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May 1, 2023

This Week in Health Policy for May 1

This Week (May 1 - 5)

Senate Health, Education, Labor & Pensions Committee executive session on "S. 1067, S. 1114, S. 1214, S. _, Pharmacy Benefit Manager Reform Act."

  • Date: Tuesday, May 2 at 10:00AM ET
  • More information available here.

Senate Finance Committee hearing on "Barriers to Mental Health Care: Improving Provider Directory Accuracy to Reduce the Prevalence of Ghost Networks."

  • Date: Wednesday, May 3 at 10:00AM ET
  • Witnesses: Keris Jän Myrick, Inseparable; Jack Resneck, American Medical Association; Robert Trestman, Carilion Clinic and Virginia Tech Carilion School of Medicine; Mary Giliberti, Mental Health America; Jeff Rideout, Integrated Healthcare Association
  • More information available here.

Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies hearing on "A Review of the President's FY 2024 Funding Request and Budget Justification for the National Institutes of Health."

  • Date: Thursday, May 4 at 10:00AM ET
  • Witnesses: Lawrence Tabak, Acting Director, National Institutes of Health; Monica Bertagnolli, Director, National Cancer Institute; Joshua Gordon, Director, National Institutes of Mental Health
  • More information available here.

Last Week (April 24 - 28)

Health Care Highlights

CMS publishes FAQ on COVID-19 waivers, flexibilities and the PHE end date. On Thursday (April 27), the Centers for Medicare and Medicaid Services (CMS) published FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 PHE. The 10-page FAQ covers waivers and flexibilities related to Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and private insurance and covers topics that impact providers, payers, and patients.

CMS issues Medicaid proposed rules. On Thursday (April 27), CMS issued two notices of proposed rulemaking that would create new standards and requirements for Medicaid and Children's Health Insurance Program (CHIP) health plans. The rules include new reporting requirements for Medicaid and CHIP health plans, set national standards for appointment wait times, create timeliness-of-access measures for home and community-based services, and requirements for states to ensure compliance with new wait times and beneficiary experience surveys. CMS will accept public comment until July 3, 2023. CMS provided several fact sheets on the rules:

  • For a fact sheet of CMS's Access-Related Notices of Proposed Rulemaking click here
  • For a fact sheet of Medicaid and CHIP Payment-Related Provisions click here
  • For a fact sheet of Key Home and Community-Based Services (HCBS) Provisions click here
  • For a fact sheet of the Medical Care Advisory Committee and Beneficiary Advisory Group Provisions click here.
  • For a fact sheet about the Medicaid or CHIP Managed Care Access, Finance, and Quality NPRM click here

CMS announces enforcement actions on hospital price transparency. On Wednesday (April 26), CMS announced they will accelerate the timelines for enforcement activities related to the hospital price transparency rules to no more than 180 days, or 90 days in cases in which CMS does not send a warning notice, down from 195 to 220 days. As of April 2023, CMS said it has issued more than 730 warning notices, 269 requests for corrective action plans, and civil monetary penalties on four hospitals for noncompliance. CMS earlier this month announced that it had taken enforcement action against two more hospitals, bringing the total to four.

House passes debt limit plan. On Wednesday, (April 26) the House voted 217-215 to pass the House Republican leadership's Limit, Save, Grow Act of 2023 (HR 2811), which would suspend the statutory debt ceiling until March 31, 2024, or until $1.5 trillion of debt over the current statutory limit is incurred (whichever happens first). The House-passed bill includes provisions to rescind unspent COVID-19 funds, add Medicaid work requirements beginning in 2024 for older adults, and clarify that one of the goals of the SNAP food stamps program is to increase work by participants. The Congressional Budget Office (CBO) earlier this week estimated about 600,000 people would become uninsured and about 900,000 people would shift to state-only funded Medicaid if House Republicans' Medicaid work requirements took effect. A separate analysis conducted by HHS estimated Medicaid work requirements would impact about 21 million Americans' access to coverage and care.

CMS proposes coverage for DACA recipients. On Monday (April 24), CMS released a proposed rule that would extend Medicaid and CHIP coverage to qualified individuals in the Deferred Action for Childhood Arrivals (DACA) program in states that cover legally residing immigrant children and pregnant women. The proposal also would enable DACA recipients to purchase federally subsidized exchange plans and apply for the Basic Health Program in states that participate. CMS estimated the rule could extend coverage to about 129,000 DACA recipients. If finalized, the rule would be effective November 1, 2023, ahead of the open enrollment period for 2024.

Supreme Court rules on Mifepristone access. On Friday (April 21), the U.S. Supreme Court issued a stay on a district court ruling that would limit access to the abortion pill mifepristone and reverse the Food and Drug Administration's approval of the generic version of the drug. The high court's decision allows the drug to remain on the market under current prescribing and dispensing rules and sends the case back to the U.S. Court of Appeals for the Fifth Circuit to reconsider the district court ruling.

Hearings, Markups, and Other Committee Action

Ways and Means Oversight Subcommittee hearing on "Tax-Exempt Hospitals and the Community Benefit Standard." On Wednesday (April 26), the Subcommittee held a hearing to consider the benefits provided by non-profit hospitals to American communities in contrast to the cost of their tax-exempt status to American taxpayers. In particular, discussion focused on how the Internal Revenue Service determines tax-exempt status, including the community benefit standard and whether the current reporting requirements (i.e., "Schedule H") are sufficient. Lawmakers heard testimony from a panel of four witnesses, including a representative from the Government Accountability Office (GAO), academics and a representative from the American Hospital Association (AHA).

  • More information available here.

