September 25, 2023
This Week in Health Policy for September 25
This Week (Sept. 25 - 29)
While Congress continues work to reach a deal to avoid a government shutdown, the House next week is expected to take up several health care bills, including the SUPPORT Act, the Medicaid Primary Care Improvement Act, the 9-8-8 Lifeline Cybersecurity Responsibility Act, and the Senate health committee-passed PREEMIE Reauthorization Act and the Preventing Maternal Deaths Reauthorization Act, under a suspension of the rules process. Other committee health care activity will include:
The Senate Budget Committee will hold a hearing on "Medicare Forever: Protecting Seniors by Making the Wealthy Pay Their Fair Share."
House Oversight and Accountability Cybersecurity, Information Technology, and Government Innovation Subcommittee and Economic Growth, Energy Policy, and Regulatory Affairs Subcommittee will hold a joint hearing on "Combating Ransomware Attacks."
Last Week (Sept. 18 - 22)
Health Care Highlights
Congressional activity on fiscal cliff. On Thursday (September 21), House Speaker Kevin McCarthy (R-CA) sent members home for the weekend without voting on a continuing resolution (CR) with the condition that they could be brought back in the event of any breakthrough in negotiations. Lawmakers will return with one legislative workweek before a government shutdown if both chambers don't pass legislation to fund the government beyond September 30. The focus of conservative holdouts has shifted from demands regarding the contents of a CR to opposing that type of short-term patch in favor of moving the remaining (in the House) 11 of 12 appropriations bills through regular order, which leaders in both chambers and the White House have long said couldn't be accomplished by the deadline. To that end, the House Rules Committee was scheduled to meet Friday (September 22) regarding the procedural parameters for consideration of the appropriations bills on Department of Defense, State, Agriculture, and Homeland Security.
Biden to sign organ transplant reform bill. On Friday (September 22), President Biden signed into law the Securing the US Organ Procurement and Transplantation Network Act (HR 2544), which would reform the US Organ Procurement and Transplantation Network and increase competition in the contracting process.
SAMHSA awards Community Behavioral Health Clinic grants. On Thursday (September 21), the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it has awarded $127.7 million in grants to health clinics in 40 states and Puerto Rico to expand Certified Community Behavioral Health Clinics (CCBHCs) across the country. The grants come ahead of the 60th anniversary of the Community Mental Health Act of 1963.
Tri-agency rule sets IDR fee at $150. On Wednesday (September 20), the Health and Human Services (HHS), Labor, and Treasury departments issued a proposed rule that would set the administrative fee for using the federal independent dispute resolution (IDR) process at $150 per party. The rule comes after a Texas district court struck down federal guidance that raised the fee to $350, noting that the federal rulemaking process was required for such a change. The departments also propose increasing the fee range for certified IDR entities by 20% for single determinations and 25% for batched determinations. If finalized, the changes would take effect for disputes initiated on or after January 1 or if issued after January 1, the effective date of the final rule.
HHS awards grants for long COVID-19 clinics. On Wednesday (September 20), HHS announced $45 million in grants for clinics treating long COVID-19 symptoms over the next five years to expand access to in person and virtual care for those in underserved, rural, vulnerable and minority populations. Similarly, the department awarded $600 million to 12 domestic COVID-19 test manufacturers and reopened the portal for US households to order COVID-19 tests at no cost.
DOL extends mental health parity rule comment period. On Wednesday (September 20), the Department of Labor announced it has extended by 15 days the comment period for the Departments of Treasury, Labor, and Health's proposed rule to update regulations implementing the Mental Health Parity and Addiction Equity Act of 2008. The comment period, which previously was set to end October 2, will now end October 17.
FTC sues PE firm, anesthesia practice alleging anticompetitive behavior. On Thursday (September 21), the Federal Trade Commission sued US Anesthesia Partners, Inc. and private equity firm Welsh, Carson, Anderson & Stowe, alleging the companies "engaged in decade-long anticompetitive acquisition spree to suppress competition and unfairly drive-up prices for anesthesiology services."
CMS halts Medicaid redeterminations in 30 states. On Thursday (September 21), the Centers for Medicare & Medicaid Services (CMS) announced that nearly 500,000 people regained Medicaid and CHIP coverage in 30 states after CMS identified a systems issue in 30 states that inappropriately disenrolled children and families, even when the state had information indicating that they remained eligible for Medicaid and CHIP coverage.
CMS awards minority research grants. On Tuesday (September 19), CMS' Office of Minority Health announced three recipients of the 2023 Minority Research Grant Program who will be awarded a $333,000 grant to examine critical public health disparities and increasing health equity research capacities at minority-serving institutions.
CMS issues final rule to streamline Medicare Savings Program enrollment. On Monday (September 18), CMS issued a final rule to streamline enrollment in Medicare Savings Programs, which are run by state Medicaid programs and help cover Medicare premiums and cost sharing for eligible beneficiaries.
