the Department of Health and Human Services (HHS) released a proposed rule to reinstate expanded Obama era health care nondiscrimination rules on gender identity and sexual orientation pulled back by the Trump administration two years ago, also issuing new protections aimed at ensuring access to care for members of the LGBTQ community. The new regulations reinstate ACA nondiscrimination requirements for providers, payers and other groups that participate in federal health care programs, as well as introduce a new rule to label Medicare Part B as federal financial assistance.
HHS, DOL, and Treasury issue birth control coverage guidance. On Thursday (July 28), HHS, alongside the Departments of Labor (DOL) and Treasury, issued guidance aimed at clarifying protections for birth control coverage under the ACA, which requires most private health plans to provide birth control and family planning counseling at no additional cost. Labor Secretary Marty Walsh said that the guidance "makes clear that the law requires group health plans and health insurance issuers to provide contraceptive coverage — including emergency contraception — at no cost to participants."
CMS seeks input on MA plans. On Thursday (July 29), CMS released a Request for Information seeking public comment on the Medicare Advantage (MA) program. CMS is asking for input on "ways to achieve the agency's vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable." Feedback from plans, providers, beneficiary advocates, states, employers and unions, and other partners is encouraged and will help inform the MA policy development and implementation process.
CMS also issued three final payment rules this week:
Hearings and Markups
House Ways and Means Committee Advances 'Improving Seniors' Timely Access to Care Act of 2022': On Wednesday (July 27), the House Ways and Means Committee advanced the bipartisan Improving Seniors' Timely Access to Care Act (H.R. 8487), which now moves to the full House for consideration. The bill, sponsored by Reps. Suzan DelBene (D-WA) and Mike Kelly (R-PA), would require MA plans to establish an electronic prior authorization program to enable timely decisions for routinely requested items and services. The bill also aims to improve transparency of coverage decisions by requiring plans to annually publish prior authorization data, like approval rates and response times, and encourages plans to base prior authorization decisions on consultation with physicians and evidenced-based medical guidelines. The legislation has broad bipartisan support along with support from leading provider groups like the American Hospital Association, as well as the Better Medicare Alliance, an advocacy group that supports Medicare Advantage. The bill was ordered to be reported favorably, as amended, by voice vote. The committee also adopted an amendment in the nature of a substitute that included technical changes.
HELP Committee Hearing on the Federal Response to the Fentanyl Crisis. On Tuesday (July 26), the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing entitled, "Fighting Fentanyl: The Federal Response to a Growing Crisis." Witnesses from Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC) and the Office of National Drug Control Policy (ONDCP) testified on their efforts to address the fentanyl crisis. Administration officials echoed concerns from committee members regarding synthetic opioids and emerging stimulant use while touting the Biden administration's Unity Agenda to increase access to a full range of care and services. They also discussed efforts to administer funding to states to address the crisis, aimed at bolstering the behavioral health workforce and carrying out educational and harm reduction activities, also discussing efforts to remove access barriers to buprenorphine and naloxone and disrupt and dismantle criminal organizations and drug trafficking. Committee members expressed bipartisan concern about the growing epidemic, impact on their communities, and need for enhanced access to care and a more robust workforce. Republicans in particular stressed the need to permanently classify fentanyl analogs as schedule I drugs and ensure stronger control of the border and customs systems and ability to combat drug cartels.
Reports, Studies, and Journals
Health Affairs: Virginia Medicaid Expansion: New Members Report Reduced Financial Concerns During The COVID-19 Pandemic. Researchers examine the association of Virginia's 2019 Medicaid expansion and changes in health care-related and non-health-care-related financial needs among newly eligible Medicaid enrollees.
NIHCM Foundation: Geographic Variation in Private Equity Penetration Across Physician Specialties. Researchers looked at geographic and specialty variation in private equity penetration nationwide.
Kaiser Family Fountain: KFF COVID-19 Vaccine Monitor: July 2022. According to a new survey, most parents of young children newly eligible for a COVID-19 vaccine are reluctant to get them vaccinated, including 43% who say they will "definitely not" do so.