House Energy and Commerce Health Subcommittee hearing on "Lowering Unaffordable Costs: Legislative Solutions to Increase Transparency and Competition in Health Care." On Wednesday (April 26), the Subcommittee held a hearing to discuss 17 bills to address rising health care costs in the United States. The bills covered a range of topics, including pharmacy benefit managers (PBMs), transparency of health care prices and ownership, site-neutral payments, physician-owned hospitals, unfair billing practices, and more. Lawmakers heard first from CMS Administrator Chiquita Brooks-LaSure, who spoke about CMS' efforts to implement policies to lower costs and increase transparency in health care and then from a panel of representatives from the hospital industry, the PBM industry, employers, patient advocates, as well as an accountable care organization leader and an economist. The hearing was notable for its bipartisan tone, but lawmakers noted wide disagreement among industry representatives on how best to lower health care prices and the merit of the draft legislation before the subcommittee.

  • More information available here.

House Committee on Education and the Workforce Subcommittee on Health, Employment, Labor and Pensions a hearing on "Reducing Health Care Costs for Working Americans." On Wednesday (April 26), the Subcommittee held a hearing to discuss policies to address health care challenges facing working families and small businesses. During the hearing, lawmakers heard testimony from a panel of four witnesses, including academics and those representing small employers and an employee benefits agency. Discussion during the hearing focused primarily on legislation to increase small business plans' access to stop-loss insurance and Association Health Plans (AHPs), as well as bills to address unfair hospital billing practices and enable employers to offer telehealth as an excepted benefit. Discussion was largely partisan with Republicans supporting efforts to expand coverage options through AHPs, telehealth flexibility, and stop-loss, and Democrats raising concerns about the potential for abuse. There was bipartisan support for the proposal to address dishonest billing practices and other proposals, such as site neutral payments in Medicare, to improve competition in health care.

  • More information available here.

House Appropriations Labor-HHS Subcommittee hearing on "Provider Relief Fund and Healthcare Workforce Shortages." On Wednesday (April 26), the Subcommittee heard testimony from Health Resources and Services Administration (HRSA) Administrator Carole Johnson who provided lawmakers with an update on the Provider Relief Fund (PRF) and other HRSA efforts to ease the transition out of the public health emergency. Ms. Johnson said 99% of the PRF has been allocated, reaching more than 440,000 providers nationwide. She also responded to lawmaker questions on PRF allocations, efforts to combat waste, fraud, and abuse, as well as efforts to combat workforce shortages.

  • More information available here.

House Energy and Commerce Innovation, Data, and Commerce Subcommittee hearing on "Addressing America's Data Privacy Shortfalls: How a National Standard Fills Gaps to Protect Americans' Personal Information." On Wednesday (April 26), the Subcommittee heard from a panel of four data privacy experts and discussed how best to fill gaps in existing data privacy laws. Discussion largely focused on the bipartisan American Data Privacy and Protection Act, which the Energy & Commerce Committee passed in a 53-2 vote last session.

  • More information available here.

Senate Judiciary Committee hearing on "The Assault on Reproductive Rights in a Post-Dobbs America." On Wednesday (April 26), the Committee held a hearing on abortion care in the United States and heard testimony from patients, providers, and academics. Conversation during the hearing largely centered on two legislative proposals, Committee Chair Dick Durbin's (D-IL) Women's Health Protection Act that would establish a statutory right for health care professionals to provide abortion care and patients to receive such care and ranking member Lindsey Graham's (R-SC) soon-to-be introduced bill that would prohibit abortion after 15 weeks of gestation with exceptions in instances of rape, incest, or risks to the life and physical health of the mother.

  • More information available here.

House Energy and Commerce Oversight and Investigations Subcommittee hearing on "Biosafety and Risky Research: Examining if Science is Outpacing Policy and Safety." On Thursday (April 27) the Subcommittee held a hearing on biosafety and risky research. During the hearing, Subcommittee members heard testimony from a panel of four witnesses including a life sciences business consulting firm, academics, and a former U.S. Army Officer. The hearing included discussion of COVID-19 origins, accountability at the National Institutes of Health, and foreign biological threats.

  • More information available here.

House Energy and Commerce Oversight and Investigations Subcommittee hearing on "Antimicrobial Resistance: Examining an Emerging Public Health Threat." On Friday (April 28), the Subcommittee held a hearing to discuss the rise of drug-resistant infections in the United States. The Subcommittee heard testimony from a panel of four experts including an academic, lawyer, a representative from the GAO, and an infectious disease expert to identify solutions to antimicrobial resistance.

  • More information available here.

Reports, Studies, and Journals

Congressional Budget Office: The Medicare and Medicaid Improvement Funds: Budgetary History and Projections. In the report, CBO provides an overview of the Medicare and Medicaid improvement funds and how the funds are accounted for in CBO's baseline and cost estimate.

Robert Wood Johnson Foundation: The Basic Health Program: Considerations for States and Lessons from New York and Minnesota. The report, conducted researchers from Georgetown University's Center on Health Insurance Reforms (CHIR) and the Urban Institute, examines the ACA's Basic Health Program implementation in two states: New York and Minnesota.

HHS Office of Inspector General: Medicare Could Have Saved Up to $128 Million Over 5 Years if CMS had Implemented Controls to Address Duplicate Payments for Services Provided to Individuals With Medicare and Veterans Health Administration Benefits. The report found Medicare paid providers for medical services that were authorized and paid for by VA's community care programs during the audit period, resulting in duplicate payments of up to $128 million.


Contact Information
For additional information concerning this Alert, please contact:
Washington Council Ernst & Young
   •  Heather Bell (