Hearings, Markups, and Other Committee Action
Senate Health, Education, Labor & Pensions Committee held a mark on "S. 1573, S. 2415, S. 1624, S._, Bipartisan Primary Care and Health Workforce Act." On Thursday (September 21), the Committee advanced four bipartisan health care bills:
Much of the discussion focused on disagreements between Chair Bernie Sanders (I-VT) and Ranking Member Bill Cassidy (R-LA) regarding the Bipartisan Primary Care and Health Workforce Act, a bipartisan package crafted by Chair Sanders and Sen. Roger Marshall (R-KS). Ranking Member Cassidy filed more than 60 amendments to the bill, but only sought votes on four. He criticized the bill for adding to the federal deficit, not having cost offset and cited concerns from hospitals that the bill would cut their funding and impede their ability to provide care. Ranking Member Cassidy also spoke critically of the process for how the bill came together, ultimately objecting to several amendments because they were not given a full hearing. Ranking Member Cassidy and Sen. Tammy Baldwin (D-WI) also raised concerns about the funding mechanisms in the bill, including cuts to the Prevention and Public Health Fund
House Energy and Commerce Subcommittee on Health held a hearing on "Examining Policies To Improve Seniors' Access To Innovative Drugs, Medical Devices, And Technology." On Tuesday (September 19), the subcommittee held a hearing during which members spoke about Medicare beneficiaries' access to innovative drugs and heard from representatives of CMS and the Government Accountability Office about ways CMS could improve coverage of innovative products.
Senate Finance Subcommittee on Health Care held a hearing on "Aging in Place: The Vital Role of Home Health in Access to Care." On Tuesday (September 19), the Subcommittee held a hearing to discuss home health and heard from witnesses representing home care services, Medicare beneficiaries, academics, and hospices.
House Energy and Commerce Oversight and Investigations Subcommittee held a hearing on "At What Cost: Oversight of How the IRA's Price Setting Scheme Means Fewer Cures for Patients." On Wednesday (September 20), the Subcommittee heard from a panel witnesses to discuss the Inflation Reduction Act's (IRA) impact on drug innovations. During the hearing, Republican members spoke critically of the IRA, saying it hampers innovation, while Democrats defended the IRA and spoke critically of the hearing being held at a time when House Republicans cannot reach an agreement on a spending package.
House Committee on Oversight and Accountability held a hearing on "The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part II: Not What the Doctor Ordered." On Tuesday (September 19), the Committee held a hearing during which members raised concerns about the role pharmacy benefit managers (PBMs) play in prescription drug prices. The committee heard from a panel representing PBMs, drug manufacturers, generic drug manufacturers, pharmacists, and academics.
House Ways & Means Committee held a hearing on "Hearing on Reduced Care for Patients: Fallout From Flawed Implementation of Surprise Medical Billing Protections." On Tuesday (September 19), the Committee held a hearing to examine the implementation of the No Surprises Act during which they heard from a panel of witnesses representing emergency physicians, patient advocates, health insurers, health systems, and independent dispute resolution entities. Lawmakers from both parties were critical of the law's implementation, particularly in relation to the independent dispute resolution process and the role of the qualifying payment amount, which many said had been implemented in ways that do not reflect Congress' intent.
House Committee on Veterans' Affairs Subcommittee on Health Oversight Hearing held a hearing on "VA's Federal Supremacy Initiative: Putting Veterans First?" On Tuesday (September 19), the Committee held a hearing on the VA's National Scope of Practice Initiative, focusing on the VA's proposed optometry national standard and the certified registered nurse anesthetist (CRNA) national standard. During the hearing the committee heard from a panel representing the American Medical Association, American Optometric Association, American Association of Nurse Anesthesiology, American Academy of Ophthalmology, American Society of Anesthesiologists, and the Veterans Health Administration. Witnesses debated scope of practice, with representatives and members of the physician societies raising concerns about patient safety, while others focused on the benefits of improving access to care.
Reports, Studies, and Journals
Commonwealth Fund: Medicare's Affordability Problem: A Look at the Cost Burdens Faced by Older Enrollees. The study found nearly one in five Medicare beneficiaries were considered underinsured due to high health care costs.
JAMA: Oral Health Among Medicare Beneficiaries in Nursing Homes. The CMS study examined oral health problems among Medicare beneficiaries in nursing homes and found prevalence of dental problems varied across demographic and clinical groups.
Health Affairs: Health Care Service Price Comparison Suggests That Employers Lack Leverage To Negotiate Lower Prices. The study by the Health Care Cost Institute compares prices for common services in self-insured plans with those in fully insured plans and found prices for most services were moderately higher in self-insured plans.