July 31, 2023
This Week in Health Policy for July 31
This Week (July 31 - August 4)
Congress will be on August recess this week, with the Senate scheduled to return September 5 and the House scheduled to return on September 12. This will leave Congress just 12 workdays to pass and reconcile appropriations bills before the end of the fiscal year on Sept. 30, a potentially tall order as the House adjourned Thursday (July 27) without passing appropriations package funding the Food and Drug Administration and agriculture programs after disagreement between conservative and moderate Republicans over funding levels and a provision to reverse the FDA's policy allowing the abortion pill mifepristone to be sold by mail and at retail pharmacies. The Biden administration next week is expected to continue releasing FY 2024 final payment rules, including the Inpatient Prospective Payment System final rule. This Week in Health Policy will return the week of September 4th.
Last Week (July 24 - 28)
Health Care Highlights
Biden admin issues Mental Health Parity and Addiction Equity Act Proposed Rule. On Tuesday (July 25), the Departments of Treasury, Labor, and Health (the Departments) issued a proposed rule to update regulations implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The Departments said it issued the proposed rules to clarify and strengthen mental health parity protections for patients and to provide "clear standards for plans and issuers on how to comply" with the MHPAEA, as well as to implement updates to the law required under the Consolidated Appropriations Acts (CAAs) of 2021 and 2023. In conjunction with the proposed rule, the Departments issued a technical release that requests public feedback on proposed new data requirements for plans and issuers as part of their comparative analysis for nonquantitative treatment limitations (NQTLs) and safe harbors related to the composition of a health plan's or issuer's network. The Departments also released their 2023 MHPAEA Report to Congress, which focuses on their efforts to implement updates to MHPAEA made under CAA, 2021, including an overview of common deficiencies in plans' and issuers' comparative analyses. Also accompanying the rule is an enforcement fact sheet, which details all enforcement actions taken related to MHPAEA since FY 2015.
CMS issues FY 2024 hospice final payment rule. On Friday (July 28), the Centers for Medicare and Medicaid Services (CMS) issued the FY 2024 Hospice Payment Rate Update Final Rule. The rule increases payments to hospices by 3.1%, or $780 million for FY 2024, compared with FY 2023, as well as updates to the Hospice Quality Reporting Program (HQRP), telehealth waiver deadlines, and more. Click here for the final rule.
CMS issues FY 2024 Inpatient Rehabilitation Facility final payment rule. On Thursday (July 27), CMS issued the FY 2024 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule. The rule increases payments to IRFs by an estimated 4%, or $355 million for FY 2024, compared with FY 2023, including adjustments for higher outlier payments. CMS also finalized updates to the IRF Quality Reporting Program, including modifying one existing measure, adding two new measures, and removing three measures. Click here for CMS' fact sheet and here for the final rule.
CMS issues FY 2024 Inpatient Psychiatric Facility final payment rule. On Thursday (July 27), CMS issued the FY 2024 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule. The rule increases payments to IRFs by 2.3%, or $70 million for FY 2024, compared with FY 2023. CMS also finalized updates to the IPF Quality Reporting Program, including modifying one existing measure, adding four new measures, and removing two measures. Click here for CMS' fact sheet and here for the final rule.
Congress passes bill to overhaul organ transplant system. On Thursday (July 27), the Senate passed H.R. 2544, the Securing the U.S. Organ Procurement and Transplantation Network Act, which would modernize the U.S. Organ Procurement and Transplantation Network (OPTN) and allow the Health Resources and Services Administration (HRSA) to award multiple contracts to support different functions of the OPTN process. The bill now goes to President Biden for his signature.
Medicaid redeterminations. CMS on Friday (July 28) announced a webinar series focused on Medicaid and Children's Health Insurance Program renewals for special populations, with individual webinars focused on reaching specific populations. HHS Secretary Xavier Becerra on Friday also sent letters to states urging them to keep eligible children on Medicaid during the unwinding. In addition, CMS on Friday is expected to release post-pandemic Medicaid renewal data.
APRA-H unveils new cancer initiative. On Thursday (July 27), the Biden administration announced that the Advanced Research Projects Agency for Health, or ARPA-H, will launch a Precision Surgical Interventions program that aims to develop more precise surgical interventions to treat cancer and improve patient outcomes. A "Proposers Day" for interested research teams is scheduled for September 7 in Chicago, Illinois.
HRSA awards funding to expand rural medical residencies. On Wednesday (July 26), HRSA awarded nearly $11 million to 15 awardees to help establish new residency programs in rural communities.
CMS updates Hospital Quality Star Ratings. On Wednesday (July 26), CMS updated its Overall Hospital Quality Star Ratings. The new ratings assigned five stars to 483 hospitals and one star to 248 hospitals.
