January 30, 2023
This Week in Health Policy for January 27
This Week (Jan. 30-Feb. 3)
House Energy and Commerce Subcommittee on Health will hold a hearing on "Lives Worth Living: Addressing the Fentanyl Crisis, Protecting Critical Lifelines, and Combatting Discrimination Against Those with Disabilities."
House Energy and Commerce Oversight and Investigations Subcommittee will hold a hearing on "Challenges and Opportunities to Investigating the Origins of Pandemics and Other Biological Events."
House Oversight and Accountability Committee will hold a hearing on "Federal Pandemic Spending: A Prescription for Waste, Fraud and Abuse."
Last Week (Jan. 23-27)
Health Care Highlights
Congressional committees take shape. Over the past two weeks, the House and Senate have announced new members of various health committees and subcommittees. Committee membership activity and organizing meetings will continue over the coming weeks.
In the House, the Republican Steering Committee continued to appoint members to House committees and subcommittees:
In the Senate, Majority Leader Chuck Schumer on Thursday (Jan. 26) announced committee memberships and leaders. The Senate Appropriations Committee will be chaired by Sen. Patty Murray (D-WA), the Senate Finance Committee will be chaired by Sen. Ron Wyden (R-OR), and the Senate Health, Education, Labor and Pensions (HELP) Committee will be chaired by Sen. Bernie Sanders (I-VT). In addition, Sen. Susan Collins (R-ME) is expected to be ranking member on the Senate Appropriations Committee, Sen. Bill Cassidy (R-LA) is expected to be ranking member on the HELP Committee, and Sen. Mike Crapo (R-ID) is expected to be ranking member of the Senate Finance Committee.
FDA's COVID-19 vaccine plan. On Thursday (Jan. 26), the Food and Drug Administration's (FDA) Vaccine and Related Biological Products Advisory Committee unanimously voted to overhaul the U.S. COVID-19 vaccine strategy and replace initial monovalent vaccines with bivalent vaccines that target specific subvariants. The committee did not vote on an FDA proposal to shift to a one-dose schedule, similar to the flu vaccine, saying they need more data on the effect on different population groups.
16.3M people signed up for exchange plans, CMS says. On Wednesday (Jan. 25), the Centers for Medicare & Medicaid Services (CMS) said 16.3 million people signed up for health insurance plans through the Affordable Care Act marketplace during the 2023 open enrollment period. CMS said the figure, which does not include those who have paid their first months premium and officially enrolled in coverage, represents a 13% year-over-year increase.
Biden admin unveils opioid plan. On Tuesday (Jan. 24), White House's Office of National Drug Control Policy held an event marking the elimination of the DATA-Waiver Program, also known as the X waiver, that providers needed to obtain to prescribe buprenorphine to treat opioid use disorder. According to the Drug Enforcement Agency, which officially revoked the waiver in a Jan. 12 letter, providers now require the standard DEA registration number to prescribe buprenorphine and that there will no longer be a cap on the number of patients a provider can prescribe buprenorphine to treat opioid use disorder.
CMMI planning primary care, total cost of care models. On Monday (Jan. 23), Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler detailed the center's plans for this year during the Value-Based Payment this week, noting that CMMI plans to roll out three to four new models on advance primary care as well as one enabling states to assume the total cost of case, which could be similar to a partnership between CMS and Maryland that established a global budget for certain state hospitals. Plans are part of a larger effort to increase the participation in value-based care models, including a focus on specialty engagement.
ICYMI: Health Care Highlights From Jan. 16-20
US hits debt ceiling. On Thursday (Jan. 19), the U.S. officially reached the $31.4 trillion debt cap and lawmakers continue to debate how they will address the problem. Treasury Department Secretary Yellen has said the department will suspend new investments in the Civil Service Retirement and Disability Fund and the Postal Service Retiree Health Benefits Fund to keep the United States from defaulting. But she has warned legislative action will need to be taken by early summer. Debt limit discussions are expected to include proposals to reduce spending on entitlement programs like Medicare, however, President Biden and Democrats have said cuts to Medicare are off the table.
CMS cracks down on overprescribing at SNFs. On Wednesday (Jan. 18), the Centers for Medicare and Medicaid (CMS) said it will conduct targeted off-site audits to identify instances of inappropriate diagnosis coding for schizophrenia as part of an effort to reduce overprescribing of psychotropic drugs. CMS said SNFs that are found to have inaccurate coding could have their quality ratings downgraded to one star.
CMS announces participation numbers for 2023 ACOs. On Tuesday (Jan. 17), CMS announced that more than 13.2 million Medicare beneficiaries and more than 700,000 health care providers and organizations will participate in one of three accountable care models in 2023. CMS said the Medicare Shared Savings Program had 456 accountable care organizations (ACOs) and 10.9 million assigned beneficiaries in 2023, a slight decline from 2022. The ACO REACH model will have 132 ACOs providing care to an estimated 2.1 million beneficiaries and the Kidney Care Choices (KCC) Model will have more than 8,398 participating health care providers and 249,983 beneficiaries in 2023, a 62% increase in beneficiaries from 2022.
CDC unveils updated ICD-10-codes with focus on SDOH. On Friday (Jan. 13), the Centers for Disease Control and Prevention (CDC) released updated ICD-10 codes that will take effect April 1. The updated code set removes seven codes, revises one code, and introduces 42 new diagnosis codes, including a new social determinants of health (SDOH) code to report problems related to education and literacy.
Reports, Studies, and Journals
HHS Office of the Assistant Secretary for Planning and Evaluation: Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics. The report concluded that if the Inflation Reduction Act's $35 monthly cap on insulin costs had been in place in 2020, 1.5 million Medicare beneficiaries would have saved an average of $500 each on insulin.
Government Accountability Office: HHS Funds Allocated to Support Disproportionately Affected Communities. The report, which examined COVID-19 relief funds allocated to support communities disproportionately affected by the pandemic, found of the $75 billion provided by HHS $29 billion went directly to disproportionately affected communities and $33 billion went to state health departments and other with recommendations to use the funds to support such communities.
Institute for Clinical and Economic Review: Assessment of Barriers to Fair Access. The report, which examined whether insurance coverage in 2022 provided fair access to drugs, found while most insurance formularies examined adhered to ICER's criteria for fair access, many costly specialty drugs were less accessible.
Centers for Disease Control and Prevention: Problems Paying Medical Bills. The National Health Statistic Report conducted by CDC found the number of people reporting trouble paying their medical bills fell by 3.2 percentage points, or 10.5 million people, from 2019 to 2021. The report found those with private coverage were the least likely to report difficulty paying their medical bills.