CMS imposes civil monetary penalties on three hospitals for price transparency non-compliance. On Tuesday (July 25), CMS announced that it imposed civil monetary penalties on three additional hospitals in Texas, Arkansas, and Illinois for not complying with the requirements of the Hospital Price Transparency final rule.
Hearings, Markups, and Other Committee Action
The Senate Finance Committee advances PBM legislation. On Wednesday (July 26), the Senate Finance Committee voted to advance the Modernizing and Ensuring Pharmaceutical Benefit Manager (PBM) Accountability (MEPA) Act, which includes several provisions aimed at advancing PBM transparency and preventing certain practices such as spread pricing and remuneration based on the price of a drug, among other provisions, in Medicare Part D and Medicaid. The hearing was noteworthy for its bipartisan nature with lawmakers voting 26-1 in support of the legislation and their desire to build on it to increase transparency into PBM practices and support independent pharmacies. For example, lawmakers spoke about adding additional language to address direct and indirect renumeration (DIR) fees impacting independent pharmacies. Senate Finance Committee Chair Ron Wyden (R-OR) said he and Ranking Member Mike Crapo (R-ID) hope to spend the next few weeks working with CBO to score related PBM legislation in advance of sending a bipartisan package to Senate leadership in the fall.
House Ways and Means Committee advances two bills on health care transparency and consolidation. On Wednesday (July 26), the House Ways and Means Committee advanced two bills that aim to increase transparency in health care and address consolidation among providers and payers. Both bills advanced along party lines with Republicans voting in favor and Democrats voting against. During the hearing, much of the debate was focused on the Health Care Price Transparency Act. Democrats on the committee spoke critically about the pace at which the bill was brought for markup. They also raised concerns that the bill does not include provisions to increase transparency around private equity ownership of health care entities and does not extend price transparency to Medicare Advantage plans. Lawmakers also debated an amendment offered by Rep. Suzan DelBene (D-WA) that sought to exempt cancer hospitals from the bill's site-neutral payments.
The Joint Economic Committee held a hearing on "The Economic Impact of Diabetes." On Thursday (July 27), the committee held a hearing during which lawmakers from both sides of aisle spoke about the rising costs of diabetes and how those costs are impacting the U.S. economy. The committee heard from a panel of witnesses representing the National Indian Health Board, the American Diabetes Association, the American Enterprise Institute, and Baylor College of Medicine.
The Senate Appropriations Committee held a markup of Fiscal Year 2024 Defense, Interior and Environment, Labor, Health and Human Services, Education, and Homeland Security Appropriations Acts. On Thursday (July 27), the committee advanced the Senate's FY 2024 appropriations bill for HHS in a 26-1 vote.
Senate Veterans' Affairs Committee held a hearing, "Implementing the PACT Act: One Year Later." On Wednesday (July 26), the committee held a hearing on the implementation of the PACT Act during which lawmakers herd testimony from Shereef Elnahal, VA Under Secretary for Health, and Joshua Jacobs, VA Under Secretary for Benefits.
House Veterans' Affairs Committee held a markup on pending legislation. On Wednesday (July 26), the committee advanced 11 bills related to veterans' education assistance programs, homelessness, disability benefits, mental health, and more.
POSTPONED: The Senate Health, Education, Labor & Pensions Committee postpones markup of "The Primary Care and Health Workforce Expansion Act." The Committee postponed until September its markup of The Primary Care and Health Workforce Expansion Act to reconcile differences between the proposal released by Chair Bernie Sanders (I-VT) and ranking member Bill Cassidy (R-LA).
Reports, Studies, and Journals
HHS Office of Inspector General: HRSA Made COVID-19 Uninsured Program Payments to Providers on Behalf of Individuals Who Had Health Insurance Coverage and for Services Unrelated to COVID-19. The report estimates that nearly 20%, or $784 million, of payments made under the HRSA COVID-19 Uninsured Program were improper and recommends HRSA recover some of the improper payments and take steps to improve similar programs in the future.
CMS: 2022 Part C and Part D Program Audit and Enforcement Report. The report showed that CMS in 2022 conducted 26 program audits across 25 sponsors covering approximately 33.6 million beneficiaries, or 63% of beneficiaries enrolled in the Part C and Part D programs and highlights issues with sponsors processing claims with incorrect provider payment amounts.
Government Accountability Office: Over-the-Counter Drugs: Status of FDA's Implementation of Exclusivity Provisions in the CARES Act. The report highlights the FDA's implementation of CARES Act provisions related to over-the-counter monograph drugs, including a new 18-month exclusivity period.